CHIEF COMPLAINT: Right flank pain

PRESENT ILLNESS: This is a 79 year old male with known metastatic adenocarcinoma
of the prostate with involvement of the pelvic lymph nodes as
well as history of nephrolithiasis who developed right flank
pain on [**2101-10-17**]. The pain started Monday evening. It was an
intermittent, sharp, pain, radiating down his groin. Pain
improved with hot water bottle and Tylenol. This was associated
with subjective fevers, nausea, vomiting, and anorexia but not
with any urinary symptoms like dysuria or hematuria (he has
baseline incontinence after prostatectomy earlier this year). He
also had some weakness. He contact[**Name (NI) **] his outpatient urologist
who sent him for CT scan on [**10-18**] that showed a new large stone
at the right ureteral pelvic junction w/ associated stranding
and mild right sided hydronephrosis and therefore he was sent to
the ED for evaluation.

MEDICAL HISTORY: - Metastatic adenocarcinoma of prostate involving right and left
pelvic lymphnodes, s/p open radical retropubic prostatectomy
with bilateral pelvic lymph node dissection on [**2101-9-22**]. Bone
scan on [**2101-8-3**] without evidence of metastatic bone disease.
- Extraction of ureteral calculus from upper pole on [**2101-9-22**]
- Umbilical hernia, s/p repair
- ? previous granulomatous disease with calcified nodes in lungs
and pericardium

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM
VS: T 101.6, P 74, BP 129/78, RR 20 98% on RA
Gen: Diaphoretic male in NAD
HEENT: Normocephalic, anicteric, OP benign, MMM
Neck: No masses or lymphadenopathy
CV: RRR, no M/R/G
Pulm: Expansion equal bilaterally, CTAB. No w/r/c.
Abd: Soft, NT, ND, BS+, no organomegaly or masses appreciated,
no CVA tenderness
Extrem: Warm and well perfused, wet, no C/C/E
Tubes: nephrostomy on right with blood-tinged urine. Insertion
point has no erythema or purulence

FAMILY HISTORY: FAMILY HISTORY:Non-contributory.

SOCIAL HISTORY: The patient is from Poland and immigrated to the US
Calculus of kidney,Acute kidney failure, unspecified,Streptococcal septicemia,Severe sepsis,Urinary tract infection, site not specified,Hydronephrosis,Atrial flutter,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin
Calculus of kidney,Acute kidney failure NOS,Streptococcal septicemia,Severe sepsis,Urin tract infection NOS,Hydronephrosis,Atrial flutter,Thrombocytopenia NOS,Hx-prostatic malignancy,Long-term use of aspirin
Admission Date:  [**2101-10-19**]              Discharge Date:   [**2101-10-25**]

Date of Birth:  [**2022-4-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5810**]
Chief Complaint:
Right flank pain

Major Surgical or Invasive Procedure:
Right percutaneous nephrostomy catheter
Ureteral stent placement


History of Present Illness:
This is a 79 year old male with known metastatic adenocarcinoma
of the prostate with involvement of the pelvic lymph nodes as
well as history of nephrolithiasis who developed right flank
pain on [**2101-10-17**]. The pain started Monday evening. It was an
intermittent, sharp, pain, radiating down his groin. Pain
improved with hot water bottle and Tylenol. This was associated
with subjective fevers, nausea, vomiting, and anorexia but not
with any urinary symptoms like dysuria or hematuria (he has
baseline incontinence after prostatectomy earlier this year). He
also had some weakness. He contact[**Name (NI) **] his outpatient urologist
who sent him for CT scan on [**10-18**] that showed a new large stone
at the right ureteral pelvic junction w/ associated stranding
and mild right sided hydronephrosis and therefore he was sent to
the ED for evaluation.

In the ED, initial vs were: T101.2 (101.9), P117, BP 124/78,
R18, O2 sat 97%. He also had rigors. He had pyuria, fever, and
with significant leukocytosis as well as marginal hypotension
requiring five liters of fluid. He also was noted to be in new
atrial flutter on ECG. After cultures were obtained he received
vancomycin and pipercillin-tazobactam and was admitted to the
MICU

Shortly after arrival to the MICU the patient went for an IR
placed percutaneous nephrostomy tube. He also had a central line
placed. He has been observed in MICU with improving symptoms and
more stable hemodynamics over the past day.


Past Medical History:
- Metastatic adenocarcinoma of prostate involving right and left
pelvic lymphnodes, s/p open radical retropubic prostatectomy
with bilateral pelvic lymph node dissection on [**2101-9-22**]. Bone
scan on [**2101-8-3**] without evidence of metastatic bone disease.
- Extraction of ureteral calculus from upper pole on [**2101-9-22**]
- Umbilical hernia, s/p repair
- ? previous granulomatous disease with calcified nodes in lungs
and pericardium

Social History:
The patient is from Poland and immigrated to the US

approximately 42 years ago. He is a retired civil engineer. He

is an active skier. He is a widower and lives by himself. He

does have a friend of 20+ years who is his HCP. [**Name (NI) **] quit smoking

30 years ago, formerly smoked half pack a day for 10 years. He

reports social alcohol use, <1 glass of wine per week.


Family History:
FAMILY HISTORY:Non-contributory.

Physical Exam:
PHYSICAL EXAM
VS: T 101.6, P 74, BP 129/78, RR 20 98% on RA
Gen: Diaphoretic male in NAD
HEENT: Normocephalic, anicteric, OP benign, MMM
Neck: No masses or lymphadenopathy
CV: RRR, no M/R/G
Pulm: Expansion equal bilaterally, CTAB. No w/r/c.
Abd: Soft, NT, ND, BS+, no organomegaly or masses appreciated,
no CVA tenderness
Extrem: Warm and well perfused, wet, no C/C/E
Tubes: nephrostomy on right with blood-tinged urine. Insertion
point has no erythema or purulence


Pertinent Results:
Micro: 2/2 Blood cultures from admission w/ GPC's in chains
.
OTHER STUDIES
CXR:
FINDINGS: As compared to the previous radiograph, a central
venous access line has been placed over the right subclavian
vein. There is a line malpositioned with the catheter pointing
upwards and being positioned in the right internal jugular vein.
There is no evidence of complication, notably no evidence of
pneumothorax.
.
ECG: From [**2101-10-19**] at 23:00: Possible ectopic atrial tachycardia
w/ rate of 110 (previous w/ abnormal P waves and ? of ectopic
atrial tachy).

LABS AT ADMISSION:

[**2101-10-19**] 04:40PM
 WBC-12.3* RBC-4.58*# Hgb-13.3*# Hct-40.5# MCV-88 MCH-29.0
MCHC-32.9
 RDW-14.5 Plt Ct-196#
 PT-15.0* PTT-26.6 INR(PT)-1.3*

 Glucose-135* UreaN-17 Creat-2.0*# Na-134 K-4.1 Cl-97 HCO3-24
AnGap-17
 ALT-15 AST-22 CK(CPK)-99 AlkPhos-93 TotBili-0.9
 Lipase-21
 cTropnT-<0.01
 CK-MB-5 cTropnT-0.02*
 Mg-1.5*
 Lactate-2.5*

[**2101-10-19**] 11:16PM URINE
 Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.042*
 Blood-LG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG
Bilirub-NEG
 Urobiln-NEG pH-5.5 Leuks-NEG
 RBC-98* WBC-1 Bacteri-NONE Yeast-NONE Epi-0

MICRO:
[**2101-10-19**] 11:16 pm
URINE CULTURE (Final [**2101-10-22**]):
      STAPHYLOCOCCUS SPECIES.    ~3000/ML.
      ENTEROCOCCUS SP..    ~3000/ML.

[**2101-10-19**] 5:30 pm BLOOD CULTURE

                            **FINAL REPORT [**2101-10-22**]**
 Blood Culture, Routine (Final [**2101-10-22**]):
      ENTEROCOCCUS FAECALIS.

      Anaerobic Bottle Gram Stain (Final [**2101-10-20**]):
      GRAM POSITIVE COCCI IN PAIRS AND IN SHORT CHAINS.

      Aerobic Bottle Gram Stain (Final [**2101-10-21**]):
      GRAM POSITIVE COCCI IN PAIRS AND IN SHORT CHAINS.

     SENSITIVITIES: MIC expressed in MCG/ML
_________________________________________________________
                             ENTEROCOCCUS FAECALIS
                             |
AMPICILLIN------------   <=2 S
PENICILLIN G----------  0.25 S
VANCOMYCIN------------   <=1 S

MRSA SCREEN (Final [**2101-10-22**]):    No MRSA isolated.

1ST NEGATIVE BLOOD CULTURE:
[**2101-10-21**] 7:35 am BLOOD CULTURE
    **FINAL REPORT [**2101-10-27**]**
     Blood Culture, Routine (Final [**2101-10-27**]):    NO GROWTH.

DISCHARGE:
[**2101-10-25**] 07:44AM
WBC-10.0 RBC-4.40* Hgb-12.6* Hct-38.2* MCV-87 MCH-28.6 MCHC-32.9
RDW-14.2 Plt Ct-315#
Glucose-100 UreaN-13 Creat-1.0 Na-141 K-4.2 Cl-106 HCO3-25
Calcium-8.9 Phos-2.6* Mg-2.0

[**2101-10-24**] 07:40AM
PT-13.5* PTT-24.4 INR(PT)-1.2*  Fibrino-567*

[**2101-10-23**] 07:40AM  LD(LDH)-199

MICRO: BOTH URINE AND BLOOD CULTURES WERE NEGATIVE ON [**2101-10-23**]


Brief Hospital Course:
70 yo M with recently diagnosed metastatic prostate cancer who
presents with R-sided flank pain, found with obstructing R
calculus stone, mild hydronephrosis, and ARF.

In the ED, initial vs were: T101.2 (101.9), P117, BP 124/78,
R18, O2 sat 97%. He also had rigors. He had pyuria, fever, and
with significant leukocytosis as well as marginal hypotension
requiring five liters of fluid. He also was noted to be in new
atrial flutter on ECG. After cultures were obtained he received
vancomycin and pipercillin-tazobactam and was admitted to the
MICU

Shortly after arrival to the MICU the patient went for an IR
placed percutaneous nephrostomy tube. He also had a central line
placed. He has been observed in MICU with improving symptoms.
Once he was hemodynamically stable he was sent to floor.

#Urosepsis: Pt presented with fevers, leukocytosis, and now
blood cultures are growing GPC's in chains. Presumed source is
urosepsis given dirty UA and known obstruction on right with
hydronephrosis.
-Continue Ampicillin 500 mg PO Q6hrs for 9 days. ( sensitivies,
S to amp)
-Follow drain output- Nephrostomy tube draining without any
problems
-[**Name (NI) **] is also able to void
-He is afebrile and asymptomatic by time of the discharge

.
#Acute Kidney Injury: Cr improved. Likely from prerenal insult
in the context of sepsis. Also can have post-renal etiology
since has ureteral stone, however, only on one side. Creatine
1.0 at time of discharge
.
#Metastatic prostate cancer: Patient is considering options
regarding further hormonal therapy or similar options.
--No acute management.
.
#Elevated Cardiac Enzymes: Most likely troponin elevated in
context of worsened renal function and perhaps slight demand
ischemia given tachycardia in ED. CE 0.02 x3.
.
5) New AF, ? ectopic atrial tachycardia: Patient is currently
well rate controlled. CHADS score of 1 currently so unclear
benefit from anticoagulation. Would likely need to delay until
urological interventions are completed.
-Continue ASA 325mg
-Pt could discuss warfarin w/ PCP
.
Code Status: Full
.
FEN: Regular/heart healthy diet

Medications on Admission:
Multivitamin

Discharge Medications:
1. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Ampicillin 500 mg Capsule Sig: One (1) Capsule PO every six
(6) hours for 9 days.
Disp:*36 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Urosepsis and hydronephrosis secondary to obstructive
nephrolithiasis
.
Secondary Diagnosis:
Metastatic prostate cancer status post radical prostatectomy


Discharge Condition:
Hemodynamical stable, febrile, pain free


Discharge Instructions:
You were admitted with a stone that was obstructing the outflow
of urine from your right kidney, leading to acute kidney damage
and to a serious urinary tract infection.  Initially, you were
cared for in the intensive care unit.   You were started on
antibiotics to treat the urinary tract infection based on blood
cultures that showed a bacteria called enterococcus had gotten
into your bloodstream.  A tube was inserted into your right
kidney to allow the urine to drain.  You tolerated the procedure
very well and your symptoms of infection and your kidney
function all improved.  After you were stable, a stent was
placed from your right kidney to your bladder.  This stent
should help dilate the ureter and make definitive stone
extraction easier in the future.  By the time of discharge, you
no longer had a fever and you were pain free.  You will need to
follow up with your urologist and primary care physician as
stated below.

Please take all your medications as previously prescribed.
Please also take your ampicillin for another 8 days for a total
two week course starting on [**10-19**].

You also were found an abnormal heart rhythm with fast heart
rate named atrial flutter. Most likely this was in the setting
of infection and it will not come back. Regardless, you need to
take full-dose aspirin (325 mg Daily) and follow up with your
primary care.

Please call your physician or return to the emergency room if
you develop any fevers, burning on urination, abdominal or back
pain, blood in your urine or any other concerning symptom.
.
All the rest of your medications were left unchanged.

Followup Instructions:
Please follow up with your primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
on [**2101-11-8**] at 11:00am at [**Location 82300**]
Phone number: [**Telephone/Fax (1) 337**]

Please follow up with your urologist, [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8941**], MD on
[**2101-11-22**] at 8:45am at [**Location (un) 830**] [**Hospital Ward Name 23**] Building [**Location (un) 3202**]
Phone:[**Telephone/Fax (1) 4537**]
{'Calculus of kidney,Acute kidney failure, unspecified,Streptococcal septicemia,Severe sepsis,Urinary tract infection, site not specified,Hydronephrosis,Atrial flutter,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin'}


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: Right flank pain

PRESENT ILLNESS: This is a 79 year old male with known metastatic adenocarcinoma
of the prostate with involvement of the pelvic lymph nodes as
well as history of nephrolithiasis who developed right flank
pain on [**2101-10-17**]. The pain started Monday evening. It was an
intermittent, sharp, pain, radiating down his groin. Pain
improved with hot water bottle and Tylenol. This was associated
with subjective fevers, nausea, vomiting, and anorexia but not
with any urinary symptoms like dysuria or hematuria (he has
baseline incontinence after prostatectomy earlier this year). He
also had some weakness. He contact[**Name (NI) **] his outpatient urologist
who sent him for CT scan on [**10-18**] that showed a new large stone
at the right ureteral pelvic junction w/ associated stranding
and mild right sided hydronephrosis and therefore he was sent to
the ED for evaluation.

MEDICAL HISTORY: - Metastatic adenocarcinoma of prostate involving right and left
pelvic lymphnodes, s/p open radical retropubic prostatectomy
with bilateral pelvic lymph node dissection on [**2101-9-22**]. Bone
scan on [**2101-8-3**] without evidence of metastatic bone disease.
- Extraction of ureteral calculus from upper pole on [**2101-9-22**]
- Umbilical hernia, s/p repair
- ? previous granulomatous disease with calcified nodes in lungs
and pericardium

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM
VS: T 101.6, P 74, BP 129/78, RR 20 98% on RA
Gen: Diaphoretic male in NAD
HEENT: Normocephalic, anicteric, OP benign, MMM
Neck: No masses or lymphadenopathy
CV: RRR, no M/R/G
Pulm: Expansion equal bilaterally, CTAB. No w/r/c.
Abd: Soft, NT, ND, BS+, no organomegaly or masses appreciated,
no CVA tenderness
Extrem: Warm and well perfused, wet, no C/C/E
Tubes: nephrostomy on right with blood-tinged urine. Insertion
point has no erythema or purulence

FAMILY HISTORY: FAMILY HISTORY:Non-contributory.

SOCIAL HISTORY: The patient is from Poland and immigrated to the US 

### Response:
{'Calculus of kidney,Acute kidney failure, unspecified,Streptococcal septicemia,Severe sepsis,Urinary tract infection, site not specified,Hydronephrosis,Atrial flutter,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of prostate,Long-term (current) use of aspirin'}
