CHIEF COMPLAINT: Dysphagia

PRESENT ILLNESS: [**Age over 90 **] year old male with a past medical history of atrial
fibrillation and diabetes mellitus admitted with a one day
history of dysphagia.
.
Patient states that the night prior to admission he was eating
dinner and felt as if food was stuck in his chest.  He continued
with his dinner and stopped when he noticed that the sensation
would not abate.   Described it as chest pressure, no chest
pain.  After dinner he had a glass of water and had an episode
of emesis.  He states food or water could not go down.  He awoke
in the morning and had similar symptoms of emesis with dysphagia
and decided to go to the ED.  He denies odynophagia, sore
throat, fevers, chills, cough.  Patient also reports
intermittent episodes of food getting stuck in his chest in the
past 4 months.  Patient also with weight loss of 15lbs since
[**7-31**], s/p his right hip surgery, assoicated with decreased
appetite.  Patient complains of persistent right lower extremity
pain s/p right hip repair.   He denies chest pain, shortness of
breath, abdominal pain, diarrhea, change in stools, melena,
numbness, tingling.
.
In the ED:
V/S   T 97.6   HR 71   BP 185/75    RR 16   O2sat 99%
Patient was transferred to the MICU for endoscopy.
.
MICU course:
Patient underwent endoscopy, which found a large food bolus
within the esophagus.  The procedure lasted 3 hours [**2-1**]
difficulty in extracting large food bolus.  GE junction noted to
be extremely narrowed.  Patient tolerated procedure well and was
transferred to the medical floor on [**2137-10-13**] in stable
condition.

MEDICAL HISTORY: Atrial Fibrillation
Diabetes Mellitus
Hypertension
Hypothyroidism
Hypercholesterolemia
Coronary Artery Disease s/p CABG - EF 40%
Congestive Heart Failure
s/p TURP
s/p Hip Fracture and recent stay at rehab
Parotid tumor s/p XRT
s/p GI bleed
Glaucoma

MEDICATION ON ADMISSION: Docusate 100mg PO bid
Amiodarone 200mg PO daily
Levothyroxine 75 mcg PO daily
Atorvastatin 20mg PO daily
Furosemide 120mg PO qAM / 40 mg PO qPM
Valsartan 80mg PO daily
Metoprolol Tartrate 50mg PO bid
Timolol Drops ou gtt
Brimonidine .15% ou gtt q8h
Effexor 75mg PO bid
Dorzolamide 2% drops tid
Imdur 90mg PO daily
ASA 81mg PO daily
Calcium Carbonate 500mg PO qid
Pantoprazole 40mg PO daily
Oxycodone 5mg PO q4h prn
Senna 2 tab PO bid
Bisacodyl 2 tab PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V/S  T 99.6   HR 70    BP 100/64   RR 16   O2sat  98% RA
Gen:  NAD, lying comfortably in bed, conversing pleasantly
HEENT: EOMI, PERRLA, AT, NC, MMM, oropharynx clear, nares
clear,dry skin on face
NECK: Supple, nl thyroid, nl JVP
CV: +S1, +S2, no M/R/G, RRR
LUNGS: CTAB
ABD: soft, NT/ND, no HSM
EXT: +1 pedal pulses, no peripheral edema
SKIN: dry skin, no rashes
NEURO: AAOx3, CN 2-12 intact

FAMILY HISTORY: Mom with Diabetes Mellitus

SOCIAL HISTORY: Home: Lives in [**Location **] with wife who has [**Name (NI) 2481**] Disease;
lives with 24 hour assistance for wife; originally from
[**Country 1931**], lived in [**Country **], and then immigrated to US in [**2090**].
No EtOH use,  40 pack year smoking history, quit 25 years ago,
no IVDA,
Foreign body in esophagus,Chronic systolic heart failure,Dyskinesia of esophagus,Foreign body accidentally entering other orifice,Home accidents,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified disorder of kidney and ureter
Foreign body esophagus,Chr systolic hrt failure,Dyskinesia of esophagus,FB entering oth orifice,Accident in home,Atrial fibrillation,DMII wo cmp nt st uncntr,Hypertension NOS,Hypothyroidism NOS,Pure hypercholesterolem,Cor ath unsp vsl ntv/gft,Renal & ureteral dis NOS
Name:  [**Known lastname 16471**],[**Known firstname 16472**]                  Unit No:   [**Numeric Identifier 16473**]

Admission Date:  [**2137-10-12**]              Discharge Date:   [**2137-10-16**]

Date of Birth:  [**2044-4-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4091**]
Addendum:
Problem 3 of the Hospital Course should read, "Chronic systolic
heart failure."

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 901**] - [**Location (un) 382**]

                             [**First Name8 (NamePattern2) 1558**] [**Last Name (NamePattern1) **] MD [**MD Number(1) 2301**]

Completed by:[**2137-11-4**]

Admission Date:  [**2137-10-12**]              Discharge Date:   [**2137-10-16**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
Dysphagia



Major Surgical or Invasive Procedure:
Endoscopy


History of Present Illness:
[**Age over 90 **] year old male with a past medical history of atrial
fibrillation and diabetes mellitus admitted with a one day
history of dysphagia.
.
Patient states that the night prior to admission he was eating
dinner and felt as if food was stuck in his chest.  He continued
with his dinner and stopped when he noticed that the sensation
would not abate.   Described it as chest pressure, no chest
pain.  After dinner he had a glass of water and had an episode
of emesis.  He states food or water could not go down.  He awoke
in the morning and had similar symptoms of emesis with dysphagia
and decided to go to the ED.  He denies odynophagia, sore
throat, fevers, chills, cough.  Patient also reports
intermittent episodes of food getting stuck in his chest in the
past 4 months.  Patient also with weight loss of 15lbs since
[**7-31**], s/p his right hip surgery, assoicated with decreased
appetite.  Patient complains of persistent right lower extremity
pain s/p right hip repair.   He denies chest pain, shortness of
breath, abdominal pain, diarrhea, change in stools, melena,
numbness, tingling.
.
In the ED:
V/S   T 97.6   HR 71   BP 185/75    RR 16   O2sat 99%
Patient was transferred to the MICU for endoscopy.
.
MICU course:
Patient underwent endoscopy, which found a large food bolus
within the esophagus.  The procedure lasted 3 hours [**2-1**]
difficulty in extracting large food bolus.  GE junction noted to
be extremely narrowed.  Patient tolerated procedure well and was
transferred to the medical floor on [**2137-10-13**] in stable
condition.

Past Medical History:
Atrial Fibrillation
Diabetes Mellitus
Hypertension
Hypothyroidism
Hypercholesterolemia
Coronary Artery Disease s/p CABG - EF 40%
Congestive Heart Failure
s/p TURP
s/p Hip Fracture and recent stay at rehab
Parotid tumor s/p XRT
s/p GI bleed
Glaucoma

Social History:
Home: Lives in [**Location **] with wife who has [**Name (NI) 2481**] Disease;
lives with 24 hour assistance for wife; originally from
[**Country 1931**], lived in [**Country **], and then immigrated to US in [**2090**].
No EtOH use,  40 pack year smoking history, quit 25 years ago,
no IVDA,


Family History:
Mom with Diabetes Mellitus


Physical Exam:

V/S  T 99.6   HR 70    BP 100/64   RR 16   O2sat  98% RA
Gen:  NAD, lying comfortably in bed, conversing pleasantly
HEENT: EOMI, PERRLA, AT, NC, MMM, oropharynx clear, nares
clear,dry skin on face
NECK: Supple, nl thyroid, nl JVP
CV: +S1, +S2, no M/R/G, RRR
LUNGS: CTAB
ABD: soft, NT/ND, no HSM
EXT: +1 pedal pulses, no peripheral edema
SKIN: dry skin, no rashes
NEURO: AAOx3, CN 2-12 intact


Pertinent Results:
Labwork on admission:
[**2137-10-12**] 05:20PM BLOOD WBC-12.2* RBC-3.49* Hgb-11.6* Hct-34.0*
MCV-98 MCH-33.4* MCHC-34.2 RDW-17.7* Plt Ct-223
[**2137-10-12**] 05:20PM BLOOD Neuts-75.8* Lymphs-15.6* Monos-5.1
Eos-3.2 Baso-0.4
[**2137-10-12**] 05:20PM BLOOD PT-15.1* PTT-25.8 INR(PT)-1.4*
[**2137-10-12**] 05:20PM BLOOD Glucose-63* UreaN-20 Creat-1.6* Na-142
K-3.6 Cl-104 HCO3-25 AnGap-17
[**2137-10-13**] 04:29AM BLOOD Calcium-8.6 Phos-2.9 Mg-2.3
[**2137-10-13**] 04:29AM BLOOD WBC-15.7* RBC-3.39* Hgb-11.1* Hct-33.0*
MCV-98 MCH-32.9* MCHC-33.7 RDW-17.9* Plt Ct-208
[**2137-10-13**] 04:29AM BLOOD PT-15.6* PTT-25.6 INR(PT)-1.4*
[**2137-10-13**] 04:29AM BLOOD Glucose-89 UreaN-19 Creat-1.6* Na-145
K-3.3 Cl-107 HCO3-23 AnGap-18
.
STUDIES:
[**2137-10-12**] CXR:
FINDINGS: PA and lateral views of the chest are obtained. A
dual-lead pacer is again noted with lead tips positioned in the
approximate location of the right atrium and right ventricle.
Midline sternotomy wires are noted. There is minimal elevation
of the left hemidiaphragm, with probable left lower lobe
subsegmental atelectasis. No large pleural effusions are seen.
There is no overt CHF. The cardiomediastinal silhouette is
unchanged. There is tortuosity of the thoracic aorta, with
calcification noted along the aortic knob. There is pleural
thickening noted at the apices bilaterally. Scoliosis is noted
in the thoracic spine.
IMPRESSION:
Left lower lobe atelectasis, stable. No acute intrathoracic
process.
.
[**2137-10-13**] CXR:
Single portable radiograph of the chest excludes the left
costophrenic angle. Visualized cardiomediastinal contours are
unchanged compared with [**2137-10-12**]. No consolidation is evident.
There is left basilar atelectasis. No pneumothorax. Trachea is
midline. Patient is status post median sternotomy.
IMPRESSION:
Persistent left basilar atelectasis
.
[**2137-10-14**] Barium swallow:
FINDINGS: The upper portion of the esophagus was patulous with
loss of normal peristaltic wave. Tertiary contractions were seen
in the lower two thirds of the esophagus. The gastroesophageal
junction is widely patent with no evidence of stricture or
intraluminal mass. Mildly prominent folds are seen in the lower
esophagus.
IMPRESSION: No evidence of stricture or esophageal mass. Mildly
patulous upper esophagus with moderate dysmotility.
D/W dr [**First Name (STitle) 679**]
.
PROCEDURES:
[**2137-10-12**] EGD:
ESOPHAGUS:
Contents: A large amount of food was found in the esophagus.
Retrieval of the food bolus was extremely difficult due to the
size of the bolus and the extremely narrowed GE junction.
Decision was made to intubate the patient for airway protection
part way through the procedure. Subsequent food bolus removal
took approximately 3 hours- during which the GE junction was
effectively dilated by an EGD scope, which was initially
difficult to pass, followed by a larger bore therapeutic scope.
The GE junction appeared extremely narrowed, but could be
traversed with gentle pressure by the endoscope and then would
remain open for a period of time. This was felt to be possibly
consistent with achalasia. No mass was seen.
Stomach: Normal stomach.
Duodenum: Normal duodenum.
Impression: Food in the esophagus (foreign body removal)
Recommendations: Barium swallow should be next step in
evaluation for achalasia, vs pseuodachalasia vs stricture etc
.
Labwork on discharge:
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2137-10-16**] 06:25AM    11.4* 3.17* 10.6* 30.9* 98 33.4* 34.3
17.6* 209
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2137-10-16**] 06:25AM    135* 16 1.5* 140 3.0* 102 28 13
BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2137-10-16**] 06:25AM        209
[**2137-10-16**] 06:25AM    13.9* 27.5   1.2*

Brief Hospital Course:
[**Age over 90 **] year old male with past medical history significant for
diabetes mellitus, hypertension, and atrial fibrillation
admitted with dysphagia and found to have food impaction with
decreased esophageal diameter at the GE junction.
.
1) Dysphagia: Patient presenting with acute episode of dysphagia
and food impaction. EGD [**2137-10-12**] showed food impaction and
narrowing of the esophagus at the GE junction which was
traversed and dilated by the EGD scope; no grossly evident
esophageal masses were observed. Barium swallow [**2137-10-14**] showed
no stricture, no narrowing of the GE junction, no esophageal
masses, however, esophageal dysmotility was noted. The patient
was advised to take small bites, chew thoroughly, and eat with
plenty of liquids to aid in esophageal transport of food
boluses. The patient is cleared for a regular diet. The patient
is advised to follow-up with PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 679**]. Differential
includes peptic stricture, achalasia, esophageal compression,
esophageal ring or neoplasm, all less likely given above
imaging.
.
2)  Atrial fibrillation: The patient has been in sinus with
outpatient amiodarone.  Patient also on metoprolol.  Coumadin
was held for above procedure but was restarted on [**2137-10-16**] with
an INR of 1.2.  INR to be followed with adjustment in Coumadin
as needed.  Goal INR is 2-2.5.
.
3) Congestive heart failure: History of CHF with EF of 40%.
Euvolemic on exam throughout admission.  The patient was
continued on metoprolol 50mg [**Hospital1 **], furosemide 40mg PM daily and
120mg AM, valsartan 80mg daily, isosorbide mononitrate 90mg.
.
4) Right hip fracture status post repair: The patient will be
discharged to a rehabilitation center to continue physical
therapy.
.
5) Macrocytic anemia: The patient's hematocrit during his
hospital stay has ranged from 30-32, with no signs or symptoms
of bleeding. MCV has been 98-103. B12/folate studies showed
normal levels. The patient is advised to follow-up with PCP for
potential myelodysplastic syndrome.
.
6) Hematuria: The patient was noted to have 21-50 RBC in his
urine. A foley catheter had been placed earlier in his course.
The patient is advised to follow-up with primary care doctor
regarding this hematuria.
.
7) Hypothyroidism: Currently stable. The patient was continued
on levothyroxine.
.
8) Glaucoma: Stable. Patient continued on Timolol Drops ou gtt,
Dorzolamide 2% drops tid, and Brimonidine 0.15% ou gtt q8h per
outpatient regimen
.
9)Diabetes Mellitus: Stable with BS 139-135 for the past two
days with PO food intake. Patient to continue on diabetic diet
with humalog insulin sliding scale.
.
10) Chronic kidney disease: Baseline creatinine 1.2 to 1.6.
Medications were renally dosed.
.
11) Depression: The patient was continued on effexor.
.
Code: Full
.
Disposition: [**Hospital3 2558**]

Medications on Admission:
Docusate 100mg PO bid
Amiodarone 200mg PO daily
Levothyroxine 75 mcg PO daily
Atorvastatin 20mg PO daily
Furosemide 120mg PO qAM / 40 mg PO qPM
Valsartan 80mg PO daily
Metoprolol Tartrate 50mg PO bid
Timolol Drops ou gtt
Brimonidine .15% ou gtt q8h
Effexor 75mg PO bid
Dorzolamide 2% drops tid
Imdur 90mg PO daily
ASA 81mg PO daily
Calcium Carbonate 500mg PO qid
Pantoprazole 40mg PO daily
Oxycodone 5mg PO q4h prn
Senna 2 tab PO bid
Bisacodyl 2 tab PO daily

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Acute Esophageal Food Impaction
Esophageal Dysmotility


Discharge Condition:
Stable, patient is eating well.


Discharge Instructions:
You were admitted into the [**Hospital1 69**]
for treatment of your trouble swallowing food.  You had a large
amount of food stuck inside of your esophagus.  This was removed
via endoscopy.  A Barium Swallow Xray showed that your esophagus
has trouble pushing the food down into your stomach.  This is
known as esophageal dysmotility.

You have been instructed to chew small amounts of food during
meals.  You are to use fluids when swallowing and you are to
increase your fluid intake during meals to help prevent future
episodes of getting food stuck in your esophagus.

You have been restarted on your Coumadin at 5mg daily.  Your INR
should be followed at the rehab facility and your Coumadin
should be adjusted as needed.

You are to continue with your regular home medications as
instructed.

If you experience trouble swallowing, inability to eat or drink,
choking, vomiting, chest pain, shortness of breath, cough,
fevers, nausea, vomiting, diarrhea or any other concerning
symptoms then please call your doctor or report to the nearest
emergency room.

Please attend all follow ups as listed below.


Followup Instructions:
Please follow up with your Primary Care Doctor, Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 679**] on
Monday [**10-28**] at 230pm.  [**Telephone/Fax (1) 682**].

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2235**], MD Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2138-1-14**] 10:00


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]
{'Foreign body in esophagus,Chronic systolic heart failure,Dyskinesia of esophagus,Foreign body accidentally entering other orifice,Home accidents,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified disorder of kidney and ureter'}


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: Dysphagia

PRESENT ILLNESS: [**Age over 90 **] year old male with a past medical history of atrial
fibrillation and diabetes mellitus admitted with a one day
history of dysphagia.
.
Patient states that the night prior to admission he was eating
dinner and felt as if food was stuck in his chest.  He continued
with his dinner and stopped when he noticed that the sensation
would not abate.   Described it as chest pressure, no chest
pain.  After dinner he had a glass of water and had an episode
of emesis.  He states food or water could not go down.  He awoke
in the morning and had similar symptoms of emesis with dysphagia
and decided to go to the ED.  He denies odynophagia, sore
throat, fevers, chills, cough.  Patient also reports
intermittent episodes of food getting stuck in his chest in the
past 4 months.  Patient also with weight loss of 15lbs since
[**7-31**], s/p his right hip surgery, assoicated with decreased
appetite.  Patient complains of persistent right lower extremity
pain s/p right hip repair.   He denies chest pain, shortness of
breath, abdominal pain, diarrhea, change in stools, melena,
numbness, tingling.
.
In the ED:
V/S   T 97.6   HR 71   BP 185/75    RR 16   O2sat 99%
Patient was transferred to the MICU for endoscopy.
.
MICU course:
Patient underwent endoscopy, which found a large food bolus
within the esophagus.  The procedure lasted 3 hours [**2-1**]
difficulty in extracting large food bolus.  GE junction noted to
be extremely narrowed.  Patient tolerated procedure well and was
transferred to the medical floor on [**2137-10-13**] in stable
condition.

MEDICAL HISTORY: Atrial Fibrillation
Diabetes Mellitus
Hypertension
Hypothyroidism
Hypercholesterolemia
Coronary Artery Disease s/p CABG - EF 40%
Congestive Heart Failure
s/p TURP
s/p Hip Fracture and recent stay at rehab
Parotid tumor s/p XRT
s/p GI bleed
Glaucoma

MEDICATION ON ADMISSION: Docusate 100mg PO bid
Amiodarone 200mg PO daily
Levothyroxine 75 mcg PO daily
Atorvastatin 20mg PO daily
Furosemide 120mg PO qAM / 40 mg PO qPM
Valsartan 80mg PO daily
Metoprolol Tartrate 50mg PO bid
Timolol Drops ou gtt
Brimonidine .15% ou gtt q8h
Effexor 75mg PO bid
Dorzolamide 2% drops tid
Imdur 90mg PO daily
ASA 81mg PO daily
Calcium Carbonate 500mg PO qid
Pantoprazole 40mg PO daily
Oxycodone 5mg PO q4h prn
Senna 2 tab PO bid
Bisacodyl 2 tab PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V/S  T 99.6   HR 70    BP 100/64   RR 16   O2sat  98% RA
Gen:  NAD, lying comfortably in bed, conversing pleasantly
HEENT: EOMI, PERRLA, AT, NC, MMM, oropharynx clear, nares
clear,dry skin on face
NECK: Supple, nl thyroid, nl JVP
CV: +S1, +S2, no M/R/G, RRR
LUNGS: CTAB
ABD: soft, NT/ND, no HSM
EXT: +1 pedal pulses, no peripheral edema
SKIN: dry skin, no rashes
NEURO: AAOx3, CN 2-12 intact

FAMILY HISTORY: Mom with Diabetes Mellitus

SOCIAL HISTORY: Home: Lives in [**Location **] with wife who has [**Name (NI) 2481**] Disease;
lives with 24 hour assistance for wife; originally from
[**Country 1931**], lived in [**Country **], and then immigrated to US in [**2090**].
No EtOH use,  40 pack year smoking history, quit 25 years ago,
no IVDA, 

### Response:
{'Foreign body in esophagus,Chronic systolic heart failure,Dyskinesia of esophagus,Foreign body accidentally entering other orifice,Home accidents,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified disorder of kidney and ureter'}
