CHIEF COMPLAINT: Left Abdomen Cellulitis of 5 days duration
Weight loss and anorexia x 1 month

PRESENT ILLNESS: Patient with known Hep C Cirrhosis (last paracentesis 4 months
ago) presents with 4-5 day history of Left side abdominal
cellulitis. Denies nausea or vomiting, although she notes weight
loss and anorexia over the last month. Denies abdominal pain, no
change in bowel habits.

MEDICAL HISTORY: 1. Hepatitis C: She is followed in liver clinic, but declined
any interventions.  She has evidence of cirrhosis and ascites.
This is believed to have resulted from transfusion 20 years ago
following an ectopic pregnancy
2. Hypertension
3. Cryoglobinemia diagnosed in [**3-23**]
4. Varicose veins status post stripping in [**5-27**] and [**12-29**]
5. Vasculitis: Leukocytoblastic diagnosed on biopsy from [**2-21**]
following 3 year history of difficulty walking and leg pain and
swelling.
6. Hypothyroidism
7. Cholecystectomy in [**2174**] that is thought to be due to chronic
vasculitis from untreated Hepatitis C.

MEDICATION ON ADMISSION: None,
refuses to take

ALLERGIES: Percocet / Ceftriaxone / Flagyl / Levofloxacin / Iodine Strong /
Unasyn / Bactrim / Vancomycin

PHYSICAL EXAM: On Admission:
VS: 101 HR 120's, BP100/50
Cardiac: Tachy
Lungs: clear bilaterally
Abd: Distended with ascites. NT, Left side of abdomen with
cellulitis, desqaumation.

FAMILY HISTORY: Her mother died of coronary arterty disease and hypertension at
the age of 72

SOCIAL HISTORY: She came to the US from [**Country 532**] about 15 years ago.  She lives
with her ex-husband, son, and daughter.  She requires assistance
in walking to the bathroom and ADLs.  She denies alcohol or
tobacco use.
Fistula of intestine, excluding rectum and anus,Polyarteritis nodosa,Cellulitis and abscess of trunk,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified pleural effusion,Hemorrhage of gastrointestinal tract, unspecified,Dehydration,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Intestinal fistula,Polyarteritis nodosa,Cellulitis of trunk,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Pleural effusion NOS,Gastrointest hemorr NOS,Dehydration,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2178-7-22**]              Discharge Date:   [**2178-8-3**]

Date of Birth:  [**2118-12-13**]             Sex:   F

Service: SURGERY

Allergies:
Percocet / Ceftriaxone / Flagyl / Levofloxacin / Iodine Strong /
Unasyn / Bactrim / Vancomycin

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Left Abdomen Cellulitis of 5 days duration
Weight loss and anorexia x 1 month

Major Surgical or Invasive Procedure:
Incision and drainage of abdominal abcess
Small bowel resection secondary to fistula in communication with
abcess

History of Present Illness:
Patient with known Hep C Cirrhosis (last paracentesis 4 months
ago) presents with 4-5 day history of Left side abdominal
cellulitis. Denies nausea or vomiting, although she notes weight
loss and anorexia over the last month. Denies abdominal pain, no
change in bowel habits.

Past Medical History:
1. Hepatitis C: She is followed in liver clinic, but declined
any interventions.  She has evidence of cirrhosis and ascites.
This is believed to have resulted from transfusion 20 years ago
following an ectopic pregnancy
2. Hypertension
3. Cryoglobinemia diagnosed in [**3-23**]
4. Varicose veins status post stripping in [**5-27**] and [**12-29**]
5. Vasculitis: Leukocytoblastic diagnosed on biopsy from [**2-21**]
following 3 year history of difficulty walking and leg pain and
swelling.
6. Hypothyroidism
7. Cholecystectomy in [**2174**] that is thought to be due to chronic
vasculitis from untreated Hepatitis C.


Social History:
She came to the US from [**Country 532**] about 15 years ago.  She lives
with her ex-husband, son, and daughter.  She requires assistance
in walking to the bathroom and ADLs.  She denies alcohol or
tobacco use.


Family History:
Her mother died of coronary arterty disease and hypertension at
the age of 72

Physical Exam:
On Admission:
VS: 101 HR 120's, BP100/50
Cardiac: Tachy
Lungs: clear bilaterally
Abd: Distended with ascites. NT, Left side of abdomen with
cellulitis, desqaumation.

Pertinent Results:
Labs on Admission:
[**2178-7-22**] 03:55AM
GLUCOSE-87 UREA N-16 CREAT-0.5 SODIUM-131* POTASSIUM-3.4
CHLORIDE-97 TOTAL CO2-19* ANION GAP-18
ALT(SGPT)-11 AST(SGOT)-30 ALK PHOS-79 AMYLASE-60 TOT BILI-1.4
LIPASE-28
ALBUMIN-2.3* CALCIUM-7.6* PHOSPHATE-3.3 MAGNESIUM-1.3*
WBC-16.2*# RBC-3.90* HGB-9.4* HCT-28.4* MCV-73* MCH-24.0*
MCHC-33.0 RDW-16.8*
NEUTS-94.2* BANDS-0 LYMPHS-4.1* MONOS-1.5* EOS-0.1 BASOS-0
PLT COUNT-171#
LACTATE-2.9*
FreeCa-1.29
PT-19.8* PTT-50.3* INR(PT)-1.9*

Brief Hospital Course:
59 y/o female with known history of Hep C/cirrhosis and ascites
requiring intermittent paracentesis presents with 4-5 day
duration of abdominal cellulitis.
CT of abdomen/pelvis revealed a large left anterior abdominal
subcutaneous abscess.
She also has a large amount of ascites, as well as moderate
right and small left pleural effusions. Surgical drainage of the
abcess and exploratory laparotomy was performed on [**7-22**] and was
complicated by the need for a small bowel resection due to an
intracutaneous fistula. Patient also underwent lysis of
adhesions and ileoileostomy with repair of abdominal wall
defect. Initially the patient had 2 abdominal JPs and was
started on Vanco and Aztreonam. These were D/C'd and Meropenem
started, then Vanco re-added as well as Fluconazole. Patient
extubated on [**7-24**]. Patient continued to require RBC's, PLts and
FFP. (History of cryoglobulinemia)
Wound Vac started on [**7-25**] to abdominal wound. Strep Viridans
isolated from the abdominal wound. Biopsy of Segments of small
bowel taken during surgery showed Focal necrotizing arteritis.
Focal perforation with surrounding necrosis, acute inflammation,
and serosal reaction, as well as focal villous flattening with
architectural distortion and metaplastic change consistent with
chronic injury.
TPN was started for nutritional support.
On [**7-28**] patient experienced approxiamtely 50 cc BRBPR, receiving
platelets and PRBCs. Hct as low as 23%, on discharge Hct 24.8%,
platelets 146
Wound VAC remained in place, being changed q 3 days. Wound is
reported to be free of any S&S of infection and granulation
tissue is noted.
Patient required detailed explanations of any procedure or
medication she was to receive, and this was better managed with
the use of the Russian interpreter. Patient had not been taking
any medications at home, and used limited ones while at the
hospital. Initially PT was refused, however patient has been
encouraged by many disciplines of the importance of ambulating,
and being OOB. Psych consult was obtained, and the
recommendation to have a translator available when reviewing
procedures and need for medications was made. Treatable
etiologies of dementia were ruled out, and patient was
encouraged to follow up with Social work or other mental health
provider to work out issues of trust with medical system.
TPN continued until discharge, patient should be given
supplements to PO intake with breakfast lunch and dinner.
Appointments as indicated.




Medications on Admission:
None,
refuses to take

Discharge Medications:
1. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
3. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Hydromorphone 2 mg/mL Syringe Sig: One (1)  Injection Q3-4H
(Every 3 to 4 Hours) as needed.
6. Pantoprazole 40 mg Recon Soln Sig: One (1) Recon Soln
Intravenous  Q24H (every 24 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Focal necrotizing arteritis
S/P small bowel resection
intracutaneous fistula, abdomen


Discharge Condition:
Stable


Discharge Instructions:
Please call [**Telephone/Fax (1) 673**] to notify if patient experiences fever,
chills, change in abdominal wound, difficulty with wound vac, or
other problems concerning to you

Followup Instructions:
Provider: [**Name Initial (NameIs) 1220**]. [**Name5 (PTitle) **]/[**Doctor Last Name **] Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2178-8-6**]
8:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2178-8-13**] 4:00
Call [**Telephone/Fax (1) 673**] for follow up appointment with surgeon



Completed by:[**2178-8-3**]
{'Fistula of intestine, excluding rectum and anus,Polyarteritis nodosa,Cellulitis and abscess of trunk,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified pleural effusion,Hemorrhage of gastrointestinal tract, unspecified,Dehydration,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: Left Abdomen Cellulitis of 5 days duration
Weight loss and anorexia x 1 month

PRESENT ILLNESS: Patient with known Hep C Cirrhosis (last paracentesis 4 months
ago) presents with 4-5 day history of Left side abdominal
cellulitis. Denies nausea or vomiting, although she notes weight
loss and anorexia over the last month. Denies abdominal pain, no
change in bowel habits.

MEDICAL HISTORY: 1. Hepatitis C: She is followed in liver clinic, but declined
any interventions.  She has evidence of cirrhosis and ascites.
This is believed to have resulted from transfusion 20 years ago
following an ectopic pregnancy
2. Hypertension
3. Cryoglobinemia diagnosed in [**3-23**]
4. Varicose veins status post stripping in [**5-27**] and [**12-29**]
5. Vasculitis: Leukocytoblastic diagnosed on biopsy from [**2-21**]
following 3 year history of difficulty walking and leg pain and
swelling.
6. Hypothyroidism
7. Cholecystectomy in [**2174**] that is thought to be due to chronic
vasculitis from untreated Hepatitis C.

MEDICATION ON ADMISSION: None,
refuses to take

ALLERGIES: Percocet / Ceftriaxone / Flagyl / Levofloxacin / Iodine Strong /
Unasyn / Bactrim / Vancomycin

PHYSICAL EXAM: On Admission:
VS: 101 HR 120's, BP100/50
Cardiac: Tachy
Lungs: clear bilaterally
Abd: Distended with ascites. NT, Left side of abdomen with
cellulitis, desqaumation.

FAMILY HISTORY: Her mother died of coronary arterty disease and hypertension at
the age of 72

SOCIAL HISTORY: She came to the US from [**Country 532**] about 15 years ago.  She lives
with her ex-husband, son, and daughter.  She requires assistance
in walking to the bathroom and ADLs.  She denies alcohol or
tobacco use. 

### Response:
{'Fistula of intestine, excluding rectum and anus,Polyarteritis nodosa,Cellulitis and abscess of trunk,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Unspecified pleural effusion,Hemorrhage of gastrointestinal tract, unspecified,Dehydration,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
