CHIEF COMPLAINT: Abdominal distention and pain

PRESENT ILLNESS: (History limited by pain, partially from prior notes)

MEDICAL HISTORY: 1) SLE (Dx [**2162**]; Proteinuria, Pulmonary Parenchymal Disease,
Pleuritis/Pericarditis, Decr C3/C4, [**Doctor First Name **] 1:1280) with Raynaud's
2) Valve Disease: AS with [**Location (un) 109**] 1.0.  1+AI, 3+MR.  [**Name13 (STitle) **] 55% by echo
[**12-6**].
3) Sjogren's (?: Elevated 'Sjogrens Abs' per OSH)
4) Hypothyroidism
5) Eczema
6) Anemia (Thalassemia vs. Chronic Disease?)
7) Recurrent PNA (B/L MRSA PNA in [**2162**])
8) H/O Dental Abscess,
9) Recent Oral/Esophageal HSV-1 and Candidiasis
10) S/P Appendectomy
1) S/P Tonsillectomy.

MEDICATION ON ADMISSION: Protonix
ASA
Lasix 20 [**Hospital1 **]
prednisone 5 (stable dose for SLE)
Hydroxychloroquine

ALLERGIES: Penicillins / Aminoglycosides / Iodine

PHYSICAL EXAM: Temp:97.0, BP:110/70, HR:110, RR:24, O2 (difficult to assess
given Raynaud's): 96% RA
Gen: Appears in moderate distress.  A/O x 3.  Can speak in full
sentences.
Using accessory muscles of respiration.  +pallor, ashen
HEENT: PEARLA.  Sclera anictric.  Not injected.  OP:No lesions.
JVP:12 cm
CV: Tachy regular.  III/VI SM heard throughout precordium.
Chest: s/p left mastectomy
Pulm: Rales at bases b/l.
ABD: Distended.  Soft.  Diffuse tenderness.
Ext: Cold.  [**Name (NI) **] PT on right, DP on left

FAMILY HISTORY: Her mother died in 60s with BRCA + Breast Ca. Her father died in
his 80s of lung
cancer (he had known asbestosis). She has three children and
three siblings who are reportedly healthy.

SOCIAL HISTORY: Patient is married with three children. She previously worked
for many years as a yoga instructor. She has never smoked, used
ETOH (more than socially), or any illegal drugs. She has a pet
dog and rabbit. [**Name2 (NI) **] family has origins in [**Country 4754**] and [**Country 19828**].
Congestive heart failure, unspecified,Mitral valve insufficiency and aortic valve stenosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Candidal enteritis,Cardiogenic shock,Pressure ulcer, buttock,Cachexia,Systemic lupus erythematosus,Unspecified vascular insufficiency of intestine,Anemia, unspecified,Unspecified acquired hypothyroidism,Periapical abscess without sinus
CHF NOS,Mitral insuf/aort stenos,React-oth vasc dev/graft,Candidal enteritis,Cardiogenic shock,Pressure ulcer, buttock,Cachexia,Syst lupus erythematosus,Vasc insuff intest NOS,Anemia NOS,Hypothyroidism NOS,Periapical abscess
Admission Date:  [**2165-2-18**]              Discharge Date:   [**2165-3-2**]

Date of Birth:  [**2100-8-8**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Aminoglycosides / Iodine

Attending:[**First Name3 (LF) 11495**]
Chief Complaint:
Abdominal distention and pain

Major Surgical or Invasive Procedure:
IJ line placement
Swan-ganz catheter placement
Arterial line placement
Dental extraction

History of Present Illness:
(History limited by pain, partially from prior notes)

64 y.o. female with multiple medical issues including SLE, AS
and MR with resulting CHF presents with increased abdominal
distention from baseline, and abdominal pain x 1 week.  The
patient was recently admitted in [**12-6**] and [**1-5**] with CHF
exacerbations presenting as abdominal distention and pain.  On
her last admission a RUQ U/S demonstrated a question of
perihepatic fluid collection.  A CT ABD demonstrated thickened
GB wall and sludge.  The abdominal distention and U/S findings
were thought to be secondary to right-sided failure secondary to
valvular disease.  She was supposed to be evaluated for AVR/MVR
by Dr. [**Last Name (STitle) 36737**] but apparently did not obtain outpatient dental
extractions.

ROS:
POSITIVE: SOB, PND, Orthopnea, cough, wt gain, nausea
NEGATIVE: fevers, chills, CP, Palp


Past Medical History:
1) SLE (Dx [**2162**]; Proteinuria, Pulmonary Parenchymal Disease,
Pleuritis/Pericarditis, Decr C3/C4, [**Doctor First Name **] 1:1280) with Raynaud's
2) Valve Disease: AS with [**Location (un) 109**] 1.0.  1+AI, 3+MR.  [**Name13 (STitle) **] 55% by echo
[**12-6**].
3) Sjogren's (?: Elevated 'Sjogrens Abs' per OSH)
4) Hypothyroidism
5) Eczema
6) Anemia (Thalassemia vs. Chronic Disease?)
7) Recurrent PNA (B/L MRSA PNA in [**2162**])
8) H/O Dental Abscess,
9) Recent Oral/Esophageal HSV-1 and Candidiasis
10) S/P Appendectomy
1) S/P Tonsillectomy.

Heart Failure: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
PCP: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 27598**] at [**Hospital3 3583**].
Rheumatologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**Location (un) 3320**].

Social History:
Patient is married with three children. She previously worked
for many years as a yoga instructor. She has never smoked, used
ETOH (more than socially), or any illegal drugs. She has a pet
dog and rabbit. [**Name2 (NI) **] family has origins in [**Country 4754**] and [**Country 19828**].

Family History:
Her mother died in 60s with BRCA + Breast Ca. Her father died in
his 80s of lung
cancer (he had known asbestosis). She has three children and
three siblings who are reportedly healthy.


Physical Exam:
Temp:97.0, BP:110/70, HR:110, RR:24, O2 (difficult to assess
given Raynaud's): 96% RA
Gen: Appears in moderate distress.  A/O x 3.  Can speak in full
sentences.
Using accessory muscles of respiration.  +pallor, ashen
HEENT: PEARLA.  Sclera anictric.  Not injected.  OP:No lesions.
JVP:12 cm
CV: Tachy regular.  III/VI SM heard throughout precordium.
Chest: s/p left mastectomy
Pulm: Rales at bases b/l.
ABD: Distended.  Soft.  Diffuse tenderness.
Ext: Cold.  [**Name (NI) **] PT on right, DP on left



Pertinent Results:
[**2165-2-18**] WBC-8.8 Hgb-10.2* Hct-35.0* MCV-80* RDW-16.4* Plt
Ct-728*
[**2165-2-25**] WBC-17.0* Hgb-10.5* Hct-33.7* MCV-77* RDW-17.9* Plt
Ct-114*
[**2165-2-27**] WBC-8.8 Hgb-8.9* Hct-29.3* MCV-79* RDW-18.4* Plt
Ct-112*
[**2165-3-2**] WBC-16.8* Hgb-11.7* Hct-35.7* MCV-80* RDW-19.2* Plt
Ct-201

[**2165-2-18**] Neuts-83.0* Bands-0 Lymphs-10.4* Monos-6.0 Eos-0.2
Baso-0.4
[**2165-2-25**] Neuts-91* Bands-0 Lymphs-3* Monos-5 Eos-0 Baso-0
Atyps-0 Metas-1* Myelos-0

[**2165-2-18**] PT-16.1* PTT-25.9 INR(PT)-1.6
[**2165-2-28**] PT-15.5* PTT-31.9 INR(PT)-1.5

[**2165-2-18**] Glucose-120* UreaN-28* Creat-1.1 Na-131* K-5.0 Cl-93*
HCO3-25
[**2165-3-2**] Glucose-68* UreaN-59* Creat-1.8* Na-136 K-5.4* Cl-98
HCO3-21*

[**2165-2-18**] ALT-193* AST-183* LD(LDH)-544* CK(CPK)-54 Amylase-38
TotBili-1.6*
[**2165-2-19**] ALT-290* AST-399* LD(LDH)-640* AlkPhos-143*
TotBili-2.0*
[**2165-2-26**] ALT-68* AST-43* AlkPhos-91 Amylase-304* TotBili-4.3*
[**2165-2-27**] ALT-51* AST-25 AlkPhos-85 Amylase-179* TotBili-3.9*

[**2165-2-18**] Lipase-77*
[**2165-2-26**] Lipase-774*
[**2165-2-27**] Lipase-372*

[**2165-2-18**] Albumin-4.1 Calcium-9.5 Phos-5.9*# Mg-2.2
[**2165-2-22**] Calcium-9.2 Phos-4.2 Mg-2.9*
[**2165-3-2**] Calcium-8.6 Phos-5.9* Mg-2.0

[**2165-2-22**] Iron-16* calTIBC-404 Ferritn-101 TRF-311

[**2165-2-18**] TSH-9.7* T3-38* Free T4-1.2

[**2165-2-22**] dsDNA-POSITIVE
[**2165-2-22**] C3-36* C4-3*

[**2165-2-18**] Lactate-10.0*
[**2165-2-19**] Lactate-3.4*
[**2165-3-1**] Lactate-2.7*

[**2165-3-1**] BLOOD THIOCYANATE 0.4 -- REFERENCE: 0-1.0 THERAPEUTIC:
[**6-11**], TOXIC: > 10

AXR [**2-18**]:  Nonspecific bowel gas pattern, without definite
obstruction.

CXR [**2-19**]:  Slight worsening of congestive heart failure.
Worsening patchy and linear basilar lung opacities, which may
relate to atelectasis. Underlying pneumonia is not excluded in
the appropriate clinical setting.

Transthoracic echo [**2-19**]:
Conclusions:
The left atrium is mildly dilated. Left ventricular wall
thicknesses and
cavity size are normal. There is mild global left ventricular
hypokinesis.  [Intrinsic left ventricular systolic function may
be more depressed given the severity of valvular regurgitation.]
with septal dyskinesis. Right ventricular chamber size is
normal. Right ventricular systolic function appears depressed.
The aortic valve leaflets are severely thickened/deformed. There
is moderate aortic valve stenosis. Trace aortic regurgitation is
seen. The mitral valve leaflets and supporting structures are
moderately thickened. There is mild mitral stenosis (?functional
from mitral annulus). Moderate to severe (3+)
mitral regurgitation is seen. [Due to acoustic shadowing, the
severity of
mitral regurgitation may be significantly UNDERestimated.]
Severe [4+]
tricuspid regurgitation is seen. There is moderate pulmonary
artery systolic hypertension. There is severe pulmonary artery
systolic hypertension. There is no pericardial effusion.

Compared with the prior study (tape reviewed) of [**2164-12-25**],
left ventricular systolic fuction is more depressed (septal
dysnchrony more apparent) The severity of aortic stenosis amd
mitral regurgitation are similar.

CXR [**2-20**]:  1) No interval change in position of Swan-Ganz
catheter tip.
2) Interval improvement in cardiopulmonary status.
3) Persistent/slightly worsened bibasilar atelectasis.
4) Patchy perihilar infiltrates persist unchanged.

EKG [**2-21**]:  Uncertain supraventricular tachycardia which could be
non-paroxysmal junctional tachycardia versus other paroxysmal
supraventricular tachycardia mechanism. Cannot exclude subtle
atrial flutter with 2:1 conduction. Underlying left ventricular
intraventricular conduction delay with left axis deviation. Left
ventricular hypertrophy by voltage. Compared to the previous
tracing of [**2165-2-19**] which showed sinus tachycardia at about the
same rate, supraventricular tachy-arrhythmia is new.

RUQ US [**2-22**]:  There is evidence of right ventricular dysfunction
on this examination. Mild increased echogenicity of the liver.
Some loculated perihepatic fluid is seen as before. A
thick-walled gallbladder containing debris and stones, thought
to be manifestation of hypoproteinemia and adjacent ascites
rather than cholecystitis. Clinical correlation is recommended.

CXR [**2-25**]:  Overall improvement in degree of congestive heart
failure, but there is a worsening area of opacity in the left
lower lobe. Although possibly due to asymmetrical pulmonary
edema, superimposed process such as aspiration or infectious
pneumonia should be considered in the appropriate clinical
setting.

MICRO:

AEROBIC BOTTLE (Final [**2165-2-24**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2165-2-24**]):    NO GROWTH.

URINE CULTURE (Final [**2165-2-27**]):    NO GROWTH.

AEROBIC BOTTLE (Final [**2165-3-4**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2165-3-2**]):
      [**Female First Name (un) **] (TORULOPSIS) [**Female First Name (un) **].
         IDENTIFICATION PERFORMED ON CULTURE # [**Numeric Identifier 43914**] FROM
[**2165-2-26**].

AEROBIC BOTTLE (Final [**2165-3-5**]):
      [**Female First Name (un) **] (TORULOPSIS) [**Female First Name (un) **].
         IDENTIFICATION PERFORMED FROM ANAEROBIC BOTTLE.

   ANAEROBIC BOTTLE (Final [**2165-3-2**]):
      REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @ 1715 ON [**2-28**] - FA6B.
      [**Female First Name (un) **] (TORULOPSIS) [**Female First Name (un) **].

URINE CULTURE (Final [**2165-2-28**]):
      YEAST.    4000 ORGANISMS/ML.

CATHETER TIP (Final [**2165-3-2**]):
      YEAST, PRESUMPTIVELY NOT C. ALBICANS.
         >15 colonies OF TWO COLONIAL MORPHOLOGIES.

CATHETER TIP (Final [**2165-3-1**]):
      YEAST, PRESUMPTIVELY NOT C. ALBICANS.    >15 colonies.

SPUTUM GRAM STAIN (Final [**2165-2-27**]):
      >25 PMNs and <10 epithelial cells/100X field.
      4+   (>10 per 1000X FIELD):   BUDDING YEAST WITH
PSEUDOHYPHAE.
      3+  (5-10 per 1000X FIELD):   GRAM POSITIVE ROD(S).
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2165-3-1**]):
      MODERATE GROWTH OROPHARYNGEAL FLORA.
      YEAST.    HEAVY GROWTH.

AEROBIC BOTTLE (Final [**2165-3-7**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2165-3-7**]):    NO GROWTH.

Brief Hospital Course:
64 y.o. female with SLE, Sjogrens, Severe AS and MR with
multiple admissions for CHF with ABD distention presented with
increased abdominal distention over the course of 1 week with
concern for low-forward flow state, Lactate of 10.0, concern for
ischemic colitis, with overall picture consistent with
cardiogenic shock.

On arrival to the CCU, the patient had an NG tube, IJ central
line with swan-ganz catheter, and arterial line placed for
closer hemodynamic monitoring.  Her subsequent hospital course
was as follows.  Briefly, however, the patient was diuresed and
maintained on inotropic support.  Despite this, her condition
worsened, with inability to maintain adequate blood pressure or
urine output, fungemia, and ultimately, death.

1) Valvular Disease:  Her valvular disease was found to be
relatively unchanged, however left ventricular systolic function
was further depressed.  As stated in the HPI, the patient had
been told months prior that she was in need of valve
replacement, however needed dental work before this could be
done.  While in house the patient had complete tooth extraction.
 Unfortunately, the patient was never deemed well enough by the
cardiothoracic surgeons to proceed with the surgery, and she
expired prior to being able to perform the surgery.

2) Ischemic Colitis:  On admission the patient had such poor
forward flow that her lactate level had risen to 10, and there
was concern for ischemic colitis (grossly bloody bowel
movements).  General surgery was consulted and recommended NG
tube, NPO, and treatment of her CHF - the mesenteric ischemia
was presumed secondary to low forward flow.  She likely also had
severe congestion from her right heart failure.  Her bloody
bowel movements resolved by the second day of the admission, and
her abdominal pain also resolved.  The cardiothoracic surgeons
said that the patient could not go to surgery unless she was
able to eat, and therefore after almost a week pain-free, it was
decided to attempt to advance her diet.  She unfortunately again
developed pain a few days later, as well as clinical features
and enzymes indicative of pancreatitis.  She also again began
having bloody stool.  She was maintained on levaquin and flagyl
throughout the hospitalization for prophylaxis against bowel
organism transudation across the bowel wall.

3) CHF:  On admission, milrinone was started for inotropic
support, and she was started on lasix and natrecor for diuresis.
 After a few days of milrinone she unfortunately developed an
atrial tachycardia that was not controlled despite lopressor,
which dropped her blood pressure.  She was switched to
dobutamine, with less tachycardia.  Her cardiac index, however,
continued to fall, and as a last resort she was also started on
nitroprusside for afterload reduction.  In [**Last Name (un) **] to accomodate
this change, her natrecor was discontinued to preserve her blood
pressure.  Her urine output slowly fell, however, and it was
difficult to diurese her any further which such severely reduced
renal perfusion.  Her MAPs also declined, and the patient
complained of severe discomfort.  A code discussion was held
between the patient and husband, and the patient decided to be
made comfort measures only.  Only a few minutes later, she
expired.

4) ID: There was question of pneumonia on CXR during the
hospitalization, however the patient was saturating well, and on
levo/flagyl, and there were other etiologies to explain her
white count elevation.  On day 8 the patient began spiking low
grade fevers.  Her swan and arterial line were pulled at this
time and resited, and vancomycin was begun.  Blood cultures at
this time grew [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**] and she was started on
caspofungin.

5) SLE/Sjogren's:  The patient was maintained on her outpatient
dose of 5 mg prednisone daily.

6) Nutrition:  This was a problem for Mrs. [**Known lastname 43915**], as she
could not take POs, and we were hesitant to start TPN given her
poor urine output and goal of diuresis.  Eventually TPN was
started, however she expired later that day.

Medications on Admission:
Protonix
ASA
Lasix 20 [**Hospital1 **]
prednisone 5 (stable dose for SLE)
Hydroxychloroquine


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation
Congestive heart failure
Cardiogenic shock
Ischemic colitis
Fungemia
Systemic lupus erythematosus

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Congestive heart failure, unspecified,Mitral valve insufficiency and aortic valve stenosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Candidal enteritis,Cardiogenic shock,Pressure ulcer, buttock,Cachexia,Systemic lupus erythematosus,Unspecified vascular insufficiency of intestine,Anemia, unspecified,Unspecified acquired hypothyroidism,Periapical abscess without sinus'}


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 distention and pain

PRESENT ILLNESS: (History limited by pain, partially from prior notes)

MEDICAL HISTORY: 1) SLE (Dx [**2162**]; Proteinuria, Pulmonary Parenchymal Disease,
Pleuritis/Pericarditis, Decr C3/C4, [**Doctor First Name **] 1:1280) with Raynaud's
2) Valve Disease: AS with [**Location (un) 109**] 1.0.  1+AI, 3+MR.  [**Name13 (STitle) **] 55% by echo
[**12-6**].
3) Sjogren's (?: Elevated 'Sjogrens Abs' per OSH)
4) Hypothyroidism
5) Eczema
6) Anemia (Thalassemia vs. Chronic Disease?)
7) Recurrent PNA (B/L MRSA PNA in [**2162**])
8) H/O Dental Abscess,
9) Recent Oral/Esophageal HSV-1 and Candidiasis
10) S/P Appendectomy
1) S/P Tonsillectomy.

MEDICATION ON ADMISSION: Protonix
ASA
Lasix 20 [**Hospital1 **]
prednisone 5 (stable dose for SLE)
Hydroxychloroquine

ALLERGIES: Penicillins / Aminoglycosides / Iodine

PHYSICAL EXAM: Temp:97.0, BP:110/70, HR:110, RR:24, O2 (difficult to assess
given Raynaud's): 96% RA
Gen: Appears in moderate distress.  A/O x 3.  Can speak in full
sentences.
Using accessory muscles of respiration.  +pallor, ashen
HEENT: PEARLA.  Sclera anictric.  Not injected.  OP:No lesions.
JVP:12 cm
CV: Tachy regular.  III/VI SM heard throughout precordium.
Chest: s/p left mastectomy
Pulm: Rales at bases b/l.
ABD: Distended.  Soft.  Diffuse tenderness.
Ext: Cold.  [**Name (NI) **] PT on right, DP on left

FAMILY HISTORY: Her mother died in 60s with BRCA + Breast Ca. Her father died in
his 80s of lung
cancer (he had known asbestosis). She has three children and
three siblings who are reportedly healthy.

SOCIAL HISTORY: Patient is married with three children. She previously worked
for many years as a yoga instructor. She has never smoked, used
ETOH (more than socially), or any illegal drugs. She has a pet
dog and rabbit. [**Name2 (NI) **] family has origins in [**Country 4754**] and [**Country 19828**]. 

### Response:
{'Congestive heart failure, unspecified,Mitral valve insufficiency and aortic valve stenosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Candidal enteritis,Cardiogenic shock,Pressure ulcer, buttock,Cachexia,Systemic lupus erythematosus,Unspecified vascular insufficiency of intestine,Anemia, unspecified,Unspecified acquired hypothyroidism,Periapical abscess without sinus'}
