CHIEF COMPLAINT: 1) Diffuse abdomenal pain
2) Admitted for cardiac catherization of renal artery stenosi

PRESENT ILLNESS: THE FIRST HALF OF THE HISTORY AND PHYSICAL AS WELL AS THE BRIEF
HOSPITAL COURSE WAS DONE BY THE ADMITING CARDIOLOGY TEAM AND THE
SECOND WAS DONE BY THE SURGERY TEAM, RESPECTIVELY:

MEDICAL HISTORY: HTN
CVA [**2186**] with residual right sided weakness
NIDDM
s/p Appendectomy and hysterectomy
Breast cancer [**2186**] s/p right lumpectomy and radiation
AFib

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 168/89 (152-181/39-55), HR 51 (50-64), RR 20, 91% RA, Wt 62.7
kg, I/O 600/900
.
Gen: well appearing female in NAD
HEENT: MMM, anicteric
Neck: no JVD, b/l carotid bruits
CV: irregularly irregular, III/VI systolic murmer at LUSB
radiating throughout chest and into carotids
Lungs: rhonchi right base o/w clear
Abd: soft, NT/ND, pos BS, no abd bruit
Groin: small right hematoma, no bruit
Ext: no edema, weak DP/PT pulses
Neuro: A&Ox3

FAMILY HISTORY: Denies FH of heart disease.

SOCIAL HISTORY: Lives with husband. [**Name (NI) **] 6 children. Quit tob [**1-11**]. Denies EtOH
or drug use.
Coronary atherosclerosis of native coronary artery,Acute vascular insufficiency of intestine,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal aneurysm without mention of rupture,Atherosclerosis of renal artery,Personal history of malignant neoplasm of breast,Osteoporosis, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Iron deficiency anemia, unspecified
Crnry athrscl natve vssl,Ac vasc insuff intestine,Atrial fibrillation,CHF NOS,Ac kidny fail, tubr necr,Hyposmolality,Hyp kid NOS w cr kid V,DMII wo cmp nt st uncntr,Abdom aortic aneurysm,Renal artery atheroscler,Hx of breast malignancy,Osteoporosis NOS,Adv eff medicinal NEC,Iron defic anemia NOS
Admission Date:  [**2192-7-5**]              Discharge Date:   [**2192-7-16**]

Date of Birth:  [**2116-8-4**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
1) Diffuse abdomenal pain
2) Admitted for cardiac catherization of renal artery stenosi

Major Surgical or Invasive Procedure:
Exploratory Laporatomy with right colectomy
Cardiac catheterization with stenting of LAD

History of Present Illness:
THE FIRST HALF OF THE HISTORY AND PHYSICAL AS WELL AS THE BRIEF
HOSPITAL COURSE WAS DONE BY THE ADMITING CARDIOLOGY TEAM AND THE
SECOND WAS DONE BY THE SURGERY TEAM, RESPECTIVELY:

75 yo F with HTN, Hyperlipidemia, DM, h/o CVA in [**2186**], AFib,
breast cancer s/p radiation and lumpectomy initally admitted to
[**Hospital 1474**] Hospital for CHF and a SBP of 240. She ruled out for MI
at that time. She was trasferred to [**Hospital1 18**] for evaluation of
Renal Artery Stenosis seen on MRI on [**2192-6-21**]. She underwent
cardiac cath on [**2192-7-5**] showing single vessel CAD. The LMCA was
free of disease. The LAD had severe proximal calcium with an 80%
stenosis in the mid vessel. The LAD was stented with a
drug-eluding stent. The LCX had a 50% stenosis in the mid
vessel. The RCA had moderate diffuse disease with a 40% proximal
stenosis. Selective angiography of the renal arteries showed a
50% stenosis of the left and a 20-30% stenosis of the right
renal artery.
.
She is being transferred from CMI to [**Hospital Unit Name **] for acute on chronic
renal insufficiency, increasing CK-MB post procedure, and
intermittent Aflutter with poor conduction seen on telemetry.
Her ACEI, Diuretic, and Dig are currently being held. An EP
consult was obtained. Her BP is being controlled BP with
hydralazine.
.
Currently pt denies CP/SOB/N/V/belly pain.
.
Surgery was consult for her abdomenal pain.

Past Medical History:
HTN
CVA [**2186**] with residual right sided weakness
NIDDM
s/p Appendectomy and hysterectomy
Breast cancer [**2186**] s/p right lumpectomy and radiation
AFib

Social History:
Lives with husband. [**Name (NI) **] 6 children. Quit tob [**1-11**]. Denies EtOH
or drug use.

Family History:
Denies FH of heart disease.

Physical Exam:
BP 168/89 (152-181/39-55), HR 51 (50-64), RR 20, 91% RA, Wt 62.7
kg, I/O 600/900
.
Gen: well appearing female in NAD
HEENT: MMM, anicteric
Neck: no JVD, b/l carotid bruits
CV: irregularly irregular, III/VI systolic murmer at LUSB
radiating throughout chest and into carotids
Lungs: rhonchi right base o/w clear
Abd: soft, NT/ND, pos BS, no abd bruit
Groin: small right hematoma, no bruit
Ext: no edema, weak DP/PT pulses
Neuro: A&Ox3

Pertinent Results:
[**2192-7-12**] 03:47AM BLOOD PT-17.1* PTT-34.9 INR(PT)-1.9
[**2192-7-10**] 10:11AM BLOOD PT-18.9* PTT-32.3 INR(PT)-2.4
[**2192-7-9**] 06:00AM BLOOD PT-22.9* PTT-33.9 INR(PT)-3.5
[**2192-7-12**] 03:47AM BLOOD LD(LDH)-239 CK(CPK)-941*
[**2192-7-10**] 03:31AM BLOOD WBC-21.6*# RBC-3.45* Hgb-10.1* Hct-28.7*
MCV-83 MCH-29.2 MCHC-35.1* RDW-15.7* Plt Ct-291

Brief Hospital Course:
75 yo F with HTN, PAF, h/o CVA, mild RAS, CAD s/p drug-eluding
stent of LAD on [**7-5**] now with increasing Cr post procedure and
episode of AFlutter.
.
1. CAD s/p drug-eluding stent to LAD. Currently chest pain free.
Initial bump in CK-MB post procedure now trending down. Will
continue to follow. groin site with bruit but no hematoma or
ooze. evaluated with femoral ultrasound which was negative.
.
2. Rhythm. h/o PAF with Aflutter noted on tele. Awaiting EP
consult. Restarted on Coumadin. Goal INR 1.5-2.0. Continue
Amiodarone. d/c digoxin
.
3. Acute on Chronic Renal Insufficiency likely secondary to dye
load from cath. Baseline Cr unclear. [**Name2 (NI) **] diurectic and ACEI for
now and continue to monitor Cr. Worsening renal function most
likely from contrast nephropathy. Hydrated and monitored for
fluid overload treated with lasix. Had echocardiogram on [**7-6**]
which revealed....
.
4. DM. Continue on outpt regimen of Glyburide with ISS.
.
5. HTN. Continue outpt regimen of Amlodipine and Metoprolol with
hydralazine while holding ACEI and diuretic.
.
6. Hyperlipidemia. Continue statin.
.
7. PPX. Ranitidine, INR 1.4 on coumadin

Because of her abdomenal pain, Surgery was consulted.  A CT of
the abdomen was obtained showing marked thickening of the right
colon and proximal transverse colon indicating grangrenous
bowel.  A decision was made to take the patient immediately to
the operating room for an exploratory laporotomy.
Intra-operatively, the patient was found to have ischemic bowel
with gangrene and a right colectomy was performed.  She
tolerated the procedure well and was transferred to the surgical
intensive care unit.  The she was intubated and sedated and
closely monitorred by both the ICU team and the primary team, as
well as other consulting services to optimize her recovery.  She
slowly recovered over the course of a few days and was
extubated.  She soon became strong enough to be transferred to
the surgical floor were she began to tolerate regular meals,
pass flatus, and have good urine output.  She also started to
work with the physical therapist to regain he straingth.
Eventually, she was able to be close to her baseline and was in
a good enough condition to be discharged home with services.


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): For refills please call Dr. [**Last Name (STitle) **].
Disp:*30 Tablet(s)* Refills:*5*
3. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain: If 3rd
tab needed seek medical attention.
Disp:*100 Tablet, Sublingual(s)* Refills:*0*
4. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO once a
day.
10. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
11. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
13. Furosemide 40 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
14. Warfarin Sodium 2 mg Tablet Sig: Two (2) Tablet PO ONCE
(once) for 1 doses.
15. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
Disp:*80 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
NECROTIC CECUM


Discharge Condition:
FAIR


Discharge Instructions:
PLEASE GO TO THE CALL OR GO TO THE ER IF SUDDEN PAIN IN ABDOMEN,
NAUSE/VOMITING, FEVER, OR ABDOMENAL DISTENTION.  TAKE
MEDICATIONS AS PRESCRIBED AND READ WARNING LABELS CAREFULLY.
FOLLOW WITH [**First Name8 (NamePattern2) **] [**Doctor Last Name **] IN [**1-8**] WEEKS (SEE BELOW) AND DOCTOR
[**Date Range **]/[**Hospital **] CLINIC WITHIN A WEEK.  [**Month (only) **] SHOWER.  DO NOT SCRUB
WOUND, PAD DRY. STRIPS WILL FALL OFF ON ITS OWN IN ABOUT 4 DAYS.


Followup Instructions:
DR. [**Last Name (STitle) **]([**Telephone/Fax (1) 2300**]   ([**Telephone/Fax (1) 2300**] IN [**1-8**] WEEKS AND DR.
[**Last Name (STitle) **]



Completed by:[**2192-9-13**]
{'Coronary atherosclerosis of native coronary artery,Acute vascular insufficiency of intestine,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal aneurysm without mention of rupture,Atherosclerosis of renal artery,Personal history of malignant neoplasm of breast,Osteoporosis, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Iron deficiency anemia, 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: 1) Diffuse abdomenal pain
2) Admitted for cardiac catherization of renal artery stenosi

PRESENT ILLNESS: THE FIRST HALF OF THE HISTORY AND PHYSICAL AS WELL AS THE BRIEF
HOSPITAL COURSE WAS DONE BY THE ADMITING CARDIOLOGY TEAM AND THE
SECOND WAS DONE BY THE SURGERY TEAM, RESPECTIVELY:

MEDICAL HISTORY: HTN
CVA [**2186**] with residual right sided weakness
NIDDM
s/p Appendectomy and hysterectomy
Breast cancer [**2186**] s/p right lumpectomy and radiation
AFib

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 168/89 (152-181/39-55), HR 51 (50-64), RR 20, 91% RA, Wt 62.7
kg, I/O 600/900
.
Gen: well appearing female in NAD
HEENT: MMM, anicteric
Neck: no JVD, b/l carotid bruits
CV: irregularly irregular, III/VI systolic murmer at LUSB
radiating throughout chest and into carotids
Lungs: rhonchi right base o/w clear
Abd: soft, NT/ND, pos BS, no abd bruit
Groin: small right hematoma, no bruit
Ext: no edema, weak DP/PT pulses
Neuro: A&Ox3

FAMILY HISTORY: Denies FH of heart disease.

SOCIAL HISTORY: Lives with husband. [**Name (NI) **] 6 children. Quit tob [**1-11**]. Denies EtOH
or drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute vascular insufficiency of intestine,Atrial fibrillation,Congestive heart failure, unspecified,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal aneurysm without mention of rupture,Atherosclerosis of renal artery,Personal history of malignant neoplasm of breast,Osteoporosis, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Iron deficiency anemia, unspecified'}
