CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 74yo female p/w abdominal pain and decreased stoma output. This
began [**2114-4-5**]. Pt noticed increasing pain and became concerned

MEDICAL HISTORY: Breast cancer
HTN
NIDDM

MEDICATION ON ADMISSION: HCTZ
Glipizide
Metoprolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: nad
ctab
rrr
soft/tender, diminshed bowel sounds
cva tenderness

FAMILY HISTORY: n/a

SOCIAL HISTORY: n/a
Other colostomy and enterostomy complication,Other specified intestinal obstruction,Other postoperative infection,Unspecified septicemia,Sepsis,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Colstmy/enteros comp NEC,Intestinal obstruct NEC,Other postop infection,Septicemia NOS,Sepsis,Acute kidney failure NOS,Chronic kidney dis NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2114-4-6**]              Discharge Date:   [**2114-5-4**]

Date of Birth:  [**2039-7-15**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 17683**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
s/p ex-lap
parastomal hernia repair
fascial dehiscence


History of Present Illness:
74yo female p/w abdominal pain and decreased stoma output. This
began [**2114-4-5**]. Pt noticed increasing pain and became concerned

Past Medical History:
Breast cancer
HTN
NIDDM

colostomy [**3-15**] GIB
appendectomy
fibroid resection

Social History:
n/a

Family History:
n/a

Physical Exam:
nad
ctab
rrr
soft/tender, diminshed bowel sounds
cva tenderness

Pertinent Results:
[**2114-4-6**] 07:20PM BLOOD WBC-10.9 RBC-4.30# Hgb-12.7# Hct-38.1
MCV-89 MCH-29.5 MCHC-33.4 RDW-13.5 Plt Ct-274#
[**2114-4-9**] 08:19AM BLOOD WBC-8.5 RBC-3.91* Hgb-11.5* Hct-34.2*
MCV-87 MCH-29.4 MCHC-33.6 RDW-13.4 Plt Ct-227
[**2114-4-13**] 01:00PM BLOOD WBC-5.9 RBC-3.78* Hgb-11.2* Hct-34.3*
MCV-91 MCH-29.6 MCHC-32.6 RDW-13.2 Plt Ct-287
[**2114-4-18**] 10:29PM BLOOD WBC-21.7* RBC-3.18* Hgb-9.4* Hct-28.9*
MCV-91 MCH-29.7 MCHC-32.6 RDW-14.1 Plt Ct-290
[**2114-4-30**] 06:10AM BLOOD WBC-10.4 RBC-2.72* Hgb-8.0* Hct-24.9*
MCV-92 MCH-29.4 MCHC-32.1 RDW-14.0 Plt Ct-448*
[**2114-5-3**] 04:30AM BLOOD WBC-6.4 RBC-2.81* Hgb-8.3* Hct-25.5*
MCV-91 MCH-29.7 MCHC-32.7 RDW-14.0 Plt Ct-458*
[**2114-4-6**] 07:20PM BLOOD PT-12.3 PTT-22.6 INR(PT)-1.1
[**2114-5-1**] 07:28PM BLOOD PT-11.9 PTT-21.7* INR(PT)-1.0
[**2114-4-6**] 07:20PM BLOOD Glucose-173* UreaN-19 Creat-1.6* Na-141
K-4.3 Cl-104 HCO3-24 AnGap-17
[**2114-4-11**] 12:20PM BLOOD Glucose-104 UreaN-12 Creat-1.2* Na-143
K-3.8 Cl-103 HCO3-29 AnGap-15
[**2114-4-13**] 06:55AM BLOOD Glucose-115* UreaN-21* Creat-1.8* Na-142
K-5.2* Cl-100 HCO3-31 AnGap-16
[**2114-4-17**] 06:55AM BLOOD Glucose-98 UreaN-20 Creat-1.5* Na-146*
K-4.1 Cl-109* HCO3-28 AnGap-13
[**2114-4-19**] 02:47AM BLOOD Glucose-134* UreaN-29* Creat-1.8* Na-142
K-3.8 Cl-112* HCO3-21* AnGap-13
[**2114-4-24**] 02:12AM BLOOD Glucose-175* UreaN-25* Creat-1.2* Na-142
K-4.1 Cl-109* HCO3-24 AnGap-13
[**2114-5-3**] 04:30AM BLOOD Glucose-116* UreaN-4* Creat-0.9 Na-143
K-3.9 Cl-104 HCO3-32 AnGap-11
[**2114-4-6**] 07:20PM BLOOD AST-16 Amylase-135* TotBili-0.5
[**2114-5-1**] 11:11PM BLOOD ALT-7 AST-16 CK(CPK)-50 AlkPhos-77
Amylase-310*
[**2114-5-3**] 04:30AM BLOOD Amylase-200*
[**2114-4-19**] 02:47AM BLOOD Lipase-9
[**2114-4-8**] 08:05AM BLOOD Calcium-8.8 Phos-3.8 Mg-1.9
[**2114-5-3**] 04:30AM BLOOD Calcium-8.0* Phos-4.3 Mg-1.8
[**2114-4-17**] 01:56PM BLOOD Type-ART Tidal V-600 FiO2-23 pO2-68*
pCO2-42 pH-7.40 calHCO3-27 Base XS-0 Intubat-INTUBATED
Vent-CONTROLLED
[**2114-4-19**] 12:16PM BLOOD Type-ART pO2-111* pCO2-49* pH-7.26*
calHCO3-23 Base XS--5
[**2114-4-23**] 10:11PM BLOOD Type-ART pO2-129* pCO2-44 pH-7.37
calHCO3-26 Base XS-0
[**2114-4-27**] 04:01AM BLOOD Type-ART Temp-37.2 Rates-/20 pO2-102
pCO2-47* pH-7.41 calHCO3-31* Base XS-3 Intubat-NOT INTUBA
Comment-NASAL [**Last Name (un) 154**]
[**2114-5-2**] 06:51AM BLOOD Type-ART pO2-86 pCO2-55* pH-7.35
calHCO3-32* Base XS-2

Brief Hospital Course:
On [**2114-4-6**] Ms. [**Known lastname **] was admitted to the surgery service under
the care of Dr. [**Last Name (STitle) **] with a diagnosis of a partial small
bowel obstruction secondary to a parastomal hernia. An NG tube
was placed and she was resuscitated with IF fluids. On HD 5 her
NG tube was d/c'd and over the next several days her diet was
slowly advanced. She was tolerating clears until her ostomy
output started to decrease. She developed increasing abdominal
pain and nausea. An NG tube was replaced and approximately 1600
cc of fecal material was suctioned. On hospital day 12 she was
taken to the OR for a parastomal hernia repair and anastomosis
of her ileum to her sigmoid colon. For details of the operation,
please see Dr.[**Name (NI) 22019**] operative report. Postoperatively she
remained intubated for several days in the ICU. TPN was
initiated. On POD 5 she had to return to the OR for a wound
dehiscence. Postoperatively from this second operation, Ms.
[**Known lastname **] did well. Her TPN was weaned down as tube feeds were
increased to goal via an NGT. On POD 10 from her initial
operation she was transferred to the floor and started on
clears. On POD 12 her NG tube was d/c'd and she was tolerating
fulls. By POD 13 she was tolerating a regular diet and walking
with physical therapy.On HD 26, patient found unresponsive in
bed. She was unable to move her extremities or mouth. Appeared
to have left facial droop and significant weakness on left side.
Vital signs were noted to be stable. Neurology was consulted. A
CXR, head CTA were performed and found to be negative. A EEG
showed some evidence of slow waves consistent with a post-ictal
state. On HD 27, pt noted to have significant imporvement. By HD
28, pt had returned to her baseline state. A VAC dressing was
placed at the bedside on the day of discharge for wound healing.
The pt was doing well.

Medications on Admission:
HCTZ
Glipizide
Metoprolol


Discharge Medications:
1. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday).
7. Albuterol 90 mcg/Actuation Aerosol Sig: Six (6) Puff
Inhalation Q4H (every 4 hours) as needed for wheezing.
8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
9. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
11. Loperamide 2 mg Capsule Sig: One (1) Capsule PO TID (3 times
a day): titrate to [**3-16**] BM's/day.  .
12. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
13. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 672**] Hospital

Discharge Diagnosis:
s/p partial small bowel obstruction
ex-lap
parastomal hernai repair


Discharge Condition:
good


Discharge Instructions:
Please call your doctor or the ER if you experience any of the
following: increased pain, fever >101.1, nausea, vomitting,
increasign diarrhea, chest pain, pus from your wound site or any
other concerns.

Followup Instructions:
Please follow up with Dr [**Last Name (STitle) **] in 1 week from discharge. An
appointment can be scheduled at ([**Telephone/Fax (1) 33502**]
Please remove VAC prior to follow up for wound evaluation


                             [**Name6 (MD) 843**] [**Name8 (MD) 844**] MD [**MD Number(1) 845**]

Completed by:[**0-0-0**]
{'Other colostomy and enterostomy complication,Other specified intestinal obstruction,Other postoperative infection,Unspecified septicemia,Sepsis,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 74yo female p/w abdominal pain and decreased stoma output. This
began [**2114-4-5**]. Pt noticed increasing pain and became concerned

MEDICAL HISTORY: Breast cancer
HTN
NIDDM

MEDICATION ON ADMISSION: HCTZ
Glipizide
Metoprolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: nad
ctab
rrr
soft/tender, diminshed bowel sounds
cva tenderness

FAMILY HISTORY: n/a

SOCIAL HISTORY: n/a 

### Response:
{'Other colostomy and enterostomy complication,Other specified intestinal obstruction,Other postoperative infection,Unspecified septicemia,Sepsis,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
