CHIEF COMPLAINT: right sided abdominal pain

PRESENT ILLNESS: 80 year old male who is well-known to the
surgical service who presented on [**11-13**] with abdominal pain and
was found to have evidence of choledocholithiasis. He underwent
ERCP on [**11-14**] for delivery of stone and sphincterotomy with
stent
placement. He was discharged yesterday and was pain free until
9pm this evening. He describes sudden onset of right sided
abdominal burning that is identical in character to the pain
that
originally brought him to the hospital several days prior. He
currently denies nausea/vomiting/fevers/chills.

MEDICAL HISTORY: Degenerative arthritis right knee
gout
prostate Ca s/p XRT and Lupron
secondary gynecomastia (resolved)
CAD s/p PTCA/2 stents
glaucoma
mild hearing impairment
non-toxic goiter
hypertension
hypercholesterolemia
hiatal hernia with GERD
mild irritable bowel syndrome
history of intestinal polyps (benign)
hemorrhoids

MEDICATION ON ADMISSION: Simvastatin 20', Allopurinol 300', Lisinopril 10', Isosorbide
Mononitrate SR 120', Metoprolol 50", Acetaminophen PRN, HCTZ
12.5', Zantac 150', Prevacid 30", ASA 81'

ALLERGIES: E-Mycin

PHYSICAL EXAM: 98.7 60 165/68 16 98
General- well appearing elderly male in no acute distress
CV- RRR
Pulm- CTA b/l
Abd- soft, protuberant, moderately tender on palpation in
RUQ > epigastrium, no rebound or guarding, no palpable masses
Ext- no edema

FAMILY HISTORY: sister with lung cancer and
sister with [**Name2 (NI) 499**] cancer

SOCIAL HISTORY: lives with wife, runs a business
prior tobacco ~30pk/yrs.  quit 40yrs ago
no etoh, no ilicits
Cholangitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Cardiac complications, not elsewhere classified,Paroxysmal supraventricular tachycardia,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Irritable bowel syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Cholangitis,Cholelith w ac cholecyst,Surg compl-heart,Parox atrial tachycardia,Osteoarthros NOS-l/leg,Status-post ptca,Old myocardial infarct,Hx-prostatic malignancy,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Diaphragmatic hernia,Esophageal reflux,Irritable bowel syndrome,Abn react-surg proc NEC
Admission Date:  [**2176-11-17**]              Discharge Date:   [**2176-11-24**]

Date of Birth:  [**2096-10-24**]             Sex:   M

Service: SURGERY

Allergies:
E-Mycin

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
right sided abdominal pain

Major Surgical or Invasive Procedure:
laparoscopic cholecystectomy


History of Present Illness:
80 year old male who is well-known to the
surgical service who presented on [**11-13**] with abdominal pain and
was found to have evidence of choledocholithiasis. He underwent
ERCP on [**11-14**] for delivery of stone and sphincterotomy with
stent
placement. He was discharged yesterday and was pain free until
9pm this evening. He describes sudden onset of right sided
abdominal burning that is identical in character to the pain
that
originally brought him to the hospital several days prior. He
currently denies nausea/vomiting/fevers/chills.

Past Medical History:
Degenerative arthritis right knee
gout
prostate Ca s/p XRT and Lupron
secondary gynecomastia (resolved)
CAD s/p PTCA/2 stents
glaucoma
mild hearing impairment
non-toxic goiter
hypertension
hypercholesterolemia
hiatal hernia with GERD
mild irritable bowel syndrome
history of intestinal polyps (benign)
hemorrhoids

Past Surgical History:
glaucoma surgery
b/l cataract surgery
Inginal hernia '[**70**] (Dr. [**Last Name (STitle) **]
meniscus knee surgery


Social History:
lives with wife, runs a business
prior tobacco ~30pk/yrs.  quit 40yrs ago
no etoh, no ilicits


Family History:
sister with lung cancer and
sister with [**Name2 (NI) 499**] cancer


Physical Exam:
98.7 60 165/68 16 98
General- well appearing elderly male in no acute distress
CV- RRR
Pulm- CTA b/l
Abd- soft, protuberant, moderately tender on palpation in
RUQ > epigastrium, no rebound or guarding, no palpable masses
Ext- no edema


Pertinent Results:
[**2176-11-17**] 09:10PM   PT-11.3 PTT-29.7 INR(PT)-0.9
[**2176-11-17**] 09:20AM   ALT(SGPT)-139* AST(SGOT)-59* ALK PHOS-123*
AMYLASE-48 TOT BILI-3.0*
[**2176-11-17**] 09:20AM   LIPASE-26
[**2176-11-17**] 09:20AM   ALT(SGPT)-139* AST(SGOT)-59* ALK PHOS-123*
AMYLASE-48 TOT BILI-3.0*
[**2176-11-17**] 09:20AM   CALCIUM-8.3* PHOSPHATE-2.6* MAGNESIUM-2.1
[**2176-11-17**] 09:20AM   LIPASE-26
[**2176-11-17**] 09:20AM   WBC-5.0 RBC-4.16* HGB-13.2* HCT-38.2* MCV-92
MCH-31.7 MCHC-34.5 RDW-13.5
[**2176-11-17**] 09:20AM   WBC-5.0 RBC-4.16* HGB-13.2* HCT-38.2* MCV-92
MCH-31.7 MCHC-34.5 RDW-13.5
[**2176-11-17**] 09:20AM   PLT COUNT-133*
[**2176-11-17**] 12:30AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2176-11-17**] 12:30AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-TR BILIRUBIN-MOD UROBILNGN-2* PH-5.0 LEUK-NEG
[**2176-11-16**] 11:24PM   LACTATE-1.5
[**2176-11-16**] 11:00PM   GLUCOSE-148* UREA N-18 CREAT-0.9 SODIUM-139
POTASSIUM-3.5 CHLORIDE-103 TOTAL CO2-26 ANION GAP-14
[**2176-11-16**] 11:00PM   ALT(SGPT)-170* AST(SGOT)-71* ALK PHOS-131*
TOT BILI-4.4*
[**2176-11-16**] 11:00PM   LIPASE-65*
[**2176-11-16**] 11:00PM   NEUTS-75.9* LYMPHS-13.2* MONOS-9.0 EOS-1.6
BASOS-0.4
[**2176-11-16**] 11:00PM   PLT COUNT-125*

[**2176-11-17**] CT Abdomen: no fluid collections. b/l renal cysts, gb
distention,
wall thickening and stones are unchanged with pneumobilia seen,
likely secondary to instrumentation

[**2176-11-18**] TTE  (post op due to new onset a fib): There is
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Due to suboptimal technical quality, a
focal wall motion abnormality cannot be fully excluded. Overall
left ventricular systolic function is normal (LVEF>55%). Doppler
parameters are most consistent with normal left ventricular
diastolic function. Right ventricular chamber size and free wall
motion are normal. There are three aortic valve leaflets. The
aortic valve leaflets are moderately thickened. There is no
aortic valve stenosis. Mild (1+) aortic regurgitation is seen.
No mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.

IMPRESSION: Preserved [**Hospital1 **]-ventricular systolic function. Mild
aortic insufficiency.

[**2176-11-18**] ECG: Probable atrial fibrillation with rapid
ventricular response. Left axis deviation. Consider left
ventricular hypertrophy. ST-T wave abnormalities. Since the
previous tracing of [**2176-11-17**] atrial fibrillation is new.

[**2176-11-19**] ECG: Sinus bradycardia. P-R interval prolongation. Left
ventricular hypertrophy. ST-T wave abnormalities. Since the
previous tracing sinus bradycardia is new.

[**2176-11-19**] CXR: Stable chest findings, bilateral basal atelectasis
and mild
blunting of pleural sinuses.

[**2176-11-20**] ECG:Atrial fibrillation with rapid ventricular
response. Left axis deviation. Poor R wave progression. Left
ventricular hypertrophy with lateral ST-T wave abnormalities.
Compared to the previous tracing of [**2176-11-19**] rapid atrial
fibrillation is new. Lateral ST-T wave abnormalities are new.
Poor R wave progression is new.

[**2176-11-21**] ECG:
Atrial fibrillation with a rapid ventricular response. Left axis
deviation. Left anterior fascicular block. There is an abnormal
transition across the precordium most likely due to lead
placement with additional evidence of possible prior anterior
myocardial infarction. Left ventricular hypertrophy with
associated ST-T wave changes, although ischemia or myocardial
infarction cannot be excluded. Compared to the previous tracing
atrial fibrillation is new.


Brief Hospital Course:
[**2176-11-17**] HD1 POD0: Patient admitted to surgery, Dr. [**Last Name (STitle) **]. He
was made NPO and given IVF. He was taken to the OR for a
laparoscopic cholecystectomy. His surgery was relatively
uncomplicated with minimal blood loss, however the patient
developed afib with RVR to 180 after extubation. He was
initially given lopressor which improved his HR, and then was
started on a dilt drip as per the primary team. He was also
started on a nitro drip for HTN with good control over his BP.
He has hx of MI and CAD s/p stents in [**2165**] and is admitted to
the TSICU for ROMI and stabilization. He denied chest pain,
nausea, or SOB at that time.

[**2176-11-18**] HD2 POD1: A cariology consult was obtained. They stated
that the atrial fibrillation likely secodnary to operative
course and has now resolved. Pt has not had any recurrances of
atrial fibrillation or atrial flutter since being on telemetry.
Cardiac enzymes were negative and pt did not have any chest
pain.
Repeated short runs of SVT are likely the palpitatiosn the pt
has been having for years. It appears to be a short RP
tachycardia and possible etiologies include atrial tachycardia,
AVNRT, or circus movement tachycardia. These are not dangeours
arrhythmias and the pt has likely been having it for years as
his symptoms suggest. Cardiology recommended no anticoagulation
needed. Pt should be sent home with his beta blocker and his
[**Doctor Last Name **] of hearts monitor.  They continued to follow throughout the
hospital course. The patient was tranferred from the ICU to the
floor.  He was placed on telemetry.

[**2176-11-19**] HD3 POD2: 12 lead ECG's performed [**Hospital1 **]. Patient was
given a clear liquid diet.

[**2176-11-20**] HD4 POD3: Patient's diet was advanced to regular kosher
diet, which the patient tolerated well.

[**2176-11-21**] HD5 POD4: Patient was placed on a full bowel regiment.
A holter monited was placed on the patient per cardiology
recommendations. Lopressor, IV was used for rate control.

[**2176-11-22**] HD6 POD5: Patient had a small bowel movement with the
bowel regiment in place. Potassium was repleted. Labs were
monitored daily.

[**2176-11-23**] HD7 POD6: A 12 lead ECG was performed due to some
ectopy seen on telemetry. The patient had a large bowel
movement. Spoke to electrophysiology fellow who stated that
despite the ectopy, the patient may go home with the [**Doctor Last Name **] of
hearts monitor.

[**2176-11-24**] HD8 POD7: The [**Doctor Last Name **] of hearts monitor was placed on the
patient and he was given adequate instructions on its use as
well as relevant follow up.  The metoprolol controlled the
patients heart rate and he did not have any episodes of atrial
fibrillation since POD 1. Patient was discharged to home.


Medications on Admission:
Simvastatin 20', Allopurinol 300', Lisinopril 10', Isosorbide
Mononitrate SR 120', Metoprolol 50", Acetaminophen PRN, HCTZ
12.5', Zantac 150', Prevacid 30", ASA 81'


Discharge Medications:
1. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
2. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
3. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO three times a day as needed for constipation for 2 weeks.
Disp:*qs ML(s)* Refills:*0*
8. Dronedarone 400 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO TID (3 times a day) as needed for gas.
Disp:*12 Tablet, Chewable(s)* Refills:*2*
10. Zantac 150 mg Tablet Sig: One (1) Tablet PO once a day.
11. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
12. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain: For pain not controlled by
Acetaminophen .
Disp:*40 Tablet(s)* Refills:*0*
13. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily).
14. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO BID (2 times a
day).
15. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
16. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

17. Lopressor 50 mg Tablet Sig: 1.5 Tablets PO twice a day.
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
s/p cholecystectomy
A Fib with rapid ventricular response


Discharge Condition:
Ambulating, tolerating POs, pain controlled, afebrile and with
stable vital signs


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.  These medications include but are not
limited to: narcotics and benzodiazepines.  Use extreme caution
when combining these substances with each other, alcohol, or
other central nervous system depressants.

For your atrial fibrillation events, you have been fitted with a
[**Doctor Last Name **] of Hearts monitor to wear at home. Dr. [**Last Name (STitle) **] will be
following you for this.

For post-operative pain, please take Tylenol (Acetaminophen) as
prescribed. Note that Acetaminophen is also in many
over-the-counter medications, so check labels -- do not exceed a
daily dose of 4 grams (4,000 mgs) of Acetaminophen.

For pain that breaks thru despite Tylenol, as discussed you
should take Dilaudid as prescribed.

Take all medications as directed.

 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 [**10-10**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in [**12-29**] weeks. Call for an
appointment at ([**Telephone/Fax (1) 2300**].

Please also follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from the
electrophysiology cardiology department. ([**Telephone/Fax (1) 2037**] for an
appointment.

You will also want to follow up with your primary care doctor,
Dr. [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) 141**].



Completed by:[**2176-11-25**]
{'Cholangitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Cardiac complications, not elsewhere classified,Paroxysmal supraventricular tachycardia,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Irritable bowel syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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 sided abdominal pain

PRESENT ILLNESS: 80 year old male who is well-known to the
surgical service who presented on [**11-13**] with abdominal pain and
was found to have evidence of choledocholithiasis. He underwent
ERCP on [**11-14**] for delivery of stone and sphincterotomy with
stent
placement. He was discharged yesterday and was pain free until
9pm this evening. He describes sudden onset of right sided
abdominal burning that is identical in character to the pain
that
originally brought him to the hospital several days prior. He
currently denies nausea/vomiting/fevers/chills.

MEDICAL HISTORY: Degenerative arthritis right knee
gout
prostate Ca s/p XRT and Lupron
secondary gynecomastia (resolved)
CAD s/p PTCA/2 stents
glaucoma
mild hearing impairment
non-toxic goiter
hypertension
hypercholesterolemia
hiatal hernia with GERD
mild irritable bowel syndrome
history of intestinal polyps (benign)
hemorrhoids

MEDICATION ON ADMISSION: Simvastatin 20', Allopurinol 300', Lisinopril 10', Isosorbide
Mononitrate SR 120', Metoprolol 50", Acetaminophen PRN, HCTZ
12.5', Zantac 150', Prevacid 30", ASA 81'

ALLERGIES: E-Mycin

PHYSICAL EXAM: 98.7 60 165/68 16 98
General- well appearing elderly male in no acute distress
CV- RRR
Pulm- CTA b/l
Abd- soft, protuberant, moderately tender on palpation in
RUQ > epigastrium, no rebound or guarding, no palpable masses
Ext- no edema

FAMILY HISTORY: sister with lung cancer and
sister with [**Name2 (NI) 499**] cancer

SOCIAL HISTORY: lives with wife, runs a business
prior tobacco ~30pk/yrs.  quit 40yrs ago
no etoh, no ilicits 

### Response:
{'Cholangitis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Cardiac complications, not elsewhere classified,Paroxysmal supraventricular tachycardia,Osteoarthrosis, unspecified whether generalized or localized, lower leg,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Irritable bowel syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
