CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: The patient is a 68-year-old male who is transferred to [**Hospital1 18**]
from [**Hospital **] Hospital with chief complaint of abdominal pain.
He was brought to [**Hospital **] Hospital by supervisors at his group
home.  He reports dull pain in the midepigastrum  At [**Hospital1 **] he
had a lipase of greater than 4000 and an US which demonstrated
gallstones and slude, with no evidence of cholecystitis.

MEDICAL HISTORY: Past Medical History:
1. h/o CHF, MR
2. DM2
3. GERD
4. h/o diverticulitis
5. [**Location (un) 805**] syndrome, Mental retardation
6. HTN
7. h/o SBO (last in [**10-22**])
8. Impulse control d/o
9. Depression

MEDICATION ON ADMISSION: 1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.3 F   86    113/63    16    97% RA   Pain [**4-22**]
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: well healed midline incision, soft, mildly distended,
mildly
tender in midepigastrum, no RUQ pain, no [**Doctor Last Name **] sign, no rebound
or guarding, normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives in a group home.
Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction,Acute pancreatitis,Cholangitis,Other specified congenital anomalies,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Depressive disorder, not elsewhere classified,Unspecified essential hypertension
Gal&bil cal w/oth w/o ob,Acute pancreatitis,Cholangitis,Specfied cong anomal NEC,Mitral valve disorder,DMII wo cmp nt st uncntr,Esophageal reflux,Depressive disorder NEC,Hypertension NOS
Admission Date:  [**2148-8-6**]              Discharge Date:   [**2148-8-9**]

Date of Birth:  [**2079-12-19**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 4691**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
Laparoscopic cholecystectomy ([**2148-8-8**])
ERCP with sphincterotomy and balloon sweep ([**2148-8-6**])

History of Present Illness:
The patient is a 68-year-old male who is transferred to [**Hospital1 18**]
from [**Hospital **] Hospital with chief complaint of abdominal pain.
He was brought to [**Hospital **] Hospital by supervisors at his group
home.  He reports dull pain in the midepigastrum  At [**Hospital1 **] he
had a lipase of greater than 4000 and an US which demonstrated
gallstones and slude, with no evidence of cholecystitis.


Past Medical History:
Past Medical History:
1. h/o CHF, MR
2. DM2
3. GERD
4. h/o diverticulitis
5. [**Location (un) 805**] syndrome, Mental retardation
6. HTN
7. h/o SBO (last in [**10-22**])
8. Impulse control d/o
9. Depression

Past Surgical History:
s/p colectomy (reason unclear)


Social History:
Lives in a group home.

Family History:
Non-contributory.

Physical Exam:
99.3 F   86    113/63    16    97% RA   Pain [**4-22**]
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: well healed midline incision, soft, mildly distended,
mildly
tender in midepigastrum, no RUQ pain, no [**Doctor Last Name **] sign, no rebound
or guarding, normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused


Pertinent Results:
[**2148-8-6**] 12:20AM BLOOD WBC-15.7* RBC-3.71* Hgb-12.7* Hct-37.2*
MCV-100* MCH-34.4* MCHC-34.2 RDW-14.0 Plt Ct-168
[**2148-8-6**] 10:14AM BLOOD WBC-11.4* RBC-3.18* Hgb-11.6* Hct-32.5*
MCV-102* MCH-36.4* MCHC-35.6* RDW-14.0 Plt Ct-143*
[**2148-8-7**] 01:47AM BLOOD WBC-8.5 RBC-3.60* Hgb-11.8* Hct-36.8*
MCV-102* MCH-32.8* MCHC-32.0# RDW-13.7 Plt Ct-151
[**2148-8-8**] 05:30AM BLOOD WBC-5.7 RBC-3.60* Hgb-12.3* Hct-36.7*
MCV-102* MCH-34.1* MCHC-33.5 RDW-13.7 Plt Ct-160

[**2148-8-6**] 12:20AM BLOOD ALT-57* AST-77* AlkPhos-155* TotBili-0.9
[**2148-8-6**] 10:14AM BLOOD ALT-40 AST-45* AlkPhos-112 Amylase-724*
TotBili-0.7
[**2148-8-6**] 07:10PM BLOOD ALT-56* AST-91* AlkPhos-170* Amylase-562*
TotBili-2.1*
[**2148-8-7**] 01:47AM BLOOD ALT-93* AST-165* AlkPhos-247*
Amylase-356* TotBili-2.6* DirBili-2.4* IndBili-0.2
[**2148-8-7**] 01:47AM BLOOD ALT-93* AST-165* AlkPhos-247*
Amylase-356* TotBili-2.6* DirBili-2.4* IndBili-0.2
[**2148-8-8**] 05:30AM BLOOD ALT-68* AST-66* AlkPhos-272* Amylase-85
TotBili-1.1
[**2148-8-9**] 06:00AM BLOOD ALT-73* AST-57* AlkPhos-221* TotBili-0.9
[**2148-8-9**] 08:33AM BLOOD ALT-70* AST-54* AlkPhos-207* TotBili-0.8

[**2148-8-6**] 12:20AM BLOOD Lipase-1890*
[**2148-8-6**] 10:14AM BLOOD Lipase-793*
[**2148-8-6**] 07:10PM BLOOD Lipase-450*
[**2148-8-7**] 01:47AM BLOOD Lipase-244*
[**2148-8-8**] 05:30AM BLOOD Lipase-36

Brief Hospital Course:
The patient was initially admitted to the unit because of
concern for hypotenstion in the ED.  His SBPs were never lower
than the 80's but a central line was placed prior to his leaving
the ED.  His pressures responded to fluid resuscitation and he
never required pressors.  The patient was taken to ERCP on the
day of admission, the results of which are listed below.  He
tolerated the procedure well and was transferred to the floor.
His labs were checked the next day and his lipase was
decreasing.  He was taken for laparoscopic cholecystectomy the
following day.  His diet was then advanced as tolerated and his
pain was controlled with PO pain meds.  He was ready for
discharge on HD4. His foley catheter was removed and the patient
voided.

RUQ/Liver US ([**2148-8-6**]) - Intra and extrahepatic biliary
dilation with intraductal sludge. Choledocholithiasis cannot be
excluded due to limitations of visualization.
ERCP or MRCP could be used for further evaluation. Gallbladder
distention with sludge and wall thickening. Imaging findings
suggest cholecystitis. Clinical correlation is recommended as
son[**Name (NI) 493**] [**Name2 (NI) 515**] sign was negative; HIDA could be performed
to better evaluate for cholecystitis if clinically appropriate.
Trace ascites.

CXR ([**2148-8-6**]) - Multifocal opacities, worrisome for infection.
Right internal jugular central line with tip at cavoatrial
junction. Pulmonary vascular congestion. Cardiomegaly, which may
be in part due to pericardial fluid.

ERCP ([**2148-8-6**]) - A moderate diffuse dilation was seen at the
main duct with the CBD measuring 13 mm. The intrahepatic ducts
were also dilated. The cystic duct filled with contrast.
Successful sphincterotomy. Biliary sludge was seen exiting the
ampulla along with very dark, almost black, bile. Otherwise
normal ercp to third part of the duodenum.


Medications on Admission:
1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Verapamil 120 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q24H (every 24 hours).
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. Align 4 mg Capsule Sig: One (1) Capsule PO once a day.
8. Trazodone 50 mg Tablet Sig: One (1) Tablet PO at bedtime.
9. Buspirone 5 mg Tablet Sig: Three (3) Tablet PO BID (2 times a
day).
10. Tolterodine 2 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).

Discharge Medications:
1. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as
needed for pain.
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
3. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Verapamil 120 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q24H (every 24 hours).
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*40 Capsule(s)* Refills:*0*
10. Align 4 mg Capsule Sig: One (1) Capsule PO once a day.
11. Trazodone 50 mg Tablet Sig: One (1) Tablet PO at bedtime.
12. Buspirone 5 mg Tablet Sig: Three (3) Tablet PO BID (2 times
a day).
13. Tolterodine 2 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
15. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).


Discharge Disposition:
Home

Discharge Diagnosis:
Sympomatic choledocholithiasis


Discharge Condition:
Mental Status: Clear and coherent (Baseline mental retardation)
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down fluids or your
medications.

*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.

*You see blood or dark/black material when you vomit or have a
bowel movement.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.

Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than [**4-22**] lbs until you follow-up with your
surgeon.

Avoid driving or operating heavy machinery while taking pain
medications.

Incision Care:

*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.

*Avoid swimming and baths until your follow-up appointment.

*You may shower, and wash surgical incisions with a mild soap
and warm water. Gently pat the area dry.

*If you have staples, they will be removed at your follow-up
appointment.

*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.


Followup Instructions:
Please call the Acute Care Surgery clinic at [**Telephone/Fax (1) 600**] to
arrange for a follow-up appointment in [**1-17**] weeks.  The clinic is
located on the [**Location (un) 10043**] of the [**Hospital **] Medical Building at [**Last Name (NamePattern1) 12939**].
{'Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction,Acute pancreatitis,Cholangitis,Other specified congenital anomalies,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Depressive disorder, not elsewhere classified,Unspecified essential hypertension'}


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: The patient is a 68-year-old male who is transferred to [**Hospital1 18**]
from [**Hospital **] Hospital with chief complaint of abdominal pain.
He was brought to [**Hospital **] Hospital by supervisors at his group
home.  He reports dull pain in the midepigastrum  At [**Hospital1 **] he
had a lipase of greater than 4000 and an US which demonstrated
gallstones and slude, with no evidence of cholecystitis.

MEDICAL HISTORY: Past Medical History:
1. h/o CHF, MR
2. DM2
3. GERD
4. h/o diverticulitis
5. [**Location (un) 805**] syndrome, Mental retardation
6. HTN
7. h/o SBO (last in [**10-22**])
8. Impulse control d/o
9. Depression

MEDICATION ON ADMISSION: 1. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.3 F   86    113/63    16    97% RA   Pain [**4-22**]
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: well healed midline incision, soft, mildly distended,
mildly
tender in midepigastrum, no RUQ pain, no [**Doctor Last Name **] sign, no rebound
or guarding, normoactive bowel sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives in a group home. 

### Response:
{'Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction,Acute pancreatitis,Cholangitis,Other specified congenital anomalies,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Depressive disorder, not elsewhere classified,Unspecified essential hypertension'}
