CHIEF COMPLAINT: Nausea/vomiting

PRESENT ILLNESS: The patient is a 76 year old male with a history of HTN, HL who
presented to the ER on [**2159-4-4**] after developing nausea,
vomiting, abdominal pain after eating dinner around 5:30 pm. The
patient was watching The Sopranos on TV after dinner and
developed sharp, epigastric pain radiating to his right flank.
He had two episodes of nonbilious vomiting. He denies any recent
fevers/chills/sick contacts/diarrhea/constipation. He admits to
occasional alcohol and had 3 beers that night with his meals. He
also admits to drinking one glass of scotch. He denies a history
of heavy alcohol use.
.
The patient says that he has had 1 similar episode to this in
the past about 15 years ago that he believes was gastric reflux.

MEDICAL HISTORY: HTN
Hyperlipidemia
Elevated PSA/ ? prostate cancer - Followed by Dr. [**Last Name (STitle) **]
Cataracts s/p surgical removal in both eyes
CRI Cr 1.1-1.2, CT in [**8-16**] showed severe chronic right
uteropelvic junction obstruction (believed to be congenital)
Diverticulosis
Colonic polyps
h/o cholelithiasis

MEDICATION ON ADMISSION: Lipitor 10 mg PO QD
HCTZ 25 mg PO QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc=97 P=80 BP=122/70 RR=16 85-90% on RA
.
Gen - NAD, AOX3
HEENT - anicteric, MMM, external JVD to jaw, internal JVD [**7-20**]
cm pulsations
Heart - RRR, no M/R/G, physiologic split S2
Lungs - Crackles at both bases extending 1/2 up on the right
Abdomen - Soft, NT, ND, + BS, no hepatosplenomegaly, no palpable
masses
Ext - No C/C/E, +1 d pedis bilaterally
Back - No back pain, CVAT
Skin - No rashes noted
Neuro - CN II-XII grossly intact

FAMILY HISTORY: Mother died at 60 of pancreatic cancer; father
died at 74, unsure of the cause of death possibly black lung as
he was a coal miner

SOCIAL HISTORY: The patient lives with his wife [**Name (NI) 6409**]. He drinks on
occasion but denies heavy alcohol use. He drinks 1 glass of
scotch on occasion (not daily) + 1-3 beers. Denies tobacco.
Acute pancreatitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Hydronephrosis,Laparoscopic surgical procedure converted to open procedure,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of colonic polyps
Acute pancreatitis,Cholelith w ac cholecyst,CHF NOS,Pneumonia, organism NOS,Hydronephrosis,Lap surg convert to open,Hypertension NOS,Hyperlipidemia NEC/NOS,Prsnl hst colonic polyps
Admission Date:  [**2159-4-5**]              Discharge Date:   [**2159-4-13**]

Date of Birth:  [**2082-8-22**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7760**]
Chief Complaint:
Nausea/vomiting


Major Surgical or Invasive Procedure:
Open Cholecystectomy


History of Present Illness:
The patient is a 76 year old male with a history of HTN, HL who
presented to the ER on [**2159-4-4**] after developing nausea,
vomiting, abdominal pain after eating dinner around 5:30 pm. The
patient was watching The Sopranos on TV after dinner and
developed sharp, epigastric pain radiating to his right flank.
He had two episodes of nonbilious vomiting. He denies any recent
fevers/chills/sick contacts/diarrhea/constipation. He admits to
occasional alcohol and had 3 beers that night with his meals. He
also admits to drinking one glass of scotch. He denies a history
of heavy alcohol use.
.
The patient says that he has had 1 similar episode to this in
the past about 15 years ago that he believes was gastric reflux.

.
In the ED, the patient received dilaudid for pain control and
IVF at 200 cc/hr for 3 liters. His amylase was noted to be 151,
lipase 125, Hct 40, and Cr 1.3. An abdominal ultrasound showed:
Redemonstration of cholelithiasis. No evidence of cholecystitis.
Normal CBD. No other imaging was performed. He was admitted for
pain control which is now well controlled with dilaudid.
.
ROS:
.
No chest pain, shortness of breath, cough, fevers, chills,
diarrhea or constipation. No weight loss or jaundice. No bloody
stools, no blood in urine.


Past Medical History:
HTN
Hyperlipidemia
Elevated PSA/ ? prostate cancer - Followed by Dr. [**Last Name (STitle) **]
Cataracts s/p surgical removal in both eyes
CRI Cr 1.1-1.2, CT in [**8-16**] showed severe chronic right
uteropelvic junction obstruction (believed to be congenital)
Diverticulosis
Colonic polyps
h/o cholelithiasis


Social History:
The patient lives with his wife [**Name (NI) 6409**]. He drinks on
occasion but denies heavy alcohol use. He drinks 1 glass of
scotch on occasion (not daily) + 1-3 beers. Denies tobacco.

Family History:
Mother died at 60 of pancreatic cancer; father
died at 74, unsure of the cause of death possibly black lung as
he was a coal miner


Physical Exam:
Tc=97 P=80 BP=122/70 RR=16 85-90% on RA
.
Gen - NAD, AOX3
HEENT - anicteric, MMM, external JVD to jaw, internal JVD [**7-20**]
cm pulsations
Heart - RRR, no M/R/G, physiologic split S2
Lungs - Crackles at both bases extending 1/2 up on the right
Abdomen - Soft, NT, ND, + BS, no hepatosplenomegaly, no palpable
masses
Ext - No C/C/E, +1 d pedis bilaterally
Back - No back pain, CVAT
Skin - No rashes noted
Neuro - CN II-XII grossly intact


Pertinent Results:
[**2159-4-5**] 12:17AM   PT-11.9 PTT-26.4 INR(PT)-1.0
[**2159-4-5**] 12:17AM   PLT COUNT-318
[**2159-4-5**] 12:17AM   MICROCYT-1+
[**2159-4-5**] 12:17AM   NEUTS-72.8* LYMPHS-18.9 MONOS-4.8 EOS-2.4
BASOS-1.1
[**2159-4-5**] 12:17AM   WBC-7.0 RBC-4.80 HGB-13.9* HCT-40.4 MCV-84
MCH-29.0 MCHC-34.5 RDW-15.5
[**2159-4-5**] 12:17AM   ALBUMIN-4.2 CALCIUM-9.1 PHOSPHATE-3.2
MAGNESIUM-2.4
[**2159-4-5**] 12:17AM   LIPASE-125*
[**2159-4-5**] 12:17AM   ALT(SGPT)-15 AST(SGOT)-25 ALK PHOS-70
AMYLASE-151* TOT BILI-0.6
[**2159-4-5**] 12:17AM   estGFR-Using this
[**2159-4-5**] 12:17AM   GLUCOSE-148* UREA N-23* CREAT-1.3* SODIUM-140
POTASSIUM-3.3 CHLORIDE-97 TOTAL CO2-31 ANION GAP-15
[**2159-4-5**] 06:50AM   PLT COUNT-308
[**2159-4-5**] 06:50AM   MICROCYT-1+
[**2159-4-5**] 06:50AM   NEUTS-93.2* LYMPHS-3.7* MONOS-2.6 EOS-0
BASOS-0.5
[**2159-4-5**] 06:50AM   WBC-14.5*# RBC-5.00 HGB-13.6* HCT-42.4 MCV-85
MCH-27.2 MCHC-32.1 RDW-15.6*
[**2159-4-5**] 06:50AM   MAGNESIUM-2.1
[**2159-4-5**] 06:50AM   LIPASE-52
[**2159-4-5**] 06:50AM   ALT(SGPT)-16 AST(SGOT)-23 ALK PHOS-69
AMYLASE-171*
[**2159-4-5**] 06:50AM   GLUCOSE-132* UREA N-20 CREAT-1.1 SODIUM-142
POTASSIUM-3.4 CHLORIDE-99 TOTAL CO2-31 ANION GAP-15
[**2159-4-5**] 06:50AM   GLUCOSE-132* UREA N-20 CREAT-1.1 SODIUM-142
POTASSIUM-3.4 CHLORIDE-99 TOTAL CO2-31 ANION GAP-15
[**2159-4-5**] 02:34PM URINE  HYALINE-0-2
[**2159-4-5**] 02:34PM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0-2
[**2159-4-5**] 02:34PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2159-4-5**] 02:34PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.017
.
[**2159-4-5**] EKG
Sinus bradycardia at 50 bpm. NL axis. No ST changes. Nonspecific
TWI in AVL. Q waves in III, AVF. Compared to [**2152**], no change.
CHEST (PORTABLE AP)  [**2159-4-5**] 6:53 PM
Right lower lobe atelectasis without evidence for pneumonia.
.
CHEST (PORTABLE AP)  [**2159-4-5**] 4:28 AM
Portable AP chest radiograph compared to [**2153-10-17**]. The
heart size is normal. Mediastinal and hilar contours are
unremarkable. There is mild perihilar haziness and bronchial
wall thickening which may represent fluid overload as well as
small left pleural effusion cannot be excluded. There is no
pneumothorax or focal lung consolidation.
.
LIVER OR GALLBLADDER US (SINGLE ORGAN)  [**2159-4-5**] 2:45 AM
FINDINGS: A 1.3 cm stone is again noted in the gallbladder neck.
Additional nondependent foci along the gallbladder wall are
consistent with small polyps or adherent stones. There is no
wall thickening or pericholecystic fluid. The common duct is not
dilated. Again seen is massive right hydronephrosis.
IMPRESSION: Cholelithiasis without evidence of cholecystitis.
.
[**2159-4-6**]- CT abdomen/pelvis- in discussion with radiologist,
evidence of acute cholecystitis, with stone in cystic duct, fat
stranding.
.


Brief Hospital Course:
The patient is a 76 year old male with a history of HTN, HL,
?prostate cancer who presents with nausea/vomiting,epigastric
pain->back believed to be consistent with pancreatitis.
.
#Acute pancreatitis-
The patient reports an equivocal history of alcohol use. His
mother had pancreatic cancer. The patient has only one
functional kidney with a Cr of 1.3. CT scan not performed on
admission as felt patient had greater risk than benefit at this
point to further assess the pancreas. Abdominal ultrasound shows
cholelithiasis without obstruction, cholecystitis. Continue to
monitor progression of pain, trended enzymes. cholelithiasis and
alcohol considered as likely etiology. Zofran for nausea,
morphine, then to oxycodone for pain. Patient had minimal
discomfort on admission. Fever to 102.4 and leukocytosis
worsening overnight day two of admission. CT abdomen/pelvis
ordered. Performed [**4-6**] night. [**4-7**] 7AM, CT with evidence of
acute cholecystitis. Abx initiated, unasyn. Pt with +[**Doctor Last Name **]
sign, very tender RUQ. Surgery contact[**Name (NI) **]. To OR for lap
cholecystectomy. Hydration as tolerated, given CHF.
.
Hypoxia- Desaturation post 3 liters fluid given in ED. JVP
elevated. Only sparse crackled. To 85% RA transiently. Stable on
2L NC. CXR with atelectasis at right base. Held on further
hydration. Considered PE. Compression given splinting. Pt was
moved out of the ICU after 3 days and his respiratory efforts
improved. On HD 7 the patient was able to maintain adequate
saturations of 97% on RA
.
# CHF, EF unknown. Evidence of hypoxia with crackles bilaterally
on exam after aggressive fluid hydration with NS at 200 cc/hr x
3 liters in ED. DC'd IVF for now  10 mg IV lasix given hypoxia
by nightfloat admitting resident. The patient had been sat'ing
100% on RA prior to receiving 3 liters of IVF in ED. Sats stable
at 95% 2L, CT abdomen with lung cuts to assess bases.
.
# Glutealregion hematoma- as per previous CT scan in 06. Patient
will likely need repeat MRI as outpatient as per Dr. [**Last Name (STitle) 4026**] to
reassess as still present.
.
# HTN - HCTZ re initiated.
.
# Hyperlipidemia- Continue Lipitor 10 mg PO QD.
.
#FEN - NPO, IVF - held given fluid overload and desaturation.
Repleted potassium.
.
PPX - Hep SQ TID, PPI
.
Code - FULL

Pt was able to tolerate a full regular diet on HD 7. His foley,
JP drain were removed and his IVs were heplocked on HD7. Staple
were romved on POD #6.  Pt was tolerating a regular diet and was
discharched home.




Medications on Admission:
Lipitor 10 mg PO QD
HCTZ 25 mg PO QD


Discharge Medications:
1. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
2. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3-4H (Every
3 to 4 Hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Gangrenous cholecystitis


Discharge Condition:
Good, Tolerating POs, ambulating, voiding


Discharge Instructions:
You had your gallbladder removed. Your drains were removed
during your hospital course. You will be discharged on pain
medication. Do drive or operate heavy machinery while on this
medication. You will not be discharged on antibiotics. You may
go about your usual daily activities.
Please call the clinic or go to your local Emergency department
for the following
1) Temperate >101.5
2) Increased pain
3) Increased redness around the incision sites
4) Increased drainage out of incision sites
5) Inability to pass flatus
6) Inability to pass stool for several days

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 11136**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Date/Time:[**2159-7-18**] 9:30
Provider: [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 276**], M.D. Phone:[**Telephone/Fax (1) 277**]
Date/Time:[**2159-7-19**] 11:40
Provider: [**First Name8 (NamePattern2) 6118**] [**Last Name (NamePattern1) 6119**], RN,MS,[**MD Number(3) 1240**]:[**Telephone/Fax (1) 1971**]
Date/Time:[**2159-7-24**] 10:00
You should follow up with Dr. [**Last Name (STitle) 6633**] in her clinic in 2 weeks.
You should call [**Telephone/Fax (1) 2998**] to schedule an appointment. When
making the appointment be sure to tell the nurse that you are
scheduling your 1st post-operative appointment



Completed by:[**2159-4-13**]
{'Acute pancreatitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Hydronephrosis,Laparoscopic surgical procedure converted to open procedure,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of colonic polyps'}


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: Nausea/vomiting

PRESENT ILLNESS: The patient is a 76 year old male with a history of HTN, HL who
presented to the ER on [**2159-4-4**] after developing nausea,
vomiting, abdominal pain after eating dinner around 5:30 pm. The
patient was watching The Sopranos on TV after dinner and
developed sharp, epigastric pain radiating to his right flank.
He had two episodes of nonbilious vomiting. He denies any recent
fevers/chills/sick contacts/diarrhea/constipation. He admits to
occasional alcohol and had 3 beers that night with his meals. He
also admits to drinking one glass of scotch. He denies a history
of heavy alcohol use.
.
The patient says that he has had 1 similar episode to this in
the past about 15 years ago that he believes was gastric reflux.

MEDICAL HISTORY: HTN
Hyperlipidemia
Elevated PSA/ ? prostate cancer - Followed by Dr. [**Last Name (STitle) **]
Cataracts s/p surgical removal in both eyes
CRI Cr 1.1-1.2, CT in [**8-16**] showed severe chronic right
uteropelvic junction obstruction (believed to be congenital)
Diverticulosis
Colonic polyps
h/o cholelithiasis

MEDICATION ON ADMISSION: Lipitor 10 mg PO QD
HCTZ 25 mg PO QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc=97 P=80 BP=122/70 RR=16 85-90% on RA
.
Gen - NAD, AOX3
HEENT - anicteric, MMM, external JVD to jaw, internal JVD [**7-20**]
cm pulsations
Heart - RRR, no M/R/G, physiologic split S2
Lungs - Crackles at both bases extending 1/2 up on the right
Abdomen - Soft, NT, ND, + BS, no hepatosplenomegaly, no palpable
masses
Ext - No C/C/E, +1 d pedis bilaterally
Back - No back pain, CVAT
Skin - No rashes noted
Neuro - CN II-XII grossly intact

FAMILY HISTORY: Mother died at 60 of pancreatic cancer; father
died at 74, unsure of the cause of death possibly black lung as
he was a coal miner

SOCIAL HISTORY: The patient lives with his wife [**Name (NI) 6409**]. He drinks on
occasion but denies heavy alcohol use. He drinks 1 glass of
scotch on occasion (not daily) + 1-3 beers. Denies tobacco. 

### Response:
{'Acute pancreatitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Hydronephrosis,Laparoscopic surgical procedure converted to open procedure,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of colonic polyps'}
