CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85-year-old
female with a 24-hour history of abdominal pain that started
the day prior to admission.  The patient also complained of
urgency to defecate and nausea.  The patient had emesis x 2
the night prior to admission.  She felt lightheaded and had
increasing abdominal pain.  She was taken to [**Hospital **] Hospital
where she was hypotensive at the time.  She was admitted to
the unit.  A femoral line was placed and volume resuscitation
was initiated.  She continued to have worsening abdominal
pain this morning.

MEDICAL HISTORY: 1. Coronary artery disease.  2. Atrial
pacer.  3. Primary pulmonary hypertension.  4. Ischemic heart
disease.  5. Atrial fibrillation.  6. Hypertension.  7. Gout.
8. Myocardial infarction.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute vascular insufficiency of intestine,Atrial fibrillation,Primary pulmonary hypertension,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction,Gout, unspecified
Ac vasc insuff intestine,Atrial fibrillation,Prim pulm hypertension,Acidosis,Crnry athrscl natve vssl,Hypertension NOS,Old myocardial infarct,Gout NOS
Admission Date:  [**2120-6-18**]       Discharge Date:  [**2120-6-26**]


Service:  Green Surgery

HISTORY OF PRESENT ILLNESS:  The patient is an 85-year-old
female with a 24-hour history of abdominal pain that started
the day prior to admission.  The patient also complained of
urgency to defecate and nausea.  The patient had emesis x 2
the night prior to admission.  She felt lightheaded and had
increasing abdominal pain.  She was taken to [**Hospital **] Hospital
where she was hypotensive at the time.  She was admitted to
the unit.  A femoral line was placed and volume resuscitation
was initiated.  She continued to have worsening abdominal
pain this morning.

PAST MEDICAL HISTORY:  1. Coronary artery disease.  2. Atrial
pacer.  3. Primary pulmonary hypertension.  4. Ischemic heart
disease.  5. Atrial fibrillation.  6. Hypertension.  7. Gout.
8. Myocardial infarction.

PAST SURGICAL HISTORY:  Open cholecystectomy.

MEDICATIONS AT HOME:  1. Amiodarone 200 b.i.d.  2. Lopressor
25 b.i.d.  3. Protonix 40 q.d.  4. Nitroglycerin patch 0.2
p.r.n.  5. Plavix 75 q.d.  6. Aspirin q.d.  7. Digoxin 0.125
q.o.d.

ALLERGIES:  Codeine causes hallucinations.

PHYSICAL EXAMINATION:  Vital signs were temperature 95.3,
heart rate 79, blood pressure 94/41, respiratory rate 18, 96%
on two liters nasal cannula.  She was on a Neo-Synephrine
drip.  Her cardiovascular examination showed a paced rhythm
with no murmurs, gallops, or rubs.  Her lung examination was
clear to auscultation bilaterally.  On abdominal examination
the patient was distended with decreased bowel sounds.  She
was tender in the lower left lateral abdomen with mild tenderness
in the right lower and left upper quadrants.  She exhibited
voluntary guarding of the left lower quadrant.  There was no
rebound tenderness.  On rectal examination there were no
masses and she was guaiac positive.  Her extremity
examination showed no evidence of cyanosis, clubbing or
edema.

LABORATORY DATA:  White blood cell count was 15 with 34%
bands, creatinine 1.6, amylase in the 600s, lipase 15.  CAT
scan from yesterday showed a contained perforation and mild
thickening of the descending colon with stranding of the
mesentery.

HOSPITAL COURSE:  The patient was taken to the operating room
on [**2120-6-18**] emergently with a preoperative diagnosis of
ischemic left colon.  While in the operating room the patient
had a left hemicolectomy, a Hartmann pouch and end ileostomy.
Details of the procedure can be found in the operative note. She
had complete transmural necrosis of the proximal left decending
colon with obvious perforation or peritonitis.  The SMA pulse was
strong.  The presumed etiology was an embolis with ischemia vs.
a low flow state (less likely given strong SMA pulse).
While in the operating room the patient's blood pressure
dropped initially.  The patient was treated with increasing
IV fluids, Neo-Synephrine drip and was transfused two units
of packed red blood cells.  In addition, the calcium and
bicarbonate were repleted for lactic acidosis.  The patient
was transferred to the surgical intensive care unit
postoperatively intubated and on a Neo-Synephrine drip.
Vital signs were stable when transferred to the surgical
intensive care unit.

While the patient was in the surgical intensive care unit,
the patient was heparinized for presumed embolic event.  A
transesophageal echocardiogram was performed to evaluate for
cardiac source of embolus.  No thrombus was seen, however the
echocardiogram was positive for a right-to-left shunt at rest
with the bubble study, consistent with a stretched patent
foramen ovale.  While in the surgical intensive care unit the
patient continued to be intubated until mobilizing her
fluids.

On postoperative day number three in the surgical intensive
care unit, it was attempted to extubate the patient, but the
patient started to desaturate to the 80s and so the patient
was placed back on the ventilator.  She was given Lasix with
good diuresis and staff was able to extubate the patient in
the afternoon post diuresis.  The patient was weaned to O2 by
nasal cannula at four liters when her oxygen saturations were
greater than 95% with no shortness of breath and her arterial
blood gas was within normal limits.

On postoperative day five the patient was tolerating clear
liquids without any nausea or vomiting.  Her intake was
greater than 400 cc p.o. that day.  Her colostomy stoma was
pink with small round brown ischemic areas on the outer
aspect.  Her ostomy was producing stool and the ostomy nurse
replaced the appliance.  The patient continued to be
monitored in the surgical intensive care unit.  Her heparin
drip was titrated accordingly.  The patient continued to be
hemodynamically stable and on postoperative day six the
patient was transferred to the floor.

While on the floor the patient continued to tolerate p.o.
without difficulty.  Her ostomy stoma was pink, viable and
showed good output.  Her abdominal examination continued to
be soft and nontender.  Anticoagulation was continued as the
patient was started on Coumadin.  Heparin was discontinued
when the INR was greater than 2.0.  The patient's diet was
advanced.  She would continue to tolerate a regular diet
without difficulty.  Physical therapy was consulted and
recommended aggressive physical therapy and rehabilitation
placement.  The patient was discharged on postoperative day
11 with an INR of 2.0 and her last dose of Coumadin prior to
discharge was 0.5 mg on that day.  The patient's pain was
well controlled and the patient had been out of bed with
physical therapy help.

Arrangements were made by the case manager for the patient to
go to rehabilitation at [**Hospital6 25759**] and
Rehabilitation Center in [**Location (un) **].

CONDITION ON DISCHARGE:  Good, stable.

DISCHARGE STATUS:  To rehabilitation at [**Hospital6 25759**]
and Rehabilitation Center in [**Location (un) **], [**State 350**].

DISCHARGE DIAGNOSES:
1. Ischemic left colon probable cause thromboembolism, status
post exploratory laparotomy, left hemicolectomy, Hartmann
pouch, and end ileostomy.
2. Coronary artery disease.
3. Atrial pacing.
4. Primary pulmonary hypertension.
5. Ischemic heart disease.
6. Atrial fibrillation.
7. Hypertension.
8. Gout.
9. Myocardial infarction.

DISCHARGE MEDICATIONS:
1. Ostomy care.
2. Amiodarone 200 mg q.d.
3. Famotidine 20 mg b.i.d.
4. Metoprolol tartrate 50 mg b.i.d.
5. Digoxin 125 mcg q.d.
6. Coumadin 0.5 mg q.d.
7. Outpatient laboratory work for Coumadin dosing.

DISPOSITION:  The patient is to go to rehabilitation and then
to follow up with Dr. [**Last Name (STitle) **] in one to two weeks for staple
removal and follow up.  Dr.[**Name (NI) 6218**] number is included in
the discharge summary.





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 28129**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 28130**]
MEDQUIST36

D:  [**2120-6-27**]  10:01
T:  [**2120-6-27**]  10:24
JOB#:  [**Job Number 28131**]
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Primary pulmonary hypertension,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction,Gout, 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: 

PRESENT ILLNESS: The patient is an 85-year-old
female with a 24-hour history of abdominal pain that started
the day prior to admission.  The patient also complained of
urgency to defecate and nausea.  The patient had emesis x 2
the night prior to admission.  She felt lightheaded and had
increasing abdominal pain.  She was taken to [**Hospital **] Hospital
where she was hypotensive at the time.  She was admitted to
the unit.  A femoral line was placed and volume resuscitation
was initiated.  She continued to have worsening abdominal
pain this morning.

MEDICAL HISTORY: 1. Coronary artery disease.  2. Atrial
pacer.  3. Primary pulmonary hypertension.  4. Ischemic heart
disease.  5. Atrial fibrillation.  6. Hypertension.  7. Gout.
8. Myocardial infarction.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine causes hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute vascular insufficiency of intestine,Atrial fibrillation,Primary pulmonary hypertension,Acidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Old myocardial infarction,Gout, unspecified'}
