CHIEF COMPLAINT: Fever, abdominal pain

PRESENT ILLNESS: This is an 82 year old male with 5 days of diarrhea as well as
dysuria treated with bactrim and now with new-onset abdominal
pain and distension. He denies nauseas or vomiting. He has
chills and today had a fever to 101. He has no constipation .
His prior abdominal history os notable for a hernia repair 20
years ago

MEDICAL HISTORY: Lumpar stenosis s/p repair
COPD
Peripheral [**Month/Day/Year 1106**] disease
Prostatectomy
Hernia repair
Hypertension

MEDICATION ON ADMISSION: Lipitor
Toprol XL
Prilosec
Colace
Rhinocort

ALLERGIES: Penicillins

PHYSICAL EXAM: ON admission:

FAMILY HISTORY: non-contirbutory

SOCIAL HISTORY: Lives with wife. Retired president of insurance company. The
patient is a 100-pack year smoker. He drinks alcohol socially.
Unspecified septicemia,Cholangitis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Sepsis,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension
Septicemia NOS,Cholangitis,Chr airway obstruct NEC,CHF NOS,Sepsis,Periph vascular dis NOS,Hx-prostatic malignancy,Hypertension NOS
Admission Date:  [**2153-7-28**]              Discharge Date:   [**2153-8-2**]


Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 17683**]
Chief Complaint:
Fever, abdominal pain

Major Surgical or Invasive Procedure:
[**2153-7-29**] PTC tube placement
[**2153-7-30**] ERCP


History of Present Illness:
This is an 82 year old male with 5 days of diarrhea as well as
dysuria treated with bactrim and now with new-onset abdominal
pain and distension. He denies nauseas or vomiting. He has
chills and today had a fever to 101. He has no constipation .
His prior abdominal history os notable for a hernia repair 20
years ago

Past Medical History:
Lumpar stenosis s/p repair
COPD
Peripheral [**Month/Day/Year 1106**] disease
Prostatectomy
Hernia repair
Hypertension


Social History:
Lives with wife. Retired president of insurance company. The
patient is a 100-pack year smoker. He drinks alcohol socially.

Family History:
non-contirbutory

Physical Exam:
ON admission:

Temp 103, 85/48, pulse 120, 22, 95% on 2 liters
Gen: alert, awake
Pulm: CTAB
CV: RRR, no murmur
Abd: soft, no tendreness, no rebound, negative [**Doctor Last Name **] sign
Extr: warm, well-perfused, palpable distal pulses

Pertinent Results:
[**2153-7-28**] 04:00PM BLOOD WBC-22.7*# RBC-3.60* Hgb-9.5* Hct-29.2*
MCV-81* MCH-26.4* MCHC-32.6 RDW-14.1 Plt Ct-402
[**2153-7-29**] 02:46AM BLOOD WBC-23.4* RBC-3.07* Hgb-8.4* Hct-25.4*
MCV-83 MCH-27.3 MCHC-33.1 RDW-14.4 Plt Ct-257
[**2153-7-29**] 11:23AM BLOOD WBC-19.0* RBC-3.40* Hgb-9.3* Hct-27.2*
MCV-80* MCH-27.3 MCHC-34.0 RDW-14.5 Plt Ct-283
[**2153-7-30**] 03:13AM BLOOD WBC-11.7* RBC-3.28* Hgb-8.8* Hct-26.8*
MCV-82 MCH-26.8* MCHC-32.8 RDW-14.8 Plt Ct-267
[**2153-7-31**] 05:03AM BLOOD WBC-11.0 RBC-3.72* Hgb-9.9* Hct-30.9*
MCV-83 MCH-26.6* MCHC-32.1 RDW-14.6 Plt Ct-263
[**2153-7-28**] 04:00PM BLOOD Neuts-96.9* Bands-0 Lymphs-2.3*
Monos-0.7* Eos-0.1 Baso-0.1
[**2153-7-28**] 12:40PM BLOOD PT-15.9* PTT-30.1 INR(PT)-1.7
[**2153-7-28**] 09:19PM BLOOD PT-17.2* PTT-32.5 INR(PT)-2.0
[**2153-7-30**] 03:13AM BLOOD PT-15.3* PTT-29.2 INR(PT)-1.6
[**2153-7-28**] 09:19PM BLOOD Glucose-119* UreaN-26* Creat-2.0* Na-132*
K-4.1 Cl-100 HCO3-21* AnGap-15
[**2153-7-29**] 02:46AM BLOOD Glucose-116* UreaN-26* Creat-2.0* Na-135
K-4.1 Cl-98 HCO3-24 AnGap-17
[**2153-7-29**] 11:23AM BLOOD Na-136 K-3.6
[**2153-7-30**] 03:13AM BLOOD Glucose-93 UreaN-41* Creat-2.0* Na-138
K-3.9 Cl-101 HCO3-25 AnGap-16
[**2153-7-31**] 05:03AM BLOOD Glucose-108* UreaN-37* Creat-1.7* Na-139
K-3.5 Cl-100 HCO3-25 AnGap-18
[**2153-7-28**] 04:00PM BLOOD ALT-1076* AST-1591* AlkPhos-749*
Amylase-49 TotBili-3.7*
[**2153-7-28**] 09:19PM BLOOD ALT-759* AST-922* LD(LDH)-333*
AlkPhos-569* Amylase-44 TotBili-3.2* DirBili-2.8* IndBili-0.4
[**2153-7-29**] 02:46AM BLOOD ALT-587* AST-623* LD(LDH)-233
AlkPhos-478* Amylase-49 TotBili-2.4* DirBili-1.9* IndBili-0.5
[**2153-7-30**] 03:13AM BLOOD ALT-363* AST-187* LD(LDH)-164
AlkPhos-382* Amylase-54 TotBili-1.6*
[**2153-7-31**] 05:03AM BLOOD ALT-254* AST-71* LD(LDH)-176 AlkPhos-395*
Amylase-108* TotBili-1.4
[**2153-7-28**] 04:00PM BLOOD Lipase-26
[**2153-7-28**] 09:19PM BLOOD Lipase-22
[**2153-7-29**] 02:46AM BLOOD Lipase-17
[**2153-7-30**] 03:13AM BLOOD Lipase-25
[**2153-7-31**] 05:03AM BLOOD Lipase-55
[**2153-7-31**] 05:03AM BLOOD Albumin-3.1* Calcium-9.0 Phos-2.8 Mg-2.0
[**2153-7-28**] 04:12PM BLOOD Lactate-9.4*
[**2153-7-28**] 06:22PM BLOOD Lactate-2.8*
[**2153-7-28**] 08:08PM BLOOD Lactate-2.5*
[**2153-7-28**] 09:29PM BLOOD Lactate-2.2*
[**2153-7-29**] 03:26AM BLOOD Glucose-121* Lactate-1.4
[**2153-7-30**] 03:26AM BLOOD Glucose-98 Lactate-1.1

RADIOLOGY:
[**2153-7-28**] RUQ ultrasound:
1. Distended gallbladder containing sludge and nonshadowing
stones without
correlative ultrasonographic findings to suggest acute
cholecystitis. This
could be further evaluated with HIDA scan if clinically
indicated.
2. Right lobe hepatic cyst versus gallbladder diverticulum.

ERCP [**2153-7-30**]:
1. Periampullary diverticulum.
2. Mild dilation of the common bile duct and intrahepatic ducts.
3. No stones in the common bile duct.
4. 9 cm 10 French Cotton [**Doctor Last Name **] biliary stent successfully
placed, with drainage of bile into the duodenum.


Brief Hospital Course:
This is an 82 year old gentleman who was admitted on [**2153-7-28**] with
the fevers, abdominal pain, and significantly elevated LFTs. The
admitting diagnosis was cholangitis with cholecystitis. On
presentation in the ER he was found to be hemodynamically
unstable and the sepsis protocol was initiated with central line
placement, fluid resuscitation, and broad spectrum antibiotics.
He was admitted to the ICU. He underwent emergent
cholecystostomy tube placement shortly after admission. His
condition improved on hospital day two with an improvement in
his white blood cell count and LFTs and normalization of his
hemodynamics. ON hospital day 3 he underwent ERCP with stent
placement( 9 cm 10 french); no stones were appreciated and there
was minimal ductal dilitation. A periampullary diverticulum was
seen.  His LFTs continued to trend downward and he was
transferred out of the ICU on hospital day 3. He was advanced to
a regular diet by hospital day 6 which he tolerated well. He was
discharged to home on hospital day 6 with continuation of a 2
week course of Levofloxacin and a home visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 108497**]e with his PTC drainage tube. All questions were
answered to his satisfaction upon discharge.

Medications on Admission:
Lipitor
Toprol XL
Prilosec
Colace
Rhinocort

Discharge Medications:
1. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 12 days.
Disp:*12 Tablet(s)* Refills:*0*
2. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Lipitor  Oral
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
Prilosec
Colace


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Cholangitis


Discharge Condition:
Stable. Tolerating POs. Good pain control. AMbulating.

Discharge Instructions:
Take all medications as prescribed. Do not drive while taking
narcotics. You should call the office with any worsening
abdominal pain or nausea/vomitting or fever to 101. You may
continue with a regular diet. A visiting nurse [**First Name (Titles) **] [**Last Name (Titles) **] you
with your drain care

Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] [**Name (STitle) **] in 2 weeks (call for an
appointment-- [**Telephone/Fax (1) 10533**])

Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 3627**] [**Name12 (NameIs) 3628**] [**Name12 (NameIs) **] [**Name12 (NameIs) 3628**] (NHB) Where: [**Name12 (NameIs) **]
[**Name12 (NameIs) 3628**] (NHB) Date/Time:[**2154-7-8**] 9:30
Provider: [**Name10 (NameIs) 1111**],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY (NHB) Where:
[**Last Name (NamePattern4) **] SURGERY (NHB) Date/Time:[**2154-7-8**] 10:00


                             [**Name6 (MD) 843**] [**Name8 (MD) 844**] MD [**MD Number(1) 845**]

Completed by:[**2153-8-2**]
{'Unspecified septicemia,Cholangitis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Sepsis,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension'}


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: Fever, abdominal pain

PRESENT ILLNESS: This is an 82 year old male with 5 days of diarrhea as well as
dysuria treated with bactrim and now with new-onset abdominal
pain and distension. He denies nauseas or vomiting. He has
chills and today had a fever to 101. He has no constipation .
His prior abdominal history os notable for a hernia repair 20
years ago

MEDICAL HISTORY: Lumpar stenosis s/p repair
COPD
Peripheral [**Month/Day/Year 1106**] disease
Prostatectomy
Hernia repair
Hypertension

MEDICATION ON ADMISSION: Lipitor
Toprol XL
Prilosec
Colace
Rhinocort

ALLERGIES: Penicillins

PHYSICAL EXAM: ON admission:

FAMILY HISTORY: non-contirbutory

SOCIAL HISTORY: Lives with wife. Retired president of insurance company. The
patient is a 100-pack year smoker. He drinks alcohol socially. 

### Response:
{'Unspecified septicemia,Cholangitis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Sepsis,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension'}
