CHIEF COMPLAINT: abdominal pain x3days

PRESENT ILLNESS: 25F had [**Last Name (NamePattern1) **] and biliary stent placement [**12-15**] for Mirizzi's
syndrome.  She was pregnant at the time.  She has not had her
gallbladder out and she failed to make the appointment to have
the stent taken out.
Today she presents with sharp, non-radiating [**8-16**] RUQ pain
x3days. Pain has been consistent, associated with fevers, chills
(rigors), severe nausea, and 1 episode of bilious vomiting.
Denies diarrhea.  Last BM and flatus 3-4 days ago, but pt. notes
that is normal.  Transferred from [**Hospital3 **] this evening where
she
was treated with [**Last Name (un) **]/Flagyl.

MEDICAL HISTORY: PMH: none
PSH: biliary stent placement [**12/2100**] ([**Doctor First Name **] [**Doctor Last Name **]); 2
C-sections (last in [**12/2100**])

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
PE:
99.0 105 114/62 20 100
NAD
RRR
CTAB
Abd soft, non-distended; ttp in the RUQ, positive [**Doctor Last Name 515**] sign.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in [**Location 2498**], MA with her boyfriend and 2 kids.  No a/t/d.
Acute cholecystitis,Cholangitis,Urinary tract infection, site not specified,Acidosis,Iron deficiency anemia secondary to blood loss (chronic)
Acute cholecystitis,Cholangitis,Urin tract infection NOS,Acidosis,Chr blood loss anemia
Admission Date:  [**2101-5-21**]              Discharge Date:   [**2101-5-27**]

Date of Birth:  [**2076-3-27**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 4659**]
Chief Complaint:
abdominal pain x3days


Major Surgical or Invasive Procedure:
Percutaneous Cholecystostomy Tube Placement
[**Last Name (NamePattern1) **] stent exchanged


History of Present Illness:
25F had [**Last Name (NamePattern1) **] and biliary stent placement [**12-15**] for Mirizzi's
syndrome.  She was pregnant at the time.  She has not had her
gallbladder out and she failed to make the appointment to have
the stent taken out.
Today she presents with sharp, non-radiating [**8-16**] RUQ pain
x3days. Pain has been consistent, associated with fevers, chills
(rigors), severe nausea, and 1 episode of bilious vomiting.
Denies diarrhea.  Last BM and flatus 3-4 days ago, but pt. notes
that is normal.  Transferred from [**Hospital3 **] this evening where
she
was treated with [**Last Name (un) **]/Flagyl.

Past Medical History:
PMH: none
PSH: biliary stent placement [**12/2100**] ([**Doctor First Name **] [**Doctor Last Name **]); 2
C-sections (last in [**12/2100**])


Social History:
Lives in [**Location 2498**], MA with her boyfriend and 2 kids.  No a/t/d.


Family History:
NC

Physical Exam:
On admission:
PE:
99.0 105 114/62 20 100
NAD
RRR
CTAB
Abd soft, non-distended; ttp in the RUQ, positive [**Doctor Last Name 515**] sign.

Normoactive BS in all 4 quadrants.
Ext warm/well-perfused with no c/c/e.

On discharge:
AFVSS
Gen: NAD AOx3
CVS: reg
Pulm: no resp distress
Abd: S/AT/ND perc drain in place


Pertinent Results:
OSH LABS:
WBC 23.9
HCT 33.2
PLT 318
.
NA 130
K 2.8
CL 95
Bicarb 23
BUN 17
CR 1.7
.
.
ADMISSION LABS:
[**2101-5-20**] 08:23PM   WBC-18.6* RBC-4.04* HGB-9.3* HCT-28.4*
MCV-71* MCH-23.1* MCHC-32.7 RDW-16.5*
[**2101-5-20**] 08:23PM   PLT COUNT-287
[**2101-5-20**] 08:23PM   NEUTS-81.8* LYMPHS-10.8* MONOS-7.0 EOS-0.1
BASOS-0.4
[**2101-5-20**] 08:23PM   GLUCOSE-92 UREA N-20 CREAT-1.1 SODIUM-135
POTASSIUM-3.9
CHLORIDE-103 TOTAL CO2-21* ANION GAP-15
[**2101-5-20**] 08:23PM   ALT(SGPT)-9 AST(SGOT)-12 ALK PHOS-64 TOT
BILI-1.6*
[**2101-5-20**] 08:23PM   ALBUMIN-3.6
[**2101-5-20**] 09:00PM URINE  UCG-NEGATIVE
[**2101-5-20**] 09:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.021
[**2101-5-20**] 09:00PM URINE  BLOOD-LG NITRITE-POS PROTEIN-75
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-SM

Liver/Gallbladder U/S: --IMPRESSION:
1. Findings suggestive of acute cholecystitis with mucosal
sloughing and
necrosis.
2. Cholelithiasis without evidence of choledocholithiasis.
3. Distal CBD not visualized due to bowel gas.

[**Month/Day/Year **]:  --Findings:
Esophagus: Limited exam of the esophagus was normal
Stomach: Limited exam of the stomach was normal
Duodenum: Limited exam of the duodenum was normal
Major Papilla: A plastic stent placed in the biliary duct was
found in the major papilla. The plastic stent was removed using
a snare. Evidence of a previous sphincterotomy was noted in the
major papilla.
Biliary Tree: An occlusion cholangiogram was performed to define
the biliary tree. A limited amount of contrast was used due to
concern for cholangitis. However, no pus, no thick bile, no
biliary stones were extracted from the common bile duct.
Evidence of extrinsic compression was noted at the middle third
of the common bile duct. This was compatible with a stone in the
cystic duct as seen previously. Due to these findings,  A 9cm by
10FR Cotton [**Doctor Last Name **] biliary stent was placed successfully.
Impression: A plastic stent placed in the biliary duct was found
in the major papilla.
The plastic stent was removed using a snare.
Evidence of a previous sphincterotomy was noted in the major
papilla.
An occlusion cholangiogram was performed to define the biliary
tree.
A limited amount of contrast was used due to concern for
cholangitis.
However, no pus, no thick bile, no biliary stones were extracted
from the common bile duct.
Evidence of extrinsic compression was noted at the middle third
of the common bile duct.
This was compatible with a stone in the cystic duct as seen
previously. Due to these findings,
Due to these findings,  A 9cm by 10FR Cotton [**Doctor Last Name **] biliary stent
was placed successfully.
Otherwise normal [**Doctor Last Name **] to third part of the duodenum

Recommendations:
NPO today - diet orders as per the primary team.
The patient's clinical picture is not explained by these [**Doctor Last Name **]
findings - cholecystitis is the most likely cause: further
management per Dr[**Name (NI) 6218**] service.
Continue IV antibiotics.
Follow-up with Dr. [**Last Name (STitle) **] and Dr [**First Name (STitle) **].


Brief Hospital Course:
25 year old female with biliary stent placed for Mirizzi
syndrome [**12-15**], now with acute cholecystitis and concern
regarding infected stent.  Patient had [**Month/Year (2) **] and stent
replacement.  She also had a percutaneous cholecystotomy tube
placed and she was treated with IV antibiotics.  By the time of
discharge she was tolerating regular diet, afebrile and adequate
pain control.  She will follow up as an outpatient with [**Month/Year (2) **] for
stent removal and with Dr. [**Last Name (STitle) **].  Her drain will remain in
place until follow up and she will be placed on PO antibiotics.
.
# Acute cholecystitis: The patient was treated with unasyn for
her acute cholecysistis.  She underwent [**Last Name (STitle) **] due to concern for
acute cholangitis given the fact that she has had a previous
stent.  [**Last Name (STitle) **] showed that the patient's bile duct stent was
working properly and there was no pus in the bile duct.  Again
noted was the stone in the cystic duct, which was felt to be
intermittently compressing the common bile duct.  For this
reason, a stent was again placed in the common bile duct.  It
was felt that the patient's symptoms were primarily related to
acute cholecystitis rather than cholangitis.   Drain to be left
in place until follow up with antibiotics
.
# Anemia: microcytic, likely blood loss, either GI or GU or
hemolysis/DIC, unclear [**Name2 (NI) 83617**], at least partially acute
(HCT 33 at OSH). Pt did report lightheadedness prior to this
event. Guaiac negative, denies blood in vomit, report mentrual
cycles not particularly heavy. No prior baseline.
- blood smear, fibrinogin, hapto, INR, FDP, D bili
- q8h HCT
.
# [**Last Name (un) **]: The patient's kidney fuction improved from the
presentation to OSH to the time of admission to [**Hospital1 18**].  It
improved with fluid resuscitation.
.
# Non-gap metabolic acidosis: Most likely related to fluid
resuscitation and gastric losses from vomiting.  The patient was
given lactated ringers for further volume resusciation and her
acidosis resolved.
.
# Urinary tract infection: Treated with unasyn as above.
.
# Left Black Eye: The patient was noted to have a black eye on
admission.  The patient reported it occurred as an injury
related to falling down the stairs.  The was concern about
physical abuse.  Social work was consulted


Medications on Admission:
None

Discharge Medications:
1. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO every
twelve (12) hours for 10 days.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Cholecystitis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital for an infected gall bladder.
You were admitted to the ICU for a short peroid of time because
you were very sick. We treated your symptoms with the placement
of a percutaneous cholecystostomy tube and antibiotics. This
tube will stay in place. You are ready to return home until your
surgery to remove your gallbladder which will be with Dr.
[**Last Name (STitle) **] at the end of six weeks. However, you must follow-up
with Dr. [**Last Name (STitle) **] in her office in [**1-8**] weeks. You will be taking
the antibiotic Augmentin twice daily for the next 10 days.
Please take this prescription as written and be sure to finish
the entire prescription. The tube in your abdomen will remain in
place until your surgery. Please monitor the output and empty
the drain twice daily. The fluid in this drain should have
green/brown drainage, if this turns into frank red blood please
seek medical attention or if severe go to the emergency room. If
this drain begins to put out more than 50 millileters daily
please call the office. Follow drain care instructions as
ordered, your nurse should provide you with a container to
measure the drainage.

If you return home and you have increased abdominal pain,
nausea, vomiting, fever, constipation, or you are unable to
tolerate food please seek medical attention or come to the
emergency room if it is severe. Please keep yourself well
hydrated and take it easy for the next week. Please follow a low
fat diet, the gall bladder secretes bile which is important for
fat absorption and its secretion is stimulate when you eat food
and foods especially high in fat. That is why you have pain when
you eat so it is best to avoid these foods for now.

While you were in the hospital, your heart rate was elevated and
your blood pressure at times was elevated. We gave you
medication to help with this. It is important that you have your
blood pressure and heart rate checked by your PCP within the
next 1-2 weeks. Please call them to make an appointment.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] call ([**Telephone/Fax (1) 15665**] to make an
appointment.
Call PCP to make an appointment for a blood pressure and heart
rate check.
Provider: [**Name Initial (NameIs) **] 2 (ST-4) GI ROOMS Date/Time:[**2101-7-14**] 1:00
Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2101-7-14**] 1:00


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **] MD, [**MD Number(3) 4661**]
{'Acute cholecystitis,Cholangitis,Urinary tract infection, site not specified,Acidosis,Iron deficiency anemia secondary to blood loss (chronic)'}


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 x3days

PRESENT ILLNESS: 25F had [**Last Name (NamePattern1) **] and biliary stent placement [**12-15**] for Mirizzi's
syndrome.  She was pregnant at the time.  She has not had her
gallbladder out and she failed to make the appointment to have
the stent taken out.
Today she presents with sharp, non-radiating [**8-16**] RUQ pain
x3days. Pain has been consistent, associated with fevers, chills
(rigors), severe nausea, and 1 episode of bilious vomiting.
Denies diarrhea.  Last BM and flatus 3-4 days ago, but pt. notes
that is normal.  Transferred from [**Hospital3 **] this evening where
she
was treated with [**Last Name (un) **]/Flagyl.

MEDICAL HISTORY: PMH: none
PSH: biliary stent placement [**12/2100**] ([**Doctor First Name **] [**Doctor Last Name **]); 2
C-sections (last in [**12/2100**])

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
PE:
99.0 105 114/62 20 100
NAD
RRR
CTAB
Abd soft, non-distended; ttp in the RUQ, positive [**Doctor Last Name 515**] sign.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives in [**Location 2498**], MA with her boyfriend and 2 kids.  No a/t/d. 

### Response:
{'Acute cholecystitis,Cholangitis,Urinary tract infection, site not specified,Acidosis,Iron deficiency anemia secondary to blood loss (chronic)'}
