CHIEF COMPLAINT: Abdominal pain.

PRESENT ILLNESS: The patient is a 47-year-old female with end
stage renal disease on hemodialysis, status post epigastric
ventral hernia repair in the distant past, who was noted
recurrence of the ventral hernia but without any symptoms.
The day PTA, during hemodialysis, she developed abdominal
discomfort and nausea, and thereafter, severe pain at the
side of the recurrent epigastric ventral hernia. She came to
the emergency room where a CT scan of the abdomen revealed a
small omental fat- containing ventral hernia above the
umbilicus with mild adjacent inflammatory fat stranding.
Adjacent to this region, there were multiple prominent loops
of small bowel with fecalization of bowel contents and
surrounding inflammatory fat stranding and fluid locally. The
loops of bowel distal to these prominent loops appeared
decompressed and the findings were suggestive of a recent
reduction of an incarcerated hernia with high grade
obstruction. She now presents for exploratory laparotomy.

MEDICAL HISTORY: 1. Significant for end-stage renal disease secondary to
glomerulonephritis possibly secondary to IgA diagnosed in
[**2165**], and the patient has been on hemodialysis since [**2170**].
She is anuric and is on Monday, Wednesday, and Friday
dialysis schedule.
2. The patient has had bilateral below-the-knee amputations
secondary to calciphylaxis in [**2181-1-19**] as well as
multiple finger amputations during the same year.
3. She is status post a parathyroidectomy for previous
admissions for hypercalcemia.
4. The patient is status post a left arteriovenous fistula on
her left upper extremity placed in [**2179**], which became
injured during a fistulogram in [**2183-3-22**].
5. She has chronic pain.
6. She is status post a mitral valve replacement in [**2180-3-21**] with a mechanical Carbomedics 29-mm valve for
rheumatic heart disease; and she is on Coumadin for this
valve. She also has a history of endocarditis.
7. History of hypertension.
8. Anxiety.

MEDICATION ON ADMISSION: xanax
MS [**First Name (Titles) **]
[**Last Name (Titles) **]
protonix
fentanyl
levoxyl
dilaudid
coumadin

ALLERGIES: Penicillins / Acetaminophen / Ultram / Oxycontin / Zantac /
Levofloxacin

PHYSICAL EXAM: On admission:
99.8   100   90/49   19
A&Ox3 in obvious pain
MMM, w/o JVD
RRR, tachy, no murmur
CTAB
soft +BS, epigastric TTP, voluntary gaurding, non-distended, no
rebound
guaiac negative
s/p bilat BKA

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient smokes one-third of a pack per
day. She denies any EtOH and is disabled.
Acute vascular insufficiency of intestine,Incisional ventral hernia with obstruction,End stage renal disease,Sedative, hypnotic or anxiolytic dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Below knee amputation status,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Long-term (current) use of anticoagulants,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Other finger(s) amputation status,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Anemia in chronic kidney disease
Ac vasc insuff intestine,Obstr incisional hernia,End stage renal disease,Sed,hyp,anxiolyt dep-con,Peritoneal adhesions,Status amput below knee,Nephritis NOS,Long-term use anticoagul,Rheumatic heart dis NOS,Heart valve replac NEC,Status amput oth fingers,Hypertension NOS,Anxiety state NOS,Tobacco use disorder,Anemia in chr kidney dis
Admission Date:  [**2184-9-9**]              Discharge Date:   [**2184-9-19**]

Date of Birth:  [**2137-5-6**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins / Acetaminophen / Ultram / Oxycontin / Zantac /
Levofloxacin

Attending:[**Last Name (NamePattern1) 15344**]
Chief Complaint:
Abdominal pain.

Major Surgical or Invasive Procedure:
Exploratory laparotomy, lysis of adhesions,
small bowel resection, primary repair of recurrent ventral
hernia, placement of left femoral vein triple lumen central
venous line, placement of PICC.


History of Present Illness:
The patient is a 47-year-old female with end
stage renal disease on hemodialysis, status post epigastric
ventral hernia repair in the distant past, who was noted
recurrence of the ventral hernia but without any symptoms.
The day PTA, during hemodialysis, she developed abdominal
discomfort and nausea, and thereafter, severe pain at the
side of the recurrent epigastric ventral hernia. She came to
the emergency room where a CT scan of the abdomen revealed a
small omental fat- containing ventral hernia above the
umbilicus with mild adjacent inflammatory fat stranding.
Adjacent to this region, there were multiple prominent loops
of small bowel with fecalization of bowel contents and
surrounding inflammatory fat stranding and fluid locally. The
loops of bowel distal to these prominent loops appeared
decompressed and the findings were suggestive of a recent
reduction of an incarcerated hernia with high grade
obstruction. She now presents for exploratory laparotomy.


Past Medical History:
1. Significant for end-stage renal disease secondary to
glomerulonephritis possibly secondary to IgA diagnosed in
[**2165**], and the patient has been on hemodialysis since [**2170**].
She is anuric and is on Monday, Wednesday, and Friday
dialysis schedule.
2. The patient has had bilateral below-the-knee amputations
secondary to calciphylaxis in [**2181-1-19**] as well as
multiple finger amputations during the same year.
3. She is status post a parathyroidectomy for previous
admissions for hypercalcemia.
4. The patient is status post a left arteriovenous fistula on
her left upper extremity placed in [**2179**], which became
injured during a fistulogram in [**2183-3-22**].
5. She has chronic pain.
6. She is status post a mitral valve replacement in [**2180-3-21**] with a mechanical Carbomedics 29-mm valve for
rheumatic heart disease; and she is on Coumadin for this
valve. She also has a history of endocarditis.
7. History of hypertension.
8. Anxiety.

Social History:
The patient smokes one-third of a pack per
day. She denies any EtOH and is disabled.


Family History:
Non-contributory

Physical Exam:
On admission:
99.8   100   90/49   19
A&Ox3 in obvious pain
MMM, w/o JVD
RRR, tachy, no murmur
CTAB
soft +BS, epigastric TTP, voluntary gaurding, non-distended, no
rebound
guaiac negative
s/p bilat BKA

Pertinent Results:
[**2184-9-17**] 01:10PM BLOOD WBC-4.6 RBC-3.30* Hgb-9.9*# Hct-28.9*
MCV-88 MCH-30.0# MCHC-34.2# RDW-18.4* Plt Ct-176
[**2184-9-15**] 06:05AM BLOOD WBC-6.3 RBC-2.66* Hgb-7.2* Hct-23.1*
MCV-87 MCH-26.9* MCHC-31.0 RDW-18.5* Plt Ct-148*
[**2184-9-14**] 06:48AM BLOOD WBC-5.6 RBC-2.72* Hgb-7.4* Hct-23.9*
MCV-88 MCH-27.1 MCHC-30.8* RDW-18.0* Plt Ct-142*
[**2184-9-13**] 08:10AM BLOOD WBC-6.2 RBC-2.69* Hgb-7.5* Hct-23.8*
MCV-89 MCH-27.8 MCHC-31.3 RDW-18.3* Plt Ct-146*
[**2184-9-13**] 05:39AM BLOOD WBC-5.9 RBC-2.73* Hgb-7.5* Hct-24.5*
MCV-90 MCH-27.4 MCHC-30.6* RDW-18.1* Plt Ct-135*
[**2184-9-12**] 06:15AM BLOOD WBC-6.9 RBC-2.99* Hgb-8.5* Hct-26.8*
MCV-90 MCH-28.6 MCHC-31.9 RDW-17.9* Plt Ct-127*
[**2184-9-11**] 03:03AM BLOOD WBC-7.2 RBC-3.17* Hgb-8.9* Hct-27.5*
MCV-87 MCH-28.2 MCHC-32.4 RDW-17.9* Plt Ct-120*
[**2184-9-10**] 07:43PM BLOOD Hct-30.2*
[**2184-9-10**] 03:08AM BLOOD WBC-12.5* RBC-3.66* Hgb-10.1* Hct-31.1*
MCV-85 MCH-27.6 MCHC-32.6 RDW-18.1* Plt Ct-118*
[**2184-9-9**] 02:15PM BLOOD WBC-16.1* RBC-3.51* Hgb-9.7* Hct-29.0*
MCV-83 MCH-27.7 MCHC-33.6 RDW-18.2* Plt Ct-114*
[**2184-9-9**] 08:00AM BLOOD WBC-15.9* RBC-3.61*# Hgb-10.0*#
Hct-31.1*# MCV-86 MCH-27.7 MCHC-32.2 RDW-18.6* Plt Ct-107*
[**2184-9-8**] 09:40PM BLOOD WBC-11.5*# RBC-5.47* Hgb-15.5 Hct-46.2
MCV-84 MCH-28.3 MCHC-33.5 RDW-17.9* Plt Ct-138*
[**2184-9-17**] 09:30AM BLOOD PT-23.8* PTT-49.4* INR(PT)-4.1
[**2184-9-16**] 05:40AM BLOOD PT-24.5* PTT-59.0* INR(PT)-4.4
[**2184-9-15**] 09:12PM BLOOD PT-23.6* PTT-48.0* INR(PT)-4.0
[**2184-9-15**] 06:05AM BLOOD PT-27.4* PTT-56.0* INR(PT)-5.5
[**2184-9-14**] 06:48AM BLOOD PT-24.3* PTT-54.4* INR(PT)-4.3
[**2184-9-13**] 08:55PM BLOOD PT-23.1* PTT-50.8* INR(PT)-3.9
[**2184-9-13**] 05:39AM BLOOD PT-22.9* PTT-104.3* INR(PT)-3.8
[**2184-9-12**] 06:15AM BLOOD PT-18.0* PTT-58.2* INR(PT)-2.3
[**2184-9-11**] 03:03AM BLOOD PT-16.8* PTT-56.5* INR(PT)-1.9
[**2184-9-8**] 07:00AM BLOOD PT-18.9* INR(PT)-2.5
[**2184-9-16**] 05:40AM BLOOD Glucose-68* UreaN-22* Creat-5.0*# Na-141
K-3.4 Cl-96 HCO3-28 AnGap-20
[**2184-9-15**] 06:05AM BLOOD Glucose-68* UreaN-43* Creat-7.3*# Na-141
K-3.7 Cl-102 HCO3-23 AnGap-20
[**2184-9-14**] 06:48AM BLOOD Glucose-86 UreaN-35* Creat-6.0*# Na-144
K-4.0 Cl-102 HCO3-25 AnGap-21*
[**2184-9-12**] 06:15AM BLOOD Glucose-70 UreaN-45* Creat-6.6*# Na-144
K-4.3 Cl-100 HCO3-24 AnGap-24*
[**2184-9-11**] 03:03AM BLOOD Glucose-92 UreaN-32* Creat-5.3*# Na-143
K-4.4 Cl-102 HCO3-24 AnGap-21*
[**2184-9-10**] 03:08AM BLOOD Glucose-74 UreaN-46* Creat-6.7* Na-139
K-4.5 Cl-98 HCO3-22 AnGap-24*
[**2184-9-9**] 02:15PM BLOOD Glucose-89 UreaN-37* Creat-5.9* Na-140
K-4.6 Cl-99 HCO3-25 AnGap-21*
[**2184-9-9**] 08:00AM BLOOD Glucose-141* UreaN-33* Creat-5.5* Na-141
K-4.2 Cl-100 HCO3-25 AnGap-20
[**2184-9-8**] 11:20PM BLOOD Glucose-142* UreaN-28* Creat-5.7* Na-141
K-4.5 Cl-94* HCO3-27 AnGap-25*
[**2184-9-8**] 09:40PM BLOOD Glucose-119* UreaN-25* Creat-5.7*# Na-139
K-4.7 Cl-90* HCO3-30 AnGap-24*
[**2184-9-8**] 09:40PM BLOOD ALT-66* AST-41* AlkPhos-468* Amylase-415*
TotBili-0.5
[**2184-9-16**] 05:40AM BLOOD Calcium-8.6 Phos-3.8 Mg-1.4*
[**2184-9-15**] 06:05AM BLOOD Calcium-8.3* Phos-4.4 Mg-1.5*
[**2184-9-14**] 06:48AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.7
[**2184-9-13**] 08:10AM BLOOD Albumin-3.0* Calcium-8.7 Phos-5.8* Mg-1.7
UricAcd-6.7*
[**2184-9-12**] 06:15AM BLOOD Calcium-8.9 Phos-5.2* Mg-1.7
[**2184-9-11**] 03:03AM BLOOD Calcium-9.3 Phos-5.1* Mg-1.9
[**2184-9-10**] 03:08AM BLOOD Calcium-8.4 Phos-5.2* Mg-1.5*
[**2184-9-9**] 02:15PM BLOOD Calcium-8.3* Phos-4.5 Mg-1.5*
[**2184-9-9**] 08:00AM BLOOD Calcium-8.3* Phos-4.3 Mg-1.5*
[**2184-9-8**] 09:40PM BLOOD Albumin-4.9* Calcium-10.0 Phos-4.8*
Mg-1.8
[**2184-9-10**] 11:25AM BLOOD freeCa-1.14
[**2184-9-9**] 02:22PM BLOOD freeCa-1.15
[**2184-9-9**] 06:33AM BLOOD freeCa-1.04*
[**2184-9-9**] 05:23AM BLOOD freeCa-1.04*

Brief Hospital Course:
Pt admitted to surgery from the ED.

Ct showed:
1. Prominent loops of proximal small bowel adjacent to an
omental fat containing ventral hernia with fecalization of bowel
contents, adjacent inflammatory fat stranding, and small amount
of fluid and extraluminal air consistent with bowel ischemia and
contained perforation. There also is apparent caliber change
just below the level of the ventral hernia within the small
bowel loops, as the distal loops of small bowel are markedly
collapsed. All these findings are suggestive of interval
reduction of an incarcerated hernia with high-grade bowel
obstruction. At this time, no bowel loops are demonstrated
within the ventral hernia.
2. Patent mesenteric vessels.
3. 2, low-density lesions within the spleen, likely representing
hemangiomas.
4. Stable appearance of simple hepatic cyst within the dome of
the liver.
5. Diffuse increase in density of the osseous structures
consistent with renal osteodystrophy.
6. Collateral vessels within the right lateral chest wall. These
findings are suggestive of a right subclavian vein stenosis.
Clinical correlation is recommended.

Pt taken to the OR for operation.  Taken to the ICU intubated.
Renal consulted for HD and recs.  Pt extubated on POD1.  Renal
was consulted for continuation of her hemodialysis, which went
on with out complication.  She was kept NPO until bowel function
resumed on POD 3, She transferred out of the ICU once extubated
on POD 1.  She was kept on heparin gtt due to her need for
anti-coagulation.  Once she had resumed POs, coumadin was
started, and she was brought up to her normal coagulation level
of 2.5-3.  She will follow up in the coumadin clinic and
hemodialysis for follwing her INR.  Through the remained of her
postoperative course, she was advnced through sips, to clears,
fulls, then to a regular diet which she tolerated well.  By POD
10, she was tolerating regular diet, having bowel movements and
her coumadin was theraputic.  She was d/c'ed home.

Medications on Admission:
xanax
MS [**First Name (Titles) **]
[**Last Name (Titles) **]
protonix
fentanyl
levoxyl
dilaudid
coumadin

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
3. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
4. Levothyroxine Sodium 25 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO daily ().
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
7. Fentanyl 75 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).


Discharge Disposition:
Home

Discharge Diagnosis:
Recurrent ventral hernia with small
bowel obstruction and compromised bowel.
Chronic renal failure


Discharge Condition:
good

Discharge Instructions:
You may resume your home medications, please take all new
medications as prescribed.

You may resume your regular activities.  You may shower, pat the
wound dry.  Do not soak the wound for one week.  The staples
will be removed at your follow up appointment.  Please refrain
from driving while taking narcotic pain medication.

Please call your physician or return to the hoptial if you
experience:
- Increasing pain
- Fever (>101.5)
- Inability to eat/persistant vomiting
- Other symptoms concerning to you

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **].  Call ([**Telephone/Fax (1) 10820**] to make
an appointment.


Completed by:[**2184-9-19**]
{'Acute vascular insufficiency of intestine,Incisional ventral hernia with obstruction,End stage renal disease,Sedative, hypnotic or anxiolytic dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Below knee amputation status,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Long-term (current) use of anticoagulants,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Other finger(s) amputation status,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Anemia in chronic kidney disease'}


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.

PRESENT ILLNESS: The patient is a 47-year-old female with end
stage renal disease on hemodialysis, status post epigastric
ventral hernia repair in the distant past, who was noted
recurrence of the ventral hernia but without any symptoms.
The day PTA, during hemodialysis, she developed abdominal
discomfort and nausea, and thereafter, severe pain at the
side of the recurrent epigastric ventral hernia. She came to
the emergency room where a CT scan of the abdomen revealed a
small omental fat- containing ventral hernia above the
umbilicus with mild adjacent inflammatory fat stranding.
Adjacent to this region, there were multiple prominent loops
of small bowel with fecalization of bowel contents and
surrounding inflammatory fat stranding and fluid locally. The
loops of bowel distal to these prominent loops appeared
decompressed and the findings were suggestive of a recent
reduction of an incarcerated hernia with high grade
obstruction. She now presents for exploratory laparotomy.

MEDICAL HISTORY: 1. Significant for end-stage renal disease secondary to
glomerulonephritis possibly secondary to IgA diagnosed in
[**2165**], and the patient has been on hemodialysis since [**2170**].
She is anuric and is on Monday, Wednesday, and Friday
dialysis schedule.
2. The patient has had bilateral below-the-knee amputations
secondary to calciphylaxis in [**2181-1-19**] as well as
multiple finger amputations during the same year.
3. She is status post a parathyroidectomy for previous
admissions for hypercalcemia.
4. The patient is status post a left arteriovenous fistula on
her left upper extremity placed in [**2179**], which became
injured during a fistulogram in [**2183-3-22**].
5. She has chronic pain.
6. She is status post a mitral valve replacement in [**2180-3-21**] with a mechanical Carbomedics 29-mm valve for
rheumatic heart disease; and she is on Coumadin for this
valve. She also has a history of endocarditis.
7. History of hypertension.
8. Anxiety.

MEDICATION ON ADMISSION: xanax
MS [**First Name (Titles) **]
[**Last Name (Titles) **]
protonix
fentanyl
levoxyl
dilaudid
coumadin

ALLERGIES: Penicillins / Acetaminophen / Ultram / Oxycontin / Zantac /
Levofloxacin

PHYSICAL EXAM: On admission:
99.8   100   90/49   19
A&Ox3 in obvious pain
MMM, w/o JVD
RRR, tachy, no murmur
CTAB
soft +BS, epigastric TTP, voluntary gaurding, non-distended, no
rebound
guaiac negative
s/p bilat BKA

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient smokes one-third of a pack per
day. She denies any EtOH and is disabled. 

### Response:
{'Acute vascular insufficiency of intestine,Incisional ventral hernia with obstruction,End stage renal disease,Sedative, hypnotic or anxiolytic dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Below knee amputation status,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Long-term (current) use of anticoagulants,Rheumatic heart disease, unspecified,Heart valve replaced by other means,Other finger(s) amputation status,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Anemia in chronic kidney disease'}
