CHIEF COMPLAINT: Chronic ulcerative colitis with
multiple pseudopolyps

PRESENT ILLNESS: Mr. [**Known lastname **] is a 53 year old gentleman with a past medical
history of ulcerative colitis diagnosed in [**2085**], who presents
for a total abdominal colectomy, ileostomy for multiple polyps
throughout the colon.

MEDICAL HISTORY: UC dx [**2085**], DM2, CAD s/p MI [**2109**], stents x4

MEDICATION ON ADMISSION: lantus 30QPM, humalog SS, MVI 1', caltrate 600', 6-MP 50'',
metoprolol 12.5'', lipitor 40', ASA 81', celexa 20', lialda
1200'
.

ALLERGIES: Prednisone

PHYSICAL EXAM: 99.2   84    114/60    13   982L
gen: NAD
CV:  RR, occasionally tachycardic

FAMILY HISTORY: Physical Exam:
99.2   84    114/60    13   982L
gen: NAD
CV:  RR, occasionally tachycardic

SOCIAL HISTORY: The patient is married, and works for an engineering firm.
Ulcerative colitis, unspecified,Acute respiratory failure,Acidosis,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction
Ulceratve colitis unspcf,Acute respiratry failure,Acidosis,Parox ventric tachycard,Surg compl-heart,Subendo infarct, initial,DMII wo cmp nt st uncntr,Abn reac-organ rem NEC,Status-post ptca,Crnry athrscl natve vssl,Old myocardial infarct
Admission Date:  [**2112-5-9**]              Discharge Date:   [**2112-5-16**]

Date of Birth:  [**2058-6-22**]             Sex:   M

Service: SURGERY

Allergies:
Prednisone

Attending:[**First Name3 (LF) 1**]
Chief Complaint:
Chronic ulcerative colitis with
multiple pseudopolyps

Major Surgical or Invasive Procedure:
total abdominal colectomy with ileostomy creation,
cardiac catheterization

History of Present Illness:
Mr. [**Known lastname **] is a 53 year old gentleman with a past medical
history of ulcerative colitis diagnosed in [**2085**], who presents
for a total abdominal colectomy, ileostomy for multiple polyps
throughout the colon.

Past Medical History:
UC dx [**2085**], DM2, CAD s/p MI [**2109**], stents x4


Social History:
The patient is married, and works for an engineering firm.

Family History:


Physical Exam:
99.2   84    114/60    13   982L
gen: NAD
CV:  RR, occasionally tachycardic


Pertinent Results:
[**2112-5-9**] 12:16PM BLOOD WBC-10.5 RBC-4.28* Hgb-14.8 Hct-41.5
MCV-97 MCH-34.5* MCHC-35.6* RDW-14.0 Plt Ct-294
[**2112-5-10**] 04:16AM BLOOD WBC-9.3 RBC-3.96* Hgb-13.8* Hct-38.7*
MCV-98 MCH-34.8* MCHC-35.7* RDW-14.1 Plt Ct-249
[**2112-5-10**] 07:14PM BLOOD WBC-12.7* RBC-3.56* Hgb-12.3* Hct-34.4*
MCV-97 MCH-34.5* MCHC-35.7* RDW-14.5 Plt Ct-233
[**2112-5-12**] 06:30AM BLOOD WBC-15.8* RBC-3.48* Hgb-12.0* Hct-34.8*
MCV-100* MCH-34.6* MCHC-34.6 RDW-13.6 Plt Ct-253
[**2112-5-13**] 06:45AM BLOOD WBC-11.7* RBC-3.22* Hgb-10.8* Hct-32.0*
MCV-99* MCH-33.6* MCHC-33.9 RDW-13.6 Plt Ct-344
[**2112-5-9**] 12:16PM BLOOD CK(CPK)-191*
[**2112-5-9**] 02:18PM BLOOD CK(CPK)-303*
[**2112-5-9**] 10:15PM BLOOD CK(CPK)-1225*
[**2112-5-10**] 04:16AM BLOOD CK(CPK)-1038*
[**2112-5-10**] 11:53AM BLOOD CK(CPK)-794*
[**2112-5-10**] 07:14PM BLOOD CK(CPK)-652*
[**2112-5-11**] 04:23AM BLOOD CK(CPK)-482*
[**2112-5-9**] 12:16PM BLOOD CK-MB-3 cTropnT-<0.01
[**2112-5-9**] 02:18PM BLOOD CK-MB-13* MB Indx-4.3 cTropnT-0.12*
[**2112-5-9**] 10:15PM BLOOD CK-MB-171* MB Indx-14.0* cTropnT-2.68*
[**2112-5-10**] 04:16AM BLOOD CK-MB-120* MB Indx-11.6* cTropnT-3.85*
[**2112-5-10**] 11:53AM BLOOD CK-MB-73* MB Indx-9.2* cTropnT-3.24*
[**2112-5-10**] 07:14PM BLOOD CK-MB-31* MB Indx-4.8 cTropnT-2.37*
[**2112-5-11**] 04:23AM BLOOD CK-MB-12* MB Indx-2.5 cTropnT-1.65*

[**5-9**] Path: Ileocolectomy:



1) Ulcerative colitis, chronic focally active:

a)  Diffuse disease from ascending colon to distal margin, more
prominent in the distal part.



b)  Inflammatory pseudopolyps in distal two-thirds, most
prominent in the sigmoid.



c)  No sinus tracts or granulomas.



d)  No dysplasia.

2)  Ileal segment and appendix: Within normal limits.

 [**5-9**] Echo: Left ventricular wall thicknesses and cavity size
are normal. There is mild regional left ventricular systolic
dysfunction with hypokinesis of the basal to mid inferior
segments. Right ventricular chamber size and free wall motion
are normal. There is abnormal septal motion/position. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are structurally normal. The pulmonary artery systolic pressure
could not be determined.

IMPRESSION: Suboptimal image quality. The inferior segments are
probably hypokinetic. Overall LVEF is normal as the other
segments are hyperdynamic. RV function appears preserved.

3)  Omentum, within normal limits.
[**5-10**] cardiac catheterization: .  Coronary angiography in this
right-dominant system revealed:
--the LMCA had no angiographically apparent disease.
--the LAD had no angiographically apparent disease, with patent
stents
both proximally and distally.
--the LCx had no angiographically apparent disease.
--the RCA had patent stents with serial moderate stenoses
including 50%
proximal, 60% mid, and 50% distal.
2.  Limited resting hemodynamics revealed normal systemic
arterial
systolic pressures, with SBP 113 mmHg; normal left-sided filling

pressures with LVEDP 11 mmHg.  There was no gradient across the
aortic
valve upon pullback of the angled pigtail catheter from LV to
ascending
aorta.
3.  Left ventriculography revealed normal LV wall motion, LVEF
60%, and
no significant mitral regurgitation.

FINAL DIAGNOSIS:
1.  No tight coronary stenoses.  Continue with medical therapy.

[**5-11**] CTA: 1. No filling defect within the pulmonary arteries to
suggest pulmonary embolus.

2. Bilateral dependent atelectasis. Small right pleural
effusion.

3. Small amount of perihepatic ascites. Tiny locule of air is
seen anterior to the liver which likely relates to recent
surgery.

Brief Hospital Course:
The patient was admitted to the surgery service for evaluation
and treatment post operatively.  The patient underwent a total
abdominal colectomy, ileostomy ([**5-9**]); for details, please see
operative note.  The patient initially recovered in the PACU
where the patient was observed to have ventricular tachycardia;
he had no complaints of chest pain or shortness of breath at
that time.

Neuro: The patient received a diluadid  PCA with good effect and
satisfactory pain control initially. When tolerating oral
intake, the patient was transitioned to oral pain medications.
His PCA was held immediately post operatively, as the patient
was noted to have a respiratory acidosis, which promptly
resolved. The patient continued to experience significant post
operative pain, not entirely controlled with the PCA, and
Toradol was ordered with good effect.



CV:  The patient initially recovered in the PACU where the
patient was observed to have ventricular tachycardia; he had no
complaints of chest pain or shortness of breath at that time.
The patient received amiodarone and magnesium, and his vital
signs were closely monitored.  The patient was then given
aspirin with the possibility of coronary ischemia, and also
received calcium and lipitor.  An ABG at that time showed
acidosis.  Cardiac enzymes were cycled, the patient was
transferred to the ICU, and cardiology was [**Month/Day (4) 4221**].  The
patient was also put on IV metoprolol for beta blockade.  An
echo was performed; for details, please see reports section.
Serial EKGS and cardiac enzymes were sent; the patient had
suffered an NSTEMI.  A heparin drip was subsequently started;
levels were adjusted according to his coagulation profile.  On
[**5-10**], the patient was taken for cardiac catheterization, which
revealed patent stents proximally and distally in the LAD, and
moderate stenoses in the RCA; he was transferred to the CCU for
initial recovery.  The amiodarone was stopped without
recurrence.

The patient's heart rate was closely monitored, and his beta
blockade dosage was adjusted accordingly.

On [**5-10**]-2, the patient complained of pleuritic chest pain, with
tachycardia and hypoxia at 92% on room air.  A CTA was performed
to rule out a PE; for details, please see results section.

Pulmonary:  The patient was initially stable from a respiratory
standpoint.  During the episode of ventricular tachycardia
postoperatively, an ABG revealed respiratory acidosis, for which
narcotics were temporarily held.  On [**5-10**]-2, the patient
complained of pleuritic chest pain, with tachycardia and hypoxia
at 92% on room air.  A CTA was performed to rule out a PE; for
details, please see results section.

The patient was stable from a pulmonary standpoint afterwards;
vital signs were routinely monitored.  Good pulmonary toilet,
early ambulation and incentive spirometry were encouraged
throughout this hospitalization.

GI/GU/FEN:

Post operatively, the patient was made NPO with IVF.

The patient's diet was advanced when appropriate, which was
tolerated well (clears on [**5-12**], and diet as tolerated on [**5-13**]).
The ostomy nurse [**First Name (Titles) **] [**Last Name (Titles) 4221**] for post operative care and
ostomy teaching; the patient will be discharged home with ostomy
nursing visits

The patient's intake and output were closely monitored, and IVF
were adjusted when necessary.  The patient's electrolytes were
routinely followed during this hospitalization, and repleted
when necessary.

 On [**5-14**], the patient was noted to have high ostomy output, and
was put on loperamide with good result; he was discharged home
on loperamide.

ID: The patient's white blood count and fever curves were
closely watched for signs of infection.



Endocrine:  The patient's blood sugar was monitored throughout
this stay; insulin dosing was adjusted accordingly. His Lantus
dose was also increased gradually with increasing PO intake.



Hematology:  The patient's complete blood count was examined
routinely; no transfusions were required during this stay.



Prophylaxis:  The patient received subcutaneous heparin during
this stay, and was encouraged to get up and ambulate as early as
possible.  He was put on a heparin drip initially, which was
stopped by [**5-11**].  The patient was also put on aspirin, which was
increased from 81 to 325 mg on [**5-13**] on the recommendation of our
cardiology collegues.



At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.


Medications on Admission:
lantus 30QPM, humalog SS, MVI 1', caltrate 600', 6-MP 50'',
metoprolol 12.5'', lipitor 40', ASA 81', celexa 20', lialda
1200'
.


Discharge Medications:
1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Loperamide 2 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
6. Insulin Glargine 100 unit/mL Solution Sig: Thirty (30) U
Subcutaneous at bedtime.
7. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Home [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 269**]

Discharge Diagnosis:
chronic ulcerative colitis with pseudopolyps,
NSTEMI

Discharge Condition:
stable, tolerating usual oral diet, able to tolerate pain well
on oral pain regimen, able to ambulate independently without
difficulty, appropriate teaching with regard to self-care
post-operatively

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
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.

You are to continue working with the ostomy nursing care team to
ensure proper functionality of your ostomy.

Followup Instructions:
You are to call  Dr. [**Last Name (STitle) **] [**Name (STitle) 2678**] at [**Telephone/Fax (1) 76822**] for a
follow-up appointment.
You are to call your primary care physician [**Name9 (PRE) 2678**] for [**Name Initial (PRE) **]
post-hospitalization appointment.
{'Ulcerative colitis, unspecified,Acute respiratory failure,Acidosis,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction'}


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: Chronic ulcerative colitis with
multiple pseudopolyps

PRESENT ILLNESS: Mr. [**Known lastname **] is a 53 year old gentleman with a past medical
history of ulcerative colitis diagnosed in [**2085**], who presents
for a total abdominal colectomy, ileostomy for multiple polyps
throughout the colon.

MEDICAL HISTORY: UC dx [**2085**], DM2, CAD s/p MI [**2109**], stents x4

MEDICATION ON ADMISSION: lantus 30QPM, humalog SS, MVI 1', caltrate 600', 6-MP 50'',
metoprolol 12.5'', lipitor 40', ASA 81', celexa 20', lialda
1200'
.

ALLERGIES: Prednisone

PHYSICAL EXAM: 99.2   84    114/60    13   982L
gen: NAD
CV:  RR, occasionally tachycardic

FAMILY HISTORY: Physical Exam:
99.2   84    114/60    13   982L
gen: NAD
CV:  RR, occasionally tachycardic

SOCIAL HISTORY: The patient is married, and works for an engineering firm. 

### Response:
{'Ulcerative colitis, unspecified,Acute respiratory failure,Acidosis,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Old myocardial infarction'}
