CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 74 yoF with vascular dementia and history of cadaveric
kidney transplant at [**Hospital1 112**] ten years ago, comes form [**Hospital3 12272**] center where she had been complaining of persistent non
productive cough and dysuria for one week.  This morning she
complained of worsening LLQ abdominal pain.  She was brought to
ED where a CT scan of her abdomen revealed a large 6.6 (TRV) x
4.5 (AP) x 21.6 (CC) cm rectus sheath hematoma.

MEDICAL HISTORY: history of DVT bilateral legs [**2131**] - told by PCP she CANNOT go
off
anticoagulation.  Anxiety, frequent UTI, hypercholesterolemia,
CRF s/p CRT in [**2132**](?), HTN, vascular dementia.

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: ativan 0.5 q6 PRN, tylenol, benzonatate 100 TID prn cough,
robitussin prn cough, namenda 10 q am and 5 q pm, pravastatin 40
qhs, prednisone 10 q am, citalopram 10 q am, lisinopril 20 q am,
mycophenolate 1500 [**Hospital1 **], donepezil 10 q am, CaCO3 600 [**Hospital1 **], MVI,
Coumadin 2.5 M,F and 3.5 T,W,Th,Sa,[**Doctor First Name **].

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AAO x 1, pleasantly demented
RRR no MRG appreciated on auscultation
CTA B/L no RRW
Soft, minimally tender in Left side, palpable mass c/w rectus
sheath hemoatoma on left side, scars c/w prior surgery as above.
+ edema B/L

FAMILY HISTORY: 

SOCIAL HISTORY: Lives at [**Location (un) **] Alzheimer Unit ([**Location (un) 538**])
Nontraumatic hematoma of soft tissue,Kidney replaced by transplant,Abdominal pain, other specified site,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile
Nontrauma hema soft tiss,Kidney transplant status,Abdmnal pain oth spcf st,Vascular dementia,uncomp,Cerebral atherosclerosis,Hypertension NOS,Long-term use anticoagul,Abnrml coagultion prfile
Admission Date:  [**2143-3-2**]              Discharge Date:   [**2143-3-5**]

Date of Birth:  [**2069-1-30**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5569**]
Chief Complaint:
Abdominal pain


Major Surgical or Invasive Procedure:
none


History of Present Illness:
 74 yoF with vascular dementia and history of cadaveric
kidney transplant at [**Hospital1 112**] ten years ago, comes form [**Hospital3 12272**] center where she had been complaining of persistent non
productive cough and dysuria for one week.  This morning she
complained of worsening LLQ abdominal pain.  She was brought to
ED where a CT scan of her abdomen revealed a large 6.6 (TRV) x
4.5 (AP) x 21.6 (CC) cm rectus sheath hematoma.

She is pleasantly demented, and complains only of some mild Left
sided abdominal pain.  Her daughter, who is with her, reports
that she has been experiencing a peristent non productive cough
and dysuria.

ROS: she denies any chest pain, SOB, headache, vision changes,
musculoskeletal pain, nausea, vomiting or diarrhea.


Past Medical History:
history of DVT bilateral legs [**2131**] - told by PCP she CANNOT go
off
anticoagulation.  Anxiety, frequent UTI, hypercholesterolemia,
CRF s/p CRT in [**2132**](?), HTN, vascular dementia.

PSgH: CRTx in [**2132**] at [**Hospital1 112**].


Social History:
Lives at [**Location (un) **] Alzheimer Unit ([**Location (un) 538**])


Physical Exam:
AAO x 1, pleasantly demented
RRR no MRG appreciated on auscultation
CTA B/L no RRW
Soft, minimally tender in Left side, palpable mass c/w rectus
sheath hemoatoma on left side, scars c/w prior surgery as above.
+ edema B/L


Brief Hospital Course:
74 yo F h/o Vascular Dementia, Renal transplant, DVTs on
coumadin admitted with recuts sheath hematoma on
supratherapeutic Coumadin. She was admitted and started on
Vitamin K and give FFP given in ED. Coumadin was held. FFP 4
units and a total of 3 units of PRBC and 2 units of platelets
were administered. Serial HCT checks and coags were done until
stable. Serial abdominal exams were done noting increased
bruising along left flank and abdomen. Discomfort abated.
Bruising stopped. Vital signs remained stable. She did not
requird embolizaton.
Initially, she was kept NPO, but once stable, diet was resumed
and tolerated. PT was consulted and noted that patient was at
baseline. Recommendations were to return to chronic placement at
alzheimer unit at [**Location (un) **] in [**Location (un) 538**].

The decision was made to stop the coumadin given hematoma and
h/o falls. Information communicated to Dr.[**Name (NI) 90239**] (PCP)nurse
([**Telephone/Fax (1) 3530**]). She was discharged in stable condition back to
[**Location (un) **] off Coumadin.


Medications on Admission:
[**Last Name (un) 1724**]: ativan 0.5 q6 PRN, tylenol, benzonatate 100 TID prn cough,
robitussin prn cough, namenda 10 q am and 5 q pm, pravastatin 40
qhs, prednisone 10 q am, citalopram 10 q am, lisinopril 20 q am,
mycophenolate 1500 [**Hospital1 **], donepezil 10 q am, CaCO3 600 [**Hospital1 **], MVI,
Coumadin 2.5 M,F and 3.5 T,W,Th,Sa,[**Doctor First Name **].

ALL: nkda


Discharge Medications:
1. Discontinued Meds
Coumadin
2. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

4. memantine 5 mg Tablet Sig: Two (2) Tablet PO q am ().
5. memantine 5 mg Tablet Sig: One (1) Tablet PO q pm ().
6. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. mycophenolate mofetil 500 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
9. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **]

Discharge Diagnosis:
Left rectus sheath hematoma
supra therapeutic inr
h/o dvts
h/o renal transplant


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
See PT notes


Discharge Instructions:
You will transfer back to [**Location (un) **] in [**Location (un) 538**] with
[**Location (un) 86**] VNA

Followup Instructions:
follow up with Dr. [**Last Name (STitle) **] in 1 week



Completed by:[**2143-3-5**]
{'Nontraumatic hematoma of soft tissue,Kidney replaced by transplant,Abdominal pain, other specified site,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile'}


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: 74 yoF with vascular dementia and history of cadaveric
kidney transplant at [**Hospital1 112**] ten years ago, comes form [**Hospital3 12272**] center where she had been complaining of persistent non
productive cough and dysuria for one week.  This morning she
complained of worsening LLQ abdominal pain.  She was brought to
ED where a CT scan of her abdomen revealed a large 6.6 (TRV) x
4.5 (AP) x 21.6 (CC) cm rectus sheath hematoma.

MEDICAL HISTORY: history of DVT bilateral legs [**2131**] - told by PCP she CANNOT go
off
anticoagulation.  Anxiety, frequent UTI, hypercholesterolemia,
CRF s/p CRT in [**2132**](?), HTN, vascular dementia.

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: ativan 0.5 q6 PRN, tylenol, benzonatate 100 TID prn cough,
robitussin prn cough, namenda 10 q am and 5 q pm, pravastatin 40
qhs, prednisone 10 q am, citalopram 10 q am, lisinopril 20 q am,
mycophenolate 1500 [**Hospital1 **], donepezil 10 q am, CaCO3 600 [**Hospital1 **], MVI,
Coumadin 2.5 M,F and 3.5 T,W,Th,Sa,[**Doctor First Name **].

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: AAO x 1, pleasantly demented
RRR no MRG appreciated on auscultation
CTA B/L no RRW
Soft, minimally tender in Left side, palpable mass c/w rectus
sheath hemoatoma on left side, scars c/w prior surgery as above.
+ edema B/L

FAMILY HISTORY: 

SOCIAL HISTORY: Lives at [**Location (un) **] Alzheimer Unit ([**Location (un) 538**]) 

### Response:
{'Nontraumatic hematoma of soft tissue,Kidney replaced by transplant,Abdominal pain, other specified site,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile'}
