CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: Mr. [**Known lastname 81329**] is a 57 M with complex medical hx including
necrotizing pancreatitis and a pancreatic pseudocyst in [**2187**],
s/p open cholecystectomy, necrosectomy and cyst-jejunostomy with
roux en y omega loop in [**2189-7-22**]
which was subsequently complicated by distal CBD stricture s/p
stenting. His postoperative course was further complicated by
chylothorax treated with talc pleurodesis which led to the
development of chylous ascites which he has removed Q 2-3 weeks
with paracentesis.  He presented earlier this year with
worsening abdominal pain and emesis, and imaging showed a
recurrent pancreatic pseudocyst.  He presents now for surgical
treatment of the pseudocyst as well as his ventral hernia.

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
1. DM2 diagnosed in [**10/2187**], on insulin.
2. Necrotizing pancreatitis, pancreatic pseudocyst, and
cholangitis that required ex-lap in [**7-/2189**], with open
cholecystectomy, pancreatic pseudocyst jejeunostomy, modified
roux-en-y and pancreatic necrosectomy. He had bilateral
chylothorax in [**10/2189**] that required pleurodesis and was
recently ([**3-/2190**]) admitted with chylous ascites that required
paracentesis.
3. History of SVT with first episode during admission of
necrotizing pancreatitis. He has had 4 episodes since [**7-/2189**],
all of them terminated by ATP or diltiazem.
4. L5 herniated disc.
5. SMV thrombosis.
6. Hx of melanoma, no recurrence.

MEDICATION ON ADMISSION: diltiazem 120', lasix 80', spironolactone 150', Lantus 25 QHS,
ISS (humalog), magnesium oxide 400'', lovenox SQ 60'' (held
[**1-3**]), dilaudid [**12-25**] Q8H prn, colace 100'', FeSO4 325''', MCT Oil
15'', Senna 8.6'' prn

ALLERGIES: Bactrim

PHYSICAL EXAM: Physical exam on discharge:
Tm 98.9, Tc 98.1, HR 79, BP 101/62, RR 20, 97% on RA
NAD, AAOx3
Chest clear to auscultation b/l
HR regular, M/G/R
Abdomen firm but flat, appropriately tender, incision C/D/I
without drainage.  LUQ [**Month/Day (3) 19843**] serosanguinous.
No clubbing/cyanosis/edema

FAMILY HISTORY: No biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company. Married twice. He
lives at home with his 4 children. He does not smoke or use
drugs. He previously drank [**3-27**] drinks per week, but has not
drunk alcohol for the past two years.
Cyst and pseudocyst of pancreas,Acute posthemorrhagic anemia,Chronic vascular insufficiency of intestine,Incisional hernia without mention of obstruction or gangrene,Long-term (current) use of insulin,Personal history of malignant melanoma of skin,Other noninfectious disorders of lymphatic channels,Other specified retention of urine,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Abnormal coagulation profile,Other diseases of spleen
Pancreat cyst/pseudocyst,Ac posthemorrhag anemia,Chr vasc insuff intest,Incisional hernia,Long-term use of insulin,Hx-malig skin melanoma,Noninfect lymph dis NEC,Oth spcf retention urine,DMII wo cmp uncntrld,Abnrml coagultion prfile,Spleen disease NEC
Admission Date:  [**2191-1-4**]              Discharge Date:   [**2191-1-15**]

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

Service: SURGERY

Allergies:
Bactrim

Attending:[**First Name3 (LF) 2869**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
 pancreaticocystojejunostomy, Component separation ,Ventral
hernia repair with mesh [**2191-1-4**]

History of Present Illness:
Mr. [**Known lastname 81329**] is a 57 M with complex medical hx including
necrotizing pancreatitis and a pancreatic pseudocyst in [**2187**],
s/p open cholecystectomy, necrosectomy and cyst-jejunostomy with
roux en y omega loop in [**2189-7-22**]
which was subsequently complicated by distal CBD stricture s/p
stenting. His postoperative course was further complicated by
chylothorax treated with talc pleurodesis which led to the
development of chylous ascites which he has removed Q 2-3 weeks
with paracentesis.  He presented earlier this year with
worsening abdominal pain and emesis, and imaging showed a
recurrent pancreatic pseudocyst.  He presents now for surgical
treatment of the pseudocyst as well as his ventral hernia.

Past Medical History:
MEDICAL & SURGICAL HISTORY:
1. DM2 diagnosed in [**10/2187**], on insulin.
2. Necrotizing pancreatitis, pancreatic pseudocyst, and
cholangitis that required ex-lap in [**7-/2189**], with open
cholecystectomy, pancreatic pseudocyst jejeunostomy, modified
roux-en-y and pancreatic necrosectomy. He had bilateral
chylothorax in [**10/2189**] that required pleurodesis and was
recently ([**3-/2190**]) admitted with chylous ascites that required
paracentesis.
3. History of SVT with first episode during admission of
necrotizing pancreatitis. He has had 4 episodes since [**7-/2189**],
all of them terminated by ATP or diltiazem.
4. L5 herniated disc.
5. SMV thrombosis.
6. Hx of melanoma, no recurrence.

Social History:
He works with a software business company. Married twice. He
lives at home with his 4 children. He does not smoke or use
drugs. He previously drank [**3-27**] drinks per week, but has not
drunk alcohol for the past two years.


Family History:
No biliary or pancreatic disease


Physical Exam:
Physical exam on discharge:
Tm 98.9, Tc 98.1, HR 79, BP 101/62, RR 20, 97% on RA
NAD, AAOx3
Chest clear to auscultation b/l
HR regular, M/G/R
Abdomen firm but flat, appropriately tender, incision C/D/I
without drainage.  LUQ [**Month/Day (3) 19843**] serosanguinous.
No clubbing/cyanosis/edema

Pertinent Results:
[**2191-1-4**] 08:39PM   WBC-23.1*# RBC-4.03* HGB-9.3* HCT-30.6*
MCV-76* MCH-23.1* MCHC-30.4* RDW-16.6*
[**2191-1-4**] 08:39PM   PLT COUNT-893*
[**2191-1-4**] 08:39PM   ALBUMIN-3.1* CALCIUM-8.2* PHOSPHATE-5.5*
MAGNESIUM-1.6
[**2191-1-4**] 08:39PM   ALT(SGPT)-26 AST(SGOT)-43* ALK PHOS-163*
AMYLASE-89 TOT BILI-0.7
[**2191-1-4**] 08:39PM   GLUCOSE-195* UREA N-21* CREAT-1.1 SODIUM-132*
POTASSIUM-5.3* CHLORIDE-102 TOTAL CO2-21* ANION GAP-14
[**2191-1-4**] 08:39PM   LIPASE-15

[**2191-1-12**] 03:07AM BLOOD PT-45.4* PTT-66.9* INR(PT)-4.5*
[**2191-1-13**] 06:20AM BLOOD PT-67.6* INR(PT)-6.8*
[**2191-1-13**] 05:50PM BLOOD PT-37.4* PTT-40.4* INR(PT)-3.7*
[**2191-1-14**] 06:25AM BLOOD PT-34.7* PTT-41.4* INR(PT)-3.4*
[**2191-1-15**] 06:55AM BLOOD PT-22.3* PTT-36.4 INR(PT)-2.1*

******[**1-14**] abdominal ultrasound:
INDICATION: 57-year-old man with pancreatitis and complicated
medical
history, evaluate for ascites.

COMPARISON: Doppler ultrasound, [**2190-12-14**].

FINDINGS: A limited evaluation of the four quadrants of the
abdomen was
performed. A trace of free fluid is seen in the left upper
quadrant. A trace
of complex loculated fluid is seen in the left lower quadrant.
No ascites is
seen in the right abdomen.

IMPRESSION: Only trace ascites seen in the abdomen.


Brief Hospital Course:
Mr. [**Known lastname 81329**] [**Last Name (Titles) 1834**] pancreatic pseudocyst-jejunostomy and
ventral hernia repair with component separation and overlay mesh
on [**2191-1-4**].  Postoperatively he was admitted briefly to the ICU
for hypotension that responded to volume as well as turning down
the epidural.  He was transferred to the floor on POD 3.  His
epidural was discontinued and his pain was eventually controlled
with PO dilaudid and a two-day course of toradol.  His foley was
replaced once for urinary retention but then removed
successfully.  He began passing flatus and was advanced to
clears and then advanced to lowfat diet.  His [**Date Range 19843**] output
remaind low and non-chylous, and an abdominal ultrasound
demonstrated only trace ascites.  [**Last Name (un) **] was consulted to manage
his blood sugars and his fingersticks were adjusted.  His
subcutaneous JP drains were removed prior to discharge, leaving
behind one intraperitoneal [**Last Name (un) 19843**]. Physical therapy was consulted
and he was cleared for discharge home.

He was started on a heparin drip and coumadin for his history of
SMV thrombosis.  However, both were held when he became
supratherapeutic to 6.8 on [**1-13**].  He received 2 units of FFP and
1 mg of PO Vit K as well, and his INR was down to 2.1 on the day
of discharge.  He will be instructed to resume Coumadin at 1mg
daily at home with plans to re-check his INR on [**Month/Year (2) 766**] [**1-17**].

Medications on Admission:
diltiazem 120', lasix 80', spironolactone 150', Lantus 25 QHS,
ISS (humalog), magnesium oxide 400'', lovenox SQ 60'' (held
[**1-3**]), dilaudid [**12-25**] Q8H prn, colace 100'', FeSO4 325''', MCT Oil
15'', Senna 8.6'' prn

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. spironolactone 100 mg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
5. diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Coumadin 1 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. hydromorphone 2 mg Tablet Sig: 2-4 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
8. insulin glargine 100 unit/mL Solution Sig: Thirty Two (32)
units Subcutaneous at bedtime.
9. insulin lispro 100 unit/mL Solution Sig: sliding scale units
Subcutaneous QACHS: please provide pt with printout of inpatient
sliding scale.


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Ventral hernia, chyle leak, pancreatic pseudocyst
Splenic and smv occlusion

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

Discharge Instructions:
[**Company 269**] CareNetwork has been arranged. They will do your INR lab
work
Please call Dr.[**Name (NI) 670**] office [**Telephone/Fax (1) 673**] if you have any of
the following: temperature of 101 or greater, shaking chills,
nausea, vomiting, jaundice, increased incision or abdominal
pain, abdominal distension, incision redness/bleeding/drainage,
or [**Telephone/Fax (1) 19843**] outputs increase significantly or drainage stops.
-empty drains and record output. Bring record of [**Telephone/Fax (1) 19843**] outputs
to next clinic appointment
- no driving while taking pain medication
-you may shower
- do not lift anything heavier than 10 pounds, no straining

- Start taking 1mg of Coumadin daily tonight ([**2190-1-15**]), and
continue this dose.  You will have lab work drawn on [**Month/Day/Year 766**] and
we will adjust your dose accordingly.

- You will be discharged on half of your normal dose of
diltiazem (30 mg twice a day)

- You should stop taking your lasix for the time being.

Followup Instructions:
PLEASE CALL Dr.[**Name (NI) 670**] office [**Telephone/Fax (1) 673**] on [**Telephone/Fax (1) **] to
schedule a followup appointment for Thursday [**1-20**] or [**Month/Day (4) 766**] [**1-24**]

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2874**]

Completed by:[**2191-1-15**]
{'Cyst and pseudocyst of pancreas,Acute posthemorrhagic anemia,Chronic vascular insufficiency of intestine,Incisional hernia without mention of obstruction or gangrene,Long-term (current) use of insulin,Personal history of malignant melanoma of skin,Other noninfectious disorders of lymphatic channels,Other specified retention of urine,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Abnormal coagulation profile,Other diseases of spleen'}


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: Mr. [**Known lastname 81329**] is a 57 M with complex medical hx including
necrotizing pancreatitis and a pancreatic pseudocyst in [**2187**],
s/p open cholecystectomy, necrosectomy and cyst-jejunostomy with
roux en y omega loop in [**2189-7-22**]
which was subsequently complicated by distal CBD stricture s/p
stenting. His postoperative course was further complicated by
chylothorax treated with talc pleurodesis which led to the
development of chylous ascites which he has removed Q 2-3 weeks
with paracentesis.  He presented earlier this year with
worsening abdominal pain and emesis, and imaging showed a
recurrent pancreatic pseudocyst.  He presents now for surgical
treatment of the pseudocyst as well as his ventral hernia.

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
1. DM2 diagnosed in [**10/2187**], on insulin.
2. Necrotizing pancreatitis, pancreatic pseudocyst, and
cholangitis that required ex-lap in [**7-/2189**], with open
cholecystectomy, pancreatic pseudocyst jejeunostomy, modified
roux-en-y and pancreatic necrosectomy. He had bilateral
chylothorax in [**10/2189**] that required pleurodesis and was
recently ([**3-/2190**]) admitted with chylous ascites that required
paracentesis.
3. History of SVT with first episode during admission of
necrotizing pancreatitis. He has had 4 episodes since [**7-/2189**],
all of them terminated by ATP or diltiazem.
4. L5 herniated disc.
5. SMV thrombosis.
6. Hx of melanoma, no recurrence.

MEDICATION ON ADMISSION: diltiazem 120', lasix 80', spironolactone 150', Lantus 25 QHS,
ISS (humalog), magnesium oxide 400'', lovenox SQ 60'' (held
[**1-3**]), dilaudid [**12-25**] Q8H prn, colace 100'', FeSO4 325''', MCT Oil
15'', Senna 8.6'' prn

ALLERGIES: Bactrim

PHYSICAL EXAM: Physical exam on discharge:
Tm 98.9, Tc 98.1, HR 79, BP 101/62, RR 20, 97% on RA
NAD, AAOx3
Chest clear to auscultation b/l
HR regular, M/G/R
Abdomen firm but flat, appropriately tender, incision C/D/I
without drainage.  LUQ [**Month/Day (3) 19843**] serosanguinous.
No clubbing/cyanosis/edema

FAMILY HISTORY: No biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company. Married twice. He
lives at home with his 4 children. He does not smoke or use
drugs. He previously drank [**3-27**] drinks per week, but has not
drunk alcohol for the past two years. 

### Response:
{'Cyst and pseudocyst of pancreas,Acute posthemorrhagic anemia,Chronic vascular insufficiency of intestine,Incisional hernia without mention of obstruction or gangrene,Long-term (current) use of insulin,Personal history of malignant melanoma of skin,Other noninfectious disorders of lymphatic channels,Other specified retention of urine,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Abnormal coagulation profile,Other diseases of spleen'}
