CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Patient presented to an outside hospital with a 12 hour history
of sharp left lower quadrant pain with 1 loose bowel movement
and fever.  At [**Hospital3 3583**] a CT scan showed marked sigmoid
diverticulitis with a small amount of free air tracking along
the mesentary, pericolic gutter. She denied nausea, emesis,
anorexia.  She was transferred to [**Hospital1 18**] for further evaluation
of perforated diverticulitis.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Peptic ulcer disease

MEDICATION ON ADMISSION: atorvastatin, atenolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 99.1  heart rate 109  blood pressure 132/89
respiratons 20 O2 aturation  94% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, non-tender, non-distended. Bowel sounds present.
Pelvic drain in place, draining clear serosanguinous fluid.
Extremities warm and well perfused. No clubbing, cyanosis, or
edema.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married
Denies tobacco, IV drug use.
Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Dvrtcli colon w/o hmrhg,Intestinal abscess,Enterococcus group d,Pure hypercholesterolem,Hy kid NOS w cr kid I-IV
Admission Date:  [**2199-8-14**]              Discharge Date:   [**2199-8-24**]

Date of Birth:  [**2153-12-26**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
Pelvic abscess drainage, CT guided.


History of Present Illness:
Patient presented to an outside hospital with a 12 hour history
of sharp left lower quadrant pain with 1 loose bowel movement
and fever.  At [**Hospital3 3583**] a CT scan showed marked sigmoid
diverticulitis with a small amount of free air tracking along
the mesentary, pericolic gutter. She denied nausea, emesis,
anorexia.  She was transferred to [**Hospital1 18**] for further evaluation
of perforated diverticulitis.

Past Medical History:
Hypertension
Hypercholesterolemia
Peptic ulcer disease

Surgical history:
exploratory laparotomy at age 7 for atrophic left kidney
c-section

Social History:
Married
Denies tobacco, IV drug use.

Family History:
Non-contributory

Physical Exam:
Temperature 99.1  heart rate 109  blood pressure 132/89
respiratons 20 O2 aturation  94% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, non-tender, non-distended. Bowel sounds present.
Pelvic drain in place, draining clear serosanguinous fluid.
Extremities warm and well perfused. No clubbing, cyanosis, or
edema.

Pertinent Results:
[**2199-8-14**] 02:25AM BLOOD WBC-23.2* RBC-4.18* Hgb-13.3 Hct-38.9
MCV-93 MCH-31.7 MCHC-34.1 RDW-12.7 Plt Ct-238
[**2199-8-15**] 07:00AM BLOOD WBC-24.5* RBC-4.07* Hgb-13.0 Hct-37.3
MCV-92 MCH-31.9 MCHC-34.8 RDW-12.8 Plt Ct-236
[**2199-8-20**] 04:47AM BLOOD WBC-21.8* RBC-3.98* Hgb-12.2 Hct-36.1
MCV-91 MCH-30.7 MCHC-33.9 RDW-13.0 Plt Ct-381
[**2199-8-21**] 04:53AM BLOOD WBC-28.7* RBC-4.26 Hgb-13.0 Hct-38.9
MCV-91 MCH-30.6 MCHC-33.5 RDW-13.1 Plt Ct-421
[**2199-8-14**] 02:25AM BLOOD Neuts-75* Bands-15* Lymphs-7* Monos-3
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2199-8-21**] 04:53AM BLOOD Plt Ct-421
[**2199-8-20**] 04:47AM BLOOD Plt Ct-381
[**2199-8-19**] 06:52PM BLOOD PT-13.8* PTT-26.0 INR(PT)-1.3
[**2199-8-19**] 06:52PM BLOOD UreaN-2* Creat-0.6 K-3.8
[**2199-8-18**] 05:35AM BLOOD Glucose-110* UreaN-5* Creat-0.6 Na-142
K-3.8 Cl-106 HCO3-21* AnGap-19
[**2199-8-14**] 02:25AM BLOOD Glucose-137* UreaN-10 Creat-0.8 Na-140
K-4.2 Cl-110* HCO3-19* AnGap-15
[**2199-8-14**] 02:25AM BLOOD ALT-19 AST-17 Amylase-46 TotBili-0.8
[**2199-8-19**] 06:52PM BLOOD Calcium-9.3 Phos-3.6 Mg-1.5*
[**2199-8-15**] 07:00AM BLOOD Calcium-8.9 Phos-2.5* Mg-1.6
[**2199-8-14**] 02:51AM BLOOD Lactate-1.8

RADIOLOGY  Final Report

CT ABDOMEN W/CONTRAST  [**2199-8-19**] 2:14 PM

CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST

Reason: DIVERTICULITIS
Field of view: 36 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
45 year old woman with peforated divertivultis, clinically
better, but still elevated WBC
REASON FOR THIS EXAMINATION:
? resolve
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: The patient has known diverticulitis and elevated
white cell count. Rule out abscess.

TECHNIQUE: Axial multidetector CT acquisitions of the abdomen
and pelvis were acquired after the administration of oral and
intravenous contrast.

COMPARISON: No study available for comparison.

REPORT.

CT LUNG BASES. A minimal amount of atelectasis is identified in
the left lung base.

CT ABDOMEN WITH CONTRAST. The liver appears unremarkable. No
focal hepatic masses are seen. The gallbladder is normal. No
intra or extrahepatic biliary dilatation is seen. The pancreas
appears unremarkable. The spleen is normal.
The left kidney is small and atrophic, and there is a dilated
proximal left pelvis. Findings suggests atrophy secondary to
longstanding obstruction from PUJ.

The right kidney demonstrates some compensated hypertrophy and
appears normal with good uptake and excretion of contrast.

CT PELVIS WITH CONTRAST. The pelvis demonstrates a large central
abscess measuring 8 x 4.5 cm. Around this abscess is noted an
abnormal sigmoid colon with multiple diverticulae. Extensive
surrounding inflammation to the the mesentery is identified.
There is a fair amount of air and oral contrast within the
abscess cavity, suggesting a wide opening to the adjacent
sigmoid colon. The distal colon as far as the splenic flexure
demonstrates a significant amount of diverticular disease. The
transverse colon and right- sided colon have less divertcular
disease. The appendix appears unremarkable.
Of note, some loops of small bowel are draped over this abscess
cavity.

CT OF BONES. The visualized bones appear unremarkable.

CONCLUSION:

There is significant sigmoid diverticulitis, now complicated by
a large central pelvic diverticular abscess.

The findings were discussed with the attending surgeon Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at the time of interpretation, approximately
7:45 p.m. on [**2199-8-19**].

RADIOLOGY  Final Report

CT PELVIS W/O CONTRAST  [**2199-8-20**] 9:52 AM

CT PELVIS W/O CONTRAST; CT RETROPERITONEAL DRAINAGE

Reason: Please drain pelvic/lower abdominal abscess. Drain to
remain

[**Hospital 93**] MEDICAL CONDITION:
45 year old woman with diverticulitis, organizing abscess.
REASON FOR THIS EXAMINATION:
Please drain pelvic/lower abdominal abscess. Drain to remain in
place.
CONTRAINDICATIONS for IV CONTRAST: None.

CT GUIDED DRAINAGE OF INTRA-ABDOMINAL/PELVIC ABSCESS.

CLINICAL DETAILS: Anterior pelvic abscess collection on
preceding CT of [**2199-8-19**], shows background sigmoid
diverticulitis.

PRE-DRAINAGE NONCONTRAST CT SCAN THROUGH THE LOWER ABDOMEN AND
PELVIS:
The preprocedure noncontrast scan shows a mainly fluid
attenuating collection at the upper mid pelvis, which measures
up to 9.5 cm maximum transverse x up to 5.7 cm AP. This contains
material of mainly fluid attenuation with some air in its
anterior portion. There is adjacent stranding in the adjacent
upper sigmoid colon along its left side in the setting of
diverticulosis..

Preprocedure consent and confirmation of patient identity and
nature of procedure performed.

The patient was placed in supine position and prepped and draped
in the usual sterile fashion. Intravenous and local analgesia
were administered.

Following CT localization of the pelvic collection, a 20-gauge
needle was placed into the collection using a lower anterior
abdominal approach just to the right of midline. Initial
aspiration yielded purulent material, a sample of which has been
sent for analysis. Using the needle in place, a micropuncture
wire and then a 0.035-floppy tip wire was exchanged and the
tract dilated up to 12- French.
12 French multiprupose drianage catheter inserted and the formed
tip confirmed at the posterior aspect of the collection. 30 to
40 cc of purulent material was initially aspirated and the
abscess cavity irrigated with sterile saline.

Non-contrast CTs done through the area post drainage shows no
residual collection

/[**5-19**] 11:10 am ABSCESS     Site: PELVIS

   GRAM STAIN (Final [**2199-8-20**]):
      3+  (5-10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.

   WOUND CULTURE (Final [**2199-8-23**]):
      ENTEROCOCCUS SP..    SPARSE GROWTH.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    SPARSE GROWTH.
         COAG NEG STAPH does NOT require contact precautions,
regardless of
         resistance.
         Oxacillin RESISTANT Staphylococci MUST be reported as
also
         RESISTANT to other penicillins, cephalosporins,
carbacephems,
         carbapenems, and beta-lactamase inhibitor combinations.

         Rifampin should not be used alone for therapy.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ENTEROCOCCUS SP.
                             |          STAPHYLOCOCCUS,
COAGULASE NEGATIVE
                             |          |
AMPICILLIN------------  =>32 R
CHLORAMPHENICOL-------     8 S
CLINDAMYCIN-----------              =>8 R
ERYTHROMYCIN----------              =>8 R
GENTAMICIN------------                8 I
LEVOFLOXACIN----------   =>8 R      =>8 R
OXACILLIN-------------              =>4 R
PENICILLIN------------  =>64 R    =>0.5 R
RIFAMPIN--------------            <=0.5 S
TETRACYCLINE----------              <=1 S
VANCOMYCIN------------  =>32 R        2 S

   ANAEROBIC CULTURE (Final [**2199-8-24**]):    NO ANAEROBES ISOLATED.


   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.


Brief Hospital Course:
Patient was evaluated in the [**Hospital1 18**] emergency room with a
diagnosis of perforated diverticulitis as diagnosed on CT scan
performed at an outside hospital. She was fluid resuscitated.
Nasogastric tube was placed, ampicillin, Flagyl, and
levofloxacin antibiotics were started and patient was admitted
to the hospital.  She was initially kept under observation in
the intensive care unit and was transferred to a regular floor
on hospital day 2.  Conservative management was continued.
Patient's clinical exam continued to improve.  Patient was kept
NPO and antibiotics were continued.  Nasogastric tube was
removed and patient was begun on liquids with good tolerance.
On hospital day 6 an abdominal/pelvic CT showed a pelvic
abscess. This abscess was drained under interventional radiology
guidance on hospital day 7, using a pig-tail catheter.  Abscess
drained approximately 40 cc of purulent fluid. Cultures were
sent.  Patient tolerated the procedure well. She was
subsequently transitioned to PO medications with good tolerance.
 Abscess cultures showed vancomycin and methicillin resistant
enterococcal sp. Ampicillin was discontinued and patient was
started on linezolid.  Patient remained hemodynamically stable
throughout the hospitalization. She was discharged home on
hospital day 11 with a 2 week course of levofloxacin, linezolid,
and Flagyl and with strict instructions for follow up.


Medications on Admission:
atorvastatin, atenolol

Discharge Medications:
1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Acyclovir 5 % Ointment Sig: One (1) Appl Topical  6X/D (6
times a day) for 7 days.
Disp:*1 tube* Refills:*0*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for PAIN for 5 days.
Disp:*40 Tablet(s)* Refills:*0*
5. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*1*
6. Linezolid 600 mg Tablet Sig: One (1) Tablet PO every twelve
(12) hours for 14 days.
Disp:*28 Tablet(s)* Refills:*0*
7. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed for Perforated diverticulitis for 2
weeks.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Perforated diverticulitis


Discharge Condition:
Patient discharged home on good condition.


Discharge Instructions:
having worsening pains, fevers, chills, nausea, vomiting,
shortness of breath, chest pain, redness or drainage about the
wounds, or if there are any questions or concerns.  Patient to
take antibiotics and other medications as directed.  Patient not
to drive or operate heavy machinery while on any narcotic pain
medication such as percocet as it can be sedating.  Patient to
take colace to soften the stool as needed for constipation as
narcotic pain medication can cause this issue.
Patient may return to regular diet as tolerated.
Patient may shower but should not use soap or scrub the drain
insertion site.
Patient is to see Dr. [**Last Name (STitle) **] in [**6-23**] days.

Followup Instructions:
Please call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 1864**] to schedule your follow
up appointment. Appointment should be in [**6-23**] days.

Please make sure you see Dr. [**Last Name (STitle) **] before your antibiotics
run out.



Completed by:[**2199-8-26**]
{'Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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: Patient presented to an outside hospital with a 12 hour history
of sharp left lower quadrant pain with 1 loose bowel movement
and fever.  At [**Hospital3 3583**] a CT scan showed marked sigmoid
diverticulitis with a small amount of free air tracking along
the mesentary, pericolic gutter. She denied nausea, emesis,
anorexia.  She was transferred to [**Hospital1 18**] for further evaluation
of perforated diverticulitis.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Peptic ulcer disease

MEDICATION ON ADMISSION: atorvastatin, atenolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 99.1  heart rate 109  blood pressure 132/89
respiratons 20 O2 aturation  94% on room air.
Alert and oriented. No acute distress.
Sclerae anicteric. PERRL.
Regular rate and rhythm. S1 S2 normal. No rubs, gallops
Clear to auscultation bilaterally. No wheezing
Abdomen soft, non-tender, non-distended. Bowel sounds present.
Pelvic drain in place, draining clear serosanguinous fluid.
Extremities warm and well perfused. No clubbing, cyanosis, or
edema.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married
Denies tobacco, IV drug use. 

### Response:
{'Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
