CHIEF COMPLAINT: CC: Abdominal pain & diarrhea

PRESENT ILLNESS: Ms. [**Known lastname 110101**] is a 66yo female with PMH significant for CAD,
atrial fibrillation, HTN, and ? Sjogren's, who presents with
abdominal pain and diarrhea. Per patient, her symptoms first
began back in early [**Month (only) **]. At that time she felt tired and
bloated. Her PCP thought she had a bacterial infection in her
abdomen and started her on Augmentin x 2 weeks. Her pain
improved but as a result of the antibiotics she developed a
yeast infection and was given Diflucan. 2 weeks later, she was
also started on Protonix, which she states was very helpful.
Since her insurance required pre-approval for the Protonix, she
was switched to Prilosec which was not as helpful. In addition
her Protonix, Celebrex was changed to Ibuprofen which further
worsened her symptoms.  She is not taking celebrex again.  She
also admits to nausea, which she has had for years.
.
Starting about 1 week prior to admission, she notes an episode
of increased pain and bloating.  She experienced some urgency
and noted a dark bowel movement with increased [**Last Name (un) **].  This bowel
movement also had some blood and mucus mixed with the stool.
These loose BMs resolved over the day and she returned to
regular BMs until the day prior to presentation.  She again
noted urgency and abdominal pain followed by a loose stool mixed
with blood.  This diarrhea continued for two more BMs while in
the emergency room.  She denies any fevers, chest pain, SOB,
dizziness, or recent travel. She states that her son-in-law had
a stomach virus last week. She has not had a colonoscopy or
endoscopy.
.
ROS: positive for whats noted above.  Denies fevers / chestpain
/ shortness of breath / vomiting / dysuria.  Positive for
chronic fatigue, noted since the start of these symptoms as well
as a chronic stable fatigue / decreased exercise tolerance that
has occured for years.  She also notes that she has experienced
mechanical falls for her lifetime that has been worked up by
multiple physicians.  She also noted dry mouth and decreased
tear production that is currently being workup by her PCP for
Sjogrens syndrome.

MEDICAL HISTORY: 1)?Sjogrens syndrome-being worked up by PCP
2)Spinal stenosis
3)Hypothyroidism
4)Type 2 DM
5)CAD
6)Atrial fibrillation
7)Hypertension
8)Mitral valve regurgitation
9)Neuropathy
10)s/p R TKR
11)s/p R cataract and retinal surgery
[**07**])Arthritis
13)Asthma
14)Acne

MEDICATION ON ADMISSION: Glipizide 5mg PO QAM
Digitek 0.25mg PO daily
Lasix 40mg PO daily
Celebrex 200mg PO daily
Metoprolol 50mg PO daily
ASA 81mg PO QHS
Levoxyl 25 micrograms PO daily
Vitamin D
Prilosec 40mg PO daily

ALLERGIES: Bactrim / Tetracyclines / Erythromycin Base / Optiray 350

PHYSICAL EXAM: vitals T98.7 BP132/76 HR 80 RR 20  O2 sat 97% on RA
Gen: Pleasant female, lying in bed, NAD
HEENT: NC AT, PERRLA, EOMI, mouth dry, clear OP
NECK: No LAD, no thyromegaly
Heart: RRR, no m,r,g
Lungs: CTAB, no crackles
Abdomen: NABS, soft, obese, diffusely tender to palpation, no
guarding or rebound.  No masses were able to be palpated.
Extremities: no c/c/e, 2+ DP pulses
Rectal: guiac positive (per ED)

FAMILY HISTORY: No history of gastrointestinal diseases in her family.

SOCIAL HISTORY: Denies tobaco, alcohol, or IVDA.
Infectious colitis, enteritis, and gastroenteritis,Cerebral embolism with cerebral infarction,Atrial fibrillation,Sicca syndrome,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Knee joint replacement,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism
Infectious enteritis NOS,Crbl emblsm w infrct,Atrial fibrillation,Sicca syndrome,Hypertension NOS,Asthma NOS,Joint replaced knee,Mitral valve disorder,DMII wo cmp nt st uncntr,Hypothyroidism NOS
Admission Date:  [**2103-10-15**]              Discharge Date:   [**2103-10-22**]

Date of Birth:  [**2037-3-8**]             Sex:   F

Service: MEDICINE

Allergies:
Bactrim / Tetracyclines / Erythromycin Base / Optiray 350

Attending:[**First Name3 (LF) 4052**]
Chief Complaint:
CC: Abdominal pain & diarrhea

Major Surgical or Invasive Procedure:
TPA for acute stroke


History of Present Illness:
Ms. [**Known lastname 110101**] is a 66yo female with PMH significant for CAD,
atrial fibrillation, HTN, and ? Sjogren's, who presents with
abdominal pain and diarrhea. Per patient, her symptoms first
began back in early [**Month (only) **]. At that time she felt tired and
bloated. Her PCP thought she had a bacterial infection in her
abdomen and started her on Augmentin x 2 weeks. Her pain
improved but as a result of the antibiotics she developed a
yeast infection and was given Diflucan. 2 weeks later, she was
also started on Protonix, which she states was very helpful.
Since her insurance required pre-approval for the Protonix, she
was switched to Prilosec which was not as helpful. In addition
her Protonix, Celebrex was changed to Ibuprofen which further
worsened her symptoms.  She is not taking celebrex again.  She
also admits to nausea, which she has had for years.
.
Starting about 1 week prior to admission, she notes an episode
of increased pain and bloating.  She experienced some urgency
and noted a dark bowel movement with increased [**Last Name (un) **].  This bowel
movement also had some blood and mucus mixed with the stool.
These loose BMs resolved over the day and she returned to
regular BMs until the day prior to presentation.  She again
noted urgency and abdominal pain followed by a loose stool mixed
with blood.  This diarrhea continued for two more BMs while in
the emergency room.  She denies any fevers, chest pain, SOB,
dizziness, or recent travel. She states that her son-in-law had
a stomach virus last week. She has not had a colonoscopy or
endoscopy.
.
ROS: positive for whats noted above.  Denies fevers / chestpain
/ shortness of breath / vomiting / dysuria.  Positive for
chronic fatigue, noted since the start of these symptoms as well
as a chronic stable fatigue / decreased exercise tolerance that
has occured for years.  She also notes that she has experienced
mechanical falls for her lifetime that has been worked up by
multiple physicians.  She also noted dry mouth and decreased
tear production that is currently being workup by her PCP for
Sjogrens syndrome.


Past Medical History:
1)?Sjogrens syndrome-being worked up by PCP
2)Spinal stenosis
3)Hypothyroidism
4)Type 2 DM
5)CAD
6)Atrial fibrillation
7)Hypertension
8)Mitral valve regurgitation
9)Neuropathy
10)s/p R TKR
11)s/p R cataract and retinal surgery
[**07**])Arthritis
13)Asthma
14)Acne


Social History:
Denies tobaco, alcohol, or IVDA.

Family History:
 No history of gastrointestinal diseases in her family.

Physical Exam:
vitals T98.7 BP132/76 HR 80 RR 20  O2 sat 97% on RA
Gen: Pleasant female, lying in bed, NAD
HEENT: NC AT, PERRLA, EOMI, mouth dry, clear OP
NECK: No LAD, no thyromegaly
Heart: RRR, no m,r,g
Lungs: CTAB, no crackles
Abdomen: NABS, soft, obese, diffusely tender to palpation, no
guarding or rebound.  No masses were able to be palpated.
Extremities: no c/c/e, 2+ DP pulses
Rectal: guiac positive (per ED)


Pertinent Results:
[**2103-10-15**] 05:00AM   GLUCOSE-139* UREA N-15 CREAT-1.0 SODIUM-142
POTASSIUM-3.5 CHLORIDE-106 TOTAL CO2-26 ANION GAP-14
[**2103-10-15**] 05:00AM   CK(CPK)-373*
[**2103-10-15**] 05:00AM   CK-MB-7 cTropnT-<0.01
[**2103-10-15**] 05:00AM   WBC-8.0 RBC-4.17* HGB-13.0 HCT-37.1 MCV-89
MCH-31.2 MCHC-35.1* RDW-13.2
[**2103-10-15**] 05:00AM   NEUTS-72.3* LYMPHS-20.5 MONOS-5.7 EOS-0.7
BASOS-0.8
[**2103-10-15**] 05:00AM   PLT COUNT-171
[**2103-10-15**] 05:19AM   LACTATE-2.0
.
Studies:
Chest Xray:
UPRIGHT AND LATERAL CHEST:  Allowing for differences in
inspiration, the
cardiomediastinal silhouette is not significantly changed.
Pulmonary
vascularity is normal.  Lungs are clear and there is no pleural
effusion or
pneumothorax.  Thoracic spondylosis is observed.
IMPRESSION: No acute cardiopulmonary process.
.
CT ABD/PELVIS

IMPRESSION:
1.  Fluid filled colon with mild prominence of the bowel wall.
Findings may correlate with resolving colitis.
2.  Sigmoid diverticulosis without acute diverticulitis.
3.  3 mm pulmonary nodule requires one-year followup if there
are significant risk factors (i.e., history of smoking or
history of known malignancy). If there are no such risk factors,
no followup is required.
.
ABD U/S from [**2103-6-26**]
ABDOMINAL ULTRASOUND:

The liver parenchyma is unremarkable without evidence of focal
mass.  No
intrahepatic ductal dilatation is identified and the common bile
duct is
normal measuring approximately 7 mm.  Portal vein is patent with
normal
hepatopetal flow.  Patient is noted to be status post
cholecystectomy. Limited examination of the pancreatic head and
body appears unremarkable.  A small 2 x 0.5 x 1.8 cm
peripancreatic lymph node is identified.  The aorta is of normal
caliber throughout and the spleen is noted to be slightly
prominent but within normal limits measuring approximately 13.5
cm.  The right kidney measures approximately 10.6 cm and the
left kidney measures approximately 10.9 cm. There is no evidence
of hydronephrosis or renal calculi bilaterally.  No free fluid
is noted within the abdominal quadrant.
IMPRESSION:
Unremarkable abdominal ultrasound.  No cause for pain
identified.


Brief Hospital Course:
66 year old women who presents with chronic abd pain / bloating
and possible acute process causing recent diarrhea
.
#Stroke:  On the night of admission, the patient noted the acute
onset of headache and left sided weakness.  A code stroke was
called and the patient was evaluted by the neurology team. CT
scan of the head did not show any acute event and neurosurgery
thought a bleed was very unlikely.  She refused an MRI at the
time.  She was give IV TPA by the neurologists and transfered to
the NICU.  She did well in the ICU and most of her deficits
resolved.  She has some minimal residual weakness on the left
side and a small left facial droop.  It is believed that the
event represents a thromboembolic event, likely from her Atrial
fibrillation.  After discussing with the patient and her PCP she
was started on coumidin with IV heparin during the transition.
She tolerated the coumidin well.  She will follow up with the
neurology stroke clinic.
.
#ABD pain / Diarrhea: No clear source of the abdmoninal pain was
discovered.  The patient may have been recovering from an acute
infectious etiology at the time of admission as seen on the CT
scan.  GI saw the patient while she was in the hospital and
deferred further evaluation until she was an outpatient because
of her acute neurological event.  She was started on a lactose
free diet in the hospital and given Senna and Colace.  She will
follow up with GI as an outpatient.
.
#AFib: Patient was continued digoxin.  Metoprolol for rate
control.  Due to the thromboembolic event, she was started on
coumidin in house.  She will be followed by her PCPs to monitor
her INR.  They would like a more concervative goal of 2.0-2.5.
.
#HTN: Continued metoprolol.  Decreased dose to 25 [**Hospital1 **].  Can be
titrated as needed as an outpatient.
.
#Type 2 DM: Held orals in house.  Will keep on home regimin as
outpatient.
.
#Hypothyroidism:  continue levothyroxine


Medications on Admission:
Glipizide 5mg PO QAM
Digitek 0.25mg PO daily
Lasix 40mg PO daily
Celebrex 200mg PO daily
Metoprolol 50mg PO daily
ASA 81mg PO QHS
Levoxyl 25 micrograms PO daily
Vitamin D
Prilosec 40mg PO daily


Discharge Medications:
1. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Diphenhydramine HCl 25 mg Capsule Sig: Two (2) Capsule PO HS
(at bedtime) as needed.
6. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
7. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed for bloating.
8. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
12. Celebrex 100 mg Capsule Sig: One (1) Capsule PO twice a day.

13. Aspirin 81 mg Tablet Sig: One (1) Tablet PO at bedtime.
14. Vitamin D 400 unit Tablet Sig: One (1) Tablet PO once a day.

15. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.
16. Coumadin 4 mg Tablet Sig: One (1) Tablet PO once a day:
please take in evening.
Disp:*30 Tablet(s)* Refills:*0*
17. Outpatient Lab Work
Please check PT, PTT, INR on [**2103-10-23**] and fax results to Dr.
[**Last Name (STitle) **] at [**Telephone/Fax (1) 4647**]


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Stroke
Atrial Fibrillation
Diabetes
Abdominal Pain
Asthma


Discharge Condition:
Stable, abdominal pain improved, neurologically stable without
additional events.


Discharge Instructions:
You were seen in the hospital for abdominal pain.  We started
you on new medications and your abdominal pain improved.  You
will see the GI physicians as an outpatient to follow up.
.
While you were in the hospital you had an acute thromboembolic
stroke.  You were seen by the neurologists and given a
medication called TPA for your stroke.  While in the hospital
you were also started on a new medication called coumadin to
help prevent future [**Doctor Last Name 6056**].  Your primary care physician will
need to check blood levels to follow this medication.  Please
discuss with your primary care physician if they would like you
to continue taking Aspirin and Coumidin together.
.
A few changes were made to you medications.  Please discuss all
of these medications with your primary care physician:
[**Name10 (NameIs) 110102**] was decreased to 20mg daily
-Metoprolol was decreased to 25mg twice daily
-Coumadin 4mg daily was added to your medications.
-To help with your stomach you can take simethicone as needed
for gas, colace can be taken twice daily to soften stools, and
Senna can be taken once or twice daily as needed for
constiptation.  These medications can be purchased at the drug
store without a Rx
.
Please either call your primary care physician or return to the
emergency room if you develop any new weakness, new sensory
loss, difficulty speaking, a change in vision, new headache,
bleeding, chest pain, shortness of breath, increased abdominal
pain or other symptoms of concern to you.

Followup Instructions:
Please call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 608**] to make a follow up
appointment in [**12-12**] weeks.  Please call her and discuss when you
will need to have your blood checked to follow your coumadin.
.
Please call ([**Telephone/Fax (1) 2528**] to make an appointment with Dr.
[**Last Name (STitle) **] in the Neurology [**Hospital 4038**] Clinic.  They will need to
see you in 4 weeks.
.
Please follow up with the GI physicians.
Provider: [**Name10 (NameIs) **] WEST,ROOM THREE GI ROOMS Date/Time:[**2103-11-15**] 9:00
Provider: [**Name10 (NameIs) **] PROCEDURES FELLOW Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2103-11-15**] 9:00
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 12902**], MD Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2103-11-23**] 1:00


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 4055**]

Completed by:[**2103-10-23**]
{'Infectious colitis, enteritis, and gastroenteritis,Cerebral embolism with cerebral infarction,Atrial fibrillation,Sicca syndrome,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Knee joint replacement,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}


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: CC: Abdominal pain & diarrhea

PRESENT ILLNESS: Ms. [**Known lastname 110101**] is a 66yo female with PMH significant for CAD,
atrial fibrillation, HTN, and ? Sjogren's, who presents with
abdominal pain and diarrhea. Per patient, her symptoms first
began back in early [**Month (only) **]. At that time she felt tired and
bloated. Her PCP thought she had a bacterial infection in her
abdomen and started her on Augmentin x 2 weeks. Her pain
improved but as a result of the antibiotics she developed a
yeast infection and was given Diflucan. 2 weeks later, she was
also started on Protonix, which she states was very helpful.
Since her insurance required pre-approval for the Protonix, she
was switched to Prilosec which was not as helpful. In addition
her Protonix, Celebrex was changed to Ibuprofen which further
worsened her symptoms.  She is not taking celebrex again.  She
also admits to nausea, which she has had for years.
.
Starting about 1 week prior to admission, she notes an episode
of increased pain and bloating.  She experienced some urgency
and noted a dark bowel movement with increased [**Last Name (un) **].  This bowel
movement also had some blood and mucus mixed with the stool.
These loose BMs resolved over the day and she returned to
regular BMs until the day prior to presentation.  She again
noted urgency and abdominal pain followed by a loose stool mixed
with blood.  This diarrhea continued for two more BMs while in
the emergency room.  She denies any fevers, chest pain, SOB,
dizziness, or recent travel. She states that her son-in-law had
a stomach virus last week. She has not had a colonoscopy or
endoscopy.
.
ROS: positive for whats noted above.  Denies fevers / chestpain
/ shortness of breath / vomiting / dysuria.  Positive for
chronic fatigue, noted since the start of these symptoms as well
as a chronic stable fatigue / decreased exercise tolerance that
has occured for years.  She also notes that she has experienced
mechanical falls for her lifetime that has been worked up by
multiple physicians.  She also noted dry mouth and decreased
tear production that is currently being workup by her PCP for
Sjogrens syndrome.

MEDICAL HISTORY: 1)?Sjogrens syndrome-being worked up by PCP
2)Spinal stenosis
3)Hypothyroidism
4)Type 2 DM
5)CAD
6)Atrial fibrillation
7)Hypertension
8)Mitral valve regurgitation
9)Neuropathy
10)s/p R TKR
11)s/p R cataract and retinal surgery
[**07**])Arthritis
13)Asthma
14)Acne

MEDICATION ON ADMISSION: Glipizide 5mg PO QAM
Digitek 0.25mg PO daily
Lasix 40mg PO daily
Celebrex 200mg PO daily
Metoprolol 50mg PO daily
ASA 81mg PO QHS
Levoxyl 25 micrograms PO daily
Vitamin D
Prilosec 40mg PO daily

ALLERGIES: Bactrim / Tetracyclines / Erythromycin Base / Optiray 350

PHYSICAL EXAM: vitals T98.7 BP132/76 HR 80 RR 20  O2 sat 97% on RA
Gen: Pleasant female, lying in bed, NAD
HEENT: NC AT, PERRLA, EOMI, mouth dry, clear OP
NECK: No LAD, no thyromegaly
Heart: RRR, no m,r,g
Lungs: CTAB, no crackles
Abdomen: NABS, soft, obese, diffusely tender to palpation, no
guarding or rebound.  No masses were able to be palpated.
Extremities: no c/c/e, 2+ DP pulses
Rectal: guiac positive (per ED)

FAMILY HISTORY: No history of gastrointestinal diseases in her family.

SOCIAL HISTORY: Denies tobaco, alcohol, or IVDA. 

### Response:
{'Infectious colitis, enteritis, and gastroenteritis,Cerebral embolism with cerebral infarction,Atrial fibrillation,Sicca syndrome,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Knee joint replacement,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}
