CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Ms. [**Known lastname 60245**] is a [**Age over 90 **] year-old woman with HTN, HLD, s/p multiple
surgeries who presented from [**Location (un) 5481**] [**Hospital3 **]
facility c/o nausea, vomiting and diarrhea on [**2109-2-8**].
Patient reported one day with symptoms including several
episodes of non-bloody, non-bilious vomiting and non-bloody
diarrhea promting presentation to [**Hospital **] hospital.

MEDICAL HISTORY: Past Medical History:
SBO s/p ex-lap with LoA in [**11/2103**]
Pancreatitis s/p ERCP and sphincterotomy
H/O diarrhea / constipation
Diverticulosis and abscess
Hypertension.
Hypercholesterolemia.
Hypothyroidism.
gallstone pancreatitis

MEDICATION ON ADMISSION: Tylenol 650mg Q4H
Aspirin 81mg daily
Aricept 5mg QHS
Trusopt 1gtt OD [**Hospital1 **]
Xalatan 0.005% OD QHS
Timolol 0.25% 1gtt [**Hospital1 **]
Robitussin 200mg Q4H
Levofloxacin 250mg IV daily
Namenda 10mg daily
Reglan 10mg IV Q8H PRN
Zofran 4mg IV Q6H PRN
Simvastatin 40mg QHS

ALLERGIES: Tetanus / Cipro

PHYSICAL EXAM: General: A&Ox3, pleasant and cooperative
HEENT: OP clear, MMM
Neck: JVP 8cm, no carotid bruits
Lungs: symmetric breath sounds; no wheezes/rales/ronchi
CV: regular rate/rhythm, nl s1s2, no murmurs
Abd: TTP throughout with invoulantary guarding and rebound
tenderness, nondistended, decreased BS
Extr: no edema, 2+ PT pulses
Neuro: A&O x3, CN 2-12 intact

FAMILY HISTORY: Her kids are healthy.
Her mother passed away at the age of  65.
Her Dad passed away at the age of 82 from heart disease.
Brother lived until the age of 91 and another brother is 91 and
is alive.

SOCIAL HISTORY: She lives alone but currently in [**Hospital1 1501**]. She has two children. She
smoked one pack per day for 20 years, having quit 40 years ago.
Alcohol, she has one drink a night. No intravenous drug use.
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified coagulation defects,Thrombocytopenia, unspecified,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance,Other specified pruritic conditions,Dermatitis due to drugs and medicines taken internally,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Diarrhea,Urinary incontinence, unspecified,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified glaucoma,Other postprocedural status
Intestinal adhes w obstr,Coagulat defect NEC/NOS,Thrombocytopenia NOS,Hypertension NOS,Demen NOS w/o behv dstrb,Pruritic conditions NEC,Drug dermatitis NOS,Adv eff antinfct NEC/NOS,Diarrhea,Urinary incontinence NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Glaucoma NOS,Post-proc states NEC
Name:  [**Known lastname **],[**Known firstname **]                  Unit No:   [**Numeric Identifier 18128**]

Admission Date:  [**2109-2-9**]              Discharge Date:   [**2109-2-14**]

Date of Birth:  [**2017-9-11**]             Sex:   F

Service: MEDICINE

Allergies:
Tetanus / Cipro

Attending:[**Last Name (un) 18129**]
Addendum:
When the patient was transferred from [**Hospital 322**] Hospital, sepsis
was suspected, but ruled out later.

Discharge Disposition:
Extended Care

Facility:
Commons Residence At Orchard - [**Location (un) 271**] (a.k.a. [**Location (un) 1267**])

                             [**Last Name (un) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 18130**]

Completed by:[**2109-4-4**]

Admission Date:  [**2109-2-9**]              Discharge Date:   [**2109-2-14**]


Service: MEDICINE

Allergies:
Tetanus / Cipro

Attending:[**Last Name (un) 32349**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 60245**] is a [**Age over 90 **] year-old woman with HTN, HLD, s/p multiple
surgeries who presented from [**Location (un) 5481**] [**Hospital3 **]
facility c/o nausea, vomiting and diarrhea on [**2109-2-8**].
Patient reported one day with symptoms including several
episodes of non-bloody, non-bilious vomiting and non-bloody
diarrhea promting presentation to [**Hospital **] hospital.

On arrival to [**Hospital **] Hospital vitals were 98.0 96 101/52 16
96%RA. Labs were notable for WBC 13K and K 3.1. She was admitted
with a presumtive diagosis of gastroenteritis and was given IVF.
She was admitted to the medical floor where stool studies for C.
Diff and blood cultures were obtained and remained NGTD until
the time of transfer. An episode of increased RLQ pain prompted
CT abdomen that dientified a partial small-bowel obstruction
with ?transition point in the mid to distal ileum and sigmoid
diverticulosis with-out evidence of diverticulitis. General
surgery consult was obtained and advised IV levaquin and flagyl
in addition to NGT placement. Subsequent WBC was 24K and lactate
was 2.2. The decision was then made to transfer the patient to
the [**Hospital1 18**] MICU. Vitals on transfer were 99.0 90 96/58 20 95% on
RA.

On arrival to the [**Hospital1 18**] MICU vitals are 95.9 82 97/49 18 92%.
Patient appears comfortable and without additional complaint.

Past Medical History:
Past Medical History:
SBO s/p ex-lap with LoA in [**11/2103**]
Pancreatitis s/p ERCP and sphincterotomy
H/O diarrhea / constipation
Diverticulosis and abscess
Hypertension.
Hypercholesterolemia.
Hypothyroidism.
gallstone pancreatitis

Past Surgical History
s/p hysterectomy
s/p cholecystectomy
s/p hemicolectomy
s/p surigcal repair of anal stricture and hemorrhoidectomy
s/p ex-lap

Social History:
She lives alone but currently in [**Hospital1 1501**]. She has two children. She
smoked one pack per day for 20 years, having quit 40 years ago.
Alcohol, she has one drink a night. No intravenous drug use.


Family History:
Her kids are healthy.
Her mother passed away at the age of  65.
Her Dad passed away at the age of 82 from heart disease.
Brother lived until the age of 91 and another brother is 91 and
is alive.


Physical Exam:
General: A&Ox3, pleasant and cooperative
HEENT: OP clear, MMM
Neck: JVP 8cm, no carotid bruits
Lungs: symmetric breath sounds; no wheezes/rales/ronchi
CV: regular rate/rhythm, nl s1s2, no murmurs
Abd: TTP throughout with invoulantary guarding and rebound
tenderness, nondistended, decreased BS
Extr: no edema, 2+ PT pulses
Neuro: A&O x3, CN 2-12 intact


Pertinent Results:
Admission labs
[**2109-2-10**] 02:05AM BLOOD WBC-33.5*# RBC-3.74* Hgb-10.5* Hct-31.6*
MCV-84 MCH-28.1 MCHC-33.3 RDW-13.2 Plt Ct-87*#
[**2109-2-10**] 02:05AM BLOOD Neuts-52 Bands-22* Lymphs-1* Monos-22*
Eos-0 Baso-0 Atyps-0 Metas-3* Myelos-0
[**2109-2-10**] 02:05AM BLOOD PT-16.4* PTT-31.6 INR(PT)-1.5*
[**2109-2-10**] 02:05AM BLOOD Glucose-115* UreaN-21* Creat-1.0 Na-136
K-4.8 Cl-107 HCO3-19* AnGap-15
[**2109-2-10**] 02:05AM BLOOD ALT-17 AST-23 TotBili-0.4
[**2109-2-10**] 02:05AM BLOOD Albumin-3.2* Calcium-8.2* Phos-2.7 Mg-1.7
[**2109-2-10**] 02:54AM BLOOD Lactate-1.9

CT Abdomen and Pelvis [**2109-2-9**]:  Outside Hospital
Partial small bowel obstruction with possible transition in the
mid to distal ileum. Evidence of mild anasarca with mild diffuse
mesenteric fat stranding and small bilateral pleural effusions,
and small pelvic free fluid. Sigmoid diverticulosis without
evidence of diverticulitis.

Final Report
CHEST RADIOGRAPH

TECHNIQUE: Portable AP semi-erect chest view was read in
comparison with
prior chest radiograph from [**2109-2-10**].

FINDINGS: Orogastric tube tip terminates approximately at the
level of the
clavicles. Whether this is positioned within the esophagus or is
within the
airway is difficult to determine based on the single view.
Consider
repositioning the orogastric tube. There are no lung opacities
concerning for
pneumonia. Heart size, mediastinal and hilar contours are
normal. Mild
atherosclerotic calcification is present in the aortic arch.
Findings related
to the orogastric tube was discussed by [**Doctor Last Name **] with [**Doctor First Name **] on
[**2109-2-11**]
at 10:27 p.m.

The study and the report were reviewed by the staff radiologist.


DR. [**First Name8 (NamePattern2) 16988**] [**Name (STitle) 16989**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: TUE [**2109-2-12**] 2:14 PM

Final Report
PORTABLE ABDOMEN

INDICATION: Abdominal pain and leukocytosis, shortness of
breath.

COMPARISON: [**2104-1-6**].

FINDINGS: Status post cholecystectomy. According clips in situ.
No free
air, no pathological calcifications. Nasogastric tube with side
port
approximately 4-5 cm distal to the gastroesophageal junction.
The tip
projects over the middle parts of the stomach. Normal
distribution of
intestinal gas. No intestinal distention. No evidence of wall
thickening, no
air-fluid levels.

Extensive degenerative spine disease.

DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: SUN [**2109-2-10**] 8:58 AM

Microbiology:
Cultures from [**Hospital **] Hospital [**2109-2-8**]: NGTD as of [**2109-2-13**]

Cdiff from [**Hospital **] Hospital negative

[**2109-2-10**] URINE URINE CULTURE-FINAL INPATIENT
[**2109-2-10**] BLOOD CULTURE Blood Culture, Routine-PENDING
INPATIENT
[**2109-2-10**] BLOOD CULTURE Blood Culture, Routine-PENDING
INPATIENT


Brief Hospital Course:
Patient is a [**Age over 90 **] year-old woman with HTN, HLD, s/p multiple
surgeries and history of SOB requiring ExLap who was transferd
from [**Hospital **] Hospital with partial SBO and marked leucocytosis.
.
#. Small bowel obstruction: Patient has had mulitple admissions
for SBO, most recently in [**2103**] requiring exploratory laparotomy
with adhesionolysis now admitted with abdoinal pain, with n/v/d
and leucocytosis. Blood cultures showed no growth at [**Location (un) **] and
were no growth (from [**2-10**])here at the time of discharge. She
had diffuse TTP with rebound and guarding on admission exam.
Patient was started on levaquin and flagyl at OSH and was
continued on these medications. She was seen by the surgical
service who recommended that she undergo surgery for complete
small bowel obstruction. Both the patient and her family
declined surgery and her goals of care were transitioned to
focus on comfort while in the ICU. She was called out of the ICU
on [**2-10**] and her clinical status including exam, laboratory
data, improved from [**Date range (1) 110716**]. After discussion with her
family and the patient, the decision was made to transition to
conservative management for her SBO and IV antibiotics were
restarted.  She was changed from Cipro/Flagyl to
Ceftriaxone/Flagyl due to itching and rash which developed up
her arm with Cipro. NGT pulled night of [**2-11**] since it had been
displaced. She started having BMs on [**2-11**] to the point of [**Month/Year (2) **]
diarrhea [**2-12**] with some formed stools. C. diff was negative and
diarrhea improved by the morning of [**2-4**]. Her diet was advanced
which she tolerated well. Antibiotics were discontinued prior to
discharge.
.
# Hypertension: Home lisinopril was initially stopped and then
restarted.
.
Non-active issues:
# hypothyroidism: continued home synthroid
.
# HLD: held home simvastatin and asa until better able to
tolerate full diet.  These medications were restarted on
discharge.
.
# dementia: restarted home donezepil, holding namenda for now as
non-formulary. This medication was restarted on discharge.
.
# Code: DNR/DNI (confirmed with patient). Discussed what she
would want if SBO were to recur and plan would be to come to the
hospital to get confortable with likely transition to comfort
care (possible home hospice)
.
# Communication: Patient, daughter [**Name (NI) 717**] [**Telephone/Fax (1) 110717**] cell;
home: [**Telephone/Fax (1) 110718**]; son: [**Telephone/Fax (1) 110719**]
.
TRANSITIONAL ISSUES
- blood cultures were pending at the time of discharge

Medications on Admission:
Tylenol 650mg Q4H
Aspirin 81mg daily
Aricept 5mg QHS
Trusopt 1gtt OD [**Hospital1 **]
Xalatan 0.005% OD QHS
Timolol 0.25% 1gtt [**Hospital1 **]
Robitussin 200mg Q4H
Levofloxacin 250mg IV daily
Namenda 10mg daily
Reglan 10mg IV Q8H PRN
Zofran 4mg IV Q6H PRN
Simvastatin 40mg QHS

Discharge Disposition:
Extended Care

Facility:
Commons Residence At Orchard - [**Location (un) 2624**] (a.k.a. [**Location (un) 5481**])

Discharge Diagnosis:
Primary:
Small bowel obstruction


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to [**Hospital1 69**]
because of an obstruction in your small bowel. While you were
here, you were initially in the intensive care unit. You and
your family made the decision to NOT have surgery and proceed
with conservative management which included initial bowel rest
and nasogastric tube to suction.

Your bowel function improved.

While you were here, some of your medications were changed.
You should START:
- Sarna lotion as needed for itching
- Chloraseptic Throat Spray as needed for throat pain

You should continue to take all other medications as instructed.
Please feel free to call with any questions or concerns.

Followup Instructions:
After leaving the skilled nursing facility you should follow-up
with your primary care doctor within 1 week.

Department: [**Hospital3 1935**] CENTER
When: MONDAY [**2109-5-27**] at 2:00 PM
With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified coagulation defects,Thrombocytopenia, unspecified,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance,Other specified pruritic conditions,Dermatitis due to drugs and medicines taken internally,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Diarrhea,Urinary incontinence, unspecified,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified glaucoma,Other postprocedural 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: Ms. [**Known lastname 60245**] is a [**Age over 90 **] year-old woman with HTN, HLD, s/p multiple
surgeries who presented from [**Location (un) 5481**] [**Hospital3 **]
facility c/o nausea, vomiting and diarrhea on [**2109-2-8**].
Patient reported one day with symptoms including several
episodes of non-bloody, non-bilious vomiting and non-bloody
diarrhea promting presentation to [**Hospital **] hospital.

MEDICAL HISTORY: Past Medical History:
SBO s/p ex-lap with LoA in [**11/2103**]
Pancreatitis s/p ERCP and sphincterotomy
H/O diarrhea / constipation
Diverticulosis and abscess
Hypertension.
Hypercholesterolemia.
Hypothyroidism.
gallstone pancreatitis

MEDICATION ON ADMISSION: Tylenol 650mg Q4H
Aspirin 81mg daily
Aricept 5mg QHS
Trusopt 1gtt OD [**Hospital1 **]
Xalatan 0.005% OD QHS
Timolol 0.25% 1gtt [**Hospital1 **]
Robitussin 200mg Q4H
Levofloxacin 250mg IV daily
Namenda 10mg daily
Reglan 10mg IV Q8H PRN
Zofran 4mg IV Q6H PRN
Simvastatin 40mg QHS

ALLERGIES: Tetanus / Cipro

PHYSICAL EXAM: General: A&Ox3, pleasant and cooperative
HEENT: OP clear, MMM
Neck: JVP 8cm, no carotid bruits
Lungs: symmetric breath sounds; no wheezes/rales/ronchi
CV: regular rate/rhythm, nl s1s2, no murmurs
Abd: TTP throughout with invoulantary guarding and rebound
tenderness, nondistended, decreased BS
Extr: no edema, 2+ PT pulses
Neuro: A&O x3, CN 2-12 intact

FAMILY HISTORY: Her kids are healthy.
Her mother passed away at the age of  65.
Her Dad passed away at the age of 82 from heart disease.
Brother lived until the age of 91 and another brother is 91 and
is alive.

SOCIAL HISTORY: She lives alone but currently in [**Hospital1 1501**]. She has two children. She
smoked one pack per day for 20 years, having quit 40 years ago.
Alcohol, she has one drink a night. No intravenous drug use. 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified coagulation defects,Thrombocytopenia, unspecified,Unspecified essential hypertension,Dementia, unspecified, without behavioral disturbance,Other specified pruritic conditions,Dermatitis due to drugs and medicines taken internally,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Diarrhea,Urinary incontinence, unspecified,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified glaucoma,Other postprocedural status'}
