CHIEF COMPLAINT: Sharp abdominal pain

PRESENT ILLNESS: 43 M PMH sig for Crohn's disease presents with sharp
stabbing abdominal pain since MN. Woke up diaphoretic, extremely
painful abdomen with movement. Called EMS, was taken to OSH. At
OSH, was tachycardic and hypotensive with an acute abdomen. He
was fluid resuscitated, and CT demonstrated inflamed colon, with
fluid collections and free air. He was started on Zosyn and
transferred here. WBC was 16 with 14% bands. Hct was 34.

MEDICAL HISTORY: PMH: Crohn's disease, primarily affecting terminal ileum. Has
been stable, on no medications. Followed by a
gastroenterologist,
whom he has not seen in about 18 months. Also has depression and
anxiety.
PSH: bilateral inguinal hernia repair as child

MEDICATION ON ADMISSION: Seroquel, Paxil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
T 97.5 HR 117 BP 124/65 O2Sat 97% on 4L  RR 26
Gen: Diaphoretic, but A+O x 3. Sick-appearing.
Cor: tachy but no m/r/g
Pulm: CTAB
Abdomen: distended but not tense, absent BS, TTP diffusely but
in
particular epigastric area and RLQ. has rebound and guarding.
Umbilical hernia palpated.
Rectal: No masses, normal tone, guiaic negative
GU: normal male genitalia no discharge

FAMILY HISTORY: Father with inflammatory bowel disease, died of complications
from ileostomy reversal.

SOCIAL HISTORY: Social EtOH, denies T/D
Regional enteritis of small intestine with large intestine,Perforation of intestine,Peritonitis (acute) generalized,Unspecified septicemia,Severe sepsis,Acute kidney failure, unspecified,Septic shock,Intestinovesical fistula,Urinary tract infection, site not specified,Hypovolemia,Altered mental status,Unspecified essential hypertension,Dysthymic disorder,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health
Reg enterit sm/lg intest,Perforation of intestine,Peritonitis (acute) gen,Septicemia NOS,Severe sepsis,Acute kidney failure NOS,Septic shock,Intestinovesical fistula,Urin tract infection NOS,Hypovolemia,Altered mental status,Hypertension NOS,Dysthymic disorder,Obesity NOS,Hx of past noncompliance
Admission Date:  [**2190-5-8**]              Discharge Date:   [**2190-5-22**]

Date of Birth:  [**2146-12-14**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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


Major Surgical or Invasive Procedure:
ex lap, sigcolectomy, end colostomy, ileocecotomy

History of Present Illness:
43 M PMH sig for Crohn's disease presents with sharp
stabbing abdominal pain since MN. Woke up diaphoretic, extremely
painful abdomen with movement. Called EMS, was taken to OSH. At
OSH, was tachycardic and hypotensive with an acute abdomen. He
was fluid resuscitated, and CT demonstrated inflamed colon, with
fluid collections and free air. He was started on Zosyn and
transferred here. WBC was 16 with 14% bands. Hct was 34.

At the ED here, he has continued to receive fluids. He was
initially hypotensive to 88/55, but with fluid resus has been
120/67. Is getting IV vanc and IV pain meds. Is still
diaphoretic. Abdomen tender. Denies flatus or BM today. Denies
n/v. Denies CP/SOB.

Of note, he has been having "symptoms of a UTI" for the last
month. His urine has been cloudy to rusty on and off. He was
seen
by a urologist, Dr. [**First Name (STitle) **] [**Name (STitle) 8551**], who treated him with
antibiotics initially. He felt better for about 1.5 weeks, then
did not follow up any further. He was told that he would need
cystoscopy and that there was a concern for fistula.


Past Medical History:
PMH: Crohn's disease, primarily affecting terminal ileum. Has
been stable, on no medications. Followed by a
gastroenterologist,
whom he has not seen in about 18 months. Also has depression and
anxiety.
PSH: bilateral inguinal hernia repair as child


Social History:
Social EtOH, denies T/D


Family History:
Father with inflammatory bowel disease, died of complications
from ileostomy reversal.


Physical Exam:
On Admission:
T 97.5 HR 117 BP 124/65 O2Sat 97% on 4L  RR 26
Gen: Diaphoretic, but A+O x 3. Sick-appearing.
Cor: tachy but no m/r/g
Pulm: CTAB
Abdomen: distended but not tense, absent BS, TTP diffusely but
in
particular epigastric area and RLQ. has rebound and guarding.
Umbilical hernia palpated.
Rectal: No masses, normal tone, guiaic negative
GU: normal male genitalia no discharge


Brief Hospital Course:
43M PMH significant for Crohn's disease presents with sharp
stabbing abdominal pain since MN of admission. At OSH, was
tachycardic and hypotensive with an acute abdomen. He was fluid
resuscitated, and CT demonstrated inflamed colon, with fluid
collections and free air. He was started on Zosyn and
transferred here. WBC was 16 with 14% bands. Hct was 34.
At the ED here, he has continued to receive fluids. He was
initially hypotensive to 88/55, but with fluid resus has been
120/67. Continued on IV vanc/zosyn/pain meds.
To OR on AM of [**5-8**] for exlap, colon abscess in comunnication
with bladder identified. Pt with sigcolectomy, end colostomy,
and ileocectotomy. 4400 crystaloid, 800 urine, 350 EBL.
Persistent hypotension and transferred to SICU from OR on
phenylephrine drip and remained intubated.
[**5-8**]: Admitted to SICU. Persistent mild hypotension overnight on
phenylephrine drip. Given LR 3000. Vent weaned. Febrile.
[**5-9**]: extubated. bedside TTE with slight hypovolemia. albumin x
1. crystalloing per [**Doctor First Name **] team. increased IVF to 200. UOP good.
[**5-10**]: KVO, IV lasix x2 given for goal 1L negative fluid balance,
NG tube placed. Intermittent hypertension treated with
metoprolol. Febrile --> Cultured. MS [**First Name (Titles) **] [**Last Name (Titles) 86662**]. Self d/c'd
CVL, replaced with PIV
[**5-11**]: No transfer to floor [**2-16**] confusion, tachycardia, and HTN.
flagyl added; Started on clears with home anxiety meds, diuresed
during the day
[**5-12**]: JP d/c'd, regular diet
[**5-13**]: repeat lasix 20mg [**Hospital **]  Transferred to the floor

On the floor he did well and antibiotics were stopped on [**5-16**].
He did require metoprolol and will be discharged with this and
is to follow up with his PCP. [**Name10 (NameIs) **] was tolerating regular diet and
a wound vac was placed.  He recieved ostomy teaching with the
ostomy nurse/team.  He did have increased ostomy output and was
started on imodium, and Cdif was checked and was negative.  His
ostomy output was apporopriate by the time of discharge and he
was off imodium.  On [**5-20**] he had a positive UA and he was treated
with ciprofloxacin.  The wound vac was removed on [**5-21**] and the
wound was stapled closed and he had dry dressing changes.  By
the time of discharge he was tolerating regular diet and his
pain was well controlled with PO meds.   He will be discharged
with VNA for wound and ostomy care.

Medications on Admission:
Seroquel, Paxil

Discharge Medications:
1. Paroxetine HCl 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
3. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
5. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*1*
6. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
1.  Perforated viscus, Crohn's disease
2.  Urinary tract infection

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Call if fever > 101 F.  Call if signs of wound infection
(including increased redness and foul smelling discharge).  Call
with any questions or concerns.

You have staples closing your abdominal wound.  They will be
removed at one of your follow up appointments in surgery clinic.
 You may place a dry dressing over the wound, and this should be
changed daily.

Ostomy care per instruction/teaching you recieved in the
hospital.

Followup Instructions:
Please call Dr.[**Name (NI) 6045**] office to schedule follow-up
appointment in [**1-16**] weeks.  Phone: ([**Telephone/Fax (1) 15350**]

Please call your primary care physician to schedule follow up
appointment in [**1-16**] weeks.  PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Telephone/Fax (1) 45333**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]
{'Regional enteritis of small intestine with large intestine,Perforation of intestine,Peritonitis (acute) generalized,Unspecified septicemia,Severe sepsis,Acute kidney failure, unspecified,Septic shock,Intestinovesical fistula,Urinary tract infection, site not specified,Hypovolemia,Altered mental status,Unspecified essential hypertension,Dysthymic disorder,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: Sharp abdominal pain

PRESENT ILLNESS: 43 M PMH sig for Crohn's disease presents with sharp
stabbing abdominal pain since MN. Woke up diaphoretic, extremely
painful abdomen with movement. Called EMS, was taken to OSH. At
OSH, was tachycardic and hypotensive with an acute abdomen. He
was fluid resuscitated, and CT demonstrated inflamed colon, with
fluid collections and free air. He was started on Zosyn and
transferred here. WBC was 16 with 14% bands. Hct was 34.

MEDICAL HISTORY: PMH: Crohn's disease, primarily affecting terminal ileum. Has
been stable, on no medications. Followed by a
gastroenterologist,
whom he has not seen in about 18 months. Also has depression and
anxiety.
PSH: bilateral inguinal hernia repair as child

MEDICATION ON ADMISSION: Seroquel, Paxil

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
T 97.5 HR 117 BP 124/65 O2Sat 97% on 4L  RR 26
Gen: Diaphoretic, but A+O x 3. Sick-appearing.
Cor: tachy but no m/r/g
Pulm: CTAB
Abdomen: distended but not tense, absent BS, TTP diffusely but
in
particular epigastric area and RLQ. has rebound and guarding.
Umbilical hernia palpated.
Rectal: No masses, normal tone, guiaic negative
GU: normal male genitalia no discharge

FAMILY HISTORY: Father with inflammatory bowel disease, died of complications
from ileostomy reversal.

SOCIAL HISTORY: Social EtOH, denies T/D 

### Response:
{'Regional enteritis of small intestine with large intestine,Perforation of intestine,Peritonitis (acute) generalized,Unspecified septicemia,Severe sepsis,Acute kidney failure, unspecified,Septic shock,Intestinovesical fistula,Urinary tract infection, site not specified,Hypovolemia,Altered mental status,Unspecified essential hypertension,Dysthymic disorder,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health'}
