CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 84 yo M w/ PMH of CHF, afib, LGIB, gastric ulcer s/p clipping,
gallstone pancreatitis and cholecystitis p/w abd pain, elevated
amylase/lipase and GNR bacteremia for ERCP from OSH in NH. Pt.
was initially admitted in early [**Month (only) **] to the OSH with
abdominal pain and diagnosed with cholecystitis and gallstone
pancreatitis. He reportedly had an NSTEMI during this episode
and so was only treated with antibiotics as surgery was too
risky. He was also admitted in [**Month (only) **] w/ GIB and had gastric
ulcer clipped. Most recently, he was watching a red sox game on
[**5-21**] when he began having abdominal pain then nausea and
vomitting. He had some blood in his emesis but at OSH his Hct
remained stable and his vomiting resolved. His amylase and
lipase were elevated in the 1000 range and his LFTs and Tbili/AP
were elevated as well. He was tachycardic and moderately
hypotense to 96/67. He was planned for MRCP but this was not
done given recent ulcer clipping w/ metal clip and he was
transfered to [**Hospital1 18**] for ERCP and close monitoring from the ICU
at St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], NH.
.
On presentation to the ICU, he continued to complain of
abdominal pain which he says was only improved with dilaudid but
returns to the same baseline pain in between doses.  He was
immediately taken for ERCP where stone fragments with frank pus
were drained.

MEDICAL HISTORY: Atrial fibrillation off coumadin [**3-18**] GIB
CHF
AAA s/p remote repair
COPD emphysema on Home O2 2L
Bladder CA s/p surgery and BCG
PVD s/p fem-[**Doctor Last Name **]
Cholecystitis
Gallstone pancreatitis
CAD
Duodenal AVM s/p large bleed
Spinal stenosis
Prinzmetal angina
Sleep apnea
Urosepsis

MEDICATION ON ADMISSION: Home
ocuvite 2tabs daily
Omeprazole 20mg daily
isosorbide dinitrate 20mg [**Hospital1 **]
Simvastatin 40mg daily
doxazosin 2mg QHS
Metoprolol tartrate 25mg [**Hospital1 **]
Furosemide 40mg daily
spironolactone 25mg Daily
nitroquick 0.4mg PRN
.
On transfer
Pip/tazo 2.25g Q6hours day 1=[**5-23**]
Pantoprazole 40mg IV daily
ondansetron 4mg Q6 PRN
Hydromorphone 0.5-1mg Q4PRN
Metoprolol 2.5mg IV Q8hours
Metronidazole 500mg Q12 hours
Heparin SC Q12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - Temp 96.6F, BP 104/81, HR 117, R 20, O2-sat 94% 4l
GENERAL - well-appearing man in NAD, comfortable, appropriate
HEENT - sclerae anicteric, MM dry
NECK - JVD to Ear lobe
LUNGS - Decreased breath sounds diffusely. Crackles half way up
the back.
HEART - Irregular rhythm, II/VI systolic murmur
ABDOMEN - BS+, soft, moderately tender in LUQ and LLQ but not in
RUQ. Midline well healed laparotomy scar.
EXTREMITIES - DP and PT pulses not palpable, warm/WP, 1+ pedal
edema
SKIN - no rashes or lesions
NEURO - awake, A&Ox3, appropriately conversant

FAMILY HISTORY: Father died of CAD at age 47
Mother had breast CA

SOCIAL HISTORY: Lives at home w/ wife and oldest daughter. Quit smoking in [**2152**]
but had smoked 52yrs x 2.5PPD. Previous heavy ETOH, but only
occasional now.
Bacteremia,Acute pancreatitis,Chronic systolic heart failure,Obstructive chronic bronchitis with (acute) exacerbation,Prinzmetal angina,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified sleep apnea,Spinal stenosis, unspecified region
Bacteremia,Acute pancreatitis,Chr systolic hrt failure,Obs chr bronc w(ac) exac,Prinzmetal angina,Cholelithiasis NOS,Atrial fibrillation,Crnry athrscl natve vssl,Old myocardial infarct,Stomach ulcer NOS,Sleep apnea NOS,Spinal stenosis NOS
Admission Date:  [**2165-5-24**]              Discharge Date:   [**2165-5-28**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9853**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
ERCP

History of Present Illness:
84 yo M w/ PMH of CHF, afib, LGIB, gastric ulcer s/p clipping,
gallstone pancreatitis and cholecystitis p/w abd pain, elevated
amylase/lipase and GNR bacteremia for ERCP from OSH in NH. Pt.
was initially admitted in early [**Month (only) **] to the OSH with
abdominal pain and diagnosed with cholecystitis and gallstone
pancreatitis. He reportedly had an NSTEMI during this episode
and so was only treated with antibiotics as surgery was too
risky. He was also admitted in [**Month (only) **] w/ GIB and had gastric
ulcer clipped. Most recently, he was watching a red sox game on
[**5-21**] when he began having abdominal pain then nausea and
vomitting. He had some blood in his emesis but at OSH his Hct
remained stable and his vomiting resolved. His amylase and
lipase were elevated in the 1000 range and his LFTs and Tbili/AP
were elevated as well. He was tachycardic and moderately
hypotense to 96/67. He was planned for MRCP but this was not
done given recent ulcer clipping w/ metal clip and he was
transfered to [**Hospital1 18**] for ERCP and close monitoring from the ICU
at St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], NH.
.
On presentation to the ICU, he continued to complain of
abdominal pain which he says was only improved with dilaudid but
returns to the same baseline pain in between doses.  He was
immediately taken for ERCP where stone fragments with frank pus
were drained.


Past Medical History:
Atrial fibrillation off coumadin [**3-18**] GIB
CHF
AAA s/p remote repair
COPD emphysema on Home O2 2L
Bladder CA s/p surgery and BCG
PVD s/p fem-[**Doctor Last Name **]
Cholecystitis
Gallstone pancreatitis
CAD
Duodenal AVM s/p large bleed
Spinal stenosis
Prinzmetal angina
Sleep apnea
Urosepsis


Social History:
Lives at home w/ wife and oldest daughter. Quit smoking in [**2152**]
but had smoked 52yrs x 2.5PPD. Previous heavy ETOH, but only
occasional now.

Family History:
Father died of CAD at age 47
Mother had breast CA


Physical Exam:
VS - Temp 96.6F, BP 104/81, HR 117, R 20, O2-sat 94% 4l
GENERAL - well-appearing man in NAD, comfortable, appropriate
HEENT - sclerae anicteric, MM dry
NECK - JVD to Ear lobe
LUNGS - Decreased breath sounds diffusely. Crackles half way up
the back.
HEART - Irregular rhythm, II/VI systolic murmur
ABDOMEN - BS+, soft, moderately tender in LUQ and LLQ but not in
RUQ. Midline well healed laparotomy scar.
EXTREMITIES - DP and PT pulses not palpable, warm/WP, 1+ pedal
edema
SKIN - no rashes or lesions
NEURO - awake, A&Ox3, appropriately conversant


Pertinent Results:
[**2165-5-24**] ERCP
Normal major papilla
Cannulation of the biliary duct was successful and deep with a
sphincterotome using a free-hand technique
Contrast medium was injected resulting in complete opacification
of the biliary tree. There were few filling defects that
appeared like sludge at the lower third of the common bile duct.
A sphincterotomy was performed in the 12 o'clock position using
a sphincterotome over an existing guidewire
Sludge, few small stone fragments, and purulent bile in small
amount were extracted successfully using a 8.5 mm balloon.
Successful placement of a 10Fr 9cm biliary stent.
Otherwise, the caliber and course of the the common bile duct,
common hepatic duct, right and left hepatic ducts, and
intrahepatic bile ducts were normal.
Normal limited pancreatogram

[**2165-5-24**] AP CXR:
IMPRESSION: AP chest reviewed in the absence of prior chest
radiographs:
Lungs are clear, heart top normal size, and pulmonary
mediastinal vasculature engorged. Pleural effusion is minimal if
any. No pneumothorax.

[**2165-5-24**] 05:52PM   GLUCOSE-72 UREA N-21* CREAT-1.3* SODIUM-139
POTASSIUM-4.4 CHLORIDE-109* TOTAL CO2-22 ANION GAP-12
ALT(SGPT)-132* AST(SGOT)-81* LD(LDH)-163 ALK PHOS-247*
AMYLASE-447* TOT BILI-2.0* LIPASE-773*  ALBUMIN-3.0*
CALCIUM-7.7* PHOSPHATE-3.0 MAGNESIUM-2.2  NEUTS-84.6*
LYMPHS-7.8* MONOS-2.5 EOS-5.0* BASOS-0.1PLT COUNT-226  PT-17.4*
PTT-37.2* INR(PT)-1.6*

Brief Hospital Course:
84 yo M w/ CHF, Afib not anticoagulated, known cholelithiasis,
presents from OSH with gallstone pancreatitis and pansensitive
E.coli bactermia for ERCP.

#. E.coli bacteremia: Patient remained hemodynamically stable
throughout hospital course with good urine output. Given history
of known CHF he was carefully given IV fluid support and his
home lasix dose was initially held. OSH cultures from blood grew
E.coli pan sensative and he was switched from Zosyn to
ciprofloxacin on hospital day #2. He will finish a 14-day course
(last day [**6-5**]). Surveillance blood cultures were negative as of
day of discharge. He will follow up with ERCP in 6 weeks for
stent removal. The recommendation of the ERCP team that he be
considered for early cholecystectomy was discussed with the PCP
by both the [**Hospital Unit Name 153**] team and hospitalist, and the PCP prefers to
hold off for now given his significant cardiovascular and
pulmonary comorbidities.

#Gallstone pancreatitis s/p ERCP: Pus drained from bile ducts
with sphincterotomy and stent placement. Patient improved
clinically and was advanced to regular diet without difficulty.
He will follow up with the ERCP team in 6 weeks for stent
removal.

#. Hx of GIB: Hct stable on admission but then began to trend
downward after recieving fluids, did not have any s/s of GIB and
his Hct eventually trended back towards the value at admission.

#. CHF/CAD: Appeared mildly volume overloaded on admission, but
given borderline BP in setting known bacteremia home lasix was
held and IVF given prn. As he recovered, spironolactone, then
lasix were resumed. Given brisk diuresis on home lasix and
increased dose of metoprolol, Lasix was decreased to 20mg daily
to allow blood pressure room. Continued on BB, imdur, statin,
not on aspirin at home [**3-18**] GI bleed; restarting coumadin as
below but would observe on this before adding ASA (can be done
as outpatient).
.
#. Afib: Afib: Presented from OSH in RVR. Controlled with one
dose of IV metoprolol 5mg. He was continued on PO metoprolol for
rate control and increased on hospital day #3 due to persistent
heart rate in the 130s, likely related to increased activity on
transfer to the medical floor (now walking independently, out of
bed). His metoprolol was titrated up to 75mg [**Hospital1 **] with good
effect. He remained asymptomatic throughout all tachycardic
episodes. His PCP has been holding coumadin given recent GI
bleed but had planned to restart this on [**5-27**], so he was started
on 2mg warfarin daily, to be followed by his PCP (discussed with
PCP)


Medications on Admission:
Home
ocuvite 2tabs daily
Omeprazole 20mg daily
isosorbide dinitrate 20mg [**Hospital1 **]
Simvastatin 40mg daily
doxazosin 2mg QHS
Metoprolol tartrate 25mg [**Hospital1 **]
Furosemide 40mg daily
spironolactone 25mg Daily
nitroquick 0.4mg PRN
.
On transfer
Pip/tazo 2.25g Q6hours day 1=[**5-23**]
Pantoprazole 40mg IV daily
ondansetron 4mg Q6 PRN
Hydromorphone 0.5-1mg Q4PRN
Metoprolol 2.5mg IV Q8hours
Metronidazole 500mg Q12 hours
Heparin SC Q12


Discharge Medications:
1. Outpatient Lab Work
INR check on [**2165-5-29**], please fax results to Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) **]
office (phone # [**Telephone/Fax (1) 82541**]) per standing order.
2. Ocuvite 1,000-60-2 unit-unit-mg Tablet Sig: Two (2) Tablet PO
once a day.
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

7. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. NitroQuick 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual q5min up to three times.
11. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
12. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 8 days.
Disp:*16 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 8117**] Home Health and Hospice

Discharge Diagnosis:
Primary: gallstone pancreatitis, atrial fibrillation
Secondary: coronary artery disease, chronic systolic heart
failure


Discharge Condition:
good, stable, ambulating independently


Discharge Instructions:
You were transferred for an ERCP for gallstone pancreatitis and
your abdominal pain improved. You should continue to take
antibiotics as directed. You had a very fast heart rate
afterwards that may have been partially due to the infection,
and your metoprolol dose was increased.

If you have lightheadedness, chest pain, shortness of breath,
episodes of loss of consciousness, fevers, chills, abdominal
pain, or any other concerning symptoms, call your doctor or seek
medical attention immediately.

Followup Instructions:
Dr.[**Name (NI) 2798**] office will call you to schedule a follow up ERCP
for stent removal in [**5-20**] weeks. If you do not hear from them,
you can call them at ([**Telephone/Fax (1) 10532**].

You should follow up with your primary care physician [**Name Initial (PRE) 176**] 1
week; call Dr.[**Name (NI) 82542**] office at [**Telephone/Fax (1) 82541**] to make an
appointment.

You should have your INR checked tomorrow. Have your labs drawn
as per your prior routine and Dr.[**Name (NI) 82542**] office will call you
with any changes to your coumadin dose.
{'Bacteremia,Acute pancreatitis,Chronic systolic heart failure,Obstructive chronic bronchitis with (acute) exacerbation,Prinzmetal angina,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified sleep apnea,Spinal stenosis, unspecified region'}


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

PRESENT ILLNESS: 84 yo M w/ PMH of CHF, afib, LGIB, gastric ulcer s/p clipping,
gallstone pancreatitis and cholecystitis p/w abd pain, elevated
amylase/lipase and GNR bacteremia for ERCP from OSH in NH. Pt.
was initially admitted in early [**Month (only) **] to the OSH with
abdominal pain and diagnosed with cholecystitis and gallstone
pancreatitis. He reportedly had an NSTEMI during this episode
and so was only treated with antibiotics as surgery was too
risky. He was also admitted in [**Month (only) **] w/ GIB and had gastric
ulcer clipped. Most recently, he was watching a red sox game on
[**5-21**] when he began having abdominal pain then nausea and
vomitting. He had some blood in his emesis but at OSH his Hct
remained stable and his vomiting resolved. His amylase and
lipase were elevated in the 1000 range and his LFTs and Tbili/AP
were elevated as well. He was tachycardic and moderately
hypotense to 96/67. He was planned for MRCP but this was not
done given recent ulcer clipping w/ metal clip and he was
transfered to [**Hospital1 18**] for ERCP and close monitoring from the ICU
at St. [**Hospital 11042**] Hospital in [**Location (un) 8117**], NH.
.
On presentation to the ICU, he continued to complain of
abdominal pain which he says was only improved with dilaudid but
returns to the same baseline pain in between doses.  He was
immediately taken for ERCP where stone fragments with frank pus
were drained.

MEDICAL HISTORY: Atrial fibrillation off coumadin [**3-18**] GIB
CHF
AAA s/p remote repair
COPD emphysema on Home O2 2L
Bladder CA s/p surgery and BCG
PVD s/p fem-[**Doctor Last Name **]
Cholecystitis
Gallstone pancreatitis
CAD
Duodenal AVM s/p large bleed
Spinal stenosis
Prinzmetal angina
Sleep apnea
Urosepsis

MEDICATION ON ADMISSION: Home
ocuvite 2tabs daily
Omeprazole 20mg daily
isosorbide dinitrate 20mg [**Hospital1 **]
Simvastatin 40mg daily
doxazosin 2mg QHS
Metoprolol tartrate 25mg [**Hospital1 **]
Furosemide 40mg daily
spironolactone 25mg Daily
nitroquick 0.4mg PRN
.
On transfer
Pip/tazo 2.25g Q6hours day 1=[**5-23**]
Pantoprazole 40mg IV daily
ondansetron 4mg Q6 PRN
Hydromorphone 0.5-1mg Q4PRN
Metoprolol 2.5mg IV Q8hours
Metronidazole 500mg Q12 hours
Heparin SC Q12

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - Temp 96.6F, BP 104/81, HR 117, R 20, O2-sat 94% 4l
GENERAL - well-appearing man in NAD, comfortable, appropriate
HEENT - sclerae anicteric, MM dry
NECK - JVD to Ear lobe
LUNGS - Decreased breath sounds diffusely. Crackles half way up
the back.
HEART - Irregular rhythm, II/VI systolic murmur
ABDOMEN - BS+, soft, moderately tender in LUQ and LLQ but not in
RUQ. Midline well healed laparotomy scar.
EXTREMITIES - DP and PT pulses not palpable, warm/WP, 1+ pedal
edema
SKIN - no rashes or lesions
NEURO - awake, A&Ox3, appropriately conversant

FAMILY HISTORY: Father died of CAD at age 47
Mother had breast CA

SOCIAL HISTORY: Lives at home w/ wife and oldest daughter. Quit smoking in [**2152**]
but had smoked 52yrs x 2.5PPD. Previous heavy ETOH, but only
occasional now. 

### Response:
{'Bacteremia,Acute pancreatitis,Chronic systolic heart failure,Obstructive chronic bronchitis with (acute) exacerbation,Prinzmetal angina,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified sleep apnea,Spinal stenosis, unspecified region'}
