CHIEF COMPLAINT: Abdominal pain.

PRESENT ILLNESS: Mrs.[**Doctor Last Name 7517**] is a 86 year-old female who presents to the [**Hospital1 18**]
ER after awaking that morning with lower abdominal pain. Patient
was otherwise in her usual state of health until day of
admission when she noted bilateral lower abdominal pain. The
pain was initially dull and gradually worsened over the course
of the day. This was associated with several episodes of nausea
and vomiting. She had not been passing flatus, however has
passed loose stool.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: Miralax, MVI, Colace 100'', Labetalol 200'', Ranitidine 150'',
Amlodipine 10', Norvasc 5', Xalatan 0.005% eye drops daily, ASA
81', losartan potassium 50''.

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: On admission:

FAMILY HISTORY: father died of throat cancer, mother of uterine cancer, no
h/o stroke

SOCIAL HISTORY: Lives alone in [**Hospital1 **]. Widowed 11 years ago, no children. No
tobacco/ETOH. Niece lives in [**Location 2199**].
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified hearing loss,Contact dermatitis and other eczema, unspecified cause
Intestinal adhes w obstr,Pleural effusion NOS,Urin tract infection NOS,Atrial fibrillation,Hypertension NOS,Hearing loss NOS,Dermatitis NOS
Admission Date:  [**2131-6-23**]              Discharge Date:   [**2131-6-28**]

Date of Birth:  [**2045-2-7**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
Abdominal pain.

Major Surgical or Invasive Procedure:
[**6-23**] Exploratory laparotomy and adhesiolysis for small-bowel
obstruction.


History of Present Illness:
Mrs.[**Doctor Last Name 7517**] is a 86 year-old female who presents to the [**Hospital1 18**]
ER after awaking that morning with lower abdominal pain. Patient
was otherwise in her usual state of health until day of
admission when she noted bilateral lower abdominal pain. The
pain was initially dull and gradually worsened over the course
of the day. This was associated with several episodes of nausea
and vomiting. She had not been passing flatus, however has
passed loose stool.

Past Medical History:
Hypertension.

Social History:
Lives alone in [**Hospital1 **]. Widowed 11 years ago, no children. No
tobacco/ETOH. Niece lives in [**Location 2199**].


Family History:
father died of throat cancer, mother of uterine cancer, no
h/o stroke


Physical Exam:
On admission:

Physical Exam:
Vitals: T 97.8 P 67 BP 146/63 RR 18 O2 97%RA
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: Soft,  mild lower abdominal distention, tender to palpation
in the lower abdomen, no rebound or guarding, no palpable masses
or hernias
Ext: No LE edema, LE warm and well perfused

On discharge:

Vitals T 98.5 po, HR 59, SBP 138/54, RR 16, sat 95% RA.
Gen:  AAO x 3, extremely hard of hearing.
Card:  S1, S2.  Regular with occasional premature beats. Pulses
2+ in UE, LE.
Lungs:  Posteriorly clear bilaterally, diminished in right lower
lobe.
Abd:  Active BS.  Soft, non-tender, non-distended.  Vertical
mid-line incision closed with staples.  CDI.  No exudate or
drainage noted.
GI:  Voiding.
Extrem:  Cool, well perfused.

Pertinent Results:
[**2131-6-22**] 06:10PM BLOOD WBC-12.9* RBC-4.02* Hgb-11.6* Hct-33.8*
MCV-84 MCH-28.8 MCHC-34.2 RDW-13.9 Plt Ct-311
[**2131-6-22**] 06:10PM BLOOD Neuts-88.0* Lymphs-8.7* Monos-2.6 Eos-0.3
Baso-0.3
[**2131-6-22**] 06:10PM BLOOD Plt Ct-311
[**2131-6-22**] 09:18PM BLOOD PT-10.3 PTT-29.6 INR(PT)-0.9
[**2131-6-22**] 06:10PM BLOOD Glucose-124* UreaN-24* Creat-1.1 Na-135
K-5.0 Cl-98 HCO3-30 AnGap-12
[**2131-6-22**] 06:10PM BLOOD ALT-13 AST-19 AlkPhos-57 TotBili-0.6
[**2131-6-25**] 06:05AM BLOOD CK(CPK)-387*
[**2131-6-25**] 02:30PM BLOOD CK(CPK)-413*
[**2131-6-25**] 06:05AM BLOOD CK-MB-7 cTropnT-0.04*
[**2131-6-25**] 02:30PM BLOOD cTropnT-0.04*
[**2131-6-22**] 06:10PM BLOOD Albumin-4.2 Calcium-9.6 Phos-3.9 Mg-2.0
[**2131-6-22**] 06:08PM BLOOD Lactate-1.2
[**2131-6-26**] 03:11AM BLOOD WBC-10.7 RBC-3.31* Hgb-9.7* Hct-27.9*
MCV-84 MCH-29.2 MCHC-34.6 RDW-13.8 Plt Ct-268
[**2131-6-27**] 05:55AM BLOOD Glucose-127* UreaN-36* Creat-0.8 Na-136
K-3.7 Cl-102 HCO3-28 AnGap-10
[**2131-6-27**] 05:55AM BLOOD Calcium-8.0* Phos-2.7 Mg-2.3

[**2131-6-22**] CT A/P with contrast
1.  Findings concerning for closed loop obstruction with
evidence of
mesenteric edema and ascites.  Early bowel ischemia cannot be
excluded.
2.  Fat-containing abdominal wall hernia.

[**2131-6-25**] ECG
Atrial fibrillation with rapid ventricular response.
Non-specific ST-T wave abnormalities, likely secondary to rate.
No previous tracing available for comparison.

Intervals Axes
Rate PR QRS QT/QTc  P QRS T
156   0 70  286/454 0 -1 157

[**2131-6-25**] CXR (AP)
No previous images.  Cardiac silhouette is mildly enlarged.
There
is engorgement of ill-defined pulmonary vessels, consistent with
the clinical impression of congestive failure.  Poor definition
of the hemidiaphragms is consistent with bilateral effusions and
compressive atelectasis at the bases.

[**2131-6-26**] CXR (AP)
In comparison with the study of [**6-25**], there is increased
haziness
of the right hemithorax, suggesting worsening layering pleural
effusion.
Again there is evidence of congestive failure with bilateral
effusions and basilar atelectatic changes.  Mild enlargement of
the cardiac silhouette persists.


Brief Hospital Course:
Mrs.[**Doctor Last Name 7517**] was admitted to [**Hospital1 18**] on [**6-23**] with complaints of
abdominal pain.  Imaging revealed a closed-loop bowel
obstruction.  She was kept NPO and IV fluids were initiated.  An
NG tube was inserted for decompression of her stomach.  While
NPO, the patient's hypertension was treated with IV lopressor
and hydralazine as needed.

She was taken to the OR on [**6-23**] where she underwent a
exploratory laparotomy with lysis of adhesions.  Please see the
operative report for further details.

Ms. [**Name13 (STitle) **] was transferred from the surgical floor to the ICU
on [**6-25**] for atrial fibrillation w/ RVR.  She was placed on a
diltiazem infusion to control her heart rate.  The patient was
loaded with digoxin and given a dose of IV furosemide during the
time of rapid atrial fibrillation.  Serial troponin levels where
checked, all of which were within normal limits, and an ECG was
obtained.  It was also discovered that she had a urinary tract
infection (positive UA) with an elevated serum WBC, so she was
started on a short course of ciproflaxacin.

She returned to the floor on [**2131-6-26**] and placed on telemetry
monitoring. Her rhythm was noted to be in sinus rhythm.  She was
hypertensive to the 180s systolic with IV Lopressor. Additional
IV anti-hypertensives were initiated.  When she was able to
tolerate POs, she was placed on her home anti-hypertensive
medications Amlodipine 10mg PO QD and Labetalol 200mg [**Hospital1 **] PO
which provided adequate blood pressure control. She was placed
on a regular diet which she tolerated well.

On [**2131-6-27**], Mrs.[**Doctor Last Name 87796**] diet was advanced to regular.  She
tolerated the oral intake well, had positive flatus and began
moving her bowels.  IV fluids and foley catheter were
discontinued as well.  Physical therapy was ordered for
evaluation of her function status prior to discharge.

At the time of discharge, Mrs.[**Doctor Last Name 7517**] is hemodynamically
stable and afebrile.  Telemetry shows normal sinus rhythm with
occasional PACs and PVCs.  Her leukocytosis has resolved. She
has minimal abdominal pain and has required little analgesia.
Her entire home medication regime has been resumed.  Follow-up
appointments have been made with her PCP and the ACS service.

Medications on Admission:
Miralax, MVI, Colace 100'', Labetalol 200'', Ranitidine 150'',
Amlodipine 10', Norvasc 5', Xalatan 0.005% eye drops daily, ASA
81', losartan potassium 50''.

Discharge Medications:
1. Amlodipine 10 mg PO DAILY
2. Aspirin 81 mg PO DAILY
3. Docusate Sodium 100 mg PO BID
4. Labetalol 200 mg PO BID
5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS
6. Ranitidine 150 mg PO BID
7. Hydrocortisone Cream 0.5% 1 Appl TP TID:PRN itching
Place thin layer sparingly to back as needed for itching.
8. Losartan Potassium 50 mg PO BID
9. Polyethylene Glycol 17 g PO DAILY
10. Acetaminophen 325-650 mg PO Q6H:PRN pain


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA of [**Location (un) 5087**]

Discharge Diagnosis:
Closed loop obstruction
Intermittent rapid atrial fibrillation

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to [**Hospital1 69**] with
abdominal pain.  Imaging showed that you suffered from a small
bowel obstruction.

You were taken to the operating room on [**6-23**] where you
underwent a lysis of adhesions.  Since that time, our bowel
function has returned and you have resumed a regular diet.

Please follow with your PCP as well as in the [**Hospital 2536**] clinic at the
appointment scheduled for you below. Your staples will be
removed at this appointment.

ACTIVITY:
o Do not drive until you have stopped taking pain medicine and
feel you could respond in an emergency. You may climb stairs.
o You may go outside, but avoid traveling long distances until
you see your [**Hospital 5059**] at your next visit.
o Don't lift more than 20-25 lbs for 4-6 weeks. (This is about
the weight of a briefcase or a bag of groceries.) This applies
to lifting children, but they may sit on your lap.
o You may start some light exercise when you feel comfortable.
o You will need to stay out of bathtubs or swimming pools for a
time while your incision is healing. Ask your doctor when you
can resume tub baths or swimming.
o Heavy exercise may be started after 6 weeks, but use common
sense and go slowly at first.

HOW YOU [**Month (only) **] FEEL:

o You may feel weak or "washed out" for 6 weeks. You might want
to nap often. Simple tasks may exhaust you.
o You may have a sore throat because of a tube that was in your
throat during surgery.
o You might have trouble concentrating or difficulty sleeping.
You might feel somewhat depressed.
o You could have a poor appetite for a while. Food may seem
unappealing.
o All of these feelings and reactions are normal and should go
away in a short time.  If they do not, tell your [**Month (only) 5059**].

YOUR INCISION:
o Your incision may be slightly red around the staples. This is
normal.
o You may gently wash away dried material around your incision.
It is normal to feel a firm ridge along the incision. This will
go away.
o Avoid direct sun exposure to the incision area.
o Do not use any ointments on the incision unless you were told
otherwise.
o You may see a small amount of clear or light red fluid
staining your dressing or clothes. If the staining is severe,
please call your [**Month (only) 5059**].
o You may shower. As noted above, ask your doctor when you may
resume tub baths or swimming.
o Over the next 6-12 months, your incision will fade and become
less prominent.

YOUR BOWELS:
If needed, you may take a stool softener (such as Colace, one
capsule) or gentle laxative (such as milk of magnesia, 1 tbs)
twice a day. You can get both of these medicines without a
prescription.  If you go 48 hours without a bowel movement, or
have pain moving the bowels, call your [**Month (only) 5059**].

PAIN MANAGEMENT:
It is normal to feel some discomfort/pain following abdominal
surgery. This pain is often described as "soreness".
Your pain should get better day by day. If you find the pain is
getting worse instead of better, please contact your [**Name2 (NI) 5059**].
You will receive a prescription from your [**Name2 (NI) 5059**] for pain
medicine to take by mouth. It is important to take this medicine
as directied. Do not take it more frequently than prescribed. Do
not take more medicine at one time than prescribed.
Your pain medicine will work better if you take it before your
pain gets too severe.
Talk with your [**Name2 (NI) 5059**] about how long you will need to take
prescription pain medicine. Please don't take any other pain
medicine, including non-prescription pain medicine, unless your
[**Name2 (NI) 5059**] has said its okay.
If you are experiencing no pain, it is okay to skip a dose of
pain medicine.
Remember to use your "cough pillow" for splinting when you cough
or when you are doing your deep breathing exercises.
If you experience any of the folloiwng, please contact your
[**Name2 (NI) 5059**]:
- sharp pain or any severe pain that lasts several hours
- pain that is getting worse over time
- pain accompanied by fever of more than 101
- a drastic change in nature or quality of your pain

MEDICATIONS:
Take all the medicines you were on before the operation just as
you did before, unless you have been told differently.
If you have any questions about what medicine to take or not to
take, please call your [**Name2 (NI) 5059**].

DANGER SIGNS:
Please call your [**Name2 (NI) 5059**] if you develop:
- worsening abdominal pain
- sharp or severe pain that lasts several hours
- temperature of 101 degrees or higher
- severe diarrhea
- vomiting
- redness around the incision that is spreading
- increased swelling around the incision
- excessive bruising around the incision
- cloudy fluid coming from the wound
- bright red blood or foul smelling discharge coming from the
wound
- an increase in drainage from the wound

Followup Instructions:
Department: Primary Care
Name: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10543**]
When: Wednesday [**2131-7-11**] at 1:15 PM.
Location: [**Hospital3 **] INTERNAL MEDICINE ASSOCIATES
Address: [**Street Address(2) 4472**], [**Apartment Address(1) 4473**], [**Hospital1 **],[**Numeric Identifier 9331**]
Phone: [**Telephone/Fax (1) 4475**]

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: THURSDAY [**2131-7-19**] at 2:15 PM
With: Dr. [**Last Name (STitle) **] [**Name (STitle) **] in the ACUTE CARE CLINIC
Phone: [**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage



Completed by:[**2131-6-28**]
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified hearing loss,Contact dermatitis and other eczema, unspecified cause'}


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: Mrs.[**Doctor Last Name 7517**] is a 86 year-old female who presents to the [**Hospital1 18**]
ER after awaking that morning with lower abdominal pain. Patient
was otherwise in her usual state of health until day of
admission when she noted bilateral lower abdominal pain. The
pain was initially dull and gradually worsened over the course
of the day. This was associated with several episodes of nausea
and vomiting. She had not been passing flatus, however has
passed loose stool.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: Miralax, MVI, Colace 100'', Labetalol 200'', Ranitidine 150'',
Amlodipine 10', Norvasc 5', Xalatan 0.005% eye drops daily, ASA
81', losartan potassium 50''.

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: On admission:

FAMILY HISTORY: father died of throat cancer, mother of uterine cancer, no
h/o stroke

SOCIAL HISTORY: Lives alone in [**Hospital1 **]. Widowed 11 years ago, no children. No
tobacco/ETOH. Niece lives in [**Location 2199**]. 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Unspecified pleural effusion,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified hearing loss,Contact dermatitis and other eczema, unspecified cause'}
