CHIEF COMPLAINT: Loose stools and fevers

PRESENT ILLNESS: 79F s/p segment VII resection of metastatic colon CA to liver
([**3-1**]). Was here to have pleurex catheter placed but was having
abdominal pain, fevers, and nausea and was sent to the ED. She
reports passing flatus and stool.

MEDICAL HISTORY: Past Medical History:
Bipolar
HTN
Past Surgical History;
TAH
Appendectomy

MEDICATION ON ADMISSION: atenolol 50', lasix 20', keppra 500", risperidol 1.5', mvi',
folic acid'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: In ED
97.4, 94, 86/54 to 149/71 96% 3L NC
NAD
RRR
decreased Breath sounds in bases R>L
Abdomen soft, obese, nondistended, no tympany, Midline incision
inferior to umbilicus well healed with 2 small incisional
hernias.  Bowel easily reducible.
EXT: warm and dry

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, lives with husband and son, drinks one glass of wine
per day, former smoker
Unspecified pleural effusion,Acute edema of lung, unspecified,Incisional ventral hernia with obstruction,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Other ascites,Unspecified essential hypertension,Bipolar disorder, unspecified,Dehydration,Personal history of malignant neoplasm of large intestine
Pleural effusion NOS,Acute lung edema NOS,Obstr incisional hernia,Second malig neo liver,Urin tract infection NOS,Ascites NEC,Hypertension NOS,Bipolar disorder NOS,Dehydration,Hx of colonic malignancy
Admission Date:  [**2123-4-7**]              Discharge Date:   [**2123-5-11**]

Date of Birth:  [**2044-2-14**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Loose stools and fevers

Major Surgical or Invasive Procedure:
[**2123-4-8**] right chest tube (pleurex tube)
[**2123-4-13**] ERCP
[**2123-4-15**] removal of pleurex tube and insertion of pigtail catheter
[**2123-4-30**] Right-sided pigtail catheter drainage
[**2123-5-4**] Talc pleurodesis right lung
[**2123-5-7**] ERCP


History of Present Illness:
79F s/p segment VII resection of metastatic colon CA to liver
([**3-1**]). Was here to have pleurex catheter placed but was having
abdominal pain, fevers, and nausea and was sent to the ED. She
reports passing flatus and stool.

Past Medical History:
Past Medical History:
Bipolar
HTN
Past Surgical History;
TAH
Appendectomy

Social History:
Married, lives with husband and son, drinks one glass of wine
per day, former smoker


Family History:
Non-contributory

Physical Exam:
In ED
97.4, 94, 86/54 to 149/71 96% 3L NC
NAD
RRR
decreased Breath sounds in bases R>L
Abdomen soft, obese, nondistended, no tympany, Midline incision
inferior to umbilicus well healed with 2 small incisional
hernias.  Bowel easily reducible.
EXT: warm and dry


Pertinent Results:
JP drain fluid
 GRAM STAIN (Final [**2123-4-7**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

[**2123-4-7**] 12:05PM BLOOD WBC-19.7*# RBC-4.20 Hgb-11.5* Hct-35.2*
MCV-84 MCH-27.4 MCHC-32.7 RDW-14.1 Plt Ct-316#
[**2123-4-7**] 12:05PM BLOOD Neuts-95.4* Bands-0 Lymphs-2.4* Monos-2.0
Eos-0.1 Baso-0.1
[**2123-4-8**] 08:40AM BLOOD PT-16.1* PTT-28.2 INR(PT)-1.4*
[**2123-4-8**] 05:30AM BLOOD Glucose-106* UreaN-14 Creat-1.1 Na-135
K-3.9 Cl-101 HCO3-27 AnGap-11
[**2123-4-7**] 12:05PM BLOOD ALT-15 AST-24 AlkPhos-156* TotBili-0.4
[**2123-4-8**] 05:30AM BLOOD Calcium-8.4 Phos-3.6 Mg-1.8
[**2123-4-7**] 12:17PM BLOOD Lactate-2.9*

[**4-7**] CT chest/abd/pelvis
IMPRESSION:

1. Dilated loops of small bowel up to 3.5 cm, with air-fluid
levels, and transition point in small ventral hernia in the
midline lower abdomen, after which bowel loops are decompressed,
and contain no oral contrast. This appearance is concerning for
small-bowel obstruction, although the presence of gas within the
colon and rectum suggests that it may be an early obstruction,
or a partial obstruction.

2. Heterogeneous 6.3 x 2.5 cm fluid collection posterior to the
right hepatectomy resection margin could represent post-surgical
change and material such as Surgicel, although it is difficult
to exclude abscess formation.

3. Increased size of multiple hypodense lesions within the liver
concerning for progression of metastatic disease.

4. Unchanged appearance of ill-defined hypodense lesion within
the spleen. This lesion was characterized by MRI from [**2123-1-10**] as
having features suggestive of a lymphangioma.

5. Large right pleural effusion and right lower lobe atelectasis
Small left pleural effusion.

6. Small-volume ascites.
.
Labs at discharge: [**2123-5-8**]
WBC-8.4 RBC-4.27 Hgb-11.6* Hct-36.5 MCV-85 MCH-27.1 MCHC-31.8
RDW-14.4 Plt Ct-298
Glucose-99 UreaN-10 Creat-0.7 Na-144 K-3.7 Cl-104 HCO3-33*
AnGap-11
ALT-14 AST-20 AlkPhos-111 Amylase-35 TotBili-0.4
Albumin-2.5*

Brief Hospital Course:
Patient was seen in ED and admitted to General Surgery service.
IV cipro and flagyl was started, an NGT and Foley were placed,
and she was kept NPO with IVF.  An abdominal CT was done showing
dilated loops of small bowel up to 3.5 cm, with air-fluid
levels. Point of obstruction appeared to be a ventral hernia in
the lower abdominal wall. A heterogeneous 6.3 x 2.5 cm fluid
collection posterior to the right hepatectomy resection was
noted. There was increased size of multiple hypodense lesions
within the liver concerning for progression of metastatic
disease and small-volume ascites. A large right pleural effusion
and right lower lobe atelectasis with a small left pleural
effusion was noted.
.
Interventional pulmonology was contact[**Name (NI) **] and on [**Name (NI) 58274**] a right
pleurex catheter was placed and attached to a pleuravac and
suction. This initially drained ~ one liter of straw colored
fluid. She remained on O2 nasal cannula with diminished breath
sounds in the lower lobes. On [**4-13**], 700cc of serous fluid was
removed from the pleurx tube. The pleurx catheter was removed on
[**4-14**] due to persistent leaking at the connection site to the
pleuravac. A right pleural 14 french pigtail catheter was placed
at the 5th ICS. The pigtail was connected to a pleuravac.  On
[**2123-5-4**] a talc pleuradesis was performed on her right lung with
follow-up CXRs with no PTX and stable pleural effusion. She
remains on O2 via nasal cannula. O2 sats drop into high 80's
when ambulating, she remains asymptomatic. Most recent Chest
xray on [**5-7**] shows: the bilateral moderate pleural effusions are
unchanged with associated right lower lobe atelectasis.
.
On [**4-9**], the NG tube was removed. Diet was advanced slowly and
tolerated. LFTs remained stable as well as chemistries.
.
The JP continued to drain bilious fluid. This fluid was cultured
and grew two species of E.coli resistent to ampicillin and
cipro, but sensitive to Bactrim. Therefore, Bactrim DS [**Hospital1 **] was
started on [**4-11**]. The JP drainage averaged approximately 70cc/day.
On [**4-13**], ERCP was performed noting bile leak. Sphincterotomy was
done with stent placement. Post ERCP, the JP drainage decreased
to ~ 30cc/day. WBC was 17 on admission with downward trend to
11.  She had a second ERCP on [**5-7**] and she had a stent
exchanged. She will remain on Bactrim on discharge. The JP drain
remians in place.
.
She had a UTI with a resistant strain of E coli. She received 10
days of Meropenem IV. There was also concern for urinary
retention. She should be encouraged for frequent toileting and
bladder training. Urine culture from [**5-4**] was no growth. A
surveillance culture was sent on [**5-11**] prior to discharge and
should be followed up as an outpatient.
.
Dr.[**Name (NI) 3377**] team was consulted regarding possibility of
repairing ventral hernia. Given bile leak, infection and
effusion repair was deferred at this time.
.
PT/OT evaluated her. She was safe to transfer and ambulate with
nursing, but continued to require PT. The plan was for her to go
to rehab facility for further rehab, as she is requiring
assistive devices and has increased O2 requirements with
activity.

Medications on Admission:
atenolol 50', lasix 20', keppra 500", risperidol 1.5', mvi',
folic acid'

Discharge Medications:
1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Risperidone 1 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime).

4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day) as needed.
8. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day).
9. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location (un) 5165**]

Discharge Diagnosis:
abdominal pain
right pleural effusion
UTI
Bile leak


Discharge Condition:
Stable

Discharge Instructions:
Please call Dr.[**Name (NI) 1369**] office [**Telephone/Fax (1) 673**] if fever >101,
chills, nausea, vomiting, abdominal distension or increased
abdominal pain, jaundice, shortness of breath,

Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) **] W.  [**Telephone/Fax (1) 673**]  [**2123-5-19**]  2:00 PM
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2123-5-31**]
11:30
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6050**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2123-5-31**]
11:30
ERCP 2 (ST-4) GI ROOMS Date/Time:[**2123-7-20**] 4:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2123-5-11**]
{'Unspecified pleural effusion,Acute edema of lung, unspecified,Incisional ventral hernia with obstruction,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Other ascites,Unspecified essential hypertension,Bipolar disorder, unspecified,Dehydration,Personal history of malignant neoplasm of large intestine'}


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: Loose stools and fevers

PRESENT ILLNESS: 79F s/p segment VII resection of metastatic colon CA to liver
([**3-1**]). Was here to have pleurex catheter placed but was having
abdominal pain, fevers, and nausea and was sent to the ED. She
reports passing flatus and stool.

MEDICAL HISTORY: Past Medical History:
Bipolar
HTN
Past Surgical History;
TAH
Appendectomy

MEDICATION ON ADMISSION: atenolol 50', lasix 20', keppra 500", risperidol 1.5', mvi',
folic acid'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: In ED
97.4, 94, 86/54 to 149/71 96% 3L NC
NAD
RRR
decreased Breath sounds in bases R>L
Abdomen soft, obese, nondistended, no tympany, Midline incision
inferior to umbilicus well healed with 2 small incisional
hernias.  Bowel easily reducible.
EXT: warm and dry

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, lives with husband and son, drinks one glass of wine
per day, former smoker 

### Response:
{'Unspecified pleural effusion,Acute edema of lung, unspecified,Incisional ventral hernia with obstruction,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Other ascites,Unspecified essential hypertension,Bipolar disorder, unspecified,Dehydration,Personal history of malignant neoplasm of large intestine'}
