CHIEF COMPLAINT: Patient presented with abdominal pain at [**Hospital6 1597**], CT
scan revealed free air. Patient was transferred to [**Hospital1 18**].

PRESENT ILLNESS: This patient is a 42 year old female who complains
of ABD PAIN. Went to [**Hospital3 **] ED this am for abd pain ,has free

MEDICAL HISTORY: Hypertension, dyslipidemia, asthma, and obstructive sleep apnea
on CPAP.

MEDICATION ON ADMISSION: lisinopril 10 QD, symbicort

ALLERGIES: Amoxicillin / Erythromycin Base / Sulfa (Sulfonamides)

PHYSICAL EXAM: Temp:97.5 HR:88 BP:98/65 Resp:20 O(2)Sat:98 normal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: She denies any alcohol, drug or tobacco abuse.  She states she
quit smoking
three weeks ago.
Fistula of stomach or duodenum,Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction,Unspecified peritonitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Cellulitis and abscess of upper arm and forearm,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bariatric surgery status,Other specified disorders of peritoneum,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Gastric/duodenal fistula,Chr marginal ulc w perf,Peritonitis NOS,React-oth vasc dev/graft,Cellulitis of arm,Abn react-anastom/graft,Bariatric surgery status,Peritoneal disorder NEC,Obstructive sleep apnea,Asthma NOS,Hyperlipidemia NEC/NOS,Hypertension NOS
Name:  [**Known lastname 571**],[**Known firstname 634**]              Unit No:   [**Numeric Identifier 12080**]

Admission Date:  [**2175-1-11**]              Discharge Date:   [**2175-1-20**]

Date of Birth:  [**2132-1-28**]             Sex:   F

Service: SURGERY

Allergies:
Amoxicillin / Erythromycin Base / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 559**]
Addendum:
Jp drain discontinued and staples removed from midline incision.
VNA set up to monitor: R arm cellulitis
                       G-tube
                       Midline incision
                       Compliance with kelfex
                       Compliance with no smoking
                       Ensure appointment with Dr. [**Last Name (STitle) **]

[**First Name8 (NamePattern2) 1239**] [**Last Name (NamePattern1) **] NP


Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 560**] MD [**MD Number(1) 561**]

Completed by:[**2175-1-20**]

Admission Date:  [**2175-1-11**]              Discharge Date:   [**2175-1-20**]

Date of Birth:  [**2132-1-28**]             Sex:   F

Service: SURGERY

Allergies:
Amoxicillin / Erythromycin Base / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Patient presented with abdominal pain at [**Hospital6 1597**], CT
scan revealed free air. Patient was transferred to [**Hospital1 18**].

Major Surgical or Invasive Procedure:
Status Post Marginal ulcer repair


History of Present Illness:
 This patient is a 42 year old female who complains
of ABD PAIN. Went to [**Hospital3 **] ED this am for abd pain ,has free

air to abd per CT at bypass site.rec,d Fentanyl 50 per amb
enroute. Had Flagyl IV Appears uncomfortable MY HPI: transfer
from [**Hospital3 2568**]. Presnted there w/ diffuse abdominal pain that
started this AM. At OSH, CT demonstrated free air. Pt is s/p
gastric bypass in [**2171**] here by Dr. [**Last Name (STitle) **]. Per OSH CT, increased
air at anastamosis, suggestive of perforation. Received abx,
IVF,
analgesia at OSH. En route & at OSH had decreased SBP to 60, now

improved w/ IVF.


Past Medical History:
Hypertension, dyslipidemia, asthma, and obstructive sleep apnea
on CPAP.


Social History:
She denies any alcohol, drug or tobacco abuse.  She states she
quit smoking
three weeks ago.


Family History:
Non-contributory

Physical Exam:
 Temp:97.5 HR:88 BP:98/65 Resp:20 O(2)Sat:98 normal

               Constitutional: uncomfortable
                  Head / Eyes: Normocephalic, atraumatic, Pupils
equal, round
                               and reactive to light,
Extraocular

                               muscles intact
                   ENT / Neck: Oropharynx within normal limits
                   Chest/Resp: Clear to auscultation
               Cardiovascular: Regular Rate and Rhythm, Normal
first and
                               second heart sounds
               GI / Abdominal: Soft, Nondistended, diffusely
tender, +
                               rebound, + guarding
                     GU/Flank: No costovertebral angle
tenderness
               Musc/Extr/Back: No cyanosis, clubbing or edema
                         Skin: No rash, Warm and dry
                        Neuro: Speech fluent
                        Psych: Normal mood, Normal mentation


Pertinent Results:
[**2175-1-11**] 12:25PM BLOOD WBC-19.7*# RBC-5.07 Hgb-9.7*# Hct-33.7*
MCV-67*# MCH-19.1*# MCHC-28.6*# RDW-17.3* Plt Ct-452*#
[**2175-1-13**] 12:23PM BLOOD WBC-12.3* RBC-3.82* Hgb-7.4* Hct-25.2*
MCV-66* MCH-19.4* MCHC-29.5* RDW-17.5* Plt Ct-381
[**2175-1-18**] 06:10AM BLOOD WBC-5.1 RBC-4.24 Hgb-8.2* Hct-27.7*
MCV-65* MCH-19.2* MCHC-29.4* RDW-18.4* Plt Ct-355
[**2175-1-11**] 12:25PM BLOOD Plt Smr-HIGH Plt Ct-452*#
[**2175-1-13**] 02:07AM BLOOD PT-13.5* PTT-26.1 INR(PT)-1.2*
[**2175-1-18**] 06:10AM BLOOD Plt Ct-355
[**2175-1-11**] 12:25PM BLOOD Glucose-76 UreaN-18 Creat-0.8 Na-141
K-4.6 Cl-108 HCO3-21* AnGap-17
[**2175-1-13**] 02:07AM BLOOD Glucose-90 UreaN-10 Creat-0.7 Na-140
K-4.1 Cl-107 HCO3-26 AnGap-11
[**2175-1-16**] 06:20AM BLOOD Glucose-99 UreaN-4* Creat-0.6 Na-138
K-4.0 Cl-103 HCO3-29 AnGap-10
[**2175-1-11**] 12:25PM BLOOD Lipase-35
[**2175-1-14**] 03:34AM BLOOD Lipase-12
[**2175-1-11**] 12:39PM BLOOD Lactate-3.0*
[**2175-1-11**] 05:01PM BLOOD Calcium-8.0* Phos-3.6 Mg-1.5*
[**2175-1-14**] 01:43PM BLOOD Calcium-8.3* Phos-2.6* Mg-1.8
[**2175-1-18**] 06:10AM BLOOD Calcium-8.7 Phos-4.3 Mg-2.1

Brief Hospital Course:
Patient transferred from [**Hospital3 **] with abdominal pain and free
air noted on CT scan. Patient went to the operating room where a
Closure of marginal ulcer,Omental patch, Gastrostomy and
Takedown of gastroenteric fistula was performed.

Initially postop patient was monitored very closely in the
intensive care unit. Pain control was difficult to achieve with
use of ketamine.

On postoperative day 3 patient was transferred to the floor. PPI
and antibiotics were continued intravenously and patient's labs
were closely monitored.

On postoperative day 5 patient was started on a bariatric diet.
R arm cellulitis was noted and patient started on warm packs and
vancomycin.

On postoperative day 6 R arm celluilitis improved and patient
progressed to a bariatric stage 3 diet.

We will discharge her to home today with oral protonix, keflex
for cellulitis and follow up with Dr. [**Last Name (STitle) **] in one week.


Medications on Admission:
lisinopril 10 QD, symbicort

Discharge Medications:
1. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day: Please take for one week.
Disp:*28 Capsule(s)* Refills:*0*
2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
Disp:*300 ML(s)* Refills:*0*
4. Colace 50 mg/5 mL Liquid Sig: Ten (10) ml PO twice a day.
Disp:*500 ml* Refills:*0*
5. Multivitamin     Tablet Sig: One (1) Tablet PO twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Perforated marginal ulcer


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


Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.


Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in fluids or your
 medications.

* You are getting dehydrated due to continued vomiting,
 diarrhea or other reasons. Signs of dehydration include dry
 mouth, rapid heartbeat or feeling dizzy or faint when standing.

* You see blood or dark/black material when you vomit or have a
 bowel movement.


* You have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.
Activity:
No heavy lifting of items [**9-22**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 49**] in one week at [**Hospital Ward Name **]
[**Hospital Ward Name 23**] building [**Location (un) 470**]. Please call [**Telephone/Fax (1) 2723**] to make an
appointment.



Completed by:[**2175-1-20**]
{'Fistula of stomach or duodenum,Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction,Unspecified peritonitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Cellulitis and abscess of upper arm and forearm,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bariatric surgery status,Other specified disorders of peritoneum,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: Patient presented with abdominal pain at [**Hospital6 1597**], CT
scan revealed free air. Patient was transferred to [**Hospital1 18**].

PRESENT ILLNESS: This patient is a 42 year old female who complains
of ABD PAIN. Went to [**Hospital3 **] ED this am for abd pain ,has free

MEDICAL HISTORY: Hypertension, dyslipidemia, asthma, and obstructive sleep apnea
on CPAP.

MEDICATION ON ADMISSION: lisinopril 10 QD, symbicort

ALLERGIES: Amoxicillin / Erythromycin Base / Sulfa (Sulfonamides)

PHYSICAL EXAM: Temp:97.5 HR:88 BP:98/65 Resp:20 O(2)Sat:98 normal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: She denies any alcohol, drug or tobacco abuse.  She states she
quit smoking
three weeks ago. 

### Response:
{'Fistula of stomach or duodenum,Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction,Unspecified peritonitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Cellulitis and abscess of upper arm and forearm,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Bariatric surgery status,Other specified disorders of peritoneum,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
