CHIEF COMPLAINT: Incarcerated hernia

PRESENT ILLNESS: Pt is a 54 M w/ h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **] in
[**2151**]. He noticed a bulge in his left groin approximately 5 days,
and has been having worsening nausea/vomiting for the last ~24
hrs, with approximately 11 episodes of emesis yesterday. His
pain has been stable. He did have a subjective fever last night.

MEDICAL HISTORY: CAD s/p 3V CABG to LAD, OM1, PDA.
HTN, controlled on meds
Dyslipidemia

MEDICATION ON ADMISSION: Metoprolol Tartrate 25 mg PO BID
 Lisinopril 5 mg PO DAILY
 Atorvastatin 20 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam upon admission:
Vitals:
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft. Minimally distended. Nontender. No guarding/Rebound.
     Palpable L inguinal Hernia
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: Extensive family hx of CAD.
F died of MI [**92**], Uncle died of MI [**83**]. GF died of MI.

SOCIAL HISTORY: No tobacco hx, very rare EtOH use, no IVDU. Pt is a MSM, lives
with a steady male partner, currently sexually active, does not
use protection, no hx of STDs in himself or partner. Employed in
clothing design firm.
Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified,recurrent,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Recur unil ing hern-obst,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2157-9-28**]              Discharge Date:   [**2157-9-30**]

Date of Birth:  [**2102-11-12**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
Incarcerated hernia

Major Surgical or Invasive Procedure:
[**2157-9-28**] Left Inguinal hernia repair w/ mesh

History of Present Illness:
Pt is a 54 M w/ h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **] in
[**2151**]. He noticed a bulge in his left groin approximately 5 days,
and has been having worsening nausea/vomiting for the last ~24
hrs, with approximately 11 episodes of emesis yesterday. His
pain has been stable. He did have a subjective fever last night.



Past Medical History:
CAD s/p 3V CABG to LAD, OM1, PDA.
HTN, controlled on meds
Dyslipidemia


Social History:
No tobacco hx, very rare EtOH use, no IVDU. Pt is a MSM, lives
with a steady male partner, currently sexually active, does not
use protection, no hx of STDs in himself or partner. Employed in
clothing design firm.


Family History:
Extensive family hx of CAD.
F died of MI [**92**], Uncle died of MI [**83**]. GF died of MI.


Physical Exam:
Physical Exam upon admission:
Vitals:
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft. Minimally distended. Nontender. No guarding/Rebound.
     Palpable L inguinal Hernia
Ext: No LE edema, LE warm and well perfused

Physical Exam upon discharge:
VS: 98.2, 119/57, 78, 16, 99/RA
GEN: Resting in chair, NAD
HEENT:No scleral icterus, mucus membranes moist
CARDIAC: Normal S1, S2. RRR. No MRG
PULM: Lungs CTAB
ABDOMEN: obese, soft/nontender/mildly distended
EXT: + pedal pulses. No CCE.
NEURO: AAOx4
Skin: Left groin incision OTA, steri strips intact.

Pertinent Results:
Imaging:
[**2157-9-28**]   Radiology CT ABD & PELVIS WITH CO
Left inguinal hernia containing sigmoid colon and causing large
bowel
obstruction.  Minimal surrounding inflammation.  No bowel wall
enhancement abnormalities to suggest ischemia, though trace
fluid is identified within the abdomen.  No free air.

[**2157-9-29**] 08:25AM BLOOD WBC-9.1 RBC-4.72 Hgb-14.9# Hct-41.3#
MCV-88 MCH-31.5 MCHC-36.0* RDW-13.0 Plt Ct-173
[**2157-9-28**] 12:50PM BLOOD WBC-10.9# RBC-6.02 Hgb-18.7* Hct-51.8
MCV-86 MCH-31.1 MCHC-36.1* RDW-13.2 Plt Ct-245#
[**2157-9-28**] 12:50PM BLOOD Neuts-82.9* Lymphs-11.5* Monos-5.1
Eos-0.1 Baso-0.3
[**2157-9-29**] 08:25AM BLOOD Glucose-103* UreaN-18 Creat-0.9 Na-136
K-3.9 Cl-103 HCO3-25 AnGap-12
[**2157-9-28**] 12:50PM BLOOD Glucose-118* UreaN-19 Creat-1.1 Na-132*
K-3.6 Cl-95* HCO3-24 AnGap-17
[**2157-9-28**] 12:50PM BLOOD ALT-49* AST-31 AlkPhos-54 TotBili-1.3
[**2157-9-29**] 08:25AM BLOOD Calcium-8.1* Phos-3.9 Mg-2.0
[**2157-9-28**] 12:50PM BLOOD Albumin-5.3*
[**2157-9-28**] 12:58PM BLOOD Lactate-2.5*

Brief Hospital Course:
The patient is with h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **]
in [**2151**]. He noticed a bulge in his left groin approximately 5
days, and has been having worsening nausea/vomiting for the last
several hours. He was admitted to the Acute Care Service after a
CT Scan revealed "Left inguinal hernia containing sigmoid colon
and causing large bowel obstruction.  Minimal surrounding
inflammation."

On [**2157-9-28**], the patient was taken to the operating room for
repair of his incarcerated recurrent left inguinal hernia with
mesh. Please see operative report for details of this procedure.
He tolerated the procedure well and was extubated upon
completion. He was subsequently taken to the PACU for recovery.
He was transferred to the surgical floor hemodynamically stable.
His vital signs were routinely monitored and he remained
afebrile and hemodynamically stable. He was initially given IV
fluids postoperatively, which were discontinued when he was
tolerating PO's. His diet was advanced on the morning of
[**2157-9-29**] to regular, which he tolerated without abdominal pain,
nausea, or vomiting. He was voiding adequate amounts of urine
without difficulty. He was encouraged to mobilize out of bed and
ambulate as tolerated, which he was able to do independently.
His pain level was routinely assessed and well controlled at
discharge with an oral regimen as needed. His left groin
incision was open to air with steri strips that were
clean/dry/intact. On [**2157-9-30**], he was discharged home with
scheduled follow up in [**Hospital 2536**] clinic.

Medications on Admission:
 Metoprolol Tartrate 25 mg PO BID
 Lisinopril 5 mg PO DAILY
 Atorvastatin 20 mg PO DAILY


Discharge Medications:
1. Metoprolol Tartrate 25 mg PO BID
2. OxycoDONE (Immediate Release)  5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours
Disp #*20 Tablet Refills:*0
3. Lisinopril 5 mg PO DAILY
4. Atorvastatin 20 mg PO DAILY


Discharge Disposition:
Home

Discharge Diagnosis:
Incarcerated Inguinal Hernia


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


Discharge Instructions:
You came to the hospital complaining of nausea and abdominal
pain. A CT scan revealed an left inguinal incracerated hernia .
You were taken to the operating room for hernia repair. Your
bowel function has returned and you have resumed a regular diet.


Please follow up in [**Hospital 2536**] clinic at the appointment scheduled for
you below.

ACTIVITY:

Do not drive until you have stopped taking pain medicine and
feel you could respond in an emergency.
You may climb stairs.
You may go outside, but avoid traveling long distances until you
see your [**Hospital 5059**] at your next visit.
Don't lift more than 20-25 lbs for 4-6 weeks. (This is about the
weight of a briefcase or a bag of groceries.) This applies to
lifting children, but they may sit on your lap.
You may start some light exercise when you feel comfortable.
You will need to stay out of bathtubs or swimming pools for a
time while your incision is healing. Ask your doctor when you
can resume tub baths or swimming.
Heavy exercise may be started after 6 weeks, but use common
sense and go slowly at first.

HOW YOU [**Month (only) **] FEEL:

You may feel weak or "washed out" for 6 weeks. You might want to
nap often. Simple tasks may exhaust you.
You may have a sore throat because of a tube that was in your
throat during surgery.
You might have trouble concentrating or difficulty sleeping. You
might feel somewhat depressed.
You could have a poor appetite for a while. Food may seem
unappealing.
All of these feelings and reactions are normal and should go
away in a short time.  If they do not, tell your [**Month (only) 5059**].

YOUR INCISION:
Your incision may be slightly red around the staples. This is
normal.
You may gently wash away dried material around your incision.
It is normal to feel a firm ridge along the incision. This will
go away.
Avoid direct sun exposure to the incision area.
Do not use any ointments on the incision unless you were told
otherwise.
You may see a small amount of clear or light red fluid staining
your dressing or clothes. If the staining is severe, please call
your [**Month (only) 5059**].
You may shower. As noted above, ask your doctor when you may
resume tub baths or swimming.
Ove the next 6-12 months, your incision will fade and become
less prominent.

YOUR BOWELS:
Constipation is a common side effect of medicine such as
Percocet or codeine. If needed, you may take a stool softener
(such as Colace, one capsule) or gentle laxative (such as milk
of magnesia, 1 tbs) twice a day. You can get both of these
medicines without a prescription.
If you go 48 hours without a bowel movement, or have pain moving
the bowels, call your [**Month (only) 5059**].


PAIN MANAGEMENT:
It is normal to feel some discomfort/pain following abdominal
surgery. This pain is often described as "soreness".
Your pain should get better day by day. If you find the pain is
getting worse instead of better, please contact your [**Name2 (NI) 5059**].
You will receive a prescription from your [**Name2 (NI) 5059**] for pain
medicine to take by mouth. It is important to take this medicine
as directied. Do not take it more frequently than prescribed. Do
not take more medicine at one time than prescribed.
Your pain medicine will work better if you take it before your
pain gets too severe.
Talk with your [**Name2 (NI) 5059**] about how long you will need to take
prescription pain medicine. Please don't take any other pain
medicine, including non-prescription pain medicine, unless your
[**Name2 (NI) 5059**] has said its okay.
If you are experiencing no pain, it is okay to skip a dose of
pain medicine.
Remember to use your "cough pillow" for splinting when you cough
or when you are doing your deep breathing exercises.
If you experience any of the folloiwng, please contact your
[**Name2 (NI) 5059**]:
- sharp pain or any severe pain that lasts several hours
- pain that is getting worse over time
- pain accompanied by fever of more than 101
- a drastic change in nature or quality of your pain

MEDICATIONS:
Take all the medicines you were on before the operation just as
you did before, unless you have been told differently.
In some cases you will have a prescription for antibiotics or
other medication.
If you have any questions about what medicine to take or not to
take, please call your [**Name2 (NI) 5059**].

DANGER SIGNS:
Please call your [**Name2 (NI) 5059**] if you develop:
- worsening abdominal pain
- sharp or severe pain that lasts several hours
- temperature of 101 degrees or higher
- severe diarrhea
- vomiting
- redness around the incision that is spreading
- increased swelling around the incision
- excessive bruising around the incision
- cloudy fluid coming from the wound
- bright red blood or foul smelling discharge coming from the
wound
- an increase in drainage from the wound

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) **] D.
Location: [**Hospital1 **] [**Location (un) **]
Address: [**Street Address(2) **], 2ND FL, [**Location (un) **],[**Numeric Identifier 2900**]
Phone: [**Telephone/Fax (1) 5723**]
Appt:  [**10-5**] at 12:20pm

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: THURSDAY [**2157-10-13**] at 3:00 PM
With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage



Completed by:[**2157-9-30**]
{'Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified,recurrent,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: Incarcerated hernia

PRESENT ILLNESS: Pt is a 54 M w/ h/o L inguinal hernia repair by Dr. [**Last Name (STitle) **] in
[**2151**]. He noticed a bulge in his left groin approximately 5 days,
and has been having worsening nausea/vomiting for the last ~24
hrs, with approximately 11 episodes of emesis yesterday. His
pain has been stable. He did have a subjective fever last night.

MEDICAL HISTORY: CAD s/p 3V CABG to LAD, OM1, PDA.
HTN, controlled on meds
Dyslipidemia

MEDICATION ON ADMISSION: Metoprolol Tartrate 25 mg PO BID
 Lisinopril 5 mg PO DAILY
 Atorvastatin 20 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam upon admission:
Vitals:
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft. Minimally distended. Nontender. No guarding/Rebound.
     Palpable L inguinal Hernia
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: Extensive family hx of CAD.
F died of MI [**92**], Uncle died of MI [**83**]. GF died of MI.

SOCIAL HISTORY: No tobacco hx, very rare EtOH use, no IVDU. Pt is a MSM, lives
with a steady male partner, currently sexually active, does not
use protection, no hx of STDs in himself or partner. Employed in
clothing design firm. 

### Response:
{'Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified,recurrent,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
