CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient's history begins in
[**Month (only) 404**], where she had, at an outside hospital, had a
Billroth II procedure for gastric outlet obstruction
suspicious of malignancy, but found to be secondary to benign
polyp and ulcer.  The surgery was complicated by multiple
abdominal abscesses, pancreatic fistulas and likely
pancreatic duct and biliary tree trauma, and she was
transferred to [**Hospital1 69**] on
[**3-6**].

MEDICAL HISTORY: Previous to her surgery in [**Month (only) 404**]
was diverticulosis and peptic ulcer disease with ulcers that
was discovered at her surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other postoperative infection,Septicemia due to pseudomonas,Disseminated candidiasis,Acute kidney failure, unspecified,Acute respiratory failure,Electrolyte and fluid disorders not elsewhere classified
Other postop infection,Pseudomonas septicemia,Disseminated candidiasis,Acute kidney failure NOS,Acute respiratry failure,Electrolyt/fluid dis NEC
Admission Date:  [**2149-3-6**]     Discharge Date:  [**2149-6-22**]

Date of Birth:   [**2094-7-11**]     Sex:  F

Service:  GOLD [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:  The patient's history begins in
[**Month (only) 404**], where she had, at an outside hospital, had a
Billroth II procedure for gastric outlet obstruction
suspicious of malignancy, but found to be secondary to benign
polyp and ulcer.  The surgery was complicated by multiple
abdominal abscesses, pancreatic fistulas and likely
pancreatic duct and biliary tree trauma, and she was
transferred to [**Hospital1 69**] on
[**3-6**].

Her hospital course was extremely long and very complicated.
She had multiple percutaneous drains with VRE and
Pseudomonas, had multiple courses of antibiotics including
Ceftazidine, Flagyl, Ciprofloxacin, Linezolid, Zosyn and
Vancomycin.  She had had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 564**] fungemia treated with a
study drug, Anidulofungin and Ambazone.  The patient was
transferred between a regular patient floor and an Intensive
Care Unit setting several times, given bouts with fungemia,
acute renal failure and hypotension.

She was followed by a variety of subspecialty teams including
the Renal Team, the Infectious Disease Team, the Cardiology
Team, the Surgical Team, the Medical Team, the Intensive Care
Unit Team, and the Hemodialysis Team.

During her hospitalization, she also had bilateral pleural
effusions requiring thoracentesis.  She had respiratory
failure and was intubated.  She also suffered from
supraventricular tachycardia which was thought to be
multi-factorial including fluid shifts, ongoing sepsis,
complications of renal failure and electrolyte disturbances.

The patient, during her hospitalization, had a creatinine of
4.9.  Baseline was 1.0.  She had a pericardial friction rub
secondary and was uremic with a BUN in the 60s, creatinine as
I said, was 4.9, and a variety of electrolyte disturbances.
She had a right groin Quinton catheter placed and underwent
hemodialysis.  She did, however, stabilize from this.  This
actually occurred some time around the middle of [**Month (only) 958**].

The patient had multiple radiologic procedures for drainage
of fluid collections in her abdomen which were both infected,
as well as other fluid collections such as leaking pancreatic
fluid.  She had been maintained on total parenteral
nutrition, as well as some beta blockers and antibiotics as
mentioned earlier.

After three months of broad-spectrum antibiotics and
anti-fungals, some follow-up imaging showed improvement in
her intra-abdominal abscesses, and it was decided after she
had been off antibiotics for about two weeks, that she would
undergo elective reanastomosis of her biliary tree, given
that this was the only definitive management for the problem
that she seemed to be experiencing, mainly that of pancreatic
cutaneous fistulas and common bile duct injury.

So on [**2149-6-17**], the patient underwent a right colectomy,
a gastrojejunostomy revision, Roux-en-Y
cholecystojejunostomy, duodenojejunostomy at fistula site,
placement of two external drains at cholecystojejunostomy and
pancreatic fistula sites, cholecystomy tube placement and at
the end of the case, after receiving seven liters of
Crystalloid, six units of packed cells, with a two liter
estimated blood loss, ventilated and paralyzed, her abdomen
had to be kept open secondary to marked distention and third
spacing with edema.

Postoperatively, in the Intensive Care Unit, the patient was
hypotensive and tachycardic as well as acidemic.  She was
started on maximal pressors, Levophed, Neo-Synephrine,
Pitressin, had PA line and was becoming progressively
oliguric to aneuria for several hours.

She had no improvement of her requirement for maximal pressor
support as well as maximum ventilatory support and was
maintained on a pressure control ventilation.  Subspecialty
teams were consulted including Infectious Disease and Renal
reconsulted.  At that time, it was presumed that she was
having further intra-abdominal sepsis with a septic shock
picture, with elevated filling pressures and high cardiac
index, very low systemic venous resistance.

CDVH was attempted in the postoperative period to try to
improve the sequelae of the septic shock physiology, mainly
to try to improve her electrolyte and acid based disorders.
There was profound third spacing and volume requirements with
no improvement and then very grim prognosis.

On [**6-22**], the family brought up and decided that they would
make this patient comfort measures only and withdraw the
maximal support that she was currently and without
improvement.  This was communicated to the Surgical Team and
covering attending for the weekend, as well as the Chief
Resident.  With the family's permission and wishes, the drips
were turned off and the ventilatory support was minimized,
and the patient expired approximately 30 minutes after this
was undertaken.

The family denied post-mortem examination.

PAST MEDICAL HISTORY:   Previous to her surgery in [**Month (only) 404**]
was diverticulosis and peptic ulcer disease with ulcers that
was discovered at her surgery.

DISCHARGE DIAGNOSES:
1.  Status post Billroth II surgery at outside hospital
complicated by common bile duct ligation and pancreatic
cutaneous fistulas as well as multiple abdominal abscesses.
2.  Status post VRE and Pseudomonas bacteremia.
3.  [**First Name5 (NamePattern1) 564**] [**Last Name (NamePattern1) 10577**] fungemia.
4.  Status post acute renal failure with two weeks of
hemodialysis and normalization of renal function until her
postoperative period in [**6-15**].  Status post multiple bouts of antibiotic and anti-fungal
therapies.
6.  Uremia, resolved.
7.  Profound septic shock, pleural effusion.
8.  On [**6-17**], status post:  1) Right colectomy.
9.  On [**6-17**], status post gastrojejunostomy revision.
10. On [**6-17**], Roux-en-Y cholecystojejunostomy.
11. On [**6-17**], duodenojejunostomy at fistula site.
12. On [**6-17**], placement of cholecystotomy tube and suction
drains inter-abdominally.

ALLERGIES:   The patient had no known drug allergies.

CONDITION AT DISCHARGE:   The patient expired on [**6-22**], at
12:15 p.m.  The family was present.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1306**], M.D.  [**MD Number(1) 1307**]

Dictated By:[**Last Name (NamePattern1) 8344**]

MEDQUIST36

D:  [**2149-6-22**]  13:52
T:  [**2149-6-23**]  11:07
JOB#:  [**Job Number 38765**]
{'Other postoperative infection,Septicemia due to pseudomonas,Disseminated candidiasis,Acute kidney failure, unspecified,Acute respiratory failure,Electrolyte and fluid disorders not elsewhere classified'}


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: 

PRESENT ILLNESS: The patient's history begins in
[**Month (only) 404**], where she had, at an outside hospital, had a
Billroth II procedure for gastric outlet obstruction
suspicious of malignancy, but found to be secondary to benign
polyp and ulcer.  The surgery was complicated by multiple
abdominal abscesses, pancreatic fistulas and likely
pancreatic duct and biliary tree trauma, and she was
transferred to [**Hospital1 69**] on
[**3-6**].

MEDICAL HISTORY: Previous to her surgery in [**Month (only) 404**]
was diverticulosis and peptic ulcer disease with ulcers that
was discovered at her surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other postoperative infection,Septicemia due to pseudomonas,Disseminated candidiasis,Acute kidney failure, unspecified,Acute respiratory failure,Electrolyte and fluid disorders not elsewhere classified'}
