CHIEF COMPLAINT: Back pain

PRESENT ILLNESS: 71 yo with hx HTN, kidney stones, AAA, aortic insufficiency (s/p
AVR [**10-28**] @ [**Hospital1 2177**]), AAA, CHF has a very large 7x16mm calculus in R
kidney which will need lithotripsy according to his urologist,
Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 770**]. Pt reports that for the past three months he
has has intermittent suprapubic and rt flank pain which is
colicky in nature. Pain has been [**9-2**] at worse and has increased
in frequency over the past 3 weeks but no dysuria or hematuria.
This was initially thought to be due to his prostate but the
intermittent nature of the pain along with a normal prostate
exam suggested other causes. [**12-19**] CT showed 7 x 16 mm calculus
in the right renal pelvis with two smaller stones in the pelvis
of the left kidney. Pt was therefore electively admitted for
heparin bridge during lithotripsy since the patient needs
continuous anticoagulation with mechanical valve.

MEDICAL HISTORY: HTN
CHF secondary to AS
AS s/p AVR [**9-27**] at [**Hospital1 2177**]
AAA
nephrolithiasis

MEDICATION ON ADMISSION: coumadin 5mg alternating with 2.5mg qod
metoprolol 50mg [**Hospital1 **]
ASA 81mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:99.2 P:107 R:17 BP: 78 - 141/40 - 80 SaO2: 93% RA
General: Awake, alert, in pain
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus
noted, MMM, no lesions noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, slightly distended. painful to light palpation of
right upper and lower quadrant. normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Neurologic: Alert, oriented x 3. CN II-XII intact motor: normal
bulk, strength and tone throughout. No abnormal movements noted.
sensory: No deficits to light touch throughout.

FAMILY HISTORY: 2 brothers and a sister with stomach CA, no hx of CAD, stroke or
DMII, or kidney problems

SOCIAL HISTORY: Married with 9 children and recently moved from ElSalvador 3
months ago with wife still living there. No hx of EtOH or
tobacco.
Calculus of kidney,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hypovolemia,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Constipation, unspecified,Abdominal aneurysm without mention of rupture,Other iatrogenic hypotension
Calculus of kidney,Hematoma complic proc,CHF NOS,Ac posthemorrhag anemia,Hypovolemia,Heart valve replac NEC,Long-term use anticoagul,Hypertension NOS,Constipation NOS,Abdom aortic aneurysm,Iatrogenc hypotnsion NEC
Admission Date:  [**2108-1-3**]              Discharge Date:   [**2108-1-19**]

Date of Birth:  [**2036-6-26**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 824**]
Chief Complaint:
Back pain

Major Surgical or Invasive Procedure:
Right ureteral stent placement and right extracorporeal
shockwave lithotripsy [**2108-1-6**]


History of Present Illness:
71 yo with hx HTN, kidney stones, AAA, aortic insufficiency (s/p
AVR [**10-28**] @ [**Hospital1 2177**]), AAA, CHF has a very large 7x16mm calculus in R
kidney which will need lithotripsy according to his urologist,
Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 770**]. Pt reports that for the past three months he
has has intermittent suprapubic and rt flank pain which is
colicky in nature. Pain has been [**9-2**] at worse and has increased
in frequency over the past 3 weeks but no dysuria or hematuria.
This was initially thought to be due to his prostate but the
intermittent nature of the pain along with a normal prostate
exam suggested other causes. [**12-19**] CT showed 7 x 16 mm calculus
in the right renal pelvis with two smaller stones in the pelvis
of the left kidney. Pt was therefore electively admitted for
heparin bridge during lithotripsy since the patient needs
continuous anticoagulation with mechanical valve.

Past Medical History:
HTN
CHF secondary to AS
AS s/p AVR [**9-27**] at [**Hospital1 2177**]
AAA
nephrolithiasis


Social History:
Married with 9 children and recently moved from ElSalvador 3
months ago with wife still living there. No hx of EtOH or
tobacco.

Family History:
2 brothers and a sister with stomach CA, no hx of CAD, stroke or
DMII, or kidney problems

Physical Exam:
Vitals: T:99.2 P:107 R:17 BP: 78 - 141/40 - 80 SaO2: 93% RA
General: Awake, alert, in pain
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus
noted, MMM, no lesions noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, slightly distended. painful to light palpation of
right upper and lower quadrant. normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Neurologic: Alert, oriented x 3. CN II-XII intact motor: normal
bulk, strength and tone throughout. No abnormal movements noted.
sensory: No deficits to light touch throughout.


Pertinent Results:
CXR AP [**1-3**]: Cardiomegaly with prosthetic aortic valve. No acute
cardiopulmonary process seen.

CT abdomen and pelvis w/ contrast [**1-8**]:
1. Large right perinephric hematoma with active extravasation of
arterial contrast and hypoperfusion of the lower pole of the
kidney. There is mass effect on the anterior aspect of the
kidney from the surrounding hematoma. A nephroureteric extent is
in place with its distal end in the urinary bladder.
2. Gallstones.

CT abdomen and pelvis w/ contrast [**1-9**]:
1. Right perinephric hematoma has decreased in size since the
prior study, but does not demonstrate active contrast
extravasation at this time.
2. Delayed contrast excretion from the inferior pole of the
right kidney is noted.
3. Foci of non-dependent air within the bladder. While this may
be related to patient's trauma, correlation with U/A is
recommended to exclude infection. 4. Gallstones.
5. Tiny pericaridal effusion.

KUB [**1-12**]:
1. Prominent jejunal gases in the left upper quadrant, somewhat
increased compared to the prior CT scan, without evidence of
definite obstruction. Please closely follow by repeated
abdominal radiographs.
2. Right ureteral stone, right renal stone, and opacity
overlying the right upper quadrant corresponding to right
perinephric hematoma seen on most recent CT scan.

CT abdomen and pelvis [**1-14**]:
Interval increase in size of large right subcapsular and
perinephric renal hematoma. This hematoma is compressing the
right kidney with a persistent nephrogram consistent with a Page
kidney.

[**2108-1-3**] 04:30PM BLOOD WBC-5.8 RBC-4.16* Hgb-12.8* Hct-37.2*
MCV-89 MCH-30.8 MCHC-34.5 RDW-13.4 Plt Ct-277
[**2108-1-8**] 03:50PM BLOOD WBC-14.7*# RBC-3.56* Hgb-11.6* Hct-33.2*
MCV-93 MCH-32.4* MCHC-34.8 RDW-14.7 Plt Ct-253
[**2108-1-9**] 07:54AM BLOOD WBC-10.4 RBC-3.63* Hgb-11.4* Hct-31.8*
MCV-88 MCH-31.4 MCHC-35.9* RDW-15.7* Plt Ct-144*
[**2108-1-9**] 07:54AM BLOOD Calcium-8.8 Phos-4.4 Mg-1.6
[**2108-1-11**] 04:55AM BLOOD WBC-8.7 RBC-3.96* Hgb-12.3* Hct-33.5*
MCV-85 MCH-31.2 MCHC-36.8* RDW-14.9 Plt Ct-135*
[**2108-1-14**] 08:30AM BLOOD WBC-7.8 RBC-3.74* Hgb-12.0* Hct-33.9*
MCV-91 MCH-32.0 MCHC-35.3* RDW-14.2 Plt Ct-228
[**2108-1-19**] 06:20AM BLOOD Hct-36.5*
[**2108-1-3**] 04:30PM BLOOD PT-20.1* PTT-28.6 INR(PT)-2.9
[**2108-1-9**] 01:58AM BLOOD PT-16.7* PTT-28.6 INR(PT)-1.9
[**2108-1-11**] 08:55PM BLOOD PT-13.5* PTT-39.4* INR(PT)-1.2
[**2108-1-14**] 08:30AM BLOOD PT-15.1* PTT-72.3* INR(PT)-1.6

[**2108-1-3**] 04:30PM BLOOD Glucose-89 UreaN-16 Creat-1.0 Na-138
K-4.3 Cl-103 HCO3-26 AnGap-13
[**2108-1-9**] 01:58AM BLOOD Glucose-166* UreaN-15 Creat-1.1 Na-134
K-6.2* Cl-105 HCO3-21* AnGap-14
[**2108-1-9**] 07:54AM BLOOD K-4.9
[**2108-1-11**] 04:55AM BLOOD Glucose-91 UreaN-13 Creat-1.0 Na-140
K-3.7 Cl-102 HCO3-28 AnGap-14
[**2108-1-14**] 08:30AM BLOOD Glucose-106* UreaN-13 Creat-1.0 Na-136
K-3.9 Cl-99 HCO3-25 AnGap-16
[**2108-1-18**] 05:45AM BLOOD Glucose-86 UreaN-12 Creat-0.9 Na-138
K-4.5 Cl-102 HCO3-29 AnGap-12
[**2108-1-3**] 04:30PM BLOOD Calcium-9.4 Phos-3.9 Mg-1.9


Brief Hospital Course:
71 yo with hx HTN, kidney stones, AAA, aortic insufficiency s/p
AVR, AAA admitted for coumadin wean with heparin bridge for
scheduled lithotripsy for nephrolithiasis.  Patient underwent
right extracorporial shock wave lithotripsy with r ureteral
stent placement on [**1-6**].  Patient underwent surgery and was
recovering on [**1-7**] when he had 2 episodes of syncope [**1-7**] and
[**1-8**], hypotension and tachycardia with a HCT drop 38->31.  He
was emergently transfered to the ICU.  A CT performed at that
time showed large parinephric capsular hematoma with extension
into the lower pelvis.
.
In the ICU, the patient's heparin drip was stopped and
anticoagulation reversed. The patient ultimately recieved 8
Units PRBC, 2U FFP, and vitamin K.  A 3-way foley was placed on
[**2108-1-10**] for hematuria and continuous bladder irrigation was
initiated.  The patient was hemodynamically stable, holding at a
steady HCT and was transferred back to the floor on [**2108-1-10**].
.
On the floor, the patient remained stable and anticoagulation
was slowly restarted beginning [**2108-1-11**].  A heparin drip and
coumadin were started and the patient was monitored closely with
frequent HCT checks.  He remained stable although with continued
right abdominal and flank tenderness as expected.  He complained
of abdominal bloating and a KUB was performed which revealed
minimally dilated small bowel with no obstruction.  His bowel
regimen was increased for constipation.  The foley catheter (and
bladder irrigation) was removed on [**2108-1-13**] as hematuria had
resolved.  The patient was voiding without difficulty after
catheter removal.  A follow-up CT was performed on [**2108-1-14**] to
evaluate the hematoma.  It revealed a slight increase in size of
the hematoma.  The patient's hematocrit remained stable and his
pain was controlled.  The heparin was discontinued at this time.
 The patient was transferred to the urology service at this time
to continue managment.  He remained stable.  Coumadin was
resumed and the patient's INR and HCT was monitored closely.  He
continued to have abdominal and flank pain, although this
gradually decreased and he was taking only tylenol with an
occasional percocet for it's managment in the days leading up to
discharge.  He was given an additional 2units of PRBCs on
[**2108-1-17**] for a very slow drift in his hematocrit.  After this his
HCT remained greater that 30 and had a hematocrit of 36.5 on the
day of discharge.  His INR was followed with coumadin dosing and
was 3.4 on the day of discharge (goal 2.5-3.5).  He was
tolerating a regular diet and ambulating well with good pain
control and was discharged on [**2108-1-19**] in good condition.  He
will follow-up closely with Dr. [**Last Name (STitle) 770**] for management of his
hematoma and for eventual stent removal. He will follow-up at
[**Hospital6 **] for monitoring of his INR beginning on the
day after discharge.


Medications on Admission:
coumadin 5mg alternating with 2.5mg qod
metoprolol 50mg [**Hospital1 **]
ASA 81mg


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
5. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
6. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO at bedtime:
Take one tab (2.5mg) alternating with 2tabs (5mg) every other
night beginning with one tab [**2108-1-19**].
Disp:*50 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Nephrolithiasis (right)
Retroperitoneal hematoma
Aortic insufficiency s/p aortic valve repair
Congestive heart failure
AAA


Discharge Condition:
Good


Discharge Instructions:
Please call Dr.[**Name (NI) 825**] office with any questions or concerns.
 Call if you are experiencing high fevers >101, have a
significant increase in your abdominal/back pain, have nausea or
vomiting and are unable to take in food and liquids, or have any
other symptoms that concern you.

You will have your stent removed by Dr. [**Last Name (STitle) 770**]...you will
follow-up with him in clinic as to the timing of this.

Followup Instructions:
Please call Dr.[**Name (NI) 825**] office for your follow-up appointment
in [**12-26**] weeks.  ([**Telephone/Fax (1) 7707**].

Please follow-up with [**Hospital6 **] to have your INR
checked tomorrow morning (Friday [**2108-1-20**]).  After that please
have your INR checked at least twice a week to ensure it is
stable.
{'Calculus of kidney,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hypovolemia,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Constipation, unspecified,Abdominal aneurysm without mention of rupture,Other iatrogenic hypotension'}


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: Back pain

PRESENT ILLNESS: 71 yo with hx HTN, kidney stones, AAA, aortic insufficiency (s/p
AVR [**10-28**] @ [**Hospital1 2177**]), AAA, CHF has a very large 7x16mm calculus in R
kidney which will need lithotripsy according to his urologist,
Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 770**]. Pt reports that for the past three months he
has has intermittent suprapubic and rt flank pain which is
colicky in nature. Pain has been [**9-2**] at worse and has increased
in frequency over the past 3 weeks but no dysuria or hematuria.
This was initially thought to be due to his prostate but the
intermittent nature of the pain along with a normal prostate
exam suggested other causes. [**12-19**] CT showed 7 x 16 mm calculus
in the right renal pelvis with two smaller stones in the pelvis
of the left kidney. Pt was therefore electively admitted for
heparin bridge during lithotripsy since the patient needs
continuous anticoagulation with mechanical valve.

MEDICAL HISTORY: HTN
CHF secondary to AS
AS s/p AVR [**9-27**] at [**Hospital1 2177**]
AAA
nephrolithiasis

MEDICATION ON ADMISSION: coumadin 5mg alternating with 2.5mg qod
metoprolol 50mg [**Hospital1 **]
ASA 81mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:99.2 P:107 R:17 BP: 78 - 141/40 - 80 SaO2: 93% RA
General: Awake, alert, in pain
HEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus
noted, MMM, no lesions noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, slightly distended. painful to light palpation of
right upper and lower quadrant. normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Neurologic: Alert, oriented x 3. CN II-XII intact motor: normal
bulk, strength and tone throughout. No abnormal movements noted.
sensory: No deficits to light touch throughout.

FAMILY HISTORY: 2 brothers and a sister with stomach CA, no hx of CAD, stroke or
DMII, or kidney problems

SOCIAL HISTORY: Married with 9 children and recently moved from ElSalvador 3
months ago with wife still living there. No hx of EtOH or
tobacco. 

### Response:
{'Calculus of kidney,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Hypovolemia,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Constipation, unspecified,Abdominal aneurysm without mention of rupture,Other iatrogenic hypotension'}
