CHIEF COMPLAINT: RIGHT flank pain

PRESENT ILLNESS: 67M with a history of HTN and HL. On date of admission he
developed acute R flank pain while raking leaves. He took 3 ASA
to alleviate pain with no relief. He also had one episode of
bilious emesis at home. He presented to [**Hospital3 4107**] where a
non contrast CT scan showed a right sided retroperitoneal
hematoma. He had a hypotensive episode with SBP in 60s
associated with syncope. He was then  transferred to [**Hospital1 18**] for
further management. He received 4L crystaloid en route. SBP in
110s on arrival, but patient had an episode of hematemesis.

MEDICAL HISTORY: Hypertension, HyperlipidemiaPMH: HTN, HLD
PSH: L wrist nerve repair

MEDICATION ON ADMISSION: Aspirin 81, Atenolol 50, Hctz 25 /Triamterene 37.5, Lisinopril
10, Multivitamins 1, Niaspan [**2092**] MG qHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: WdWn Caucasion male, NAD, AVSS
Abdomen soft, nt/nd, benign
No flank pain
no peripheral edema
circumcised

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No tabacco, no illicit drug use, rare alcohol
Vascular disorders of kidney,Precipitous drop in hematocrit,Hypotension, unspecified,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Unspecified essential hypertension
Renal vascular disorder,Drop, hematocrit, precip,Hypotension NOS,Hyperlipidemia NEC/NOS,Unilat inguinal hernia,Hypertension NOS
Admission Date:  [**2103-11-25**]              Discharge Date:   [**2103-11-30**]

Date of Birth:  [**2036-1-6**]             Sex:   M

Service: UROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5272**]
Chief Complaint:
RIGHT flank pain

Major Surgical or Invasive Procedure:
[**2016-11-24**] Attempted IR embolization of right renal segmenal
artery


History of Present Illness:
67M with a history of HTN and HL. On date of admission he
developed acute R flank pain while raking leaves. He took 3 ASA
to alleviate pain with no relief. He also had one episode of
bilious emesis at home. He presented to [**Hospital3 4107**] where a
non contrast CT scan showed a right sided retroperitoneal
hematoma. He had a hypotensive episode with SBP in 60s
associated with syncope. He was then  transferred to [**Hospital1 18**] for
further management. He received 4L crystaloid en route. SBP in
110s on arrival, but patient had an episode of hematemesis.

Past Medical History:
Hypertension, HyperlipidemiaPMH: HTN, HLD
PSH: L wrist nerve repair

Social History:
No tabacco, no illicit drug use, rare alcohol

Family History:
non-contributory

Physical Exam:
WdWn Caucasion male, NAD, AVSS
Abdomen soft, nt/nd, benign
No flank pain
no peripheral edema
circumcised


Pertinent Results:
CTA ABD W&W/O C & RECONS	Study Date of [**2103-11-24**] 11:09 PM
IMPRESSION:
1. Large subcapsular right renal hematoma, with two sites of
active
extravasation from the capsular arteries in the mid and upper
poles.
2. Blood products extending to the anterior pararenal space and
along the
right paracolic gutter into the pelvis.
3. Uniform but slightly delayed perfusion of the right kidney,
likely
secondary to compression of the left main renal vein.
4. Right rneal cysts, one hemorrhagic, and other lesions with
increased
density that are too msall tocharacterize. An MRU examination is
recommended
following complete resolution of acute issues, to confirm there
is no
underlying mass as the source of bleeding.

[**2103-11-29**] 06:26AM BLOOD WBC-5.9 RBC-2.92* Hgb-9.5* Hct-26.4*
MCV-91 MCH-32.5* MCHC-35.9* RDW-13.0 Plt Ct-186
[**2103-11-28**] 02:50AM BLOOD WBC-5.6 RBC-2.54* Hgb-8.3* Hct-22.5*
MCV-89 MCH-32.9* MCHC-37.1* RDW-12.4 Plt Ct-104*
[**2103-11-27**] 02:15PM BLOOD WBC-6.0 RBC-2.73* Hgb-8.9* Hct-24.3*
MCV-89 MCH-32.4* MCHC-36.5* RDW-12.2 Plt Ct-100*
[**2103-11-27**] 03:32AM BLOOD WBC-5.0 RBC-2.53* Hgb-8.1* Hct-22.5*
MCV-89 MCH-32.1* MCHC-36.2* RDW-12.3 Plt Ct-85*
[**2103-11-26**] 08:17PM BLOOD Hct-23.8*
[**2103-11-26**] 11:44AM BLOOD Hct-26.6*
[**2103-11-26**] 12:24AM BLOOD WBC-7.3 RBC-2.86* Hgb-9.0* Hct-25.8*
MCV-90 MCH-31.5 MCHC-34.9 RDW-12.3 Plt Ct-116*
[**2103-11-25**] 11:59AM BLOOD WBC-10.9 RBC-3.10* Hgb-9.8* Hct-27.9*
MCV-90 MCH-31.6 MCHC-35.2* RDW-12.3 Plt Ct-150
[**2103-11-24**] 10:16PM BLOOD WBC-14.9* RBC-4.00* Hgb-12.5* Hct-36.3*
MCV-91 MCH-31.4 MCHC-34.5 RDW-12.1 Plt Ct-16
[**2103-11-28**] 02:50AM BLOOD PT-11.8 PTT-27.4 INR(PT)-1.0

[**2103-11-28**] 02:50AM BLOOD Glucose-104* UreaN-18 Creat-1.2 Na-139
K-3.6 Cl-107 HCO3-28 AnGap-8
[**2103-11-24**] 10:16PM BLOOD Glucose-158* UreaN-24* Creat-1.5* Na-140
K-3.9 Cl-107 HCO3-22 AnGap-15

[**2103-11-28**] 02:50AM BLOOD Calcium-8.2* Phos-3.2 Mg-1.9
[**2103-11-26**] 12:24AM BLOOD Calcium-8.4 Phos-3.2 Mg-2.0

Brief Hospital Course:
67M with spontaneous right kidney bleed with active
extravasation of contrast noted on CT scan who is admitted to
Dr.[**Name (NI) 825**] service after referral/transfer from [**Hospital1 **] where he presented earlier on [**11-24**].  He was admitted
for interventional radiology plan for embolization which was
attempted. Please see the full detailed notes for further
information. Mr. [**Known lastname **] was closely monitored throughout his
hospital course for changes in his vital signs that would have
warranted immediate intervention. He was kept on telemetry and
he was transfused with packed red blood cells. Throughout his
hospital stay his pain was minimal and he remained afebrile. He
was initially monitored in the intensive care unit before
transfer to the general surgical floor. He was discharged home
on a regular diet, ambulating independently and with pain well
controlled and without other complaints to included dizziness,
lightheadedness, palpitations.  He will follow-up as advised.

Medications on Admission:
Aspirin 81, Atenolol 50, Hctz 25 /Triamterene 37.5, Lisinopril
10, Multivitamins 1, Niaspan [**2092**] MG qHS

Discharge Medications:
1. atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.
Tablet(s)
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever.
5. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q3H (every 3
hours) as needed for pain.
Disp:*25 Tablet(s)* Refills:*0*
7. triamterene-hydrochlorothiazid 37.5-25 mg Capsule Sig: One
(1) Capsule PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
R renal bleed


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


Discharge Instructions:
-No vigorous physical activity for 2 weeks.

-Tylenol should be your first line pain medication, a narcotic
pain medication has been prescribed for breakthough pain >4.
Replace Tylenol with narcotic pain medication.  Max daily
Tylenol dose is 4gm, note that narcotic pain medication also
contains Tylenol (acetaminophen)

-Do not drive or drink alcohol while taking narcotics

-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication,
discontinue if loose stool or diarrhea develops.


-Resume all of your home medications, except hold NSAID
(aspirin,  and ibuprofen containing products such as advil &
motrin,) and fish oil until you see your urologist in follow-up

-Resume all of your home medications, but please avoid
aspirin/advil for one week.

-If you have fevers > 101.5 F, vomiting, severe abdominal pain,
or inability to urinate, call your doctor or go to the nearest
emergency room.


Followup Instructions:
-Call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office  ([**Telephone/Fax (1) 7707**] &#8206;for
follow-up AND if you have any questions (page Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 770**] at [**Telephone/Fax (1) 2756**]).

-Follow up in Acute Care Surgery Clinic Phone: ([**Telephone/Fax (1) 37488**] in
one month for f/u of possible R inguinal hernia.



Completed by:[**2103-12-2**]
{'Vascular disorders of kidney,Precipitous drop in hematocrit,Hypotension, unspecified,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Unspecified essential hypertension'}


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 flank pain

PRESENT ILLNESS: 67M with a history of HTN and HL. On date of admission he
developed acute R flank pain while raking leaves. He took 3 ASA
to alleviate pain with no relief. He also had one episode of
bilious emesis at home. He presented to [**Hospital3 4107**] where a
non contrast CT scan showed a right sided retroperitoneal
hematoma. He had a hypotensive episode with SBP in 60s
associated with syncope. He was then  transferred to [**Hospital1 18**] for
further management. He received 4L crystaloid en route. SBP in
110s on arrival, but patient had an episode of hematemesis.

MEDICAL HISTORY: Hypertension, HyperlipidemiaPMH: HTN, HLD
PSH: L wrist nerve repair

MEDICATION ON ADMISSION: Aspirin 81, Atenolol 50, Hctz 25 /Triamterene 37.5, Lisinopril
10, Multivitamins 1, Niaspan [**2092**] MG qHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: WdWn Caucasion male, NAD, AVSS
Abdomen soft, nt/nd, benign
No flank pain
no peripheral edema
circumcised

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: No tabacco, no illicit drug use, rare alcohol 

### Response:
{'Vascular disorders of kidney,Precipitous drop in hematocrit,Hypotension, unspecified,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Unspecified essential hypertension'}
