CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 73F with h/o AAA p/w 2 days of low abdominal/back pai.  6.5cm
AAA seen on CT scan at OSH. AAA was followed by Vascular Surgery
but pt has not gone for a CT scan for approx 45yrs, at which
time it was around 5.0cm.  She notes onset of very low abdominal
pain along with constipation for the last 2 days. At worst pain
is [**11-8**] constant crampy similar to previous bouts of
diverticulitis. She is currently pain free after having a BM
around noon today. Denies any dizziness or SOB, but did have
diaphoresis/nausea/syncope x1 yesterday while straining to have
a BM yesterday. + fever/chills x 1 day, last BM 2 days ago, dark
at baseline [**3-3**] iron supplements, no hematoschezia, no dysuria
or other urinary symptoms.

MEDICAL HISTORY: AAA per above, DM, MI [**2131**], Diverticulitis, Neuropathy,
Sciatica, Asthmatic, Bronchitis, Bursitis Rt shoulder, Rotator
cuff tear, Dry eyes

MEDICATION ON ADMISSION: Titralac 100mg'
Avandia 30mg'
Axid 150'
Ferrous Sulfate 325'
Tylenol Xtra strength prn
Neurontin 300'
Crestor 20mg'
Cymbalta 30mg'
Pulmocort 180mcg 1puff [**Hospital1 **]
Albuterol 90mcg prn
Foradil
Theratears
Mucinex
MVI

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals
Gen: AOx3
CV: RRR
Resp: CTAB
Abd: soft, non-tender AAA, + tenderness to deep palpation in
LLQ,
mild distended
Pulses:     Rad     Fem     [**Doctor Last Name **]     PT     DP
Rt           2+      2+     2+      2+     2+
Lt           2+      2+     2+      2+     1+

FAMILY HISTORY: NC

SOCIAL HISTORY: Former smoker quit 17yrs ago 80pack/yr, no EtOH, no illicits.
Abdominal aneurysm without mention of rupture,Diverticulitis of colon (without mention of hemorrhage),Other and unspecified ovarian cyst,Asthma, unspecified type, unspecified,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified
Abdom aortic aneurysm,Dvrtcli colon w/o hmrhg,Ovarian cyst NEC/NOS,Asthma NOS,Old myocardial infarct,DMII neuro nt st uncntrl,Neuropathy in diabetes,Crnry athrscl natve vssl,Periph vascular dis NOS
Admission Date:  [**2155-5-19**]              Discharge Date:   [**2155-5-23**]

Date of Birth:  [**2081-12-1**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1234**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
73F with h/o AAA p/w 2 days of low abdominal/back pai.  6.5cm
AAA seen on CT scan at OSH. AAA was followed by Vascular Surgery
but pt has not gone for a CT scan for approx 45yrs, at which
time it was around 5.0cm.  She notes onset of very low abdominal
pain along with constipation for the last 2 days. At worst pain
is [**11-8**] constant crampy similar to previous bouts of
diverticulitis. She is currently pain free after having a BM
around noon today. Denies any dizziness or SOB, but did have
diaphoresis/nausea/syncope x1 yesterday while straining to have
a BM yesterday. + fever/chills x 1 day, last BM 2 days ago, dark
at baseline [**3-3**] iron supplements, no hematoschezia, no dysuria
or other urinary symptoms.


Past Medical History:
AAA per above, DM, MI [**2131**], Diverticulitis, Neuropathy,
Sciatica, Asthmatic, Bronchitis, Bursitis Rt shoulder, Rotator
cuff tear, Dry eyes


Social History:
Former smoker quit 17yrs ago 80pack/yr, no EtOH, no illicits.


Family History:
NC

Physical Exam:
Vitals
Gen: AOx3
CV: RRR
Resp: CTAB
Abd: soft, non-tender AAA, + tenderness to deep palpation in
LLQ,
mild distended
Pulses:     Rad     Fem     [**Doctor Last Name **]     PT     DP
Rt           2+      2+     2+      2+     2+
Lt           2+      2+     2+      2+     1+


Pertinent Results:
Labs on admission:
[**2155-5-19**] 03:50PM BLOOD WBC-9.6 RBC-3.71* Hgb-11.2* Hct-34.1*
MCV-92 MCH-30.2 MCHC-32.9 RDW-15.4 Plt Ct-266
[**2155-5-19**] 03:50PM BLOOD Neuts-76.3* Lymphs-17.9* Monos-4.3
Eos-0.8 Baso-0.7
[**2155-5-19**] 03:50PM BLOOD PT-12.3 PTT-32.0 INR(PT)-1.0
[**2155-5-19**] 03:50PM BLOOD Glucose-121* UreaN-26* Creat-1.3* Na-138
K-6.4* Cl-101 HCO3-25 AnGap-18
[**2155-5-19**] 03:50PM BLOOD cTropnT-<0.01
[**2155-5-20**] 12:59AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2155-5-19**] 03:50PM BLOOD Calcium-9.7 Phos-3.6 Mg-2.6

Imaging:
CT PELVIS W/CONTRAST Study Date of [**2155-5-19**] 4:10 PM
1. 6-cm abdominal aortic aneurysm, with both suprarenal and
infrarenal
components. No evidence of aneurysmal rupture.
2. Diverticulosis, with suggestion of mild diverticulitis
involving the
sigmoid colon. No evidence of abscess or free air.
3. 2.5 cm left adnexal cyst. In a postmenopausal patient, this
is abnormal, and could be further evaluated with MRI.
4. Small pericardial effusion.
5. 4-mm nodule in the right lower lobe. In absence of any risk
factors for
malignancy, no further followup is needed. Otherwise, followup
CT at 12
months.

TTE [**5-20**]:
Mild regional left ventricular systolic dysfunction c/w CAD.
Pulmonary artery systolic hypertension. Mild mitral
regurgitation. Increased PCWP.

CTA ABD W&W/O C & RECONS Study Date of [**2155-5-20**] 7:14 AM:
1. Infrarenal abdominal aortic aneurysm, measuring 6.6 x 6.0 cm,
that extends to the aortic bifurcation, present with a
circumferential mural thrombus that contains calcification.
2. Extensive atherosclerotic calcifications and mural thrombus
along the
aorta, iliac arteries and visualized portion of the femoral
arteries.

PELVIS, NON-OBSTETRIC Study Date of [**2155-5-21**] 8:21 AM
Simple appearing left ovarian cyst as described above. Followup
in six months with ultrasound is suggested to assess for
expected stability.

STRESS Study Date of [**2155-5-22**]
Atypical/non-anginal type symptoms with no ischemic EKG
changes(changes are nonspecific). Nuclear report sent
separately.

CARDIAC PERFUSION DOBUTAMINE Study Date of [**2155-5-22**]:
Moderate in severity reversible ischemic defect involving the
entire
inferior wall extending to the apex.

[**2155-5-23**] 06:20AM BLOOD Hct-30.2*
[**2155-5-22**] 05:00AM BLOOD WBC-4.6 RBC-2.80* Hgb-8.4* Hct-24.9*
MCV-89 MCH-30.1 MCHC-33.8 RDW-14.7 Plt Ct-172
[**2155-5-22**] 05:00AM BLOOD Plt Ct-172
[**2155-5-23**] 12:53AM BLOOD Glucose-130* UreaN-10 Creat-1.1 Na-145
K-3.9 Cl-108 HCO3-25 AnGap-16
[**2155-5-20**] 12:59AM BLOOD CK(CPK)-86
[**2155-5-23**] 12:53AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.0

Brief Hospital Course:
Patient presented with LLQ abdominal pain.  Infrarenal AAA found
at OSH, confirmed here to be measuring 6.6 x 6.0 cm extending to
the aortic bifurcation with a circumferential mural thrombus
that contains calcification.  There was no active bleeding or
signs of dissection.  Abdominal exam revealed TTP LLQ.  AAA was
nontender.  OSH Abd CT scan also showed uncomplicated mild
diverticulitis of the sigmoid colon.  CTA was repeated here and
confirmed these findings.  Patient was started on cipro/flagyl
for mild diverticulitis based on OSH abdominal CT.  We
immediately counseled the patient that she requires operative
repair of her AAA.  She clearly did not want to have surgery at
this time, especially if it required an open procedure.  She
clearly understood the risks of nonoperative management.

Patient was admitted and started on bicarb for planned EVAR
protocol CTA of the abdomen scheduled for the following day.
Overnight the patient developed labile blood pressures that did
not initially responded to fluid boluses.  Vital signs were
otherwise stable.  IV vancomycin was added.  Patient was
transferred to the ICU for monitoring.  General surgery was
consulted, who agreed that she was suffering from a mild case of
diverticulitis.  It was hard to conclude that this mild
infection 100% accounted for her labile blood pressures given
that she clinically did not appear septic.  Cardiac enzymes were
flat.  ECG was nondiagnostic and she denied chest pain during
the entire hospitalization.  Her pressures stabilized with
adequate urine output by morning.  Cardiology consult was
obtained by Dr. [**Last Name (STitle) **], who recommended a TTE, stress test, and dob
MIBI.  He believed labile blood pressures were [**3-3**] to fluid
shifts from diverticulitis.

On hospital day 2 a TTE was obtained, showing regional left
ventricular systolic dysfunction with an EF of 45-50%.  She
underwent an EVAR protocol CT scan w/ 3D recon.  Based on this
can we concluded that she was not a candidate for endovascular
repair of her AAA.  Patient again refused operative management
and clearly understood the risks of deferring treatment.
Incidentally, a 2.5 cm left adnexal cyst was found on her
initial CTA of her abdomen.  Gynecology was consulted, who
recommended a pelvic u/s for further eval.

On hospital day 3 patient underwent a pelvic ultrasound which
showed simple left ovarian cyst measuring 2.3 x 2.9 x 1.8 cm.
Gynecology recommends f/u in clinic. Patient was scheduled an
outpt appointment prior to discharge.  GI was also consulted for
consideration of an outpatient colonoscopy.  An outpatient
appointment for a colonoscopy was scheduled prior to discharge.
She also underwent a dobumatine stress test which showed
reversible ischemic defect involving the entire
inferior wall extending to the apex.  Dr. [**Last Name (STitle) **] recommends an
outpatient catheterization.  She will follow up with him as an
outpatient.  Her diet was advanced (low residue).  General
surgery signed off recommending 14 day course of cipro/flagyl.
She will follow up in Dr.[**Name (NI) 670**] clinic in two weeks.

On hospital day 4 patient was tolerating POs, abdominal pain was
improved, and ambulating well.  She was without chest pain.
Again, she was counseled on the warning signs of a ruptured AAA.
 She again clearly stated that she did not want open AAA repair
and clearly understands the risks involved in deferring
treatment.  She will follow up with: gynecology, general
surgery, GI, cardiology, and vascular surgery in 1 month.



Medications on Admission:
Titralac 100mg'
Avandia 30mg'
Axid 150'
Ferrous Sulfate 325'
Tylenol Xtra strength prn
Neurontin 300'
Crestor 20mg'
Cymbalta 30mg'
Pulmocort 180mcg 1puff [**Hospital1 **]
Albuterol 90mcg prn
Foradil
Theratears
Mucinex
MVI


Discharge Medications:
1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
2. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN
(as needed) as needed for dry eyes.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 14 days.
Disp:*28 Tablet(s)* Refills:*0*
11. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H
(every 8 hours) for 14 days.
Disp:*42 Tablet(s)* Refills:*0*
12. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.
13. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day) as needed for heartburn.

14. Singulair 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
15. Fluticasone 110 mcg/Actuation Aerosol Sig: One (1) Puff
Inhalation [**Hospital1 **] (2 times a day).
16. Resume home puffer/COPD medications


Discharge Disposition:
Home With Service

Facility:
Caritas VNA

Discharge Diagnosis:
1. Diverticulitis
2. 6.5cm AAA
3. Left ovarian simple cyst
4. Reversible defect on stress test


Discharge Condition:
Stable


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] pain, flank pain, lower abdominal
pan, chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.




Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2155-6-17**] 10:45

Call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] office (cardiology) to schedule appointemtn
and/or cardiac catherization ([**Telephone/Fax (1) 39803**]

Please call and schedule an appointment to see Dr. [**First Name (STitle) **] at
([**Telephone/Fax (1) 3618**] in 2 weeks.

Please call and schedule an appointment with gynecology at
[**Telephone/Fax (1) 2664**] in [**3-4**] weeks.

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 21795**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2155-6-6**] 1:00 (GI)



Completed by:[**2155-5-23**]

Name:  [**Known lastname **],[**Known firstname **]                       Unit No:   [**Numeric Identifier 13163**]

Admission Date:  [**2155-5-19**]              Discharge Date:   [**2155-5-23**]

Date of Birth:  [**2081-12-1**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 270**]
Addendum:
Please note that pt received 1 unit pRBC on hospital day 3 for a
hct of 25.  This was most likely dilutional.  Appropriate post
tx jump to 30, stable for rest of admission.  Patient will
receive outpatient colonoscopy as she did have guiac positive
stool while in house.

Discharge Disposition:
Home With Service

Facility:
Caritas VNA

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 272**] MD [**MD Number(1) 273**]

Completed by:[**2155-5-23**]
{'Abdominal aneurysm without mention of rupture,Diverticulitis of colon (without mention of hemorrhage),Other and unspecified ovarian cyst,Asthma, unspecified type, unspecified,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, 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: Abdominal pain

PRESENT ILLNESS: 73F with h/o AAA p/w 2 days of low abdominal/back pai.  6.5cm
AAA seen on CT scan at OSH. AAA was followed by Vascular Surgery
but pt has not gone for a CT scan for approx 45yrs, at which
time it was around 5.0cm.  She notes onset of very low abdominal
pain along with constipation for the last 2 days. At worst pain
is [**11-8**] constant crampy similar to previous bouts of
diverticulitis. She is currently pain free after having a BM
around noon today. Denies any dizziness or SOB, but did have
diaphoresis/nausea/syncope x1 yesterday while straining to have
a BM yesterday. + fever/chills x 1 day, last BM 2 days ago, dark
at baseline [**3-3**] iron supplements, no hematoschezia, no dysuria
or other urinary symptoms.

MEDICAL HISTORY: AAA per above, DM, MI [**2131**], Diverticulitis, Neuropathy,
Sciatica, Asthmatic, Bronchitis, Bursitis Rt shoulder, Rotator
cuff tear, Dry eyes

MEDICATION ON ADMISSION: Titralac 100mg'
Avandia 30mg'
Axid 150'
Ferrous Sulfate 325'
Tylenol Xtra strength prn
Neurontin 300'
Crestor 20mg'
Cymbalta 30mg'
Pulmocort 180mcg 1puff [**Hospital1 **]
Albuterol 90mcg prn
Foradil
Theratears
Mucinex
MVI

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals
Gen: AOx3
CV: RRR
Resp: CTAB
Abd: soft, non-tender AAA, + tenderness to deep palpation in
LLQ,
mild distended
Pulses:     Rad     Fem     [**Doctor Last Name **]     PT     DP
Rt           2+      2+     2+      2+     2+
Lt           2+      2+     2+      2+     1+

FAMILY HISTORY: NC

SOCIAL HISTORY: Former smoker quit 17yrs ago 80pack/yr, no EtOH, no illicits. 

### Response:
{'Abdominal aneurysm without mention of rupture,Diverticulitis of colon (without mention of hemorrhage),Other and unspecified ovarian cyst,Asthma, unspecified type, unspecified,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified'}
