CHIEF COMPLAINT: Epigastric/RUQ pain

PRESENT ILLNESS: 81M with MMP and hx of recurrent cholecystitis who presents
[**2157-3-16**] with a one day history of RUQ/epigastric pain

MEDICAL HISTORY: PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-3**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-7**].
Afib/flutter s/p Ablation [**11-5**], EPS [**11-7**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-8**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-7**]+MR. [**Name14 (STitle) **] w/ reversible defect

MEDICATION ON ADMISSION: Amiodarone 200'; ASA 81'; Flomax 0.4'; Lasix 20'; Hydralizine
25'; Isosorbide 30'; Levoxyl 50mcg'; Lipitor 80'; Lopressor
25''; Plavix 75'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam- [**2157-3-16**]
97.1  51  148/44  18  98%RA

FAMILY HISTORY: NC

SOCIAL HISTORY: Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits.
Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency,Hemorrhage complicating a procedure,Chronic kidney disease, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Other specified disorders of gallbladder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Old myocardial infarction,Personal history of other diseases of circulatory system,Legal blindness, as defined in U.S.A.,Unspecified hearing loss
Gal&bil cal w/ac&ch w ob,Cirrhosis of liver NOS,Acq coagul factor defic,Hemorrhage complic proc,Chronic kidney dis NOS,Pleural effusion NOS,Urin tract infection NOS,Atrial fibrillation,CHF NOS,Lap surg convert to open,Dis of gallbladder NEC,DMII wo cmp nt st uncntr,Proteus infection NOS,Old myocardial infarct,Hx-circulatory dis NEC,Legal blindness-usa def,Hearing loss NOS
Admission Date:  [**2157-3-16**]              Discharge Date:   [**2157-4-18**]

Date of Birth:  [**2075-5-3**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 5188**]
Chief Complaint:
Epigastric/RUQ pain

Major Surgical or Invasive Procedure:
Laparoscopic converted to open
cholecystectomy plus liver biopsy

History of Present Illness:
81M with MMP and hx of recurrent cholecystitis who presents
[**2157-3-16**] with a one day history of RUQ/epigastric pain

Past Medical History:
PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-3**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-7**].
Afib/flutter s/p Ablation [**11-5**], EPS [**11-7**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-8**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-7**]+MR. [**Name14 (STitle) **] w/ reversible defect

PSH:
[**2142**] R Fem [**Doctor Last Name **] in situ
[**2147**] L Fem [**Doctor Last Name **] in situ
[**2150**] vein angioplasty L Fem artery


Social History:
Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits.


Family History:
NC

Physical Exam:
Admission Physical Exam- [**2157-3-16**]
97.1  51  148/44  18  98%RA

HEENT: sleep, arousable, AAOx2, anicteric, mm dry, no JVD
Car: reg S1S2, brady, II/VI SEM
Resp: Decreased BS w/ occ rhonchi
Abd: soft, ND, not specifically tender over the the aneurysm
site, +RUQ tender + distented GB; no hernia
Ext: 1+ ext edema, col, dry,, +cap refill [**2-6**] sec
Rectal: guaiac (-)

Brief Hospital Course:
[**Known firstname 122**] [**Known lastname 100582**] was evaluated in the emergency department on
[**2157-3-16**]. WBC count was 12.0;Amylase 169; Lipase 89; Alk Phos
150.  AST/ALT/T.Bili were WNL. RUQ ultrasound showed moderately
distended and mildly edematous thickened gallbladder wall,
shadowing gallstones, not overtly changed in appearance since
[**2157-1-6**].  He was admitted to the surgery service under the
care of Dr. [**Last Name (STitle) 5182**]. He was made NPO. Levofloxacin/Flagyl
were given for empiric coverage. Plavix was stopped. At HD 3 he
was afebrile and his pain was improved. Amylase/Lipase/Alk phos
were 81/28/137. WBC count was elevated at 16.9.  He remained NPO
and on IV antibiotics. AT HD 5 the diet was advanced. At HD 6
his LFTs were trending up.  He was made NPO. ERCP was completed
on HD 7 which showed an open previous spinchterotomy with bile
drainage into the duodenum.  A balloon was passed to clear
sludge from the common duct.  He tolerated the procedure well
and was returned to the floor after recovery. At HD 8 he had an
episode of ? aspiration with medications. A CXR was performed
which showed a small right pleural effusion and consolidation at
the medial aspect of the right lung base. His O2 sats were
maintained without distress with NC oxygen with no sequelae. At
HD 9 he was tolerating a regular diet. LFTs were trending down.
Operative date was planned for the following week. At HD 11 he
was tolerating a diet and denied pain. He was found to have UTI
with psotive UCx for Proteus. [**Last Name (un) **] was consulted for blood
glucose control and Lantus was added to his sliding scale. At HD
16 he was taken to the operating room where he underwent a
laparoscopic converted to open cholecystectomy. He was found to
have liver cirrhosis despite only a mildly elevated alk phos
preoperatively at 129.  AST/ALT/Bili were WNP. There was a
moderate amount of bleeding from the liver bed r/t to the
cirrhosis with a loss of approximately 1200ml. A liver biopsy
was obtained. He tolerated the procedure and was taken to the
ICU intubated and sedated. At POD 1 he was on Levophed to
maintain pressure. Urine output was low. Hct was 25.4. At POD 2
he failed to extubate and was reintubated.  Urine output was
marginally improved.  At POD 4 cardiac enzymes were cycled for
new BBB with (+) elevation of troponin. Cardiology was
consulted. He was transfused for a Hct of 22.7. He was afebrile
and hemodynamically stable off pressors. Urine output was WNL.
He was draining a moderate amount of ascitic fluid from JP
drain. TPN was started. Neurology was consulted on [**2157-4-9**] for an
episode of bradycardia and desaturation. They did not find any
focal problems. [**Name (NI) 6**] MRI was done. The patient contunied to
progress well. On [**2157-4-14**] a video swallow was done. The patient
was placed on a thin liquids and ground diet. His drain was
removed. The patient was transferred to the floor. On [**2157-4-18**]
the patient was discharged to rehab in stable condition

Medications on Admission:
Amiodarone 200'; ASA 81'; Flomax 0.4'; Lasix 20'; Hydralizine
25'; Isosorbide 30'; Levoxyl 50mcg'; Lipitor 80'; Lopressor
25''; Plavix 75'

Discharge Medications:
1. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
Inhalation Q4H (every 4 hours) as needed.
Disp:*qs qs* Refills:*0*
2. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*0*
4. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
Disp:*30 Tablet(s)* Refills:*0*
7. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
acute calculous cholecystitis


Discharge Condition:
stable


Discharge Instructions:
If you have fever>101.4, nausea, vomitting, increased abdominal
pain or any other concerns please call you doctor.
Please take medications as prescribed. We are discontinuing your
lasix.


Followup Instructions:
Please call Dr[**Name (NI) 6045**] office for a follow up appointment
([**Telephone/Fax (1) 15350**]


                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]

Completed by:[**2157-4-18**]
{'Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency,Hemorrhage complicating a procedure,Chronic kidney disease, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Other specified disorders of gallbladder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Old myocardial infarction,Personal history of other diseases of circulatory system,Legal blindness, as defined in U.S.A.,Unspecified hearing loss'}


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: Epigastric/RUQ pain

PRESENT ILLNESS: 81M with MMP and hx of recurrent cholecystitis who presents
[**2157-3-16**] with a one day history of RUQ/epigastric pain

MEDICAL HISTORY: PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-3**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-7**].
Afib/flutter s/p Ablation [**11-5**], EPS [**11-7**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-8**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-7**]+MR. [**Name14 (STitle) **] w/ reversible defect

MEDICATION ON ADMISSION: Amiodarone 200'; ASA 81'; Flomax 0.4'; Lasix 20'; Hydralizine
25'; Isosorbide 30'; Levoxyl 50mcg'; Lipitor 80'; Lopressor
25''; Plavix 75'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam- [**2157-3-16**]
97.1  51  148/44  18  98%RA

FAMILY HISTORY: NC

SOCIAL HISTORY: Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits. 

### Response:
{'Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency,Hemorrhage complicating a procedure,Chronic kidney disease, unspecified,Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Other specified disorders of gallbladder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Old myocardial infarction,Personal history of other diseases of circulatory system,Legal blindness, as defined in U.S.A.,Unspecified hearing loss'}
