CHIEF COMPLAINT: abdominal pain, nausea and vomiting

PRESENT ILLNESS: 56 y/o male presents with epigastric abdominal pain.  Sharp,
constant, [**6-30**] severity.  Associated with nausea and vomiting.
Had just had a yogurt prior to episode but does not attribute to
postprandial pain.  Has not attempted PO since then but feels
thirsty.  No diarrhea or constipation.  No fevers or
chills.  Just completed course of antibiotics for bronchitis.

MEDICAL HISTORY: Prior episode pancreatitis- admitted to OSH ~1yr prior
Hematoma/mass in head of pancreas- size decreeased at last
imaging.\
-DMII, dx [**2187-10-22**]
-Low back pain with an L5 herniated disc.
-History of melanoma, with subsequent follow-up with no
recurrence.

MEDICATION ON ADMISSION: Lisinopril 2.5mg, glipizide 2.5mg, metformin 1000mg
[**Hospital1 **]

ALLERGIES: Bactrim

PHYSICAL EXAM: GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: +BS, soft, non tender, non distended, no palbable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: no biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week.  He denies any history of
IV drug abuse.
Acute pancreatitis,Portal vein thrombosis,Pneumonia, organism unspecified,Alcohol withdrawal delirium,Unspecified pleural effusion,Mixed acid-base balance disorder,Other pulmonary insufficiency, not elsewhere classified,Paroxysmal supraventricular tachycardia,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign essential hypertension,Fever, unspecified,Bandemia,Alcohol abuse, unspecified,Personal history of malignant melanoma of skin
Acute pancreatitis,Portal vein thrombosis,Pneumonia, organism NOS,Delirium tremens,Pleural effusion NOS,Mixed acid-base bal dis,Other pulmonary insuff,Parox atrial tachycardia,Spleen disease NEC,DMII wo cmp nt st uncntr,Benign hypertension,Fever NOS,Bandemia,Alcohol abuse-unspec,Hx-malig skin melanoma
Admission Date:  [**2189-6-7**]              Discharge Date:   [**2189-6-24**]

Date of Birth:  [**2133-6-4**]             Sex:   M

Service: SURGERY

Allergies:
Bactrim

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
abdominal pain, nausea and vomiting

Major Surgical or Invasive Procedure:
none


History of Present Illness:
56 y/o male presents with epigastric abdominal pain.  Sharp,
constant, [**6-30**] severity.  Associated with nausea and vomiting.
Had just had a yogurt prior to episode but does not attribute to
postprandial pain.  Has not attempted PO since then but feels
thirsty.  No diarrhea or constipation.  No fevers or
chills.  Just completed course of antibiotics for bronchitis.


Past Medical History:
Prior episode pancreatitis- admitted to OSH ~1yr prior
Hematoma/mass in head of pancreas- size decreeased at last
imaging.\
-DMII, dx [**2187-10-22**]
-Low back pain with an L5 herniated disc.
-History of melanoma, with subsequent follow-up with no
recurrence.


Social History:
He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week.  He denies any history of
IV drug abuse.


Family History:
no biliary or pancreatic disease


Physical Exam:
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: +BS, soft, non tender, non distended, no palbable masses
Ext: No LE edema, LE warm and well perfused


Pertinent Results:
LABS AT ADMISSION:
[**2189-6-6**] 10:00PM BLOOD WBC-21.5* RBC-5.39 Hgb-16.2 Hct-46.9
MCV-87 MCH-30.0 MCHC-34.5 RDW-13.9 Plt Ct-410
[**2189-6-6**] 10:00PM BLOOD Glucose-352* UreaN-15 Creat-0.9 Na-140
K-4.2 Cl-105 HCO3-20* AnGap-19
[**2189-6-6**] 10:00PM BLOOD ALT-222* AST-246* LD(LDH)-329* AlkPhos-82
TotBili-1.5
[**2189-6-6**] 10:00PM BLOOD Lipase-1556*
[**2189-6-7**] 07:25AM BLOOD Calcium-8.0* Phos-3.7 Mg-1.9 Cholest-115
[**2189-6-7**] 07:25AM BLOOD Triglyc-44 HDL-71 CHOL/HD-1.6 LDLcalc-35

LABS AT DISCHARGE:
[**2189-6-24**] 06:12AM BLOOD WBC-15.2* RBC-3.24* Hgb-9.5* Hct-27.7*
MCV-85 MCH-29.2 MCHC-34.2 RDW-14.1 Plt Ct-452*
[**2189-6-24**] 06:12AM BLOOD Glucose-153* UreaN-15 Creat-0.8 Na-133
K-4.6 Cl-99 HCO3-25 AnGap-14
[**2189-6-18**] 03:29AM BLOOD ALT-53* AST-39 LD(LDH)-495* AlkPhos-159*
Amylase-29 TotBili-1.5
[**2189-6-18**] 03:29AM BLOOD Lipase-15
[**2189-6-24**] 06:12AM BLOOD Calcium-8.0* Phos-4.4 Mg-2.2

Brief Hospital Course:
The patient was admitted on [**6-7**] for acute abdominal pain,
nausea and vomiting. A CT scan performed in the ED showed:
"Extensive pancreatitis with findings consistent with
hypoenhancement of  the head, uncinate and a portion of the body
of the pancreas. This is  concerning for necrotizing
pancreatitis. Adjacent extensive edema of the duodenum". Lipase:
1556.
The patient was admitted to the ICU.

Neurologic: pain was controlled with dilaudid PCA. On HD2 the
patient became very agitated and combative overnight (likely DT)
needing restraints. CIWA scale was started. He continued to
require significant amounts of benzodiazepines until HD7. A head
CT was obtained to r/o intracranial pathologic processes as a
cause for waxing and [**Doctor Last Name 688**] responsiveness, which was negative.
His mental status kept improving throughout his hostpital stay.
By HD 14 he was able to be transferred to the floor.

Cardiovascular: HTN, controlled with metoprolol 20 mg Q4H,
clonidine patch 0.2mg and enalapril. Had 3 episodes of SVT which
resolved with adenosine and carotid massage. He remained stable
from the cardiovascular point of view for the rest of his
hospital stay.

Pulmonary: on HD3 the patient's O2 requirements increased and a
CXR showed small lung volumes and b/l pleural effusions which
remained unchanged on his f/u CXR on HD5. ABG showed mixed
respiratory/metabolic acidosis. His pulmonary function
subsequently improved and he was weaned off O2.

GI/Abdomen: the patient was made NPO with strict bowel rest. TPN
was started on HD4. The patient experienced diarrhea and stool
Cx were sent and came back negative for O/P and C.diff. A RUQ US
was performed on HD3 and was negative for cholecystitis.
CT scan on HD9 showed: "Interval new non-occlusive thrombus in
the main portal vein, and splenic vein". The patient was
therefore started on a heparin drip.

Nutrition: the patient was made NPO with strict bowel rest. Diet
was advanced when the patient's mental status cleared and his
abdominal pain subsided.

Renal: a foley was placed on HD1 to allow monitoring of urine
output. Required D5W boluses to maintain normonatremia. His
foley was d/c'd on HD12 and the patient was able to void.

Endocrine: Type II DM at baseline, was put on ISS [**First Name8 (NamePattern2) **] [**Last Name (un) **]
recs.

ID: developed bandemia and fever on HD6, BCx were sent,
meropenem was started. On HD8 vanc/cipro/zosyn were started for
HAP. His BCx were repeatedly negative.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient was discharged home with VNA for INR
and BG monitoring. A follow up appointment with his PCP was
scheduled for INR check and coumadin dosing. He will follow up
with Dr. [**Last Name (STitle) **] in 2 weeks. The patient is currently beeing
followed by [**Last Name (un) **] for DM management. The patient received
discharge teaching and follow-up instructions with understanding
verbalized and agreement with the discharge plan.



Medications on Admission:
Lisinopril 2.5mg, glipizide 2.5mg, metformin 1000mg
[**Hospital1 **]


Discharge Medications:
1. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
3. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4
PM.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
necrotizing pancreatitis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**3-30**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.


Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 81268**] (Nurse for Dr. [**Last Name (STitle) 28261**] on
[**2189-6-29**] at 09:00 am.
.
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2189-7-10**] 9:45
.
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2832**], MD Phone:[**Telephone/Fax (1) 1231**] Date/Time: [**2189-7-10**]
11:15
.
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2190-2-19**] 10:00
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2832**], MD Phone:[**Telephone/Fax (1) 1231**]
Date/Time:[**2190-2-19**] 11:00 [**Hospital Ward Name 23**] 3, [**Hospital Ward Name **]



Completed by:[**2189-6-25**]
{'Acute pancreatitis,Portal vein thrombosis,Pneumonia, organism unspecified,Alcohol withdrawal delirium,Unspecified pleural effusion,Mixed acid-base balance disorder,Other pulmonary insufficiency, not elsewhere classified,Paroxysmal supraventricular tachycardia,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign essential hypertension,Fever, unspecified,Bandemia,Alcohol abuse, unspecified,Personal history of malignant melanoma of skin'}


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, nausea and vomiting

PRESENT ILLNESS: 56 y/o male presents with epigastric abdominal pain.  Sharp,
constant, [**6-30**] severity.  Associated with nausea and vomiting.
Had just had a yogurt prior to episode but does not attribute to
postprandial pain.  Has not attempted PO since then but feels
thirsty.  No diarrhea or constipation.  No fevers or
chills.  Just completed course of antibiotics for bronchitis.

MEDICAL HISTORY: Prior episode pancreatitis- admitted to OSH ~1yr prior
Hematoma/mass in head of pancreas- size decreeased at last
imaging.\
-DMII, dx [**2187-10-22**]
-Low back pain with an L5 herniated disc.
-History of melanoma, with subsequent follow-up with no
recurrence.

MEDICATION ON ADMISSION: Lisinopril 2.5mg, glipizide 2.5mg, metformin 1000mg
[**Hospital1 **]

ALLERGIES: Bactrim

PHYSICAL EXAM: GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: +BS, soft, non tender, non distended, no palbable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: no biliary or pancreatic disease

SOCIAL HISTORY: He works with a software business company.  He lives at home
with his children.  He does not smoke, and drinks occasionally
five to six glasses of alcohol a week.  He denies any history of
IV drug abuse. 

### Response:
{'Acute pancreatitis,Portal vein thrombosis,Pneumonia, organism unspecified,Alcohol withdrawal delirium,Unspecified pleural effusion,Mixed acid-base balance disorder,Other pulmonary insufficiency, not elsewhere classified,Paroxysmal supraventricular tachycardia,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign essential hypertension,Fever, unspecified,Bandemia,Alcohol abuse, unspecified,Personal history of malignant melanoma of skin'}
