CHIEF COMPLAINT: chest pain from known hiatal hernia, gastroesophageal reflux,
morbid obestity

PRESENT ILLNESS: The patient is a 54-year-old woman who complained of attacks of
chest pain from known hiatal hernia.  She presented to Dr. [**Last Name (STitle) **]
having had a number of outside evaluations including endoscopy
demonstrating a large hiatal hernia as well as a barium swallow
showing a large 58% or greater of her stomach above the
diaphragm at risk obviously for gastric volvulus.  She initially
planned to undergo a gastric bypass, but elected to have a
laparoscopic adjustable band placed instead, as well as a
cholecystecomy and repair of hiatal hernia.

MEDICAL HISTORY: The patient's past medical history includes gastroesophageal
reflux disease, asthma, morbid obesity, type III hiatal hernia,
hypertension, obstructive sleep apnea, irritable bowel, back
pain
with fracture, rotator cuff, chronic fatigue, and fibromyalgia.

MEDICATION ON ADMISSION: Hydrochlorothiazide/Triamterene 37.5mg/25mg, Protonix 40mg
daily, Advair 250mcg/50 mcg daily, Singulari 10mg daily,
Flovent, Flonase, Nasonex, [**Doctor First Name **] 60mg daily, Migquin
65mg-325mg-100mg daily, Gabapentin 100mg daily, Nortriptyline
20mg qhs, Lexapro 15mg daily, Concerta 18mg dialy, Clonazepam
2mg qhs, Restasis, Systane and Lotemax ophthalmologic drops,
Vitamin A palmitate 100,000 units 1.5 tablets dialy for
retinitis pigmentosa, acetaminophen, tums, Mylanta, OTC Prilosec
prn

ALLERGIES: Cephalosporins / Penicillins / Erythromycin Base / Shellfish /
Sesame Oil

PHYSICAL EXAM: (pre-operatively as per Dr. [**Last Name (STitle) **]
On physical exam, weight is 207 pounds with BMI of 37.1.  She is
in no acute distress.  She is alert and oriented.  Neck is
supple.  Breathing comfortably with decreased breath sounds
probably related to thoracic aspect of her hiatal hernia.  Heart
is regular with no murmurs.  Abdomen is soft, nontender, no
rebound or guarding and infraumbilical scar.  Upper and lower
extremities:  Adequate range of motion and strength.  Skin
without rashes.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient denies tobacco or alchohol use and is a homemaker.
Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Body Mass Index 37.0-37.9, adult,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Other iatrogenic hypotension,Unspecified sleep apnea
Morbid obesity,Cholelith w cholecys NEC,BMI 37.0-37.9,adult,Diaphragmatic hernia,Esophageal reflux,Iatrogenc hypotnsion NEC,Sleep apnea NOS
Admission Date:  [**2126-8-13**]              Discharge Date:   [**2126-8-19**]

Date of Birth:  [**2072-5-3**]             Sex:   F

Service: SURGERY

Allergies:
Cephalosporins / Penicillins / Erythromycin Base / Shellfish /
Sesame Oil

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
chest pain from known hiatal hernia, gastroesophageal reflux,
morbid obestity

Major Surgical or Invasive Procedure:
1. Repair of diaphragmatic hernia
2. Laparoscopic adjustable band
3. Open cholecystectomy


History of Present Illness:
The patient is a 54-year-old woman who complained of attacks of
chest pain from known hiatal hernia.  She presented to Dr. [**Last Name (STitle) **]
having had a number of outside evaluations including endoscopy
demonstrating a large hiatal hernia as well as a barium swallow
showing a large 58% or greater of her stomach above the
diaphragm at risk obviously for gastric volvulus.  She initially
planned to undergo a gastric bypass, but elected to have a
laparoscopic adjustable band placed instead, as well as a
cholecystecomy and repair of hiatal hernia.


Past Medical History:
The patient's past medical history includes gastroesophageal
reflux disease, asthma, morbid obesity, type III hiatal hernia,
hypertension, obstructive sleep apnea, irritable bowel, back
pain
with fracture, rotator cuff, chronic fatigue, and fibromyalgia.

She is status post tubal ligation and excision of fibroids.


Social History:
The patient denies tobacco or alchohol use and is a homemaker.

Family History:
non-contributory

Physical Exam:
(pre-operatively as per Dr. [**Last Name (STitle) **]
On physical exam, weight is 207 pounds with BMI of 37.1.  She is
in no acute distress.  She is alert and oriented.  Neck is
supple.  Breathing comfortably with decreased breath sounds
probably related to thoracic aspect of her hiatal hernia.  Heart
is regular with no murmurs.  Abdomen is soft, nontender, no
rebound or guarding and infraumbilical scar.  Upper and lower
extremities:  Adequate range of motion and strength.  Skin
without rashes.


Pertinent Results:
Hematocrit: 27.5 - 35.1

Electrolytes ([**8-17**]): Na 148, K 3.5, HCO3 29, Cl 107, UreaN 17,
Creat 0.7, Glucose 98, Ca 8.8, Phos 2.8, Mg 2.4

Liver Function ([**8-16**]): ALT 206, AST 116, Alk Phos 46, Amylase
103, Lipase 21, TBili 0.4, Dbili 0.1, Ibili 0.3

Radiology:
[**8-14**] Portable Chest X-Ray -
1.  NG tube in acceptable position.
2.  Bibasilar pneumonia and atelectasis.
3.  Pneumoperitoneum, likely related to recent surgical
procedure.

[**8-14**] Portable Chest X-Ray - increasing pulmonary vascular
congestion

[**8-15**] Portable Chest X-Ray - There is now dense confluent opacity
involving much of both hemithoraces, with overall appearance
suggestive of
combination of pulmonary edema and posteriorly-layering pleural
effusions; the heart size and pulmonary vessels are, therefore,
difficult to evaluate, and a contribution of pneumonic
consolidation cannot be excluded.  The tip of the nasogastric
tube is not well seen, and a circular gastric band overlies the
central aspect of the upper abdomen.  The overall appearance is
significantly worse since the earlier studies.

[**8-15**] Portable Chest X-Ray - Severe bibasilar atelectasis persists
following decrease in previously large bilateral pleural
effusion and pulmonary edema.

[**8-16**] Portable Chest X-Ray - The lung volumes remain very low with

unchanged left retrocardiac opacity most likely representing
atelectasis.
Small bilateral pleural effusion cannot be excluded.  No
evidence of pulmonary failure present.

[**8-18**] Portable Chest X-Ray - Lung volumes remain low minimally
increased from the recent study.  Bibasilar atelectasis is again
demonstrated as well as small bilateral pleural effusions.

[**8-15**] - Upper GI Study - Patient swallowed barium without
difficulty.  Barium passed freely into the stomach without signs
of obstruction or extravasation.  The gastric band is located
over the gastroesophageal junction in adequate position.

Pathology - Hernia Sac:
1.  Hiatal hernia:
    1.  Unremarkable fibroadipose tissue with smooth muscle,
vasculature, mesothelial lining.
    2.  Unremarkable lymphoid tissue.
2.  Gallbladder, cholecystectomy (B,C): Mild fibrosis of
gallbladder wall consistent with chronic cholecystitis.


Brief Hospital Course:
The patient underwent a hiatal hernia repair, placement of
gastric band and cholecystecomy on [**2126-8-13**] (see operative report
for full details).  As the patient was intermittently
hypotensive with manipulation of the stomach and reduction of
the stomach into the abdominal cavity, she was admitted to the
surgical ICU post-operatively.  She was seen by the acute pain
service and had an epidural catheter placed for post-operative
analgesia with continuous epidural infusion.  This was
discontinued on post-operative day #0 secondary to hypotension,
pain then controlled with PCA, normotensive with fluid
rescusitation.  Desaturated on non-rebreather mask on
post-operative day #0, was maintaied on CPAP, nebulizers.
Portable chest x-rays were obtained throughout post-operative
day #1 and #2 with low [**Last Name (un) 101518**] volumes, initial worsening and then
improvement in pulmonary congestion.  Received 10mg Lasix x 2 on
post-operative day #1.  The patient received peri-operative
Clindamycin for infection prophylaxis.  An upper GI study on
post-operative day #2 demonstrated no leakage.  The patient was
called out of the ICU to the floor on post-operative day #3.  On
post-operative day #3 she began a stage I diet, advanced to
stage II on post-operative day #4 and to stage III on
post-operative day #5.  The foley catheter and PCA were
discontinued on post-operative day #4 and the patient was
started on oral pain medications and hoem medications.  When
provided with a walker, the patient's oxygen saturation was
94-96% on room air, including on stairs.  She had a formal PT
evaluation on the day of discharge and went home with a walker
and a commode with a plan for PT to see her at home.  On
post-operative day #6 she was afebrile with stable vital signs,
pain was well controlled on oral pain medications and she was
tolerating a stage III bariatric diet.  She was dishcharged home
with follow up with Dr. [**Last Name (STitle) **].

Medications on Admission:
Hydrochlorothiazide/Triamterene 37.5mg/25mg, Protonix 40mg
daily, Advair 250mcg/50 mcg daily, Singulari 10mg daily,
Flovent, Flonase, Nasonex, [**Doctor First Name **] 60mg daily, Migquin
65mg-325mg-100mg daily, Gabapentin 100mg daily, Nortriptyline
20mg qhs, Lexapro 15mg daily, Concerta 18mg dialy, Clonazepam
2mg qhs, Restasis, Systane and Lotemax ophthalmologic drops,
Vitamin A palmitate 100,000 units 1.5 tablets dialy for
retinitis pigmentosa, acetaminophen, tums, Mylanta, OTC Prilosec
prn

Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device [**Doctor First Name **]:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Albuterol 90 mcg/Actuation Aerosol [**Hospital1 **]: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
3. Cyclosporine 0.05 % Dropperette [**Hospital1 **]: One (1) Dropperette
Ophthalmic 2x qday ().
4. Lotemax  Ophthalmic
5. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette [**Hospital1 **]: [**12-11**]
Drops Ophthalmic Q2-4H (every 2 to 4 hours) as needed for dry
eyes.
6. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Month/Day (2) **]: 5-10 MLs
PO Q4H (every 4 hours) as needed.
Disp:*350 ML(s)* Refills:*2*
7. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (2) **]: Ten (10) mL PO BID (2
times a day) as needed for constipation.
Disp:*500 mL* Refills:*2*
8. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily) as needed for GERD.
Disp:*30 Tablet,Rapid Dissolve, DR(s)* Refills:*5*
9. shower bench


Discharge Disposition:
Home With Service

Facility:
Caregroup VNA

Discharge Diagnosis:
Hiatal hernia, cholelithiasis, gastroesophageal reflux, morbid
obesity


Discharge Condition:
stable


Discharge Instructions:
Discharge Instructions: Please call your surgeon or return to
the emergency department if you develop a fever greater than
101.5, chest pain, shortness of breath, severe abdominal pain,
pain unrelieved by your pain medication, severe nausea or
vomiting, severe abdominal bloating, inability to eat or drink,
foul smelling or colorful drainage from your incisions, redness
or swelling around your incisions, or any other symptoms which
are concerning to you.

Diet:
Stay in Stage III diet until your follow up appointment. Do not
self advance diet, do not drink out of a straw or chew gum.

Medication Instructions:
Resume your home medications, CRUSH ALL PILLS.

You will be starting some new medications:
1.  You will be given a prescription for pain medication, which
may make you drowsy. Do not drive while taking pain medication.
2. You should begin taking a Flintstones chewable complete
multivitamin. No gummy vitamins.
3. You should take a stool softener, Colace, twice daily for
constipation as needed, or until you resume a normal bowel
pattern.

Activity:
No heavy lifting of items [**9-23**] pounds for 6 weeks. You may
resume moderate exercise at your discretion, no abdominal
exercises.

Wound Care:
You may shower, no tub baths or swimming. If there is clear
drainage from your incisions, cover with clean, dry gauze. Leave
white strips above your incisions in place, allow them to fall
off on their own.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2126-8-28**] 10:15
Provider: [**Name10 (NameIs) **] [**Doctor Last Name 28352**], RD,LDN Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2126-8-28**] 11:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4853**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2126-10-2**] 11:15
{'Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Body Mass Index 37.0-37.9, adult,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Other iatrogenic hypotension,Unspecified sleep apnea'}


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: chest pain from known hiatal hernia, gastroesophageal reflux,
morbid obestity

PRESENT ILLNESS: The patient is a 54-year-old woman who complained of attacks of
chest pain from known hiatal hernia.  She presented to Dr. [**Last Name (STitle) **]
having had a number of outside evaluations including endoscopy
demonstrating a large hiatal hernia as well as a barium swallow
showing a large 58% or greater of her stomach above the
diaphragm at risk obviously for gastric volvulus.  She initially
planned to undergo a gastric bypass, but elected to have a
laparoscopic adjustable band placed instead, as well as a
cholecystecomy and repair of hiatal hernia.

MEDICAL HISTORY: The patient's past medical history includes gastroesophageal
reflux disease, asthma, morbid obesity, type III hiatal hernia,
hypertension, obstructive sleep apnea, irritable bowel, back
pain
with fracture, rotator cuff, chronic fatigue, and fibromyalgia.

MEDICATION ON ADMISSION: Hydrochlorothiazide/Triamterene 37.5mg/25mg, Protonix 40mg
daily, Advair 250mcg/50 mcg daily, Singulari 10mg daily,
Flovent, Flonase, Nasonex, [**Doctor First Name **] 60mg daily, Migquin
65mg-325mg-100mg daily, Gabapentin 100mg daily, Nortriptyline
20mg qhs, Lexapro 15mg daily, Concerta 18mg dialy, Clonazepam
2mg qhs, Restasis, Systane and Lotemax ophthalmologic drops,
Vitamin A palmitate 100,000 units 1.5 tablets dialy for
retinitis pigmentosa, acetaminophen, tums, Mylanta, OTC Prilosec
prn

ALLERGIES: Cephalosporins / Penicillins / Erythromycin Base / Shellfish /
Sesame Oil

PHYSICAL EXAM: (pre-operatively as per Dr. [**Last Name (STitle) **]
On physical exam, weight is 207 pounds with BMI of 37.1.  She is
in no acute distress.  She is alert and oriented.  Neck is
supple.  Breathing comfortably with decreased breath sounds
probably related to thoracic aspect of her hiatal hernia.  Heart
is regular with no murmurs.  Abdomen is soft, nontender, no
rebound or guarding and infraumbilical scar.  Upper and lower
extremities:  Adequate range of motion and strength.  Skin
without rashes.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient denies tobacco or alchohol use and is a homemaker. 

### Response:
{'Morbid obesity,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Body Mass Index 37.0-37.9, adult,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Other iatrogenic hypotension,Unspecified sleep apnea'}
