CHIEF COMPLAINT: 50M w/ulcerative colitis s/p proctocolectomy and diverting
ileostomy seven days prior to admission transferred from an OSH
with abd pain, nausea, emesis.

PRESENT ILLNESS: Following admission to an outside hospital, he was extensively
fluid resuscitated, intubated due to respiratory distress,
required vasopressor support, transfused 2 units of RBC for a
Hct of 21.1, started on TPN and started on IV antibiotics Invanz
and flagyl.

MEDICAL HISTORY: Ulcerative colitis, osteoporosis, polyps, depression

MEDICATION ON ADMISSION: Prednisone 30 qd
Protonix 40 qd
percocet prn
fosamax
zoloft 50 qhs

ALLERGIES: Lorazepam

PHYSICAL EXAM: On admission
T 98.5  HR 73  BP 96/59  RR 14  on CMV 0.4  500x12(5) Peep 5
sats 100%
on vaso 2.4, propofol 20
Gen - intubated, sedated, ETT, OGT in place
Card - RRR
Pulm - Coarse bilaterally
Abd - soft, mild distention, hypoactive bowel sounds, non tender
Abdominal wound - healing, clean base, no surrounding erythema.
Ileostomy with large amount of green stool, guiaic negative

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory
Other postoperative infection,Other septicemia due to gram-negative organisms,Severe sepsis,Acute respiratory failure,Cellulitis and abscess of trunk,Hyperosmolality and/or hypernatremia,Ulcerative colitis, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Attention to ileostomy,Leukocytosis, unspecified,Essential thrombocythemia,Retention of urine, unspecified
Other postop infection,Gram-neg septicemia NEC,Severe sepsis,Acute respiratry failure,Cellulitis of trunk,Hyperosmolality,Ulceratve colitis unspcf,Abn react-procedure NOS,Atten to ileostomy,Leukocytosis NOS,Essntial thrombocythemia,Retention urine NOS
Admission Date:  [**2185-5-2**]              Discharge Date:   [**2185-5-15**]

Date of Birth:  [**2134-10-26**]             Sex:   M

Service: SURGERY

Allergies:
Lorazepam

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
50M w/ulcerative colitis s/p proctocolectomy and diverting
ileostomy seven days prior to admission transferred from an OSH
with abd pain, nausea, emesis.

Major Surgical or Invasive Procedure:
[**5-3**] percutaneous drain placement

History of Present Illness:
Following admission to an outside hospital, he was extensively
fluid resuscitated, intubated due to respiratory distress,
required vasopressor support, transfused 2 units of RBC for a
Hct of 21.1, started on TPN and started on IV antibiotics Invanz
and flagyl.

Past Medical History:
Ulcerative colitis, osteoporosis, polyps, depression

Social History:
non-contributory


Family History:
non-contributory

Physical Exam:
On admission
T 98.5  HR 73  BP 96/59  RR 14  on CMV 0.4  500x12(5) Peep 5
sats 100%
on vaso 2.4, propofol 20
Gen - intubated, sedated, ETT, OGT in place
Card - RRR
Pulm - Coarse bilaterally
Abd - soft, mild distention, hypoactive bowel sounds, non tender
Abdominal wound - healing, clean base, no surrounding erythema.
Ileostomy with large amount of green stool, guiaic negative

Pertinent Results:
[**5-3**]
CT-GUIDED DRAINAGE:

Outside CT of the abdomen and pelvis was not available at time
of the procedure. Therefore, a contrast-enhanced CT of the
abdomen and pelvis was obtained prior to the procedure with
administration of 130 cc of Optiray.

CT demonstrates moderate amount of fluid in the abdomen and
pelvis, without definite loculated components or focal
abscesses. There is no evidence of bowel obstruction. This
patient is status post colectomy. There is a right anterior
abdominal wall ileostomy. Small amount of gas is present in the
anterior abdominal wall, compatible with recent postoperative
state.

The liver is normal in size contour. Note is made of multiple
hypoenhancing liver lesions, some of which are compatible with
simple cysts, the rest are too small to be accurately
characterized. The gallbladder is mildly distended and contains
hyperdense material, likely reflecting vicarious excretion of
contrast.

The spleen is enlarged and measures 14 cm in AP dimension. A 1.6
cm splenule is seen medial to the splenic hilum. The pancreas,
adrenals, and kidneys are unremarkable. The urinary bladder
contains a Foley catheter and is unremarkable. The portal vein
is patent.

Using CT fluoroscopy for guidance, an 8 French catheter was
placed into the pelvis into the largest fluid pocket utilizing
Seldinger technique via the left transabdominal approach. After
satisfactory position of the catheter was confirmed,
approximately 70 cc of yellow minimally cloudy fluid was
aspirated. A sample was sent for culture and stain. The catheter
was secured to the skin by percutaneous catheter fasteners,
connected to a drainage bag, and left to open drainage. Catheter
care discussed with the surgical resident.

The patient tolerated the procedure well. No immediate
complications occurred.Radiology attending, Dr. [**Last Name (STitle) 4401**],was
present and supervised the entire procedure.

IMPRESSION: Successful CT-guided drainage catheter placement.
Fluid sample sent for culture and stain.

[**5-8**]
CT Fluoroscopy was used to guide insertion of a 19-gauge guiding
needle via the transabdominal approach. However, CT fluoroscopy
images obtained during the procedure to confirm location of the
guiding needle demonstrated significant rapid shift of fluid
within the pelvis with only minimal amount of fluid remaining in
the initially targeted left lower quadrant pocket. Following
this, the patient was repositioned twice to achieve better
accumulation of fluid in the left lower quadrant. However,
despite these attempts, very minimal amount of fluid was seen
most of which was interdigitating between bowel loops .
Therefore, percutaneous drainage of this free flowing fluid was
deemed unsafe and therefore was not performed.

IMPRESSION: CT-guided drainage was not performed as fluid
demonstrated continuous shifting during the procedure which
rendered percutaneous catheter placement unsafe at this time.

[**5-9**]
COMPARISON: CT of the abdomen and pelvis [**2185-5-8**].
Limited images through the lung bases demonstrate a moderate
left pleural effusion and trace amount of right pleural fluid.
There is bibasilar subsegmental atelectasis.

The liver is normal in size and contour. There is no
intrahepatic or extrahepatic biliary dilatation. Multiple liver
cysts are identified and additional smaller subcentimeter
hepatic hypodensities that are too small to characterize. The
gallbladder is unremarkable. The portal vein is patent. The
spleen is mildly enlarged and measures approximately 14 cm in AP
dimension. The adrenal glands are within normal limits. The
kidneys enhance symmetrically. There is no hydronephrosis. The
patient is status post total colectomy, and ileal pouch to anal
anastomosis. There is a right anterior abdominal wall ileostomy.

As before, note is made of a gap in the suture line of ileal
pouch that measures approximately 11 mm on axial images and 3 cm
on the coronal images (series 4, image 33). This gap allows
direct communication of the lumen of the ileal pouch with the
pelvic fluid collection. Overall, there has been no significant
interval change in amount of intra-abdominal fluid and
peritoneal enhancement. No definite focal loculated fluid
collections are identified. There is no evidence of gas within
the intra- abdominal fluid. The small bowel is normal in
caliber. There is no evidence of bowel obstruction. There is no
evidence of bowel pneumatosis.
The urinary bladder is unremarkable. There is a Foley catheter
in place.
BONE WINDOWS: No suspicious lytic or sclerotic lesions are
identified. There is a healing fracture of the posterior tenth
rib.

IMPRESSION:

1. No significant interval change in the amount of
intraperitoneal fluid.
No definite loculated fluid collections are identified. There is
no evidence of gas within the intraperitoneal fluid.
2. Gap within the right wall of the ileal pouch that directly
communicates with the free pelvic fluid.
3. Moderate left pleural effusion and tiny right pleural
effusion.

[**2185-5-3**] 5:00 pm FLUID,OTHER     Site: ABDOMEN      ABDOMINAL
FLUID.
                            **FINAL REPORT [**2185-5-9**]**
   GRAM STAIN (Final [**2185-5-3**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

   FLUID CULTURE (Final [**2185-5-6**]):
      LACTOBACILLUS SPECIES.    SPARSE GROWTH.

[**2185-5-10**] 9:03 pm STOOL     CONSISTENCY: NOT APPLICABLE
      Source: Stool.
                            **FINAL REPORT [**2185-5-13**]**
   FECAL CULTURE (Final [**2185-5-13**]):
      NO ENTERIC GRAM NEGATIVE RODS FOUND.
      NO SALMONELLA OR SHIGELLA FOUND.
   CAMPYLOBACTER CULTURE (Final [**2185-5-12**]):    NO CAMPYLOBACTER
FOUND.
   OVA + PARASITES (Final [**2185-5-11**]):
      NO OVA AND PARASITES SEEN.
   CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2185-5-11**]):
      FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA.


Brief Hospital Course:
The patient was admitted to the ICU for continued close
monitoring.  He remained intubated, on pressor support,
continued TPN and broad spectrum antibiotics (ampicillin,
ciprofloxacin, flagyl).

[**5-3**] pressors weaned off, a CT abdomen was performed which
demonstrated moderate amount of fluid in the abdomen and pelvis,
without definite loculated components or focal abscesses.  A
catheter was placed and drained approximately 70 cc of yellow
minimally cloudy fluid.

[**5-4**] Ventilator settings weaned and patient extubated without
difficulty.

[**5-5**] Diet advanced as tolerated from sips to clears to regular
diet.  Foley and central venous line discontinued.  Transferred
to the floor for continued monitoring.

[**5-6**] - cont to encourage diet, ambulation, PO pain medication as
needed

[**5-7**] - ostomy/wound care nurse [**First Name (Titles) **] [**Last Name (Titles) 2742**] of patient,
started replacing ostomy output 1:1 with LR for high output.
Antibiotics discontinued, abdominal drain discontinued.

[**5-8**] - repeat CT scan abdomen demonstrating increase in the
amount of
intraperitoneal fluid and prominent peritoneal enhancement not
not ammenable to drainage.  Started on vanc/zosyn.  Ensure
supplements added TID for nutrtional support.

[**5-9**] - repeat CT scan showing no significant interval change in
the amount of intraperitoneal fluid.  No definite loculated
fluid collections are identified. There is no evidence of gas
within the intraperitoneal fluid. ID was consulted, they
recommended adding caspofungin to the above regimen.  Physical
therapy began working with the patient to aid in ambulating and
strength exercises.  PICC line placed for IV antibiotic and TPN.

[**5-10**] - [**5-13**] continued antibiotics, encouraging PO intake, ostomy
output replacement and TPN. Flomax started and foley catheter
removed at midnight and the patient voided.

[**5-13**] - caspofungin discontinued, started on fluconazole

[**5-15**] Repeat CT scan demonstrating marked decrease in abdominal
fluid collection.  The patient will be discharged home with VNA
set up for further home IV antibiotic treatment.

Medications on Admission:
Prednisone 30 qd
Protonix 40 qd
percocet prn
fosamax
zoloft 50 qhs

Discharge Medications:
1. Fluconazole in Saline(Iso-osm) 400 mg/200 mL Piggyback Sig:
One (1)  Intravenous once a day for 2 weeks.
Disp:*14 * Refills:*0*
2. Ertapenem 1 gram Recon Soln Sig: One (1)  Intravenous once a
day for 2 weeks.
Disp:*14 * Refills:*0*
3. PICC Line care
Picc line care per NEHT protocol.
4. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO q 3 hours as needed
for pain.
Disp:*75 Tablet(s)* Refills:*0*
5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2*
6. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Sertraline 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
8. Loperamide 2 mg Capsule Sig: One (1) Capsule PO TID (3 times
a day).
Disp:*90 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **]

Discharge Diagnosis:
Abdominal fluid collection


Discharge Condition:
Good


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or becoming
progressively worse, or inadequately controlled with the
prescribed pain medication.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.

Incision Care:
*You may shower. Pat incision dry.
*Avoid swimming and baths until further instruction at your
followup appointment.
*Leave the steri-strips on. They will fall off on their own, or
be removed during your followup.
*Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.

JP Drain Care:
*Please look at the site every day for signs of infection
(increased redness, swelling, tenderness, odorous or purulent
discharge).
*Maintain the bulb deflated to provide adequate suction.
*Note color, consistency, and amount of fluid in drain. Call
doctor if amount increases significantly or changes in
character.
*Be sure to empty the drain frequently and record the output.
*Maintain the site clean, dry, and intact.
*Keep drain attached safely to body to prevent pulling and
possible dislodgement.

Monitoring Ostomy Output / Prevention of Dehydration:
*Keep well hydrated.
*Replace fluid loss from ostomy daily.
*Avoid only drinking plain water. Include Gatorade and/or other
vitamin drinks to replace fluid.
*Try to maintain ostomy output between 500mL to 1000mL per day.
*If Ostomy output exceeds 1 liter, take 4mg of Imodium, repeat
2mg with each episode of loose stool. Do not exceed 16mg in 24
hours.


Followup Instructions:
Please call the office of Dr. [**Last Name (STitle) 1120**] to make a follow up
appointment in [**1-16**] weeks at [**Telephone/Fax (1) 29433**]

Please call the office of Dr. [**Last Name (STitle) 7443**] to make a follow up
appointment at ([**Telephone/Fax (1) 4170**].  You should have weekly CBC,
BUN/Creatinine, LFTs performed and faxed to Dr. [**Last Name (STitle) 7443**] at
[**Telephone/Fax (1) 432**]
{'Other postoperative infection,Other septicemia due to gram-negative organisms,Severe sepsis,Acute respiratory failure,Cellulitis and abscess of trunk,Hyperosmolality and/or hypernatremia,Ulcerative colitis, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Attention to ileostomy,Leukocytosis, unspecified,Essential thrombocythemia,Retention of urine, unspecified'}


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: 50M w/ulcerative colitis s/p proctocolectomy and diverting
ileostomy seven days prior to admission transferred from an OSH
with abd pain, nausea, emesis.

PRESENT ILLNESS: Following admission to an outside hospital, he was extensively
fluid resuscitated, intubated due to respiratory distress,
required vasopressor support, transfused 2 units of RBC for a
Hct of 21.1, started on TPN and started on IV antibiotics Invanz
and flagyl.

MEDICAL HISTORY: Ulcerative colitis, osteoporosis, polyps, depression

MEDICATION ON ADMISSION: Prednisone 30 qd
Protonix 40 qd
percocet prn
fosamax
zoloft 50 qhs

ALLERGIES: Lorazepam

PHYSICAL EXAM: On admission
T 98.5  HR 73  BP 96/59  RR 14  on CMV 0.4  500x12(5) Peep 5
sats 100%
on vaso 2.4, propofol 20
Gen - intubated, sedated, ETT, OGT in place
Card - RRR
Pulm - Coarse bilaterally
Abd - soft, mild distention, hypoactive bowel sounds, non tender
Abdominal wound - healing, clean base, no surrounding erythema.
Ileostomy with large amount of green stool, guiaic negative

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory 

### Response:
{'Other postoperative infection,Other septicemia due to gram-negative organisms,Severe sepsis,Acute respiratory failure,Cellulitis and abscess of trunk,Hyperosmolality and/or hypernatremia,Ulcerative colitis, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Attention to ileostomy,Leukocytosis, unspecified,Essential thrombocythemia,Retention of urine, unspecified'}
