CHIEF COMPLAINT: LLQ pain

PRESENT ILLNESS: 69M c h/o perforated diverticulitis s/p repair p/w LLQ pain
x 1 day.  Patient states that he developed severe pain last
night
that had worsened during the day.  Patient went to the ED at OSH
where he was found to have WBC of 31 and CT that showed
diverticulitis.  +nausea.  No vomiting.  No fevers or chills.
+loose stool output from ostomy

MEDICAL HISTORY: 1. CAD - MI, PTCA in [**2170**], deccreased EF
2. CVA - left monocular blindness
3. COPD on home O2
4. Chronic renal insufficiency
5. Renal cell carcinoma s/p nephrectomy
6. sleep apnea
7. diverticulitis
8. iliac stent

MEDICATION ON ADMISSION: Prednisone taper (currently on 10 qd)
Coumadin 1.5 daily,
Advair 250/50 [**Hospital1 **]
Procrit 40,000 qmon
ASA 81 daily
Claritin 10 daily
Nystatin S&S
Metoprolol 25 [**Hospital1 **]
Prozac 40 daily
Plavix 75 daily
Prilosec OTC 20 [**Hospital1 **]
Zocor 80 daily
Amiodarone 200 daily
Tricor 48 daily
Lisinopril 2.5 daily
Lasix 40 daily
Spiriva 1 daily
Albuterol IH
Prostat 20 mg daily

ALLERGIES: Codeine / Iodine

PHYSICAL EXAM: T 99.7  HR 99 a fib BP 73/55 RR 26  Sat 99%
A&O
IRIR
decreased BS bilaterally
Soft, ND, + ostomy on RUQ - pink, stool and air in bag, + tender
at LLQ, no rebound, no guarding
+ stage I decubitus ulcers

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient smokes a pack per day of cigarettes.
Diverticulitis of colon (without mention of hemorrhage),Intestinal infection due to Clostridium difficile,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Infection and inflammatory reaction due to other vascular device, implant, and graft,Atrial fibrillation,Unspecified protein-calorie malnutrition,Hyperpotassemia,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Pressure ulcer, lower back,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder
Dvrtcli colon w/o hmrhg,Int inf clstrdium dfcile,Ac DVT/emb prox low ext,React-oth vasc dev/graft,Atrial fibrillation,Protein-cal malnutr NOS,Hyperpotassemia,Chr airway obstruct NEC,Chronic kidney dis NOS,Pressure ulcer, low back,DMII wo cmp nt st uncntr,Old myocardial infarct,Crnry athrscl natve vssl,Status-post ptca,Hx of kidney malignancy,Colostomy status,Hy kid NOS w cr kid I-IV,Tobacco use disorder
Admission Date:  [**2176-5-7**]              Discharge Date:   [**2176-5-13**]

Date of Birth:  [**2107-3-28**]             Sex:   M

Service: SURGERY

Allergies:
Codeine / Iodine

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
LLQ pain

Major Surgical or Invasive Procedure:
placement of IVC filter


History of Present Illness:
69M c h/o perforated diverticulitis s/p repair p/w LLQ pain
x 1 day.  Patient states that he developed severe pain last
night
that had worsened during the day.  Patient went to the ED at OSH
where he was found to have WBC of 31 and CT that showed
diverticulitis.  +nausea.  No vomiting.  No fevers or chills.
+loose stool output from ostomy


Past Medical History:
1. CAD - MI, PTCA in [**2170**], deccreased EF
2. CVA - left monocular blindness
3. COPD on home O2
4. Chronic renal insufficiency
5. Renal cell carcinoma s/p nephrectomy
6. sleep apnea
7. diverticulitis
8. iliac stent


Social History:
Patient smokes a pack per day of cigarettes.


Family History:
Non-contributory

Physical Exam:
T 99.7  HR 99 a fib BP 73/55 RR 26  Sat 99%
A&O
IRIR
decreased BS bilaterally
Soft, ND, + ostomy on RUQ - pink, stool and air in bag, + tender
at LLQ, no rebound, no guarding
+ stage I decubitus ulcers


Pertinent Results:
[**2176-5-7**] 09:25PM   PT-14.3* PTT-24.9 INR(PT)-1.3*
[**2176-5-7**] 09:25PM   PLT SMR-NORMAL PLT COUNT-152
[**2176-5-7**] 09:25PM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-1+ POLYCHROM-NORMAL
[**2176-5-7**] 09:25PM   NEUTS-76* BANDS-0 LYMPHS-11* MONOS-9 EOS-1
BASOS-0 ATYPS-0 METAS-2* MYELOS-1*
[**2176-5-7**] 09:25PM   WBC-31.1*# RBC-4.93# HGB-14.6# HCT-43.7#
MCV-89 MCH-29.7 MCHC-33.5 RDW-16.1*
[**2176-5-7**] 09:25PM   GLUCOSE-114* UREA N-87* CREAT-1.9* SODIUM-133
POTASSIUM-6.1* CHLORIDE-100 TOTAL CO2-21* ANION GAP-18
[**2176-5-7**] 09:36PM   LACTATE-1.4

[**5-7**] ECG: Irregular supraventricular rhythm with baseline
artifact possibly atrial fibrillation, but cannot rule exclude
sinus mechanism with supraventricular premature depolarizations.

[**5-8**] LE u/s: IMPRESSION: Acute DVT involving entire right lower
extremity. Left lower extremity veins patent.

[**5-8**] CT ABD/PELVIS:
CT ABDOMEN WITHOUT IV CONTRAST: Limited imaging of the lung
bases demonstrate left basilar stable bronchiectasis. There is
bibasilar atelectasis.

Imaging of the intra-abdominal organs is limited due to lack of
IV contrast. There is a stable low-density lesion within the
left hepatic lobe, too small to characterize. Calcified
gallstones are demonstrated within the gallbladder. The spleen,
pancreas, right adrenal gland, and right kidney are
unremarkable. The patient is status post left nephrectomy. Again
seen is a small left abdominal wall hernia containing small
bowel without evidence of bowel obstruction, unchanged. Bowel is
normal in caliber. The patient is status post transverse loop
colostomy. Scattered colonic diverticula are demonstrated
without evidence of acute diverticulitis. There is thickening of
the cecum focally, differential diagnosis includes infectious or
inflammatory causes, and less likely ischemic. Specifically,
there is thickening of the haustra of the cecum in this region,
which can be seen in C. diff. colitis. There is stranding of the
mesenteric fat, which is unchanged. No focal fluid collections
are demonstrated to suggest abscess.

CT OF THE PELVIS: A Foley catheter is demonstrated within the
bladder, which is relatively decompressed. There are prosthetic
calcifications. There is no ascites, lymphadenopathy or free
intraperitoneal gas. There is stranding of the presacral fat,
which is of uncertain significance. There is stable
retroperitoneal fat stranding, which may be post-surgical. No
focal fluid collections are demonstrated to suggest abscess.
There is a stable infrarenal abdominal aortic aneurysm measuring
4 cm in maximum dimension. The patient is status post sigmoid
colectomy.

IMPRESSION:
1. Status post sigmoid colectomy and transverse loop colostomy.
Scattered colonic diverticula without evidence of
diverticulitis.
2. Stranding of the retroperitoneal fat, unchanged, may reflect
post-surgical changes.
3. Stable 4-cm infrarenal abdominal aortic aneurysm.
4. Status post left nephrectomy.
5. Cholelithiasis without evidence of cholecystitis.
6. Left lateral abdominal wall hernia containing small bowel
without evidence of bowel obstruction.
7. Thickening of the haustra of the cecum.

[**5-8**] Stool: C. Diff positive

[**5-8**] PICC tip: negative growth

Brief Hospital Course:
The patient presented to the ED with a WBC=31 and diverticulitis
on CT Scan.  The patient was admitted to the ICU, the PICC line
was removed and tip sent for culture, the foley catheter was
changed, blood cultures were taken, coumadin, plavix, and
aspirin were held, urine cultures was taken, a CXR was done, was
made NPO, and IV Zosyn and Linezolid were started.  A CVL was
placed on HD2.  Serial abdominal exams continued and improved.
On HD2, it was noted that the patient's RLE was more edematous
compared to the LLE.  A LE u/s showed complete DVT of the RLE.
A heparin drip was started. On HD3, an IVC filter was placed.
On HD4, there was gas in the ostomy and the patient's diet was
advanced.  The patient was restarted on his PO cardiac meds to
allow for proper rate control.  WBC was drifting back toward
normal.  The patient was transferred to the floor in stable
condition and was placed on a telemetry bed.  On the floor, the
patient tolerated a regular diet. The heparin drip was
discontinued. The patient was started on SC Lovenox and
restarted on coumadin.  On HD7, the patient remained afebrile,
was receiving Lovenox [**Hospital1 **], and continuing to tolerate a regular
diet.  The INR was subtherapeutic at 1.5, so will continue with
coumadin (3mg given [**5-12**] PM) and SC Lovenox (60mg [**Hospital1 **]).  In
addition, the patient was on a prednisone taper on admission
(initially given IV hydrocortisone due to NPO status).  On HD7,
the patient's prednisone was decreased from 10mg to 5mg, and the
taper will continue at the rehab facility.  The patient was
discharged to rehab on HD7, PPD4.

Medications on Admission:
Prednisone taper (currently on 10 qd)
Coumadin 1.5 daily,
Advair 250/50 [**Hospital1 **]
Procrit 40,000 qmon
ASA 81 daily
Claritin 10 daily
Nystatin S&S
Metoprolol 25 [**Hospital1 **]
Prozac 40 daily
Plavix 75 daily
Prilosec OTC 20 [**Hospital1 **]
Zocor 80 daily
Amiodarone 200 daily
Tricor 48 daily
Lisinopril 2.5 daily
Lasix 40 daily
Spiriva 1 daily
Albuterol IH
Prostat 20 mg daily

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale
 Injection ASDIR (AS DIRECTED).
3. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 18 days: continue Flagyl for 3 weeks (started
[**5-10**].
Disp:*54 Tablet(s)* Refills:*0*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
6. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
11. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
12. Enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours).
13. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Epoetin Alfa 10,000 unit/mL Solution Sig: [**Numeric Identifier **] ([**Numeric Identifier **])
units Injection QMOWEFR (Monday -Wednesday-Friday). units
15. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime): adjust for INR 2.0-3.0.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Manor - [**Location (un) **]

Discharge Diagnosis:
Diverticulitis
?PICC infection
RLE DVT
CAD - MI, s/p PTCA
decreased EF
CVA - left monocular blindness
COPD on home O2
Chronic renal insufficiency
Renal cell carcinoma s/p nephrectomy
sleep apnea
diverticulitis
iliac stent
a fib
DM
HTN
hx MRSA, hx VRE, hx c. dif.

Discharge Condition:
Stable

Discharge Instructions:
Please call doctor [**First Name (Titles) **] [**Last Name (Titles) **] greater than 101, nausea/vomiting,
inability to eat, wound redness/warmth/swelling/foul smelling
drainage, pain not controlled by pain medications or any other
concerns.

Please resume taking all medications as taken prior to this
admission.  Continue taking Lovenox 60mg [**Hospital1 **] until INR is
therapeutic.  Continue taking Flagyl 500mg TID for a total of 3
weeks (your treatment started on [**5-10**]).

Please follow-up as directed.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 1120**] in [**12-30**] weeks. Please call ([**Telephone/Fax (1) 6316**] for an appointment
{'Diverticulitis of colon (without mention of hemorrhage),Intestinal infection due to Clostridium difficile,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Infection and inflammatory reaction due to other vascular device, implant, and graft,Atrial fibrillation,Unspecified protein-calorie malnutrition,Hyperpotassemia,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Pressure ulcer, lower back,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder'}


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: LLQ pain

PRESENT ILLNESS: 69M c h/o perforated diverticulitis s/p repair p/w LLQ pain
x 1 day.  Patient states that he developed severe pain last
night
that had worsened during the day.  Patient went to the ED at OSH
where he was found to have WBC of 31 and CT that showed
diverticulitis.  +nausea.  No vomiting.  No fevers or chills.
+loose stool output from ostomy

MEDICAL HISTORY: 1. CAD - MI, PTCA in [**2170**], deccreased EF
2. CVA - left monocular blindness
3. COPD on home O2
4. Chronic renal insufficiency
5. Renal cell carcinoma s/p nephrectomy
6. sleep apnea
7. diverticulitis
8. iliac stent

MEDICATION ON ADMISSION: Prednisone taper (currently on 10 qd)
Coumadin 1.5 daily,
Advair 250/50 [**Hospital1 **]
Procrit 40,000 qmon
ASA 81 daily
Claritin 10 daily
Nystatin S&S
Metoprolol 25 [**Hospital1 **]
Prozac 40 daily
Plavix 75 daily
Prilosec OTC 20 [**Hospital1 **]
Zocor 80 daily
Amiodarone 200 daily
Tricor 48 daily
Lisinopril 2.5 daily
Lasix 40 daily
Spiriva 1 daily
Albuterol IH
Prostat 20 mg daily

ALLERGIES: Codeine / Iodine

PHYSICAL EXAM: T 99.7  HR 99 a fib BP 73/55 RR 26  Sat 99%
A&O
IRIR
decreased BS bilaterally
Soft, ND, + ostomy on RUQ - pink, stool and air in bag, + tender
at LLQ, no rebound, no guarding
+ stage I decubitus ulcers

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient smokes a pack per day of cigarettes. 

### Response:
{'Diverticulitis of colon (without mention of hemorrhage),Intestinal infection due to Clostridium difficile,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Infection and inflammatory reaction due to other vascular device, implant, and graft,Atrial fibrillation,Unspecified protein-calorie malnutrition,Hyperpotassemia,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Pressure ulcer, lower back,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney,Colostomy status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Tobacco use disorder'}
