CHIEF COMPLAINT: 

PRESENT ILLNESS: A 44-year-old female with
history of hepatitis C diagnosed 2 months ago, treated with
interferon and ribavirin for 2 months, who presented from
outside hospital with acute pancreatitis.  The patient
reports 2-month history of abdominal pain with weekly
interferon and ribavirin injections, followed by abdominal
and back pain, nausea, vomiting, decreased appetite, and
increased abdominal distention.  On [**2126-2-21**], the patient was
admitted in an outside hospital with 10/10 abdominal pain,
fever, and severe nausea and vomiting.  Labs at the outside
hospital were significant for hematocrit of 39, white blood
cell count of 8.6, glucose of 129, calcium 9.1, lipase of
740, AST of 198, oxygen saturation 98 percent on room air.
CAT scan from the 18 showed peripancreatic fluid surrounding
the pancreas at the head with stranding.  Abdominal
ultrasound was negative in terms of gallbladder disease.  The
patient was treated with IV fluids, pain control, imipenem
500 IV q.6 h. with progressive decline in function and,
therefore, was transferred to [**Hospital1 18**] ICU for further
management.  In the ICU, the patient's course was notable for
persistent hypoxia, worsening abdominal distention, post
initiation of tube feeds via postpyloric feeding tube.
Additionally, the patient had been persistently febrile,
despite treatment with imipenem.  There is no clear-cut
source of her infection thus far.  Repeat CT of the abdomen
did not reveal necrotic pancreas from [**2126-2-24**].  Upon
transfer, the patient was reporting abdominal pain to be
controlled with a PCA.  She was denying sensation of
shortness of breath, chest pain, nausea, or vomiting.  Her
last bowel movement was on transfer.  Noted that her abdomen
was more distended this a.m.

MEDICAL HISTORY: Hepatitis C x2 months on ribavirin and
interferon.
Fibromyalgia.
TAH.
Lumpectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: TO SULFA, WHICH CAUSES A RASH.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Negative for tobacco or alcohol use.  The
patient is currently in the process of getting a divorce.
Acute pancreatitis,Urinary tract infection, site not specified,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Myalgia and myositis, unspecified
Acute pancreatitis,Urin tract infection NOS,Chrnc hpt C wo hpat coma,CHF NOS,Myalgia and myositis NOS
Admission Date: [**2126-2-23**]        Discharge Date: [**2126-3-7**]

Date of Birth:  [**2081-5-14**]        Sex:

Service:


HISTORY OF PRESENT ILLNESS:  A 44-year-old female with
history of hepatitis C diagnosed 2 months ago, treated with
interferon and ribavirin for 2 months, who presented from
outside hospital with acute pancreatitis.  The patient
reports 2-month history of abdominal pain with weekly
interferon and ribavirin injections, followed by abdominal
and back pain, nausea, vomiting, decreased appetite, and
increased abdominal distention.  On [**2126-2-21**], the patient was
admitted in an outside hospital with 10/10 abdominal pain,
fever, and severe nausea and vomiting.  Labs at the outside
hospital were significant for hematocrit of 39, white blood
cell count of 8.6, glucose of 129, calcium 9.1, lipase of
740, AST of 198, oxygen saturation 98 percent on room air.
CAT scan from the 18 showed peripancreatic fluid surrounding
the pancreas at the head with stranding.  Abdominal
ultrasound was negative in terms of gallbladder disease.  The
patient was treated with IV fluids, pain control, imipenem
500 IV q.6 h. with progressive decline in function and,
therefore, was transferred to [**Hospital1 18**] ICU for further
management.  In the ICU, the patient's course was notable for
persistent hypoxia, worsening abdominal distention, post
initiation of tube feeds via postpyloric feeding tube.
Additionally, the patient had been persistently febrile,
despite treatment with imipenem.  There is no clear-cut
source of her infection thus far.  Repeat CT of the abdomen
did not reveal necrotic pancreas from [**2126-2-24**].  Upon
transfer, the patient was reporting abdominal pain to be
controlled with a PCA.  She was denying sensation of
shortness of breath, chest pain, nausea, or vomiting.  Her
last bowel movement was on transfer.  Noted that her abdomen
was more distended this a.m.

PAST MEDICAL HISTORY:  Hepatitis C x2 months on ribavirin and
interferon.
Fibromyalgia.
TAH.
Lumpectomy.

SOCIAL HISTORY:  Negative for tobacco or alcohol use.  The
patient is currently in the process of getting a divorce.

FAMILY HISTORY:  Noncontributory.

ALLERGIES:  TO SULFA, WHICH CAUSES A RASH.

PHYSICAL EXAMINATION:  From transfer, T max 102.2, heart rate
107 to 111, blood pressure 128/62, respiratory rate 18 to 24,
93 to 96 percent on 6 liters nasal cannula, 24 hour I&Os 4
liters and 2.8 liters for the length of stay; however, the
patient was positive at 6 liters.  General:  In no apparent
distress.  HEENT:  Negative.  Cardiac exam:  Regular
tachycardia, no murmurs.  Pulmonary exam:  Upper expiratory
wheezes, bibasilar crackles, and egophony E to A, abdominal
distention, decreased bowel sounds, mild epigastric
tenderness to palpation, no ecchymosis in the flank or back
region.  Extremities:  Trace edema, no calf tenderness, 1+
dorsalis pedis.  The patient has a NG tube in place, Foley in
place, and a PICC line in place.

LABORATORY DATA:  From admission, white blood cell count 6.3,
hematocrit of 30.8, MCV 95, platelets 156.  Chemistry profile
within normal limits with a calcium of 7.2, magnesium 2.1,
phosphorus 0.8.

HOSPITAL COURSE:  Acute pancreatitis.  There was no obvious
risk factors, however, the thought was entertained and
perhaps this was secondary to interferon and ribavirin
injections.  The patient ransom criteria on presentation was
0, at 48 hours it was 3 to 4.  On [**2126-2-24**], CT showed no
necrosis and appeared to be to be stabilized clinically.  The
patient's lipase from the 22nd was 70 at the outside hospital
was as high as 700.  Her abdominal distention was concerning
for possible ileus; however, the patient was passing stool
and felt that overall her abdominal exam was improving.
There was no evidence of Clostridium difficile colitis.
However, given her persistent fevers and elevated white blood
cell count, this was monitored closely as well as for
potentially worsening hepatobiliary disease.  The patient was
maintained on IV fluids, Dilaudid PCA, Zofran, and Phenergan
for antiemetic support.  The patient was maintained on
imipenem.  KUB did not reveal any evidence of obstruction.
GI service continued to follow the patient and recommended
continuing tube feeds to maintain integrity of the gut flora.

Hypoxia.  The patient was hypoxic in the ICU.

DIFFERENTIAL DIAGNOSES:  Pneumonia.
Congestive heart failure.
Atelectasis versus pulmonary embolus.

A chest x-ray did show effusions and left lower lobe
atelectasis and vascular prominence mainly in the left
perihilar region.  Question was what could this be, early
ARDS versus cardiogenic pulmonary edema mostly likely from
3rd spacing, however, given the patient's overall 6 liter
positive IV fluid intake, the patient maintained adequate
urine output.  Repeat echocardiogram was obtained.  The
patient reportedly had had a normal one in the outside
hospital, but given her new findings on chest x-ray and
clinically a repeat study was performed, which showed
preserved systolic function, normal valves, and no wall
motion abnormalities.

Fever.  This is likely from pancreatitis, but the patient was
persistently pan cultured, her urine did grow enterococcus
for which she was adequately covered with antibiotics.  She
also had E. coli in her urine with repeat urine cultures, no
growth to date.  The patient's fever curve began to decrease
as her symptoms began to improve with loss of abdominal
distention and less diarrhea.  All of her blood cultures
remain negative to date.  Given the patient's positive urine
culture, the Foley catheter was removed.

Nutrition.  The patient was on NG tube feeds; however, the NG
tube fell out on the evening of the 20th and the patient
refused to have a second one placed.  Therefore, the patient
was maintained on TPN and was slowly advanced to a BRAT diet,
which she tolerated.

Depression and anxiety.  The patient was instructed to follow
up with her outpatient therapist.

Abdominal pain.  Thought was that this is likely related to
the patient's known condition of hepatitis C and surrounding
inflammation in the area.  Persistently followed her LFTs
without any major abnormalities detected.  Repeat imaging was
not warranted.

DISCHARGE DIAGNOSES:  Acute pancreatitis.
Urinary tract infection.
Hepatitis C.
Fibromyalgia.
Depression and anxiety disorder.

DISCHARGE STATUS:  The patient will be discharged to home.

DISCHARGE CONDITION:  The patient is stable without an oxygen
requirement, tolerating a p.o. diet.

RECOMMENDED FOLLOWUP:  The patient is instructed to follow up
with her PCP as well as Gastroenterology in 1 to 2 weeks
since discharge.

SURGICAL OR INVASIVE PROCEDURES PERFORMED DURING THIS
HOSPITALIZATION:  PICC line placement for TPN.
Postpyloric feeding tube.

DISCHARGE MEDICATIONS:
1. Lorazepam 0.5 mg q.6 h. p.r.n. for anxiety.
2. Senna p.r.n. for constipation.
3. Percocet 1-2 tablets q.[**3-12**] h. p.r.n. for pain.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 5704**], [**MD Number(1) 5705**]

Dictated By:[**Last Name (NamePattern1) 12866**]
MEDQUIST36
D:  [**2126-5-29**] 12:58:47
T:  [**2126-5-29**] 16:25:39
Job#:  [**Job Number **]
{'Acute pancreatitis,Urinary tract infection, site not specified,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Myalgia and myositis, unspecified'}


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: 

PRESENT ILLNESS: A 44-year-old female with
history of hepatitis C diagnosed 2 months ago, treated with
interferon and ribavirin for 2 months, who presented from
outside hospital with acute pancreatitis.  The patient
reports 2-month history of abdominal pain with weekly
interferon and ribavirin injections, followed by abdominal
and back pain, nausea, vomiting, decreased appetite, and
increased abdominal distention.  On [**2126-2-21**], the patient was
admitted in an outside hospital with 10/10 abdominal pain,
fever, and severe nausea and vomiting.  Labs at the outside
hospital were significant for hematocrit of 39, white blood
cell count of 8.6, glucose of 129, calcium 9.1, lipase of
740, AST of 198, oxygen saturation 98 percent on room air.
CAT scan from the 18 showed peripancreatic fluid surrounding
the pancreas at the head with stranding.  Abdominal
ultrasound was negative in terms of gallbladder disease.  The
patient was treated with IV fluids, pain control, imipenem
500 IV q.6 h. with progressive decline in function and,
therefore, was transferred to [**Hospital1 18**] ICU for further
management.  In the ICU, the patient's course was notable for
persistent hypoxia, worsening abdominal distention, post
initiation of tube feeds via postpyloric feeding tube.
Additionally, the patient had been persistently febrile,
despite treatment with imipenem.  There is no clear-cut
source of her infection thus far.  Repeat CT of the abdomen
did not reveal necrotic pancreas from [**2126-2-24**].  Upon
transfer, the patient was reporting abdominal pain to be
controlled with a PCA.  She was denying sensation of
shortness of breath, chest pain, nausea, or vomiting.  Her
last bowel movement was on transfer.  Noted that her abdomen
was more distended this a.m.

MEDICAL HISTORY: Hepatitis C x2 months on ribavirin and
interferon.
Fibromyalgia.
TAH.
Lumpectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: TO SULFA, WHICH CAUSES A RASH.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Negative for tobacco or alcohol use.  The
patient is currently in the process of getting a divorce. 

### Response:
{'Acute pancreatitis,Urinary tract infection, site not specified,Chronic hepatitis C without mention of hepatic coma,Congestive heart failure, unspecified,Myalgia and myositis, unspecified'}
