CHIEF COMPLAINT: Abdominal pain.

PRESENT ILLNESS: This is a 51 year old man who
was recently evaluated by his primary care physician for
complaints of atypical left upper quadrant abdominal pain.  A
CT scan was obtained which detected a large right common
iliac aneurysm 4.5 by 4.5, along with a small left common
iliac aneurysm.  The patient had a cardiac work-up which
revealed an essentially normal echocardiogram with an
ejection fraction of 60 to 70% along with no ischemic
symptoms by exercise tolerance.

MEDICAL HISTORY: 1.  Hay fever.
2.  No previous surgeries.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married; he is self-employed as a
tile installer.  He lives with his wife.  [**Name (NI) **] ambulates
independently.
Aneurysm of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other shock without mention of trauma,Peripheral vascular complications, not elsewhere classified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction
Iliac artery aneurysm,Accidental op laceration,Shock w/o trauma NEC,Surg comp-peri vasc syst,Chr stomach ulc w hem
Admission Date:  [**2129-8-26**]       Discharge Date:  [**2129-10-7**]

Date of Birth:   [**2078-1-17**]       Sex:  M

Service:  VASCULAR

CHIEF COMPLAINT:   Abdominal pain.

HISTORY OF PRESENT ILLNESS:   This is a 51 year old man who
was recently evaluated by his primary care physician for
complaints of atypical left upper quadrant abdominal pain.  A
CT scan was obtained which detected a large right common
iliac aneurysm 4.5 by 4.5, along with a small left common
iliac aneurysm.  The patient had a cardiac work-up which
revealed an essentially normal echocardiogram with an
ejection fraction of 60 to 70% along with no ischemic
symptoms by exercise tolerance.

The patient underwent an arteriogram by Dr. [**Last Name (STitle) **] on [**7-28**]
which demonstrated a right pseudo-iliac aneurysm and a left
common iliac aneurysm.  The patient now is admitted
electively for repair.

PAST MEDICAL HISTORY:
1.  Hay fever.
2.  No previous surgeries.

ALLERGIES:   No known drug allergies.

MEDICATIONS:  The patient is not on any medications at the
present time.

SOCIAL HISTORY:   He is married; he is self-employed as a
tile installer.  He lives with his wife.  [**Name (NI) **] ambulates
independently.

DISCHARGE LABORATORY:  PT 12.8, INR 1.1, PTT 32.7.  CBC with
white blood cell count of 9.9, hematocrit 31.0, platelets
745k.

Electrolytes were sodium 134, potassium 4.9, chloride 97,
carbon dioxide 24, BUN 28, creatinine 0.7, glucose 103,
calcium 8.5, phosphorus 5.7, magnesium 1.9.

A video swallow done on [**2129-6-3**], demonstrated decreased
bolus control with premature spillage.  There was poor
epiglottic dysflexion throughout the entire study.  Residue
remained in the panniculi with nectar liquids and there was
trace penetration during swallowing of nectar liquids.  With
thin liquids there was aspiration; the patient could not
transfer or swallow a barium tablet.

Bilateral venous studies for deep vein thrombosis were
obtained on [**2129-9-20**], which showed no evidence of deep vein
thrombosis in the left lower extremity from the inguinal to
popliteal region as well as the right common femoral vein.

A CT scan of the chest attained on [**2129-8-31**] for persistent
fevers demonstrated heart and pericardium were unremarkable.
Anterior mediastinum was clear.  The great vessels were
intact.  There was no significant hilum or spinal, axillary
lymphadenopathy.  There are bilateral pleural effusions which
are moderate sized.  There is bilateral apical patchy
infiltrates seen greater on the right than on the left.
There is a left subclavicular and jugular line in the
inferior aspect of the superior vena cava.  The trachea is
midline with an ET in place and a nasogastric tube in place.

Abdominal CT scan:  The liver, spleen, liver and pancreas
were unremarkable.  There were small gallstones in the
dependent portion of the gallbladder, however, there was no
wall thickening or pericholecystic fluid collection.  The
left kidney showed an inferior simple cyst.  There was free
fluid in the abdomen and that has not changed significantly
in amount compared to previous study.  There is no free air
in the abdomen.

CT scan of the pelvis:  Large and small bowels are normal
caliber and course.  Fluid throughout the pelvis which
measures approximately 16 hounds filled units, unchanged from
previous.  Post-surgical changes were seen in the mesentery
on the left side.

The infraradial aorta-[**Hospital1 **]-iliac bypass was seen with a small
amount of hematoma around the graft, but no extravasation,
but there is a peri-aortic collection which has expanded
since the previous study of [**8-31**].  There is no change in the
retroperitoneum hematoma on the left.

Preoperative chest x-ray was unremarkable.  Chest x-ray,
single view only, done on [**2129-9-24**], did demonstrate low
lung volumes with subsequent atelectasis in the left lower
zones.  No evidence of pulmonary edema.

HOSPITAL COURSE:  The patient was admitted to the
Preoperative Holding Area on [**2129-8-26**].  He underwent
bilateral iliac aneurysm repair with an aorta-bifemoral
bypass.  Interoperatively, the iliac vein was injured with
repair.  The patient had open bedside laparotomy on [**8-26**],
later that day and returned to the Operating Room for
intra-abdominal sepsis and bleeding of the iliac vein.  The
patient remained in the SICU intubated during this time.

On [**9-4**], the patient had bilateral chest tubes placed
secondary to moderate pleural effusions bilaterally and
underwent an exploratory laparotomy which was unremarkable.
On [**9-9**], he underwent abdominal washout with fascial partial
closure and then returned to the Operating Room on [**9-12**] for
exploratory laparotomy, abdominal washout and repair of a
serosal small bowel tear and fascial closing with Silastic.

During his hospitalization, he required total parenteral
nutrition and nasogastric tube feeds secondary to aspiration.
He was initially evaluated by Speech Therapy on [**9-22**], and
then a repeat video swallow was done on [**10-3**], which
continued to show aspiration with thin liquids.
Recommendations were soft solid ground foods and thickened
liquids.

The patient underwent, on [**9-23**], a venogram with IVC filter
placement.  He was begun on anti-coagulation.  A repeat MRV
was recommended which the patient refused to have done.

The remaining hospital course was unremarkable.  The patient
was discharged to rehabilitation in stable condition.

DISCHARGE INSTRUCTIONS:
1.  He is to follow-up with Dr. [**Last Name (STitle) **] in one weeks time.
2.  Coumadin 2.5 mg q. day.  This should be adjusted for a
goal INR of 2.0 to  2.5.
3.  His diet will be regular soft solids with thickened
liquids.  His tube feeds were discontinued on [**2129-10-5**] by
the patient.
4.  The patient should have INR drawn on Saturday and this
should be called to Dr.[**Name (NI) 5695**] office at [**Telephone/Fax (1) 3121**].

DISCHARGE MEDICATIONS:
1.  Tomoxiprole 40 mg subcutaneously q. 12 hours.
2.  Protonix 40 mg q. day.
3.  Reglan 10 mg a.c. and h.s.
4.  Lopressor 50 mg three times a day; hold for systolic
blood pressure less than 100 and heart rate less than 60.
5.  Dazolicine 60 mg four times a day, hold for heart rate
less than 60, systolic blood pressure less than 115.
6.  Enalapril 5 mg q. day.
7.  Miconazole Powder to affected areas four times a day and
p.r.n.
8.  Artificial Tears one to two drops o.u. p.r.n.
9.  Albuterol multi-dose inhalers, puffs four to eight p.r.n.
10. Insulin sliding scale, discontinued.
11. Lorazepam intravenous q. h.s. p.r.n.; if discharged to
home this will be discontinued.

DISCHARGE DIAGNOSES:
1.  Bilateral iliac aneurysm status post aorta-bifemoral
graft with right iliac vein injury status post repair.
2.  Status post open laparotomy times three.
3.  Bilateral pleural effusions, status post chest tubes.
4.  Aspiration status post video swallow.
5.  Questionable iliac thrombus status post IVC filter
placement.
6.  Blood loss anemia, corrected.
7.  Hypertension, stable.


                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

Dictated By:[**Last Name (NamePattern1) 1479**]
MEDQUIST36

D:  [**2129-10-7**]  14:12
T:  [**2129-10-7**]  16:52
JOB#:  [**Job Number 33438**]
{'Aneurysm of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other shock without mention of trauma,Peripheral vascular complications, not elsewhere classified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction'}


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 is a 51 year old man who
was recently evaluated by his primary care physician for
complaints of atypical left upper quadrant abdominal pain.  A
CT scan was obtained which detected a large right common
iliac aneurysm 4.5 by 4.5, along with a small left common
iliac aneurysm.  The patient had a cardiac work-up which
revealed an essentially normal echocardiogram with an
ejection fraction of 60 to 70% along with no ischemic
symptoms by exercise tolerance.

MEDICAL HISTORY: 1.  Hay fever.
2.  No previous surgeries.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married; he is self-employed as a
tile installer.  He lives with his wife.  [**Name (NI) **] ambulates
independently. 

### Response:
{'Aneurysm of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other shock without mention of trauma,Peripheral vascular complications, not elsewhere classified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction'}
