CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 41 F c h/o GERD, IBS, s/p esophogeal pH probe at GE junction 3
days ago who noticed increased retrosternal chest pain since
placement of probe. She described it as esophageal spasm and
similar in nature to episode of pill esophagitis in past. Pt
notes pain became unbearable 1 day ago associated with
non-bloody, non-bilious emesis and she presented to [**Hospital1 18**] ED. CT
abdomen on [**12-22**] pm was negative for perforation. Because she
has strong FH of early CAD she was also ruled out for MI under
observation. She subsequently developed pregressive hypotension
68/35 and HR 65 (basesline 90's). Per her report, she did not
feel light headedness or symptoms at that time. She was
resuscitated with 5L NS and BP responded back to baseline of
90's. She had repeat abd CT scan on [**12-23**] afternoon now showing
bilateral pleural effusions, periportal edema, cholestyic fluid,
and free peritoneal fluid not suggestive of blood or contrast.
Subsequently, she had RUQ u/s showing gallbladder wall edema.
Hepatology, thoracic surgery, ERCP, and general surgery were
consulted in the ED for evaluation of new onset ascites and
possibility of perforation. They recommended ultrasound with
dopplers, HIDA scan, and barium esophogram. All studies were
negative. Pt denies fevers/chills/diarrhea. She has abdominal
pain unchanged from her baseline IBS symptoms. Currently, her
pain is controlled with pain meds.

MEDICAL HISTORY: 1. s/p appy
2. GERD - 00'
3. Irritable bowel disease
4. h/o esophagitis [**1-18**] doxycycline
5. fibromyalgia
6. migraines
7. arthritis

MEDICATION ON ADMISSION: 1. Nexium
2. Miralax
3. Zoloft
4. Topomax
5. Tylenol

ALLERGIES: Codeine

PHYSICAL EXAM: Physical exam on admission
Temp 98.4 bp 99/58 resp 19 O2 sat 97%(RA) pulsus 4
Gen: middle-aged female, A&OX3, NAD
HEENT: anicteric, nl conjunctiva, OMM slightly dry, OP clear,
neck supple, no JVD.
Cardiac: RRR, no M/R/G appreciated
Pulm: Decreased LS at bases bilaterally
Abd: Diffuse mild tenderness without rebound or guarding. Normal
bowel sounds. No [**Doctor Last Name **] sign
Ext: Warm, no edema noted.

FAMILY HISTORY: Gradmother died of MI at age 41, Aunt had MI at age 50. Mother
with HTN.

SOCIAL HISTORY: Homemaker, has 5 kids, oldest 21, youngest 17 months. Smokes <1
pack per day. Occasional EtOH. No IVDU
Urinary tract infection, site not specified,Acidosis,Unspecified pleural effusion,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Esophageal reflux,Anemia, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Myalgia and myositis, unspecified,Hypotension, unspecified
Urin tract infection NOS,Acidosis,Pleural effusion NOS,Streptococcus group b,Esophageal reflux,Anemia NOS,Migrne unsp wo ntrc mgrn,Myalgia and myositis NOS,Hypotension NOS
Admission Date:  [**2130-12-22**]              Discharge Date:   [**2130-12-25**]

Date of Birth:  [**2089-10-2**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 689**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
41 F c h/o GERD, IBS, s/p esophogeal pH probe at GE junction 3
days ago who noticed increased retrosternal chest pain since
placement of probe. She described it as esophageal spasm and
similar in nature to episode of pill esophagitis in past. Pt
notes pain became unbearable 1 day ago associated with
non-bloody, non-bilious emesis and she presented to [**Hospital1 18**] ED. CT
abdomen on [**12-22**] pm was negative for perforation. Because she
has strong FH of early CAD she was also ruled out for MI under
observation. She subsequently developed pregressive hypotension
68/35 and HR 65 (basesline 90's). Per her report, she did not
feel light headedness or symptoms at that time. She was
resuscitated with 5L NS and BP responded back to baseline of
90's. She had repeat abd CT scan on [**12-23**] afternoon now showing
bilateral pleural effusions, periportal edema, cholestyic fluid,
and free peritoneal fluid not suggestive of blood or contrast.
Subsequently, she had RUQ u/s showing gallbladder wall edema.
Hepatology, thoracic surgery, ERCP, and general surgery were
consulted in the ED for evaluation of new onset ascites and
possibility of perforation. They recommended ultrasound with
dopplers, HIDA scan, and barium esophogram. All studies were
negative. Pt denies fevers/chills/diarrhea. She has abdominal
pain unchanged from her baseline IBS symptoms. Currently, her
pain is controlled with pain meds.


Past Medical History:
1. s/p appy
2. GERD - 00'
3. Irritable bowel disease
4. h/o esophagitis [**1-18**] doxycycline
5. fibromyalgia
6. migraines
7. arthritis


Social History:
Homemaker, has 5 kids, oldest 21, youngest 17 months. Smokes <1
pack per day. Occasional EtOH. No IVDU


Family History:
Gradmother died of MI at age 41, Aunt had MI at age 50. Mother
with HTN.

Physical Exam:
Physical exam on admission
Temp 98.4 bp 99/58 resp 19 O2 sat 97%(RA) pulsus 4
Gen: middle-aged female, A&OX3, NAD
HEENT: anicteric, nl conjunctiva, OMM slightly dry, OP clear,
neck supple, no JVD.
Cardiac: RRR, no M/R/G appreciated
Pulm: Decreased LS at bases bilaterally
Abd: Diffuse mild tenderness without rebound or guarding. Normal
bowel sounds. No [**Doctor Last Name **] sign
Ext: Warm, no edema noted.


Pertinent Results:
Labs on admission:
GLUCOSE-102 UREA N-10 CREAT-0.8 SODIUM-141 POTASSIUM-3.7
CHLORIDE-109* TOTAL CO2-21* ANION GAP-15
CK(CPK)-46 CK-MB-NotDone cTropnT-<0.01
WBC-7.2 RBC-3.95* HGB-12.1 HCT-32.8* MCV-83 MCH-30.5 MCHC-36.7*
RDW-13.2
NEUTS-56.6 LYMPHS-35.4 MONOS-4.3 EOS-3.4 BASOS-0.3
PT-12.9 PTT-22.8 INR(PT)-1.1

Radiology:
CXR [**2130-12-22**]: No evidence of pneumomediastinum. Ph probe in the
distal esophagus.

CTA Chest/Abd [**2130-12-22**]: No evidence of mediastinal air or aortic
dissection.
4 mm pulmonary nodule. No acute abdominal process

Barium swallow [**2130-12-23**]: No evidence of esophageal perforation.
Normal esophageal motility.

HIDA scan [**2130-12-23**]: Normal visualization of the gallbladder and
small bowel with tracer.

Abd U/S w/ doppler [**2130-12-23**]: Limited ultrasound exam of the
hepatic veins was performed. Hepatic veins and IVC appear
patent. Portal vein is patent with wall-to-wall flow and
hepatopedal directionality

Abd U/S [**2130-12-23**]: Marked gallbladder wall edema.

CT Abd [**2130-12-23**]: Interval development of bilateral pleural
effusions, peritoneal fluid, periportal edema, cholecystic
fluid, and pelvic free fluid. Fluid is of low density. No active
extravasation of contrast is identified.

CXR [**2130-12-25**]: Moderate right and small left pleural effusions with
slight increase on the left; probable loculated component on the
right medially.

TTE [**2130-12-25**]: LVEF>55%. Right ventricular chamber size and free
wall motion are normal. Trivial mitral regurgitation,
trivial/physiologic pericardial effusion.


Brief Hospital Course:
41 year old female with h/o GERD s/p esophogeal pH probe
placement presents with retrosternal chest pain with ascites,
pleural effusions after aggressive IV hydration for an episode
of hypotension.

1) Hypotension: The patient was initially admitted to the MICU,
however was transferred within 24 hours to the general medical
floor, given blood pressure remained stable with sbp 90s (her
baseline) and excellent urine output. The etiology of the
asymptomatic hypotensive episode in the emergency demartment is
unclear. [**Name2 (NI) **] cortisol within normal limits, making adrenal
insufficiency unlikely. There was no fever or leukocytosis to
suggest sepsis. Given low voltage on EKG, although no
significant pulsus parodoxus was noted, a TTE was obtained,
which showed only a trivial pericardial effusion.

2) Ascites/pleural effusions: Likely related to aggressive 5L
fluid bolus in ED. She has no signs of portal hypertension or
hepatic vein occlusion on abdominal ultrasound. By ultrasound,
there was not enough fluid for paracentesis. Her albumin was
3.1, however this is not low enough to account for significant
third-spacing. TSH was within normal limits, amylase/lipase was
normal. She will follow-up with liver clinic as an outpatient.

3) Chest pain: Abdomen CT on admission showed no evidence of
esophageal perforation. EKG/cardiac enzymes were not consistent
with myocardial ischemia. Her pantoprazole was increased to
twice daily dosing. She will need continued work-up as an
outpatient for GERD.

4) Abd pain: Possibly related to distension from ascites,
although irritable bowel syndrome/GERD are also likely
contributors. There was noo evidence of acute intrabdominal
process on abdomen CT, and no evidence of cholecystitis on HIDA
scan (gallbladder wall edema likely due to ascites). UHCG (-) in
ED. Given suprapubic pain noted on exam [**12-25**], she was treated
with 3 days of Cipro for possible UTI, although ucx from [**12-23**]
grew only group B strep. She had a mild transaminitis (ALT 49,
AST 71), which resolved rapidly and was of unclear etiology,
given no evidence of biliary obstruction (as indicated above).
It may be related to transient hypotension.

5) Anemia: At time of discharge, HCT 27.6 (from 32 on admit,
baseline 37). [**Month (only) 116**] be due to hemodilution in setting of fluid
resusictation. There was no evidence of active bleeding, and the
patient was gauiac negative. Iron studies were not consistent
with iron deficiency, and vit B12 was normal. Her hematocrit was
stable at the time of discharge, and will need to be monitored
by her PCP as an outpatient.

6) Full Code

Medications on Admission:
1. Nexium
2. Miralax
3. Zoloft
4. Topomax
5. Tylenol


Discharge Medications:
1. Topiramate 25 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
2. Topiramate 25 mg Tablet Sig: Two (2) Tablet PO QPM (once a
day (in the evening)).
3. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
6. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain.
Disp:*12 Tablet(s)* Refills:*0*
7. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: ascites
Secondary: pleural effusions, gastroesophageal reflux disease,
irritable bowel syndrome, fibromyalgia, migraine, urinary tract
infection.


Discharge Condition:
Good


Discharge Instructions:
Please follow-up as scheduled below. Please follow-up with your
gastroenterologist as previously scheduled regarding your reflux
symptoms

Please call your PCP or come to the emergency room if you
develop fever, worsening chest pain, shortness of breath,
abdominal pain, or other symptoms that concern you.

Followup Instructions:
1) Primary Care
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2903**] ([**Telephone/Fax (1) 2936**]) [**2129-12-27**] at
1:45 p.m.
- if you develop a fever, additional imaging of your chest
(chest CT scan) may be considered to evaluate for infection
- you should also have a hematocrit checked at this time to
ensure that it is stable (at discharge, HCT 27.6)
2) Liver: new ascites
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 7128**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2131-2-7**] 10:00
- you may be contact[**Name (NI) **] by the liver service to move up this
appointment date



Completed by:[**2131-4-25**]
{'Urinary tract infection, site not specified,Acidosis,Unspecified pleural effusion,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Esophageal reflux,Anemia, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Myalgia and myositis, 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: chest pain

PRESENT ILLNESS: 41 F c h/o GERD, IBS, s/p esophogeal pH probe at GE junction 3
days ago who noticed increased retrosternal chest pain since
placement of probe. She described it as esophageal spasm and
similar in nature to episode of pill esophagitis in past. Pt
notes pain became unbearable 1 day ago associated with
non-bloody, non-bilious emesis and she presented to [**Hospital1 18**] ED. CT
abdomen on [**12-22**] pm was negative for perforation. Because she
has strong FH of early CAD she was also ruled out for MI under
observation. She subsequently developed pregressive hypotension
68/35 and HR 65 (basesline 90's). Per her report, she did not
feel light headedness or symptoms at that time. She was
resuscitated with 5L NS and BP responded back to baseline of
90's. She had repeat abd CT scan on [**12-23**] afternoon now showing
bilateral pleural effusions, periportal edema, cholestyic fluid,
and free peritoneal fluid not suggestive of blood or contrast.
Subsequently, she had RUQ u/s showing gallbladder wall edema.
Hepatology, thoracic surgery, ERCP, and general surgery were
consulted in the ED for evaluation of new onset ascites and
possibility of perforation. They recommended ultrasound with
dopplers, HIDA scan, and barium esophogram. All studies were
negative. Pt denies fevers/chills/diarrhea. She has abdominal
pain unchanged from her baseline IBS symptoms. Currently, her
pain is controlled with pain meds.

MEDICAL HISTORY: 1. s/p appy
2. GERD - 00'
3. Irritable bowel disease
4. h/o esophagitis [**1-18**] doxycycline
5. fibromyalgia
6. migraines
7. arthritis

MEDICATION ON ADMISSION: 1. Nexium
2. Miralax
3. Zoloft
4. Topomax
5. Tylenol

ALLERGIES: Codeine

PHYSICAL EXAM: Physical exam on admission
Temp 98.4 bp 99/58 resp 19 O2 sat 97%(RA) pulsus 4
Gen: middle-aged female, A&OX3, NAD
HEENT: anicteric, nl conjunctiva, OMM slightly dry, OP clear,
neck supple, no JVD.
Cardiac: RRR, no M/R/G appreciated
Pulm: Decreased LS at bases bilaterally
Abd: Diffuse mild tenderness without rebound or guarding. Normal
bowel sounds. No [**Doctor Last Name **] sign
Ext: Warm, no edema noted.

FAMILY HISTORY: Gradmother died of MI at age 41, Aunt had MI at age 50. Mother
with HTN.

SOCIAL HISTORY: Homemaker, has 5 kids, oldest 21, youngest 17 months. Smokes <1
pack per day. Occasional EtOH. No IVDU 

### Response:
{'Urinary tract infection, site not specified,Acidosis,Unspecified pleural effusion,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Esophageal reflux,Anemia, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Myalgia and myositis, unspecified,Hypotension, unspecified'}
