CHIEF COMPLAINT: Abdominal Pain
Nausea and vomitting

PRESENT ILLNESS: This is a 25 year old female transferred from [**Hospital3 **]
for acute pancreatitis and nausea and vomiting. She presented to
the ED on [**2146-1-17**] with sudden onset of severe epigastric pain and
vomiting (several episodes of non-bloody,non-bilious). She
denied HA, CP, SOB, dizziness, changes in bowel or bladder
habits. At the OSH, she had a CT scan that was consitent with
moderate pancreatitis, without evidence of ductal dilation or
necrosis. A RUQ US showed no evidence of biliary
obstruction/sludge/stones. She developed acute mentl status
changes on the afternoon of [**2146-1-20**], possibly related to EtOH
withdrawl. She was then transferred here.

MEDICAL HISTORY: Ankle injury - takes Tylenol with codeine PRN

MEDICATION ON ADMISSION: OCP, tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.7, 127, 153/59, 31, 96% 2L
Gen: NAD
Neuro: A+O x 3
HEENT: PEERL, EOMI intact
CV: reg rhythm, tachy
Chest: CTA bilat
Abd: mod distended, TTP, min BS
Ext: WWP without C,C,E. +2 DP bilat.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Rare tobacco
1 glass wine daily
Acute pancreatitis,Hypovolemia,Thrombocytopenia, unspecified,Unspecified essential hypertension,Alcohol abuse, unspecified,Tachycardia, unspecified
Acute pancreatitis,Hypovolemia,Thrombocytopenia NOS,Hypertension NOS,Alcohol abuse-unspec,Tachycardia NOS
Admission Date:  [**2146-1-21**]              Discharge Date:   [**2146-2-7**]

Date of Birth:  [**2120-2-26**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Abdominal Pain
Nausea and vomitting

Major Surgical or Invasive Procedure:
PICC


History of Present Illness:
This is a 25 year old female transferred from [**Hospital3 **]
for acute pancreatitis and nausea and vomiting. She presented to
the ED on [**2146-1-17**] with sudden onset of severe epigastric pain and
vomiting (several episodes of non-bloody,non-bilious). She
denied HA, CP, SOB, dizziness, changes in bowel or bladder
habits. At the OSH, she had a CT scan that was consitent with
moderate pancreatitis, without evidence of ductal dilation or
necrosis. A RUQ US showed no evidence of biliary
obstruction/sludge/stones. She developed acute mentl status
changes on the afternoon of [**2146-1-20**], possibly related to EtOH
withdrawl. She was then transferred here.

Past Medical History:
Ankle injury - takes Tylenol with codeine PRN

Social History:
Rare tobacco
1 glass wine daily

Family History:
Unknown

Physical Exam:
VS: 99.7, 127, 153/59, 31, 96% 2L
Gen: NAD
Neuro: A+O x 3
HEENT: PEERL, EOMI intact
CV: reg rhythm, tachy
Chest: CTA bilat
Abd: mod distended, TTP, min BS
Ext: WWP without C,C,E. +2 DP bilat.

Pertinent Results:
[**2146-1-21**] 01:25AM BLOOD WBC-9.8 RBC-3.40* Hgb-11.1* Hct-32.9*
MCV-97 MCH-32.7* MCHC-33.7 RDW-13.9 Plt Ct-88*
[**2146-1-25**] 05:10AM BLOOD WBC-28.4*# RBC-3.31* Hgb-10.7* Hct-31.9*
MCV-96 MCH-32.2* MCHC-33.4 RDW-14.5 Plt Ct-366#
[**2146-1-31**] 04:00PM BLOOD WBC-21.5* RBC-3.13* Hgb-9.8* Hct-29.6*
MCV-95 MCH-31.2 MCHC-33.0 RDW-14.4 Plt Ct-620*
[**2146-2-1**] 06:15AM BLOOD WBC-25.8* RBC-3.42* Hgb-10.5* Hct-32.7*
MCV-96 MCH-30.6 MCHC-32.0 RDW-14.4 Plt Ct-866*
[**2146-1-31**] 04:00PM BLOOD Glucose-89 UreaN-11 Creat-0.6 Na-133
K-4.5 Cl-96 HCO3-26 AnGap-16
[**2146-1-21**] 01:25AM BLOOD ALT-20 AST-32 AlkPhos-45 Amylase-90
TotBili-0.6
[**2146-2-1**] 06:15AM BLOOD ALT-36 AST-49* AlkPhos-96 Amylase-35
TotBili-0.4
[**2146-1-21**] 01:25AM BLOOD Lipase-118*
[**2146-1-27**] 11:43AM BLOOD Lipase-132*
[**2146-2-1**] 06:15AM BLOOD Lipase-93*
[**2146-1-21**] 01:25AM BLOOD Albumin-2.8* Calcium-7.6* Phos-1.9*
Mg-1.9 Iron-8*
[**2146-2-1**] 06:15AM BLOOD Albumin-3.3* Calcium-9.5 Phos-5.1* Mg-2.3
[**2146-1-31**] 04:00PM BLOOD calTIBC-183* Ferritn-942* TRF-141*

CT HEAD W/O CONTRAST  [**2146-1-21**] 3:07 PM

[**Hospital 93**] MEDICAL CONDITION:
25 year old woman with confusion
REASON FOR THIS EXAMINATION:
unremarkable.

IMPRESSION: No acute intracranial pathology, including no sign
of intracranial hemorrhage. Please note if high suspicion for
intracranial mass, CT examination is not sensitive and an MRI
would be recommended.
.
CHEST (PA & LAT)  [**2146-1-25**] 10:29 AM

INDICATION: 25-year-old female with pancreatitis and left
pleural effusion. ? pneumonia.

IMPRESSION:
1. Unchanged moderate left-sided pleural effusion.
2. Left lower lobe consolidation, most likely representing
atelectasis.
3. Small right-sided subpulmonic pleural effusion.
.
CHEST (PORTABLE AP)  [**2146-1-27**] 9:11 AM
[**Hospital 93**] MEDICAL CONDITION:
25 year old woman with pancreatitis, fevers, room air sat 87%
REASON FOR THIS EXAMINATION:
Interval change. Assess for effusion/PNA?

IMPRESSION: AP chest compared to [**2146-1-25**]:

There has been no recent interval change. Moderate left pleural
effusion and large area of consolidation at the base of the left
lung and a smaller region of consolidation on the right medially
are unchanged. Small right pleural effusion may also be present.
Upper lungs are clear. The heart is normal size. Tip of the left
PIC catheter projects over the mid SVC. No pneumothorax.

[**2146-2-6**] 05:47AM BLOOD WBC-13.8* RBC-3.08* Hgb-9.5* Hct-29.4*
MCV-95 MCH-30.7 MCHC-32.2 RDW-14.3 Plt Ct-705*
[**2146-2-6**] 05:47AM BLOOD Glucose-88 UreaN-16 Creat-0.7 Na-138
K-4.8 Cl-103 HCO3-24 AnGap-16
[**2146-2-6**] 05:47AM BLOOD ALT-31 AST-27 AlkPhos-67 Amylase-31
TotBili-0.2
[**2146-2-6**] 05:47AM BLOOD Lipase-78*
[**2146-2-6**] 05:47AM BLOOD Calcium-9.2 Phos-5.6* Mg-2.1
IGG SUBCLASSES 1,2,3,4
  Test                          Result              Reference
Range/Units
IGG 1                         [**Telephone/Fax (1) 70863**] MG/DL
IGG 2                         181                 35-477 MG/DL
IGG 3                         46                  15-135 MG/DL
IGG 4                         36                  4-158 MG/DL
IGG                           648  L              [**Telephone/Fax (1) **] MG/DL




Brief Hospital Course:
She was admitted to the ICU with pancreatitis. She was made NPO,
with IVF.

CV: She was tachycardic to the 130's and hypertensive in the
150's. She was hemodynamically stable. She was treated with
several boluses of fluid for hypovolemia and also placed on
Lopressor. She continued with Lopressor and her HR was WNL.

Resp: A CXR revealed left pleural effusion. Slight improvement
in right infrahilar consolidation. There was a question of
possible pneumonia as a source of her high fevers. She received
Levofloxacin for 3 days until a repeat CXR showed no evidence of
pneumonia. Her lungs cleared over the next few days.

Pancreatitis: She had moderate to severe pancreatitis and
experiencing lots of pain. She had no stone disease by U/S. Her
Lipase was as high as 143 and then decreased to 78 at time of
discharge. The other enzymes were WNL. She had a slow recovery
and was treated conservatively.

Fever + elevated WBC: She had fevers for several days, as high
as 103, and a WBC as high as 28,000. These persisted for several
days. All blood, stool, and urine cultures were negative. She
was treated with Tylenol. This was all likely due to the
pancreatitis. She was not treated with antibiotics, but instead
let the pancreatitis run its course and slowly she recovered.

FEN: She was NPO. a PICC line was placed and she was started on
TPN. She continued on TPN until [**2146-2-4**]. Her PO diet was slowly
advanced, starting with sips on [**2146-2-3**] and advanced to a
regular diet. She did not have a rise in her enzymes and so
continue to take a diet.

Pain: She was having lots of abdominal pain on admission. She
was treated with IV Dilaudid. A PCA Dilaudid was started and she
continued to need high doses of pain medications. A Pain Consult
was obtained and she received Tylenol, Ibuprofen, Amitriptyline.

Anxiety: She was very anxious on admission. She was placed on a
CIWA scale and received Ativan per the scale for possible EtOH
withdrawl. A Head CT was performed and showed No acute
intracranial pathology, including no sign of intracranial
hemorrhage. She reportedly had mental status changes at the OSH
prior to transfer to [**Hospital1 18**]. She received Valium for anxiety and
this was then switched to Ativan.

Pancreatology Consult: Dr. [**Last Name (STitle) 174**] saw and examined this patient.
Fevers were likely related to cytokine mediated inflammation.
Other differential included: increased triglycerides, CFTR
mutation mediated, autoimmune pancreatitis, sphincter of oddi
dysfunction. She will follow-up with Dr. [**Last Name (STitle) 174**] in [**8-26**] weeks.


Medications on Admission:
OCP, tylenol prn

Discharge Medications:
1. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for 2 weeks.
2. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain and fever.
Disp:*qs Tablet(s)* Refills:*0*
4. Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for pain and insomnia for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
5. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed for 1 months.
Disp:*75 Tablet(s)* Refills:*0*
6. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Pancreatitis
Fevers
Tachycardia


Discharge Condition:
Good


Discharge Instructions:
* Increasing pain
* Fever (>101.5 F)
* Inability to eat or persistent vomiting
* Inability to pass gas or stool
* Increasing shortness of breath
* Chest pain
.
Please resume all of your regular medications and take any new
meds as ordered.
.
Continue to ambulate several times per day.
.
You should avoid all alcohol consumption.


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 70864**] (GI - [**Hospital1 **]
Gastroenterology) in [**2-19**] weeks. Call ([**Telephone/Fax (1) 70865**] to schedule
an appointment.
Please follow-up with your PCP [**Last Name (NamePattern4) **] 2 weeks. You were started on
Lopressor for your HR. Discuss whether this needs to be
continued.
Please follow-up with Dr. [**Last Name (STitle) 174**] (Pancreatologist) in 8 weeks.
Call ([**Telephone/Fax (1) 22346**] to schedule an appointment.



Completed by:[**2146-2-7**]
{'Acute pancreatitis,Hypovolemia,Thrombocytopenia, unspecified,Unspecified essential hypertension,Alcohol abuse, unspecified,Tachycardia, 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: Abdominal Pain
Nausea and vomitting

PRESENT ILLNESS: This is a 25 year old female transferred from [**Hospital3 **]
for acute pancreatitis and nausea and vomiting. She presented to
the ED on [**2146-1-17**] with sudden onset of severe epigastric pain and
vomiting (several episodes of non-bloody,non-bilious). She
denied HA, CP, SOB, dizziness, changes in bowel or bladder
habits. At the OSH, she had a CT scan that was consitent with
moderate pancreatitis, without evidence of ductal dilation or
necrosis. A RUQ US showed no evidence of biliary
obstruction/sludge/stones. She developed acute mentl status
changes on the afternoon of [**2146-1-20**], possibly related to EtOH
withdrawl. She was then transferred here.

MEDICAL HISTORY: Ankle injury - takes Tylenol with codeine PRN

MEDICATION ON ADMISSION: OCP, tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 99.7, 127, 153/59, 31, 96% 2L
Gen: NAD
Neuro: A+O x 3
HEENT: PEERL, EOMI intact
CV: reg rhythm, tachy
Chest: CTA bilat
Abd: mod distended, TTP, min BS
Ext: WWP without C,C,E. +2 DP bilat.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Rare tobacco
1 glass wine daily 

### Response:
{'Acute pancreatitis,Hypovolemia,Thrombocytopenia, unspecified,Unspecified essential hypertension,Alcohol abuse, unspecified,Tachycardia, unspecified'}
