CHIEF COMPLAINT: abdominal pain, suprapubic pain

PRESENT ILLNESS: 67M with multiple medical problems with recent admissions
for bleeding duodenal ulcer p/w vague complaints of lower
abdominal and suprapubic pain. On work-up, found to have an
enlarged AAA. He is taken emergently to the operating room for
repair.

MEDICAL HISTORY: - large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.

MEDICATION ON ADMISSION: Toprol xl 25mg daily, ASA 81mg daily, simvastatin 20mg
daily, glyburide 2.5mg daily, lisinopril 5mg daily, hyoscyamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
VS: 37.2, 87, 88/44, 19, 96% (30% face mask)
General: pleasant, nad
HEENT:PERRL, EOEMI, sclerae anicteric
OP: MMM, no ulcers/lesions/thrush
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, normal S1, S2, + 2/6 M at RUSB
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no focal tenderness, no CVAT; L. gluteus abscess with
clean
base and borders
Gastrointestinal: +bs, soft, non-tender, non-distended;
suprapubic cath with no surrounding drainage
Musculoskeletal: moving all extremities
Ext: Warm and well perfused, no edema. 2+ DP pulses palpable
bilaterally
Skin: no rashes, no jaundice
Neurological: aaox3, cn 2-12

FAMILY HISTORY: Colon cancer in father

SOCIAL HISTORY: Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs.
Abdominal aneurysm, ruptured,Cellulitis and abscess of buttock,Aneurysm of iliac artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Rupt abd aortic aneurysm,Cellulitis of buttock,Iliac artery aneurysm,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2197-2-15**]              Discharge Date:   [**2197-2-22**]

Date of Birth:  [**2129-4-11**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
abdominal pain, suprapubic pain


Major Surgical or Invasive Procedure:
Incision and drainage of left buttock abscess.

Stent graft repair of ruptured abdominal aortic aneurysm,
coiling of left hypogastric artery.

Flex sigmoidoscopy


History of Present Illness:
67M with multiple medical problems with recent admissions
for bleeding duodenal ulcer p/w vague complaints of lower
abdominal and suprapubic pain. On work-up, found to have an
enlarged AAA. He is taken emergently to the operating room for
repair.

He was recently admitted for Fournier's gangrene to his scrotum
and perineum on [**2197-1-10**] requiring operative debridement by
[**Date Range 159**]. Per family, reports indurated area increasing past
several days with erythema. On examination, noticed purulent
drainage on dressing.


Past Medical History:
- large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.


Social History:
Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs.


Family History:
Colon cancer in father

Physical Exam:
PHYSICAL EXAM:
VS: 37.2, 87, 88/44, 19, 96% (30% face mask)
General: pleasant, nad
HEENT:PERRL, EOEMI, sclerae anicteric
OP: MMM, no ulcers/lesions/thrush
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, normal S1, S2, + 2/6 M at RUSB
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no focal tenderness, no CVAT; L. gluteus abscess with
clean
base and borders
Gastrointestinal: +bs, soft, non-tender, non-distended;
suprapubic cath with no surrounding drainage
Musculoskeletal: moving all extremities
Ext: Warm and well perfused, no edema. 2+ DP pulses palpable
bilaterally
Skin: no rashes, no jaundice
Neurological: aaox3, cn 2-12


Pertinent Results:
[**2197-2-21**] 06:12AM BLOOD

WBC-5.5 RBC-3.33* Hgb-9.2* Hct-28.4* MCV-85 MCH-27.5 MCHC-32.2
RDW-15.5 Plt Ct-202

[**2197-2-21**] 06:12AM BLOOD

Plt Ct-202

[**2197-2-22**] 05:36AM BLOOD

PT-12.6 PTT-27.5 INR(PT)-1.1

[**2197-2-21**] 06:12AM BLOOD

Glucose-99 UreaN-17 Creat-1.4* Na-139 K-4.1 Cl-101 HCO3-31
AnGap-11

[**2197-2-16**] 06:20PM BLOOD

ALT-9 AST-12 LD(LDH)-169 AlkPhos-61 Amylase-18 TotBili-1.5

[**2197-2-21**] 06:12AM BLOOD

Calcium-8.1* Phos-3.4 Mg-2.1

[**2197-2-15**] 01:05PM

URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.017
URINE Blood-LG Nitrite-NEG Protein-150 Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-4* pH-6.5 Leuks-MOD
URINE RBC-[**12-9**]* WBC-[**12-9**]* Bacteri-MOD Yeast-FEW Epi-0


WOUND CULTURE (Final [**2197-2-19**]):

Due to mixed bacterial types (>=3) an abbreviated workup is
performed; P.aeruginosa, S.aureus and beta strep. are reported
if
present. Susceptibility will be performed on P.aeruginosa and
S.aureus if sparse growth or greater..

STAPHYLOCOCCUS, COAGULASE NEGATIVE.    SPARSE GROWTH.
STAPHYLOCOCCUS, COAGULASE NEGATIVE.    RARE GROWTH.  SECOND
STRAIN.

                             STAPHYLOCOCCUS, COAGULASE NEGATIVE
                             |
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------<=0.12 S
OXACILLIN-------------<=0.25 S
TETRACYCLINE----------     2 S
VANCOMYCIN------------ <=0.5 S

CTA:

Status post endovascular repair with stent extending from the
infrarenal
aorta into bilateral common iliac arteries. There is no evidence
of endoleak at this time. The caliber of the aortic aneurysm and
right greater than left iliac artery aneurysms are stable.
2. Small bilateral low-density pleural effusions, left greater
than right
with mild compressive atelectasis. Two pulmonary nodules in the
right lower lobe are stable.
3. Status post incision and drainage of a left gluteal
subcutaneous fluid
collection.


Brief Hospital Course:
Pt admitted, emergently taken to the OR.

CTA showed ruptured AAA and Buttock abcess.

Stent graft repair of ruptured abdominal aortic aneurysm,
coiling of left hypogastric artery.

Buttuck abcess, this was also I/D by Dr [**Last Name (STitle) 12352**] team.

Tolerated the procedure. No complications, Transfered to the VCU
for further care.

Pt did have BM post repair. Taken for flex sig for possible
bowel ischemia

There were no obvious luminal masses but a careful examination
of all folds was not performed. The mucosa appeared slightly
pale, but there were multiple visible vessels in the bowel wall.
The mucosal folds were not thickened and there was no
evidence of mucosal edema. There was no evidence of ulceration
or mucosal sloughing.

Pt pan cx'd, blood cx's are negative.

ID consult because of stranding on CT, Forniers gangrene and
buttock abcess.

PICC line placed

Recommended vancomycin 4 weeks, Cipro and flagyl x 6 weeks. Pt
on current regime at time of DC.

PT consult, case management. Pt stable for home with PICC and IV
AB.

Medications on Admission:
Toprol xl 25mg daily, ASA 81mg daily, simvastatin 20mg
daily, glyburide 2.5mg daily, lisinopril 5mg daily, hyoscyamine

0.125mg qid PRN


Discharge Medications:
1. Vancomycin 500 mg Recon Soln Sig: One (1) Recon Soln
Intravenous Q 12H (Every 12 Hours) for 1 months: Check trough
twice weekly.
Disp:*90 Recon Soln(s)* Refills:*0*
2. Normal Saline Flush 0.9 % Syringe Sig: One (1)  Injection
three times a day for 1 months: flush after each use and prn,
then with heparin flush.
Disp:*90 Normal Saline Flush (Injection) 0.9 % Syringe*
Refills:*0*
3. Heparin Flush 10 unit/mL Kit Sig: One (1)  Intravenous three
times a day for 1 months: follow NS flush.
Disp:*90 Heparin Flush (Intravenous) 10 unit/mL Kit* Refills:*0*
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 6
weeks.
Disp:*84 Tablet(s)* Refills:*0*
10. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a
day for 6 weeks.
Disp:*126 Tablet(s)* Refills:*0*
11. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Ruptured abdominal aortic aneurysm
Left buttock abcess


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


Discharge Instructions:
Division of Vascular and Endovascular Surgery

Endovascular Discharge Instructions

Medications:
??????	If instructed, Take Aspirin 325mg (enteric coated) once daily
??????	If instructed, do not stop Aspirin unless your Vascular
Surgeon instructs you to do so.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort

What to expect when you go home:
It is normal to have slight swelling of the legs:
??????	Elevate your leg above the level of your heart (use [**2-22**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated
It is normal to feel tired and have a decreased appetite, your
appetite will return with time
??????	Drink plenty of fluids and eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs
??????	You may shower (let the soapy water run over groin incision,
rinse and [**Month/Day (3) **] dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
??????	After 1 week, you may resume sexual activity
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate
??????	No driving until you are no longer taking pain medications
??????	Call and schedule an appointment to be seen in [**4-25**] weeks for
post procedure check and CTA

What to report to office:
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site or
incision)
??????	Lie down, keep leg straight and have someone apply firm
pressure to area for 10 minutes. If bleeding stops, call
vascular office. If bleeding does not stop, call 911 for
transfer to closest Emergency Room.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name12 (NameIs) **] ID WEST (SB) Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2197-3-13**] 3:50

Provider: [**Name10 (NameIs) **] UNIT Phone:[**Telephone/Fax (1) 164**] Date/Time:[**2197-3-15**]
10:00

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 2625**]
Date/Time:[**2197-3-15**] 1:00

Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital1 18**] on [**3-24**], at 1115. [**Location (un) **]
[**Location (un) 470**] [**Hospital Ward Name 23**] Building. She I/D your abcess.
([**Telephone/Fax (1) 6347**]



Completed by:[**2197-2-22**]
{'Abdominal aneurysm, ruptured,Cellulitis and abscess of buttock,Aneurysm of iliac artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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, suprapubic pain

PRESENT ILLNESS: 67M with multiple medical problems with recent admissions
for bleeding duodenal ulcer p/w vague complaints of lower
abdominal and suprapubic pain. On work-up, found to have an
enlarged AAA. He is taken emergently to the operating room for
repair.

MEDICAL HISTORY: - large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.

MEDICATION ON ADMISSION: Toprol xl 25mg daily, ASA 81mg daily, simvastatin 20mg
daily, glyburide 2.5mg daily, lisinopril 5mg daily, hyoscyamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
VS: 37.2, 87, 88/44, 19, 96% (30% face mask)
General: pleasant, nad
HEENT:PERRL, EOEMI, sclerae anicteric
OP: MMM, no ulcers/lesions/thrush
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, normal S1, S2, + 2/6 M at RUSB
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no focal tenderness, no CVAT; L. gluteus abscess with
clean
base and borders
Gastrointestinal: +bs, soft, non-tender, non-distended;
suprapubic cath with no surrounding drainage
Musculoskeletal: moving all extremities
Ext: Warm and well perfused, no edema. 2+ DP pulses palpable
bilaterally
Skin: no rashes, no jaundice
Neurological: aaox3, cn 2-12

FAMILY HISTORY: Colon cancer in father

SOCIAL HISTORY: Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs. 

### Response:
{'Abdominal aneurysm, ruptured,Cellulitis and abscess of buttock,Aneurysm of iliac artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
