CHIEF COMPLAINT: Chief Complaint: elective lap chole for symptomatic
cholelithiasis
Reason for MICU admissioN: persisting post op hypotension

PRESENT ILLNESS: 42F with history of depression, cholelithiasis, presenting to
[**Hospital1 18**] for elective lap chole, now admit to [**Hospital Unit Name 153**] for persistent
post op hypotension.
.
She reports being in her usual state of health prior to planned
lap chole. She notes two years of intermittent abdominal pain
often occurring after food intake. Had a recent abdominal
ultrasound which showed gallstones and was thus scheduled for
lap cholecystectomy.
.
She had an unremarkable operative course today. Came out of PACU
about 945 am. Initial SBPs > 120. She was later noted to have
BPs in 60s systolic. Symptomatic with lightheadedness and ?of
syncope. For her hypotension she received boluses of
phenylephrine and 6 liters LR. She had transient improvement in
BPs with these interventions but ultimately required start of
phenylephrine gtt up to 0.5, now off. Given her prolonged
hypotension she had an abdominal US and ultimately an abdominal
CT which was initially read as small amount of simple fluid, but
was later reread as concern for intraabdominal hematoma, ~8cm.
She was admitted to the [**Hospital Unit Name 153**] for continued monitoring of BPs.

MEDICAL HISTORY: - Depression
- obesity
- Cholelithiasis
- Hyperlipidemia
- s/p laparoscopic supracervical hysterectomy

MEDICATION ON ADMISSION: - Bupropion PO 150mg [**Hospital1 **]
- Fluoxetine PO 20mg TID
- Lamotrigine PO 25mg QD
- VitD PO uncertain dosage weekly
- Oxycodone - acetaminophen PO 5mg-325mg 1-2 tabs Q4-6H PRN pain

ALLERGIES: Morphine

PHYSICAL EXAM: General: Alert, oriented, no distress.
HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear
Neck: supple, JVD difficult to appreciate.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Borderline tachy, normal S1 + S2, no murmurs, rubs, gallops,
slightly distant.
Abdomen: Obese. Hypoactive bowel sounds. soft, mildly distended.
TTP at midline laparoscopy sites, most in epigastric site
followed by low anterior site; other port sites nontender. no
rebound tenderness or guarding, no organomegaly.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema.
Neuro: grossly intact.

FAMILY HISTORY: Breast cancer and diabetes in various family members; mother
also had CAD. Mother had ?[**Name2 (NI) 11011**].

SOCIAL HISTORY: Lives with husband and daughter, also has other children. Denies
smoking and EtOH. Not currently working
Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Pure hypercholesterolemia,Hypoxemia,Depressive disorder, not elsewhere classified
Cholelith w cholecys NEC,Hemorrhage complic proc,Ac posthemorrhag anemia,Pure hypercholesterolem,Hypoxemia,Depressive disorder NEC
Admission Date:  [**2160-1-28**]              Discharge Date:   [**2160-2-1**]

Date of Birth:  [**2117-8-26**]             Sex:   F

Service: SURGERY

Allergies:
Morphine

Attending:[**Doctor First Name 5188**]
Chief Complaint:
Chief Complaint: elective lap chole for symptomatic
cholelithiasis
Reason for MICU admissioN: persisting post op hypotension


Major Surgical or Invasive Procedure:
Lap Chole
Ex lap

History of Present Illness:
42F with history of depression, cholelithiasis, presenting to
[**Hospital1 18**] for elective lap chole, now admit to [**Hospital Unit Name 153**] for persistent
post op hypotension.
.
She reports being in her usual state of health prior to planned
lap chole. She notes two years of intermittent abdominal pain
often occurring after food intake. Had a recent abdominal
ultrasound which showed gallstones and was thus scheduled for
lap cholecystectomy.
.
She had an unremarkable operative course today. Came out of PACU
about 945 am. Initial SBPs > 120. She was later noted to have
BPs in 60s systolic. Symptomatic with lightheadedness and ?of
syncope. For her hypotension she received boluses of
phenylephrine and 6 liters LR. She had transient improvement in
BPs with these interventions but ultimately required start of
phenylephrine gtt up to 0.5, now off. Given her prolonged
hypotension she had an abdominal US and ultimately an abdominal
CT which was initially read as small amount of simple fluid, but
was later reread as concern for intraabdominal hematoma, ~8cm.
She was admitted to the [**Hospital Unit Name 153**] for continued monitoring of BPs.

Review of sytems:
(+) Per HPI. Daughter reports URI symptoms in family members
over last week. Patient endorses recent cough.
(-) Denies recent fever, headache, shortness of breath. Denied
chest pain or tightness, palpitations. Denied diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.


Past Medical History:
- Depression
- obesity
- Cholelithiasis
- Hyperlipidemia
- s/p laparoscopic supracervical hysterectomy


Social History:
Lives with husband and daughter, also has other children. Denies
smoking and EtOH. Not currently working

Family History:
Breast cancer and diabetes in various family members; mother
also had CAD. Mother had ?[**Name2 (NI) 11011**].

Physical Exam:
General: Alert, oriented, no distress.
HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear
Neck: supple, JVD difficult to appreciate.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Borderline tachy, normal S1 + S2, no murmurs, rubs, gallops,
slightly distant.
Abdomen: Obese. Hypoactive bowel sounds. soft, mildly distended.
TTP at midline laparoscopy sites, most in epigastric site
followed by low anterior site; other port sites nontender. no
rebound tenderness or guarding, no organomegaly.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema.
Neuro: grossly intact.


Pertinent Results:
[**2160-1-30**] 04:53AM BLOOD WBC-11.9* RBC-2.77*# Hgb-8.4*# Hct-24.2*
MCV-87 MCH-30.3 MCHC-34.7 RDW-14.8 Plt Ct-210
[**2160-1-28**] 01:16PM BLOOD Hct-30.5*#
[**2160-1-29**] 12:23AM BLOOD PT-11.7 PTT-19.0* INR(PT)-1.0
[**2160-1-28**] 02:41PM BLOOD Glucose-126* UreaN-17 Creat-0.8 Na-140
K-4.1 Cl-103 HCO3-26 AnGap-15
[**2160-1-28**] 02:41PM BLOOD CK(CPK)-66
[**2160-1-28**] 08:44PM BLOOD CK(CPK)-80
[**2160-1-29**] 05:21AM BLOOD CK(CPK)-78
[**2160-1-28**] 02:41PM BLOOD CK-MB-2 cTropnT-<0.01
[**2160-1-28**] 08:44PM BLOOD CK-MB-3 cTropnT-<0.01
[**2160-1-29**] 05:21AM BLOOD CK-MB-2 cTropnT-<0.01
[**2160-1-29**] 05:21AM BLOOD Calcium-7.8* Phos-3.4 Mg-2.3
[**2160-1-30**] 12:49PM BLOOD Type-ART pO2-61* pCO2-39 pH-7.44
calTCO2-27 Base XS-1
[**2160-1-28**] 06:45PM BLOOD Glucose-147* Lactate-3.7* Na-136 K-4.7
Cl-101 calHCO3-27
[**2160-1-28**] 06:45PM BLOOD Hgb-8.9* calcHCT-27
[**2160-1-28**] 06:45PM BLOOD freeCa-1.15

CT ABDOMEN/PELVIS [**2160-1-28**]:
1. S/p cholecystectomy. Hematoma adjacent to the surgical bed
and in the left upper quadrant. Moderate amount of free fluid in
the abdomen and pelvis. Consider repeat CT with IV contrast if
concern for active bleeding.
2. Bibasilar lung opacities may represent aspiration,
atelectasis or
infection.

ABDOMINAL U/S [**2160-1-28**]:
IMPRESSION: Trace perihepatic fluid. Small slightly complex
fluid collection above the bladder with possible layering debris
or blood. CT may be obtained if patient is stable enough and
clinically indicated.

CXR AP [**2160-1-28**]:
FINDINGS: Lung volumes are low. Cardiomediastinal contours are
within normal limits allowing for this factor. New patchy and
linear bibasilar opacities are suggestive of atelectasis in the
post-operative setting, but a co-existing aspiration is also
possible. No free intraperitoneal air is identified.

CXR AP [**2160-1-30**]:
1. S/p cholecystectomy. Hematoma adjacent to the surgical bed
and in the left upper quadrant. Moderate amount of free fluid in
the abdomen and pelvis. Consider repeat CT with IV contrast if
concern for active bleeding.
2. Bibasilar lung opacities may represent aspiration,
atelectasis or
infection.


Brief Hospital Course:
42F with depression, biliary colic, now admitted to [**Hospital Unit Name 25503**]#0
from lap chole with hypotension, hematocrit drop, and evidence
of intraabdominal hematoma.
.
# Hypotension. Most likely secondary to bleed from lap chole.
Was weaned off pressors quickly upon arrival to the [**Hospital Unit Name 153**] and
remained hemodynamically stable. HCT dropped to 20 and pt
initially refusing blood transfusions after long discussions
citing concern for infection transmission. Eventually accepted
transfusion in the AM and went to OR which found hematoma
perihepatic, and had 1-1.5L of blood drained. Gallbladder fossa
with oozing and this was cauterized. The pt returned to the
floor and remained hemodynamically stable. HCT stabilized and pt
was called out to surgical floor.
.
# Fever/leukocytosis: Had post-op fever and leukocytosis thought
to be [**1-8**] operative stress, inflammation. CXR unremarkable,
blood and urine cultures with no growth to date.

Patient arrived in the surgical floor, she was hemodynamically
stable, great urinary out up. However she has history of
migraine and she was symptomatic on the floor so she did not
ambulate at all and felt dizzy.

We restarted her migraine medications.
Patient did well, ambulation with out assistance.
For pain control we gave her Percocet which gave her pruritus,
pain medication was changed to Dilaudid with good effect.

Patient was discharge and we will see her in Dr. [**Last Name (STitle) 5182**]
office in 4 days.

Medications on Admission:
- Bupropion PO 150mg [**Hospital1 **]
- Fluoxetine PO 20mg TID
- Lamotrigine PO 25mg QD
- VitD PO uncertain dosage weekly
- Oxycodone - acetaminophen PO 5mg-325mg 1-2 tabs Q4-6H PRN pain

- Colace PO 100mg [**Hospital1 **] PRN constipation from percocet.


Discharge Medications:
1. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain for 7 days.
Disp:*65 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation for 7 days: Use while taking percocet.
Disp:*14 Capsule(s)* Refills:*1*
3. Bupropion HCl 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO once a day.
4. Fluoxetine 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. Lamotrigine 25 mg Tablet Sig: One (1) Tablet PO once a day.
6. Vitamin D  Oral


Discharge Disposition:
Home

Discharge Diagnosis:
1. Biliary colic
2. Postoperative bleeding following laparoscopic cholecystectomy
3. Need for reoperation


Discharge Condition:
stable; mental status intact, independently ambulatory


Discharge Instructions:
Please call Dr.[**Name (NI) 6045**] office or return to the ED if you
experience fevers, chills, nausea, vomiting, lightheadedness,
drainage or redness from the incision sites, chest pain,
shortness of breath, or severe abdominal pain.

You may remove the outer dressings on your incisions.  Leave the
steri-strips (small white adhesive strips) in place and they
will fall off on their own.

You may shower and bathe, and you may resume your usual level of
activity.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. SURGICAL SPECIALTIES CC-3 (NHB)
Phone:[**Telephone/Fax (1) 274**] Date/Time:[**2160-2-5**] 1:30
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2160-3-12**]
10:45
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2160-5-19**] 9:15


                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]

Completed by:[**2160-2-7**]
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Pure hypercholesterolemia,Hypoxemia,Depressive disorder, not elsewhere classified'}


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: Chief Complaint: elective lap chole for symptomatic
cholelithiasis
Reason for MICU admissioN: persisting post op hypotension

PRESENT ILLNESS: 42F with history of depression, cholelithiasis, presenting to
[**Hospital1 18**] for elective lap chole, now admit to [**Hospital Unit Name 153**] for persistent
post op hypotension.
.
She reports being in her usual state of health prior to planned
lap chole. She notes two years of intermittent abdominal pain
often occurring after food intake. Had a recent abdominal
ultrasound which showed gallstones and was thus scheduled for
lap cholecystectomy.
.
She had an unremarkable operative course today. Came out of PACU
about 945 am. Initial SBPs > 120. She was later noted to have
BPs in 60s systolic. Symptomatic with lightheadedness and ?of
syncope. For her hypotension she received boluses of
phenylephrine and 6 liters LR. She had transient improvement in
BPs with these interventions but ultimately required start of
phenylephrine gtt up to 0.5, now off. Given her prolonged
hypotension she had an abdominal US and ultimately an abdominal
CT which was initially read as small amount of simple fluid, but
was later reread as concern for intraabdominal hematoma, ~8cm.
She was admitted to the [**Hospital Unit Name 153**] for continued monitoring of BPs.

MEDICAL HISTORY: - Depression
- obesity
- Cholelithiasis
- Hyperlipidemia
- s/p laparoscopic supracervical hysterectomy

MEDICATION ON ADMISSION: - Bupropion PO 150mg [**Hospital1 **]
- Fluoxetine PO 20mg TID
- Lamotrigine PO 25mg QD
- VitD PO uncertain dosage weekly
- Oxycodone - acetaminophen PO 5mg-325mg 1-2 tabs Q4-6H PRN pain

ALLERGIES: Morphine

PHYSICAL EXAM: General: Alert, oriented, no distress.
HEENT: Sclera anicteric, PERRL, MMM, oropharynx clear
Neck: supple, JVD difficult to appreciate.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Borderline tachy, normal S1 + S2, no murmurs, rubs, gallops,
slightly distant.
Abdomen: Obese. Hypoactive bowel sounds. soft, mildly distended.
TTP at midline laparoscopy sites, most in epigastric site
followed by low anterior site; other port sites nontender. no
rebound tenderness or guarding, no organomegaly.
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema.
Neuro: grossly intact.

FAMILY HISTORY: Breast cancer and diabetes in various family members; mother
also had CAD. Mother had ?[**Name2 (NI) 11011**].

SOCIAL HISTORY: Lives with husband and daughter, also has other children. Denies
smoking and EtOH. Not currently working 

### Response:
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Pure hypercholesterolemia,Hypoxemia,Depressive disorder, not elsewhere classified'}
