CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 62-year-old male
with past medical history of sigmoid diverticulitis, coronary
artery disease, status post myocardial infarction, congestive
heart failure, hypertension, and gastroesophageal reflux
disease, who was transferred from [**Hospital 1474**] Hospital.  Patient
complained of fever, right upper quadrant malaise, and
decreased appetite for two weeks prior to admission.  Patient
was admitted to the [**Hospital 1474**] Hospital, and was found to have
a large mass in the right hepatic lobe consistent with
hepatic abscess by CT scan.  The patient became septic and
was transferred to [**Hospital1 69**] and
Medical Intensive Care Unit on [**5-26**] while on dopamine drip.

MEDICAL HISTORY: 1.  Coronary artery disease; status post inferior myocardial
infarction.
2.  Hypertension.
3.  Gastroesophageal reflux disease.
4.  History of colonic polyps.

MEDICATION ON ADMISSION: Home medications included,
Tylenol, enteric-coated aspirin, Lopressor, Lipitor, Diovan,
and Zantac.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife in [**Name (NI) 1474**].
He works as a forklift operator.  He has a son and a
daughter.  [**Name (NI) **] has a 40-pack-year tobacco history and reports
occasional alcohol use.  No history of intravenous drug use.
Abscess of liver,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Bacteremia,Anemia, unspecified,Unspecified essential hypertension,Esophageal reflux,Old myocardial infarction
Abscess of liver,Chr airway obstruct NEC,Thrombocytopenia NOS,Bacteremia,Anemia NOS,Hypertension NOS,Esophageal reflux,Old myocardial infarct
Admission Date:  [**2170-5-26**]     Discharge Date:  [**2170-6-5**]

Date of Birth:   [**2107-8-3**]     Sex:  M

Service:  Blue Surgery

HISTORY OF PRESENT ILLNESS:  Patient is a 62-year-old male
with past medical history of sigmoid diverticulitis, coronary
artery disease, status post myocardial infarction, congestive
heart failure, hypertension, and gastroesophageal reflux
disease, who was transferred from [**Hospital 1474**] Hospital.  Patient
complained of fever, right upper quadrant malaise, and
decreased appetite for two weeks prior to admission.  Patient
was admitted to the [**Hospital 1474**] Hospital, and was found to have
a large mass in the right hepatic lobe consistent with
hepatic abscess by CT scan.  The patient became septic and
was transferred to [**Hospital1 69**] and
Medical Intensive Care Unit on [**5-26**] while on dopamine drip.

PHYSICAL EXAM ON TIME OF ADMISSION:  Heart rate 60-70s, blood
pressure 88-98/50 on dopamine 3 mcg/kg/minute, respiratory
rate was [**11-29**] with O2 saturation of 95% on room air.  The
patient was alert and oriented times three.  Cardiac
examination was not significant.  Lungs had decreased breath
sounds bilaterally consistent with bilateral pleural
effusions.  Abdomen was distended.  Bowel sounds present.
Foley was in place.

On admission, white count was 18.8 with 90% neutrophils, H&H
was 9.3/27.1, platelets 175.  Chemistries were within normal
limits.  AST and ALT were elevated at 111 and 291
respectively.  Alkaline phosphatase was 446, but amylase and
lipase were within normal limits.  Cardiac enzymes were
normal.

Electrocardiogram showed normal sinus rhythm at 75.

During the MICU stay, the patient developed intermittent
fever and chills, and was started on intravenous Zosyn.  The
patient was transferred to Surgical Intensive Care Unit under
Dr.[**Name (NI) 670**] care on hospital day three and continued on IV
Zosyn.  Patient underwent CT-guided percutaneous drainage of
right hepatic abscess on hospital day six without any
complications.  The patient had a pigtail catheter left in
the abscess site for further drainage.  Drains ultimately
grew back E. coli without antibiotic resistance.  The patient
also received a PICC line for IV antibiotic therapy on
hospital day six.  The patient was also found to have a
pelvic abscess, a likely complication from prior
diverticulitis which was also the cause of this hepatic
abscesses.

The patient remained afebrile, and was transferred to the
floor.  On hospital day nine, the patient underwent
additional ultrasound-guided percutaneous drainage of
remaining multiple small hepatic abscesses draining a total
of 20 cc of pus.  The patient did not have any complications.
Sites of percutaneous drainage were nontender on discharge,
but there was minimal drainage from the pigtail catheter.

CONDITION ON DISCHARGE:  Stable.

DISPOSITION:  Discharged to home with VNA service.

DISCHARGE DIAGNOSES:
1. Multiple hepatic abscesses.
2. Septic shock.
3. Pelvic abscess.
4. Status post diverticulitis.
5. Coronary artery disease.
6. Status post myocardial infarction.
7. Congestive heart failure.
8. Hypertension.
9. Gastroesophageal reflux disease.

DISCHARGE MEDICATIONS:
1. Percocet 5/325 mg 1-2 tablets po q4-6 prn pain.
2. Zosyn 1.5 gram IV q6h via PICC line.
3. Protonix 40 mg q day.

FOLLOW-UP PLAN:  Patient is to followup with Dr. [**First Name (STitle) **]
within two weeks of discharge.



                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 10201**]

MEDQUIST36

D:  [**2170-6-7**]  11:37
T:  [**2170-6-14**]  08:28
JOB#:  [**Job Number 48732**]


Admission Date:  [**2170-5-26**]       Discharge Date:  [**2170-6-5**]

Date of Birth:   [**2107-8-3**]       Sex:  M

Service:  Surgery

NOTE:  This job put with job #[**Numeric Identifier 48730**].





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 1053**]
MEDQUIST36

D:  [**2170-6-5**]  02:13
T:  [**2170-6-5**]  08:06
JOB#:  [**Job Number 48731**]


Admission Date:  [**2170-5-26**]       Discharge Date:  [**2170-6-5**]

Date of Birth:   [**2107-8-3**]       Sex:  M

Service:  Surgery, Blue Team

HISTORY OF PRESENT ILLNESS:  This is a 62-year-old male with
a history of coronary artery disease, hypertension,
gastroesophageal reflux disorder, and tobacco use who was
admitted to [**Hospital1 69**] as a
transfer from [**Hospital 1474**] Hospital on [**2170-5-26**] with a
presumptive diagnosis of hepatic abscess.

The patient was reportedly in his usual state of health until
approximately two weeks prior to admission when he noted the
gradual onset of decreased appetite and lethargy with an
associated low-grade temperature over the course of one week.
The patient then reportedly experienced two to three days of
right upper quadrant abdominal pain with associated fever and
rigors at home.

The patient denied any recent travel history or the
consumption of unusual foods.  Additionally, the patient
denied any associated nausea, vomiting, or diarrhea.  The
patient denied any tarry stools or acholic stools, and he
denied any urinary changes.

The patient subsequently presented to [**Hospital 1474**] Hospital on
[**2170-5-20**], where an abdominal computed tomography scan was
conducted which demonstrated a large mass on the right lobe
of the patient's liver with a questionable associated bladder
mass.  Shortly thereafter, the patient demonstrated an
elevated temperature to 103.2 accompanied by mental status
changes and diminished blood pressures.

The patient was subsequently sent to the Coronary Care Unit
where he effectively ruled out for a myocardial infarction
and was started on triple antibiotic therapy with
ceftazidime, clindamycin, and gentamicin.  A liver biopsy was
thereafter conducted which demonstrated evidence of hepatic
abscesses with cultures that subsequently demonstrated
Bacteroides fragilis.  The patient remained hemodynamically
labile for several days, requiring pressor therapy, and was
subsequently transferred to [**Hospital1 188**] on [**2170-5-26**] for additional evaluation and
management.

PAST MEDICAL HISTORY:
1.  Coronary artery disease; status post inferior myocardial
infarction.
2.  Hypertension.
3.  Gastroesophageal reflux disease.
4.  History of colonic polyps.

MEDICATIONS ON ADMISSION:  Home medications included,
Tylenol, enteric-coated aspirin, Lopressor, Lipitor, Diovan,
and Zantac.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives with his wife in [**Name (NI) 1474**].
He works as a forklift operator.  He has a son and a
daughter.  [**Name (NI) **] has a 40-pack-year tobacco history and reports
occasional alcohol use.  No history of intravenous drug use.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed temperature was 97.6, heart rate was
71, blood pressure was 93/48, respiratory rate was 14, and
oxygen saturation was 94% on room air.  In general, the
patient was a well-appearing male in no apparent distress.
Sclerae were anicteric.  Head, eyes, ears, nose, and throat
examination revealed pupils were equal, round, and reactive
to light and accommodation.  Extraocular movements were
intact bilaterally.  No scleral icterus was noted.  The
patient's oropharynx was noted to be slightly dry.  No
jugular venous distention was noted.  No palpable
lymphadenopathy existed in the cervical or axillary nodes.
Chest examination demonstrated bibasilar rales with positive
breath sounds bilaterally.  Cardiovascular examination
demonstrated a regular rate and rhythm.  Normal first heart
sounds and second heart sounds and a notable fourth heart
sound.  The abdomen was noted to be soft with tenderness to
palpation in the right upper quadrant and an enlarged liver.
Bowel sounds were auscultated in all four quadrants.  No
fluctuance or overlying erythema was noted.  Extremities were
noted to be warm and well perfused with no clubbing,
cyanosis, or edema.

PERTINENT LABORATORY VALUES ON PRESENTATION: Laboratory
studies on admission revealed white blood cell count was
24.1, hematocrit was 26, and platelets were 227.  Sodium was
138, potassium was 3.9, chloride was 105, bicarbonate was 22,
blood urea nitrogen was 21, creatinine was 1.1, and blood
glucose was 108.  ALT was 327, AST was 310, alkaline
phosphatase was 410, total bilirubin was 1.2, and direct
bilirubin was 0.5, protein was 5.1, albumin was 2.3.
Magnesium was 1.5, calcium was 7.9, and phosphate was 1.2.
Prothrombin time was 13.8, partial thromboplastin time was
24.6, and INR was 1.3.  Fibrinogen was 286.  D-dimer was
positive.  Culture data on admission, dated [**2170-5-23**],
demonstrated Bacteroides fragilis in [**1-14**] bottles.

PERTINENT RADIOLOGY/IMAGING:  A computed tomography scan on
admission demonstrated multiple liver abscesses, a pelvic
abscess contiguous with the sigmoid colon (likely secondary
to prior diverticulosis), and a right lower lobe lung nodule.

HOSPITAL COURSE:  On [**2170-5-26**] the patient was admitted
to the Medical Intensive Care Unit under the direction of Dr.
[**Last Name (STitle) **].  Initial antibiotic coverage was provided via Zosyn.

A General Surgery consultation was obtained, and the patient
was subsequently recommended for Interventional Radiology
guided percutaneous drainage of his liver abscesses.  Initial
Interventional Radiology consultation stated that the
patient's abscesses were not amenable Interventional
Radiology guided drainage.  Following this input, the
decision was made to transfer the patient to the Blue Surgery
Service under the direction of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] as further
interventional measures were assessed.

On [**2170-5-29**], therefore, the patient was transferred from
the [**Hospital Ward Name **] [**Hospital Ward Name 332**] Intensive Care Unit to the [**Hospital Ward Name **]
surgical/trauma Intensive Care Unit under the direction of
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].

A repeat computerized axial tomography of the abdomen was
conducted which demonstrated multiple hepatic abscess; the
largest of which was measured at 5.4 cm X 4.1 cm located at
the dome of the bladder.  While various treatment options
were being assessed, the patient continued on intravenous
Zosyn without complications.  Of note, the patient was noted
to be tolerant of a regular diet and demonstrated a gradual
diminution in his white blood cell count.

On [**2170-6-1**], the patient under Interventional Radiology
guided drainage of his hepatic abscesses by using computed
tomography-guided technique identified in the right lobe of
the liver, a 20-gauge spinal needle, single pass aspiration
was performed yielding approximately 25 cc of pus.  Shortly
following 25 cc a single puncture insertion of 10-gauge
French pigtail catheter was performed with approximately 20
cc of pus subsequently aspirated.

The patient tolerated the procedure well and was subsequently
cleared for transfer back to the floor for further evaluation
and management.  Cultures from the abscess aspirate
subsequently were positive for pan-sensitive Escherichia
coli.

Shortly after the aspirate, the patient demonstrated a
transient temperature spike to 101.3 but was subsequently
noted to successfully defervesce with continued antibiotic
therapy.

A follow-up ultrasound performed on [**2170-6-4**]
demonstrated at least four persistent collections within the
right lobe of the liver which did not appear to communicate
with the previously drained cavity.  The patient subsequently
underwent a repeat abscess drainage procedure which was noted
to yield approximately 25 cc of additional pus.

The patient tolerated this additional procedure well and was
subsequently cleared for discharge to home with services on
the following day ([**2170-6-5**]) with instructions for
followup.

DISCHARGE STATUS:  The patient was to be discharged to home
with services.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE DIAGNOSES:
1.  Multiple hepatic abscesses.
2.  Status post radiologically-guided aspiration procedure
(times two).
3.  Coronary artery disease; status post inferior  myocardial
infarction.
4.  Hypertension.
5.  Gastroesophageal reflux disease.
6.  Colonic polyps.

MEDICATIONS ON DISCHARGE:
1.  Percocet one to two tablets p.o. q.4-6h. as needed (for
pain).
2.  Protonix 40 mg p.o. once per day.
3.  Zosyn 4.5 g intravenously q.6h. (times four weeks).

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to receive standard peripherally inserted
central catheter line care with normal saline flushes q.8h.
and as needed.  No heparin is to be used with the patient's
peripherally inserted central catheter line flushes secondary
to a positive heparin-induced thrombocytopenia antibody
screen.
2.  The patient was to maintain his drain site clean and dry
at all times.
3.  The patient may shower but should pat dry his drain site
afterwards; no bathing or swimming until further notice.
4.  The patient may resume a regular diet.
5.  The patient was to limit physical activity; no heavy
exertion.
6.  The patient was to complete a 4-week course of home
intravenous antibiotic therapy via his peripherally inserted
central catheter line.
7.  Home [**Hospital6 407**] for standard peripherally
inserted central catheter line care and peripherally inserted
central catheter line dressing changes, in addition to
pigtail drain care.
8.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] two
to three weeks following discharge; the patient was to call
to schedule this appointment.





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 1053**]
MEDQUIST36

D:  [**2170-6-5**]  00:35
T:  [**2170-6-5**]  07:31
JOB#:  [**Job Number 48730**]
{'Abscess of liver,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Bacteremia,Anemia, unspecified,Unspecified essential hypertension,Esophageal reflux,Old myocardial infarction'}


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: 

PRESENT ILLNESS: Patient is a 62-year-old male
with past medical history of sigmoid diverticulitis, coronary
artery disease, status post myocardial infarction, congestive
heart failure, hypertension, and gastroesophageal reflux
disease, who was transferred from [**Hospital 1474**] Hospital.  Patient
complained of fever, right upper quadrant malaise, and
decreased appetite for two weeks prior to admission.  Patient
was admitted to the [**Hospital 1474**] Hospital, and was found to have
a large mass in the right hepatic lobe consistent with
hepatic abscess by CT scan.  The patient became septic and
was transferred to [**Hospital1 69**] and
Medical Intensive Care Unit on [**5-26**] while on dopamine drip.

MEDICAL HISTORY: 1.  Coronary artery disease; status post inferior myocardial
infarction.
2.  Hypertension.
3.  Gastroesophageal reflux disease.
4.  History of colonic polyps.

MEDICATION ON ADMISSION: Home medications included,
Tylenol, enteric-coated aspirin, Lopressor, Lipitor, Diovan,
and Zantac.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife in [**Name (NI) 1474**].
He works as a forklift operator.  He has a son and a
daughter.  [**Name (NI) **] has a 40-pack-year tobacco history and reports
occasional alcohol use.  No history of intravenous drug use. 

### Response:
{'Abscess of liver,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Bacteremia,Anemia, unspecified,Unspecified essential hypertension,Esophageal reflux,Old myocardial infarction'}
