CHIEF COMPLAINT: post ERCP pancreatitis

PRESENT ILLNESS: Mr. [**Known lastname 31164**] is a 70 yo with ulcerative colitis x 10yrs and PSC who
presents with abdominal pain post-ERCP. He was in his usual
health until about 1-2 weeks ago when he developed night sweats
and chills (no abdominal pain or jaundice) and he contact[**Name (NI) **] his
GI doctor because he knew this was a sign of recurrent biliary
stricture. He underwent an ERCP this morning and underwent
common hepatic duct balloon dilation and sludge removal without
complications and was discharged home. A few hours later (around
1pm) he developed gradual onset of abdominal pain (in a circular
peri-umbilical distribution) that he cannot describe in more
detail, also associated with mild B flank/lower back pain, and
minimal yellow emesis. He has had flatus and 1x BM. He presented
to [**Hospital3 **] where his Lipase was 1800 and his 79/55 with
improvement to the 100's with 2L NS. CT scan showed
peripancreatic stranding without clear obstruction. He was
transferred to [**Hospital1 18**] for further evaluation. In our ED, he was
afebrile with stable vitals (BP in 90's-100's) and he was given
1L NS and 4mg morphine. His abdominal pain has almost completely
resolved now as has his nausea/vomiting.
.
ROS is negative for fevers, chills, SOB, jaundice, dysyuria,
cough,

MEDICAL HISTORY: - CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
- CHF EF 30%
- primary sclerosing cholangitis dx [**2178**] (s/p 3 ERCPs; atypical
cytology in [**2178**], repeat neg for atypical cells in [**2180**] and
[**2181**])
- ulcerative colitis x10-15 years
- recurrent mild intermittent cholangitis
- GERD
- h/o Lyme disease [**8-24**]
- hypercholesterolemia
- hypertension
- Raynaud's disease s/p multiple finger and toe amputations
- OSAS on home BiPAP
- esophageal stricture
- depression

MEDICATION ON ADMISSION: Asacol 1600 daily, baby aspirin (on hold x 1 week), folate 1mg,
Simvastatin 10mg daily, Prilosec 20mg, Ursodiol 1200mg,
Moexepril 7.5mg daily, Toprol XL 50mg daily, zoloft 50mg daily,
levofloxacin

ALLERGIES: Penicillins

PHYSICAL EXAM: Vital signs stable, afebrile
G

FAMILY HISTORY: There is no family history of liver disease or liver cancer.
There is no family history of colon cancer. His father developed

SOCIAL HISTORY: He is a retired carpenter and married with 3 grown children. No
Tob. 1-2 drinks per day until recently. Denies Illicit drug use.
Acute pancreatitis,Cholangitis,Dehydration,Hypotension, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Raynaud's syndrome,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Ulcerative colitis, unspecified
Acute pancreatitis,Cholangitis,Dehydration,Hypotension NOS,Abn react-surg proc NEC,Crnry athrscl natve vssl,Pure hypercholesterolem,Hypertension NOS,Raynaud's syndrome,Obstructive sleep apnea,Depressive disorder NEC,Ulceratve colitis unspcf
Admission Date:  [**2183-12-6**]              Discharge Date:   [**2183-12-8**]

Date of Birth:  [**2113-2-21**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
post ERCP pancreatitis

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 31164**] is a 70 yo with ulcerative colitis x 10yrs and PSC who
presents with abdominal pain post-ERCP. He was in his usual
health until about 1-2 weeks ago when he developed night sweats
and chills (no abdominal pain or jaundice) and he contact[**Name (NI) **] his
GI doctor because he knew this was a sign of recurrent biliary
stricture. He underwent an ERCP this morning and underwent
common hepatic duct balloon dilation and sludge removal without
complications and was discharged home. A few hours later (around
1pm) he developed gradual onset of abdominal pain (in a circular
peri-umbilical distribution) that he cannot describe in more
detail, also associated with mild B flank/lower back pain, and
minimal yellow emesis. He has had flatus and 1x BM. He presented
to [**Hospital3 **] where his Lipase was 1800 and his 79/55 with
improvement to the 100's with 2L NS. CT scan showed
peripancreatic stranding without clear obstruction. He was
transferred to [**Hospital1 18**] for further evaluation. In our ED, he was
afebrile with stable vitals (BP in 90's-100's) and he was given
1L NS and 4mg morphine. His abdominal pain has almost completely
resolved now as has his nausea/vomiting.
.
ROS is negative for fevers, chills, SOB, jaundice, dysyuria,
cough,


Past Medical History:
- CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
- CHF EF 30%
- primary sclerosing cholangitis dx [**2178**] (s/p 3 ERCPs; atypical
cytology in [**2178**], repeat neg for atypical cells in [**2180**] and
[**2181**])
- ulcerative colitis x10-15 years
- recurrent mild intermittent cholangitis
- GERD
- h/o Lyme disease [**8-24**]
- hypercholesterolemia
- hypertension
- Raynaud's disease s/p multiple finger and toe amputations
- OSAS on home BiPAP
- esophageal stricture
- depression


Social History:
He is a retired carpenter and married with 3 grown children. No
Tob. 1-2 drinks per day until recently. Denies Illicit drug use.



Family History:
There is no family history of liver disease or liver cancer.
There is no family history of colon cancer. His father developed

diabetes and ischemic heart disease in later life.


Physical Exam:
Vital signs stable, afebrile
G

Pertinent Results:
[**2183-12-5**] 09:00AM BLOOD WBC-5.6 RBC-3.63* Hgb-13.0* Hct-36.0*
MCV-99* MCH-35.8* MCHC-36.0* RDW-14.4 Plt Ct-195
[**2183-12-7**] 05:29AM BLOOD WBC-8.9 RBC-3.53* Hgb-12.5* Hct-35.3*
MCV-100* MCH-35.5* MCHC-35.4* RDW-14.4 Plt Ct-162
[**2183-12-5**] 09:00AM BLOOD Neuts-73.6* Lymphs-17.9* Monos-6.3
Eos-1.5 Baso-0.8
[**2183-12-5**] 09:00AM BLOOD PT-14.1* INR(PT)-1.3*
[**2183-12-6**] 12:30AM BLOOD Glucose-94 UreaN-9 Creat-0.8 Na-139 K-3.9
Cl-109* HCO3-21* AnGap-13
[**2183-12-7**] 05:29AM BLOOD Glucose-101 UreaN-7 Creat-0.7 Na-137
K-3.4 Cl-105 HCO3-24 AnGap-11
[**2183-12-5**] 09:00AM BLOOD ALT-85* AlkPhos-245* Amylase-56
TotBili-2.1* DirBili-1.5* IndBili-0.6
[**2183-12-7**] 05:29AM BLOOD ALT-70* AST-66* AlkPhos-223* Amylase-205*
TotBili-2.4*
[**2183-12-5**] 09:00AM BLOOD Lipase-39
[**2183-12-6**] 12:30AM BLOOD Lipase-1161*
[**2183-12-6**] 04:45AM BLOOD Lipase-800*
[**2183-12-7**] 05:29AM BLOOD Lipase-118*
[**2183-12-6**] 12:30AM BLOOD Albumin-2.7* Calcium-7.8* Phos-4.1 Mg-1.7
[**2183-12-6**] 12:30AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.018
[**2183-12-6**] 12:30AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG

Brief Hospital Course:
1. acute pancreatitis -- post ERCP.  Resolved quickly with IVFs,
analgesics and supportive care.  Tolerated regular diet prior to
discharge without pain.

2. cholangitis from PSC/biliary strictures -- Bile duct dilated
with baloon in ERCP.  Prescribed 10 day total course of
ciprofloxacin.  Held aspirin for one week after dilation (to
resume [**12-13**]).


Medications on Admission:
Asacol 1600 daily, baby aspirin (on hold x 1 week), folate 1mg,
Simvastatin 10mg daily, Prilosec 20mg, Ursodiol 1200mg,
Moexepril 7.5mg daily, Toprol XL 50mg daily, zoloft 50mg daily,
levofloxacin

Discharge Medications:
1. Ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q12H
(every 12 hours) for 7 days.
Disp:*42 Tablet(s)* Refills:*0*
2. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO TID (3 times a day).
Disp:*180 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Ursodiol 300 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
Disp:*120 Capsule(s)* Refills:*0*
7. Moexipril 7.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
10. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day:
START ON [**12-13**] - do not take any aspirin until [**12-13**].
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Cholangitis
ERCP with common hepatic duct dilation
Post-ERCP pancreatitis and hypotension


Discharge Condition:
stable

Discharge Instructions:
Take all medications as prescribed.

Return to the [**Hospital1 18**] Emergency Department for:

Fevers and chills
Nausea and vomiting
Worsening abdominal pain

Followup Instructions:
Call your primary doctor for a follow up appointment for within
2 weeks of leaving the hospital: [**Last Name (LF) **],[**First Name3 (LF) 198**] P. [**Telephone/Fax (1) 19980**]

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2183-12-19**] 10:40
{"Acute pancreatitis,Cholangitis,Dehydration,Hypotension, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Raynaud's syndrome,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Ulcerative colitis, 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: post ERCP pancreatitis

PRESENT ILLNESS: Mr. [**Known lastname 31164**] is a 70 yo with ulcerative colitis x 10yrs and PSC who
presents with abdominal pain post-ERCP. He was in his usual
health until about 1-2 weeks ago when he developed night sweats
and chills (no abdominal pain or jaundice) and he contact[**Name (NI) **] his
GI doctor because he knew this was a sign of recurrent biliary
stricture. He underwent an ERCP this morning and underwent
common hepatic duct balloon dilation and sludge removal without
complications and was discharged home. A few hours later (around
1pm) he developed gradual onset of abdominal pain (in a circular
peri-umbilical distribution) that he cannot describe in more
detail, also associated with mild B flank/lower back pain, and
minimal yellow emesis. He has had flatus and 1x BM. He presented
to [**Hospital3 **] where his Lipase was 1800 and his 79/55 with
improvement to the 100's with 2L NS. CT scan showed
peripancreatic stranding without clear obstruction. He was
transferred to [**Hospital1 18**] for further evaluation. In our ED, he was
afebrile with stable vitals (BP in 90's-100's) and he was given
1L NS and 4mg morphine. His abdominal pain has almost completely
resolved now as has his nausea/vomiting.
.
ROS is negative for fevers, chills, SOB, jaundice, dysyuria,
cough,

MEDICAL HISTORY: - CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
- CHF EF 30%
- primary sclerosing cholangitis dx [**2178**] (s/p 3 ERCPs; atypical
cytology in [**2178**], repeat neg for atypical cells in [**2180**] and
[**2181**])
- ulcerative colitis x10-15 years
- recurrent mild intermittent cholangitis
- GERD
- h/o Lyme disease [**8-24**]
- hypercholesterolemia
- hypertension
- Raynaud's disease s/p multiple finger and toe amputations
- OSAS on home BiPAP
- esophageal stricture
- depression

MEDICATION ON ADMISSION: Asacol 1600 daily, baby aspirin (on hold x 1 week), folate 1mg,
Simvastatin 10mg daily, Prilosec 20mg, Ursodiol 1200mg,
Moexepril 7.5mg daily, Toprol XL 50mg daily, zoloft 50mg daily,
levofloxacin

ALLERGIES: Penicillins

PHYSICAL EXAM: Vital signs stable, afebrile
G

FAMILY HISTORY: There is no family history of liver disease or liver cancer.
There is no family history of colon cancer. His father developed

SOCIAL HISTORY: He is a retired carpenter and married with 3 grown children. No
Tob. 1-2 drinks per day until recently. Denies Illicit drug use. 

### Response:
{"Acute pancreatitis,Cholangitis,Dehydration,Hypotension, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Raynaud's syndrome,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Ulcerative colitis, unspecified"}
