CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
gentleman who is status post gastric bypass in [**2152**], who has
had several admissions in the last several weeks which
included problems for postoperative pancreatitis, duodenal
stump bleed, multiple episodes of cholangitis, dumping
problems, episodes of hypoglycemia.  Most recently he has
been NPO and receiving TPN.  He was admitted through the
Emergency Department to the Intensive Care Unit for episode
of hypotension.  This was following a four day history of
right upper quadrant pain.  He presented to the Emergency
Department with a four day history of right upper quadrant
pain and fever for one day with rigors, nausea and vomiting.
He was admitted to the Intensive Care Unit through the
Emergency Department.

MEDICAL HISTORY: 1.  Obesity.
2.  Malnutrition.
3.  Hypoglycemia.

MEDICATION ON ADMISSION: 1.  Octreotide 400 mg subcutaneous three times a day.
2.  Ciprofloxacin 500 mg p.o. twice a day.
3.  TPN.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker, no alcohol.
Single parent of one child.
Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Acute and subacute bacterial endocarditis,Cholangitis,Other and unspecified postsurgical nonabsorption,Thrombocytopenia, unspecified,Hypotension, unspecified
React-oth vasc dev/graft,Bacteremia,Ac/subac bact endocard,Cholangitis,Intest postop nonabsorb,Thrombocytopenia NOS,Hypotension NOS
Admission Date:  [**2153-9-19**]       Discharge Date:  [**2153-9-25**]

Date of Birth:   [**2108-1-21**]       Sex:  M

Service:  PURPLE SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year old
gentleman who is status post gastric bypass in [**2152**], who has
had several admissions in the last several weeks which
included problems for postoperative pancreatitis, duodenal
stump bleed, multiple episodes of cholangitis, dumping
problems, episodes of hypoglycemia.  Most recently he has
been NPO and receiving TPN.  He was admitted through the
Emergency Department to the Intensive Care Unit for episode
of hypotension.  This was following a four day history of
right upper quadrant pain.  He presented to the Emergency
Department with a four day history of right upper quadrant
pain and fever for one day with rigors, nausea and vomiting.
He was admitted to the Intensive Care Unit through the
Emergency Department.

PAST MEDICAL HISTORY:
1.  Obesity.
2.  Malnutrition.
3.  Hypoglycemia.

PAST SURGICAL HISTORY:
1.  Roux-en-y gastric bypass in [**2152-5-10**], with postoperative
complications as above.
2   Revision and hepatic jejunostomy [**2152-12-10**].
3.  Revision laparotomy in [**2153-1-10**].
4.  Revision laparotomy with subsequent cholangitis in [**2153-3-10**].

SOCIAL HISTORY:  The patient is a nonsmoker, no alcohol.
Single parent of one child.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Octreotide 400 mg subcutaneous three times a day.
2.  Ciprofloxacin 500 mg p.o. twice a day.
3.  TPN.

PHYSICAL EXAMINATION:  The patient's vital signs on
presentation included a temperature maximum of 103.2,
temperature current 102.7, blood pressure 83/34, heart rate
118, respiratory rate 23, oxygen saturation 96% in room air.
In general, the patient is awake and oriented in no acute
distress.  Head, eyes, ears, nose and throat - The pupils are
equal, round, and reactive to light and accommodation.
Extraocular movements are intact. Cranial nerves II through
XII are grossly intact.  There is no evidence of any
lymphadenopathy or distention.  Cardiovascular shows regular
rate and rhythm, no murmurs, rubs or gallops.  Lungs are
clear to auscultation bilaterally.  The abdomen is soft,
nontender, scaphoid with many surgical incisions well healed
without any evidence of any herniation.  On deep palpation,
he does show some right upper quadrant pain.  However, there
is negative [**Doctor Last Name **] sign.

LABORATORY DATA:   On presentation, white blood cell count
was 5.4, hematocrit 35.8.  Sodium 138, potassium 4.6,
chloride 100, CO2 27, blood urea nitrogen 25, creatinine 1.1,
glucose 129.  Prothrombin time 13.3, partial thromboplastin
time 29.0, INR 1.2.  ALT 38, AST 44, alkaline phosphatase
144, amylase 78, total bilirubin 2.1, lipase 25, albumin 4.9,
lactate of 2.8.  Blood cultures are pending.

CLINICAL COURSE:  Upon presentation to the Intensive Care
Unit, the patient remained febrile with a temperature of
103.2.  He was started empirically on Zosyn and Vancomycin
and Gentamicin.  His white blood cell count increased to 7.8.
In the Intensive Care Unit, the patient's hypotension
responded well to fluid boluses and his vital signs improved.
After consulting infectious disease service while in the
Intensive Care Unit, the patient had another two sets of
blood cultures drawn.  At that time, his port-a-cath was also
removed and sent for cultures.  He was continued on
Vancomycin, Zosyn and Gentamicin.  His TPN was discontinued.
By [**2153-9-21**], the patient's blood cultures had grown six out
of six positive for gram positive cocci.  He also had
positive blood cultures.  CT scan also showed evidence of
periportal edema and perihepatic fluid collections.
Subsequent workup which included assessments by the
gastroenterology service, ultrasound, showed no areas that
could explain infection.  Antibiotics were changed to include
Vancomycin.  On hospital day five, a PICC line catheter was
placed and per infectious disease recommendations, the
patient was discharged with a six week course of Vancomycin.

DISPOSITION:  The patient was discharged to home with
visiting nursing care for home intravenous antibiotic
therapy.

DISCHARGE DIAGNOSES:
1.  Presumed line sepsis.
2.  Status post gastric bypass.
3.  Common bile duct stricture.
4.  Dumping syndrome.
5.  TPN dependent.

FOLLOW-UP:  The patient will make plans to have a follow-up
visit with Dr. [**Last Name (STitle) **] at which time he can assess the need for
longer term intravenous antibiotic therapy.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3799**], M.D.  [**MD Number(1) 3800**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36

D:  [**2153-10-20**]  13:53
T:  [**2153-10-20**]  15:28
JOB#:  [**Job Number 39267**]
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Acute and subacute bacterial endocarditis,Cholangitis,Other and unspecified postsurgical nonabsorption,Thrombocytopenia, unspecified,Hypotension, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
gentleman who is status post gastric bypass in [**2152**], who has
had several admissions in the last several weeks which
included problems for postoperative pancreatitis, duodenal
stump bleed, multiple episodes of cholangitis, dumping
problems, episodes of hypoglycemia.  Most recently he has
been NPO and receiving TPN.  He was admitted through the
Emergency Department to the Intensive Care Unit for episode
of hypotension.  This was following a four day history of
right upper quadrant pain.  He presented to the Emergency
Department with a four day history of right upper quadrant
pain and fever for one day with rigors, nausea and vomiting.
He was admitted to the Intensive Care Unit through the
Emergency Department.

MEDICAL HISTORY: 1.  Obesity.
2.  Malnutrition.
3.  Hypoglycemia.

MEDICATION ON ADMISSION: 1.  Octreotide 400 mg subcutaneous three times a day.
2.  Ciprofloxacin 500 mg p.o. twice a day.
3.  TPN.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker, no alcohol.
Single parent of one child. 

### Response:
{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Acute and subacute bacterial endocarditis,Cholangitis,Other and unspecified postsurgical nonabsorption,Thrombocytopenia, unspecified,Hypotension, unspecified'}
