CHIEF COMPLAINT: Abdominal aortic aneurysm with right iliac
extension.

PRESENT ILLNESS: This 71 year-old male was noted
to have an elevated creatinine by routine screen at his
primary care physician's office and abdominal ultrasound
demonstrated abdominal aortic aneurysm. A CT scan was
performed which demonstrated a 5.4 to 6 cm juxtarenal
abdominal aortic aneurysm asymptomatic. Patient denies
abdominal pain, claudication, can play a round of golf
without symptoms. Denies rest pain, strokes, symptoms or
amaurosis. The patient now is admitted for preoperative IV
hydration for elective aortic repair.

MEDICAL HISTORY: No known drug allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of a myocardial infarction.
Mother with asthma and colon carcinoma.

SOCIAL HISTORY: The patient is a 50 pack year history of
smoking. He is a retired banker. He denies alcohol use.
Abdominal aneurysm without mention of rupture,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aneurysm of iliac artery,Pseudomonas infection in conditions classified elsewhere and of unspecified site
Abdom aortic aneurysm,Ac kidny fail, tubr necr,Urin tract infection NOS,Hyp kid NOS w cr kid V,CHF NOS,Ac posthemorrhag anemia,Iliac artery aneurysm,Pseudomonas infect NOS
Admission Date: [**2179-11-21**]        Discharge Date: [**2179-12-11**]

Date of Birth:  [**2108-7-30**]        Sex:  M

Service:  VSU


CHIEF COMPLAINT:  Abdominal aortic aneurysm with right iliac
extension.

HISTORY OF PRESENT ILLNESS:  This 71 year-old male was noted
to have an elevated creatinine by routine screen at his
primary care physician's office and abdominal ultrasound
demonstrated abdominal aortic aneurysm. A CT scan was
performed which demonstrated a 5.4 to 6 cm juxtarenal
abdominal aortic aneurysm asymptomatic. Patient denies
abdominal pain, claudication, can play a round of golf
without symptoms. Denies rest pain, strokes, symptoms or
amaurosis. The patient now is admitted for preoperative IV
hydration for elective aortic repair.

PAST MEDICAL HISTORY:  No known drug allergies.

MEDICATIONS:  Felodipine 10 mg daily, atenolol 50 mg daily,
simvastatin 20 mg daily.

ILLNESSES:  Include hypertension, hypercholesterolemia,
chronic renal insufficiently. The patient had a PMIBI which
was negative and ejection fraction was calculated at 57%.

PAST SURGICAL HISTORY:  Tonsillectomy.

SOCIAL HISTORY:  The patient is a 50 pack year history of
smoking. He is a retired banker. He denies alcohol use.

FAMILY HISTORY:  Father died of a myocardial infarction.
Mother with asthma and colon carcinoma.

PHYSICAL EXAMINATION:  Vital signs: 98, 60, 16, blood
pressure 170/90, O2 saturation 99% on room air. General
appearance: This is an alert, cooperative white male in no
acute distress. Head, eyes, ears, nose and throat examination
shows 2+ carotids bilaterally without bruits. Chest is
diminished in sound but clear to auscultation. Heart has a
regular rate and rhythm. Abdominal examination is soft,
nontender, nondistended with a palpable aorta. The pulse
examination shows 2+ radials, dorsalis pedis and posterior
tibials bilaterally palpable.

HOSPITAL COURSE:  The patient was admitted to the vascular
service on [**11-21**] and IV hydration was begun in
anticipation for surgery. The patient underwent an open
repair of the juxtarenal abdominal aortic aneurysm and right
iliac aneurysm. He tolerated the procedure well and was
transferred to the post anesthesia care unit in stable
condition. Epidural catheter was placed intraoperatively for
analgesic control. The patient developed overnight oliguria
and renal was consulted, recommendations were to maintain a
systolic blood pressure greater than 140 to 160, volume
repletion, rule out for myocardial infarction and cardiac
enzymes were negative. Postoperative day 2 the patient was
begun a pressor support trial which he failed and remained
intubated. Postoperative day 3 the epidural was discontinued
and the patient was put back on assist control for blood gas
of 7.29, 37, 114, 19 and 7. His creatinine was stable at 3.9.
Although he had diminished urinary output an ultrasound of
the renals were obtained which showed echogenicity consistent
with chronic cystic renal disease without obstructive
disease. On [**11-26**] tube feeds were begun. On [**11-27**]
his CVL was changed and trialed to wean to extubate which
failed. The patient required 2 units of packed red blood
cells on [**11-26**]. On [**11-29**] the nasogastric tube
trial was clamped. The patient's tube feeds were held
secondary to residuals greater than 150. Patient developed a
temperature. CT of the abdomen was obtained which showed
gallbladder thickening. There was no obstructive disease or
ischemic disease noted. Blood and urine cultures were
obtained. Patient's blood, urine and sputum cultures were all
negative. The urine culture did grow pseudomonas which was
pansensitive. The patient was begun on Levofloxacin at that
time. CT scan showed no retroperitoneal hematoma. There was a
small amount of hyperdense fluid in the dependent pelvis in
keeping with the recent blood products. A moderate
atelectasis in the dependent lower lobes from basilar pleural
effusions, a moderately distended, mildly thickened
gallbladder. The wall thickening may be due to patient's low
albumin rather than inflammatory process. There was no other
intraoperative findings on CT. General surgery was consulted
regarding patient with postoperative fever, undetermined
etiology, looking for an intra-abdominal source. After
examining the patient and review of the patient's CT and
gallbladder ultrasound I felt there was no intra-abdominal
source. Recommendations were serial examinations and re-
evaluation if there were clinical changes. On [**11-30**] the
patient was successfully extubated. On [**12-1**] patient
continued to have episodes of hypertension requiring
adjustment in his beta blockade and hydralazine. His central
line was changed at that time. On [**12-2**] his antibiotics
were discontinued and his nasogastric tube was discontinued.
Thoughts were that he might require a bedside swallow but
this was reviewed and decided it was not necessary. The
patient did have episodes of hyperglycemia while on total
parenteral nutrition requiring IV insulin drip or glycemic
control. The patient's Foley was changed and Zosyn was added
as double coverage for the pseudomonas. A repeat urine
culture was sent which was positive for pseudomonas. The
patient's continued to do well and was transferred to the VCU
on [**2179-12-3**]. P.o.s were begun with sips and on the
19th the patient's diet was advanced secondary to passing
flatus. Procrit was begun at 10,000 units twice a week which
will be given at dialysis. Patient's renal function remained
with an elevated creatinine between 3.6 and 4.6. The patient
was placed on dialysis on [**12-8**]. His total parenteral
nutrition was discontinued and his diet was advanced as
tolerated. The remaining of the hospital course was
unremarkable. The patient will be discharged to
rehabilitation when bed is available and renal is satisfied
with patient's renal function. The last hemodialysis was
[**2179-12-10**].

DISCHARGE DIAGNOSIS:
1.  Juxtarenal abdominal aortic aneurysm and right iliac
    aneurysm, status post repair on [**2179-11-22**].
2.  Chronic renal insufficiency compounded with postoperative
    acute tubular necrosis and acute renal failure.
    Hemodialysis access catheter placed [**2179-12-8**].
3.  Postoperative blood loss anemia, transfused, corrected.
4.  Postoperative failure to extubate secondary to volume
    overload, corrected.
5.  Postoperative fever, treated.
6.  Postoperative pseudomonas urinary tract infection,
    treated.
7.  Postoperative hypertension, corrected.
8.  Postoperative hyperglycemia, treated.

DISCHARGE MEDICATIONS:  Albuterol aerosol 1 to 2 inhalations
q 6 hours p.r.n., ipratropium bromide aerosol puffs 2
inhalations q 4 to 6 hours p.r.n., acetaminophen 650 mg
suppository q 6 hours p.r.n., acetylcholine 20% solution 1 cc
aerosol q 4 to 6 hours p.r.n., levofloxacin 250 mg q 4 to 6
hours for a total of 6 more days on [**12-10**] which is day
8 out of 14 days of antibiotic course. Protonix 40 mg q.d.,
Colace 100 mg b.i.d., hold for loose stools, metoprolol
partate 100 mg t.i.d., hydralazine 50 mg q 6 hours,
hydromorphone tablets 2 mg tablets 1 to 2 q 4 hours p.r.n.
for pain, amlodipine 5 mg daily, parconazole nitrate powder
to affected areas b.i.d., nystatin Swish and Swallow 5 cc q 6
hours p.r.n., Zolpidem 5 mg q.h.s. as needed, vitamin B
complex capsule daily as needed.

Patient should follow up with Dr. [**Last Name (STitle) **] as directed and call
for an appointment at [**Telephone/Fax (1) 1241**].



                        [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3186**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2179-12-10**] 13:10:00
T:  [**2179-12-10**] 15:57:50
Job#:  [**Job Number **]


Name:  [**Known lastname 17007**],[**Known firstname 5173**]                   Unit No:   [**Numeric Identifier 17008**]

Admission Date:  [**2179-11-21**]              Discharge Date:   [**2179-12-14**]

Date of Birth:  [**2108-7-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 270**]
Addendum:
Pt Discharged on [**2179-12-15**]

Pt has been set up for hemodialysis at the [**Last Name (un) **] Kidney Center
in [**Location (un) 50**], Ma.

He will recieve Hemodialysis on TUES / THURS / SAT.

Renal is aware and approves of the plan.

Pt to go home with VNA services - for Hickman cath / PT / wound
care.

On DC, pt is stable.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 272**] MD [**MD Number(1) 273**]

Completed by:[**2179-12-14**]
{'Abdominal aneurysm without mention of rupture,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aneurysm of iliac artery,Pseudomonas infection in conditions classified elsewhere and of unspecified site'}


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: Abdominal aortic aneurysm with right iliac
extension.

PRESENT ILLNESS: This 71 year-old male was noted
to have an elevated creatinine by routine screen at his
primary care physician's office and abdominal ultrasound
demonstrated abdominal aortic aneurysm. A CT scan was
performed which demonstrated a 5.4 to 6 cm juxtarenal
abdominal aortic aneurysm asymptomatic. Patient denies
abdominal pain, claudication, can play a round of golf
without symptoms. Denies rest pain, strokes, symptoms or
amaurosis. The patient now is admitted for preoperative IV
hydration for elective aortic repair.

MEDICAL HISTORY: No known drug allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of a myocardial infarction.
Mother with asthma and colon carcinoma.

SOCIAL HISTORY: The patient is a 50 pack year history of
smoking. He is a retired banker. He denies alcohol use. 

### Response:
{'Abdominal aneurysm without mention of rupture,Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Acute posthemorrhagic anemia,Aneurysm of iliac artery,Pseudomonas infection in conditions classified elsewhere and of unspecified site'}
