CHIEF COMPLAINT: abdominal pain w/HIDA suggestive of biliary leak

PRESENT ILLNESS: This 46-year-old gentleman is a patient well known to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
in our minimally invasive surgery group for morbid obesity. Dr.
[**Last Name (STitle) **] performed an open
gastric bypass via a Roux-en-Y technique a number of years ago.
Mr. [**Known lastname 18097**] also had a laparoscopic cholecystectomy performed
prior to this in the distant past. He presents recently with a
history of common bile duct stones. Given
his prior open Roux-en-Y bypass, this was unable to be addressed
through endoscopic retrograde cholangiopancreatography.
Therefore, he had a percutaneous
transhepatic cholangiography performed and during this, multiple
stones were removed from the bile duct via radiology technique.
His percutaneous tube remained in place until Friday, [**8-17**],
when Dr. [**Last Name (STitle) **] removed this in the office. There had been a
question of a distal stricture in the bile duct on the recent
PTC.

MEDICAL HISTORY: Morbid obesity.
Sleep apnea.
Hypertension.
Gastroesophageal reflux.
Osteoarthritis.
Lap chole [**2-6**]
Rou-en-Y bypass [**9-6**]
PTC placement for biliary sludge/stone [**7-8**]

MEDICATION ON ADMISSION: none

ALLERGIES: Unasyn

PHYSICAL EXAM: Vitals:
T 97.5 P78  BP148/80  R20  O2 96%RA
Gen: Large gentleman in no acute distress
Chest: clear to auscultation bilaterally
CV: regular rate and rhythm
Abd: soft, nondistended, obese, with mild RUQ tenderness, no
rebound, no guarding

FAMILY HISTORY: His father is alive with prostate cancer.  Mother with
congestive heart failure.

SOCIAL HISTORY: He continues to smoke about one pack per day for the last 20
years. He drinks alcohol for the last 20 years and has recently
drinks 2-3 beers/day. He denies any drug abuse.
Obstruction of bile duct,Incisional hernia without mention of obstruction or gangrene,Intestinal bypass or anastomosis status,Unspecified sleep apnea,Esophageal reflux,Unspecified essential hypertension
Obstruction of bile duct,Incisional hernia,Intestinal bypass status,Sleep apnea NOS,Esophageal reflux,Hypertension NOS
Admission Date:  [**2142-8-18**]              Discharge Date:   [**2142-8-27**]

Date of Birth:  [**2096-6-10**]             Sex:   M

Service: SURGERY

Allergies:
Unasyn

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
abdominal pain w/HIDA suggestive of biliary leak

Major Surgical or Invasive Procedure:
1. Exploratory laparotomy.
2. Exploration of retroperitoneum.
3. Exploration of common bile duct.
4. Cholangiogram with fluoroscopic guidance.
5. Choledochoduodenostomy.
6. Primary incisional hernia repair.


History of Present Illness:
This 46-year-old gentleman is a patient well known to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
in our minimally invasive surgery group for morbid obesity. Dr.
[**Last Name (STitle) **] performed an open
gastric bypass via a Roux-en-Y technique a number of years ago.
Mr. [**Known lastname 18097**] also had a laparoscopic cholecystectomy performed
prior to this in the distant past. He presents recently with a
history of common bile duct stones. Given
his prior open Roux-en-Y bypass, this was unable to be addressed
through endoscopic retrograde cholangiopancreatography.
Therefore, he had a percutaneous
transhepatic cholangiography performed and during this, multiple
stones were removed from the bile duct via radiology technique.
His percutaneous tube remained in place until Friday, [**8-17**],
when Dr. [**Last Name (STitle) **] removed this in the office. There had been a
question of a distal stricture in the bile duct on the recent
PTC.

Mr. [**Known lastname 18097**] [**Last Name (Titles) **] and over the ensuing 3 days was admitted
to the hospital and had abdominal and back pain. An initial
workup with a CAT scan showed some mild peri hepatic fluid but
no evidence of any hemorrhage or leak in the
abdomen. Furthermore, there was a normal caliber bile duct and
intra-hepatic radicals. He continued to have a [**Last Name **] problem with
an elevated bilirubin. A PTC attempt was made again and this was
aborted due to small nondilated ducts.
Given the patient's clinical down turn and an elevated
bilirubin, concern was brought up for a leak. Therefore a HIDA
scan was obtained the night of this operation. This scan was
read by the attending radiologist and he indicated that
this was indicative of a significant lateral leak from the bile
duct.

The patient was met directly before this procedure in the
holding area. He was ill and toxic appearing. He had abdominal
tenderness and back pain. He appeared somewhat confused and was
not clear in his thoughts or conversation. Given these findings
and the declaration of a bile duct leak with very few
interventional or non invasive techniques available for a
gentleman like this, an immediate exploration was warranted to
drain the leak, if not permanently address the problem.
Therefore, the patient was taken to the operating room on the
evening of [**2142-8-20**]. Mr. [**Known lastname 18097**] understood that this was
a major operation in an emergent setting and given his gross
obesity and other factors, that this had a heightened risk
profile. The risks were described in depth by our resident team
and they included poor wound healing, bleeding and infection as
well as the chance of a leak of any connection or persistent
fistula from drainage. He understood these risks and wished to
proceed and provided informed consent to that effect in the
holding area tonight.

Past Medical History:
Morbid obesity.
Sleep apnea.
Hypertension.
Gastroesophageal reflux.
Osteoarthritis.
Lap chole [**2-6**]
Rou-en-Y bypass [**9-6**]
PTC placement for biliary sludge/stone [**7-8**]

Social History:
He continues to smoke about one pack per day for the last 20
years. He drinks alcohol for the last 20 years and has recently
drinks 2-3 beers/day. He denies any drug abuse.


Family History:
His father is alive with prostate cancer.  Mother with
congestive heart failure.


Physical Exam:
Vitals:
T 97.5 P78  BP148/80  R20  O2 96%RA
Gen: Large gentleman in no acute distress
Chest: clear to auscultation bilaterally
CV: regular rate and rhythm
Abd: soft, nondistended, obese, with mild RUQ tenderness, no
rebound, no guarding


Pertinent Results:
CT RECONSTRUCTION  [**2142-8-18**] 11:39 AM
IMPRESSION:
1. No ductal dilatation, abscess or drainable collections.
2. Small right pleural effusion.
3. Small amount of enhancement along the catheter tract
consistent with inflammatory change and trace amount of fluid
density in the right properitoneal space.

Gallbladdar scan [**8-19**]:
IMPRESSION: Pooled tracer adjacent to the gallbladder fossa
which may represent tracer witin a biliary leak or aperistaltic
loop of proximal bowel. Recommend correlation with CT. Findings
discussed with the surgical team by Dr. [**Last Name (STitle) 11925**] after the study.


CHOLANGIOGRAM,IN OR W FILMS  [**2142-8-21**] 2:22 AM
IMPRESSION: There is irregular narrowing of the distal
two-thirds of the common bile duct, but there is no evidence of
obstruction. There is mild upstream dilatation, suggesting that
this could have a component of partial obstruction.

[**2142-8-24**] 03:36AM BLOOD WBC-6.6 RBC-2.83* Hgb-9.3* Hct-27.0*
MCV-96 MCH-32.7* MCHC-34.2 RDW-13.3 Plt Ct-160
[**2142-8-24**] 03:36AM BLOOD Plt Ct-160
[**2142-8-24**] 03:36AM BLOOD Glucose-102 UreaN-6 Creat-0.5 Na-139
K-3.8 Cl-108 HCO3-26 AnGap-9
[**2142-8-20**] 05:35AM BLOOD ALT-20 AST-13 LD(LDH)-143 AlkPhos-122*
Amylase-23 TotBili-1.9* DirBili-0.9* IndBili-1.0
[**2142-8-24**] 03:36AM BLOOD ALT-21 AST-15 LD(LDH)-123 AlkPhos-94
TotBili-0.6

Brief Hospital Course:
46 yo morbidly obese male admitted on [**2142-8-18**] for abdominal and
back pain.  He was emergently taken to the OR late in the
evening of [**2142-8-20**] for 1. Exploratory laparotomy. 2. Exploration
of retroperitoneum. 3. Exploration of common bile duct. 4.
Cholangiogram with fluoroscopic guidance. 5.
Choledochoduodenostomy. 6. Primary incisional hernia repair.
There was no hemodynamic instability throughout this procedure
and the patient tolerated it well.  He remained intubated on
transfer to the SICU.  Pt was placed on levo/flagyl/vanco.  He
was weaned from vent and  extubated on POD2.  His condition
improved and pt was transferred to the floor on POD4. His
alkaline phosphatase (from 122 to 83) and total bilirubin (from
2.2 to 0.5) [**Date Range **] to normal values during his course.
Physical therapy participated in his rehabilitation, but pt was
ambulatory on his own by POD5.  He continued to tolerate PO
intake and his pain was controlled with PO analgesia.  He was
discharged home on [**2142-8-27**] in good condition and instructed to
follow-up in Dr.[**Name (NI) 1745**] clinic on [**2142-9-7**].

Medications on Admission:
none

Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3-4H (Every
3 to 4 Hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*20 Capsule(s)* Refills:*0*
3. Advil 100 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Biliary stricture.
2. Probable cholangitis.


Discharge Condition:
good

Discharge Instructions:
- Showers OK, no soaking in tub or pool for several weeks
- Please restart all medications you were taking at home
- Please [**Name8 (MD) 138**] MD or return to ER if T>101.5, chills, nausea,
vomitting, erythema/smelly discharge around wound, or for any
other concern.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] on Friday, [**2142-9-7**] at 830AM
[**Hospital Ward Name 23**] [**Location (un) 470**] surgical clinic ([**Telephone/Fax (1) 18098**]).



Completed by:[**2142-8-27**]
{'Obstruction of bile duct,Incisional hernia without mention of obstruction or gangrene,Intestinal bypass or anastomosis status,Unspecified sleep apnea,Esophageal reflux,Unspecified essential hypertension'}


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 w/HIDA suggestive of biliary leak

PRESENT ILLNESS: This 46-year-old gentleman is a patient well known to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
in our minimally invasive surgery group for morbid obesity. Dr.
[**Last Name (STitle) **] performed an open
gastric bypass via a Roux-en-Y technique a number of years ago.
Mr. [**Known lastname 18097**] also had a laparoscopic cholecystectomy performed
prior to this in the distant past. He presents recently with a
history of common bile duct stones. Given
his prior open Roux-en-Y bypass, this was unable to be addressed
through endoscopic retrograde cholangiopancreatography.
Therefore, he had a percutaneous
transhepatic cholangiography performed and during this, multiple
stones were removed from the bile duct via radiology technique.
His percutaneous tube remained in place until Friday, [**8-17**],
when Dr. [**Last Name (STitle) **] removed this in the office. There had been a
question of a distal stricture in the bile duct on the recent
PTC.

MEDICAL HISTORY: Morbid obesity.
Sleep apnea.
Hypertension.
Gastroesophageal reflux.
Osteoarthritis.
Lap chole [**2-6**]
Rou-en-Y bypass [**9-6**]
PTC placement for biliary sludge/stone [**7-8**]

MEDICATION ON ADMISSION: none

ALLERGIES: Unasyn

PHYSICAL EXAM: Vitals:
T 97.5 P78  BP148/80  R20  O2 96%RA
Gen: Large gentleman in no acute distress
Chest: clear to auscultation bilaterally
CV: regular rate and rhythm
Abd: soft, nondistended, obese, with mild RUQ tenderness, no
rebound, no guarding

FAMILY HISTORY: His father is alive with prostate cancer.  Mother with
congestive heart failure.

SOCIAL HISTORY: He continues to smoke about one pack per day for the last 20
years. He drinks alcohol for the last 20 years and has recently
drinks 2-3 beers/day. He denies any drug abuse. 

### Response:
{'Obstruction of bile duct,Incisional hernia without mention of obstruction or gangrene,Intestinal bypass or anastomosis status,Unspecified sleep apnea,Esophageal reflux,Unspecified essential hypertension'}
