CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 61 year old obese man, with DM Type 2 who
began having abdominal pain in his RUQ on Friday [**2107-3-25**] while
at work. The pain worsened over the next two days and was not
alleviated by Percocet, which patient had PRN for leg pain. The
patient rated the pain as [**8-24**] through Friday and Saturday and
began experiencing nausea. He denies diarrhea, vomiting,
fever and chills. He presented to OSH on Sunday [**2107-3-27**], and had
CT scan and ultrasound. He was transfered to [**Hospital1 18**] Sunday night
and was hypotensive on arrival to 70s requiring 3L of IVF. On
arrival his pain is [**6-24**] and still has nausea. Of note, patient
has an incarcerated umbilical hernia which he states has been
present for many years and is unchanged.

MEDICAL HISTORY: Past Medical History:
- Two cardiac stents placed 10-15 years ago
- Type 2 Diabetes Mellitus dx [**2104**]
- Peripheral neuropathy
- Hypertension
- Hyperlipidemia

MEDICATION ON ADMISSION: Allopurinol  100mg 2x Daily
Percocet     PRN
Citalopram   20 mg 1 tab QD
Lisinopril   10 mg Daily
Pantoprazole 40 mg Daily
Clonazepam   1  mg 1 tab daily
Folic acid   1  mg QD
Simvastatin  40 mg Evening
Lorazepam    0.5 mg 1-2 tabs at bedtime
Bupropion    150 mg 1 tab 2x day
Nitro        PRN
Vitamin D, Mag, ASA

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: Temp 97.6, HR 82, BP 85/47, RR 25, SpO2 96% on 2 L NC
General: Aptient appears is alert and cooperative. He appears
mildly uncomfortable but is in no acute distress.
HEENT: Right pupil round, reactive to light. Left pupil fixed
and
elliptical shaped. Had previous surgery on left eye.
CV: RRR, no m/r/g
Lungs: CTAB
Abdomen: Soft, obese, non-distended. TTP in RUQ without
rebound/gaurding. [**Doctor Last Name 515**] sign negative, though exam limited by
body habitus.  Incarcerated umbilical hernia present,
non-tender,
with no overlying skin changes.
Extremities: No edema or cyanosis. Peripheral pulses present.
             Bruising on ankles bilaterally.

FAMILY HISTORY: Family History: non-contributory

SOCIAL HISTORY: Social History: Does not drink, smoke or use recreational drugs
Acute cholecystitis,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Bariatric surgery status
Acute cholecystitis,Obesity NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Idio periph neurpthy NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Bariatric surgery status
Admission Date:  [**2107-3-28**]              Discharge Date:   [**2107-3-31**]

Date of Birth:  [**2045-9-8**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
[**2107-3-28**]: Ultrasound guided percutaneous cholecystostomy drain
placement


History of Present Illness:
Mr. [**Known lastname **] is a 61 year old obese man, with DM Type 2 who
began having abdominal pain in his RUQ on Friday [**2107-3-25**] while
at work. The pain worsened over the next two days and was not
alleviated by Percocet, which patient had PRN for leg pain. The
patient rated the pain as [**8-24**] through Friday and Saturday and
began experiencing nausea. He denies diarrhea, vomiting,
fever and chills. He presented to OSH on Sunday [**2107-3-27**], and had
CT scan and ultrasound. He was transfered to [**Hospital1 18**] Sunday night
and was hypotensive on arrival to 70s requiring 3L of IVF. On
arrival his pain is [**6-24**] and still has nausea. Of note, patient
has an incarcerated umbilical hernia which he states has been
present for many years and is unchanged.

Past Medical History:
Past Medical History:
- Two cardiac stents placed 10-15 years ago
- Type 2 Diabetes Mellitus dx [**2104**]
- Peripheral neuropathy
- Hypertension
- Hyperlipidemia

Past Surgical History:
- Gastric bypass [**2085**]
- Umbilical hernia repair 10 years ago complicated by mesh
infection requiring removal resulting in subsequent recurrence
- Left eye cataract surgery


Social History:
Social History: Does not drink, smoke or use recreational drugs

Family History:
Family History: non-contributory


Physical Exam:
On admission:
Vitals: Temp 97.6, HR 82, BP 85/47, RR 25, SpO2 96% on 2 L NC
General: Aptient appears is alert and cooperative. He appears
mildly uncomfortable but is in no acute distress.
HEENT: Right pupil round, reactive to light. Left pupil fixed
and
elliptical shaped. Had previous surgery on left eye.
CV: RRR, no m/r/g
Lungs: CTAB
Abdomen: Soft, obese, non-distended. TTP in RUQ without
rebound/gaurding. [**Doctor Last Name 515**] sign negative, though exam limited by
body habitus.  Incarcerated umbilical hernia present,
non-tender,
with no overlying skin changes.
Extremities: No edema or cyanosis. Peripheral pulses present.
             Bruising on ankles bilaterally.


Pertinent Results:
[**2107-3-27**] 10:45PM BLOOD WBC-21.1* RBC-4.34* Hgb-12.7* Hct-40.3
MCV-93 MCH-29.2 MCHC-31.5 RDW-13.5 Plt Ct-225 Neuts-86* Bands-4
Lymphs-4* Monos-4 Eos-0 Baso-0 Atyps-0 Metas-2* Myelos-0 ALT-15
AST-31 AlkPhos-127 TotBili-1.2 Lipase-11 Lactate-1.5

[**2107-3-28**] 02:30AM BLOOD CK-MB-5 cTropnT-<0.01

[**2107-3-29**] 03:55AM BLOOD PT-13.7* PTT-28.4 INR(PT)-1.3* Lipase-13

[**2107-3-30**] 05:17AM BLOOD WBC-11.0 RBC-3.95* Hgb-11.7* Hct-37.6*
MCV-95 MCH-29.7 MCHC-31.2 RDW-13.6 Plt Ct-195 Glucose-94
UreaN-25* Creat-1.1 Na-140 K-4.1 Cl-102 HCO3-25 AnGap-17 ALT-20
AST-33 AlkPhos-111 TotBili-0.7 Calcium-8.9 Phos-3.8 Mg-2.2

IMAGING:
[**2107-3-27**]: CHEST (PORTABLE AP):
IMPRESSION:  Bibasilar atelectasis without acute intrathoracic
process.

[**2107-3-28**] ECG: Normal sinus rhythm. Precordial leads [**Location (un) 381**]
voltage and non-specific T wave abnormalities. No previous
tracing available for comparison

[**2107-3-28**]: LIVER OR GALLBLADDER US (SINGLE ORGAN):
IMPRESSION:  Findings suggestive of acute cholecystitis.  The
patient was
scheduled for percutaneous cholecystostomy drain placement.

[**2107-3-28**] GB DRAINAGE,INTRO PERC TRANHEP BIL US:
IMPRESSION:  Successful ultrasound-guided percutaneous
cholecystostomy tube placement.  A sample of the drained bile
sent for microbiological analysis

[**2107-3-29**]: CHEST (PORTABLE AP):
IMPRESSION:  AP chest compared to [**3-27**]:
Previous mild pulmonary edema and vascular congestion have
resolved and lung volumes have improved.  There are no findings
to suggest pneumonia.  Heart size, currently normal.  No pleural
abnormality.

Brief Hospital Course:
He was admitted to the Acute Care Surgery team and underwent
gallbladder ultrasound revealing findings suggestive of acute
cholecystitis. He was given intravenous antibiotics and placed
NPO. He was then referred to Radiology for placement of
percutaneous gallbladder drainage. There were no procedural
complications.

Post procedure he progressed without any issues and was provided
with drain teaching. His antibiotics were changed to Augmentin
for which he will continue with for another 3 days after
discharge.

His diet was advanced and his home medications were restarted.
He is being discharged to home with instructions to follow up
with his PCP and in Acute Care Surgery clinic in the next few
weeks.

Medications on Admission:
Allopurinol  100mg 2x Daily
Percocet     PRN
Citalopram   20 mg 1 tab QD
Lisinopril   10 mg Daily
Pantoprazole 40 mg Daily
Clonazepam   1  mg 1 tab daily
Folic acid   1  mg QD
Simvastatin  40 mg Evening
Lorazepam    0.5 mg 1-2 tabs at bedtime
Bupropion    150 mg 1 tab 2x day
Nitro        PRN
Vitamin D, Mag, ASA


Discharge Medications:
1. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
2. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*25 Tablet(s)* Refills:*0*
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain: Do not exceed 4000 mg per 24 hours.

4. allopurinol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
5. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. clonazepam 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

11. bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
12. iron 325 mg (65 mg iron) Tablet Sig: One (1) Tablet PO once
a day.
13. multivitamin with minerals     Capsule Sig: One (1) Capsule
PO once a day.
14. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.

15. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO Q12H (every 12 hours) for 3 days.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Acute cholecystitis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with abdominal pain due to
acute cholecytisis. You were placed on bowel rest, intravenous
fluids/ antibiotics and a percutaneous catheter was placed into
your gallbladder to drain the infected fluid. You should measure
the output from this drain everyday and record it on a
log/jounral and bring this inforamtion with you to your follow
up appointment with the Acute Care Surgery clinic.

Be sure to finish all of your antibiotics as prescribed.
As you recovered in the hospital, your diet was advanced, which
was well tolerated. You are now preparing for discharge to home
with your drain in place.  Additionally, please note the
following instructions:

Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down 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.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain in not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than [**3-24**] lbs until you follow-up with your
surgeon.
Avoid driving or operating heavy machinery while taking pain
medications.
Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water. Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.

General Drain Care:
*Please look at the site every day for signs of infection
(increased redness or pain, swelling, odor, yellow or bloody
discharge, warm to touch, fever).
*If the drain is connected to a collection container, please
note color, consistency, and amount of fluid in the drain. Call
the doctor, nurse practitioner, or VNA nurse if the amount
increases significantly or changes in character. Be sure to
empty the drain frequently. Record the output, if instructed to
do so.
*Wash the area gently with warm, soapy water.
*Keep the insertion site clean and dry otherwise.
*Avoid swimming, baths, hot tubs; do not submerge yourself in
water.
*Make sure to keep the drain attached securely to your body to
prevent pulling or dislocation.

Additionally, please avoid all NSAIDs including Aleve, Motrin,
ibuprofen, naproxen, etc.

Followup Instructions:
Name:[**First Name11 (Name Pattern1) 21939**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **],MD
Specialty: Primary Care
Location: THE MEDICAL GROUP
Address: [**Last Name (un) 15488**] [**Apartment Address(1) 31103**], [**Hospital1 420**],[**Numeric Identifier 15489**]
Phone: [**Telephone/Fax (1) 10508**]
When: The offie is working on an appointment in the next two
weeks.  You will be called at home with an appointment.  If you
have not heard, please call above number for status.

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: TUESDAY [**2107-4-19**] at 2:00 PM
With: ACUTE CARE CLINIC with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Phone:[**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2107-4-1**]
{'Acute cholecystitis,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Bariatric surgery 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: Abdominal pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 61 year old obese man, with DM Type 2 who
began having abdominal pain in his RUQ on Friday [**2107-3-25**] while
at work. The pain worsened over the next two days and was not
alleviated by Percocet, which patient had PRN for leg pain. The
patient rated the pain as [**8-24**] through Friday and Saturday and
began experiencing nausea. He denies diarrhea, vomiting,
fever and chills. He presented to OSH on Sunday [**2107-3-27**], and had
CT scan and ultrasound. He was transfered to [**Hospital1 18**] Sunday night
and was hypotensive on arrival to 70s requiring 3L of IVF. On
arrival his pain is [**6-24**] and still has nausea. Of note, patient
has an incarcerated umbilical hernia which he states has been
present for many years and is unchanged.

MEDICAL HISTORY: Past Medical History:
- Two cardiac stents placed 10-15 years ago
- Type 2 Diabetes Mellitus dx [**2104**]
- Peripheral neuropathy
- Hypertension
- Hyperlipidemia

MEDICATION ON ADMISSION: Allopurinol  100mg 2x Daily
Percocet     PRN
Citalopram   20 mg 1 tab QD
Lisinopril   10 mg Daily
Pantoprazole 40 mg Daily
Clonazepam   1  mg 1 tab daily
Folic acid   1  mg QD
Simvastatin  40 mg Evening
Lorazepam    0.5 mg 1-2 tabs at bedtime
Bupropion    150 mg 1 tab 2x day
Nitro        PRN
Vitamin D, Mag, ASA

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: Temp 97.6, HR 82, BP 85/47, RR 25, SpO2 96% on 2 L NC
General: Aptient appears is alert and cooperative. He appears
mildly uncomfortable but is in no acute distress.
HEENT: Right pupil round, reactive to light. Left pupil fixed
and
elliptical shaped. Had previous surgery on left eye.
CV: RRR, no m/r/g
Lungs: CTAB
Abdomen: Soft, obese, non-distended. TTP in RUQ without
rebound/gaurding. [**Doctor Last Name 515**] sign negative, though exam limited by
body habitus.  Incarcerated umbilical hernia present,
non-tender,
with no overlying skin changes.
Extremities: No edema or cyanosis. Peripheral pulses present.
             Bruising on ankles bilaterally.

FAMILY HISTORY: Family History: non-contributory

SOCIAL HISTORY: Social History: Does not drink, smoke or use recreational drugs 

### Response:
{'Acute cholecystitis,Obesity, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Bariatric surgery status'}
