CHIEF COMPLAINT: pancreatic pseudocyst

PRESENT ILLNESS: Patient is a 56 year old gentleman who recently underwent an
exploratory laparotomy and debriedment of abdominal wall abscess
at [**Hospital3 3583**] in setting of prior subtotal gastrectomy and
and partial colon resection in past. HIDA scan at [**Hospital1 3325**] was consistent with biliary leak.
Patient complained of epigastric abdominal pain and was found to
have pancreatits with amylase 1035, lipase 2280 and CT scan
showing significant peripancreatic inflammatory changes
consisitent with pancreatitis.  He improved and was discharged
home on [**2187-2-21**] from [**Hospital3 3583**] but returned on [**2-24**] with
lower extremity edema. He was found to hava a R popliteal vein
thrombosis extending to the superficial femoral vein.  Repeat CT
scan showed extensive perihepatic fluid collections consistent
with pancreatic psuedocysts and pancreatic necrosis.  Patient
was subsequently transferred to the [**Hospital1 18**] for further
management.

MEDICAL HISTORY: Atrial fibrilation
Pancreatitis
DM (recent)
DVT (recent)
HTN
bilateral CEAs

MEDICATION ON ADMISSION: 

ALLERGIES: Heparin Agents

PHYSICAL EXAM: NAD
Tracheostomy capped
Bibasilar crackles, good air entry
abdomen soft, non-tender, healing midline open incision with
overlying wound drain

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory
Cyst and pseudocyst of pancreas,Other pulmonary embolism and infarction,Acute respiratory failure,Acute cholecystitis,Pressure ulcer, buttock,Atrial fibrillation,Obstruction of bile duct,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anticoagulants causing adverse effects in therapeutic use
Pancreat cyst/pseudocyst,Pulm embol/infarct NEC,Acute respiratry failure,Acute cholecystitis,Pressure ulcer, buttock,Atrial fibrillation,Obstruction of bile duct,DMII wo cmp nt st uncntr,Hypertension NOS,Adv eff anticoagulants
Admission Date:  [**2187-2-26**]              Discharge Date:   [**2187-4-24**]

Date of Birth:  [**2128-11-24**]             Sex:   M

Service: SURGERY

Allergies:
Heparin Agents

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
pancreatic pseudocyst

Major Surgical or Invasive Procedure:
1. Exploratory laparotomy.
2. Washout and drainage of the abdomen.
3. External drainage of pancreatic pseudocyst.
4. Pancreatic necrosectomy.
5. Open cholecystectomy.
6. G tube placement.
7. J tube placement.


History of Present Illness:
Patient is a 56 year old gentleman who recently underwent an
exploratory laparotomy and debriedment of abdominal wall abscess
at [**Hospital3 3583**] in setting of prior subtotal gastrectomy and
and partial colon resection in past. HIDA scan at [**Hospital1 3325**] was consistent with biliary leak.
Patient complained of epigastric abdominal pain and was found to
have pancreatits with amylase 1035, lipase 2280 and CT scan
showing significant peripancreatic inflammatory changes
consisitent with pancreatitis.  He improved and was discharged
home on [**2187-2-21**] from [**Hospital3 3583**] but returned on [**2-24**] with
lower extremity edema. He was found to hava a R popliteal vein
thrombosis extending to the superficial femoral vein.  Repeat CT
scan showed extensive perihepatic fluid collections consistent
with pancreatic psuedocysts and pancreatic necrosis.  Patient
was subsequently transferred to the [**Hospital1 18**] for further
management.

Past Medical History:
Atrial fibrilation
Pancreatitis
DM (recent)
DVT (recent)
HTN
bilateral CEAs


Social History:
non-contributory

Family History:
non-contributory

Physical Exam:
NAD
Tracheostomy capped
Bibasilar crackles, good air entry
abdomen soft, non-tender, healing midline open incision with
overlying wound drain

Pertinent Results:
[**2187-4-22**] 8:25 pm STOOL     CONSISTENCY: WATERY      Source:
Stool.

                            **FINAL REPORT [**2187-4-23**]**

   CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2187-4-23**]):
      FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA.
      Reference Range:  Negative.

[**2187-4-2**] 7:07 am SWAB      Source: Rectal swab.

                            **FINAL REPORT [**2187-4-4**]**

   R/O VANCOMYCIN RESISTANT ENTEROCOCCUS (Final [**2187-4-4**]):
      No VRE isolated.

[**2187-3-22**] 09:28PM URINE Blood-TR Nitrite-NEG Protein-TR
Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG
[**2187-3-22**] 09:28PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.030
[**2187-4-21**] 07:25AM BLOOD WBC-9.7 RBC-2.83* Hgb-9.3* Hct-29.0*
MCV-102* MCH-32.8* MCHC-32.0 RDW-24.4* Plt Ct-268
[**2187-4-17**] 06:00AM BLOOD WBC-6.5 RBC-2.62* Hgb-8.4* Hct-26.2*
MCV-100* MCH-32.1* MCHC-32.1 RDW-22.9* Plt Ct-271
[**2187-3-11**] 07:05AM BLOOD Hct-23.7*
[**2187-3-12**] 04:14AM BLOOD WBC-6.4 RBC-2.71* Hgb-8.6* Hct-25.1*
MCV-93 MCH-31.7 MCHC-34.3 RDW-16.2* Plt Ct-130*

Brief Hospital Course:
58-year-old gentleman admitted for treatment of a complex
pancreatic pseudocyst situation secondary to gallstone
pancreatitis. He had been at an outside hospital for 2 weeks
prior to his transfer to us where he had evidence of a lower
extremity DVT. Upon transfer to us, he had clear-cut pulmonary
embolism identified and this was treated with anticoagulation.
In the antrum we accessed the pancreas via CT and
found it to be stable with a complex multi-loculated cystic
architecture that appears to be growing slightly in size while
here at [**Hospital1 18**]. We also recognized a bile duct stone on imaging
and he had an ERCP performed prior to this procedure.
He was doing well except from a respiratory standpoint where he
had decompensation and evidence of an advancing pulmonary
embolism. For this reason, a DVT filter was placed 3 to 4 days
prior to this procedure. He continued to have respiratory
distress but was doing well other than that. On the night prior
to this operation, he had an acute decompensation and moved from
an alkalotic state to an acidotic state. He required massive
amounts of fluid resuscitation and had a progressive lactic
acidosis. He had a tender tense abdomen as well.He was seen
early in the morning of the [**5-11**] and felt that he
had an acute abdominal catastrophe requiring emergent
exploration. He went to the operating room on the morning of
[**2187-3-13**] with the intent of performing exploratory
laparotomy. The presumed diagnosis was ruptured pseudocyst with
secondary diagnosis of dead bowel. Over the next three weeks
patient remained in ICU for postop care. On [**2187-4-15**] patient was
transfered to the floors for further care. remainder of hospital
course was uneventful, he continued to be stable on TPN,
tolerating regular diet. On POD 51/39 patient was cleared for
discharge to rehabilitation center for further recovery.


Discharge Medications:
1. Magnesium Hydroxide 400 mg/5 mL Suspension [**Date Range **]: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
2. Docusate Sodium 150 mg/15 mL Liquid [**Date Range **]: One (1)  PO BID (2
times a day).
3. Amiodarone 200 mg Tablet [**Date Range **]: One (1) Tablet PO BID (2 times
a day).
4. Acetaminophen 325 mg Tablet [**Date Range **]: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
5. Octreotide Acetate 100 mcg/mL Solution [**Date Range **]: One (1)
Injection Q8H (every 8 hours).
6. Albuterol 90 mcg/Actuation Aerosol [**Date Range **]: Six (6) Puff
Inhalation Q4H (every 4 hours) as needed for dyspnea.
7. Trazodone 50 mg Tablet [**Date Range **]: 0.5 Tablet PO TID (3 times a day)
as needed for Agitation.
8. Warfarin 5 mg Tablet [**Date Range **]: One (1) Tablet PO HS (at bedtime).

9. Oxycodone-Acetaminophen 5-325 mg Tablet [**Date Range **]: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed for pain.
10. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
11. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
12. Acetylcysteine 20 % (200 mg/mL) Solution [**Last Name (STitle) **]: One (1) ML
Miscell.  Q4-6H (every 4 to 6 hours) as needed for congestion.
13. Albuterol Sulfate 0.083 % Solution [**Last Name (STitle) **]: One (1)  Inhalation
Q6H (every 6 hours) as needed.
14. Calcium Carbonate 500 mg Tablet, Chewable [**Last Name (STitle) **]: One (1)
Tablet, Chewable PO QID (4 times a day) as needed.
15. Cephalexin 500 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO Q6H (every
6 hours).
16. Metronidazole 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO TID (3
times a day).
17. Acetazolamide 250 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q12H
(every 12 hours) for 5 days: d/c [**4-29**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
ruptured Pancreatic psuedocyst


Discharge Condition:
stable


Discharge Instructions:
Resume your regular medications. Take all new medications as
directed. Do not drive while taking narcotics.

You may shower.  Allow water to run over the wound, and do not
scrub.  Pat the wound dry.  Do not take a bath or swim until
after follow-up appointment.  No heavy lifting (> 10 lbs) for 6
weeks.

Please call your doctor or return to the ER if you experience:
-Fever (> 101.4)
-Inability to eat/drink or persistant vomiting
-Increased pain
-Redness or discharge from your wound
-Other symptoms concerning to you


Followup Instructions:
Please followup with Dr. [**Last Name (STitle) **] in [**3-24**] weeks  call [**Numeric Identifier 66571**]
to schedule an appointment



Completed by:[**2187-4-24**]
{'Cyst and pseudocyst of pancreas,Other pulmonary embolism and infarction,Acute respiratory failure,Acute cholecystitis,Pressure ulcer, buttock,Atrial fibrillation,Obstruction of bile duct,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anticoagulants causing adverse effects in therapeutic use'}


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: pancreatic pseudocyst

PRESENT ILLNESS: Patient is a 56 year old gentleman who recently underwent an
exploratory laparotomy and debriedment of abdominal wall abscess
at [**Hospital3 3583**] in setting of prior subtotal gastrectomy and
and partial colon resection in past. HIDA scan at [**Hospital1 3325**] was consistent with biliary leak.
Patient complained of epigastric abdominal pain and was found to
have pancreatits with amylase 1035, lipase 2280 and CT scan
showing significant peripancreatic inflammatory changes
consisitent with pancreatitis.  He improved and was discharged
home on [**2187-2-21**] from [**Hospital3 3583**] but returned on [**2-24**] with
lower extremity edema. He was found to hava a R popliteal vein
thrombosis extending to the superficial femoral vein.  Repeat CT
scan showed extensive perihepatic fluid collections consistent
with pancreatic psuedocysts and pancreatic necrosis.  Patient
was subsequently transferred to the [**Hospital1 18**] for further
management.

MEDICAL HISTORY: Atrial fibrilation
Pancreatitis
DM (recent)
DVT (recent)
HTN
bilateral CEAs

MEDICATION ON ADMISSION: 

ALLERGIES: Heparin Agents

PHYSICAL EXAM: NAD
Tracheostomy capped
Bibasilar crackles, good air entry
abdomen soft, non-tender, healing midline open incision with
overlying wound drain

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-contributory 

### Response:
{'Cyst and pseudocyst of pancreas,Other pulmonary embolism and infarction,Acute respiratory failure,Acute cholecystitis,Pressure ulcer, buttock,Atrial fibrillation,Obstruction of bile duct,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anticoagulants causing adverse effects in therapeutic use'}
