CHIEF COMPLAINT: Abdominal Pain and Tremors

PRESENT ILLNESS: History of Present Illness:  Mr. [**Known lastname **] is a 52 year old Spanish
speaking male who was brought to the emergency room by EMS on
[**2191-8-7**].  The patient reports that he drank a bottle of vodka on
the day prior to admission.  He subsequently developed severe
right upper quadrant abdominal pain.  The pain is constant and
associated with nausea and vomiting of food stuff.  It is also
associated with diarrhea.  It is not associated with jaundice,
hematemasis, hematochezia.  It is associated with dark stools.
He has also noticed some decreased urine output but no change in
urine color.  He has never experienced pain of this nature
before (although in ER note it reports that he has had RUQ pain
for five months since moving to the United States).  The patient
reports himself that it was the pain that prompted his admission
to the hospital.  Emergency room records, however, report that
he was found down and intoxicated by EMS.
.
On review of systems he currently endorses lightheadedness,
dizziness, and unsteadiness on his feet.  He endorses RUQ pain,
nausea, vomiting and dark stools as above.  He denies fevers,
chills, chest pain, shortness of breath, dysuria, hematuria,
numbness, tingling, leg pain or swelling.  He reports no
previous episodes of alcohol withdrawal.  He has lost
consciousness on once occassion secondary to alcohol use.  He
has never experienced DTs.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 100.0 HR: 77 BP: 138/75 RR: 14 O2: 97% on RA
.
General: Alert, orientedx3, tremulous, conversant
HEENT: Sclera anicteric, MM dry, oropharynx clear, purulent
conjunctival discharge with erythematous conjunctiva R > L, no
LAD
Neck: JVP not elevated
Chest: RRR, s1 + s2, no murmurs, rubs, gallops
Resp: Clear to ausculation bilaterally, no wheezes, rales,
ronchi
GI: Soft, tender in RUQ, no rebound tenderness or guarding, +BS,
liver tip palpable at 2 cm below costal margin, negative
[**Doctor Last Name 515**].
GU: no foley
Ext: WWP, 2+ pulses, no clubbing, cyanosis or edema
Skin: No rashes, jaundice.  No palmar erythema.  No spider
hemagiomas.  No caput medusa.
Neurologic: Alert and oriented x 3, strength grossly intact,
sensation intact to light touch, gait not tested.  Grossly
tremulous

FAMILY HISTORY: None per the patient's knowledge.  He has no known history of
liver disease.

SOCIAL HISTORY: The patient is originally from [**Country 3594**].  He has a wife and two
children in [**Country 3594**] ages 12 and 7.  He came to the United
States five months ago to find work.  He has been unable to find
food and housing since moving to the United States and has been
sleeping at the beach and finding food in dumpsters.  He used to
have a drinking problem in [**Country 3594**] but reportedly has not had
alcohol in ten years prior to this week.  He used to smoke
heavily but for the past month has only been smoking 1 pack per
week.  He has no history of IVDU.  He has no tattoos.  He has
not been sexually active for four months.  He is sexually active
with women exclusively.  He always uses condoms.
Alcohol withdrawal,Acute alcoholic hepatitis,Acute conjunctivitis, unspecified,Thrombocytopenia, unspecified,Anemia of other chronic disease,Diarrhea,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction
Alcohol withdrawal,Ac alcoholic hepatitis,Acute conjunctivitis NOS,Thrombocytopenia NOS,Anemia-other chronic dis,Diarrhea,Cholelithiasis NOS
Admission Date:  [**2191-8-8**]              Discharge Date:   [**2191-8-12**]

Date of Birth:  [**2139-5-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
Abdominal Pain and Tremors

Major Surgical or Invasive Procedure:
None

History of Present Illness:
History of Present Illness:  Mr. [**Known lastname **] is a 52 year old Spanish
speaking male who was brought to the emergency room by EMS on
[**2191-8-7**].  The patient reports that he drank a bottle of vodka on
the day prior to admission.  He subsequently developed severe
right upper quadrant abdominal pain.  The pain is constant and
associated with nausea and vomiting of food stuff.  It is also
associated with diarrhea.  It is not associated with jaundice,
hematemasis, hematochezia.  It is associated with dark stools.
He has also noticed some decreased urine output but no change in
urine color.  He has never experienced pain of this nature
before (although in ER note it reports that he has had RUQ pain
for five months since moving to the United States).  The patient
reports himself that it was the pain that prompted his admission
to the hospital.  Emergency room records, however, report that
he was found down and intoxicated by EMS.
.
On review of systems he currently endorses lightheadedness,
dizziness, and unsteadiness on his feet.  He endorses RUQ pain,
nausea, vomiting and dark stools as above.  He denies fevers,
chills, chest pain, shortness of breath, dysuria, hematuria,
numbness, tingling, leg pain or swelling.  He reports no
previous episodes of alcohol withdrawal.  He has lost
consciousness on once occassion secondary to alcohol use.  He
has never experienced DTs.

Past Medical History:
None

Social History:
The patient is originally from [**Country 3594**].  He has a wife and two
children in [**Country 3594**] ages 12 and 7.  He came to the United
States five months ago to find work.  He has been unable to find
food and housing since moving to the United States and has been
sleeping at the beach and finding food in dumpsters.  He used to
have a drinking problem in [**Country 3594**] but reportedly has not had
alcohol in ten years prior to this week.  He used to smoke
heavily but for the past month has only been smoking 1 pack per
week.  He has no history of IVDU.  He has no tattoos.  He has
not been sexually active for four months.  He is sexually active
with women exclusively.  He always uses condoms.

Family History:
None per the patient's knowledge.  He has no known history of
liver disease.

Physical Exam:
Vitals: T: 100.0 HR: 77 BP: 138/75 RR: 14 O2: 97% on RA
.
General: Alert, orientedx3, tremulous, conversant
HEENT: Sclera anicteric, MM dry, oropharynx clear, purulent
conjunctival discharge with erythematous conjunctiva R > L, no
LAD
Neck: JVP not elevated
Chest: RRR, s1 + s2, no murmurs, rubs, gallops
Resp: Clear to ausculation bilaterally, no wheezes, rales,
ronchi
GI: Soft, tender in RUQ, no rebound tenderness or guarding, +BS,
liver tip palpable at 2 cm below costal margin, negative
[**Doctor Last Name 515**].
GU: no foley
Ext: WWP, 2+ pulses, no clubbing, cyanosis or edema
Skin: No rashes, jaundice.  No palmar erythema.  No spider
hemagiomas.  No caput medusa.
Neurologic: Alert and oriented x 3, strength grossly intact,
sensation intact to light touch, gait not tested.  Grossly
tremulous

Pertinent Results:
On Admission:
[**2191-8-8**] 01:30AM   WBC-8.4 RBC-4.00* HGB-12.6* HCT-38.3* MCV-96
MCH-31.5 MCHC-32.9 RDW-14.7
[**2191-8-8**] 01:30AM   NEUTS-54.6 LYMPHS-27.9 MONOS-2.5 EOS-14.2*
BASOS-0.8
[**2191-8-8**] 01:30AM   PLT SMR-LOW PLT COUNT-92*
[**2191-8-8**] 01:30AM   GLUCOSE-82 UREA N-11 CREAT-0.6 SODIUM-141
POTASSIUM-3.3 CHLORIDE-99 TOTAL CO2-28 ANION GAP-17
[**2191-8-8**] 01:30AM   ALT(SGPT)-87* AST(SGOT)-216* ALK PHOS-95 TOT
BILI-0.5
[**2191-8-8**] 01:30AM   LIPASE-53
[**2191-8-8**] 01:30AM   ALBUMIN-4.2
.
RUQ U/S: FINDINGS: The liver echotexture is diffusely echogenic.
No focal lesions identified. Appropriate direction of flow is
seen within the portal vein.
Gallstone noted within the gallbladder. There is no evidence of
wall
thickening, edema, or pericholecystic fluid. The common duct is
not dilated. Views of the pancreatic head and body appear
unremarkable. The assessment of the tail is limited by bowel
gas. The right kidney measures 10.1 cm. The left kidney measures
10.4 cm. There is no evidence of hydronephrosis or stones.
Spleen is not enlarged.

IMPRESSION:
1. Echogenic liver suggesting fatty infiltration; however, other
forms of
liver disease including more advanced liver disease such as
hepatic
cirrhosis/fibrosis cannot be excluded.
2. Cholelithiasis, without evidence of acute cholecystitis.
The study and the report were reviewed by the staff radiologist.



Brief Hospital Course:
In the emergency room his initial vital signs were T: 97.9 HR:
98 BP: 137/87 RR: 16 O2: 94% on RA.  His initial serum alcohol
was 312.  The remainder of his toxicology screen was negative.
His AST was elevated at 216 and ALT at 87.  Lipase was normal at
53.  He received IV folate, thiamine and a multivitamin. He was
started on a valium CIWA scale.  He was admitted to the floor
for further management.
.
On the floor the patient had a right upper quadrant ultrasound
which showed an echogenic liver and cholelithiasis without
evidence of cholecystitis. He was persistently requiring valium
Q1-2 hours on the floor per CIWA scale.  He was transferred to
the [**Hospital Unit Name 153**] for closer monitoring for alcohol withdrawal.
.
In the ICU patient did not have any CIWA score >10; so he did
not require any more benzodiacepine doses. He was transfered to
the floor <24 hours after admission to the unit (on [**8-9**]). On
the floor, he was placed on standing diazepam given high CIWA
scores >25 on arrival and severe tremors and hallucinations. He
was placed on telemetry. His CIWA scores gradually decreased. He
was seen by social work who recommended a few shelthers, as well
as assistance with job search. He continued to have mild
diarrhea, but tolerating good pos, without fevers, leukocytosis,
or blood in his stool.
.
Patient received Sulfacetamide for conjuntivitis. He was noted
to have a thrombocytopenia, thought to be related to poor liver
synthetic function, which improved after discontinuation of
heparin. He did not have an elevated INR. He was discharged
without services to a shelter.

Medications on Admission:
None

Discharge Medications:
1. Sulfacetamide Sodium 10 % Drops Sig: 1-2 Drops Ophthalmic Q6H
(every 6 hours) as needed for conjunctivitis.
Disp:*1 bottle* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Acute alcohol withdrawal
2. Alcoholic hepatitis
3. Thrombocytopenia
4. Anemia of chronic disease
5. Diarrhea


Discharge Condition:
Stable


Discharge Instructions:
You were admitted with severe alcohol withdrawal. You were in
the intensive care unit for close monitoring in the setting of
alcohol withdrawal.

If you develop worsening tremors, headache, nausea, vomiting, or
worsening abdominal pain, you should go to the emergency room.
The diarrhea should improve with time, as it is likely related
to the alcohol use. We do not suspect infection since you did
not have a fever and your labs did not look as though you had an
infection.

Followup Instructions:
Please follow up with a primary care doctor.
{'Alcohol withdrawal,Acute alcoholic hepatitis,Acute conjunctivitis, unspecified,Thrombocytopenia, unspecified,Anemia of other chronic disease,Diarrhea,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction'}


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: Abdominal Pain and Tremors

PRESENT ILLNESS: History of Present Illness:  Mr. [**Known lastname **] is a 52 year old Spanish
speaking male who was brought to the emergency room by EMS on
[**2191-8-7**].  The patient reports that he drank a bottle of vodka on
the day prior to admission.  He subsequently developed severe
right upper quadrant abdominal pain.  The pain is constant and
associated with nausea and vomiting of food stuff.  It is also
associated with diarrhea.  It is not associated with jaundice,
hematemasis, hematochezia.  It is associated with dark stools.
He has also noticed some decreased urine output but no change in
urine color.  He has never experienced pain of this nature
before (although in ER note it reports that he has had RUQ pain
for five months since moving to the United States).  The patient
reports himself that it was the pain that prompted his admission
to the hospital.  Emergency room records, however, report that
he was found down and intoxicated by EMS.
.
On review of systems he currently endorses lightheadedness,
dizziness, and unsteadiness on his feet.  He endorses RUQ pain,
nausea, vomiting and dark stools as above.  He denies fevers,
chills, chest pain, shortness of breath, dysuria, hematuria,
numbness, tingling, leg pain or swelling.  He reports no
previous episodes of alcohol withdrawal.  He has lost
consciousness on once occassion secondary to alcohol use.  He
has never experienced DTs.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 100.0 HR: 77 BP: 138/75 RR: 14 O2: 97% on RA
.
General: Alert, orientedx3, tremulous, conversant
HEENT: Sclera anicteric, MM dry, oropharynx clear, purulent
conjunctival discharge with erythematous conjunctiva R > L, no
LAD
Neck: JVP not elevated
Chest: RRR, s1 + s2, no murmurs, rubs, gallops
Resp: Clear to ausculation bilaterally, no wheezes, rales,
ronchi
GI: Soft, tender in RUQ, no rebound tenderness or guarding, +BS,
liver tip palpable at 2 cm below costal margin, negative
[**Doctor Last Name 515**].
GU: no foley
Ext: WWP, 2+ pulses, no clubbing, cyanosis or edema
Skin: No rashes, jaundice.  No palmar erythema.  No spider
hemagiomas.  No caput medusa.
Neurologic: Alert and oriented x 3, strength grossly intact,
sensation intact to light touch, gait not tested.  Grossly
tremulous

FAMILY HISTORY: None per the patient's knowledge.  He has no known history of
liver disease.

SOCIAL HISTORY: The patient is originally from [**Country 3594**].  He has a wife and two
children in [**Country 3594**] ages 12 and 7.  He came to the United
States five months ago to find work.  He has been unable to find
food and housing since moving to the United States and has been
sleeping at the beach and finding food in dumpsters.  He used to
have a drinking problem in [**Country 3594**] but reportedly has not had
alcohol in ten years prior to this week.  He used to smoke
heavily but for the past month has only been smoking 1 pack per
week.  He has no history of IVDU.  He has no tattoos.  He has
not been sexually active for four months.  He is sexually active
with women exclusively.  He always uses condoms. 

### Response:
{'Alcohol withdrawal,Acute alcoholic hepatitis,Acute conjunctivitis, unspecified,Thrombocytopenia, unspecified,Anemia of other chronic disease,Diarrhea,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction'}
