CHIEF COMPLAINT: 

PRESENT ILLNESS: This is the dictation of
Discharge Summary which had been left neglected by the
resident staff.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus.
2.  History of deep venous thrombosis.
3.  Hypertension.
4.  History of upper gastrointestinal bleed.
5.  History of prior tracheotomy and Whipple procedure.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Septicemia due to anaerobes,Other shock without mention of trauma,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Defibrination syndrome,Cholangitis,Acidosis,Personal history of malignant neoplasm of other gastrointestinal tract
Anaerobic septicemia,Shock w/o trauma NEC,Acute respiratry failure,Ac kidny fail, tubr necr,Defibrination syndrome,Cholangitis,Acidosis,Hx of GI malignancy NEC
Admission Date:  [**2155-10-4**]     Discharge Date:  [**2155-10-8**]

Date of Birth:              Sex:  M

Service:  GEN [**Doctor First Name 147**]

HISTORY OF PRESENT ILLNESS:  This is the dictation of
Discharge Summary which had been left neglected by the
resident staff.

This was a 79 year old man who was transferred to my care
from the [**Hospital 16843**] Hospital with purported mesenteric
ischemia.  In [**2131**], he apparently had undergone a Whipple
procedure for an apparent benign neuro-endocrine tumor.
Several years later and approximately three years prior to
the present admission, he had been admitted to the [**Hospital 43537**] Medical Center for what appeared consistent
with obstructive cholangitis.  From what I could determine,
the patient had had intrahepatic biliary duct stones which
were successfully treated by lithotripsy and percutaneous
drainage.  He then did well until the present admission.

Three weeks prior to presentation to [**Hospital 16843**] Hospital, the
patient had developed progressive shortness of breath and
crampy abdominal pain with nausea; 48 hours prior to transfer
here he was admitted to the outlying hospital where he was
septic and completely anuric.  I was told that a colonoscopy
on [**9-9**] had been unremarkable and had been performed for
anemia.  The patient also was found to be in new onset atrial
fibrillation at the time of his transfer to us.

PAST MEDICAL HISTORY:
1.  Insulin dependent diabetes mellitus.
2.  History of deep venous thrombosis.
3.  Hypertension.
4.  History of upper gastrointestinal bleed.
5.  History of prior tracheotomy and Whipple procedure.

MEDICATIONS:
1.  Paxil.
2.  Lisinopril.
3.  Insulin.
4.  Ranitidine.

LABORATORY:  On admission, the white blood cell count was
67,000 with a hematocrit of 35.  The platelets were 25,000
with laboratories consistent with disseminated intervascular
coagulation.  The creatinine was 3.7.  His liver function
tests were diffusely elevated with a total bilirubin of 9.7.
He was acidotic with a pH of 7.21.  His lactate was 6.

HOSPITAL COURSE:  The patient was transferred by [**Location (un) 7622**]
Helicopter and was intubated en route.  After presentation
here, he was immediately transferred to the Intensive Care
Unit.  I performed a bedside rigid sigmoidoscopy which showed
normal mucosa to 20 cm.  His stool was heme negative.

Reviewing the CT scan from the outside lying hospital, he
clearly had intrahepatic ductal dilatation.  He was
profoundly septic requiring intravenous Levophed.  He was
taken to the Interventional Radiology Suite where a
successful transhepatic cholangiogram was performed showing
complete obstruction, presumably at the level of a previous
hepaticojejunostomy.  A catheter was left to external
drainage.

Over the next two days, he remained profoundly hypotensive
requiring multiple pressors.  He was maintained on broad
spectrum antibiotics.  His urine output was restored to a
very low level of oliguria.  He developed progressive dry
gangrene of the fingers and toes.  Despite his very very
modest improvement, after consultation with the family, in
view of his grim prognosis, he was made comfort measures only
and expired on [**2155-10-8**].

CONDITION AT DISCHARGE:   Expired.

DISCHARGE STATUS:  Expired.

DISCHARGE DIAGNOSES:  Ascending cholangitis with biliary
tract obstruction.

SURGICAL PROCEDURES AND DATE:  None.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern4) 1779**]

MEDQUIST36

D:  [**2155-12-9**]  13:39
T:  [**2155-12-9**]  15:52
JOB#:  [**Job Number 43538**]
{'Septicemia due to anaerobes,Other shock without mention of trauma,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Defibrination syndrome,Cholangitis,Acidosis,Personal history of malignant neoplasm of other gastrointestinal tract'}


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: 

PRESENT ILLNESS: This is the dictation of
Discharge Summary which had been left neglected by the
resident staff.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus.
2.  History of deep venous thrombosis.
3.  Hypertension.
4.  History of upper gastrointestinal bleed.
5.  History of prior tracheotomy and Whipple procedure.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Septicemia due to anaerobes,Other shock without mention of trauma,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Defibrination syndrome,Cholangitis,Acidosis,Personal history of malignant neoplasm of other gastrointestinal tract'}
