CHIEF COMPLAINT: Bile Leak

PRESENT ILLNESS: 62yo M POD#2 s/p LSC CCY at [**Hospital3 2568**] transferred for
management of suspected bile leak. He had an otherwise
uncomplicated CCY [**5-9**] after presenting to the [**Hospital3 **] ED with
biliary colic. His post-operative course was notable for
increased abdominal pain. He began to show peritoneal signs with
increased distention today. A RUQ ultrasound at Mt. A was
inconclusive, and a HIDA was performed today which showed
contrast leaking to the gallbladder fossa and the peritoneal
cavity as well as transit to the small bowel.

MEDICAL HISTORY: PMH: HTN, hyperlipidemia
PSH: LSC CCY

MEDICATION ON ADMISSION: Medications:
lisinopril 10mg PO QD
lipitor 10mg PO daily
aspirin 81mg Po daily
multivitamin daily
.
Medications on transfer

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
Gen: NAD, appears slightly somnolent but interactive
Cor: slightly tachycardic, normal S1 and S2, no m/r/g
Lungs: CTAB
Abdomen: Obese, distended and somewhat firm. TTP throughout but
particularly RUQ. No rebound, mild anticipatory guarding. BS
absent.
LE: NT, NE

FAMILY HISTORY: NC

SOCIAL HISTORY: Unemployed, used to work on computers. Drinks ~1 glass
wine/night, denies tobacco or illicits.
Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Alkalosis,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Acute respiratry failure,Food/vomit pneumonitis,Alkalosis,Delirium d/t other cond,Hypertension NOS,Hyperlipidemia NEC/NOS,Abn react-surg proc NEC
Name:  [**Known lastname 12703**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 13713**]

Admission Date:  [**2143-5-11**]              Discharge Date:   [**2143-5-16**]

Date of Birth:  [**2080-10-9**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 10794**]
Addendum:
[**2143-5-15**]

HTN: Mr [**Known lastname **] was hypertensive to 180/100, we has restarted on
his home dose of lisinopril and given lasix (20mg PO) for
ongoing diuresis. Ongoing BP medication titration may be needed.

Delirium: The patient remains disoriented to hospital name and
date. However he has continued to improve since extubation and
is able to respond to questioning coherently. Thought to be
secondary to residual sedation medication (received fentanyl and
dilaudid post extubation) and ICU delirium


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 13714**] - [**Hospital1 15**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 10795**] MD, [**MD Number(3) 10796**]

Completed by:[**2143-5-15**]

Admission Date:  [**2143-5-11**]              Discharge Date:   [**2143-5-16**]

Date of Birth:  [**2080-10-9**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 5188**]
Chief Complaint:
Bile Leak


Major Surgical or Invasive Procedure:
1) ERCP
2) bronchoscopy


History of Present Illness:
62yo M POD#2 s/p LSC CCY at [**Hospital3 2568**] transferred for
management of suspected bile leak. He had an otherwise
uncomplicated CCY [**5-9**] after presenting to the [**Hospital3 **] ED with
biliary colic. His post-operative course was notable for
increased abdominal pain. He began to show peritoneal signs with
increased distention today. A RUQ ultrasound at Mt. A was
inconclusive, and a HIDA was performed today which showed
contrast leaking to the gallbladder fossa and the peritoneal
cavity as well as transit to the small bowel.

Given the anticipated need for urgent intervention, including
ERCP and likely percutaneous drain placement, Mr. [**Known lastname **] was
transferred to [**Hospital1 18**].

Prior to transfer, he had been receiving both toradol and
dilaudid for pain. He was started on Flagyl and Levofloxacin.
His
vital signs were stable prior to transfer. He had an NGT and a
foley placed. He was made NPO.

He currently feels like his pain is well-controlled. He denies
CP, but does have abdominal pain with deep inspirations.


Past Medical History:
PMH: HTN, hyperlipidemia
PSH: LSC CCY


Social History:
Unemployed, used to work on computers. Drinks ~1 glass
wine/night, denies tobacco or illicits.


Family History:
NC

Physical Exam:
On Admission:
Gen: NAD, appears slightly somnolent but interactive
Cor: slightly tachycardic, normal S1 and S2, no m/r/g
Lungs: CTAB
Abdomen: Obese, distended and somewhat firm. TTP throughout but
particularly RUQ. No rebound, mild anticipatory guarding. BS
absent.
LE: NT, NE


Pertinent Results:
ADMISSION LABS:
[**2143-5-11**] 09:30PM   WBC-14.3* RBC-3.95* HGB-12.9* HCT-37.1*
MCV-94 MCH-32.7* MCHC-34.9 RDW-13.2
[**2143-5-11**] 09:30PM   NEUTS-93.6* LYMPHS-3.9* MONOS-2.1 EOS-0.4
BASOS-0.1
[**2143-5-11**] 09:30PM   PLT COUNT-192
[**2143-5-11**] 09:30PM   PT-13.5* PTT-25.2 INR(PT)-1.2*
[**2143-5-11**] 09:30PM   GLUCOSE-157* UREA N-22* CREAT-0.9 SODIUM-137
POTASSIUM-3.7 CHLORIDE-96 TOTAL CO2-35* ANION GAP-10
[**2143-5-11**] 09:30PM   ALT(SGPT)-44* AST(SGOT)-34 ALK PHOS-57
AMYLASE-54 TOT BILI-5.9* DIR BILI-3.3* INDIR BIL-2.6
[**2143-5-11**] 09:30PM   LIPASE-27
.
.
CT abdomen/Pelvis [**5-11**]
Small amount of fluid and air in gallbladder fossa, which could
be from recent cholecystectomy. small amount of perihepatic
fluid and small amount of fluid tracking along the right
paracolic gutter into the pelvis which could be consistent with
a bile leak.
small hiatal hernia. small right sided pleural effusion with
adjacent compressive atelectasis.
.
CXR [**5-12**]: Low lung volumes with increased vascular diameter,
cardiomegaly, widened mediastinum.  atelectasis at right base.
no pleural effusions or consilidations.  ETT 6cm above carina.
NGT in place.


Brief Hospital Course:
62M POD #3 s/p cholecystectomy at OSH, complicated by bile leak,
transferred to [**Hospital1 18**] for ERCP from [**Last Name (un) 1724**]. The ERCP on [**5-12**] showed
a bile leak from the cystic duct. A sphincterotomy was performed
with placement of biliary and pancreatic duct stents. The ERCP
service recommends repeat for removal of stents in three weeks.
His Aspirin and Plavix were held, and should restart [**5-17**].
During his MAC sedation he had a hypoxic event likely due to
aspiration. He was empirically started on levofloxacin and
flagyl. Flagyl was discontinued on [**5-13**]. As of [**5-14**] he is stable
and ready for transfer back to [**Hospital6 2561**].


Medications on Admission:
Medications:
lisinopril 10mg PO QD
lipitor 10mg PO daily
aspirin 81mg Po daily
multivitamin daily
.
Medications on transfer


Discharge Medications:
1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of
breath or wheezing  2. Levofloxacin 500 mg IV Q24H
3. Famotidine 20 mg IV Q12H
4. Furosemide 40 mg IV ONCE
5. HYDROmorphone (Dilaudid) 0.25 mg IV ONCE

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2561**] - [**Hospital1 8**]

Discharge Diagnosis:
bile leak status post laparoscopic cholecystectomy


Discharge Condition:
per receiving facility, is alert and responsive on discharge


Discharge Instructions:
Patient being transferred to [**Hospital6 2561**] for
continuation of care (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], surgical service)

Followup Instructions:
resume previous care


                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Alkalosis,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Bile Leak

PRESENT ILLNESS: 62yo M POD#2 s/p LSC CCY at [**Hospital3 2568**] transferred for
management of suspected bile leak. He had an otherwise
uncomplicated CCY [**5-9**] after presenting to the [**Hospital3 **] ED with
biliary colic. His post-operative course was notable for
increased abdominal pain. He began to show peritoneal signs with
increased distention today. A RUQ ultrasound at Mt. A was
inconclusive, and a HIDA was performed today which showed
contrast leaking to the gallbladder fossa and the peritoneal
cavity as well as transit to the small bowel.

MEDICAL HISTORY: PMH: HTN, hyperlipidemia
PSH: LSC CCY

MEDICATION ON ADMISSION: Medications:
lisinopril 10mg PO QD
lipitor 10mg PO daily
aspirin 81mg Po daily
multivitamin daily
.
Medications on transfer

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
Gen: NAD, appears slightly somnolent but interactive
Cor: slightly tachycardic, normal S1 and S2, no m/r/g
Lungs: CTAB
Abdomen: Obese, distended and somewhat firm. TTP throughout but
particularly RUQ. No rebound, mild anticipatory guarding. BS
absent.
LE: NT, NE

FAMILY HISTORY: NC

SOCIAL HISTORY: Unemployed, used to work on computers. Drinks ~1 glass
wine/night, denies tobacco or illicits. 

### Response:
{'Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Alkalosis,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
