CHIEF COMPLAINT: Morbid obesity

PRESENT ILLNESS: [**Known firstname **] has class II/class III borderline severe/morbid obesity
with weight of 230 lbs as of [**2101-5-19**] (initial screen weight on
[**2101-4-20**] was 225.6 lbs), height of 64 inches and BMI of 39.6. His
12 weeks of exercise program in [**2099**] losing 15 lbs that he
maintained for 6 months, Weight Watchers in [**2098**] without much
results, 12 weeks of the South Beach diet in [**2097**] losing 15 lbs
that he regained after 6 months and 12-14 weeks of HMR in [**2094**]
losing 25 lbs that he kept off for 8 months. He has tried both
hypnosis and acupuncture for weight loss without any results. He
has not taken prescription weight loss medications or used
over-the-counter ephedra-containing dietary aids/appetite
suppressants or herbal supplements. He weighed 120 lbs at age 21
his lowest adult weight with his highest weight being his
current
weight of 230 lbs. He weighed 212 lbs one year ago. He stated he
developed significant [**Last Name 4977**] problem in his 20's and cites as
factors contributing to his excess weight large portions,
inconsistent meal schedules, frequent eating out, emotional
eating, bingeing out of habit not due to hunger and lack of
exercise. He denied history of eating disorders. He has h/o
depression as well as attention deficit disorder followed in
counseling by a therapist and on psychotropic medications.

MEDICAL HISTORY: His medical history is significant for coronary artery disease
s/p non-ST elevation MI in [**2095**] with cardiac catheterization
demonstrating borderline 60% LAD lesion, type 2 diabetes,
hypertension, sleep apnea on BiPAP, dyslipidemia, GERD with
hiatal hernia and h/o Schatzki's ring s/p dilation in [**2092**] and
several previously ([**2083**] and [**2087**]), diverticular disease with
sigmoid sessile polyp s/p colonoscopy in [**2098**], psoriasis,
osteoarthritis of finger joints and back pain.

MEDICATION ON ADMISSION: ASA 81, Toprol XL 100', Altace 2.5', Lipitor 20', Norvasc 5',
Glyburide 15', Metformin 1g'', Celexa 40', Adderall XR 20', MVI

ALLERGIES: Penicillins

PHYSICAL EXAM: His skin was warm and dry.  Pupils were equal, round, and
reactive to light, sclerae were anicteric, conjunctivae clear.
Oropharynx was pink and moist.  The trachea was midline and
there was no jugular venous distension or bruits.  His lungs
were clear to auscultation bilaterally with no crackles,
wheezes, or ronchi.  Heart sounds were regular rate and rhythm
with no murmurs, gallops, or rubs.  Abdomen was obese, soft,
nontender, nondistended, with bowel sounds.  His extremities
were without cyanosis, clubbing, or edema, and peripheral pulses

FAMILY HISTORY: Family history is noted for father deceased age [**Age over 90 **] of MI with
h/o
hyperlipidemia, diabetes, stroke, arthritis and cancer; mother
deceased age 82 with asthma, diabetes and obesity; younger
siblings with h/o skin cancer; family h/o colon cancer.

SOCIAL HISTORY: He does not smoke and has not used
recreational drugs, has occasional glass of wine, no caffeinated
beverages, drinks carbonated beverages 5 times a week.
Morbid obesity,Stricture and stenosis of esophagus,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Morbid obesity,Esophageal stricture,Hypertension NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Diaphragmatic hernia,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2101-6-20**]              Discharge Date:   [**2101-6-26**]

Date of Birth:  [**2041-3-4**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Morbid obesity

Major Surgical or Invasive Procedure:
1.  Laparoscopic adjustable gastric band.
2.  Repair of hiatal hernia.

History of Present Illness:
[**Known firstname **] has class II/class III borderline severe/morbid obesity
with weight of 230 lbs as of [**2101-5-19**] (initial screen weight on
[**2101-4-20**] was 225.6 lbs), height of 64 inches and BMI of 39.6. His
12 weeks of exercise program in [**2099**] losing 15 lbs that he
maintained for 6 months, Weight Watchers in [**2098**] without much
results, 12 weeks of the South Beach diet in [**2097**] losing 15 lbs
that he regained after 6 months and 12-14 weeks of HMR in [**2094**]
losing 25 lbs that he kept off for 8 months. He has tried both
hypnosis and acupuncture for weight loss without any results. He
has not taken prescription weight loss medications or used
over-the-counter ephedra-containing dietary aids/appetite
suppressants or herbal supplements. He weighed 120 lbs at age 21
his lowest adult weight with his highest weight being his
current
weight of 230 lbs. He weighed 212 lbs one year ago. He stated he
developed significant [**Last Name 4977**] problem in his 20's and cites as
factors contributing to his excess weight large portions,
inconsistent meal schedules, frequent eating out, emotional
eating, bingeing out of habit not due to hunger and lack of
exercise. He denied history of eating disorders. He has h/o
depression as well as attention deficit disorder followed in
counseling by a therapist and on psychotropic medications.

Past Medical History:
His medical history is significant for coronary artery disease
s/p non-ST elevation MI in [**2095**] with cardiac catheterization
demonstrating borderline 60% LAD lesion, type 2 diabetes,
hypertension, sleep apnea on BiPAP, dyslipidemia, GERD with
hiatal hernia and h/o Schatzki's ring s/p dilation in [**2092**] and
several previously ([**2083**] and [**2087**]), diverticular disease with
sigmoid sessile polyp s/p colonoscopy in [**2098**], psoriasis,
osteoarthritis of finger joints and back pain.

Social History:
He does not smoke and has not used
recreational drugs, has occasional glass of wine, no caffeinated
beverages, drinks carbonated beverages 5 times a week.

Family History:
Family history is noted for father deceased age [**Age over 90 **] of MI with
h/o
hyperlipidemia, diabetes, stroke, arthritis and cancer; mother
deceased age 82 with asthma, diabetes and obesity; younger
siblings with h/o skin cancer; family h/o colon cancer.

Physical Exam:
His skin was warm and dry.  Pupils were equal, round, and
reactive to light, sclerae were anicteric, conjunctivae clear.
Oropharynx was pink and moist.  The trachea was midline and
there was no jugular venous distension or bruits.  His lungs
were clear to auscultation bilaterally with no crackles,
wheezes, or ronchi.  Heart sounds were regular rate and rhythm
with no murmurs, gallops, or rubs.  Abdomen was obese, soft,
nontender, nondistended, with bowel sounds.  His extremities
were without cyanosis, clubbing, or edema, and peripheral pulses

were 2+ at all four extremities.  There were no focal
neurological deficits.

Pertinent Results:
STUDY: Barium esophagram upper GI study with KUB.

INDICATION: 66-year-old male status post gastric banding. Please
assess for passage of contrast exam.

COMPARISONS: None.

FINDINGS: A single scout view demonstrates no free air beneath
the diaphragms. There is marked distension of the dtomach distal
to the band. The gastric band can be seen in the left upper
abdomen.Watewr soluble contrast followed by thin barium was used
in this examination. Contrast was demonstrated to flow freely
through the esophagus and through the region of the gastric
band. There is no evidence of obstruction or leak.

IMPRESSION: Status post gastric banding. No evidence of leak or
obstruction. Distended stomach distal to band

[**2101-6-21**] 04:35PM BLOOD WBC-9.9 RBC-4.53* Hgb-13.0* Hct-37.9*
MCV-84 MCH-28.7 MCHC-34.3 RDW-14.6 Plt Ct-239
[**2101-6-21**] 04:35PM BLOOD Glucose-111* UreaN-7 Creat-0.7 Na-138
K-3.9 Cl-98 HCO3-29 AnGap-15
[**2101-6-22**] 09:33AM BLOOD Type-ART pO2-63* pCO2-56* pH-7.39
calTCO2-35* Base XS-6

Brief Hospital Course:
See post-operative report dictated [**2101-6-20**] for details of the
procedure.  Mr. [**Known lastname 32729**] was admitted to the floor from the
PACU postoperatively in stable condition.  On POD 1, he
underwent a swallow study which showed no evidence of leak or
obstruction, but there was gastric distension distal to the
band.  Radiology attempted passage of a pediatric NG tube under
fluoroscopic guidance, but this was unsuccessful.  Soon after
the patient returned to the floor, he began to develop increased
abdominal distension and tenseness, and complained of feeling
"funny", was diaphoretic, restless, and anxious.  That evening,
his O2 saturation dropped to 81% on 4L NC, so he was switched to
a mask with 10L O2, on which he was still satting only 89-91.  A
trigger was called, he was placed on NRB on which he satted up
to 98%, and the decision was made to transfer him to the SICU.

GI was consulted to perform upper endoscopy, which was notable
only for stomach dilated with air.  No Schatzki's ring was seen,
and the scope passed readily into the duodenum.  Subsequently an
NG tube was inserted blindly by Dr. [**Last Name (STitle) **] and placed to wall
suction, with immediate relief of the patient's abdominal
discomfort.  He pulled out his own NGT the next day, but as he
was passing flatus and no longer distended, the decision was
made to transfer him back to the floor.

Back on the floor, Mr. [**Known lastname 32729**] [**Last Name (Titles) 27836**] quite well, and he
was advanced through to stage III diet by POD 5.  He tolerated
his diet well, was urinating well, and had rapid return of bowel
function, so the decision was made to discharge him to home in
good condition on POD 6.

Medications on Admission:
ASA 81, Toprol XL 100', Altace 2.5', Lipitor 20', Norvasc 5',
Glyburide 15', Metformin 1g'', Celexa 40', Adderall XR 20', MVI

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed.
Disp:*250 ML(s)* Refills:*2*
2. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO twice a
day.
3. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
Tablet(s)


Discharge Disposition:
Home

Discharge Diagnosis:
Morbid obesity


Discharge Condition:
good.


Discharge Instructions:
Please call your surgeon or return to the emergency department
if you
develop a fever greater than 101.5, chest pain, shortness of
breath, severe abdominal pain, pain unrelieved by your pain
medication, severe nausea or vomiting, severe abdominal
bloating, inability to eat or drink, foul smelling or colorful
drainage from your incisions, redness or swelling around your
incisions, or any other symptoms which are concerning to you.

Diet:
Stay in Stage III diet until your follow up appointment. Do not
self advance diet, do not drink out of a straw or chew gum.

Medication Instructions:

Resume your home medications, CRUSH ALL PILLS.

You will be starting some new medications:
1.  You will be given a prescription for pain medication, which
may make you drowsy. Do not drive while taking pain medication.
2. You should begin taking a Flintstones chewable complete
multivitamin. No gummy vitamins.
3. You should take a stool softener, Colace, twice daily for
constipation as needed, or until you resume a normal bowel
pattern.

Activity:
No heavy lifting of items [**10-3**] pounds for 6 weeks. You may
resume moderate exercise at your discretion, no abdominal
exercises.

Wound Care:
You may shower, no tub baths or swimming. If there is clear
drainage from your incisions, cover with clean, dry gauze. Leave
white strips above your incisions in place, allow them to fall
off on their own.

Followup Instructions:
Please call Dr. [**Last Name (STitle) 15645**] office to schedule a followup appointment
if you do not already have one



Completed by:[**2101-6-26**]
{'Morbid obesity,Stricture and stenosis of esophagus,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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: Morbid obesity

PRESENT ILLNESS: [**Known firstname **] has class II/class III borderline severe/morbid obesity
with weight of 230 lbs as of [**2101-5-19**] (initial screen weight on
[**2101-4-20**] was 225.6 lbs), height of 64 inches and BMI of 39.6. His
12 weeks of exercise program in [**2099**] losing 15 lbs that he
maintained for 6 months, Weight Watchers in [**2098**] without much
results, 12 weeks of the South Beach diet in [**2097**] losing 15 lbs
that he regained after 6 months and 12-14 weeks of HMR in [**2094**]
losing 25 lbs that he kept off for 8 months. He has tried both
hypnosis and acupuncture for weight loss without any results. He
has not taken prescription weight loss medications or used
over-the-counter ephedra-containing dietary aids/appetite
suppressants or herbal supplements. He weighed 120 lbs at age 21
his lowest adult weight with his highest weight being his
current
weight of 230 lbs. He weighed 212 lbs one year ago. He stated he
developed significant [**Last Name 4977**] problem in his 20's and cites as
factors contributing to his excess weight large portions,
inconsistent meal schedules, frequent eating out, emotional
eating, bingeing out of habit not due to hunger and lack of
exercise. He denied history of eating disorders. He has h/o
depression as well as attention deficit disorder followed in
counseling by a therapist and on psychotropic medications.

MEDICAL HISTORY: His medical history is significant for coronary artery disease
s/p non-ST elevation MI in [**2095**] with cardiac catheterization
demonstrating borderline 60% LAD lesion, type 2 diabetes,
hypertension, sleep apnea on BiPAP, dyslipidemia, GERD with
hiatal hernia and h/o Schatzki's ring s/p dilation in [**2092**] and
several previously ([**2083**] and [**2087**]), diverticular disease with
sigmoid sessile polyp s/p colonoscopy in [**2098**], psoriasis,
osteoarthritis of finger joints and back pain.

MEDICATION ON ADMISSION: ASA 81, Toprol XL 100', Altace 2.5', Lipitor 20', Norvasc 5',
Glyburide 15', Metformin 1g'', Celexa 40', Adderall XR 20', MVI

ALLERGIES: Penicillins

PHYSICAL EXAM: His skin was warm and dry.  Pupils were equal, round, and
reactive to light, sclerae were anicteric, conjunctivae clear.
Oropharynx was pink and moist.  The trachea was midline and
there was no jugular venous distension or bruits.  His lungs
were clear to auscultation bilaterally with no crackles,
wheezes, or ronchi.  Heart sounds were regular rate and rhythm
with no murmurs, gallops, or rubs.  Abdomen was obese, soft,
nontender, nondistended, with bowel sounds.  His extremities
were without cyanosis, clubbing, or edema, and peripheral pulses

FAMILY HISTORY: Family history is noted for father deceased age [**Age over 90 **] of MI with
h/o
hyperlipidemia, diabetes, stroke, arthritis and cancer; mother
deceased age 82 with asthma, diabetes and obesity; younger
siblings with h/o skin cancer; family h/o colon cancer.

SOCIAL HISTORY: He does not smoke and has not used
recreational drugs, has occasional glass of wine, no caffeinated
beverages, drinks carbonated beverages 5 times a week. 

### Response:
{'Morbid obesity,Stricture and stenosis of esophagus,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diaphragmatic hernia without mention of obstruction or gangrene,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
