CHIEF COMPLAINT: pancreatitis, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear

PRESENT ILLNESS: 56 year old male with a history of HCV ([**3-15**] IVDU; last biopsy
[**5-/2196**] with portal fibrosis, no viral load or genotype on file),
chronic pancreatitis, alcoholism, CAD, presented initially on
[**12-24**] with abdominal pain, elevated lipase, consistent with
acute exacerbation of his chronic pancreatitis, secondary to
recent alcohol use. Of note, on admission, he reported one
episode sometime the week prior to admission of hematemesis
(coffee-grounds, dark brown). On day prior to admission, had
non-bilious, non-bloody vomitus x1, one episode of yellowish
diarrhea, no melena or hematochezia. He admitted to [**6-16**] drinks
day prior to admission, last drink at 6 PM on day prior to
admission. CT abdomen [**12-24**] demonstrated new 31 x 23mm soft
tissue density peripherally enhancing mass extending
superiorally off the pancreatic tail; Mild surrounding soft
tissue stranding c/w recurrent or residual pancreatitis;
cholelithiasis; fatty liver. He was placed on bowel rest, pain
control, CIWA scale for alcohol withdrawal. On day after
admission, had an episode of hematemesis (bright red blood and
clots), remained hemodynamically stable throughout, but was
transferred to MICU for emergent EGD, which demonstrated [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tear with stigmata of recent bleed (clot). Hematocrit
remained stable at 35-40 throughout. The area of erythema and
bleeding was injected with epinephrine without residual bleed.
Subsequently, remained stable without further episodes of
hematemesis or fall in hematocrit. Per GI, will follow-up with
repeat abdominal CT on [**1-1**] for re-evaluation of suspected
pancreatic pseudocyst.

MEDICAL HISTORY: 1.)ETOH abuse
2.)HCV
3.)Frequent episodes of pancreatitis related to etoh abuse
4.)CAD with [**2195**] MIBI showing mod partially reversible defect in
LAD region
5.)Osteoarthritis
6.)s/p colectomy for ?SBO/bowel perforation, done at [**Hospital1 112**]

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.1  P: 73  BP:  162/73  R: 16  O2 sat 98% on RA
Gen: fatigued male in NAD, NGT in place
HEENT: pink conjunctiva, sclerae anicteric, MM dry
Neck: no jvd
CV: RRR S1 S2.
Pulm: CTAB, crackles at bases that cleared with repeat
respirations.
Abd: +bs.  Soft. TTP in epigastric region with mild voluntary
guarding, no rebound . Non-distended.  Liver edge palpable at
3cm below costal margin.
Ext: WWP. No edema. 2+ DP/PT pulses bilaterally
Neuro: A&Ox3

FAMILY HISTORY: Dad with ETOH cirrhosis, uncle with Diabetes, Mom with MI at 72.

SOCIAL HISTORY: ETOH: 5 beers and 3 shots every night, Tob: 1/2ppd since age 16,
Drugs: +ivdu, none since [**60**], +cocaine and marijuana but none
since 7 months.
Acute pancreatitis,Gastroesophageal laceration-hemorrhage syndrome,Other and unspecified alcohol dependence, continuous,Cocaine dependence, continuous,Unspecified viral hepatitis C without hepatic coma
Acute pancreatitis,Mallory-weiss syndrome,Alcoh dep NEC/NOS-contin,Cocaine depend-contin,Hpt C w/o hepat coma NOS
Admission Date:  [**2197-12-24**]              Discharge Date:   [**2197-12-27**]

Date of Birth:  [**2141-10-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
pancreatitis, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear

Major Surgical or Invasive Procedure:
EGD, epinephrine cautery of distal GE junction tear

History of Present Illness:
56 year old male with a history of HCV ([**3-15**] IVDU; last biopsy
[**5-/2196**] with portal fibrosis, no viral load or genotype on file),
chronic pancreatitis, alcoholism, CAD, presented initially on
[**12-24**] with abdominal pain, elevated lipase, consistent with
acute exacerbation of his chronic pancreatitis, secondary to
recent alcohol use. Of note, on admission, he reported one
episode sometime the week prior to admission of hematemesis
(coffee-grounds, dark brown). On day prior to admission, had
non-bilious, non-bloody vomitus x1, one episode of yellowish
diarrhea, no melena or hematochezia. He admitted to [**6-16**] drinks
day prior to admission, last drink at 6 PM on day prior to
admission. CT abdomen [**12-24**] demonstrated new 31 x 23mm soft
tissue density peripherally enhancing mass extending
superiorally off the pancreatic tail; Mild surrounding soft
tissue stranding c/w recurrent or residual pancreatitis;
cholelithiasis; fatty liver. He was placed on bowel rest, pain
control, CIWA scale for alcohol withdrawal. On day after
admission, had an episode of hematemesis (bright red blood and
clots), remained hemodynamically stable throughout, but was
transferred to MICU for emergent EGD, which demonstrated [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tear with stigmata of recent bleed (clot). Hematocrit
remained stable at 35-40 throughout. The area of erythema and
bleeding was injected with epinephrine without residual bleed.
Subsequently, remained stable without further episodes of
hematemesis or fall in hematocrit. Per GI, will follow-up with
repeat abdominal CT on [**1-1**] for re-evaluation of suspected
pancreatic pseudocyst.


Past Medical History:
1.)ETOH abuse
2.)HCV
3.)Frequent episodes of pancreatitis related to etoh abuse
4.)CAD with [**2195**] MIBI showing mod partially reversible defect in
LAD region
5.)Osteoarthritis
6.)s/p colectomy for ?SBO/bowel perforation, done at [**Hospital1 112**]


Social History:
ETOH: 5 beers and 3 shots every night, Tob: 1/2ppd since age 16,
Drugs: +ivdu, none since [**60**], +cocaine and marijuana but none
since 7 months.


Family History:
Dad with ETOH cirrhosis, uncle with Diabetes, Mom with MI at 72.


Physical Exam:
Vitals: T: 98.1  P: 73  BP:  162/73  R: 16  O2 sat 98% on RA
Gen: fatigued male in NAD, NGT in place
HEENT: pink conjunctiva, sclerae anicteric, MM dry
Neck: no jvd
CV: RRR S1 S2.
Pulm: CTAB, crackles at bases that cleared with repeat
respirations.
Abd: +bs.  Soft. TTP in epigastric region with mild voluntary
guarding, no rebound . Non-distended.  Liver edge palpable at
3cm below costal margin.
Ext: WWP. No edema. 2+ DP/PT pulses bilaterally
Neuro: A&Ox3

Pertinent Results:
Abd CT [**12-24**]:
1. New 31 x 23 mm soft tissue density rim-enhancing mass
extending superiorly off the pancreatic tail. This most likley
represents a hemorrhagic pancreatic pseudocyst given the
patient's history of pancreatitis.
2. Mild surrounding soft tissue stranding consistent with
residual or recurrent inflammation.
3. Cholelithiasis without evidence of acute cholecystitis.
4. Fatty liver.

[**2197-12-24**] 08:50PM   WBC-6.0 RBC-3.95* HGB-12.0* HCT-35.8* MCV-91
MCH-30.3 MCHC-33.5 RDW-14.6
[**2197-12-24**] 08:50PM   PLT COUNT-180

[**2197-12-24**] 11:10AM   GLUCOSE-105 UREA N-11 CREAT-0.9 SODIUM-137
POTASSIUM-3.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-12
[**2197-12-24**] 11:10AM   ALT(SGPT)-96* AST(SGOT)-122* ALK PHOS-126*
TOT BILI-0.8
[**2197-12-23**] 11:13PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG
[**2197-12-23**] 11:13PM URINE  RBC-1 WBC-1 BACTERIA-RARE YEAST-NONE
EPI-1
[**2197-12-23**] 10:30AM   ALT(SGPT)-108* AST(SGOT)-148* ALK PHOS-170*
AMYLASE-206* TOT BILI-0.6
[**2197-12-23**] 10:30AM   LIPASE-82*
[**2197-12-23**] 10:30AM   ALBUMIN-3.8 CALCIUM-9.1 PHOSPHATE-2.3*
MAGNESIUM-1.5* IRON-153
[**2197-12-23**] 10:30AM   calTIBC-250 VIT B12-575 FOLATE-7.6
FERRITIN-1165* TRF-192*
[**2197-12-23**] 10:30AM   ASA-5 ETHANOL-103* ACETMNPHN-NEG bnzodzpn-NEG
barbitrt-NEG tricyclic-NEG

Brief Hospital Course:
Initial assessment: Patient was admitted for alcoholic
pancreatitis, which rapidly resolved, but hematemesis was
concerning for variceal hemorrhage versus peptic ulcer disease
versus [**Doctor First Name 329**] [**Doctor Last Name **] tear, given history of HCV and possible
cirrhosis. Abdomen remained supple after transfer from MICU to
floor, and no further nausea, vomiting, hematemesis. EGD
demonstrated evidence of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear, which was injected
with epinephrine and did not rebleed per stable hematocrit, lack
of pain.
.
1. Abdominal pain: Pancreatitis as etiology given symptoms,
similar presentation to past episodes and abdominal CT findings;
patient was placed on bowel rest, PPI, and rapidly advanced on
day 2 to clear liquids, but given hematemesis and EGD, diet was
intermittently held throughout course; on discharge, patient was
hungry without abdominal pain. Abdominal CT disclosed pancreatic
pseudocyst, which will be followed by GI with repeat CT scan on
[**1-5**]. Patient was re-EGD on day of discharge to confirm
pharmacologic cure of [**Doctor First Name 329**] [**Doctor Last Name **] tear, and will follow-up
with Dr. [**First Name (STitle) **] [**Name (STitle) **] in [**Hospital **] clinic for pseudocyst, pancreatitis,
HCV management. Pain was controlled with dilaudid, discharged on
limited course of percocet for pain control.
.
2. Substance abuse: Patient was placed on CIWA scale, aggressive
fluid replacement. Electrolytes were repleted as needed, for
refeeding syndrome. Thiamine and folate and MVI were
administered daily throughout. Beta-blockers were held for
hypertension throughout given positive urine toxicology screen
for cocaine, and risk of hypertensive emergency. However, blood
pressure on return from MICU remained at 130-140 throughout off
anti-hypertensives.
.
3. Cardiovascular: Depressed EF on prior ECHO was felt to be
progressive ischemic disease (cocaine-related accelerated
atherosclerosis) or dilated (secondary to alcohol, cocaine,
HCV). Did not receive stress test in this admission, and this
should be pursued as an outpatient. ASA was held given bleed,
and will be held on discharge.
.
3. Prophylaxis: On PPI throughout. Held anticoagulation for DVT
prophylaxis given bleed.
.
Patient was full code throughout.


Medications on Admission:
None

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours for 4 days.
Disp:*20 Tablet(s)* Refills:*0*
3. Radiology
Please perform and abdominal CT scan with contrast to assess the
pancreas 31x23 mm pancreatic tail mass (suspected hemorrhagic
pseudocyst at [**Hospital1 18**]).  Please page Dr. [**First Name (STitle) **] [**Name (STitle) **] ([**Hospital1 18**],
Gastroenterology) with the results. (Page Operator [**Telephone/Fax (1) 10339**],
Page ID# [**Serial Number 34686**].


Discharge Disposition:
Home

Discharge Diagnosis:
Upper GI bleed secondary to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Tear
Acute on chronic pancreatitis complicated by hemorrhagic
pancreatic pseudocyst
Cocaine abuse
Alcohol abuse
Coronary artery disease


Discharge Condition:
stable


Discharge Instructions:
Please follow-up with Dr. [**First Name (STitle) **] [**Name (STitle) **], Gastroenterology, on
Tuesday [**2198-1-2**], in [**Hospital Ward Name 23**] 7 at the [**Hospital1 18**], at 1:20 PM. (Phone#
[**Telephone/Fax (1) 11048**])

You have an ABDOMINAL CT on Friday [**2198-1-5**] at [**Hospital3 9947**], [**Last Name (NamePattern1) 34687**], behind the gift shop; ARRIVE AT 4
PM. YOU NEED TO HAVE NOTHING BY MOUTH (no liquids or solid food)
AFTER 11:30 ON [**2198-1-5**] (THE DAY OF THE CAT-SCAN). Call
[**Telephone/Fax (1) 34688**] for details.

Please follow-up with Dr. [**Last Name (STitle) 410**] in [**3-16**] weeks [**Telephone/Fax (1) 2660**].

****PLEASE MAKE SURE TO TAKE YOUR COPY OF THE ABDOMINAL CT SCAN
(on a CD) WITH YOU TO [**Hospital6 **] ON [**2198-1-5**] FOR YOUR
REPEAT CT SCAN.*****

Followup Instructions:
Provider: [**Last Name (NamePattern4) **]. [**First Name (STitle) 5376**] [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 1954**] Date/Time:[**2198-1-2**]
1:20
Please follow-up with Dr. [**First Name (STitle) **] [**Name (STitle) **], Gastroenterology, on
Tuesday [**2198-1-2**], in [**Hospital Ward Name 23**] 7 at the [**Hospital1 18**], at 1:20 PM. (Phone#
[**Telephone/Fax (1) 11048**])

You have an ABDOMINAL CT on Friday [**2198-1-5**] at [**Hospital3 9947**], [**Last Name (NamePattern1) 34687**], behind the gift shop; ARRIVE AT 4
PM. YOU NEED TO HAVE NOTHING BY MOUTH (no liquids or solid food)
AFTER 11:30 ON [**2198-1-5**] (THE DAY OF THE CAT-SCAN). Call
[**Telephone/Fax (1) 34688**] for details.

Please follow-up with Dr. [**Last Name (STitle) 410**] in [**3-16**] weeks [**Telephone/Fax (1) 2660**].
{'Acute pancreatitis,Gastroesophageal laceration-hemorrhage syndrome,Other and unspecified alcohol dependence, continuous,Cocaine dependence, continuous,Unspecified viral hepatitis C without hepatic coma'}


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: pancreatitis, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear

PRESENT ILLNESS: 56 year old male with a history of HCV ([**3-15**] IVDU; last biopsy
[**5-/2196**] with portal fibrosis, no viral load or genotype on file),
chronic pancreatitis, alcoholism, CAD, presented initially on
[**12-24**] with abdominal pain, elevated lipase, consistent with
acute exacerbation of his chronic pancreatitis, secondary to
recent alcohol use. Of note, on admission, he reported one
episode sometime the week prior to admission of hematemesis
(coffee-grounds, dark brown). On day prior to admission, had
non-bilious, non-bloody vomitus x1, one episode of yellowish
diarrhea, no melena or hematochezia. He admitted to [**6-16**] drinks
day prior to admission, last drink at 6 PM on day prior to
admission. CT abdomen [**12-24**] demonstrated new 31 x 23mm soft
tissue density peripherally enhancing mass extending
superiorally off the pancreatic tail; Mild surrounding soft
tissue stranding c/w recurrent or residual pancreatitis;
cholelithiasis; fatty liver. He was placed on bowel rest, pain
control, CIWA scale for alcohol withdrawal. On day after
admission, had an episode of hematemesis (bright red blood and
clots), remained hemodynamically stable throughout, but was
transferred to MICU for emergent EGD, which demonstrated [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tear with stigmata of recent bleed (clot). Hematocrit
remained stable at 35-40 throughout. The area of erythema and
bleeding was injected with epinephrine without residual bleed.
Subsequently, remained stable without further episodes of
hematemesis or fall in hematocrit. Per GI, will follow-up with
repeat abdominal CT on [**1-1**] for re-evaluation of suspected
pancreatic pseudocyst.

MEDICAL HISTORY: 1.)ETOH abuse
2.)HCV
3.)Frequent episodes of pancreatitis related to etoh abuse
4.)CAD with [**2195**] MIBI showing mod partially reversible defect in
LAD region
5.)Osteoarthritis
6.)s/p colectomy for ?SBO/bowel perforation, done at [**Hospital1 112**]

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.1  P: 73  BP:  162/73  R: 16  O2 sat 98% on RA
Gen: fatigued male in NAD, NGT in place
HEENT: pink conjunctiva, sclerae anicteric, MM dry
Neck: no jvd
CV: RRR S1 S2.
Pulm: CTAB, crackles at bases that cleared with repeat
respirations.
Abd: +bs.  Soft. TTP in epigastric region with mild voluntary
guarding, no rebound . Non-distended.  Liver edge palpable at
3cm below costal margin.
Ext: WWP. No edema. 2+ DP/PT pulses bilaterally
Neuro: A&Ox3

FAMILY HISTORY: Dad with ETOH cirrhosis, uncle with Diabetes, Mom with MI at 72.

SOCIAL HISTORY: ETOH: 5 beers and 3 shots every night, Tob: 1/2ppd since age 16,
Drugs: +ivdu, none since [**60**], +cocaine and marijuana but none
since 7 months. 

### Response:
{'Acute pancreatitis,Gastroesophageal laceration-hemorrhage syndrome,Other and unspecified alcohol dependence, continuous,Cocaine dependence, continuous,Unspecified viral hepatitis C without hepatic coma'}
