CHIEF COMPLAINT: The patient was admitted to [**Hospital1 18**] on [**9-7**] for an elective
revision of his prior gastric bypass secondary to persistent
weight gain following his initial surgery that was likely caused
by a gastro-gastric fistula.  (His prior surgery was first
complicated by a leak requiring return to the OR for leak
repair, which was then complicated by a second leak causing an
intra-abdominal abscess.)

PRESENT ILLNESS: The patient has a history of morbid obesity s/p gastric bypass
in [**2172**] complicated by a leak necessitating return to the OR for
repair, which was then complicated by a second leak that
eventually led to an intraabdominal abscess that was treated
with antibiotics and via JP drain placement.

MEDICAL HISTORY: PMx:
back pain/DJD, dyslipidemia and hypoglycemia, morbid obesity
PSx: [**2173-9-21**] open gastric bypass c/b ileus and leak s/p
exploratory laparotomy, [**Location (un) 1661**]-[**Location (un) 1662**] drain placement, revision
of his gastrojejunostomy, and gastrostomy tube placement c/b
persistent gastrojejunal leak with intraabdominal abscess
formation s/p drainage via gastric JP drain and abx therapy

MEDICATION ON ADMISSION: Sucralfate 1 g tablet 4 times a day for her heartburn/peptic
ulcer disease prophylaxis; Prilosec 20 mg daily for reflux;
multivitamin daily, magnesium/zinc capsules daily, iron 600 mg
daily, folic acid 0.8-mg tablet daily, vitamin B12 1000 mcg
tablets sublingually daily and vitamin D in the form of calcium
citrate twice daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: His blood pressure was 127/81, pulse 80, respirations 12 and O2
saturation 97% on room air.  On physical examination [**Known firstname **] was
casually dressed, healthy appearing and in no distress.  His
skin
was warm, dry with no rashes, occasional skin tags otherwise no
lesions. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue was paint and the oropharynx was
without exudates or hyperemia.  Trachea was in the midline and
the neck was supple with full range of motion, no adenopathy,
thyromegaly or carotid bruits.  Chest was symmetric and the
lungs
were clear to auscultation bilaterally with good air movement.
Cardiac exam was regular rate and rhythm with normal S1 and S2,
no murmurs, rubs or gallops.  The abdomen was soft, non-tender,
non-distended with normal bowel sounds activity, no appreciable
masses and there was a well-healed midline vertical incision
scar
with no hernias.  There was no spinal tenderness or flank pain.
Lower extremities were without edema, venous insufficiency or
clubbing.  There was no evidence of joint swelling or
inflammation of the joints.  There were no focal neurological
deficits and his gait was normal.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, has children
Persistent postoperative fistula,Peritoneal abscess,Cardiac complications, not elsewhere classified,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Bariatric surgery status,Morbid obesity,Tachycardia, unspecified,Body Mass Index 34.0-34.9, adult,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Esophageal reflux,Iron deficiency anemia, unspecified
Persist postop fistula,Peritoneal abscess,Surg compl-heart,Ac DVT/emb distl low ext,Abn react-anastom/graft,Peritoneal adhesions,Incisional hernia,Bariatric surgery status,Morbid obesity,Tachycardia NOS,BMI 34.0-34.9,adult,Klebsiella pneumoniae,Hyperlipidemia NEC/NOS,Esophageal reflux,Iron defic anemia NOS
Admission Date:  [**2179-9-7**]              Discharge Date:   [**2179-10-19**]

Date of Birth:  [**2138-7-9**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
The patient was admitted to [**Hospital1 18**] on [**9-7**] for an elective
revision of his prior gastric bypass secondary to persistent
weight gain following his initial surgery that was likely caused
by a gastro-gastric fistula.  (His prior surgery was first
complicated by a leak requiring return to the OR for leak
repair, which was then complicated by a second leak causing an
intra-abdominal abscess.)

Major Surgical or Invasive Procedure:
[**9-6**] revison of gastric bypass, partial gastrectomy, LOA, G tube
placement
[**9-8**] gastric perforation repair, placement gastrostomy tube,
fibrin glue/reinforcement	


History of Present Illness:
The patient has a history of morbid obesity s/p gastric bypass
in [**2172**] complicated by a leak necessitating return to the OR for
repair, which was then complicated by a second leak that
eventually led to an intraabdominal abscess that was treated
with antibiotics and via JP drain placement.

The patient has had persistent weight gain over the past few
years, although he was not following the post bypass diet per
report.  He was also noted to have anemia and underwent an EGD
and colonoscopy; the latter was normal but the EGD showed a
patent gastro-gastric fistula.  The fistula is thought to be
contributing to his weight gain.  For this reason, along with
the anemia, the patient was admitted to [**Hospital1 18**] on [**9-7**] for
revision of his gastric bypass and repair of the gastro-gastric
fistula.

Past Medical History:
PMx:
back pain/DJD, dyslipidemia and hypoglycemia, morbid obesity
PSx: [**2173-9-21**] open gastric bypass c/b ileus and leak s/p
exploratory laparotomy, [**Location (un) 1661**]-[**Location (un) 1662**] drain placement, revision
of his gastrojejunostomy, and gastrostomy tube placement c/b
persistent gastrojejunal leak with intraabdominal abscess
formation s/p drainage via gastric JP drain and abx therapy

Social History:
Married, has children

Family History:
Noncontributory

Physical Exam:
His blood pressure was 127/81, pulse 80, respirations 12 and O2
saturation 97% on room air.  On physical examination [**Known firstname **] was
casually dressed, healthy appearing and in no distress.  His
skin
was warm, dry with no rashes, occasional skin tags otherwise no
lesions. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue was paint and the oropharynx was
without exudates or hyperemia.  Trachea was in the midline and
the neck was supple with full range of motion, no adenopathy,
thyromegaly or carotid bruits.  Chest was symmetric and the
lungs
were clear to auscultation bilaterally with good air movement.
Cardiac exam was regular rate and rhythm with normal S1 and S2,
no murmurs, rubs or gallops.  The abdomen was soft, non-tender,
non-distended with normal bowel sounds activity, no appreciable
masses and there was a well-healed midline vertical incision
scar
with no hernias.  There was no spinal tenderness or flank pain.
Lower extremities were without edema, venous insufficiency or
clubbing.  There was no evidence of joint swelling or
inflammation of the joints.  There were no focal neurological
deficits and his gait was normal.


Pertinent Results:
[**2179-9-7**] 05:29PM BLOOD WBC-24.3*# RBC-4.88 Hgb-12.4* Hct-38.8*
MCV-80* MCH-25.5* MCHC-32.0 RDW-15.9* Plt Ct-381
[**2179-9-17**] 04:23AM BLOOD WBC-25.0* RBC-3.60* Hgb-9.5* Hct-29.4*
MCV-82 MCH-26.3* MCHC-32.2 RDW-16.1* Plt Ct-520*
[**2179-9-22**] 04:14AM BLOOD WBC-13.2* RBC-3.34* Hgb-9.0* Hct-26.8*
MCV-80* MCH-27.1 MCHC-33.7 RDW-16.4* Plt Ct-722*
[**2179-10-7**] 07:24AM BLOOD WBC-4.5 RBC-3.49* Hgb-9.2* Hct-27.8*
MCV-80* MCH-26.3* MCHC-32.9 RDW-14.6 Plt Ct-296
[**2179-9-9**] 01:55AM BLOOD Neuts-91.5* Lymphs-5.5* Monos-3.0 Eos-0
Baso-0.1
[**2179-9-13**] 09:25PM BLOOD Neuts-80.6* Lymphs-10.9* Monos-6.7
Eos-1.2 Baso-0.6
[**2179-9-20**] 08:36AM BLOOD Neuts-78.0* Lymphs-14.6* Monos-5.4
Eos-1.6 Baso-0.3
[**2179-9-7**] 10:24PM BLOOD Glucose-156* UreaN-10 Creat-0.9 Na-139
K-4.5 Cl-105 HCO3-24 AnGap-15
[**2179-9-11**] 10:30AM BLOOD Glucose-107* UreaN-11 Creat-0.6 Na-139
K-3.5 Cl-106 HCO3-25 AnGap-12
[**2179-10-11**] 04:26AM BLOOD Glucose-90 UreaN-17 Creat-0.5 Na-138
K-4.0 Cl-105 HCO3-27 AnGap-10
[**2179-9-7**] 10:24PM BLOOD CK(CPK)-637*
[**2179-9-8**] 03:10PM BLOOD CK(CPK)-1372*
[**2179-9-13**] 09:25PM BLOOD CK(CPK)-455*
[**2179-9-22**] 04:14AM BLOOD ALT-30 AST-23 AlkPhos-86 Amylase-121*
TotBili-0.8
[**2179-9-7**] 10:24PM BLOOD Calcium-8.5 Phos-3.4 Mg-1.5*
[**2179-9-10**] 04:46AM BLOOD Albumin-2.5* Calcium-7.6* Phos-1.4*
Mg-1.8
[**2179-9-17**] 04:23AM BLOOD Albumin-2.2* Calcium-7.4* Phos-3.6 Mg-1.8
[**2179-10-1**] 04:41AM BLOOD Albumin-2.7* Calcium-8.2* Phos-4.3 Mg-1.8
Iron-14*
[**2179-10-12**] 02:13AM BLOOD Albumin-3.0* Calcium-8.3* Phos-4.3 Mg-1.8
Iron-13*
[**2179-9-14**] 06:45AM BLOOD calTIBC-229* Ferritn-134 TRF-176*
[**2179-9-28**] 05:42AM BLOOD calTIBC-241* VitB12-649 Ferritn-82
TRF-185*
[**2179-10-12**] 02:13AM BLOOD calTIBC-309 Ferritn-36 TRF-238

Brief Hospital Course:
OPERATIONS DURING ADMISSION
[**9-7**]:  Revision of Roux-en-Y gastric bypass, Partial
gastrectomy, Placement of gastrostomy tube, Adhesiolysis,
Incisional hernia repair
[**9-9**]:  Repair of gastric perforation, Gastrostomy tube,
Application of fibrin glue
[**9-13**]:  Exploratory Laparotomy with repair of leak, drainage of
intraabdominal abscess, closure
[**9-13**]:  Intraoperative endoscopy for peritonitis and gastric
perforation.

Other procedures:  Placement of CVL, Epidural placement

CONSULTATIONS DURING ADMISSION
Infectious Disease
General Surgery, Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **]
[**Name5 (PTitle) **] Surgery, Dr [**Last Name (STitle) **]

1.  Revision of gastric bypass and repair of gastro-gastric
fistula:
The patient was admitted to [**Hospital1 18**] on [**9-7**] for revision of his
gastric bypass and repair of the gastro-gastric fistula.  He
went to the OR on [**9-7**] and underwent revison of gastric bypass,
partial gastrectomy, LOA, and G tube placement with three JP
drains in place.  The patient was found to have extensive
adhesions requiring lengthy lysis.  Intraoperative methylene
blue placement down NGT did not reveal any gastric leak.

2.  Intraabdominal leak:  Postoperatively his methylene blue
repeat test down the NGT was again negative.  Since the
operation, however, the patient was persistently tachycardic to
the 120s unrelieved by changing his epidural and multiple pain
medications titrations by Pain Medicine.  On [**9-8**] throughout the
day he remained in sinus tachycardia and was noted to have
increasing oxygen requirements.  The patient was also febrile,
pan cultures were negative, though CXR revealed LLL basilar
opacity (unchanged).  The patient was continued on unasyn.  A
repeat methylene blue test was positive.

3.  Repair of gastric perforation, Gastrostomy tube, Application
of fibrin glue:
Given the leak findings, on [**9-8**] the patient was taken
emergently to the operating room for gastric perforation repair,
placement gastrostomy tube, and fibrin glue/reinforcement.  The
patient tolerated the procedure well, was extubated, and brought
to the PACU in stable condition.

Postoperatively the patient did well.  He was started on TPN
through CVL, and then on G-tube feeds on [**9-13**].  His NGT was
removed.  His pain was well controlled on an epidural of
bupivicaine and clonidine, which was discontinued on [**9-13**].  He
ambulated and was having bowel movements.

He did continue to have temperatures at night to 101.6 but his
blood and urine culture workup was negative.  His CXR continued
to show a LLL basilar opacity.  He was continued on unasyn.

3.  Fever and Tachycardia:  On POD [**5-27**], the patient was noted to
develop sudden tachycardia without any change in symptoms.  ECG,
cardiac enzymes, blood and urine cultures were negative; CXR
unchanged.  He was placed on telemetry.  A repeat methylene blue
test was negative for a leak.  The day's events were noteable
for starting G tube feeds and discontinuing the epidural.  He
was taken to the operating room on [**9-14**] for tachycardia, fever,
and leukocytosis to a peak of 25.5.

4.  Exploratory Laparotomy revealing persistent leak and
intraabdominal abscess:  Intraoperatively the patient had gross
pus (>400cc) oozing from his abdomen, primarily from the left
upper quadrant.  Following drainage of the abscess, Dr [**Last Name (STitle) **]
was consulted to perform an intraoperative endoscopy, which
revealed a retrocolic gastric leak via bubble test.  Given the
deep location of the leak, Dr. [**Last Name (STitle) **] of general surgery was
consulted for repair of the leak.  The leak was repaired, the
patient had 3 JP drains placed in addition to the prior G-tube.
He was started on zosyn postoperatively and the unasyn
discontinued.

He remained tachycardic and febrile, however, with his WBC
continuing to rise to 25.5.  On [**9-16**] vancomycin and fluconazole
were added in addition to the zosyn.  His signs of infection
failed to resolve, however, and so on [**9-17**] infectious disease
was consulted.

Intraoperative swab cultures grew 4+ PMNs, 2+ GPCs in pairs and
clusters, and 2+ GNR,with cultures showing Hafnia alvei
resistant to Unasyn, intermediate to Zosyn, and Klebsiella
pneumoniae.  For this reason ID recommended that the zosyn,
vancomycin, and fluconazole be discontinued, and the patient was
started on meropenem on [**9-17**] with a resultant defeversence and
decline in his leukocytosis.

For nutrition, given the persistent leak, the patient was made
NPO, the G tube feedings discontinued with the surgery, and he
remained on TPN.

His JP drain 2 was placed on high suction and continued to put
out high volumes of pus.  JP 3 and the G tube were alternated on
suction.  JP 1 was pulled approximately one week after the
surgery.

By [**9-27**] the patient's fevers had defervesced and his tachycardia
improved.  His urine output remained profused throughout.

5.  RLE DVT:  On [**2179-9-24**] the patient was out of bed and
ambulated with physical therapy when he noted pain behind his
right knee. Though he had been maintained on venodynes and SQ
heparin for DVT prophylaxis, ultrasound of right lower extremity
performed revealed a thrombus within the right gastrocnemius
vein.  [**Date Range **] surgery consult was called, and they recommended
anticoagulation with heparin.  A repeat RLE ultrasound on [**9-27**]
revealed interval resolution of the thrombus. Heparin drip
continued for several weeks and then discontinued as recommended
by [**Month/Year (2) 1106**].

6.  Persistent Leak:  On [**9-26**] the patient underwent a repeat
methylene blue test that revealed leakage into the peritoneum.
With the thought that the JP drains, being on high suction may
be preventing healing of a persistent leak, both JP 2 and JP3
were pulled back approximately one inch on [**9-27**].

On [**10-3**], the patient underwent a repeat methylene blue test.
This continues to show a leak into the peritoneum. Will continue
present course and repeat methylene blue in one week.

Infectious disease had recommended changing meropeneum to cipro
until all drains are out.

On [**2179-10-6**] CT Scan performed. No evidence of contrast leakage
or obstruction from the portion of stomach that contains the G
tube.

On [**2179-10-10**] Methylene blue was injected into G-tube with no
appearance of leak from drains. G-tube feedings begun at 10cc/hr
and advanced 10cc q 6 hours at 1/2 strength to 100cc with low
residuals.

On [**2179-10-12**] Upper Gi study done showing leak at GJ site.
Meropeneum discontinued and cipro po started until last JP
discontinued.

[**2179-10-17**] tube feedings increased to full strength at 100 cc/hr.
TPN discontinued.
[**2179-10-18**] Dilaudid pca discontinued and dilaudid po given. Tube
feedings cycled from 1800 to noon. Discharge planning
instituted.

[**2179-10-19**] Patient will be discharged today. He will go home on
full strength tube feedings. Cycled from 1800 until 10am with 8
hours of free time daily. He will have a VNA to teach regarding
tube feedings and monitor wound. His return to see Dr. [**Last Name (STitle) **] is
in one week.


Medications on Admission:
Sucralfate 1 g tablet 4 times a day for her heartburn/peptic
ulcer disease prophylaxis; Prilosec 20 mg daily for reflux;
multivitamin daily, magnesium/zinc capsules daily, iron 600 mg
daily, folic acid 0.8-mg tablet daily, vitamin B12 1000 mcg
tablets sublingually daily and vitamin D in the form of calcium
citrate twice daily

Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
Disp:*60 Tablet(s)* Refills:*2*
2. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours): please crush.
Disp:*60 Tablet(s)* Refills:*3*
3. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q2H (every 2
hours) as needed for pain: Please crush and try to wean as
tolerated.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Home [**Hospital 43333**] Hospice and Community

Discharge Diagnosis:
1. Gastrogastric fistula.
2. Obesity.
3. Incisional hernia.


Discharge Condition:
Stable


Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.


Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.
Activity:
No heavy lifting of items [**10-6**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
You may place drain sponges around your g-tube and JP drain. You
may place a dry gauze on the upper portion of your abdominal
incision.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Dr. [**First Name (STitle) **] (for Dr. [**Last Name (STitle) **] On [**10-27**] at 11:15 in the
[**Hospital 1560**] clinic. [**Hospital Ward Name 23**] [**Location (un) 470**].



Completed by:[**2179-10-19**]
{"Persistent postoperative fistula,Peritoneal abscess,Cardiac complications, not elsewhere classified,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Bariatric surgery status,Morbid obesity,Tachycardia, unspecified,Body Mass Index 34.0-34.9, adult,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Esophageal reflux,Iron deficiency anemia, unspecified"}


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: The patient was admitted to [**Hospital1 18**] on [**9-7**] for an elective
revision of his prior gastric bypass secondary to persistent
weight gain following his initial surgery that was likely caused
by a gastro-gastric fistula.  (His prior surgery was first
complicated by a leak requiring return to the OR for leak
repair, which was then complicated by a second leak causing an
intra-abdominal abscess.)

PRESENT ILLNESS: The patient has a history of morbid obesity s/p gastric bypass
in [**2172**] complicated by a leak necessitating return to the OR for
repair, which was then complicated by a second leak that
eventually led to an intraabdominal abscess that was treated
with antibiotics and via JP drain placement.

MEDICAL HISTORY: PMx:
back pain/DJD, dyslipidemia and hypoglycemia, morbid obesity
PSx: [**2173-9-21**] open gastric bypass c/b ileus and leak s/p
exploratory laparotomy, [**Location (un) 1661**]-[**Location (un) 1662**] drain placement, revision
of his gastrojejunostomy, and gastrostomy tube placement c/b
persistent gastrojejunal leak with intraabdominal abscess
formation s/p drainage via gastric JP drain and abx therapy

MEDICATION ON ADMISSION: Sucralfate 1 g tablet 4 times a day for her heartburn/peptic
ulcer disease prophylaxis; Prilosec 20 mg daily for reflux;
multivitamin daily, magnesium/zinc capsules daily, iron 600 mg
daily, folic acid 0.8-mg tablet daily, vitamin B12 1000 mcg
tablets sublingually daily and vitamin D in the form of calcium
citrate twice daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: His blood pressure was 127/81, pulse 80, respirations 12 and O2
saturation 97% on room air.  On physical examination [**Known firstname **] was
casually dressed, healthy appearing and in no distress.  His
skin
was warm, dry with no rashes, occasional skin tags otherwise no
lesions. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue was paint and the oropharynx was
without exudates or hyperemia.  Trachea was in the midline and
the neck was supple with full range of motion, no adenopathy,
thyromegaly or carotid bruits.  Chest was symmetric and the
lungs
were clear to auscultation bilaterally with good air movement.
Cardiac exam was regular rate and rhythm with normal S1 and S2,
no murmurs, rubs or gallops.  The abdomen was soft, non-tender,
non-distended with normal bowel sounds activity, no appreciable
masses and there was a well-healed midline vertical incision
scar
with no hernias.  There was no spinal tenderness or flank pain.
Lower extremities were without edema, venous insufficiency or
clubbing.  There was no evidence of joint swelling or
inflammation of the joints.  There were no focal neurological
deficits and his gait was normal.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, has children 

### Response:
{"Persistent postoperative fistula,Peritoneal abscess,Cardiac complications, not elsewhere classified,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Bariatric surgery status,Morbid obesity,Tachycardia, unspecified,Body Mass Index 34.0-34.9, adult,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other and unspecified hyperlipidemia,Esophageal reflux,Iron deficiency anemia, unspecified"}
