CHIEF COMPLAINT: Cholangitis, sepsis, admitted to ICU for monitoring prior to
ERCP

PRESENT ILLNESS: 83 y/o male with history of choledocolithiasis in [**2113**] s/p ERCP
and sphincterotomy who presents with malasie and dark colored
urine x 5 days. He denies symptoms abdominal pain, n/v, chills,
cp, sob, dysuria. Denies weight loss, had poor appetite this
week. called his PCP after noticing the dark urine and was told
to go to OSH. He was evaluated at [**Hospital1 **] Ed which revealed
elevated LFT's, total bili 12.5, U/S with CBD dilation, sludge,
and distended gallbladder wall with pericholecystic fluid. Was
transfered to [**Hospital1 18**] for ERCP.
.
In ED was hypotensive 94/50 and febrile, requiring levophed
through a peripheral IV. He received 4L NS in ED, his BP
recovered and levophed was d/c'd. He got one dose unasyn and was
transfered to the [**Hospital Unit Name 153**] for monitoring prior to ERCP in AM.

MEDICAL HISTORY: 1. CAD s/p CABG in [**2110**].
2. Billroth II gastrectomy in [**2077**].
3. ERCP on [**2114-4-12**].
4. Herniorrhaphy times two.
5. Hypertension

MEDICATION ON ADMISSION: Metoprolol 25mg po BID

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: VS T:99.8 HR:81 BP:118/62 O2sat 98%RA
GEN: A/O, nad, well appearing, jaundiced
HEENT: icteric sclera, sublingual icterus
CV: RRR s1, s2, 2/6 systolic murmur heard in axilla
RESP: CTA bl
ABD: soft, NT, ND, no masses. prior scars noted on abd and chest

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: SH: Lives in [**Location 27252**], MA with one of his 4 sons. Wife
passed away 10 years ago, has 9 children. Team photographer for
the [**Location (un) 86**] Red Sox.
Cholangitis,Bacteremia,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Anemia of other chronic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Aortocoronary bypass status
Cholangitis,Bacteremia,Gall&bil cal w/o ch w ob,Anemia-other chronic dis,Cor ath unsp vsl ntv/gft,Hypertension NOS,Aortocoronary bypass
Admission Date:  [**2121-11-1**]              Discharge Date:   [**2121-11-6**]


Service: MEDICINE

Allergies:
Ciprofloxacin

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
Cholangitis, sepsis, admitted to ICU for monitoring prior to
ERCP

Major Surgical or Invasive Procedure:
[**11-1**]: ERCP

History of Present Illness:
83 y/o male with history of choledocolithiasis in [**2113**] s/p ERCP
and sphincterotomy who presents with malasie and dark colored
urine x 5 days. He denies symptoms abdominal pain, n/v, chills,
cp, sob, dysuria. Denies weight loss, had poor appetite this
week. called his PCP after noticing the dark urine and was told
to go to OSH. He was evaluated at [**Hospital1 **] Ed which revealed
elevated LFT's, total bili 12.5, U/S with CBD dilation, sludge,
and distended gallbladder wall with pericholecystic fluid. Was
transfered to [**Hospital1 18**] for ERCP.
.
In ED was hypotensive 94/50 and febrile, requiring levophed
through a peripheral IV. He received 4L NS in ED, his BP
recovered and levophed was d/c'd. He got one dose unasyn and was
transfered to the [**Hospital Unit Name 153**] for monitoring prior to ERCP in AM.


Past Medical History:
1. CAD s/p CABG in [**2110**].
2. Billroth II gastrectomy in [**2077**].
3. ERCP on [**2114-4-12**].
4. Herniorrhaphy times two.
5. Hypertension


Social History:
SH: Lives in [**Location 27252**], MA with one of his 4 sons. Wife
passed away 10 years ago, has 9 children. Team photographer for
the [**Location (un) 86**] Red Sox.


Family History:
Non-contributory

Physical Exam:
VS T:99.8 HR:81 BP:118/62 O2sat 98%RA
GEN: A/O, nad, well appearing, jaundiced
HEENT: icteric sclera, sublingual icterus
CV: RRR s1, s2, 2/6 systolic murmur heard in axilla
RESP: CTA bl
ABD: soft, NT, ND, no masses. prior scars noted on abd and chest

EXT: + pulses distally, warm, no erythema or swelling
SKIN: icteric, no rashes


Pertinent Results:
CXR [**11-1**]: FINDINGS: There has been no significant change from
the patient's prior examination of [**2113**]. There is no new
infiltrate. Patient is status post a median sternotomy.
Cardiomediastinal contours are within normal limits. IMPRESSION:
No evidence of acute disease in the chest.
.
ERCP [**11-1**]: Sludge and CBD stones cleared. Tolerated procedure
well.
.
[**2121-10-31**] 08:40PM BLOOD Lactate-3.3*
[**2121-11-1**] 02:29AM BLOOD Lactate-3.4*
[**2121-11-3**] 07:00AM BLOOD calTIBC-127* VitB12-[**2104**]* Folate-6.7
Ferritn-790* TRF-98*
[**2121-10-31**] 08:30PM BLOOD Lipase-15
[**2121-10-31**] 08:30PM BLOOD ALT-194* AST-170* AlkPhos-394* Amylase-51
TotBili-9.6* DirBili-7.8* IndBili-1.8
[**2121-11-1**] 04:57AM BLOOD ALT-160* AST-135* LD(LDH)-242
AlkPhos-312* Amylase-57 TotBili-7.2*
[**2121-11-6**] 06:55AM BLOOD ALT-52* AST-51* AlkPhos-168* Amylase-38
TotBili-1.6*
[**2121-11-1**] 02:30AM BLOOD Glucose-102 UreaN-21* Creat-1.3* Na-135
K-4.0 Cl-106 HCO3-14* AnGap-19
[**2121-11-6**] 06:55AM BLOOD Glucose-95 UreaN-13 Creat-0.9 Na-137
K-3.6 Cl-105 HCO3-26 AnGap-10
[**2121-10-31**] 08:30PM BLOOD PT-15.1* PTT-27.9 INR(PT)-1.4*
[**2121-11-3**] 07:00AM BLOOD PT-12.3 PTT-26.9 INR(PT)-1.1
[**2121-10-31**] 08:30PM BLOOD WBC-12.3*# RBC-4.19* Hgb-12.4* Hct-36.6*
MCV-87 MCH-29.5 MCHC-33.8 RDW-14.9 Plt Ct-181
[**2121-11-1**] 05:32PM BLOOD WBC-17.1* RBC-4.46* Hgb-12.9* Hct-38.3*
MCV-86 MCH-29.0 MCHC-33.8 RDW-15.1 Plt Ct-114*
[**2121-11-6**] 06:55AM BLOOD WBC-8.3 RBC-3.65* Hgb-10.4* Hct-30.3*
MCV-83 MCH-28.5 MCHC-34.3 RDW-15.3 Plt Ct-190
.
Blood Cultures [**11-1**]
        MORGANELLA MORGANII
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------  =>64 R
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------  =>64 R
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
IMIPENEM--------------     4 S
LEVOFLOXACIN----------<=0.25 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------    64 R
PIPERACILLIN----------   <=4 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S


Brief Hospital Course:
Hosptial Course, by Problem:
.
#Ascending Cholangitis/Choledocolithiasis:  had ERCP with
sphincterotomy; stones and sludge removed.  Needs f/u with PCP
for discussion of cholecystectomy.
.
#Bacteremia:  blood cultures at OSH grew pan-S E coli.  Pt
initially on Unasyn; however, patient spiked on the floor.  CTX
added.  Repeat blood cultures grew Morganelli (R) to Unasyn and
(S) to CTX.  Was eventually transitioned to PO
Augmentin/Cefpodoxime.  Will complete a total of a 10 day
course.  ID consulted and agreed with plan.
.
#Anemia:  Fe studies c/w Anemia of Chronic Disease. Remained
stable in house.

Medications on Admission:
Metoprolol 25mg po BID

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Cefpodoxime 200 mg Tablet Sig: Two (2) Tablet PO twice a day
for 5 days.
Disp:*20 Tablet(s)* Refills:*0*
3. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses
1.  Ascending Cholangitis
2.  Choledocolithiasis
3.  Morganella/E. Coli bacteremia
4.  Anemia of Chronic Disease

Secondary Diagnoses
1.  Hypertension
2.  h/o CAD s/p CABG
3.  h/o Billroth II


Discharge Condition:
stable, afebrile


Discharge Instructions:
Please contact Dr. [**Last Name (STitle) **] should you develop any worsening
abdominal pain, nausea, vomiting, diarrhea, fevers, chills,
sweats, or any other serious complaints.

Please take your antibiotics are prescribed for the next 5 days.

Followup Instructions:
Please call dr. [**Last Name (STitle) **] as soon as possible to make a follow-up
appointment.
{'Cholangitis,Bacteremia,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Anemia of other chronic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Aortocoronary bypass 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: Cholangitis, sepsis, admitted to ICU for monitoring prior to
ERCP

PRESENT ILLNESS: 83 y/o male with history of choledocolithiasis in [**2113**] s/p ERCP
and sphincterotomy who presents with malasie and dark colored
urine x 5 days. He denies symptoms abdominal pain, n/v, chills,
cp, sob, dysuria. Denies weight loss, had poor appetite this
week. called his PCP after noticing the dark urine and was told
to go to OSH. He was evaluated at [**Hospital1 **] Ed which revealed
elevated LFT's, total bili 12.5, U/S with CBD dilation, sludge,
and distended gallbladder wall with pericholecystic fluid. Was
transfered to [**Hospital1 18**] for ERCP.
.
In ED was hypotensive 94/50 and febrile, requiring levophed
through a peripheral IV. He received 4L NS in ED, his BP
recovered and levophed was d/c'd. He got one dose unasyn and was
transfered to the [**Hospital Unit Name 153**] for monitoring prior to ERCP in AM.

MEDICAL HISTORY: 1. CAD s/p CABG in [**2110**].
2. Billroth II gastrectomy in [**2077**].
3. ERCP on [**2114-4-12**].
4. Herniorrhaphy times two.
5. Hypertension

MEDICATION ON ADMISSION: Metoprolol 25mg po BID

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: VS T:99.8 HR:81 BP:118/62 O2sat 98%RA
GEN: A/O, nad, well appearing, jaundiced
HEENT: icteric sclera, sublingual icterus
CV: RRR s1, s2, 2/6 systolic murmur heard in axilla
RESP: CTA bl
ABD: soft, NT, ND, no masses. prior scars noted on abd and chest

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: SH: Lives in [**Location 27252**], MA with one of his 4 sons. Wife
passed away 10 years ago, has 9 children. Team photographer for
the [**Location (un) 86**] Red Sox. 

### Response:
{'Cholangitis,Bacteremia,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Anemia of other chronic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Aortocoronary bypass status'}
