CHIEF COMPLAINT: Peri-hepatic fluid collection, abdominal pain.

PRESENT ILLNESS: 79 M with recent history of cholangitis s/p uneventful ERCP
at [**Hospital1 18**] on [**8-31**] for removal of previous pancreatic stent and
sphincterotomy for papillary stenosis.  Original stent was
placed
[**8-27**] after failed attempts to cannulated the CBD for
cholangitis.
He subsequently underwent attempted CT guided percutaneous
transhepatic gallbladder drainage which also failed.  On [**8-31**] he
was transferred to the [**Hospital1 18**] where ERCP was successfully
performed.  His admission was complicated by AF with RVR, CHF,
and hypotension.  He was stablized and discharged on [**9-2**].

MEDICAL HISTORY: - HTN
- Hyperlipidemia
- Symptomatic AFIB - on coumadin, with pacer
- Psoriasis
- IBS
- Obesity
- hx bladder cancer, details unknown but pt states he was given
"clean [**Doctor First Name **] of health" by the treating urologist
- s/p at least 4 hernia repairs, one for bowel strangulation
which required resection

MEDICATION ON ADMISSION: Metoprolol Succinate 200', Lisinopril 20', Simvastatin 20',
Pantoprazole 40', Albuterol Sulfate 90 mcg/Actuation HFA Aerosol
Inhaler Q4-6 hours PRN shortness of breath or wheezing, Docusate
Sodium 100", Imodium A-D 2 mg PRN for diarrhea, Metronidazole
500 mg Q8H until [**2178-9-8**], Ciprofloxacin 500 mg Q12H until
[**2178-9-8**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals-97.5 78 100/60 20  95%RA
Gen- AxOx3, NAD
Irregularly Irregular
CTABL
Abd-Soft, NT, ND, R subcostal drain tube in place
Ext-no C/C/E

FAMILY HISTORY: Mother: colon cancer at 84, asthma.

SOCIAL HISTORY: Retired pharmacist.  Lives with wife. Supportive family.
Cardiac pacemaker in situ,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Obesity, unspecified,Cholangitis,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation
Status cardiac pacemaker,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx of bladder malignancy,Obesity NOS,Cholangitis,Pleural effusion NOS,Abn react-surg proc NEC,Atrial fibrillation
Admission Date:  [**2178-9-4**]              Discharge Date:   [**2178-9-8**]

Date of Birth:  [**2099-6-6**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Peri-hepatic fluid collection, abdominal pain.

Major Surgical or Invasive Procedure:
Interventional Radiology Subcostal fluid drainage


History of Present Illness:
79 M with recent history of cholangitis s/p uneventful ERCP
at [**Hospital1 18**] on [**8-31**] for removal of previous pancreatic stent and
sphincterotomy for papillary stenosis.  Original stent was
placed
[**8-27**] after failed attempts to cannulated the CBD for
cholangitis.
He subsequently underwent attempted CT guided percutaneous
transhepatic gallbladder drainage which also failed.  On [**8-31**] he
was transferred to the [**Hospital1 18**] where ERCP was successfully
performed.  His admission was complicated by AF with RVR, CHF,
and hypotension.  He was stablized and discharged on [**9-2**].

He presented to [**Hospital 47**] Hospital with c/o RUQ discomfort and
SOB. He was doing well, tolerating diet, and afebrile until 4AM
on the day of admission.  He awoke with chest discomfort, mild
SOB, and right upper quadrent discomfort and fullness.  He then
presented to the OSH.  CT scan demonstrated a right pleural
effusion and subdiaphragmatic fluid collection.  He was given IV
lasix and transferred to the [**Hospital1 18**] for further management.


Past Medical History:
- HTN
- Hyperlipidemia
- Symptomatic AFIB - on coumadin, with pacer
- Psoriasis
- IBS
- Obesity
- hx bladder cancer, details unknown but pt states he was given
"clean [**Doctor First Name **] of health" by the treating urologist
- s/p at least 4 hernia repairs, one for bowel strangulation
which required resection

Social History:
Retired pharmacist.  Lives with wife. Supportive family.


Family History:
Mother: colon cancer at 84, asthma.

Physical Exam:
Vitals-97.5 78 100/60 20  95%RA
Gen- AxOx3, NAD
Irregularly Irregular
CTABL
Abd-Soft, NT, ND, R subcostal drain tube in place
Ext-no C/C/E

Pertinent Results:
[**2178-9-4**] 12:26PM   LACTATE-1.4
[**2178-9-4**] 09:50AM   GLUCOSE-195* UREA N-16 CREAT-1.0 SODIUM-139
POTASSIUM-4.1 CHLORIDE-96 TOTAL CO2-37* ANION GAP-10
[**2178-9-4**] 09:50AM   ALT(SGPT)-45* AST(SGOT)-32 ALK PHOS-82 TOT
BILI-0.9
[**2178-9-4**] 09:50AM   LIPASE-20
[**2178-9-4**] 09:50AM   cTropnT-<0.01
[**2178-9-4**] 09:50AM URINE  HOURS-RANDOM
[**2178-9-4**] 09:50AM URINE  GR HOLD-HOLD
[**2178-9-4**] 09:50AM   WBC-11.1* RBC-4.18* HGB-14.0 HCT-42.0
MCV-101* MCH-33.5* MCHC-33.4 RDW-13.0
[**2178-9-4**] 09:50AM   NEUTS-87.4* LYMPHS-8.1* MONOS-3.8 EOS-0.4
BASOS-0.3
[**2178-9-4**] 09:50AM   PLT COUNT-265
[**2178-9-4**] 09:50AM   PT-15.7* PTT-24.2 INR(PT)-1.4*
[**2178-9-4**] 09:50AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.019
[**2178-9-4**] 09:50AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG

EKG
Atrial fibrillation with a mean ventricular rate of 101 with
ventricular
premature depolarizations and diffuse non-diagnostic
repolarization
abnormalities. No previous tracing available for comparison.


Brief Hospital Course:
Pt was admitted [**2178-9-4**] for symptoms previously described. He
went to IR for drainage of a peri-hepatic fluid collection and
was transferred to the floor in stable condition. He was NPO
except for his medications and was given IV fluid hydration and
was continued on his course of antibiotics. On the evening of
[**2178-9-4**] pt was noted to be in Afib with RVR with HR of
120-150's. His BP and other vitals were normal and the pt was in
stable condition, asymptomatic. An EKG was done which was
unchanged/normal. And a CXR was done which showed an unchanged R
pleural effusion. Pt was given a dose of lopressor followed by 3
doses of diltiazem which did not effectively lower his HR. Pt
was then transferred to the TSICU for closer monitoring. He was
started on PO diltiazem supplemented by IV boluses and his HR
was controlled. The next day [**2178-9-5**] pt was stable and HR was
controlled and he was transferredback tot he floor where he was
continued on diltiazem and lopressor PO with good rate control.
Pt was seen by the cardiology team who recommended continuing
diltiazem at 90QID with lopressor as needed and that he should
be discharged on this regimen to follow up with his regular
cardiologist as an outpatient. Pt continued to do well and the
ERCP/GI team recommended no role for ERCP at this time. Pt was
started on coumadin prior to discharge. Pt remained asymptomatic
and was tolerating a regular diet with minimal output from his
drain. Pt was ambulating and was stable to be DC'd home with
nursing services and drain care to follow up with Dr. [**Last Name (STitle) **] in
2 weeks.

Medications on Admission:
Metoprolol Succinate 200', Lisinopril 20', Simvastatin 20',
Pantoprazole 40', Albuterol Sulfate 90 mcg/Actuation HFA Aerosol
Inhaler Q4-6 hours PRN shortness of breath or wheezing, Docusate
Sodium 100", Imodium A-D 2 mg PRN for diarrhea, Metronidazole
500 mg Q8H until [**2178-9-8**], Ciprofloxacin 500 mg Q12H until
[**2178-9-8**]


Discharge Medications:
1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Diltiazem HCl 30 mg Tablet Sig: Three (3) Tablet PO QID (4
times a day).
Disp:*360 Tablet(s)* Refills:*2*
3. Warfarin 2 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).


Discharge Disposition:
Home With Service

Facility:
[**Last Name (un) 2646**] [**Last Name (un) 269**]

Discharge Diagnosis:
Cholangitis with perihepatic fluid collection s/p drainage and
placement of drain.

Afib with RVR


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


Discharge Instructions:
You were admitted after multiple procedures for the treatment of
cholangitis. You presented with a fluid collection around your
liver that was drained and a tube was kept in place. After this
procedure you went into atrial fibrillation witha  rapid heart
rate and were closely monitored and seen by the cardiology team.
Your heart rate was controlled and your medications were
changed.

Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
.
General Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**5-25**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.
Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.
JP Drain Care:
*Please look at the site every day for signs of infection
(increased redness or pain, swelling, odor, yellow or bloody
discharge, warm to touch, fever).
*Maintain suction of the bulb.
*Note color, consistency, and amount of fluid in the drain.
Call the doctor, nurse practitioner, or [**Month/Year (2) 269**] nurse if the amount
increases significantly or changes in character.
*Be sure to empty the drain frequently.  Record the output, if
instructed to do so.
*You may shower; wash the area gently with warm, soapy water.
*Keep the insertion site clean and dry otherwise.
*Avoid swimming, baths, hot tubs; do not submerge yourself in
water.
*Make sure to keep the drain attached securely to your body to
prevent pulling or dislocation.

General Drain Care:
*Please look at the site every day for signs of infection
(increased redness or pain, swelling, odor, yellow or bloody
discharge, warm to touch, fever).
*If the drain is connected to a collection container, please
note color, consistency, and amount of fluid in the drain.  Call
the doctor, nurse practitioner, or [**Month/Year (2) 269**] nurse if the amount
increases significantly or changes in character. Be sure to
empty the drain frequently.  Record the output, if instructed to
do so.
*Wash the area gently with warm, soapy water or 1/2 strength
hydrogen peroxide followed by saline rinse, pat dry, and place a
drain sponge. Change daily and as needed.
*Keep the insertion site clean and dry otherwise.
*Avoid swimming, baths, hot tubs; do not submerge yourself in
water.
*Make sure to keep the drain attached securely to your body to
prevent pulling or dislocation.
[**Month/Year (2) 269**] Drain Care Rx:
Drain Catheter: To gravity drainage. Cleanse insertion site with
1/2 strength hydrogen peroxide and rinse with saline moistened
q-tip or with mild soap and water.  Apply a drain sponge if
needed. Change dressing daily and as needed. Monitor for s/s
infection or dislocation. Check the patency of tube and that the
tube and drainage bag are secured to the patient. Monitor and
record quality and quantity of output.
PICC Line:
*Please monitor the site regularly, and [**Name6 (MD) 138**] your MD, nurse
practitioner, or [**Name6 (MD) 269**] Nurse if you notice redness, swelling,
tenderness or pain, drainage or bleeding at the insertion site.
* [**Name6 (MD) **] your MD [**First Name (Titles) **] [**Last Name (Titles) 10836**] to the Emergency Room immediately if
the PICC Line tubing becomes damaged or punctured, or if the
line is pulled out partially or completely.  DO NOT USE THE PICC
LINE IN THESE CIRCUMSTANCES.Please keep the dressing clean and
dry. Contact your [**Name2 (NI) 269**] Nurse if the dressing comes undone or is
significantly soiled for further instructions.
Outpatient TPN Labs:
Please check Chem10 (electrolytes, Magnesium, Calcium,
Phosphate, glucose), triglycerides, transferrin, TIBC, albumin,
ALT, AST, T.bili, ALP, amylase, lipase, and ferritin weekly. Fax
results to [**First Name4 (NamePattern1) 553**] [**Last Name (NamePattern1) 18971**], RD/[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 519**], MD at ([**Telephone/Fax (1) 18972**].
Call ([**Telephone/Fax (1) 18973**] with questions. Thank you.
Outpatient Ertepenem Labs:
While on IV Ertepenem, please check CBC with differential, BUN,
creatinine, ALT, AST, Tbili, ALP once weekly and fax results to
the Infectious Disease RN at ([**Telephone/Fax (1) 16411**].
Monitoring Ostomy output/Prevention of Dehydration:
*Keep well hydrated.
*Replace fluid loss from ostomy daily.
*Avoid only drinking plain water. Include Gatorade and/or other
vitamin drinks to replace fluid.
*Try to maintain ostomy output between 1000mL to 1500mL per day.

*If Ostomy output >1 liter, take 4mg of Imodium, repeat 2mg with
each episode of loose stool. Do not exceed 16mg/24 hours.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in clinic in 2 weeks.
{'Cardiac pacemaker in situ,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Obesity, unspecified,Cholangitis,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation'}


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: Peri-hepatic fluid collection, abdominal pain.

PRESENT ILLNESS: 79 M with recent history of cholangitis s/p uneventful ERCP
at [**Hospital1 18**] on [**8-31**] for removal of previous pancreatic stent and
sphincterotomy for papillary stenosis.  Original stent was
placed
[**8-27**] after failed attempts to cannulated the CBD for
cholangitis.
He subsequently underwent attempted CT guided percutaneous
transhepatic gallbladder drainage which also failed.  On [**8-31**] he
was transferred to the [**Hospital1 18**] where ERCP was successfully
performed.  His admission was complicated by AF with RVR, CHF,
and hypotension.  He was stablized and discharged on [**9-2**].

MEDICAL HISTORY: - HTN
- Hyperlipidemia
- Symptomatic AFIB - on coumadin, with pacer
- Psoriasis
- IBS
- Obesity
- hx bladder cancer, details unknown but pt states he was given
"clean [**Doctor First Name **] of health" by the treating urologist
- s/p at least 4 hernia repairs, one for bowel strangulation
which required resection

MEDICATION ON ADMISSION: Metoprolol Succinate 200', Lisinopril 20', Simvastatin 20',
Pantoprazole 40', Albuterol Sulfate 90 mcg/Actuation HFA Aerosol
Inhaler Q4-6 hours PRN shortness of breath or wheezing, Docusate
Sodium 100", Imodium A-D 2 mg PRN for diarrhea, Metronidazole
500 mg Q8H until [**2178-9-8**], Ciprofloxacin 500 mg Q12H until
[**2178-9-8**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals-97.5 78 100/60 20  95%RA
Gen- AxOx3, NAD
Irregularly Irregular
CTABL
Abd-Soft, NT, ND, R subcostal drain tube in place
Ext-no C/C/E

FAMILY HISTORY: Mother: colon cancer at 84, asthma.

SOCIAL HISTORY: Retired pharmacist.  Lives with wife. Supportive family. 

### Response:
{'Cardiac pacemaker in situ,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Obesity, unspecified,Cholangitis,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atrial fibrillation'}
