CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 69M with history of gastric bypass presents with 3 days of
RUQ abdominal pain and jaundice. Patient had sudden onset of RUQ
pain 3 days ago after a large dinner. His pain has decreased
slightly since then, but has not completely resolved. He denies
nausea and vomiting but had one episode of diarrhea when his
pain
started. He has been feeling weak, ill, and had a fever to 101
today. He reports episodes of abdominal pain after meals in the
past, but has never been told that he has gallstones.

MEDICAL HISTORY: 1. Morbid obesity - pt has lost 145 lbs
2. hypertension - now improved
3. hyperlipidemia - now improved
4. Obstructive sleep apnea - now improved

MEDICATION ON ADMISSION: Benicar 40', omeprazole 20'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 100.1   HR 100   BP 144/83   RR 16   O2 sat 94% RA
Gen: Appears jaundiced and dehydrated, NAD
CV: Irregular
Resp: CTAB, no distress
Abd: Soft, midly distended, tender in RUQ and mildly tender in
epigastrium, midline scar noted with laparoscopic scars as well,
no rebound or guarding
Ext: Warm, well perfused

FAMILY HISTORY: Father had MI.

SOCIAL HISTORY: Pt denies tobacco or alcohol use.  He has 2 kids and works in
sales.
Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute kidney failure, unspecified,Jaundice, unspecified, not of newborn,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Bariatric surgery status,Personal history of peptic ulcer disease
Cholelith w cholecys NEC,Acute kidney failure NOS,Jaundice NOS,Atrial fibrillation,Obstructive sleep apnea,Bariatric surgery status,Prsnl hst peptic ulcr ds
Admission Date:  [**2197-10-16**]              Discharge Date:   [**2197-10-19**]

Date of Birth:  [**2128-8-28**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1390**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
[**2197-10-18**]
Laparoscopic cholecystectomy


History of Present Illness:
69M with history of gastric bypass presents with 3 days of
RUQ abdominal pain and jaundice. Patient had sudden onset of RUQ
pain 3 days ago after a large dinner. His pain has decreased
slightly since then, but has not completely resolved. He denies
nausea and vomiting but had one episode of diarrhea when his
pain
started. He has been feeling weak, ill, and had a fever to 101
today. He reports episodes of abdominal pain after meals in the
past, but has never been told that he has gallstones.

Patient was initially seen at [**Hospital1 18**] [**Location (un) 620**] where he was in new
afib with RVR to 120s. He was afebrile at the time, but appeared
jaundiced. He was fluid resuscitated and transferred to [**Hospital1 18**]
[**Location (un) 86**] for management of possible cholangitis. On arrival to ED,
patient was still in afib but down to 100s. He reported
persistent RUQ pain but denied nausea, chills, and vomiting.


Past Medical History:
1. Morbid obesity - pt has lost 145 lbs
2. hypertension - now improved
3. hyperlipidemia - now improved
4. Obstructive sleep apnea - now improved

PSH:
1. Mini-gastric bypass surgery ~10 months ago
2. left thigh tumor excision
3. right inguinal hernia repair

Social History:
Pt denies tobacco or alcohol use.  He has 2 kids and works in
sales.


Family History:
Father had MI.

Physical Exam:
Temp 100.1   HR 100   BP 144/83   RR 16   O2 sat 94% RA
Gen: Appears jaundiced and dehydrated, NAD
CV: Irregular
Resp: CTAB, no distress
Abd: Soft, midly distended, tender in RUQ and mildly tender in
epigastrium, midline scar noted with laparoscopic scars as well,
no rebound or guarding
Ext: Warm, well perfused


Pertinent Results:
[**2197-10-16**] 11:20PM   WBC-12.2*# RBC-4.55* HGB-13.6* HCT-39.1*
MCV-86 MCH-29.9 MCHC-34.8 RDW-14.2
[**2197-10-16**] 11:20PM   NEUTS-94.7* LYMPHS-3.9* MONOS-1.2* EOS-0.1
BASOS-0.1
[**2197-10-16**] 11:20PM   PLT COUNT-133*
[**2197-10-16**] 11:20PM   PT-16.6* PTT-31.6 INR(PT)-1.5*
[**2197-10-16**] 11:20PM   ALT(SGPT)-232* AST(SGOT)-97* ALK PHOS-204*
TOT BILI-3.8*
[**2197-10-16**] 11:20PM   GLUCOSE-124* UREA N-27* CREAT-1.2 SODIUM-138
POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-21* ANION GAP-15

[**2197-10-17**] MRCP :
1. Cholelithiasis with a small amount of pericholecystic fluid.
No biliary
duct dilatation.
2. Multiple renal cysts with a single hemorrhagic cyst in the
upper pole of the left kidney.
3. Stable left adrenal adenoma.
4. Multiple small pancreatic cysts, the largest is an 8-mm cyst
in the
pancreatic head, given the patient's age, recommend followup
with repeat MRCP in one year.


Brief Hospital Course:
Mr. [**Known lastname 2405**] was evaluated by the Acute Care team in the
Emergency Room and based on his symptom, leukocytosis and
physical exam he was admitted to the hospital with cholangitis
and atrial fibrillation.  For that reason he was monitored in
the ICU where he was made NPO, hydrated with IV fluids and given
broad spectrum antibiotics.  He received one dose of lopressor
for rate control of his afib and responded well. His initial T
Bili was 6 and ERCP was recommended but due to his prior gastric
bypass surgery it would be too difficult therefore MRCP was
performed that showed cholelithiasis with pericholecystic fluid.
All of his LFTs were trending down after 24 hours suggesting
that a stone may have passed. His creatinine was 1.5 at the
outside hospital but quickly declined with adequate fluid
hydration. He was transferred to the floor on [**2197-10-17**] in good
condition.

Following transfer his LFT's were monitored and his T Bili
decreased to 1.5 therefore plans were made for a laparoscopic
cholecystectomy .  He was taken to the Operating Room on
[**2197-10-18**] and underwent a laparoscopic cholecystectomy.  He
tolerated the procedure well and returned to the PACU in stable
condition.  He maintained stable hemodynamics and his pain was
well controlled.  He was transferred back to the Surgical floor
and continued to make good progress.  His diet was gradually
advanced and was tolerated well. He was up and walking without
difficulty and his pain was well controlled.  His port sites
were dry.

He remained in rate controlled atrial fibrillation since his
admission in the 70-80 range with a blood pressure of 120/80.
He has no associated symptoms and preferred to follow up with
his Cardiologist Dr. [**First Name (STitle) **] [**Name (STitle) **].  After discussing the
situation with Dr. [**Last Name (STitle) **] he recommended starting an aspirin a
day and he will see him in his office next week for further work
up.

He was discharged to home on [**2197-10-19**] with a total bili of 1.1
and a creatinine of 1.2.

Medications on Admission:
Benicar 40', omeprazole 20'


Discharge Disposition:
Home

Discharge Diagnosis:
1. Acute cholecystitis
2. Atrial fibrillation


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.

You also have an irregular heart beat which will need to be
followed.  You have a visit with Dr. [**Last Name (STitle) **] on [**Last Name (STitle) 766**].

 Please call your doctor or return to the emergency room if you
have any of the following:


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

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

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

* Please resume all regular home medications and take any new
meds
 as ordered.

Activity:
No heavy lifting of items [**10-7**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.

If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites


Followup Instructions:
Dr. [**Last Name (STitle) **] [**Name (STitle) 766**], [**2197-10-23**] at 1:50PM at [**State 71623**]. [**Location (un) 3678**], MA. ( [**Telephone/Fax (1) 18278**].

Call the Acute Care Clinic at [**Telephone/Fax (1) 600**] for a follow up
appointment in [**1-26**] weeks.

Call Dr. [**Last Name (STitle) **] for a follow up appointment in [**12-25**] weeks.



Completed by:[**2197-10-19**]
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute kidney failure, unspecified,Jaundice, unspecified, not of newborn,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Bariatric surgery status,Personal history of peptic ulcer disease'}


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: 69M with history of gastric bypass presents with 3 days of
RUQ abdominal pain and jaundice. Patient had sudden onset of RUQ
pain 3 days ago after a large dinner. His pain has decreased
slightly since then, but has not completely resolved. He denies
nausea and vomiting but had one episode of diarrhea when his
pain
started. He has been feeling weak, ill, and had a fever to 101
today. He reports episodes of abdominal pain after meals in the
past, but has never been told that he has gallstones.

MEDICAL HISTORY: 1. Morbid obesity - pt has lost 145 lbs
2. hypertension - now improved
3. hyperlipidemia - now improved
4. Obstructive sleep apnea - now improved

MEDICATION ON ADMISSION: Benicar 40', omeprazole 20'

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 100.1   HR 100   BP 144/83   RR 16   O2 sat 94% RA
Gen: Appears jaundiced and dehydrated, NAD
CV: Irregular
Resp: CTAB, no distress
Abd: Soft, midly distended, tender in RUQ and mildly tender in
epigastrium, midline scar noted with laparoscopic scars as well,
no rebound or guarding
Ext: Warm, well perfused

FAMILY HISTORY: Father had MI.

SOCIAL HISTORY: Pt denies tobacco or alcohol use.  He has 2 kids and works in
sales. 

### Response:
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute kidney failure, unspecified,Jaundice, unspecified, not of newborn,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Bariatric surgery status,Personal history of peptic ulcer disease'}
