CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: This is a 87 year old female with a history of chronic atrial
fibrillation, hypertension and hypothyroidism who presents to
the [**Hospital Unit Name 153**] with cholecystitis. She had been in her usual state of
health until 5 days ago when she suddenly began to have
abdominal pain. Her abdominal pain was initially intermittent
lasting for a few hours at at time. No clear correlation with
food. Yesterday, she noticed that her pain was much more severe,
[**2200-6-23**] in severity and more localized to the right. This was
accompanied by nausea and vomitting. She vomitted twice, with
clear liquid emesis and was sent to [**Hospital3 **]. At [**Hospital1 **], she was noted to have elevated amylase/lipase to 538
and 516 with elevated bili to 4.1 and AST/ALT to 198/115 and was
given ciprofloxacin, flagyl and 500cc NS and was transferred to
the [**Hospital1 18**] emergency department for evaluation for ERCP for
presumed gallstone pancreatitis.

MEDICAL HISTORY: hypothyroidism, HTN

MEDICATION ON ADMISSION: Lopressor 25", Furosemide 20', Digoxin 250', Levothyroxine 175',

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Trimethoprim / Penicillins /
Celecoxib / Valdecoxib

PHYSICAL EXAM: GEN: A and O x 1 person, confused at times. NAD
CV: RRR no m/r/g
RESP: LSCTA bilat
ABD soft, nt, nd, + BS
EXT:  1+edema in feet/legs with skin discoloration at ankles

FAMILY HISTORY: unknown

SOCIAL HISTORY: lives alone, never smoked, never drank alcohol or used
illicit drugs
Acute pancreatitis,Calculus of bile duct with other cholecystitis, without mention of obstruction,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Acute pancreatitis,Choledochlith/gb inf NEC,Urin tract infection NOS,Atrial fibrillation,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2199-6-11**]              Discharge Date:   [**2199-6-14**]


Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics) / Trimethoprim / Penicillins /
Celecoxib / Valdecoxib

Attending:[**Doctor First Name 5188**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
ERCP


History of Present Illness:
This is a 87 year old female with a history of chronic atrial
fibrillation, hypertension and hypothyroidism who presents to
the [**Hospital Unit Name 153**] with cholecystitis. She had been in her usual state of
health until 5 days ago when she suddenly began to have
abdominal pain. Her abdominal pain was initially intermittent
lasting for a few hours at at time. No clear correlation with
food. Yesterday, she noticed that her pain was much more severe,
[**2200-6-23**] in severity and more localized to the right. This was
accompanied by nausea and vomitting. She vomitted twice, with
clear liquid emesis and was sent to [**Hospital3 **]. At [**Hospital1 **], she was noted to have elevated amylase/lipase to 538
and 516 with elevated bili to 4.1 and AST/ALT to 198/115 and was
given ciprofloxacin, flagyl and 500cc NS and was transferred to
the [**Hospital1 18**] emergency department for evaluation for ERCP for
presumed gallstone pancreatitis.

Past Medical History:
 hypothyroidism, HTN


Social History:
lives alone, never smoked, never drank alcohol or used
illicit drugs


Family History:
unknown

Physical Exam:
GEN: A and O x 1 person, confused at times. NAD
CV: RRR no m/r/g
RESP: LSCTA bilat
ABD soft, nt, nd, + BS
EXT:  1+edema in feet/legs with skin discoloration at ankles


Pertinent Results:
[**2199-6-14**] 06:45AM BLOOD WBC-16.9* RBC-3.43* Hgb-10.3* Hct-31.6*
MCV-92 MCH-30.1 MCHC-32.7 RDW-17.7* Plt Ct-225
[**2199-6-11**] 01:45AM BLOOD WBC-16.7* RBC-4.48 Hgb-13.8 Hct-41.4
MCV-93 MCH-30.9 MCHC-33.4 RDW-17.0* Plt Ct-299
[**2199-6-12**] 04:10AM BLOOD Neuts-83.1* Lymphs-6.9* Monos-9.1 Eos-0.5
Baso-0.3
[**2199-6-11**] 01:45AM BLOOD Neuts-92.2* Lymphs-4.7* Monos-2.7 Eos-0.1
Baso-0.3
[**2199-6-14**] 06:45AM BLOOD Plt Ct-225
[**2199-6-11**] 01:07PM BLOOD PT-15.5* PTT-25.0 INR(PT)-1.4*
[**2199-6-14**] 06:45AM BLOOD Glucose-77 UreaN-5* Creat-0.5 Na-141
K-3.2* Cl-106 HCO3-26 AnGap-12
[**2199-6-14**] 06:45AM BLOOD ALT-57* AST-31 AlkPhos-128* Amylase-32
TotBili-1.4
[**2199-6-11**] 01:45AM BLOOD ALT-168* AST-271* AlkPhos-171*
Amylase-335* TotBili-4.9*
[**2199-6-14**] 06:45AM BLOOD Lipase-42
[**2199-6-11**] 01:45AM BLOOD Lipase-537*
[**2199-6-14**] 06:45AM BLOOD Calcium-8.6 Phos-2.1* Mg-2.1
[**2199-6-11**] 01:45AM BLOOD Albumin-3.5 Calcium-10.3* Phos-2.7 Mg-1.8
[**2199-6-11**] 01:07PM BLOOD Digoxin-1.4
[**2199-6-11**] 01:53AM BLOOD Lactate-2.4* K-4.1
[**2199-6-11**] 05:40AM URINE Color-Amber Appear-Hazy Sp [**Last Name (un) **]-1.021
[**2199-6-11**] 05:40AM URINE Blood-TR Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-TR Bilirub-SM Urobiln-8* pH-6.5 Leuks-MOD
[**2199-6-11**] 05:40AM URINE RBC-0-2 WBC-21-50* Bacteri-FEW Yeast-NONE
Epi-[**1-17**] TransE-0-2 RenalEp-0-2
.
 MRSA SCREEN (Final [**2199-6-13**]):    No MRSA isolated.
.
URINE CULTURE (Final [**2199-6-12**]): MIXED BACTERIAL FLORA ( >= 3
COLONY TYPES), CONSISTENT WITH FECAL CONTAMINATION.
.
 URINE CULTURE (Final [**2199-6-13**]):    NO GROWTH\
.
IMAGING:
[**6-11**] RUQ US - Cholecystitis - sludge and stones in a distended
gallbladder with wall thickening, peri-GB fluid and son[**Name (NI) 493**]
[**Name2 (NI) 515**] sign. CBD 5mm. No intrahepatic biliary duct dilation.
.
[**6-11**]/ERCP:
A possible filling defect was seen in the distal [**11-17**] of the
common bile duct.  A biliary sphincterotomy was successfully
performed, sludge extracted. A balloon sweep was performed on
the cystic duct with no stone or sludge extraction. A spiral
basket was placed in the common bile duct after multiple balloon
sweeps and no further stone was extracted.
.


Brief Hospital Course:
At [**Hospital1 18**] EDVS 97.9 HR 83 157/92 RR 18 97% RA. She had a RUQ US
that revealed cholecystitis and was given unasyn. Surgery was
consulted and recommended admission to [**Hospital Unit Name 153**] for closer
monitoring under the surgical service. She was also seen by the
ERCP service and ERCP was recommended for today. She was given
unasyn and 2 L NS and was admitted to the [**Hospital Unit Name 153**] service.
.
An ERCP was done showing A possible filling defect was seen in
the distal [**11-17**] of the common bile duct.  A biliary
sphincterotomy was successfully performed, sludge extracted. A
balloon sweep was performed on the cystic duct with no stone or
sludge extraction. A spiral basket was placed in the common bile
duct after multiple balloon sweeps and no further stone was
extracted.
.
On the floor, she reports [**2-22**] abdominal pain, improved from
before. She continues to have nausea. No other complaints.  With
decreased pain and nausea the patient's diet was advanced from
sips to regular, tolerated well. She was restarted on PO meds
and IVF was d/c'd. The patient will continue on augmentin for 10
days and follow up with Dr. [**Last Name (STitle) 5182**] on [**2199-6-25**] to discuss
removing her gallbladder. She will be d/c'd to rehab.
.


Medications on Admission:
Lopressor 25", Furosemide 20', Digoxin 250', Levothyroxine 175',

Tramadol 50", Trazadone 12.5, Aricept, Percocet prn, MVI,
Xalatan eye drops


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

5. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO twice a day for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
6. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
Cape [**Hospital **] Rehabilitation & Nursing Center - [**Location (un) **]

Discharge Diagnosis:
cholecystitis and gallstone pancreatitis


Discharge Condition:
Stable.
Tolerating regular diet.
Pain well controlled.


Discharge Instructions:
Please call your doctor or return to the ER for 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.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* 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.
* Continue to ambulate several times per day.


Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. SURGICAL SPECIALTIES CC-3 (NHB)
Phone:[**Telephone/Fax (1) 274**] Date/Time:[**2199-6-25**] 2:30


                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]

Completed by:[**2199-6-14**]
{'Acute pancreatitis,Calculus of bile duct with other cholecystitis, without mention of obstruction,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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 pain

PRESENT ILLNESS: This is a 87 year old female with a history of chronic atrial
fibrillation, hypertension and hypothyroidism who presents to
the [**Hospital Unit Name 153**] with cholecystitis. She had been in her usual state of
health until 5 days ago when she suddenly began to have
abdominal pain. Her abdominal pain was initially intermittent
lasting for a few hours at at time. No clear correlation with
food. Yesterday, she noticed that her pain was much more severe,
[**2200-6-23**] in severity and more localized to the right. This was
accompanied by nausea and vomitting. She vomitted twice, with
clear liquid emesis and was sent to [**Hospital3 **]. At [**Hospital1 **], she was noted to have elevated amylase/lipase to 538
and 516 with elevated bili to 4.1 and AST/ALT to 198/115 and was
given ciprofloxacin, flagyl and 500cc NS and was transferred to
the [**Hospital1 18**] emergency department for evaluation for ERCP for
presumed gallstone pancreatitis.

MEDICAL HISTORY: hypothyroidism, HTN

MEDICATION ON ADMISSION: Lopressor 25", Furosemide 20', Digoxin 250', Levothyroxine 175',

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Trimethoprim / Penicillins /
Celecoxib / Valdecoxib

PHYSICAL EXAM: GEN: A and O x 1 person, confused at times. NAD
CV: RRR no m/r/g
RESP: LSCTA bilat
ABD soft, nt, nd, + BS
EXT:  1+edema in feet/legs with skin discoloration at ankles

FAMILY HISTORY: unknown

SOCIAL HISTORY: lives alone, never smoked, never drank alcohol or used
illicit drugs 

### Response:
{'Acute pancreatitis,Calculus of bile duct with other cholecystitis, without mention of obstruction,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
