CHIEF COMPLAINT: Abdominal pain
Recurrent Pancreatitis

PRESENT ILLNESS: This is a 65 year old male who was admitted here in [**Month (only) **]
for ETOH pancreatitis. He returns now with recurrent
pancreatitis

MEDICAL HISTORY: ETOH pancreatitis [**9-24**]
C.diff [**9-24**]
Hepatitis B (dx [**2081**]), hyperlipidemia, cellulitis after fly
bite ([**7-24**] tx with penicillin)

MEDICATION ON ADMISSION: lipitor 20', protonix 40'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
NCAT, NAD, talking, A&Ox3
EOM full, anicteric.
Neck supple
Chest clear
Heart regular, no MRG
Abdomen soft, distended, tender to deep palpation,
tympanitic to percussion with hyperactive BS, no rebound or
guarding
LE bilateral 1+ edema to halfway up shins, 2+DP pulses
bilaterally
CN2-12 intact, 5/5 strength of UE/LE

FAMILY HISTORY: mother died of ?pancreatic cancer, brother with heart valve
dz/renal calculi

SOCIAL HISTORY: lives with domestic partner in [**Name (NI) 86**] and on [**Hospital3 **];
currently self employed as interior designer; frequent Etoh on
weekends; former 15 p-y smoker (quit [**2069**])
Cyst and pseudocyst of pancreas,Obstruction of bile duct,Disruption of internal operation (surgical) wound,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Urinary complications, not elsewhere classified,Hypopotassemia
Pancreat cyst/pseudocyst,Obstruction of bile duct,Disrup internal op wound,Protein-cal malnutr NOS,Urin tract infection NOS,Int inf clstrdium dfcile,Surg compl-urinary tract,Hypopotassemia
Admission Date:  [**2106-10-21**]              Discharge Date:   [**2106-11-25**]

Date of Birth:  [**2041-6-13**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 148**]
Chief Complaint:
Abdominal pain
Recurrent Pancreatitis

Major Surgical or Invasive Procedure:
1. Exploratory laparotomy.
2. Pancreatic pseudocyst gastrostomy.
3. Jejunal tube placement.
4. External drainage of pancreatic pseudocyst.
5. Repair of fascial wound dehiscence.
6. Mesh interposition graft using SurgiSis mesh.


History of Present Illness:
This is a 65 year old male who was admitted here in [**Month (only) **]
for ETOH pancreatitis. He returns now with recurrent
pancreatitis

Past Medical History:
ETOH pancreatitis [**9-24**]
C.diff [**9-24**]
Hepatitis B (dx [**2081**]), hyperlipidemia, cellulitis after fly
bite ([**7-24**] tx with penicillin)


Social History:
lives with domestic partner in [**Name (NI) 86**] and on [**Hospital3 **];
currently self employed as interior designer; frequent Etoh on
weekends; former 15 p-y smoker (quit [**2069**])


Family History:
mother died of ?pancreatic cancer, brother with heart valve
dz/renal calculi


Physical Exam:
AVSS
NCAT, NAD, talking, A&Ox3
EOM full, anicteric.
Neck supple
Chest clear
Heart regular, no MRG
Abdomen soft, distended, tender to deep palpation,
tympanitic to percussion with hyperactive BS, no rebound or
guarding
LE bilateral 1+ edema to halfway up shins, 2+DP pulses
bilaterally
CN2-12 intact, 5/5 strength of UE/LE


Pertinent Results:
[**2106-10-21**] 03:10PM BLOOD WBC-12.8* RBC-4.24* Hgb-13.7* Hct-39.3*
MCV-93 MCH-32.3* MCHC-34.9 RDW-14.0 Plt Ct-530*
[**2106-10-26**] 06:53AM BLOOD WBC-9.3 RBC-3.56* Hgb-11.2* Hct-32.6*
MCV-92 MCH-31.5 MCHC-34.4 RDW-13.9 Plt Ct-361
[**2106-10-21**] 03:10PM BLOOD Glucose-129* UreaN-16 Creat-1.3* Na-135
K-6.2* Cl-98 HCO3-30 AnGap-13
[**2106-10-23**] 07:30AM BLOOD Glucose-76 UreaN-12 Creat-1.1 Na-137
K-4.3 Cl-100 HCO3-26 AnGap-15
[**2106-10-26**] 06:53AM BLOOD Glucose-130* UreaN-7 Creat-0.8 Na-138
K-3.5 Cl-101 HCO3-30 AnGap-11
[**2106-10-21**] 03:10PM BLOOD ALT-87* AST-113* AlkPhos-525*
Amylase-659* TotBili-1.1 DirBili-0.1 IndBili-1.0
[**2106-10-23**] 07:30AM BLOOD ALT-34 AST-30 AlkPhos-257* Amylase-308*
TotBili-0.7
[**2106-10-26**] 06:53AM BLOOD ALT-17 AST-19 AlkPhos-181* Amylase-238*
TotBili-0.5
[**2106-10-21**] 03:10PM BLOOD Lipase-581*
[**2106-10-23**] 07:30AM BLOOD Lipase-129*
[**2106-10-26**] 06:53AM BLOOD Lipase-157*
[**2106-10-22**] 10:45AM BLOOD Albumin-2.7* Calcium-8.4 Phos-4.1 Mg-1.7
Cholest-116
[**2106-10-26**] 06:53AM BLOOD Calcium-7.9* Phos-2.9 Mg-1.7
[**2106-10-22**] 10:45AM BLOOD Triglyc-112
[**2106-11-12**] 02:05AM BLOOD WBC-17.0* RBC-3.25* Hgb-9.8* Hct-29.8*
MCV-92 MCH-30.1 MCHC-32.9 RDW-15.0 Plt Ct-492*
[**2106-11-16**] 04:59AM BLOOD WBC-19.4* RBC-3.53*# Hgb-10.4*#
Hct-32.8*# MCV-93 MCH-29.4 MCHC-31.7 RDW-15.0 Plt Ct-742*#
[**2106-11-24**] 05:00AM BLOOD WBC-10.4 RBC-2.85* Hgb-8.2* Hct-25.4*
MCV-89 MCH-28.8 MCHC-32.3 RDW-15.1 Plt Ct-614*
[**2106-11-24**] 05:00AM BLOOD Glucose-96 UreaN-10 Creat-0.8 Na-141
K-3.2* Cl-101 HCO3-33* AnGap-10
[**2106-11-25**] 05:05AM BLOOD K-3.8
[**2106-10-26**] 06:53AM BLOOD ALT-17 AST-19 AlkPhos-181* Amylase-238*
TotBili-0.5
[**2106-10-28**] 05:40AM BLOOD ALT-16 AST-24 AlkPhos-235* Amylase-246*
TotBili-0.4
[**2106-11-15**] 04:40AM BLOOD ALT-16 AST-24 AlkPhos-193* Amylase-73
TotBili-0.4
[**2106-11-22**] 06:30AM BLOOD ALT-14 AST-26 AlkPhos-152* Amylase-40
TotBili-0.4
[**2106-10-23**] 07:30AM BLOOD Lipase-129*
[**2106-10-28**] 05:40AM BLOOD Lipase-138*
[**2106-11-10**] 12:55PM BLOOD Lipase-69*
[**2106-11-22**] 06:30AM BLOOD Lipase-26
[**2106-11-24**] 05:00AM BLOOD Calcium-7.7* Phos-3.6 Mg-1.8
[**2106-11-19**] 07:15AM BLOOD Albumin-2.0* Calcium-7.5* Phos-3.2 Mg-1.7
Iron-16*
[**2106-11-19**] 07:15AM BLOOD calTIBC-91* Ferritn-709* TRF-70*
[**2106-11-23**] 06:10AM BLOOD calTIBC-87* Ferritn-782* TRF-67*
[**2106-11-19**] 07:15AM BLOOD Triglyc-189*
[**2106-11-23**] 06:10AM BLOOD Triglyc-179*
.
CT ABDOMEN W/CONTRAST  [**2106-10-21**] 6:24 PM
IMPRESSION:
Large pancreatic pseudocyst replacing the head, neck, and body
of the pancreas, with smaller pseudocysts about the tail of the
pancreas. No ongoing pancreas necrosis. Pseudocyst compresses
the splenic vein, SMV, common bile duct, and duodenum, but there
is no thrombosis, aneurysm or obstruction.
.
CT PELVIS W/CONTRAST  [**2106-11-8**] 12:49 PM
IMPRESSION:

1. Interval increase in size of both previously noted dominant
pseudocysts.

2. The pancreatic pseudocyst surrounds and encases the
gastroduodenal artery. Attention to this area should be paid
during subsequent surgical procedures.

3. Interval increase in amount of parapancreatic
fluid/inflammatory changes.

4. Interval increase in intrahepatic and extrahepatic biliary
dilatation.

5. Interval increase in size of the left pleural effusion.

6. New small pericardial effusion.

.

CT ABDOMEN W/CONTRAST  [**2106-11-16**] 3:16 PM
IMPRESSION:
1. Status post cyst-gastrostomy with marked improvement in
previously noted large fluid collection within the head of the
pancreas. Compared to prior exam, there is slightly increased
abdominal and pelvic ascites.
2. Extensive peripancreatic stranding extending into the
mesentery inferiorly consistent with pancreatitis.
3. Resolution of intrahepatic biliary dilatation likely related
to decompression of large pseudocyst within the head of the
pancreas.
4. Small stable bilateral pleural effusions, left greater than
right.
.


Brief Hospital Course:
This is a 65 year old male who presented with recurrent
pancreatitis. His Amylase and Lipase were elevated to 659 and
581.

Pancreatitis: He was NPO with IVF. He was severely dehydrated on
admission and received aggressive IVF resuscitation. We
monitored his labs, watching his Amylase and Lipase trend down.
His abdominal pain began to improve. He was then allowed clear
fluids on HD 5, He had a slight bump in his Amylase/Lipase.

On [**10-27**], he was ordered for a PICC and TPN and was made NPO. He
continued on TPN and we monitored his Amylase, Lipase and Alk
Phos.

                              AlkPhos Amylase TotBili Lipase
[**2106-10-30**] 09:32AM            300*    271*    0.7     144*
[**2106-10-29**] 09:32AM            275*    271*    0.5     164*
[**2106-10-28**] 05:40AM            235*    246*    0.4     138*
[**2106-10-27**] 06:38AM            200*    255*    0.4     146*
[**2106-10-26**] 06:53AM            181*    238*    0.5     157*
[**2106-10-25**] 06:25AM            188*    203*    0.5     100*

Due to insurance and disposition issues, he remained in house on
TPN.

On HD 19, [**2106-11-8**], his WBC increased to 16K and then 18K the
next day. He also complained of increased pain. We obtained a CT
and this showed interval increase in size of both previously
noted dominant pseudocysts, an interval increase in amount of
parapancreatic fluid/inflammatory changes. He also required IV
fluid bolus x 3 for hypotension and low urinary output.
He was schedule to go to the OR on Thursday [**11-11**]
.
C.diff: He contracted C.diff during his previous hospitalization
and was taking antibiotics. He continued on antibiotics while
here. We rechecked his stool and he continued to be positive for
C.diff. His antibiotics continued.

Urinary Tract infection: He complained or urinary frequency. A
urine culture on [**11-8**] revealed GNR, ENTEROCOCCUS SP.
He was started on Vancomycin and Unasyn. His PICC line was also
removed for potential line infection.

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He went to the OR on [**2106-11-11**] for s/p cyst-gastrostomy, J-tube.
He stayed in the ICU for monitoring due to fluid shifts. He did
well post-operatively and was transferred to the floor. He
continued with IVF, NGT and we started J-tube feedings. The NGT
was removed on [**11-15**], POD 4. His diet was advanced to clears on
POD 5.
We were able to remove the superior drain on POD 6, the
remaining drain had an Amylase of 118.

His wound was slightly opened and packed with W->D dressing. A
swab showed [**2106-11-18**] ENTEROBACTER AEROGENES,
CIPROFLOXACIN---------<=0.25 S. He was started on Cipro and will
complete his course at rehab.

On POD 8, while sitting in the chair, he coughed hard and felt
something "[**Doctor Last Name **]" and starting draining fluid from his abdomen. He
had a fascial dehiscence and went to the OR on [**2102-11-19**] for:
1. Repair of fascial wound dehiscence.
2. Mesh interposition graft using SurgiSis mesh.

He had 2 JP drains in place and these were to wall suction. On
discharge the drains were to bulb suction. Continue with
Abdominal Binder at all times.

His previous drain, that was placed at the original surgery, was
removed on POD 12. This had an Amylase of 41.

His diet was advanced and he was also on tubefeedings at this
time to supplement his diet. His tubedfeedings were stopped at
time of discharge.

C.Diff: His last 3 stool samples were negative for C.diff. He
reported some loose stool, however he was also receiving
tubefeedings during this time.


Medications on Admission:
lipitor 20', protonix 40'

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed.
3. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 3 doses.
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
5. Multi-Vitamin W/Minerals     Capsule Sig: One (1) Capsule PO
once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
1. Recurrent pancreatitis and large peri-panreatic fluid
collection (Pancreatic pseudocyst)
2. Necrotizing pancreatitis.
3. Biliary obstruction.
4. Malnutrition
5. Fascial wound dehiscence
Post-op edema
Post-op hypokalemia
Post-op Urinary tract infection
+C.diff


Discharge Condition:
Good
Diet: Regular
Continue with JP drain care to bulb suction
Continue with Abdominal binder


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.
* 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 vomitting,
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 not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* 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.
* Continue to amubulate several times per day.


Followup Instructions:
[**Known firstname **] [**Last Name (NamePattern4) 2832**], MD Phone:[**Telephone/Fax (1) 1231**]. Please follow-up in 2
weeks. Call to schedule your appointment.



Completed by:[**2106-11-25**]
{'Cyst and pseudocyst of pancreas,Obstruction of bile duct,Disruption of internal operation (surgical) wound,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Urinary complications, not elsewhere classified,Hypopotassemia'}


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
Recurrent Pancreatitis

PRESENT ILLNESS: This is a 65 year old male who was admitted here in [**Month (only) **]
for ETOH pancreatitis. He returns now with recurrent
pancreatitis

MEDICAL HISTORY: ETOH pancreatitis [**9-24**]
C.diff [**9-24**]
Hepatitis B (dx [**2081**]), hyperlipidemia, cellulitis after fly
bite ([**7-24**] tx with penicillin)

MEDICATION ON ADMISSION: lipitor 20', protonix 40'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
NCAT, NAD, talking, A&Ox3
EOM full, anicteric.
Neck supple
Chest clear
Heart regular, no MRG
Abdomen soft, distended, tender to deep palpation,
tympanitic to percussion with hyperactive BS, no rebound or
guarding
LE bilateral 1+ edema to halfway up shins, 2+DP pulses
bilaterally
CN2-12 intact, 5/5 strength of UE/LE

FAMILY HISTORY: mother died of ?pancreatic cancer, brother with heart valve
dz/renal calculi

SOCIAL HISTORY: lives with domestic partner in [**Name (NI) 86**] and on [**Hospital3 **];
currently self employed as interior designer; frequent Etoh on
weekends; former 15 p-y smoker (quit [**2069**]) 

### Response:
{'Cyst and pseudocyst of pancreas,Obstruction of bile duct,Disruption of internal operation (surgical) wound,Unspecified protein-calorie malnutrition,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Urinary complications, not elsewhere classified,Hypopotassemia'}
