CHIEF COMPLAINT: Abdominal pain with fever

PRESENT ILLNESS: Mr. [**Known lastname 59755**] is a 67-year-old gentleman who developed gallstone
pancreatitis and persistent fevers one month ago while visiting
[**Country 2559**]. He was recently admitted to a local hospital with a
diagnosis of pancreatic abscess as well as bilateral pulmonary
emboli and left popliteal DVT. He was treated with intravenous
antibiotics and heparin. However, he continued to have fevers
and gram negative bacteremia was subsequently found on culture.
CT scan demonstrated extensive pancreatic abscess and gas within
the abscess cavity. He was then trasnferred to [**Hospital1 18**] for planned
surgical intervention.

MEDICAL HISTORY: DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

MEDICATION ON ADMISSION: Tenazapam 7.5mg PO QHS
Promethazine 25mg PO QD:PRN
Protonix 40mg PO QD
Pancrease 4500 TID
Heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: temp 102.6  HR 104  BP 102/72  RR 22  Oxygen 94% 2L
NAD mildly tachypneic
HEENT: anicteric, dry mucous membranes
Neck: supple, no JVD
CV: tachycardic, regular rhythm, no murmurs
Pulm: [**Hospital1 **]-basilar crackles R > L
Abdomen: soft, non-tender, non-distended, no rebound or guarding
Extremeties: no LE edema, no peripheral stigmata of endocarditis
Neuro: A + O x 3

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with his wife.  Denies tobacco.  Occasional EtOH.
Acute pancreatitis,Other pulmonary embolism and infarction,Intestinal infection due to Clostridium difficile,Acute cholecystitis,Bacteremia,Incisional hernia without mention of obstruction or gangrene,Other specified disorders of biliary tract,Retention of urine, unspecified,Peritoneal adhesions (postoperative) (postinfection)
Acute pancreatitis,Pulm embol/infarct NEC,Int inf clstrdium dfcile,Acute cholecystitis,Bacteremia,Incisional hernia,Dis of biliary tract NEC,Retention urine NOS,Peritoneal adhesions
Admission Date:  [**2185-1-8**]              Discharge Date:   [**2185-2-15**]

Date of Birth:  [**2117-5-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
Abdominal pain with fever

Major Surgical or Invasive Procedure:
Exploratory laparotomy
Pancreatic abscess drainage
Feeding jejunostomy
IVC filter placement
4 [**Location (un) 1661**]-[**Location (un) 1662**] tube placements
Foley catheter placement
Cholecystostomy tube placement
Nasogastric tube placement


History of Present Illness:
Mr. [**Known lastname 59755**] is a 67-year-old gentleman who developed gallstone
pancreatitis and persistent fevers one month ago while visiting
[**Country 2559**]. He was recently admitted to a local hospital with a
diagnosis of pancreatic abscess as well as bilateral pulmonary
emboli and left popliteal DVT. He was treated with intravenous
antibiotics and heparin. However, he continued to have fevers
and gram negative bacteremia was subsequently found on culture.
CT scan demonstrated extensive pancreatic abscess and gas within
the abscess cavity. He was then trasnferred to [**Hospital1 18**] for planned
surgical intervention.

Past Medical History:
DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

Social History:
Lives with his wife.  Denies tobacco.  Occasional EtOH.

Family History:
non-contributory

Physical Exam:
temp 102.6  HR 104  BP 102/72  RR 22  Oxygen 94% 2L
NAD mildly tachypneic
HEENT: anicteric, dry mucous membranes
Neck: supple, no JVD
CV: tachycardic, regular rhythm, no murmurs
Pulm: [**Hospital1 **]-basilar crackles R > L
Abdomen: soft, non-tender, non-distended, no rebound or guarding
Extremeties: no LE edema, no peripheral stigmata of endocarditis
Neuro: A + O x 3

Pertinent Results:
[**2185-1-8**] 08:28PM BLOOD PT-18.5* PTT-31.8 INR(PT)-2.2
[**2185-2-11**] 04:56AM BLOOD PT-19.0* PTT-35.1* INR(PT)-2.3
[**2185-1-8**] 08:28PM BLOOD Glucose-107* UreaN-13 Creat-0.7 Na-140
K-3.6 Cl-103 HCO3-26 AnGap-15
[**2185-2-11**] 04:56AM BLOOD Glucose-98 UreaN-6 Creat-0.5 Na-139 K-3.4
Cl-105 HCO3-30* AnGap-7*
[**2185-1-8**] 08:28PM BLOOD ALT-8 AST-18 LD(LDH)-88* AlkPhos-46
Amylase-17 TotBili-0.8
[**2185-2-5**] 05:08AM BLOOD ALT-8 AST-10 AlkPhos-80 Amylase-24
TotBili-0.9
[**2185-2-2**] 04:15PM BLOOD Lipase-1172*
[**2185-2-3**] 05:10AM BLOOD Lipase-832*
[**2185-2-4**] 06:00AM BLOOD Lipase-66*
[**2185-2-2**] 04:15PM BLOOD ALT-28 AST-119* AlkPhos-193* Amylase-321*
TotBili-1.3
[**2185-2-3**] 05:10AM BLOOD ALT-17 AST-42* AlkPhos-170* Amylase-393*
TotBili-0.7
[**2185-2-4**] 06:00AM BLOOD ALT-13 AST-14 AlkPhos-104 Amylase-81
TotBili-0.9
[**2185-1-8**] 08:28PM BLOOD Albumin-2.7* Calcium-8.0* Phos-3.1 Mg-1.9
[**2185-2-11**] 04:56AM BLOOD Calcium-7.6* Phos-3.6 Mg-2.0

CT PELVIS W/CONTRAST  [**2185-1-8**] 11:25 PM
Extensive interconnecting fluid collections with enhancing walls
and gas within them, consistent with extensive peripancreatic
abscess. No evidence of pancreatic necrosis or pseudocyst
formation.

CT ABDOMEN W/CONTRAST  [**2185-1-17**] 6:12 PM
1. Interval placement of multiple surgical drains including a
cholecystostomy tube with significant interval improvement of
the previously identified peri-pancreatic abscess.
2. Development of a small fluid collection in the anterior mid
abdomen.

CHEST (PORTABLE AP)  [**2185-2-4**] 6:16 PM
Left lower lobe collapse and/or consolidation. Note change in
position of tip of right subclavian PICC line, now coursing
cranially toward jugular vein.

CHEST (PA & LAT)  [**2185-2-12**] 10:48 AM
There is a triangular opacity in the right lower lung consistent
with a small right lower lobe infiltrate. There are small
bilateral pleural effusions. Compared to the film from a week
ago, the right lower lobe infiltrate is new.

Brief Hospital Course:
Mr. [**Known lastname 59755**] was admitted on [**2185-1-8**] and taken to the
operating room the following day for an exploratory laparotomy
and drainage of a peripancreatic abscess.  He tolerated the
procedure well.  For details of the procedure, see operative
note.  He was started on unasyn and gentamicin as treatment for
his gram negative bacteremia.  Following the procedure he was
tranferred to the surgical ICU for further observation, fluid
resuscitation and further management.  Lower extremity
ultrasound confirmed a left popliteal DVT, for which an IVC
filter was placed on [**2185-1-10**].  He was started on imipenem and
extubated while in the ICU.  He was transferred to the floor on
POD 6 after being afebrile for 24-48 hours and with a white
blood cell count that was within normal limits.

He had four JP drains as well as a chole drain in place upon
transfer.  He was started on TPN and tube feeds on POD 9.  His
NGT was removed on POD 10.  The following day (POD 11) three of
his JP drains were withdrawn slightly; the day after that JP #1
was removed altogether.

On POD 15 the output from JP #4 was noted to be bilious and
found to have a Total Bili of 53.4.  The ERCP fellow was
consulted after a tube study revealed a bile leak near the
cholecystostomy tube site.  After two unsuccessful attempts at
ERCP (due to an edematous duodenum), he was treated with
ocreotide, which resulted in his drain output reducing
dramatically over the following few days.

On POD 28 he was noted to have loose watery stools that tested
positive for C. difficile.  He was started on metronidazole.
The following day JP #3 was removed.

On POD 31 JP #2 was removed and his imipenem was stopped.  He
started coumadin on POD 30 and was theraputic on POD 33, at
which time his heparin was stopped.  On POD 35, he was having
more solid stooling and his flagyl was summarily stopped.  He
was tolerating a regular, low-fat diet but continued his tube
feeds by POD 36.  He was then discharged to a Rehab facility on
POD 37 in good condition, ambulating and tolerating a low-fat
diet with tube feed supplementation.  He is asked to follow-up
with Dr. [**Last Name (STitle) **] in [**2-13**] weeks.

Medications on Admission:
Tenazapam 7.5mg PO QHS
Promethazine 25mg PO QD:PRN
Protonix 40mg PO QD
Pancrease 4500 TID
Heparin gtt

Discharge Medications:
1. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day).
2. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Metoclopramide HCl 10 mg Tablet Sig: One (1) Tablet PO
QIDACHS (4 times a day (before meals and at bedtime)).
Disp:*qs Tablet(s)* Refills:*2*
6. Terazosin HCl 2 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
Disp:*qs Capsule(s)* Refills:*2*
7. Megestrol Acetate 40 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
8. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to
6 hours) as needed.
Disp:*qs Tablet(s)* Refills:*0*
9. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
Disp:*qs * Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **] Center

Discharge Diagnosis:
s/p exploratory laparotomy and drainage of pancreatic abscess on
[**2185-1-9**]
DVT and PE s/p placement of IVC filter
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia


Discharge Condition:
good

Discharge Instructions:
Go to an Emergency Room if you experience new and continuing
nausea,
vomiting, fevers (>101.5 F), chills, or shortness of breath.
Also go to the ER if your wound becomes red, swollen, warm, or
produces pus.

If you experience clear drainage from your wounds, cover them
with a
clean dressing and stop showering until the drainage subsides
for at
least 2 days.

No heavy lifting or exertion for at least 6 weeks.

No driving while taking pain medications.

Narcotics can cause constipation.  Please take an over the
counter stool softener such as Colace or a gentle laxative such
as Milk of Magnesia if you experience constipation.

Be sure to take your complete course of antibiotics.

You may resume your regular diet as tolerated.

You may take showers (no baths) after your dressings have been
removed from your wounds.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in [**2-13**] weeks.  Call ([**Telephone/Fax (1) 15148**] to schedule an appointment.





Name:  [**Known lastname 10972**],[**Known firstname 3061**]               Unit No:   [**Numeric Identifier 10973**]

Admission Date:  [**2185-1-8**]              Discharge Date:   [**2185-2-15**]

Date of Birth:  [**2117-5-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3524**]
Addendum:
Patient is asked to continue his metronidazole for six more days
(i.e. for a total of 14 days) for his C. difficile infection.
Furthermore, patient is asked to follow-up with Dr. [**Last Name (STitle) **] in 1
month; he is aked to continue the octreotide in the meantime.
And he is to follow-up with Dr. [**Last Name (STitle) 7116**] (PCP) for his warfarin
(coumadin) dosing.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 643**] Center

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2207**] MD [**MD Number(1) 3525**]

Completed by:[**2185-2-15**]
{'Acute pancreatitis,Other pulmonary embolism and infarction,Intestinal infection due to Clostridium difficile,Acute cholecystitis,Bacteremia,Incisional hernia without mention of obstruction or gangrene,Other specified disorders of biliary tract,Retention of urine, unspecified,Peritoneal adhesions (postoperative) (postinfection)'}


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 with fever

PRESENT ILLNESS: Mr. [**Known lastname 59755**] is a 67-year-old gentleman who developed gallstone
pancreatitis and persistent fevers one month ago while visiting
[**Country 2559**]. He was recently admitted to a local hospital with a
diagnosis of pancreatic abscess as well as bilateral pulmonary
emboli and left popliteal DVT. He was treated with intravenous
antibiotics and heparin. However, he continued to have fevers
and gram negative bacteremia was subsequently found on culture.
CT scan demonstrated extensive pancreatic abscess and gas within
the abscess cavity. He was then trasnferred to [**Hospital1 18**] for planned
surgical intervention.

MEDICAL HISTORY: DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

MEDICATION ON ADMISSION: Tenazapam 7.5mg PO QHS
Promethazine 25mg PO QD:PRN
Protonix 40mg PO QD
Pancrease 4500 TID
Heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: temp 102.6  HR 104  BP 102/72  RR 22  Oxygen 94% 2L
NAD mildly tachypneic
HEENT: anicteric, dry mucous membranes
Neck: supple, no JVD
CV: tachycardic, regular rhythm, no murmurs
Pulm: [**Hospital1 **]-basilar crackles R > L
Abdomen: soft, non-tender, non-distended, no rebound or guarding
Extremeties: no LE edema, no peripheral stigmata of endocarditis
Neuro: A + O x 3

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with his wife.  Denies tobacco.  Occasional EtOH. 

### Response:
{'Acute pancreatitis,Other pulmonary embolism and infarction,Intestinal infection due to Clostridium difficile,Acute cholecystitis,Bacteremia,Incisional hernia without mention of obstruction or gangrene,Other specified disorders of biliary tract,Retention of urine, unspecified,Peritoneal adhesions (postoperative) (postinfection)'}
