CHIEF COMPLAINT: gallstone pancreatitis and possible cholangitis

PRESENT ILLNESS: 76F with malaise, mild epigastric pain, severe nausea and
vomiting for 9 days, and diarrhea initially, now with abdominal
distention & no flatus with subjective fever and chills. The
patient was initially evaluated at [**Hospital6 1597**], found to
have severe gallstone pancreatitis +/- cholangitis. She was
transferred to [**Hospital1 18**] for ERCP.

MEDICAL HISTORY: Hypertension
Diabetes
hypercholesterolemia
osteopenia
CAD / no MI

MEDICATION ON ADMISSION: zocor 20', tricor 145', lopressor 50", Actos/metformin 15/500',
ASA 325', fosamax 70 wk, iron [**Hospital1 **], Hctz/moexipril 15/12.5'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Neuro: no corneal reflex, pupils non-reactive to light,
unresponsive to painful stimuli.
Cardiac: no heart sounds for 1 minute, no radial, femoral,
carotid pulses
Lungs: no breath sounds, no air movement in mouth
Chest: no chest movement.
Time of death 1:56 AM [**2191-4-2**]

FAMILY HISTORY: n/c

SOCIAL HISTORY: non-smoker, no ETOH, no IVDU
Cholangitis,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Cholangitis,Acute pancreatitis,Choledochlith NOS w obst,Acute kidney failure NOS,Gastrointest hemorr NOS,Cardiac arrest,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2191-4-1**]              Discharge Date:   [**2191-4-2**]

Date of Birth:  [**2114-4-12**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
gallstone pancreatitis and possible cholangitis


Major Surgical or Invasive Procedure:
ERCP
Emergent bedside EGD
bedside emergent explorative laparotomy


History of Present Illness:
76F with malaise, mild epigastric pain, severe nausea and
vomiting for 9 days, and diarrhea initially, now with abdominal
distention & no flatus with subjective fever and chills. The
patient was initially evaluated at [**Hospital6 1597**], found to
have severe gallstone pancreatitis +/- cholangitis. She was
transferred to [**Hospital1 18**] for ERCP.


Past Medical History:
Hypertension
Diabetes
hypercholesterolemia
osteopenia
CAD / no MI

PSH:
s/p hysterectomy + appy (age 32)
s/p CABG x3 '[**76**] ([**Hospital1 112**])


Social History:
non-smoker, no ETOH, no IVDU


Family History:
n/c

Physical Exam:
Neuro: no corneal reflex, pupils non-reactive to light,
unresponsive to painful stimuli.
Cardiac: no heart sounds for 1 minute, no radial, femoral,
carotid pulses
Lungs: no breath sounds, no air movement in mouth
Chest: no chest movement.
Time of death 1:56 AM [**2191-4-2**]


Pertinent Results:
[**2191-4-1**] 04:10PM [**Month/Day/Year 3143**] WBC-9.3 RBC-2.86* Hgb-8.9* Hct-25.9*
MCV-90 MCH-31.2 MCHC-34.5 RDW-16.0* Plt Ct-211
[**2191-4-1**] 11:51PM [**Month/Day/Year 3143**] WBC-20.6* RBC-UNABLE TO  Hgb-4.3*#
Hct-14.0* MCV-UNABLE TO  MCH-UNABLE TO  MCHC-34.0 RDW-UNABLE TO
Plt Ct-152
[**2191-4-1**] 09:49PM [**Month/Day/Year 3143**] Type-ART Temp-36.7 pO2-87 pCO2-29*
pH-7.17* calTCO2-11* Base XS--16 Intubat-NOT INTUBA
[**2191-4-2**] 01:41AM [**Month/Day/Year 3143**] Type-ART pO2-72* pCO2-60* pH-6.67*
calTCO2-8* Base XS--34


Brief Hospital Course:
The patient was admitted for ERCP. Finding from ERCP included:

1) 50-100 cc pus material mixed with liquid material suctioned
from the stomach.
2) Pus in the major papilla
3) Impacted stone in the major papilla
4) Periampullary diverticulum
5) A single 6mm irregular stone that was causing complete
obstruction was seen at the major papilla.

A sphincterotomy was performed. The stone and sludge mixed with
pus were extracted.

Post-procedure the patient was admitted to the [**Hospital Unit Name 153**] following
ERCP. Post-procedure labs were significant for a decreased
hematocrit from an admission level of 25.9 to 15.0. The test was
repeated and confirmed. The [**Hospital Unit Name **] bank was contact[**Name (NI) **] and [**Name2 (NI) **]
products were ordered. Lactate increased from 8 to 13.0. The
patient was transferred to the [**Hospital Ward Name **] SICU.

On arrival to the [**Hospital Ward Name **], the patient was evaluated by the
surgical service, and was stable. The abdominal exam was soft,
without rebound with some moderate distension. She was
experiencing some mild epigastric pain. [**Hospital Ward Name **] product delivery
was pending.

Just prior to midnight, the patient was discovered to be
unresponsive.  She maintained a [**Hospital Ward Name **] pressure but was
experiencing agonal breathing. Anesthesia was contact[**Name (NI) **] stat as
was the surgical senior in house. Intubation was initiated.

The abdominal exam was significant for increasing distension.
[**Name (NI) **] was noted per rectum. Rapid infusion protocol was
initiated for delivery of [**Name (NI) **] products.

The surgical attending, surgical chief, critical care fellow, GI
fellow, and GI attending were contact[**Name (NI) **] by the surgical and ICU
teams.

About 15 minutes after intubation, a pulse became undetectable.
ACLS protocol, including chest compressions, were begun and were
carried out for one hour and fifty minutes. The lungs were
needled during this period and no tension pneumothorax was
suspected. No improvement was noted in vital signs.

EGD was carried out at bedside by the Gold chief surgical
resident, showing no upper GI source of bleeding.

Due to a concern for abdominal compartment syndrome, and
significant distension, an emergency explorative laparotomy was
performed at bedside. The small bowel and colon showed no
obvious evidence of distension. No free [**Name (NI) **] was found in the
abdomen. Vital signs did not improve.

The patient was pronounced dead at 1:56 AM [**2191-4-2**].

Mrs.[**Name (NI) 82285**] son [**Name (NI) **] was aware and in the hospital while all
ICU procedures were taking place. These actions were taken with
his understanding and at his request for further possible life
saving actions.

The family was offered autopsy and the decision was pending at
the time of this summary.


Medications on Admission:
zocor 20', tricor 145', lopressor 50", Actos/metformin 15/500',
ASA 325', fosamax 70 wk, iron [**Hospital1 **], Hctz/moexipril 15/12.5'


Discharge Disposition:
Expired

Discharge Diagnosis:
cardiopulmonary arrest
cholangitis
pancreatitis

Discharge Condition:
expired


Completed by:[**2191-4-2**]
{'Cholangitis,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,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: gallstone pancreatitis and possible cholangitis

PRESENT ILLNESS: 76F with malaise, mild epigastric pain, severe nausea and
vomiting for 9 days, and diarrhea initially, now with abdominal
distention & no flatus with subjective fever and chills. The
patient was initially evaluated at [**Hospital6 1597**], found to
have severe gallstone pancreatitis +/- cholangitis. She was
transferred to [**Hospital1 18**] for ERCP.

MEDICAL HISTORY: Hypertension
Diabetes
hypercholesterolemia
osteopenia
CAD / no MI

MEDICATION ON ADMISSION: zocor 20', tricor 145', lopressor 50", Actos/metformin 15/500',
ASA 325', fosamax 70 wk, iron [**Hospital1 **], Hctz/moexipril 15/12.5'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Neuro: no corneal reflex, pupils non-reactive to light,
unresponsive to painful stimuli.
Cardiac: no heart sounds for 1 minute, no radial, femoral,
carotid pulses
Lungs: no breath sounds, no air movement in mouth
Chest: no chest movement.
Time of death 1:56 AM [**2191-4-2**]

FAMILY HISTORY: n/c

SOCIAL HISTORY: non-smoker, no ETOH, no IVDU 

### Response:
{'Cholangitis,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Cardiac arrest,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
