CHIEF COMPLAINT: 1. Status post sigmoid resection
2. Ventral hernia

PRESENT ILLNESS: This is a 67 yo M with a history of sigmoid resection with
[**Doctor Last Name 3379**] procedure for ischemic colitis in [**2147**]. Patient
presents to [**Hospital1 18**] for a colostomy takedown with colorectal
anastamosis with component separation hernia repair by Drs [**First Name (STitle) **]
and [**Doctor First Name **] The [**Hospital 228**] medical history is significant for
DVT/PEs for
which he is on coumadin (goal INR [**12-31**]), aortobifem bypass, left
AKA, and quadruple vessel CABG. His last dose of coumadin was on
[**2150-6-19**] in preparation for this admission's surgery. He recently
develope two skin ulcers adjacent to his colostomy site for
which he completed a seven day course of cipro yesterday,
Saturday [**6-20**]. Otherwise, he has had no new medical diagnoses or
medication changes in the past 30 days.

MEDICAL HISTORY: HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA

MEDICATION ON ADMISSION: warfarin, Toprol Xl 50", HCTZ 12.5', lisinopril 20', omeprazole
20'

ALLERGIES: Percocet / Adhesive Tape

PHYSICAL EXAM: On Discharge:
VS:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: Midline and bilateral incision with staples c/d/i, JP sites
x 5 with occlusive dressings c/d/i
Ext: Left AKA, right warm, with positive pp

FAMILY HISTORY: -vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia

SOCIAL HISTORY: lives w/ wife, daughter, son-in-law, teenage grandson, and
mother in law
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist
Attention to colostomy,Other colostomy and enterostomy complication,Regional enteritis of unspecified site,Other chronic pulmonary heart diseases,Other specified cardiac dysrhythmias,Chronic ulcer of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Above knee amputation status,Aortocoronary bypass status,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block
Atten to colostomy,Colstmy/enteros comp NEC,Regional enteritis NOS,Chr pulmon heart dis NEC,Cardiac dysrhythmias NEC,Chronic skin ulcer NEC,Peritoneal adhesions,Meth resis Staph carrier,Hx-ven thrombosis/embols,Long-term use anticoagul,Status amput above knee,Aortocoronary bypass,Hypertension NOS,Pure hypercholesterolem,Left bb block NEC
Admission Date:  [**2150-6-21**]              Discharge Date:   [**2150-7-1**]

Date of Birth:  [**2083-3-6**]             Sex:   M

Service: SURGERY

Allergies:
Percocet / Adhesive Tape

Attending:[**First Name3 (LF) 2836**]
Chief Complaint:
1. Status post sigmoid resection
2. Ventral hernia

Major Surgical or Invasive Procedure:
[**2150-6-22**]:
1. Colostomy takedown with colorectal anastamosis
2. Repair of complex ventral hernia.
3. Placement of acellular dermal matrix, Strattice, 20 x 25 cm.
4. Bilateral component separation


History of Present Illness:
This is a 67 yo M with a history of sigmoid resection with
[**Doctor Last Name 3379**] procedure for ischemic colitis in [**2147**]. Patient
presents to [**Hospital1 18**] for a colostomy takedown with colorectal
anastamosis with component separation hernia repair by Drs [**First Name (STitle) **]
and [**Doctor First Name **] The [**Hospital 228**] medical history is significant for
DVT/PEs for
which he is on coumadin (goal INR [**12-31**]), aortobifem bypass, left
AKA, and quadruple vessel CABG. His last dose of coumadin was on
[**2150-6-19**] in preparation for this admission's surgery. He recently
develope two skin ulcers adjacent to his colostomy site for
which he completed a seven day course of cipro yesterday,
Saturday [**6-20**]. Otherwise, he has had no new medical diagnoses or
medication changes in the past 30 days.


Past Medical History:
HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA


Social History:
lives w/ wife, daughter, son-in-law, teenage grandson, and
mother in law
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist


Family History:
-vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia


Physical Exam:
On Discharge:
VS:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: Midline and bilateral incision with staples c/d/i, JP sites
x 5 with occlusive dressings c/d/i
Ext: Left AKA, right warm, with positive pp

Pertinent Results:
[**2150-6-21**] 03:30PM   WBC-8.8 RBC-5.09 HGB-13.8* HCT-40.2 MCV-79*
MCH-27.2 MCHC-34.4 RDW-15.2
[**2150-6-21**] 03:30PM   GLUCOSE-159* UREA N-19 CREAT-0.8 SODIUM-129*
POTASSIUM-3.8 CHLORIDE-94* TOTAL CO2-24 ANION GAP-15
[**2150-6-21**] 03:30PM   ALT(SGPT)-24 AST(SGOT)-25 LD(LDH)-169 ALK
PHOS-94 AMYLASE-72 TOT BILI-0.3
[**2150-6-21**] 03:30PM   PT-38.3* PTT-46.9* INR(PT)-4.0*
[**2150-6-24**] 01:40AM BLOOD WBC-17.9* RBC-3.74* Hgb-10.4* Hct-30.0*
MCV-80* MCH-27.9 MCHC-34.8 RDW-15.2 Plt Ct-311
[**2150-6-25**] 08:00AM BLOOD Glucose-116* UreaN-9 Creat-0.7 Na-132*
K-4.0 Cl-100 HCO3-25 AnGap-11
[**2150-6-25**] 08:00AM BLOOD Calcium-7.7* Phos-2.5* Mg-2.4
[**2150-6-30**] 07:55AM BLOOD PT-15.6* PTT-106.5* INR(PT)-1.4*

                   Pathology Examination
Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 81633**],[**Known firstname 1112**]       [**2083-3-6**]    67 Male      [**-8/2991**] [**Numeric Identifier 81634**]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
[**Last Name (NamePattern1) 2093**] Description by:   DR. [**Last Name (STitle) **]. WILLIM/mtd
SPECIMEN SUBMITTED: Colostomy.
Procedure date     Tissue received     Report Date    Diagnosed
by
[**2150-6-22**] [**2150-6-22**] [**2150-6-24**] DR. [**Last Name (STitle) **]. [**Doctor Last Name 15706**]/ttl
Previous biopsies:    [**Numeric Identifier 81635**]  Sigmoid Colon, Small bowel
segment.
  [**Numeric Identifier 81636**]  SIGMOID BX, 1 JAR.
  [**-6/5031**]  False Aneursym.
DIAGNOSIS: Colostomy: Consistent with colostomy.

[**2150-6-23**] EKG:
Sinus tachycardia. Left bundle-branch block. Compared to the
previous tracing of [**2150-6-19**] the rate has increased and there are
new ST-T wave changes with T wave inversion in leads I, aVL and
V5-V6. The QRS complex has widened. Rule out active ischemic
process.

[**2150-6-24**] EKG:
Sinus rhythm. Left bundle-branch block. Compared to the previous
tracing
of [**2150-6-23**] the rate has slowed. Otherwise, no diagnostic interim
change.



Brief Hospital Course:
The patient was admitted to the General Surgical Service for
elective ventral hernia repair and colostomy takedown on
[**2150-6-21**]. Patient on Coumadin at home for DVT/PE treatment, INR
on admission was 4.0. Patient was given vitamin K, and started
on Heparin gtt for bridging therapy. Cardiology was consulted
for pre-op clearance, and patient was cleared for surgery from
cardiology stand point.  On [**2150-6-22**], the patient underwent
colostomy takedown and ventral hernia repair, which went well
without complication (reader referred to the Operative Note for
details). After surgery patient was extubated in the PACU, he
was noticed to have sinus tachycardia, and secondary to his
cardiac history, patient was transferred in ICU foe observation.
Patient was NPO, on IV fluids and antibiotics, with Foley
catheter and Dilaudid PCA for pain control. The patient was
hemodynamically stable.
Neuro: The patient received Dilaudid PCA with good effect and
adequate pain control.  When tolerating oral intake, the patient
was transitioned to oral pain medications.
CV: Patient with a history of CAD s/p CABG and chronic left
bundle-branch block, after surgery was found to have sinus
tachycardia. Patient was transferred into ICU where he converted
in regular rhythm with fluid resuscitation. Cardiac enzymes were
checked and were negative x 2. Patient was transferred on the
floor for continue treatment and observation. He remained stable
from cardiac stand point.
Pulmonary: The patient remained stable from a pulmonary
standpoint; vital signs were routinely monitored. Good pulmonary
toilet, early ambulation and incentive spirrometry were
encouraged throughout hospitalization.
GI/GU/FEN: Post-operatively, the patient was made NPO with IV
fluids. Diet was advanced when appropriate, which was well
tolerated.  Patient's intake and output were closely monitored,
and IV fluid was adjusted when necessary.  Electrolytes were
routinely followed, and repleted when necessary. On discharge,
patient tolerates regular diet and had several BM.
ID: Intraoperatively 5 JP drains were placed and patient was
started on empirical treatment with IV Abx. After JP drains were
removed  all antibiotics were discontinued, patient remained
afebrile during hospitalization, WBC was routinely monitored and
on dischared was 9.0.
Wound care: staples will be removed during follow up appointment
with Plastic surgery. Keep wound open to air, patient can
shower.
Endocrine: The patient's blood sugar was monitored throughout
his stay; insulin dosing was adjusted accordingly.
Hematology: The patient's complete blood count was examined
routinely; no transfusions were required.
DVT/PE Prophylaxis and Treatment: Patient was started on Heparin
gtt after operation and his PTT was kept between 60-80. When
tolerated PO, patient was started on PO Coumadin. PTT/INR was
checked periodically, and Heparin gtt/Coumadin PO was adjusted
according to results. Prior discharge INR was sub therapeutic
(1.5), patient was discharged in Acute Care Rehab on continuous
Heparin gtt.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, voiding without assistance, and pain was well controlled.
The patient received discharge teaching and follow-up
instructions with understanding verbalized and agreement with
the discharge plan.


Medications on Admission:
warfarin, Toprol Xl 50", HCTZ 12.5', lisinopril 20', omeprazole
20'


Discharge Medications:
1. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
4. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
8. Coumadin 7.5 mg Tablet Sig: One (1) Tablet PO once a day: INR
goal [**12-31**]. Tablet(s)
9. Heparin (Porcine) in D5W 25,000 unit/250 mL Parenteral
Solution Sig: One (1)  Intravenous ASDIR (AS DIRECTED): please
d/c when INR [**12-31**].
10. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain, fever.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
Primary:
1. Colostomy takedown with colorectal anastamosis
2. Ventral hernia, complex.

Secondary:
1. H/O PE/DVT


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.


Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**4-6**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.
Continue to follow with [**Hospital 197**] clinic to check your INR level
per week.
Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 2053**] [**Last Name (NamePattern1) 6751**], MD Phone:[**Telephone/Fax (1) 6742**]
Date/Time:[**2150-7-7**] 12:00 Plastic Surgery Clinic
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD Phone:[**Telephone/Fax (1) 2998**] Date/Time:[**2150-7-15**]
3:30
[**Hospital1 **] [**Location (un) 620**], [**Street Address(2) **], [**Location (un) 620**], [**Numeric Identifier 3002**]
.
Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2150-10-13**] 11:00



Completed by:[**2150-7-1**]
{'Attention to colostomy,Other colostomy and enterostomy complication,Regional enteritis of unspecified site,Other chronic pulmonary heart diseases,Other specified cardiac dysrhythmias,Chronic ulcer of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Above knee amputation status,Aortocoronary bypass status,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block'}


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: 1. Status post sigmoid resection
2. Ventral hernia

PRESENT ILLNESS: This is a 67 yo M with a history of sigmoid resection with
[**Doctor Last Name 3379**] procedure for ischemic colitis in [**2147**]. Patient
presents to [**Hospital1 18**] for a colostomy takedown with colorectal
anastamosis with component separation hernia repair by Drs [**First Name (STitle) **]
and [**Doctor First Name **] The [**Hospital 228**] medical history is significant for
DVT/PEs for
which he is on coumadin (goal INR [**12-31**]), aortobifem bypass, left
AKA, and quadruple vessel CABG. His last dose of coumadin was on
[**2150-6-19**] in preparation for this admission's surgery. He recently
develope two skin ulcers adjacent to his colostomy site for
which he completed a seven day course of cipro yesterday,
Saturday [**6-20**]. Otherwise, he has had no new medical diagnoses or
medication changes in the past 30 days.

MEDICAL HISTORY: HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA

MEDICATION ON ADMISSION: warfarin, Toprol Xl 50", HCTZ 12.5', lisinopril 20', omeprazole
20'

ALLERGIES: Percocet / Adhesive Tape

PHYSICAL EXAM: On Discharge:
VS:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: Midline and bilateral incision with staples c/d/i, JP sites
x 5 with occlusive dressings c/d/i
Ext: Left AKA, right warm, with positive pp

FAMILY HISTORY: -vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia

SOCIAL HISTORY: lives w/ wife, daughter, son-in-law, teenage grandson, and
mother in law
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist 

### Response:
{'Attention to colostomy,Other colostomy and enterostomy complication,Regional enteritis of unspecified site,Other chronic pulmonary heart diseases,Other specified cardiac dysrhythmias,Chronic ulcer of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Above knee amputation status,Aortocoronary bypass status,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block'}
