CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 83 year old male who presented to the [**Hospital1 18**] w/ ECG changes and
hypotension and was admitted to rule out MI.

MEDICAL HISTORY: CAD sp IMI [**2163**]
sp cardiac cath [**4-21**]: EF 35%, 2VD
Atrial fibrillation
CHF
h/o complete heart block s/p pace maker placement [**2163**]
COPD
OA
h/o AAA 4.5 cm
diverticulosis
h/o GI bleed [**2170**]
sp Right colectomy
[**Last Name (un) 1724**]: ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor
20qd, percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]

MEDICATION ON ADMISSION: ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor 20qd,
percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Admission PE:
PE: T HR 77 BP 90/44 RR 24 90%3Lnc
GEN: alert, conversive, in pain, thin
HEENT: PERRL, anicteric, OP clear, MM dry
Neck: supple, JVP nondistended
CV: irreg irreg, no mrg
Resp: trace crackles R>L
Abd: decreased BS, firm, ttp BLQ with guarding.
erythematous crusting rash over RUQ and flank
Ext: no edema, 1+ DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, MAEW

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use.
Acute vascular insufficiency of intestine,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Iatrogenic pneumothorax,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Congestive heart failure, unspecified,Herpes zoster with other specified complications,Dehydration,Pneumonia, organism unspecified,Sinoatrial node dysfunction,Disruption of external operation (surgical) wound,Anemia of other chronic disease,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of malignant neoplasm of bladder,Cardiac pacemaker in situ
Ac vasc insuff intestine,Acute kidney failure NOS,Chr airway obstruct NEC,Iatrogenic pneumothorax,Acute respiratry failure,Gastrointest hemorr NOS,CHF NOS,H zoster complicated NEC,Dehydration,Pneumonia, organism NOS,Sinoatrial node dysfunct,Disrup-external op wound,Anemia-other chronic dis,Hypotension NOS,Crnry athrscl natve vssl,Old myocardial infarct,Hx of bladder malignancy,Status cardiac pacemaker
Admission Date:  [**2172-8-11**]              Discharge Date:   [**2172-9-1**]


Service: SURGERY

Allergies:
Ace Inhibitors

Attending:[**Doctor First Name 5188**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
sp Exploratory Laparotomy, small bowel resection x 80cm for
ischemic enteritis [**8-14**]
sp Exploratory Laparotomy, closure of abdominal wall [**8-15**]
sp tracheostomy
sp retention suture placement for facial defect [**8-26**]

History of Present Illness:
83 year old male who presented to the [**Hospital1 18**] w/ ECG changes and
hypotension and was admitted to rule out MI.

Past Medical History:
CAD sp IMI [**2163**]
sp cardiac cath [**4-21**]: EF 35%, 2VD
Atrial fibrillation
CHF
h/o complete heart block s/p pace maker placement [**2163**]
COPD
OA
h/o AAA 4.5 cm
diverticulosis
h/o GI bleed [**2170**]
sp Right colectomy
[**Last Name (un) 1724**]: ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor
20qd, percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]



Social History:
Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use.


Family History:
Non-contributory

Physical Exam:
Admission PE:
PE: T HR 77 BP 90/44 RR 24 90%3Lnc
GEN: alert, conversive, in pain, thin
HEENT: PERRL, anicteric, OP clear, MM dry
Neck: supple, JVP nondistended
CV: irreg irreg, no mrg
Resp: trace crackles R>L
Abd: decreased BS, firm, ttp BLQ with guarding.
erythematous crusting rash over RUQ and flank
Ext: no edema, 1+ DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, MAEW


Pertinent Results:
[**2172-8-10**] 06:30PM BLOOD WBC-8.1# RBC-3.42* Hgb-11.1* Hct-32.7*
MCV-96 MCH-32.6* MCHC-34.0 RDW-13.9 Plt Ct-249
[**2172-8-14**] 07:29AM BLOOD WBC-4.0 RBC-3.40* Hgb-10.8* Hct-31.2*
MCV-92 MCH-31.8 MCHC-34.6 RDW-17.6* Plt Ct-180
[**2172-8-14**] 06:37PM BLOOD WBC-6.2 RBC-2.95* Hgb-9.4* Hct-26.4*
MCV-90 MCH-31.7 MCHC-35.4* RDW-18.4* Plt Ct-138*
[**2172-8-16**] 02:22AM BLOOD WBC-9.4 RBC-2.51* Hgb-7.7* Hct-23.1*
MCV-92 MCH-30.8 MCHC-33.6 RDW-18.2* Plt Ct-105*
[**2172-8-17**] 02:22AM BLOOD WBC-14.9* RBC-3.32* Hgb-10.4* Hct-30.7*
MCV-92 MCH-31.2 MCHC-33.7 RDW-17.4* Plt Ct-104*
[**2172-8-19**] 03:20PM BLOOD Hct-22.4*
[**2172-8-22**] 01:54AM BLOOD WBC-12.4* RBC-2.36* Hgb-7.4* Hct-21.7*
MCV-92 MCH-31.4 MCHC-34.2 RDW-16.3* Plt Ct-132*
[**2172-8-23**] 07:21PM BLOOD Hct-27.1*
[**2172-8-27**] 02:48PM BLOOD Hct-21.0*
[**2172-8-28**] 02:01AM BLOOD WBC-7.7 RBC-2.80* Hgb-8.7* Hct-25.3*
MCV-91 MCH-31.1 MCHC-34.3 RDW-16.0* Plt Ct-207
[**2172-8-30**] 03:22AM BLOOD WBC-22.0*# RBC-3.38* Hgb-10.4* Hct-31.5*
MCV-93 MCH-30.7 MCHC-33.0 RDW-16.0* Plt Ct-255
[**2172-9-1**] 04:45AM BLOOD WBC-14.4* RBC-2.52* Hgb-7.7* Hct-24.1*
MCV-96 MCH-30.6 MCHC-32.0 RDW-16.3* Plt Ct-145*
[**2172-8-30**] 02:58PM BLOOD PT-14.8* PTT-69.5* INR(PT)-1.3*
[**2172-8-25**] 07:38PM BLOOD PT-14.0* PTT-32.0 INR(PT)-1.2*
[**2172-8-10**] 06:30PM BLOOD Glucose-109* UreaN-56* Creat-2.6* Na-135
K-5.5* Cl-95* HCO3-28 AnGap-18
[**2172-8-13**] 06:25AM BLOOD Glucose-70 UreaN-45* Creat-1.9* Na-140
K-5.0 Cl-103 HCO3-30 AnGap-12
[**2172-8-14**] 12:55AM BLOOD Glucose-126* UreaN-50* Creat-2.4* Na-140
K-4.2 Cl-105 HCO3-23 AnGap-16
[**2172-8-16**] 06:48PM BLOOD Glucose-106* UreaN-46* Creat-1.9* Na-135
K-4.4 Cl-107 HCO3-20* AnGap-12
[**2172-8-24**] 02:40AM BLOOD Glucose-99 UreaN-82* Creat-1.3* Na-141
K-4.2 Cl-112* HCO3-22 AnGap-11
[**2172-8-27**] 03:08AM BLOOD Glucose-123* UreaN-94* Creat-1.6* Na-140
K-4.2 Cl-106 HCO3-23 AnGap-15
[**2172-8-29**] 01:39AM BLOOD Glucose-135* UreaN-89* Creat-1.8* Na-138
K-4.7 Cl-106 HCO3-20* AnGap-17
[**2172-8-30**] 02:58PM BLOOD Glucose-154* UreaN-89* Creat-2.5* Na-132*
K-5.2* Cl-102 HCO3-17* AnGap-18
[**2172-9-1**] 04:45AM BLOOD Glucose-172* UreaN-93* Creat-3.0* Na-131*
K-5.4* Cl-102 HCO3-23 AnGap-11
[**2172-8-10**] 06:30PM BLOOD ALT-18 AST-27 CK(CPK)-38 AlkPhos-166*
Amylase-57 TotBili-0.6
[**2172-8-24**] 05:15PM BLOOD ALT-7 AST-13 AlkPhos-63 Amylase-72
TotBili-0.5
[**2172-8-10**] 06:30PM BLOOD CK-MB-NotDone cTropnT-0.02*
[**2172-8-11**] 12:37AM BLOOD cTropnT-0.01
[**2172-8-21**] 03:13AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2172-8-10**] 06:30PM BLOOD Calcium-9.0 Phos-3.8 Mg-3.2*
[**2172-9-1**] 04:45AM BLOOD Calcium-7.1* Phos-7.3* Mg-2.3
[**2172-8-11**] 12:37AM BLOOD calTIBC-153* Ferritn-727* TRF-118*
[**2172-8-24**] 02:40AM BLOOD calTIBC-57* TRF-44*
[**2172-8-31**] 03:05AM BLOOD calTIBC-46* Ferritn-GREATER TH TRF-35*
[**2172-8-31**] 02:12PM BLOOD Cortsol-29.3*
[**2172-8-31**] 03:28PM BLOOD Cortsol-35.0*
[**2172-8-14**] 05:44AM BLOOD Type-ART pO2-148* pCO2-41 pH-7.25*
calTCO2-19* Base XS--8
[**2172-8-14**] 03:58PM BLOOD Type-ART pO2-126* pCO2-39 pH-7.33*
calTCO2-21 Base XS--4
[**2172-8-17**] 11:07AM BLOOD Type-ART pO2-107* pCO2-39 pH-7.32*
calTCO2-21 Base XS--5
[**2172-8-30**] 03:21PM BLOOD Type-ART pO2-105 pCO2-42 pH-7.26*
calTCO2-20* Base XS--7
[**2172-8-31**] 02:22PM BLOOD Type-ART pO2-92 pCO2-45 pH-7.22*
calTCO2-19* Base XS--9
[**2172-9-1**] 05:09AM BLOOD Type-ART pO2-88 pCO2-47* pH-7.16*
calTCO2-18* Base XS--11
[**2172-9-1**] 08:00AM BLOOD Type-ART pO2-92 pCO2-44 pH-7.20*
calTCO2-18* Base XS--10
[**2172-8-10**] 06:35PM BLOOD Lactate-1.7
[**2172-8-14**] 06:29AM BLOOD Glucose-99 Lactate-6.0* Na-132* K-3.7
Cl-112
[**2172-8-15**] 02:22AM BLOOD Lactate-1.5
[**2172-8-20**] 05:01PM BLOOD Glucose-121* Lactate-0.8
[**2172-8-29**] 07:27AM BLOOD Lactate-2.3*
[**2172-8-30**] 09:31AM BLOOD Glucose-154* Lactate-2.4*
[**2172-9-1**] 10:23AM BLOOD Lactate-1.6
[**2172-8-18**] 09:18AM BLOOD HEPARIN DEPENDENT ANTIBODIES-

[**8-14**] CT Abd: Marked portal venous gas and pneumatosis within the
proximal small bowel and stomach consistent with ischemic bowel.
Given extensive vascular calcifications as well as history of
atrial fibrillation a likely etiology includes thromboembolic
disease.

[**8-15**] CXR: increased pneumothorax and increased subcutaneous air
[**8-16**] CXR: interval placement of a second left chest tube with
re-expansion of the left lung

[**8-28**] duplex B LE: thrombus identified in the great saphenous
vein continuing into the junction with the common femoral vein
and extending down to the mid portion of the right superficial
femoral vein

[**8-31**] CXR: Moderate-to-large right pleural effusion has
increased. Very small residual of left pneumothorax is seen at
the base of the left hemithorax with increasing
small-to-moderate left pleural effusion. Subcutaneous emphysema
in left chest wall has decreased since [**8-29**]. Mid level and
apical left pleural tubes are unchanged in their respective
positions. Progressive consolidation at the base of the left
lung could be atelectasis alone though pneumonia cannot be
excluded. Cardiac silhouette is substantially obscured by
adjacent pleura and parenchymal abnormality , but does not
appear appreciably changed. Increasing consolidation in the
right upper lung concerning for progressive pneumonia. Circular
lucency at the upper margin of this region is a subsumed bulla,
not a cavity.
Tracheostomy tube, right internal jugular line, right atrial and
right ventricular pacer leads are in standard placements.
Esophageal feeding and drainage tubes pass into the stomach and
out of view.


Brief Hospital Course:
83 year old male who presented to the [**Hospital1 18**] w/ ECG changes and
hypotension and was admitted to rule out MI.  During his
hospital course, he had hematemesis and increasing abdominal
pain.  A CT abdomen was obtained which showed small bowel
pneumotosis.  The pt was brought to the operating room for
exploratory laparotomy and an 8o cm segment of small bowel was
found to be ischemic.  The abdomen was left open and the pt was
brought back to the operating room the following day for a
"second look" procedure. Intraoperatively, the bowel appeared
viable with the exception of 1 cm of ischemia which was oversewn
with 3-0 silk.  Post-operatively, the pt developed respiratory
distress in the ICU and was found to have decreased breath
sounds on the Left side.  An emergent chest tube was placed X 2
with good result.  The pneumothorax was thought to be a result
of his COPD/positive pressure ventilation.

Hospital Course was remarkable for the following events:

Failure to wean ventilator sp tracheostomy

DVT: B duplex of lower extremities were obtained as a part of a
fever work up which revealed RLE DVT.  A heparin ggt was started
for a goal PTT of 60-80

Malnutrition-Albumin 1.5/TRF 144:
The pt was initially sustained on TPN and TF were started one
week post operatively via a Dobhoff feeding tube placed in the
jejunum.  The TPN was weaned off as the pt was tolerating tube
feeds.  When the pt became septic and hypotensive two weeks post
op, his tube feeds were held as he required multiple
vasopressors to sustain a MAP > 60.  At this time, TPN was
restarted.
Secondary to the pt's severe malnutrition and catabolic state,
the pt exhibited impaired wound healing which led to fascial
dehiscence mid wound for approximately 2 cm.  Ethicon wound
bridges were palced at the bedside on [**8-26**] to prevent
eviseration.

Sepsis/Hypotension:
The pt spiked a temperature to 101.5 and became massively
hypotensive requiring multiple vasopressors to sustain a mean
arterial pressure of 60.
Broad spectrum antibiotics were started.  CXR revealed a R
pneumonia which did not improve despite antibiotics.  Sputum
cultures grew pan sensitive Klebsiella.

Acute renal failure/anuria:
The pt's BUN and Creatine increased to 93/3.0 respectively.
Worsening renal failure led to volume overload, electrolyte
abnormalities and metabolic acidosis.

Due to the patient's comorbidies and worsening clinical
condition, a family meeting with the ICU Attending, social
worker and the patient's family was held on [**9-1**] and the a
decision to provide "comfort measures only" was made.  The pt
expired shortly after.


Medications on Admission:
ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor 20qd,
percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
ischemic bowel
pneumonia
atrial fibrillation
acute renal failure
wound dehiscence
CAD sp IMI [**2163**]/ sp cardiac cath [**4-21**]-EF 35%, 2VD
Complete heart block s/p pace maker placement
COPD
OA
AAA 4.5 cm
diverticulosis
PSH: R colectomy


Discharge Condition:
NA

Discharge Instructions:
NA

Followup Instructions:
NA

                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]

Completed by:[**2172-9-16**]
{'Acute vascular insufficiency of intestine,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Iatrogenic pneumothorax,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Congestive heart failure, unspecified,Herpes zoster with other specified complications,Dehydration,Pneumonia, organism unspecified,Sinoatrial node dysfunction,Disruption of external operation (surgical) wound,Anemia of other chronic disease,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of malignant neoplasm of bladder,Cardiac pacemaker in situ'}


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: 83 year old male who presented to the [**Hospital1 18**] w/ ECG changes and
hypotension and was admitted to rule out MI.

MEDICAL HISTORY: CAD sp IMI [**2163**]
sp cardiac cath [**4-21**]: EF 35%, 2VD
Atrial fibrillation
CHF
h/o complete heart block s/p pace maker placement [**2163**]
COPD
OA
h/o AAA 4.5 cm
diverticulosis
h/o GI bleed [**2170**]
sp Right colectomy
[**Last Name (un) 1724**]: ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor
20qd, percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]

MEDICATION ON ADMISSION: ASA 325qd, amio200qd, lasix 20qd, toprol xl 50qd, lipitor 20qd,
percocet prn, protonix 40qd, tums+vitD, feso4 [All: ACE-I]

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Admission PE:
PE: T HR 77 BP 90/44 RR 24 90%3Lnc
GEN: alert, conversive, in pain, thin
HEENT: PERRL, anicteric, OP clear, MM dry
Neck: supple, JVP nondistended
CV: irreg irreg, no mrg
Resp: trace crackles R>L
Abd: decreased BS, firm, ttp BLQ with guarding.
erythematous crusting rash over RUQ and flank
Ext: no edema, 1+ DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, MAEW

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use. 

### Response:
{'Acute vascular insufficiency of intestine,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Iatrogenic pneumothorax,Acute respiratory failure,Hemorrhage of gastrointestinal tract, unspecified,Congestive heart failure, unspecified,Herpes zoster with other specified complications,Dehydration,Pneumonia, organism unspecified,Sinoatrial node dysfunction,Disruption of external operation (surgical) wound,Anemia of other chronic disease,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Personal history of malignant neoplasm of bladder,Cardiac pacemaker in situ'}
