CHIEF COMPLAINT: Right back and abdominal pain

PRESENT ILLNESS: Ms [**Known lastname 63724**] is a 17y/o G2P0 at 24+6 weeks gestation with [**Last Name (un) **]
[**2164-10-20**]. She presents to triage with right lower back pain that
began this morning. She reports diffuse abdominal pain since
Sunday. She describes her pain as constant and sharp. She
reports some nausea with one episode of vomiting today. She has
been tolerating po's, although she's had a decreased appetite.
She denies any dysuria, diarrhea, vaginal bleeding, leaking of
fluid, sick contacts, fever/chills, contractions. Active fetal
movement.

MEDICAL HISTORY: PRENATAL COURSE:
(1)Dating: [**Last Name (un) **] [**2164-10-2**]
(2)Labs: O+/Ab-,RPRnr,RI
(3)nl FFS
(4)Proteus UTI treated [**4-7**]

MEDICATION ON ADMISSION: Flintstones MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.7, HR 90, BP 115/46, RR 24
GENERAL: NAD
HEART: RRR
LUNGS: CTAB
No flank tenderness, no spine tenderness
ABDOMEN: gravid, soft, NTND, normal BS
PELVIC: no CMT, L/C/P
EXTREMITIES: NT,NE
FHR: 140 AGA
TOCO: No ctxs
TAUS: BPP AGA, posterior placenta

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies tobacco/etoh/drugs
Teen pregnancy - parents and boyfriend supportive
Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Calculus of ureter,Hydronephrosis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Acute respiratory failure,Thrombocytopenia, unspecified,Acute kidney failure with lesion of tubular necrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Threatened premature labor, antepartum condition or complication,Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified,Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site
Oth curr cond-antepartum,Calculus of ureter,Hydronephrosis,Urin tract infection NOS,Pneumonia, organism NOS,Acute respiratry failure,Thrombocytopenia NOS,Ac kidny fail, tubr necr,Gu infection-antepartum,Thrt prem labor-antepart,Coagulation def-antepart,Anemia NOS,Hypertens NOS-antepartum,Proteus infection NOS
Admission Date:  [**2164-6-20**]              Discharge Date:   [**2164-7-3**]

Date of Birth:  [**2147-6-22**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 60240**]
Chief Complaint:
Right back and abdominal pain

Major Surgical or Invasive Procedure:
Attempted nephrostomy tube placement, ureteral stent placement,
transfusion

History of Present Illness:
Ms [**Known lastname 63724**] is a 17y/o G2P0 at 24+6 weeks gestation with [**Last Name (un) **]
[**2164-10-20**]. She presents to triage with right lower back pain that
began this morning. She reports diffuse abdominal pain since
Sunday. She describes her pain as constant and sharp. She
reports some nausea with one episode of vomiting today. She has
been tolerating po's, although she's had a decreased appetite.
She denies any dysuria, diarrhea, vaginal bleeding, leaking of
fluid, sick contacts, fever/chills, contractions. Active fetal
movement.

Past Medical History:
PRENATAL COURSE:
(1)Dating: [**Last Name (un) **] [**2164-10-2**]
(2)Labs: O+/Ab-,RPRnr,RI
(3)nl FFS
(4)Proteus UTI treated [**4-7**]

PAST OBSTETRIC HISTORY
-TAB x 1

PAST GYNECOLOGIC HISTORY
-benign

PAST MEDICAL HISTORY
-none

PAST SURGICAL HISTORY
-none

Social History:
Denies tobacco/etoh/drugs
Teen pregnancy - parents and boyfriend supportive

Family History:
N/C

Physical Exam:
Temp 98.7, HR 90, BP 115/46, RR 24
GENERAL: NAD
HEART: RRR
LUNGS: CTAB
No flank tenderness, no spine tenderness
ABDOMEN: gravid, soft, NTND, normal BS
PELVIC: no CMT, L/C/P
EXTREMITIES: NT,NE
FHR: 140 AGA
TOCO: No ctxs
TAUS: BPP AGA, posterior placenta

Pertinent Results:
[**2164-6-19**] CREAT-0.8
[**2164-6-20**] GLUCOSE-81 UREA N-11 CREAT-0.8 SODIUM-139 POTASSIUM-3.8
CHLORIDE-101 TOTAL CO2-25 ANION GAP-17
[**2164-6-20**] ALT(SGPT)-8 AST(SGOT)-17 ALK PHOS-55 AMYLASE-76
[**2164-6-20**] LIPASE-27
.
[**2164-6-19**] URINE BLOOD-SM  NITRITE-NEG PROTEIN-TR GLUCOSE-NEG
KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-TR
[**2164-6-19**] URINE  RBC-17 WBC-6 BACTERIA-RARE YEAST-NONE EPI-<1
[**2164-6-19**] WBC-11.3 RBC-3.44 HGB-11.3 HCT-32.6 MCV-95
[**2164-6-19**] NEUTS-86.9 BANDS-0 LYMPHS-10.2 MONOS-2.6 EOS-0.1
BASOS-0.1
.
[**6-20**] RENAL ULTRASOUND: The right kidney measures 10.4 cm. The
left kidney measures 12.0 cm. No mass or stone is identified in
either kidney. There is mild right hydronephrosis.
.
[**6-20**] MRI w/ contrast:
IMPRESSION:
1. Right-sided hydronephrosis and right ureteral obstructing
stone with small amount of perinephric fluid. Results were
discussed with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at 12:15 p.m. on [**2164-6-20**].
2. Normal appendix.
.
[**6-23**]  CTA:
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Multiple airspace opacities in the left lung, more nodular in
the left upper lobe and confluent at the left base - this likely
represents multifocal pneumonia with a possible element of
aspiration at the left lung base. There is also a small
associated left pleural effusion.
.
[**6-25**] ECHO:
Conclusions:
The left atrium is mildly dilated. Left ventricular wall
thickness, cavity size, and systolic function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. No masses or
vegetations are seen on the aortic valve. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no mitral valve prolapse. No mass or vegetation is seen
on the mitral valve. There is borderline pulmonary artery
systolic hypertension. There is a small pericardial effusion.
There are no echocardiographic signs of tamponade.

IMPRESSION: Normal biventricular systolic function. No valvular
vegetations seen.

Brief Hospital Course:
17 G2P0 24+6, presented to OB triage [**6-19**] with right lower back
and abdominal pain, nausea/vomiting. She was afebrile, with no
CVA or abdominal tenderness. Her UA was notable for 17 RBC,
trace leuks, rare bacteria. Her pain resolved with Tylenol, and
she was discharged home with Macrobid and PO pain meds.
.
On [**6-20**], she returned with worsening pain, nausea/vomiting, with
mild RLQ tenderness on exam. A pelvic ultrasound was obtained,
which showed mild right hydronephrosis, normal ovaries. An MRI
with contrast was ordered to rule out appendicitis; a normal
appendix was seen, but there was noted to be right-sided
hydronephrosis and a  right ureteral obstructing stone, with a
small amount of perinephric fluid. The patient was initially
afebrile, but her temperature increased to 100.2 and she was
started on IV Kefzol [**6-20**]. [**6-21**], she spiked to 103.8, and
Gentamicin was added. Her Ucx from [**6-19**] was positive for
pan-sensitive Proteus.
.
On [**6-23**], the patient desaturated to 91% on RA, 98-99% on 2LNC. A
CTA showed no evidence of PE, but there were multiple airspace
opacities in the consistent with multifocal pneumonia, with a
possible element of aspiration at the left lung base; there was
also a small associated left pleural effusion. Her antibiotics
were changed to IV Vanco/Zosyn/Azithromycin for coverage of both
pneumonia and proteus.
.
On [**6-24**], IR attempted unsuccessfully to place a percutaneous
nephrostomy tube. A right ureteral stent was placed by urology
the same day. Prior to the procedure, she had a cervical exam
was revealed a long, closed, and posterior cervix. Ultrasound
revealed a vertex fetus with BPP [**8-8**], AFI 13, EFW 878g(50%). She
was contracting irregularly and was treated with indomethacin
for 48 hours for tocolysis due to her increased risk of preterm
labor. Per anesthesia, she desaturated to the 60s when
attempting bag ventilations, and she was taken to the ICU for
further management of her hypoxemic respiratory failure and
urosepsis.
.
PLEASE SEE SEPARATE DICTATION FOR ICU COURSE.
.
Briefly, she was transfused with 2 units of PRBCs for a
hematocrit of 22.9. A TTE was negative. On [**6-25**], a renal
ultrasound revealed no evidence of hydronephrosis, stones, or
mass. The stent was observed in the right renal pelvis. No
perinephric hematoma. There was no indication to remove the
stone with the stent in place and the repeat US showed no
hydronephrosis. She developed acute renal failure which was
thought to be due to hypoperfusion injury per the renal team.
She was aggressively hydrated and her renal failure resolved.
She also developed new onset hypertension, briefly requiring IV
labetolol, which quickly resolved and the labetolol was
discontinued due to hypotension. Preeclampsia labs were normal,
although she had thrombocytopenia with platelets ranging from
99-111, which were stable and eventually climbed back up to the
200s. She remained intubated for 4 days and she was slowly
weaned down. She developed frothy pink sputum suggestive of
ARDS, sputum gram stain was negative, as well as cultures,
including Legionella.
.
On [**6-28**], a NICU consult was obtained.
.
On [**2164-6-29**], she was extubated and transferred back to the
antepartum floor. At the time of transfer, she was getting IV
Cefepime, which was switched to IV Cefazolin on [**6-30**] which was
continued until her day of discharge ([**2164-7-3**]). At that time, she
had completed a 14 day course of IV antibiotics and was
discharged with Keflex. In regards to her ureteral stent, this
will need to be changed every 4-8 weeks and she will be followed
by urology. The stone is still present and she should remain on
prophylatic antibiotics. Fetal testing was reassuring; ATU
testing ([**2164-7-2**]) revealed BPP [**8-8**], AFI 13.1, vtx, EFW 916g(40%).
She was discharged home on [**2164-7-3**] at 27+0 weeks gestation and
will have close outpatient follow up.

Medications on Admission:
Flintstones MVI

Discharge Medications:
1. Keflex 250 mg Capsule Sig: One (1) Capsule PO three times a
day.
Disp:*100 Capsule(s)* Refills:*3*

Discharge Disposition:
Home

Discharge Diagnosis:
- Ureteral stone
- Urosepsis
- Pneumonia, pulmonary edema, ARDS
- Pre-term contractions

Discharge Condition:
Good

Discharge Instructions:
Continue Keflex three times a day for the duration of your
pregnancy.  Call for any fever, chest pain/shortness of breath,
abdominal pain, contractions, leakage of fluid, bleeding,
decreased fetal movement, other concerns.  Continue straining
your urine with coffee filters to collect the stone if it
passes.

Followup Instructions:
Provider: [**Name10 (NameIs) 10582**],[**Name11 (NameIs) 4952**] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 10590**]  Friday, [**2164-7-6**]
11:45AM

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7447**], MD (Infectious Disease)
Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2164-7-30**] 10:30

Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD (Urology) [**Telephone/Fax (1) 3752**]
Please call to schedule an appointment in 2 weeks


Completed by:[**2164-7-5**]
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Calculus of ureter,Hydronephrosis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Acute respiratory failure,Thrombocytopenia, unspecified,Acute kidney failure with lesion of tubular necrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Threatened premature labor, antepartum condition or complication,Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified,Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}


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: Right back and abdominal pain

PRESENT ILLNESS: Ms [**Known lastname 63724**] is a 17y/o G2P0 at 24+6 weeks gestation with [**Last Name (un) **]
[**2164-10-20**]. She presents to triage with right lower back pain that
began this morning. She reports diffuse abdominal pain since
Sunday. She describes her pain as constant and sharp. She
reports some nausea with one episode of vomiting today. She has
been tolerating po's, although she's had a decreased appetite.
She denies any dysuria, diarrhea, vaginal bleeding, leaking of
fluid, sick contacts, fever/chills, contractions. Active fetal
movement.

MEDICAL HISTORY: PRENATAL COURSE:
(1)Dating: [**Last Name (un) **] [**2164-10-2**]
(2)Labs: O+/Ab-,RPRnr,RI
(3)nl FFS
(4)Proteus UTI treated [**4-7**]

MEDICATION ON ADMISSION: Flintstones MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.7, HR 90, BP 115/46, RR 24
GENERAL: NAD
HEART: RRR
LUNGS: CTAB
No flank tenderness, no spine tenderness
ABDOMEN: gravid, soft, NTND, normal BS
PELVIC: no CMT, L/C/P
EXTREMITIES: NT,NE
FHR: 140 AGA
TOCO: No ctxs
TAUS: BPP AGA, posterior placenta

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies tobacco/etoh/drugs
Teen pregnancy - parents and boyfriend supportive 

### Response:
{'Other current conditions classifiable elsewhere of mother, antepartum condition or complication,Calculus of ureter,Hydronephrosis,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Acute respiratory failure,Thrombocytopenia, unspecified,Acute kidney failure with lesion of tubular necrosis,Infections of genitourinary tract in pregnancy, antepartum condition or complication,Threatened premature labor, antepartum condition or complication,Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Anemia, unspecified,Unspecified hypertension complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}
