CHIEF COMPLAINT: Continued purulent drainage, increased drainage around drain
insertion site, 10 kg weight loss

PRESENT ILLNESS: 43M s/p MVC on [**5-31**] and was transferred in from an OSH with
multiple injuries including an acute abdomen with avulsion of
small bowel and multiple liver lacerations. Following an ICU
course was found to have a R posterior large
necrotic liver lesion in which a drain was placed. He has been
treated with antibiotics and was readmitted x 1 for 9 days to
restart antibiotics and have new drain placed. He continued
antibiotics for one week following that admission and since that
time has the drain in place which drains approximately 70-80 cc
of milky pale thick drainage daily. The patient reports that the
drainage from around the catheter haa increased significantly
over the last few days, and it has developed a very bad odor
that has caused him to be unable to eat. Since the last
admission he has dropped another 10 kg, and has lost nearly 45
kg since the
MVC.

MEDICAL HISTORY: MVC with liver lacs leading to necrotic liver lesion

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Dronabinol 2.5 mg PO BID
2. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
3. Calcium Carbonate 500 mg PO TID
4. Vitamin D 400 UNIT PO DAILY
5. Docusate Sodium 100 mg PO BID
6. Milk of Magnesia 30 mL PO DAILY:PRN constipation
7. Multivitamins 1 TAB PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 98.8, 118, 121/79, 20, 100%, 98.8 kg
Gen: Sl pale, more interactive
CV: Sl Tachy, reg rhythm
Lungs: CTA B/L
Abd: soft, mild tenderness most at drain site on rt lateral
abdomen and RUQ, Well healed abdominal incision, drain with
milky
light tan drainage, drain site slightly red with same tan
drainage around site and on dressing
Extr: no edema, 2+ DPs
Neuro: A+Ox3, Collar has been removed

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Supportive wife, works in construction building houses
(currently not working)
+ETOH, unknown tobacco/IVDU
Abscess of liver,Acute pancreatitis,Obstruction of bile duct,Peritoneal abscess,Unspecified protein-calorie malnutrition,Paralytic ileus,Unspecified pleural effusion,Adult failure to thrive
Abscess of liver,Acute pancreatitis,Obstruction of bile duct,Peritoneal abscess,Protein-cal malnutr NOS,Paralytic ileus,Pleural effusion NOS,Failure to thrive-adult
Admission Date:  [**2198-8-29**]              Discharge Date:   [**2198-9-22**]

Date of Birth:  [**2155-4-24**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Continued purulent drainage, increased drainage around drain
insertion site, 10 kg weight loss


Major Surgical or Invasive Procedure:
[**2198-8-30**]: ERCP, drain exchange with upsize, feeding tube
placement
[**2198-9-3**]: Central line placement
[**2198-9-4**]: PPFT replaced
[**2198-9-7**]: CT guided drain upsizing, 10 -> 14 French


History of Present Illness:
43M s/p MVC on [**5-31**] and was transferred in from an OSH with
multiple injuries including an acute abdomen with avulsion of
small bowel and multiple liver lacerations. Following an ICU
course was found to have a R posterior large
necrotic liver lesion in which a drain was placed. He has been
treated with antibiotics and was readmitted x 1 for 9 days to
restart antibiotics and have new drain placed. He continued
antibiotics for one week following that admission and since that
time has the drain in place which drains approximately 70-80 cc
of milky pale thick drainage daily. The patient reports that the
drainage from around the catheter haa increased significantly
over the last few days, and it has developed a very bad odor
that has caused him to be unable to eat. Since the last
admission he has dropped another 10 kg, and has lost nearly 45
kg since the
MVC.

Patient denies recent fevers or chills, no chest pain or
shortness of breath, he reports abdominal pain associated with
the drain site area, and has poor appetite and occasional
constipation. He still is taking PO dilaudid intermittently for
musculoskeletal pain of the lower back and also neck from the
MVC. The collar has been removed. He reports no edema or
abdominal swelling. Reports very low energy and barely able to
move about house.

Past Medical History:
MVC with liver lacs leading to necrotic liver lesion

PSH:
Exploratory laparotomy, washout of hemoperitoneum, debridement
of laceration of the liver, ileocecectomy, ileocolostomy.
s/p Left ankle ORIF
s/p removal of adenoids

Social History:
Supportive wife, works in construction building houses
(currently not working)
+ETOH, unknown tobacco/IVDU

Family History:
Noncontributory

Physical Exam:
VS: 98.8, 118, 121/79, 20, 100%, 98.8 kg
Gen: Sl pale, more interactive
CV: Sl Tachy, reg rhythm
Lungs: CTA B/L
Abd: soft, mild tenderness most at drain site on rt lateral
abdomen and RUQ, Well healed abdominal incision, drain with
milky
light tan drainage, drain site slightly red with same tan
drainage around site and on dressing
Extr: no edema, 2+ DPs
Neuro: A+Ox3, Collar has been removed

Pertinent Results:
On Admission: [**2198-8-29**]
WBC-8.2 RBC-3.53* Hgb-8.7* Hct-28.9* MCV-82 MCH-24.5* MCHC-30.0*
RDW-16.2* Plt Ct-356
PT-15.6* PTT-30.0 INR(PT)-1.5*
Glucose-112* UreaN-6 Creat-0.4* Na-131* K-3.9 Cl-96 HCO3-28
AnGap-11
ALT-8 AST-19 AlkPhos-97 TotBili-0.6
Iron-15* calTIBC-113* Ferritn-828* TRF-87*
Albumin-2.9* Calcium-8.8 Phos-3.7 Mg-1.9

Brief Hospital Course:
43 y/o male admitted for continued medical issues following MVC.
On admission the patient had an abdominal CT performed showing:
1. No interval change in size of the larger hepatic abscess,
status post interval removal or dislodgement of a previously
placed pigtail drain catheter.
2. Pigtail catheter remains in appropriate position in a
subhepatic collection, which is contiguous with, but possibly
minimally communicating with, the larger collection.
3. Slight decrease in size of the loculated right pleural
effusion with pleural thickening and enhancement. There was
drainage occuring around the pigtail catheter requiring multiple
dressing changes daily.
On HD 2([**8-30**]) the patient underwent ERCP. Per report,
cannulation of the biliary duct initially was not possible using
a free-hand technique. Cannulation of the pancreatic duct was
successful and deep using a free-hand technique. A 5Fr 4 cm
pancreatic duct stent was placed to facilitate cannulation of
the bile duct. An additional cannulation attempt of the biliary
duct was successful and deep with a sphincterotome using a
free-hand technique. Contrast medium was injected resulting in
complete opacification. Fluoroscopy on the biliary tree showed
the common bile duct, common hepatic duct, right and left
hepatic ducts, biliary radicles, cystic duct, and gallbladder
were filled with contrast and well visualized, and there was no
evidence of bile leak. A 10cm by 7FR Cotton [**Doctor Last Name **] biliary stent
was placed successfully in the main duct due to the stenotic
papilla following the sphincterotomy. Also, a nasojejunal
feeding tube was placed using standard endoscopic nasojejunal
feeding tube placement rechnique. The [**Last Name (un) **]-jejunal tube was
secured at 120 cm at the nose.
Immediately following the ERCP, the patient also underwent
exchange and upsizing to 10 Fr of the existing pigtail in the
subhepatic fluid collection. The intra-hepatic  collection has
not had any intervention with this hospitalization.

Initially, the patient was kept NPO overnight per protocol
following the sphincterotomy, and on the following day, as the
day progressed, the patient was having increased abdominal and
back pain, and urine output decreased significantly. A foley was
placed for monitoring, and he received fluid boluses. A mild
elevation in the lipase was noted, and temp to 100.5 was noted
and blood cultures were obtained. 2 days following the ERCP the
patient had fever to 101.2, and was becoming tachycardic to the
140's. He was also reporting that the epigastric and back pain
were worsening.
On [**9-2**], due to continued decreased urine output, abdominal pain
and tachycardia, and fever, the patient was transferred to the
SICU. He was kept NPO, and was started on TPN folloewing central
line placement. Lipase peaked at 363 and then started to trend
down, however his abdominal exam still revealed pain and still
with significant back pain. The abscess pigtail drain was
draining 150 - 300 cc daily of purulent appearing, thick light
tan fluid. Blood cultures have remained negative throughout.
With resuscitaion and NPO status, the patient's symptoms started
to improve. Urine output improved, he was afebrile, and so was
transferred back to the surgical floor. He was continued on TPN.

He received 2 units of RBCs for symptomatic Hct 22.9 with
appropriate response.
As symptoms subsided, he was very slowly advanced on his diet,
and the tube feeds were started via the post pyloric feeding
tube, which had to be replaced while in the SICU due to
clogging. On [**9-3**] he underwent an abdominal CT, assessing the
severity of the pancreatitis. There was mild peri-pancreatic
stranding and thickening of gerotas fascia. The pigtail catheter
was still in appropriate position in the subhepatic fluid
collection. The patient was continued on TPN, and he remained
NPO. The pigtail drain dressing was noted to have drainage that
seems to increase when patient upright or ambulating. On [**9-7**] he
was sent to CT for another drain upsize to a 12 Fr drain. At the
time of the surveillance CT, it was noted that there is oral
contrast from the previous CT scan layering in the abscess
cavity, suggestive of a fistulous tract to the bowel. He
underwent a fluoro study with Optiray injected through the new
12Fr catheter. This sjowed the abscess cavity filling and a
small fistulous communication with what appeared to be the small
bowel. Upon return to the floor, the drainage has taken on a
brown and thick appearance. At this time he was made NPO and
will continue on TPN.

TPN was continued on the surgical floor until [**2198-9-20**]. Prior to
discontinuation of the TPN, Mr. [**Known lastname 9450**] received a CT scan with
injection of contrast through his pigtail catheter to further
elucidate the anatomy. The plan at that time was operative
intervention assuming the fistula was still patent. However, the
CT did not identify fistula. Per report, the following was
identified: "Opacification of the right perihepatic and
paracolic gutter abscess cavity without evidence of small bowel
fistulous communication on CT." Operative intervention was
therefore withheld. Mr. [**Known lastname 9450**] completed a few more days of TPN,
and then was transitioned to an oral diet. After several days of
increasing PO intake, he was consuming approximately 1800 kcal
per day. He was safely discharged on [**2198-9-22**] with PTBD
in place and planned follow-up in clinic.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Dronabinol 2.5 mg PO BID
2. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
3. Calcium Carbonate 500 mg PO TID
4. Vitamin D 400 UNIT PO DAILY
5. Docusate Sodium 100 mg PO BID
6. Milk of Magnesia 30 mL PO DAILY:PRN constipation
7. Multivitamins 1 TAB PO DAILY


Discharge Medications:
1. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*40 Capsule Refills:*2
2. Calcium Carbonate 500 mg PO TID
3. Vitamin D 400 UNIT PO DAILY
4. Milk of Magnesia 30 mL PO DAILY:PRN constipation
5. Multivitamins 1 TAB PO DAILY
6. Senna 1 TAB PO BID:PRN constipation
RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day
Disp #*40 Capsule Refills:*2
7. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN Pain
RX *hydromorphone 2 mg 1 tablet(s) by mouth three times a day
Disp #*40 Tablet Refills:*0


Discharge Disposition:
Home

Discharge Diagnosis:
Hepatic abscess
post endoscopic retrograde cholangiopancreatography pancreatitis
Malnutrition


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Please call Dr[**Name (NI) 1369**] office at [**Telephone/Fax (1) 673**] for fever > 101,
chills, nausea, vomiting, diarrhea, constipation, yellowing of
skin or eyes, drainage stops completetely or increases to
greater then 400 cc daily, drainage turns bloody in apprearance,
or develops a worsening odor, swelling of legs, increased
abdominal size, drainage around the drain is increasing, or the
drain site becomes red or painful.
You may shower, avoid having the drain hanging freely at any
time. Place a new drain sponge around the drain site daily and
as needed.

Please drain and record the drain bag three times daily and as
needed. Bring a copy of the drain output with you to clinic.
Please call if the output increases significantly, stops
completely, becomes bloody in appearance or develops a worsening
odor.

No heavy lifting greater than 10 pounds.
No driving if taking narcotic pain medication.
Please ensure you are hydrating well, and be sure to maintain
adequate nutrition.

Followup Instructions:
1. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**]
Date/Time:[**2198-10-3**] 1:40

2. ERCP followup on [**2198-9-30**] for removal of bile duct drain.
Appointment is at 11:00 AM, please come to ERCP center at 10:30
AM ([**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Lobby to check in)


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]
{'Abscess of liver,Acute pancreatitis,Obstruction of bile duct,Peritoneal abscess,Unspecified protein-calorie malnutrition,Paralytic ileus,Unspecified pleural effusion,Adult failure to thrive'}


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: Continued purulent drainage, increased drainage around drain
insertion site, 10 kg weight loss

PRESENT ILLNESS: 43M s/p MVC on [**5-31**] and was transferred in from an OSH with
multiple injuries including an acute abdomen with avulsion of
small bowel and multiple liver lacerations. Following an ICU
course was found to have a R posterior large
necrotic liver lesion in which a drain was placed. He has been
treated with antibiotics and was readmitted x 1 for 9 days to
restart antibiotics and have new drain placed. He continued
antibiotics for one week following that admission and since that
time has the drain in place which drains approximately 70-80 cc
of milky pale thick drainage daily. The patient reports that the
drainage from around the catheter haa increased significantly
over the last few days, and it has developed a very bad odor
that has caused him to be unable to eat. Since the last
admission he has dropped another 10 kg, and has lost nearly 45
kg since the
MVC.

MEDICAL HISTORY: MVC with liver lacs leading to necrotic liver lesion

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Dronabinol 2.5 mg PO BID
2. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
3. Calcium Carbonate 500 mg PO TID
4. Vitamin D 400 UNIT PO DAILY
5. Docusate Sodium 100 mg PO BID
6. Milk of Magnesia 30 mL PO DAILY:PRN constipation
7. Multivitamins 1 TAB PO DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 98.8, 118, 121/79, 20, 100%, 98.8 kg
Gen: Sl pale, more interactive
CV: Sl Tachy, reg rhythm
Lungs: CTA B/L
Abd: soft, mild tenderness most at drain site on rt lateral
abdomen and RUQ, Well healed abdominal incision, drain with
milky
light tan drainage, drain site slightly red with same tan
drainage around site and on dressing
Extr: no edema, 2+ DPs
Neuro: A+Ox3, Collar has been removed

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Supportive wife, works in construction building houses
(currently not working)
+ETOH, unknown tobacco/IVDU 

### Response:
{'Abscess of liver,Acute pancreatitis,Obstruction of bile duct,Peritoneal abscess,Unspecified protein-calorie malnutrition,Paralytic ileus,Unspecified pleural effusion,Adult failure to thrive'}
