CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 79-year-old
male with a complex past medical history transferred from
[**Hospital3 3583**].  The patient had a UTI for which he had
received a course of Levaquin.  During the course of
antibiotics he developed lower abdominal pain, dry heaves,
and significant diarrhea.  At [**Hospital3 3583**], the patient
was found to be slightly hypotensive.  He had a KUB and it
showed a dilated colon.  Abdominal CT performed at [**Hospital3 6265**] also demonstrated a dilated transverse colon.  He
was felt to need surgical intervention and was transferred to
the [**Hospital1 **] for further management.

MEDICAL HISTORY: 1.  Colon cancer, status post a colectomy 16 years ago.
2.  Cancer cancer.
3.  Atrial fibrillation, off Coumadin due to a history of GI
bleed.
4.  Cardiomyopathy with an EF of around 25%.
5.  History of peptic ulcer disease.
6.  Previous sternotomy with resection of a thymoma.
7.  Status post left lower lobe wedge resection for cancer,
status post TURP.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified septicemia,Other shock without mention of trauma,Other pulmonary insufficiency, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac arrest,Acute vascular insufficiency of intestine,Dissection of aorta, thoracoabdominal,Intestinal infection due to Clostridium difficile
Septicemia NOS,Shock w/o trauma NEC,Other pulmonary insuff,AMI NOS, initial,Cardiac arrest,Ac vasc insuff intestine,Dsct of thoracoabd aorta,Int inf clstrdium dfcile
Admission Date:  [**2120-8-9**]       Discharge Date:  [**2120-8-12**]


Service:  BLUE SURGERY

HISTORY OF THE PRESENT ILLNESS:  The patient is a 79-year-old
male with a complex past medical history transferred from
[**Hospital3 3583**].  The patient had a UTI for which he had
received a course of Levaquin.  During the course of
antibiotics he developed lower abdominal pain, dry heaves,
and significant diarrhea.  At [**Hospital3 3583**], the patient
was found to be slightly hypotensive.  He had a KUB and it
showed a dilated colon.  Abdominal CT performed at [**Hospital3 6265**] also demonstrated a dilated transverse colon.  He
was felt to need surgical intervention and was transferred to
the [**Hospital1 **] for further management.

PAST MEDICAL HISTORY:
1.  Colon cancer, status post a colectomy 16 years ago.
2.  Cancer cancer.
3.  Atrial fibrillation, off Coumadin due to a history of GI
bleed.
4.  Cardiomyopathy with an EF of around 25%.
5.  History of peptic ulcer disease.
6.  Previous sternotomy with resection of a thymoma.
7.  Status post left lower lobe wedge resection for cancer,
status post TURP.

ADMISSION MEDICATIONS:
1.  Amiodarone.
2.  Carafate.
3.  Protonix.
4.  Lopressor.
5.  Lasix.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile at 97.5 with a heart rate of 75 and blood
pressure of 111/44, saturating 96% on 2 liters.  He was alert
and oriented, clear to auscultation.  He had a significant
murmur, grade IV.  Abdomen:  Soft, but distended and tender
to palpation profusely.  He also had guarding.

LABORATORY/RADIOLOGIC DATA:  A KUB showed a dilated cecum and
small bowel.

His white count on admission was 38.  Troponin positive at
136.  LFTs were normal.  Amylase and lipase were normal.  A
BUN and creatinine were 52 and 3.4.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit with a preliminary diagnosis of C. difficile
colitis.  Due to a murmur, PTE was obtained.  PTE
demonstrated an aortic dissection.  The Vascular Service was
consulted and an MRA was obtained.  MR demonstrated a type A
dissection involving the root of the aorta and the left
brachycephalic.  The aortic dissection continued down to the
level of the SMA.  The SMA and the celiac access were
supplied by the true lumen.

The Thoracic Service was consulted for intervention regarding
this aortic dissection.  The Cardiothoracic Service felt that
he was not a surgical candidate due to his age, elevated
creatinine, and risk of bleeding.  Given this, the patient
was placed on an Esmolol drip which he did not tolerate and
subsequently a Diltiazem drip for rate control.  It was
decided not to intervene his aortic dissection.

His abdominal examination improved and his white count
trended downwards being 29 at the time of discharge.  He was
kept on broad spectrum antibiotics, ampicillin, ceftriaxone,
and Flagyl as treatment for his ischemic or C. difficile
colitis.  After three days in the hospital, the patient's
renal function was worsening with his creatinine peaking at
4.2 on the 15th.

After a discussion with the family, they decided that the
patient would not want hemodialysis and they decided that
making him CMO would be the most appropriate measure.  It was
decided after discussion with the patient's primary care
physician to
then make him CMO at that institution.

DISCHARGE DIAGNOSIS:
1.  Clostridium difficile versus ischemic colitis, with
sepsis. Respiratory Failure
2.  Type A aortic dissection.
3.  Cardiomyopathy with an EF of 25%, Congestive  heart
failure
4.  Acute on chronic renal failure.
5.  Prostate cancer.
6. History of Colon cancer
7. History of Lung Cancer
8. History of Thymoma
DISCHARGE MEDICATIONS:
1.  Amiodarone 200 mg p.o. b.i.d.
2.  Sucralfate 1 gram p.o. q.i.d.
3.  Heparin subcutaneously.
4.  Ampicillin 1 gram IV q. six hours.
5.  Ceftriaxone 1 gram IV q. 24 hours.
6.  Flagyl 500 mg IV q. eight hours.
7.  Protonix 40 mg IV q. 24 hours.
8.  Atrovent.
9.  Albuterol.
10. Haldol p.r.n.
11. Lorazepam 0.5 to 1 mg IV q. four hours.
12. Tylenol.
13. Diltiazem.



                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Last Name (NamePattern1) 40667**]
MEDQUIST36

D:  [**2120-8-12**]  03:55
T:  [**2120-8-12**]  18:02
JOB#:  [**Job Number 50139**]


Name:  [**Known lastname 3654**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 9260**]

Admission Date:  [**2120-8-9**]     Discharge Date:  [**2120-8-13**]

Date of Birth:   [**2041-3-19**]     Sex:  M

Service:  BLUE SURGERY

DISPOSITION:  Deceased.

After family discussion as well as with the health care team,
it was decided the patient would be made comfort measures
only.  He was placed on Morphine and expired on the morning
of [**8-13**].



                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 3676**]

Dictated By:[**Last Name (NamePattern1) 799**]

MEDQUIST36

D:  [**2120-8-13**]  06:43
T:  [**2120-8-13**]  06:46
JOB#:  [**Job Number 9261**]
{'Unspecified septicemia,Other shock without mention of trauma,Other pulmonary insufficiency, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac arrest,Acute vascular insufficiency of intestine,Dissection of aorta, thoracoabdominal,Intestinal infection due to Clostridium difficile'}


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: The patient is a 79-year-old
male with a complex past medical history transferred from
[**Hospital3 3583**].  The patient had a UTI for which he had
received a course of Levaquin.  During the course of
antibiotics he developed lower abdominal pain, dry heaves,
and significant diarrhea.  At [**Hospital3 3583**], the patient
was found to be slightly hypotensive.  He had a KUB and it
showed a dilated colon.  Abdominal CT performed at [**Hospital3 6265**] also demonstrated a dilated transverse colon.  He
was felt to need surgical intervention and was transferred to
the [**Hospital1 **] for further management.

MEDICAL HISTORY: 1.  Colon cancer, status post a colectomy 16 years ago.
2.  Cancer cancer.
3.  Atrial fibrillation, off Coumadin due to a history of GI
bleed.
4.  Cardiomyopathy with an EF of around 25%.
5.  History of peptic ulcer disease.
6.  Previous sternotomy with resection of a thymoma.
7.  Status post left lower lobe wedge resection for cancer,
status post TURP.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified septicemia,Other shock without mention of trauma,Other pulmonary insufficiency, not elsewhere classified,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac arrest,Acute vascular insufficiency of intestine,Dissection of aorta, thoracoabdominal,Intestinal infection due to Clostridium difficile'}
