CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 69-year-old female who has had abdominal pain for some time.
She
presented with dizziness, abdominal pain, hypotension, and
bradycardia at the [**Hospital1 18**] Emergency room essentially in
shock.  On CT scan she was found to have a ruptured spleen
with layering of hemorrhage consistent with a large
hemoperitoneum.  Hematocrit on arrival was 20.3 and she was
requiring pressor support as well as volume.  As such
emergency laparotomy was indicated.

MEDICAL HISTORY: paroxysmal atrial fibrillation, breast cancer, DVT previously on
coumadin (several years ago), PE, hypothyroidism, chronic
leukopenia, anemia, peripheral neuropathy, depression, HTN, HLD,
hyponatremia, BCC
PSH:
lumpectomy '[**62**], hip replacement b/l, lumbar diskectomy
Meds:

MEDICATION ON ADMISSION: ARMOUR THYROID 60 MG TABS (THYROID) 2 and [**11-25**] by mouth one time
daily
ASA 81', valsartan 80', triamterene-hctz 75-50', OMEGA-3 1000 MG
CAP', FLECAINIDE 125'', fluvastatin XL 80', nifedipine XL 30',
KCl 10 mEq', vit D [**2159**] IU', COENZYME Q10 400', FOLATE 400MCG',
melatonin 1 qhs prn, diazepam 5'prn

ALLERGIES: Sulfonamides

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married
Other diseases of spleen,Hemoperitoneum (nontraumatic),Anemia, unspecified,Atrial fibrillation
Spleen disease NEC,Hemoperitoneum,Anemia NOS,Atrial fibrillation
Admission Date:  [**2170-7-29**]              Discharge Date:   [**2170-8-2**]

Date of Birth:  [**2101-5-19**]             Sex:   F

Service: SURGERY

Allergies:
Sulfonamides

Attending:[**First Name3 (LF) 3200**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
[**2170-7-29**] Exploratory Laparotomy, Splenectomy

History of Present Illness:
69-year-old female who has had abdominal pain for some time.
She
presented with dizziness, abdominal pain, hypotension, and
bradycardia at the [**Hospital1 18**] Emergency room essentially in
shock.  On CT scan she was found to have a ruptured spleen
with layering of hemorrhage consistent with a large
hemoperitoneum.  Hematocrit on arrival was 20.3 and she was
requiring pressor support as well as volume.  As such
emergency laparotomy was indicated.

Past Medical History:
paroxysmal atrial fibrillation, breast cancer, DVT previously on
coumadin (several years ago), PE, hypothyroidism, chronic
leukopenia, anemia, peripheral neuropathy, depression, HTN, HLD,
hyponatremia, BCC
PSH:
lumpectomy '[**62**], hip replacement b/l, lumbar diskectomy
Meds:


Social History:
Married

Family History:
Noncontributory

Pertinent Results:
[**2170-7-29**] 11:45PM   PO2-527* PCO2-34* PH-7.26* TOTAL CO2-16* BASE
XS--10
[**2170-7-29**] 11:45PM   LACTATE-1.6
[**2170-7-29**] 11:38PM   GLUCOSE-160* UREA N-13 CREAT-0.5 SODIUM-133
POTASSIUM-2.8* CHLORIDE-109* TOTAL CO2-16* ANION GAP-11
[**2170-7-29**] 11:38PM   ALT(SGPT)-31 AST(SGOT)-34 ALK PHOS-46 TOT
BILI-0.6
[**2170-7-29**] 11:38PM   WBC-13.3* RBC-4.36# HGB-13.3# HCT-38.6#
MCV-88 MCH-30.4 MCHC-34.4 RDW-14.7
[**2170-7-29**] 11:38PM   PLT COUNT-98*
[**2170-7-29**] 11:38PM   PT-13.9* PTT-26.7 INR(PT)-1.2*
[**2170-7-29**] 07:40PM   ALT(SGPT)-11 AST(SGOT)-14 ALK PHOS-44 TOT
BILI-0.2
[**2170-7-29**] 07:40PM   LIPASE-11
[**2170-7-29**] 07:40PM   ALBUMIN-2.8*

IMPRESSION:
1. Splenic rupture with large hemoperitoneum. Subcentimeter foci
of
hyperdensity in the left upper quandrant with progressive
increased
conspicuity on venous and delayed phases favor nonarterial
etiology, although active arterial extravasation cannot be
excluded.

2. Two right lower lobe pulmonary nodules measuring 5 and 2.5
mm. In the
setting of breast cancer, followup in three months is
recommended. Probable post radiation treatment changes of right
anterior lung subpleural thickening.

3. Multiple foci of sclerosis within the bony pelvis may
represent bone
islands, however, in the absence of priors, metastatic lesions
cannot be
excluded in the setting of breast cancer. Recommend comparison
to any prior outside studies. Consider bone scan if these
findings have not already been evaluated.

4. No evidence of abdominal aortic aneurysm. Extensive
atherosclerotic
disease.

5. Nonspecific breast calcifications. Please correlate with
mammography



Brief Hospital Course:
She was admitted to the ACS service and after discussing the
risks, benefits, and alternatives to emergency laparotomy and
possible splenectomy with the patient and the patient's family
she was immediately and emergently taken to the OR. Her
intraoperative course was stable. Postoperatively she was
transferred to the ICU for close monitoring. She remained
hemodynamically stable and was eventually transferred to the
regular nursing unit where she continued to progress.

She did have pain control issues requiring higher doses of
Dilaudid as she reported an allergy to Oxycodone. She was noted
to have a mild ileus felt secondary to the narcotics and was
given a 1 time dose of methylnaltrexone. Her diet was slowly
advanced and she is tolerating a regular diet. She is ambulating
independently.

She received her splenectomy vaccines prior to discharge and
will follow up with Dr. [**Last Name (STitle) **] in Surgery clinic in the next
1-2 weeks for removal of her staples.


Medications on Admission:
ARMOUR THYROID 60 MG TABS (THYROID) 2 and [**11-25**] by mouth one time
daily
ASA 81', valsartan 80', triamterene-hctz 75-50', OMEGA-3 1000 MG
CAP', FLECAINIDE 125'', fluvastatin XL 80', nifedipine XL 30',
KCl 10 mEq', vit D [**2159**] IU', COENZYME Q10 400', FOLATE 400MCG',
melatonin 1 qhs prn, diazepam 5'prn


Discharge Medications:
1. Thyroid (Pork) 90 mg Tablet Sig: One (1) Tablet PO once a
day: take with 60 mg tablet to equal 150 mg.
Disp:*30 Tablet(s)* Refills:*2*
2. Thyroid (Pork) 60 mg Tablet Sig: One (1) Tablet PO once a
day: take with 90 mg tablet to equal 150 mg tablet.
Disp:*30 Tablet(s)* Refills:*2*
3. Valsartan 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Flecainide 50 mg Tablet Sig: 2.5 Tablets PO Q12H (every 12
hours).
5. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
6. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q12H (every 12 hours) as needed for constipation.
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
12. Tramadol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Splenic rupture

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

Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.





Please call your doctor or return to the emergency room if you
have any of the following:


 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* 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.


* 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.

* Please resume all regular home medications and take any new
meds
 as ordered.

Activity:
No heavy lifting of items [**9-7**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.

If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in [**11-25**] weeks; call [**Telephone/Fax (1) 3201**] for
an appointment.



Completed by:[**2170-8-13**]
{'Other diseases of spleen,Hemoperitoneum (nontraumatic),Anemia, unspecified,Atrial fibrillation'}


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: 69-year-old female who has had abdominal pain for some time.
She
presented with dizziness, abdominal pain, hypotension, and
bradycardia at the [**Hospital1 18**] Emergency room essentially in
shock.  On CT scan she was found to have a ruptured spleen
with layering of hemorrhage consistent with a large
hemoperitoneum.  Hematocrit on arrival was 20.3 and she was
requiring pressor support as well as volume.  As such
emergency laparotomy was indicated.

MEDICAL HISTORY: paroxysmal atrial fibrillation, breast cancer, DVT previously on
coumadin (several years ago), PE, hypothyroidism, chronic
leukopenia, anemia, peripheral neuropathy, depression, HTN, HLD,
hyponatremia, BCC
PSH:
lumpectomy '[**62**], hip replacement b/l, lumbar diskectomy
Meds:

MEDICATION ON ADMISSION: ARMOUR THYROID 60 MG TABS (THYROID) 2 and [**11-25**] by mouth one time
daily
ASA 81', valsartan 80', triamterene-hctz 75-50', OMEGA-3 1000 MG
CAP', FLECAINIDE 125'', fluvastatin XL 80', nifedipine XL 30',
KCl 10 mEq', vit D [**2159**] IU', COENZYME Q10 400', FOLATE 400MCG',
melatonin 1 qhs prn, diazepam 5'prn

ALLERGIES: Sulfonamides

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married 

### Response:
{'Other diseases of spleen,Hemoperitoneum (nontraumatic),Anemia, unspecified,Atrial fibrillation'}
