CHIEF COMPLAINT: Abdominal aortic aneurysm

PRESENT ILLNESS: This is a 62-year-old woman with an 6-cm infrarenal
abdominal aortic aneurysm. It is of the size that warrants
intervention. She is not an endovascular stent graft
candidate. This was discovered on imaging studies for a recent
acetabular
fracture.  She has a family history of aneurysm with a brother
who died of rupture

MEDICAL HISTORY: PMH:
Osteoporosis
PSH:
-[**2183**] Retrograde nailing of left distal femur fracture.
-[**2183**] Dynamazation of the L femoral rod
-[**2184**] Removal of IMN. ORIF L supracondylar femoral nonunion w/
ICBG
-[**2185**] take-down of non [**Hospital1 **] internal fixation of Schatzker VI
tibial plateau fracture with allograft.
-[**2185**] [**Last Name (un) **] L proximal tibia. ORIF L tibial nonunion with 95 deg
blade plate and ICBG from right.
-[**2190**] ORIF L subtrochanteric fracture with IMN
-[**2190**] Revision of gamma nail with derotation.

MEDICATION ON ADMISSION: Atenolol 12.5', Colace 100', Fosamax 70qwk, systane eye gtts,
Claritin-prn

ALLERGIES: Codeine / Droperidol / Dilaudid

PHYSICAL EXAM: VSS: 156/60 84 10 96% 99.4
Gen: NAD
Cardiac: RRR
Lungs: CTA
ABD: soft/NT
Wound: C/D/I
Pulses: B/L DP palp, B/L PT dop

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with husband
[**Name (NI) 19041**]
[**Name (NI) 19042**]
[**Name (NI) 19043**]
Abdominal aneurysm without mention of rupture,Blood in stool,Chronic vascular insufficiency of intestine,Nausea with vomiting,Elevated blood pressure reading without diagnosis of hypertension,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Aftercare for healing traumatic fracture of other bone,Unequal leg length (acquired),Obesity, unspecified
Abdom aortic aneurysm,Blood in stool,Chr vasc insuff intest,Nausea with vomiting,Elev bl pres w/o hypertn,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Aftrce traum fx bone NEC,Unequal leg length,Obesity NOS
Admission Date:  [**2195-8-13**]              Discharge Date:   [**2195-8-19**]

Date of Birth:  [**2133-4-6**]             Sex:   F

Service: SURGERY

Allergies:
Codeine / Droperidol / Dilaudid

Attending:[**First Name3 (LF) 6088**]
Chief Complaint:
Abdominal aortic aneurysm

Major Surgical or Invasive Procedure:
[**2195-8-13**] Open repair of abdominal aortic aneurysm with 18 mm
Gelsoft tube graft.


History of Present Illness:
This is a 62-year-old woman with an 6-cm infrarenal
abdominal aortic aneurysm. It is of the size that warrants
intervention. She is not an endovascular stent graft
candidate. This was discovered on imaging studies for a recent
acetabular
fracture.  She has a family history of aneurysm with a brother
who died of rupture

Past Medical History:
PMH:
Osteoporosis
PSH:
-[**2183**] Retrograde nailing of left distal femur fracture.
-[**2183**] Dynamazation of the L femoral rod
-[**2184**] Removal of IMN. ORIF L supracondylar femoral nonunion w/
ICBG
-[**2185**] take-down of non [**Hospital1 **] internal fixation of Schatzker VI
tibial plateau fracture with allograft.
-[**2185**] [**Last Name (un) **] L proximal tibia. ORIF L tibial nonunion with 95 deg
blade plate and ICBG from right.
-[**2190**] ORIF L subtrochanteric fracture with IMN
-[**2190**] Revision of gamma nail with derotation.


Social History:
Lives with husband
[**Name (NI) 19041**]
[**Name (NI) 19042**]
[**Name (NI) 19043**]


Family History:
NC

Physical Exam:
VSS: 156/60 84 10 96% 99.4
Gen: NAD
Cardiac: RRR
Lungs: CTA
ABD: soft/NT
Wound: C/D/I
Pulses: B/L DP palp, B/L PT dop

Pertinent Results:
[**2195-8-18**] 07:35AM BLOOD WBC-5.4 RBC-3.53* Hgb-10.2* Hct-30.6*
MCV-87 MCH-29.0 MCHC-33.4 RDW-15.3 Plt Ct-189
[**2195-8-17**] 08:55AM BLOOD WBC-4.6 RBC-3.22* Hgb-9.3* Hct-28.4*
MCV-88 MCH-28.8 MCHC-32.7 RDW-15.2 Plt Ct-129*
[**2195-8-18**] 07:35AM BLOOD Plt Ct-189
[**2195-8-18**] 07:35AM BLOOD Glucose-71 UreaN-15 Creat-0.6 Na-135
K-3.9 Cl-98 HCO3-23 AnGap-18
[**2195-8-17**] 05:40PM BLOOD Glucose-85 UreaN-16 Creat-0.8 Na-135
K-3.8 Cl-97 HCO3-27 AnGap-15
[**2195-8-14**] 04:58AM BLOOD ALT-121* AST-135* CK(CPK)-195* AlkPhos-52
TotBili-0.4
[**2195-8-18**] 07:35AM BLOOD Calcium-8.4 Phos-2.9 Mg-2.1

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 19044**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 19045**]Portable TEE
(Complete) Done [**2195-8-14**] at 12:44:08 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 251**] C.
[**Hospital Unit Name 19046**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2133-4-6**]
Age (years): 62 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Hypertension. Left ventricular function.
ICD-9 Codes: 440.20
Test Information
Date/Time: [**2195-8-14**] at 12:44    Interpret MD: [**Name6 (MD) 19047**] [**Name8 (MD) 19048**], MD

Test Type: Portable TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 19048**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR non-cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW538-: Machine: IE33
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.2 cm  <= 4.0 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.8 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.0 cm
Left Ventricle - Fractional Shortening:  0.38  >= 0.29
Left Ventricle - Lateral Peak E':  *0.08 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  8  < 15
Aorta - Ascending:  3.2 cm  <= 3.4 cm
Aortic Valve - Valve Area:  3.4 cm2  >= 3.0 cm2
Mitral Valve - E Wave:  0.6 m/sec
Mitral Valve - A Wave:  0.4 m/sec
Mitral Valve - E/A ratio:  1.50
Mitral Valve - E Wave deceleration time:  167 ms  140-250 ms

Findings
62 years old for AAA repair
LEFT ATRIUM: Normal LA size. No spontaneous echo contrast in the
body of the LA. No spontaneous echo contrast is seen in the LAA.


RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. No ASD by 2D
or color Doppler. Normal IVC diameter (<2.1cm) with >55%
decrease during respiration (estimated RA pressure (0-5mmHg).

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Mild symmetric LVH with normal cavity
size and global systolic function (LVEF>55%). Overall normal
LVEF (>55%). TDI E/e' < 8, suggesting normal PCWP (<12mmHg).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Simple atheroma in ascending aorta. Normal descending
aorta diameter. Mildly dilated descending aorta. Focal
calcifications in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
Three aortic valve leaflets.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. Mild
(1+) MR. Normal LV inflow pattern for age.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
The left atrium is normal in size. No spontaneous echo contrast
is seen in the body of the left atrium. No spontaneous echo
contrast is seen in the left atrial appendage. No atrial septal
defect is seen by 2D or color Doppler. The estimated right
atrial pressure is 0-5 mmHg. There is mild symmetric left
ventricular hypertrophy with normal cavity size and global
systolic function (LVEF>55%). Overall left ventricular systolic
function is normal (LVEF>55%). Tissue Doppler imaging suggests a
normal left ventricular filling pressure (PCWP<12mmHg). Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the ascending aorta. The descending
thoracic aorta is mildly dilated. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. There are three aortic valve leaflets. The
mitral valve appears structurally normal with trivial mitral
regurgitation. Mild (1+) mitral regurgitation is seen.
  Interpretation assigned to [**Name6 (MD) 19047**] [**Name8 (MD) 19048**], MD, Interpreting
physician


?????? [**2188**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**2195-8-13**] Underwent uneventful open AAA repair. Intubated and
transfered to CVICU. Pulses intact, BP kept 100-130.
POD1- Failed extubation secondary to hypertension, vomiting.
Hydralazine and zofran given. Received fluid boluses for low
urinary output and tachycardia. Pain controlled. Large melena
output- flex sig -no ischemic mucosa. Electrolyes repleted.
POD2- Extubated. No further melena or diarrhea. Pain controlled.
OOB to chair. Incision wihtout evidence of infection. Pulses
palpable. NGT discontinued. Transfered to VICU.
POD3- VSS, low grade Tmax 100.6. Pain service following. SBP
kept between 100-140. Diet advanced. Physical therapy consulted
for likely rehab (known pelvic fracture).
POD4- VSS. swan discontinued. Diet advanced to regular.
Continued diuresis, electrolyte replacement. Foley discontinued
at midnight.
POD5- VSS. Pain controlled with Vicodin. Tolerating regular
diet. COntinue PT, plan for discharge to rehab.
POD6- Discharged to Rehab for PT and wound care. Stable on DC

Medications on Admission:
Atenolol 12.5', Colace 100', Fosamax 70qwk, systane eye gtts,
Claritin-prn

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): hold for sbp < 100, hr < 55   .
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
4. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
5. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.
6. Claritin 10 mg Tablet Sig: One (1) Tablet PO once a day as
needed for allergy symptoms.
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 745**]  Health Care Center

Discharge Diagnosis:
AAA now s/p Open repair of abdominal aortic aneurysm

PMH: 1. Osteoporosis; 2. Left femur fracture [**2183**] 3. Left
tib/fibula fracture [**2185**], 4. Left hip fracture [**Numeric Identifier 19049**]. Left leg 2
inches shorter due to multiple fractures 6. arthritis in hip
7. Recovering compulsive over eater 8. h/o hyperlipidemia
.
PSH:
s/p Retrograde nailing of left distal femur fracture [**12/2183**]
s/p Dynamazation of the left femoral rod [**9-/2184**]
s/p  Removal of retrograde, intramedullary nail, left femur;
ORIFleft supracondylar femoral nonunion with iliac crest bone
graft [**5-/2185**]
s/p  Open reduction; take-down  of  nonunion  internal  fixation
of Schatzker VI tibial plateau fracture with allograft [**3-/2186**]
s/p Removal of hardware from left proximal tibia; ORIF of left
tibial nonunion  with  a  95 degree blade plate and iliac crest
bone graft from right side. [**8-/2186**]
s/p ORIF of left subtrochanteric fracture with intramedullary
nail [**11-28**] w/revision [**11-28**]


Discharge Condition:
Stable


Discharge Instructions:
Division of Vascular and Endovascular Surgery
Abdominal Aortic Aneurysm (AAA) Surgery Discharge Instructions

What to expect when you go home:
1. It is normal to feel weak and tired, this will last for [**6-1**]
weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	You may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have incisional and leg swelling:
??????	Wear loose fitting pants/clothing (this will be less
irritating to incision)
??????	Elevate your legs above the level of your heart (use [**1-27**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	You should get up every day, get dressed and walk, gradually
increasing your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (let the soapy water run over incision, rinse
and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks for
staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your leg or the
ability to feel your leg
??????	Temperature greater than 101.5F for 24 hours
??????	Bleeding from incision
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions


Followup Instructions:
Dr [**Doctor Last Name 19050**] op visit [**Telephone/Fax (1) 2395**] Date/Time:[**2195-8-26**] 10:15

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**], MD Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2195-11-3**] 8:00
Provider: [**First Name4 (NamePattern1) 8990**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2196-1-18**]
1:30



Completed by:[**2195-8-19**]
{'Abdominal aneurysm without mention of rupture,Blood in stool,Chronic vascular insufficiency of intestine,Nausea with vomiting,Elevated blood pressure reading without diagnosis of hypertension,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Aftercare for healing traumatic fracture of other bone,Unequal leg length (acquired),Obesity, 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: Abdominal aortic aneurysm

PRESENT ILLNESS: This is a 62-year-old woman with an 6-cm infrarenal
abdominal aortic aneurysm. It is of the size that warrants
intervention. She is not an endovascular stent graft
candidate. This was discovered on imaging studies for a recent
acetabular
fracture.  She has a family history of aneurysm with a brother
who died of rupture

MEDICAL HISTORY: PMH:
Osteoporosis
PSH:
-[**2183**] Retrograde nailing of left distal femur fracture.
-[**2183**] Dynamazation of the L femoral rod
-[**2184**] Removal of IMN. ORIF L supracondylar femoral nonunion w/
ICBG
-[**2185**] take-down of non [**Hospital1 **] internal fixation of Schatzker VI
tibial plateau fracture with allograft.
-[**2185**] [**Last Name (un) **] L proximal tibia. ORIF L tibial nonunion with 95 deg
blade plate and ICBG from right.
-[**2190**] ORIF L subtrochanteric fracture with IMN
-[**2190**] Revision of gamma nail with derotation.

MEDICATION ON ADMISSION: Atenolol 12.5', Colace 100', Fosamax 70qwk, systane eye gtts,
Claritin-prn

ALLERGIES: Codeine / Droperidol / Dilaudid

PHYSICAL EXAM: VSS: 156/60 84 10 96% 99.4
Gen: NAD
Cardiac: RRR
Lungs: CTA
ABD: soft/NT
Wound: C/D/I
Pulses: B/L DP palp, B/L PT dop

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with husband
[**Name (NI) 19041**]
[**Name (NI) 19042**]
[**Name (NI) 19043**] 

### Response:
{'Abdominal aneurysm without mention of rupture,Blood in stool,Chronic vascular insufficiency of intestine,Nausea with vomiting,Elevated blood pressure reading without diagnosis of hypertension,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Aftercare for healing traumatic fracture of other bone,Unequal leg length (acquired),Obesity, unspecified'}
