CHIEF COMPLAINT: 71 year old female s/p laparoscopic ventral hernia repair on
[**2105-5-4**] presents with nausea and vomiting and weakness.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname **] is a 71-year-old woman who underwent
a laparoscopic hernia repair approximately a month ago. She
developed abdominal pain, nausea, vomiting and symptoms
consistent with ileus versus bowel obstruction. She was
initially treated with nonoperative management. She developed
abdominal pain as well as leukocytosis necessitating surgical
treatment.

MEDICAL HISTORY: [**Known firstname 103294**] past medical history is significant
for a possible heart attack, mitral valve prolapse, and a stroke

MEDICATION ON ADMISSION: avapro 225', citalopram 40', ASA 81', colace, percocet prn

ALLERGIES: Shellfish

PHYSICAL EXAM: 97.7 heartrate 144 blood pressure 80/60 respiratory rate 20 96%
on room air.
NAD
comfortable
NCAT
slight anterior cervical LAD
RRR
Decreased breath sounds at right base
Abdomen: Non-distended, normal active bowel sounds, soft,
nontender throughout, well healing scars, no hernias
Rectal guiac negative, no masses, small amount of brown stool.

FAMILY HISTORY: FAMILY HISTORY:  She denies any family history of cancer.

SOCIAL HISTORY: SOCIAL HISTORY:  She smoked in the past, but denies tobacco use
for the past 5 years.  She denies IV drug use or alcohol.  She
lives alone and has four cats.
Other postoperative infection,Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Toxic encephalopathy,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of ovary,Mitral valve disorders,Unspecified essential hypertension,Dehydration,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Other postop infection,Ac vasc insuff intestine,Perforation of intestine,Peritoneal abscess,Intestinal adhes w obstr,React-int pros devic NEC,Toxic encephalopathy,Pleural effusion NOS,Abn react-surg proc NEC,Hx of ovarian malignancy,Mitral valve disorder,Hypertension NOS,Dehydration,Neuropathy due to drugs,Adv eff antineoplastic
Admission Date:  [**2105-5-25**]              Discharge Date:   [**2105-6-15**]

Date of Birth:  [**2034-2-15**]             Sex:   F

Service: SURGERY

Allergies:
Shellfish

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
71 year old female s/p laparoscopic ventral hernia repair on
[**2105-5-4**] presents with nausea and vomiting and weakness.

Major Surgical or Invasive Procedure:
PICC Line Placement
1. Exploratory laparotomy.
2. Lysis of adhesions (greater than 1 hour).
3. Drainage of intra-abdominal abscess.
4. Resection of small intestine (ileum 20 cm).
5. Ileostomy creation.
6. Cecal mucous fistula creation.
7. Excision of infected prosthetic mesh.
8. Appendectomy.
9. Closure of abdomen with prosthetic mesh (Vicryl).


History of Present Illness:
[**First Name8 (NamePattern2) **] [**Known lastname **] is a 71-year-old woman who underwent
a laparoscopic hernia repair approximately a month ago. She
developed abdominal pain, nausea, vomiting and symptoms
consistent with ileus versus bowel obstruction. She was
initially treated with nonoperative management. She developed
abdominal pain as well as leukocytosis necessitating surgical
treatment.

Past Medical History:
[**Known firstname 103294**] past medical history is significant
for a possible heart attack, mitral valve prolapse, and a stroke

in [**2096**]. She is uncertain as to whether she had a heart attack
or not. She has had several echos of the heart, which have been
negative. She has had stress test in the past. After her stroke
in [**2096**], she underwent an endarterectomy. Diagnosed with ovarian
cancer in [**2103**].


Social History:
SOCIAL HISTORY:  She smoked in the past, but denies tobacco use
for the past 5 years.  She denies IV drug use or alcohol.  She
lives alone and has four cats.


Family History:
FAMILY HISTORY:  She denies any family history of cancer.


Physical Exam:
97.7 heartrate 144 blood pressure 80/60 respiratory rate 20 96%
on room air.
NAD
comfortable
NCAT
slight anterior cervical LAD
RRR
Decreased breath sounds at right base
Abdomen: Non-distended, normal active bowel sounds, soft,
nontender throughout, well healing scars, no hernias
Rectal guiac negative, no masses, small amount of brown stool.

Pertinent Results:
[**2105-5-24**] 11:45PM BLOOD WBC-19.7*# RBC-4.84 Hgb-14.7 Hct-43.6
MCV-90 MCH-30.3 MCHC-33.6 RDW-14.0 Plt Ct-289
[**2105-6-1**] 04:50AM BLOOD WBC-18.2*# RBC-3.73* Hgb-11.4* Hct-34.6*
MCV-93 MCH-30.4 MCHC-32.9 RDW-14.4 Plt Ct-264
[**2105-6-9**] 04:31AM BLOOD WBC-10.3 RBC-2.89* Hgb-9.0* Hct-26.9*
MCV-93 MCH-31.2 MCHC-33.5 RDW-13.9 Plt Ct-289
[**2105-5-24**] 11:45PM BLOOD Glucose-145* UreaN-36* Creat-1.0 Na-129*
K-4.4 Cl-96 HCO3-21* AnGap-16
[**2105-5-30**] 04:26AM BLOOD Glucose-187* UreaN-16 Creat-0.5 Na-139
K-2.9* Cl-105 HCO3-29 AnGap-8
[**2105-6-11**] 04:42AM BLOOD Glucose-120* UreaN-17 Creat-0.6 Na-138
K-4.4 Cl-108 HCO3-23 AnGap-11
[**2105-5-24**] 11:45PM BLOOD ALT-15 AST-42* AlkPhos-75 TotBili-1.2
[**2105-6-10**] 05:06AM BLOOD ALT-25 AST-23 AlkPhos-119* TotBili-0.7
[**2105-5-25**] 05:25AM BLOOD Albumin-2.7* Calcium-8.1* Phos-2.1*
Mg-2.0
[**2105-6-11**] 04:42AM BLOOD Calcium-8.2* Phos-3.7 Mg-1.9
[**2105-5-28**] 06:05AM BLOOD calTIBC-147* Ferritn-203* TRF-113*
[**2105-6-10**] 05:06AM BLOOD calTIBC-131* Ferritn-205* TRF-101*
[**2105-5-24**] 11:48PM BLOOD Lactate-3.2*
[**2105-6-5**] 10:51AM BLOOD Glucose-148* Lactate-1.3 Na-137 K-3.4*
Cl-99*

[**2105-5-25**] CT Scan 1. Interval development of small bowel
dilatation with relative decompression of distal ileal and large
bowel loops, concerning for small-bowel obstruction.
Transitional point is not definitely identified.

2. Interval development of right greater than left pleural
effusions and perihepatic ascites.

3. Bilateral adrenal nodules, previously characterized as
adrenal adenomas..

4. Interval decrease in size of low-density fluid collection
anterior to the anterior abdominal wall mesh.

[**2105-5-28**] CT Scan IMPRESSION:
1. Findings of persistent small-bowel obstruction, with
transition point not definitely identified, but thought to be
within distal ileum.
2. Slight increase in size of right greater than left pleural
effusions.
3. No evidence of drainable fluid collection in the abdomen or
pelvis.

Brief Hospital Course:
Patient admitted on [**2105-5-25**] approx. one month after a
laparoscopic ventral hernia repair. She complains of nausea,
abdominal pain, heaving, unable to eat and vomiting.  Her last
bowel movement was 2 days prior and was not passing flatus.  An
NGT was placed and she was kept NPO.  She became tachycardic and
was bolused several times for low urine output.  Leukocytosis
developed and CT scan showed R>L pleural effusions and bowel
dilations.  On HD3, some flatus developed and patient looked
better.  Patient started receiving TPN through a PICC line.  On
HD4, patient felt better and wanted to discontinue TPN, take out
the NGT and eat a regular diet.  However, tachycardia and
leukocytosis continued and patient was no longer having flatus.
On HD8, surgery was discussed with the patient, as no-operative
management of the ileus/SBO has failed so far.  20 cm of
necrotic small intestine was found upon operation along with
right abdominal abscess.  The following procedures were
performed:  1) laparotomy, 2) lysis of adhesions, 3) drainage of
intrabdominal abscess, 4) resection of small intestine, 5)
ileostomy creation, 6) cecal mucous fistula, 7) closure with
prosthetic mesh, 8) appendecomy, 9) excision of prosthetic mesh.
 The abdominal wound was left open for delayed closure at a
later date.
On POD0, patient was taken to the SICU.  Sedation was not
reversed and patient was placed on CMV ventilation.  Patient was
given pressors to SBP>100.  Antibiotics (zosyn, fluc, vanc) were
started.  Pressors were weaned.  On POD4, a delayed primary
closure of the abdominal wound was performed.  Upon return to
the SICU, the ventilator and sedation were weaned.  Pon POD7,
patient was transferred to [**Wardname 7911**].  A neurology consult was
called to check patient's mental status.  Brain and Cspine MRI
was ordered for hyperreflexia and [**Wardname 2841**] was ordered for nerve
conduction to be done on a outpatient basis. PT was consulted
for discharge to rehab.

Current Issues:
1. Nutrition- TPN as well as a regular diet with ensure tid to
be given at rehab. Calorie counts of patient's diet last couple
of days has been minimal.
2. Neurology - Patient is alert and orientated and has not been
confused for the last 4 days. Neurology has recommended to get
the rest of the MRI/[**Wardname **] testing on a outpatient basis. Those
appointments have been made and are included in the discharge
plan.
3. Mobility/Ostomy teaching - patient is being sent to a
rehabilitation center to increase strength to preoperative level
and to learn how to manage her ostomy by herself.
4. She will follow up with Dr. [**Last Name (STitle) **] on [**6-26**] and will call
and make an appointment with her oncology physician (Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **])


Medications on Admission:
avapro 225', citalopram 40', ASA 81', colace, percocet prn

Discharge Medications:
1. Albuterol 90 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation Q6H (every 6 hours) as needed.
2. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
4. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
8. Loperamide 2 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
9. TPN
Please see TPN sheet.
10. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML
Intravenous daily and PRN as needed for line flush.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **]-[**Location (un) 686**]

Discharge Diagnosis:
bowel ischemia and necrotic ileum


Discharge Condition:
Stable


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.


Followup Instructions:

Provider:[**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**6-26**] at 2:45 [**Hospital Ward Name 23**] building [**Location (un) 470**].
Provider: [**Name10 (NameIs) 2841**] on Friday [**2105-7-10**], at 8:30, on [**Hospital Ward Name 23**] 8.
[**Telephone/Fax (1) 558**]
Provider: [**Name Initial (NameIs) **]. [**Last Name (STitle) 2442**] and [**Name5 (PTitle) 10340**] [**2105-7-15**] at 4 PM [**Hospital Ward Name 23**] 8
[**Telephone/Fax (1) 3506**].
Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2105-6-23**]
4:55 [**Hospital Ward Name 23**] 4.
Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2105-6-23**]
5:35

Please follow up with your oncology physician and your primary
care provider.


Completed by:[**2105-6-15**]
{'Other postoperative infection,Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Toxic encephalopathy,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of ovary,Mitral valve disorders,Unspecified essential hypertension,Dehydration,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs 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: 71 year old female s/p laparoscopic ventral hernia repair on
[**2105-5-4**] presents with nausea and vomiting and weakness.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname **] is a 71-year-old woman who underwent
a laparoscopic hernia repair approximately a month ago. She
developed abdominal pain, nausea, vomiting and symptoms
consistent with ileus versus bowel obstruction. She was
initially treated with nonoperative management. She developed
abdominal pain as well as leukocytosis necessitating surgical
treatment.

MEDICAL HISTORY: [**Known firstname 103294**] past medical history is significant
for a possible heart attack, mitral valve prolapse, and a stroke

MEDICATION ON ADMISSION: avapro 225', citalopram 40', ASA 81', colace, percocet prn

ALLERGIES: Shellfish

PHYSICAL EXAM: 97.7 heartrate 144 blood pressure 80/60 respiratory rate 20 96%
on room air.
NAD
comfortable
NCAT
slight anterior cervical LAD
RRR
Decreased breath sounds at right base
Abdomen: Non-distended, normal active bowel sounds, soft,
nontender throughout, well healing scars, no hernias
Rectal guiac negative, no masses, small amount of brown stool.

FAMILY HISTORY: FAMILY HISTORY:  She denies any family history of cancer.

SOCIAL HISTORY: SOCIAL HISTORY:  She smoked in the past, but denies tobacco use
for the past 5 years.  She denies IV drug use or alcohol.  She
lives alone and has four cats. 

### Response:
{'Other postoperative infection,Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft,Toxic encephalopathy,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of ovary,Mitral valve disorders,Unspecified essential hypertension,Dehydration,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
