CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 42 yo male inmate who presents with LUQ/LLQ abdominal pain on
transfer from
[**Hospital **] Hospital with scan showing ungraded splenic laceration.
He is s/p unspecified abdominal trauma to Left side during
"running game" in the prison yard two days ago ([**2-20**]).  HCT at
[**Hospital1 **] 29.

MEDICAL HISTORY: Type II DM (diet controlled)
Cirrhosis, Hepatitis C

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on Admission:
Tc 100.7 HR 84 BP 143/64 RR 22 Sats 100% RA
GEN: WDWN M in NAD
HEENT: PERRLA
CV: RRR, no murmurs, rubs or gallops
RESP: CTAB
GI/ABD: soft, slightly distended
Ext: no cyanosis, clubbing or edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: 
Injury to spleen with open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Disruption of external operation (surgical) wound,Pneumonitis due to inhalation of food or vomitus,Unspecified viral hepatitis C with hepatic coma,Portal hypertension,Cirrhosis of liver without mention of alcohol,Other and unspecified coagulation defects,Epistaxis,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Acute respiratory failure,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Unarmed fight or brawl,Accidents occurring in residential institution,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Spleen parnchym lac-opn,Peritoneum injury-closed,Disrup-external op wound,Food/vomit pneumonitis,Hpt C w hepatic coma NOS,Portal hypertension,Cirrhosis of liver NOS,Coagulat defect NEC/NOS,Epistaxis,Hyposmolality,Pressure ulcer, low back,Acute respiratry failure,Surg compl-heart,Tachycardia NOS,Unarmed fight or brawl,Accid in resident instit,Enterococcus group d,Oliguria & anuria,DMII wo cmp nt st uncntr
Admission Date:  [**2191-2-22**]              Discharge Date:   [**2191-4-12**]

Date of Birth:  [**2148-10-29**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
[**2191-2-23**] Splenectomy
[**2191-3-9**] PICC placement


History of Present Illness:
42 yo male inmate who presents with LUQ/LLQ abdominal pain on
transfer from
[**Hospital **] Hospital with scan showing ungraded splenic laceration.
He is s/p unspecified abdominal trauma to Left side during
"running game" in the prison yard two days ago ([**2-20**]).  HCT at
[**Hospital1 **] 29.


Past Medical History:
Type II DM (diet controlled)
Cirrhosis, Hepatitis C

Family History:
Noncontributory

Physical Exam:
Exam on Admission:
Tc 100.7 HR 84 BP 143/64 RR 22 Sats 100% RA
GEN: WDWN M in NAD
HEENT: PERRLA
CV: RRR, no murmurs, rubs or gallops
RESP: CTAB
GI/ABD: soft, slightly distended
Ext: no cyanosis, clubbing or edema

Exam on discharge:
GEN: WD, thin M w/ no movement
HEENT: icteric sclera, pupils fixed at 6mm, nonreactive, blood
dripping from nose, excoriated lips with dried blood present
CV: no rhythm, no radial pulses, no brachial pulse, no carotid
pulse
RESP: no respirations, no breath sounds, no respiratory effort
Skin: grossly jaundiced

Pertinent Results:
[**2191-2-22**] 07:50PM   GLUCOSE-96 UREA N-8 CREAT-0.8 SODIUM-136
POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-23 ANION GAP-13
[**2191-2-22**] 07:50PM   AST(SGOT)-129*
[**2191-2-22**] 07:50PM   WBC-5.9 RBC-3.00* HGB-9.3* HCT-29.2* MCV-97
MCH-30.8 MCHC-31.7 RDW-13.4
[**2191-2-22**] 07:50PM   PLT SMR-VERY LOW PLT COUNT-81*

[**2-22**] CTA ABD: There is mild dependent atelectasis, (left greater
than right). A left pleural effusion is minute. A hiatal hernia
is small.

There is a complex splenic laceration, which traverses the
spleen at multiple sites. There are also multiple sites of
devascularized parenchyma, which comprise less than 25% of the
total splenic volume. In the arterial phase of enhancement,
there is an 8-mm contrast collection in the parenchyma, which is
contiguous with a splenic artery branch in the hilum (3A, 39).
There is a second 3- mm focus in the anterior superior spleen
(3A, 25), which is surrounded by more ill defined high
attenuation in the arterial phase. These focal collections are
suggestive of pseudoaneurysms, as they do not increase in size
and in fact become less conspicuous on delayed phases. The
hyperattenuation surrounding the smaller focus is suggestive of
active contrast extravasation. The spleen is enlarged at 16.2
cm. There is a heterogeneously hyperattenuating capsular
hematoma, which measures 33 mm in thickness. There is moderate
hemoperitoneum, particularly in the pelvis.
The liver, pancreas, adrenal glands, and kidneys are within
normal limits. There are multiple mildly enlarged periportal,
portacaval, celiac and retroperitoneal nodes, which measure up
to 13 mm in short axis and may be reactive. Gallstones are
present. There is no bowel dilatation or free intraperitoneal
air.
The osseous structures are intact.
IMPRESSION:
1. Complex splenic laceration (grade III/IV) with two
pseudoaneurysms, the smaller of which appears to be associated
with active extravasation. There is a moderate splenic capsular
hematoma and associated hemoperitoneum.

[**2-23**] Liver biopsy: 1. Advanced fibrosis with bridging, sinusoidal
fibrosis and multifocal early nodule formation, suspicious for
evolving cirrhosis (stage 3-4, confirmed by trichrome stain).
2. Mild-to-moderate portal septal, mild periportal and lobular
predominantly mononuclear cell inflammation (grade 2).
3. Mild cholestasis.
4. No significant steatosis or intracellular hyalin seen.
5. Iron stain shows mild focal iron deposition in hepatocytes
and Kupffer cells.
Note: The findings are consistent with chronic viral hepatitis,
clinically HCV. The sinusoidal fibrosis is suggestive of a
component of prior toxic/metabolic injury.

[**3-2**] CT head: Normal head CT without evidence of brain edema
[**3-2**] Abd US: The liver shows no focal or textural abnormalities.
The gallbladder contains sludge and shows wall edema. No intra
or extrahepatic biliary dilatation is appreciated. The common
duct measures 4 mm. The portal vein is patent with hepatopetal
flow. Small amount of ascites is present. The pancreas is poorly
visualized. The patient is status post splenectomy.

[**3-3**] CT Abd/pelvis:  Status post splenectomy with small amount
of fluid remaining in the abdomen, but no evidence of abscess or
recurrence of hematoma.  New bibasilar pulmonary parenchymal
opacities could reflect pulmonary edema/ARDS, aspiration or
pneumonia. Correlation is recommended.
Diffuse mild dilation of small bowel, most likely representing
ileus.
Decreased size of a small rim-enhancing collection in the right
lower quadrant, which could reflect appendiceal pathology
including improving tip appendicitis. However, there is a
question of coloenteric fistula and therefore repeat CT with
contrast is recommended when symptoms have resolved.

[**3-10**] Abd US: No significant interval change in the appearance of
gallbladder. Although these findings may be related to
hypoalbuminemia and prolonged NPO status, acute cholecystitis
cannot be excluded.  Right pleural effusion.


Brief Hospital Course:
He was admitted to the Trauma service on [**2-22**]. He was taken to
the Trauma ICU for close monitoring. His hematocrit was followed
closely; he continued to have left shoulder pain and
tachycardia; concerning for hemorrhage. He was taken to the
operating room for splenectomy on [**2-23**]. There were no
intraoperative complications. Postoperatively his tachycardia
persisted; he also had a low urinary output. He was given
intravenous fluid bolus with increased urine output. He required
supplemental oxygen because of low oxygen saturations; incentive
spirometer use was strongly encouraged.  On post operative day 1
([**2-24**]) he was transfused 1 unit pRBC and transferred to the
floor.  On [**2-25**] he was again transfused for a low hematocrit.  On
post op day 3, he developed increasing somnolence and he was
started on lactulose, his narcotics were discontinued and
hepatology was consulted.  An ammonia level was 71 and he
continued to have low urine output.  He was started on rifaximin
and albumin.  On [**2-27**] his mental status worsened, he had
vomiting and his abdominal wound dehisced with an ascitic leak.
He was transferred back to the trauma ICU for further care.  He
was started on tube feeds for nutrition.  A VAC dressing was
placed in the abdominal wound.  He was intubated for worsening
mental status and airway protection on [**2-28**].  1 of 2 blood
cultures drawn on [**3-1**] returned as positive for vancomycin
sensitive enterococcus and he was started on Vancomycin and
Zosyn on [**3-2**], which was continued for 10 days.  He had a normal
head CT and a RUQ ultrasound which showed a sludge filled
gallbladder and no stones.  He continued to have an ascitic
leak, and his bloodwork results were followed closely for
increasing bilirubin, creatinine peak of 2.4, moderately
increased LFTs and pancreatic enzymes, elevated INR (peak of
1.9) and increased ammonia levels.  He was extubated on [**3-8**] and
his mental status improved.  His bilirubin remained elevated,
his ammonia level decreased and his creatinine returned to
baseline.  He was awake and alert and was able to be transferred
to the floor on [**3-11**] and was started on a regular diet on [**3-12**].
He continued to have an ascitic leak and his vac was changed
every 3 days on the floor.  His INR and bilirubin continued to
increase. In discussions with MDs regarding his overall poor
prognosis, he clarified that he still preferred aggressive
treatment unless he was dying of irreversible liver failure.
Psychiatry evaluated him and determined that he was currently
competent to make this decision despite any underlying
encephalopathic process. He was evaluated and treated by
physical therapy.  A repeat CT abdomen on [**3-19**] showed slight
increase in the free fluid in the pelvis, decreased left
subphrenic collection and improvement in the bibasilar
aspiration and pneumonia of the lung fields. A chest xray on
[**4-1**] showed marked improvement in widespread pulmonary opacities
with no definite new abnormalities to suggest acute pneumonia.
Mr. [**Known lastname **] was made DNR/DNI per Dr. [**Last Name (STitle) **] on [**3-29**]. On the
evening of [**4-11**] the patient had blood pressures that dropped
into the 80s/50s while resting in a chair. He was found to have
electrolytes that were very irregular on the evening of [**4-11**].
Mr. [**Known lastname **] started to have agonal breathing later that evening,
and started bleeding persistently from his nose and mouth. On
the morning of [**4-12**] the patient appeared in distress with
agonal, noisy wet sounding breaths. The patient was made CMO by
Dr. [**Last Name (STitle) **] on [**4-12**]. Mr. [**Known lastname **] died secondary to respiratory
failure on [**4-12**] at 1:09PM.

Neuro: The patient was started on a narcotic pain regimen upon
admission to the trauma service. He was weaned off of the
narcotics on [**2-25**]. His mental status was noted to be worsened on
[**2-27**]. Between the dates of [**2-27**] and [**4-10**], his mental status has
waxed and waned persistently. On [**4-11**] his mental status
deteriorated profoundly to the point where the patient was
nonverbal and only moved his head in response to other people's
voices. On [**4-12**] the patient became unresponsive to others in the
room. He was put on a morphine drip which was titrated for
comfort.

HEENT: The patient had intermittent nose bleeds during his
hospitalization. An ENT consult was placed on [**3-29**] for
persistent nose bleeds. Absorbable packing was placed
intranasally which controlled the bleeding for some time. On
[**3-31**] ENT was reconsulted because the patient started bleeding
from the nose again and the bleeding vessel was identified and
cauterized. Nonabsorbable packing was placed intranasally and
antibiotics were started at that time. His packing was removed 5
days later and he did not have another nose bleed at that time.

CV: The patient had no problems with his cardiovascular status
during his hospitalization.

RESP: The patient had low oxygen saturations postoperatively. He
was extubated on [**3-8**]. He was weaned off of supplemental oxygen
when he was transferred to the floor on [**3-11**]. He developed
agonal breathing on [**4-11**] due to his worsening encephalopathy and
persistent, uncontrolled bleeding.

GI: The patient was started on lansoprazole on [**3-11**] for GI
prophylaxis. He was also started on lactulose for his chronic
hepatic failure. On admission his liver function panel had some
slightly elevated values. His ALT was 89 , AST [**Last Name (un) **] 175, T bili
3.1 D bili 1.8 Alb 2.4. His liver function panel on [**4-9**] had an
AST 342, ALT 140, T bili 28 D bili 15.4. A hepatology consult
was called on [**2-26**] and it was suggested that he be started on
rifamixin. On [**3-11**] hepatology agreed with continuing his
rifamixin and albumin replacement for wound vac losses.

GU: The patient had no problems with this system during his
hospitalization.

FEN: The patient was started on a regular diet on [**3-12**]. He was
tolerating a regular diet until [**4-10**] when he started having less
of an appetite. Mr. [**Known lastname 17391**] electrolytes were monitored every
third day showing a persistent hyponatremia starting on [**3-13**].
His BUN had a bimodal distribution of elevation first peaking at
45 on [**3-6**] and then peaking again at 97 on [**4-11**]. His potassium
peaked at 5.5 on [**2-24**] but then returned to [**Location 213**] only to peak
again on [**4-11**] to 7.0. His creatinine initially peaked at 2.4 on
[**3-5**] and then returned to [**Location 213**] levels until he peaked on [**4-11**]
to 6.9.

HEME: Mr. [**Known lastname 17391**] admitting coagulation profile was PT 14.7 INR
1.3 PTT 31.3. His admitting hematocrit was 29.2 and platelets
were 81. Postoperatively, the patient received 2units of packed
red blood cells for a hematocrit of 23.9. On [**3-29**], he received a
unit of FFP and a unit of packed red blood cells. His last
hematocrit on [**4-9**] was 27.1.

ID: The patient had [**1-19**] positive blood cultures on [**3-1**] for
vancomycin sensitive enterococcus. He also had a positive sputum
culture on [**3-1**] which grew haemophilus influenza. He was started
on vancomycin and zosyn on [**3-2**] for the positive cultures. The
antibiotics were stopped on [**3-9**]. Mr. [**Known lastname **] was started on
Augmentin on [**4-1**] for prophylaxis against gram positive microbes
while he had nasal packing in place. It was discontinued on
[**4-5**]. The patient had a history of viral hepatitis.

Discharge Disposition:
Expired

Discharge Diagnosis:
s/p Assault
Grade III/IV splenic laceartion
s/p splenectomy
hepatic encephalopathy
respiratory failure
multi organ system failure
chronic hepatitis C


Discharge Condition:
deceased


Followup Instructions:
N/A
{'Injury to spleen with open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Disruption of external operation (surgical) wound,Pneumonitis due to inhalation of food or vomitus,Unspecified viral hepatitis C with hepatic coma,Portal hypertension,Cirrhosis of liver without mention of alcohol,Other and unspecified coagulation defects,Epistaxis,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Acute respiratory failure,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Unarmed fight or brawl,Accidents occurring in residential institution,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 42 yo male inmate who presents with LUQ/LLQ abdominal pain on
transfer from
[**Hospital **] Hospital with scan showing ungraded splenic laceration.
He is s/p unspecified abdominal trauma to Left side during
"running game" in the prison yard two days ago ([**2-20**]).  HCT at
[**Hospital1 **] 29.

MEDICAL HISTORY: Type II DM (diet controlled)
Cirrhosis, Hepatitis C

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on Admission:
Tc 100.7 HR 84 BP 143/64 RR 22 Sats 100% RA
GEN: WDWN M in NAD
HEENT: PERRLA
CV: RRR, no murmurs, rubs or gallops
RESP: CTAB
GI/ABD: soft, slightly distended
Ext: no cyanosis, clubbing or edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY:  

### Response:
{'Injury to spleen with open wound into cavity, laceration extending into parenchyma,Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Disruption of external operation (surgical) wound,Pneumonitis due to inhalation of food or vomitus,Unspecified viral hepatitis C with hepatic coma,Portal hypertension,Cirrhosis of liver without mention of alcohol,Other and unspecified coagulation defects,Epistaxis,Hyposmolality and/or hyponatremia,Pressure ulcer, lower back,Acute respiratory failure,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Unarmed fight or brawl,Accidents occurring in residential institution,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Oliguria and anuria,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
