CHIEF COMPLAINT: Abdominal pain.

PRESENT ILLNESS: This 68 year-old gentleman with
abdominal pain x 6 weeks with sudden onset associated with
eating, occurs 15 minutes post eating and lasts several
hours. Partially relieved with Darvocet. The patient had a
diagnostic work-up at an outside hospital for mesenteric
ischemia which was positive.

MEDICAL HISTORY: Peripheral vascular disease, status
post angioplasty and stenting of the right lower extremity in
[**2143**].  Vessel angioplastied is now known. History of
hypertension, controlled.

MEDICATION ON ADMISSION: Atenolol 100 mg daily,
hydrochlorothiazide 25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive in the father for liver disease.
Mother myocardial infarction and breast cancer.

SOCIAL HISTORY: The patient is a 12 pack per week beer
drinker. History of copious alcohol use previously.  One and
1/2 packs per day times 55 years smoking, which is current.
Acute vascular insufficiency of intestine,Atrial fibrillation,Acute pancreatitis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Seroma complicating a procedure,Alcohol abuse, unspecified,Toxic encephalopathy,Alcoholic cirrhosis of liver,Acidosis,Atherosclerosis of native arteries of the extremities with rest pain,Unspecified essential hypertension,Candidiasis of other urogenital sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere
Ac vasc insuff intestine,Atrial fibrillation,Acute pancreatitis,Pneumonia, organism NOS,Thrombocytopenia NOS,Seroma complicting proc,Alcohol abuse-unspec,Toxic encephalopathy,Alcohol cirrhosis liver,Acidosis,Ath ext ntv at w rst pn,Hypertension NOS,Candidias urogenital NEC,DMII wo cmp nt st uncntr,Delirium d/t other cond
Admission Date: [**2152-1-18**]        Discharge Date:

Date of Birth:  [**2083-2-25**]        Sex:  M

Service:  VSU


CHIEF COMPLAINT:  Abdominal pain.

HISTORY OF PRESENT ILLNESS:  This 68 year-old gentleman with
abdominal pain x 6 weeks with sudden onset associated with
eating, occurs 15 minutes post eating and lasts several
hours. Partially relieved with Darvocet. The patient had a
diagnostic work-up at an outside hospital for mesenteric
ischemia which was positive.

REVIEW OF SYSTEMS:  Positive for weight loss, nausea,
vomiting, diarrhea, shortness of breath. He denies chest pain
or night sweats.  The patient now is admitted for
prehydration prior to undergoing mesenteric ischemic
revascularization.

PAST MEDICAL HISTORY:  Peripheral vascular disease, status
post angioplasty and stenting of the right lower extremity in
[**2143**].  Vessel angioplastied is now known. History of
hypertension, controlled.

PAST SOCIAL HISTORY:  The patient is a 12 pack per week beer
drinker. History of copious alcohol use previously.  One and
1/2 packs per day times 55 years smoking, which is current.

FAMILY HISTORY:  Positive in the father for liver disease.
Mother myocardial infarction and breast cancer.

MEDICATIONS ON ADMISSION:  Atenolol 100 mg daily,
hydrochlorothiazide 25 mg daily.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  Vital signs 97.6; 65; 18; blood
pressure 124/86; oxygen saturation 90% on room air.  General
appearance: Alert, white male, in no acute distress.  HEENT:
Unremarkable.  Lungs are clear to auscultation. Heart is
regular rate and rhythm without murmur, rub or gallop.
Abdomen is soft, mildly distended. Mild tympany in the right
lower quadrant. There are no bruits. Rectal exam was
deferred. Extremity examination shows non palpable
Dopplerable DP and PT bilaterally.  Right femoral is
palpable. Left femoral is nonpalpable.

HOSPITAL COURSE:  The patient was admitted to the vascular
service. Nutritional service was requested to see the patient
in anticipation of postoperative nutritional needs. The
patient was IV hydrated and began on IV heparin with serial
PTT monitored for a goal PTT of 60 to 70. The patient
proceeded to surgery on [**2152-1-20**] and underwent an aorta
bifemoral bypass graft with a reimplantation of the inferior
mesenteric artery and an aorta to superior mesenteric artery
bypass graft.  The patient tolerated the procedure well and
was transferred to the PACU extubated but did require
reintubation. The patient was transferred to the surgical
intensive care unit the following day for vent support for
respiratory failure. The patient was transfused and
aggressive pulmonary care was instituted.

On postoperative day number 2, it was noted that his platelet
counts were in the 25 range. The heparin was discontinued. He
was started on Fondopain-RX.  His PA line was converted to a
central line.  A hip panel was sent and results returned as
negative. It was also noted that the patient had an elevated
white count and Vancomycin and Zosyn were instituted.  A
chest x-ray was obtained on [**1-23**], secondary to increasing
white count. The chest x-ray showed right lower lobe changes,
probably consistent with multi-focal pneumonia. Nutrition
recommended to start tube feeds. This was held secondary to
his respiratory status. On [**1-24**], postoperative day number 4,
patient required a CIWA scale for postoperative agitation and
combativeness. On [**1-26**], the TPN was instituted.  On [**2152-1-28**],
the patient did have a bowel movement with the use of a
suppository. His white count continued to be elevated at
13.9. On [**1-29**], the white count continued to increase. The
right groin showed a serosanguineous drainage. A VAC dressing
was applied. The central line was changed over a wire. Tube
feeds were held secondary to his elevated white count and
abdominal distention. CT of the abdomen was obtained which
showed a filling defect in the SMA distal to the graft which
they felt was thrombus with some thickening of the small
bowel.  Intravenous heparin was restarted. Amylase was
obtained which was 109 and lactate was .8.  General surgery
was consulted for the possibility of abdominal exploration
and bowel resection. They felt that the patient could be
managed conservatively. The patient developed hypercarbia
with a C02 of 72, requiring reintubation. He was
bronchoscoped which showed right lower lobe collapse and
atelectasis. The antibiotics were continued.  His tube feeds
were started on [**1-31**].  Head CT was obtained which showed
subacute right temporal parietal occipital lobe changes which
were consistent with old infarcts per neurology service. CT
of the abdomen was obtained and it showed the graft was
patent.

The patient had a second bronchoscopy done and his
antibiotics were restarted. The patient had a third
bronchoscopy which showed clear secretions with mucus
plugging times one. Venous studies were negative for DVT.  On
[**2-3**], the patient was extubated and new CVL was placed via new
stick. On [**2-4**], sedation was weaned. His aspirin was restarted
and he was reintubated secondary to aspiration. His white
count continued to rise. He required neo for hemodynamic
support. This was weaned overnight and Flagyl was begun
empirically for questionable C. Diff. The cultures eventually
were determined to be negative and the Flagyl was
discontinued.  On [**2-5**], the patient had an episode of atrial
fibrillation which was confirmed with Lopressor. CT of the
abdomen was repeated secondary to increasing white count
which showed a low attenuation and peri-aortic fluid. The
right renal artery showed changes, questionable infarct and
the white count began to show improvement.  On [**2-8**], the
patient underwent a PEG and trache procedure. His tube feeds
were restarted on [**2-9**]. His chest x-ray showed a left lower
pneumonia.  His TPN was discontinued.  On [**2-12**], he had
elevated LFTs and they felt this was related to pancreatitis
postoperatively. Fluconazole was started for a yeast UTI and
his Zosyn was discontinued on [**2-13**]. On [**2-14**], his tube feeds
were readjusted for abdominal distention and high residuals.
Tobramycin inhalation was begun for gram negative rods found
in his sputum.  LFTs have been slowly improving but amylase
remained elevated at 450. On [**2-15**], the patient's LFTs
continued to improve. His amylase and lipase continued to
improve. The patient was transferred to the VICU for
continued care. His Vancomycin, fluconazole and Tobramycin
were discontinued on [**2-15**].  On [**2-16**], a PICC line was placed.
Physical therapy will evaluate the patient. He will require
rehab at the time of discharge. Patient will be discharged to
rehab when medically stable and bed available.

DISCHARGE MEDICATIONS:  Iproprium bromide aerosol puffs q. 4
hours. Albuterol 90 mcg actuation aerosol, 1 to 2 puffs q. 4
hours. Fluconazole nitrate powder 2% to affected areas t.i.d.
Fluconazole actuation and aerosol 2 puffs b.i.d..  Medium
chain triglycerides 30 cc b.i.d.. Metoprolol 37.5 mg b.i.d.
Ranitidine  150 mg b.i.d.. Montelukast 10 mg daily.
Erythromycin 500 mg liquid daily. Aspirin 325 mg extended
release daily.  Heparin flush to PICC line 2 cc IV daily and
prn followed by 10 cc of normal saline, followed by 2 cc of
100 units U of heparin, i.e. 200 units of heparin each lumen
daily and prn.

DISCHARGE DIAGNOSES:
1.  Mesenteric ischemia.
2.  Postoperative thrombocytopenia; HIT negative, resolved.
3.  Postoperative nicotine withdraw, resolved.
4.  Postoperative delirium confusion. Head CT with old
    temporal parietal occipital infarcts.
5.  Postoperative pneumonia, treated.
6.  Postoperative SMA thrombus improved, anticoagulated.
7.  Postoperative hypercarbia, status post bronchoscopy.
8.  Postoperative aspiration reintubation for respiratory
    failure.
9.  Postoperative atrial fibrillation, converted with
    Lopressor.
10. Postoperative right groin seroma.
11. Postoperative aspiration, treated.
12. Postoperative failure to thrive.
13. PEG with tube feeds.

MAJOR SURGICAL PROCEDURES:
1.  Aorta bifemoral with reimplantation of the [**Female First Name (un) 899**], aorta,
    SMA bypass on [**1-18**].
2.  Right groin VAC dressing application starting on
    [**2152-1-29**].
3.  CVL change over wire on [**2152-1-29**].
4.  Bronchoscopy on [**1-30**] and [**2152-2-1**].
5.  PEG/trache on [**2152-2-8**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2380**], [**MD Number(1) 2381**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2152-2-16**] 11:22:52
T:  [**2152-2-16**] 11:51:30
Job#:  [**Job Number 71554**]


Name:  [**Known lastname 2578**],[**Known firstname **] M                 Unit No:   [**Numeric Identifier 12021**]

Admission Date:  [**2152-1-18**]              Discharge Date:   [**2152-2-23**]

Date of Birth:  [**2083-2-25**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 231**]
Addendum:
[**2152-2-17**] speech/swallow service consulted for pessiemeyer trach.
patient tolerating trach. Will scheduale viedo-swallow for
assesment of silent aspiration.
[**2-18**]/assement of viedo swallow, no aspiration may advance to
ground solids and thin liquids. advance to regular when patient
has his dentures
[**2152-2-23**] tube feed converted to cycling. discharged to rehab.
stable

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2215**] Northeast - [**Location (un) 42**]

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern1) 237**] MD [**MD Number(1) 238**]

Completed by:[**2152-2-23**]
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Acute pancreatitis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Seroma complicating a procedure,Alcohol abuse, unspecified,Toxic encephalopathy,Alcoholic cirrhosis of liver,Acidosis,Atherosclerosis of native arteries of the extremities with rest pain,Unspecified essential hypertension,Candidiasis of other urogenital sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere'}


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 pain.

PRESENT ILLNESS: This 68 year-old gentleman with
abdominal pain x 6 weeks with sudden onset associated with
eating, occurs 15 minutes post eating and lasts several
hours. Partially relieved with Darvocet. The patient had a
diagnostic work-up at an outside hospital for mesenteric
ischemia which was positive.

MEDICAL HISTORY: Peripheral vascular disease, status
post angioplasty and stenting of the right lower extremity in
[**2143**].  Vessel angioplastied is now known. History of
hypertension, controlled.

MEDICATION ON ADMISSION: Atenolol 100 mg daily,
hydrochlorothiazide 25 mg daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive in the father for liver disease.
Mother myocardial infarction and breast cancer.

SOCIAL HISTORY: The patient is a 12 pack per week beer
drinker. History of copious alcohol use previously.  One and
1/2 packs per day times 55 years smoking, which is current. 

### Response:
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Acute pancreatitis,Pneumonia, organism unspecified,Thrombocytopenia, unspecified,Seroma complicating a procedure,Alcohol abuse, unspecified,Toxic encephalopathy,Alcoholic cirrhosis of liver,Acidosis,Atherosclerosis of native arteries of the extremities with rest pain,Unspecified essential hypertension,Candidiasis of other urogenital sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Delirium due to conditions classified elsewhere'}
