CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 24F s/p gastric bypass (roux-en-Y) in [**7-2**] c/b PE and UGIB with
IVC fliter placement, presents with 3 days of progressive
worsening abdominal pain.  The pain was most severe last night,
when the patient became nauseous and lightheaded, and almost
passed out.  She had no LOC, vomiting, F/C/D.  In the ED,
underwent EGD that showed evidence of ulceration with overlying
clot at the gastrojejunostomy site, with surrounding erythema,
friability, and few erosions.  The area was injected with 5cc of
epinephrine and electrocaudery was applied.  She had several
tarry BMs in the ED, had a Hct drop to 24, and was transfused
PRBCs.
*
Of note, the patient was previously hospitalized in [**3-3**] for
acute abdominal pain, with EGD that showed para-anastomotic
ulceration and concern that residual gastric antrum was
remaining from the bypass.  She was followed medically, which
required high doses of narcotics.

MEDICAL HISTORY: Gastric bypass--c/b PE and UGIB, IVC filter placed
     Asthma
     Back pain
     Obesity
     Fibroadenoma
     Peri-rectal abscess

MEDICATION ON ADMISSION: Advair diskus, Albuterol INH, Ferrous Sulfate, Axert, Loratidane

ALLERGIES: Keflex / Augmentin

PHYSICAL EXAM: V: T 97.7   BP 110/64   HR 78    R 18
*
PE: G: Obese female, resting in NAD, AAOx3
    HEENT: MMM
    Lungs: CTA, BL BS, No W/R/C
    CV: RRR, S1S2, No M/R/G
    Abd: Soft, tender to deep palpation, no rebound/guarding, BS
active
    Ext: No E/C/C   Pulses palable throughout

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Ms. [**Known lastname 6633**] has a 2 year-old daughter who is
currently staying with her mother.  She denies any alcohol or
drug use.  She is on disability.  She use to a [**Company 22795**].
She reports that she denies any smoking, although D/C summary
from past admission notes that she was going outside to smoke
during the admission.
Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified
Chr marginal ulcer w hem,Oth spcf cmplc procd NEC,Abn react-anastom/graft,Asthma NOS
Admission Date:  [**2148-11-17**]              Discharge Date:   [**2148-11-21**]

Date of Birth:  [**2124-11-2**]             Sex:   F

Service: MEDICINE

Allergies:
Keflex / Augmentin

Attending:[**First Name3 (LF) 1865**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
24F s/p gastric bypass (roux-en-Y) in [**7-2**] c/b PE and UGIB with
IVC fliter placement, presents with 3 days of progressive
worsening abdominal pain.  The pain was most severe last night,
when the patient became nauseous and lightheaded, and almost
passed out.  She had no LOC, vomiting, F/C/D.  In the ED,
underwent EGD that showed evidence of ulceration with overlying
clot at the gastrojejunostomy site, with surrounding erythema,
friability, and few erosions.  The area was injected with 5cc of
epinephrine and electrocaudery was applied.  She had several
tarry BMs in the ED, had a Hct drop to 24, and was transfused
PRBCs.
*
Of note, the patient was previously hospitalized in [**3-3**] for
acute abdominal pain, with EGD that showed para-anastomotic
ulceration and concern that residual gastric antrum was
remaining from the bypass.  She was followed medically, which
required high doses of narcotics.


Past Medical History:
Gastric bypass--c/b PE and UGIB, IVC filter placed
     Asthma
     Back pain
     Obesity
     Fibroadenoma
     Peri-rectal abscess


Social History:
Ms. [**Known lastname 6633**] has a 2 year-old daughter who is
currently staying with her mother.  She denies any alcohol or
drug use.  She is on disability.  She use to a [**Company 22795**].
She reports that she denies any smoking, although D/C summary
from past admission notes that she was going outside to smoke
during the admission.


Family History:
Noncontributory.

Physical Exam:
V: T 97.7   BP 110/64   HR 78    R 18
*
PE: G: Obese female, resting in NAD, AAOx3
    HEENT: MMM
    Lungs: CTA, BL BS, No W/R/C
    CV: RRR, S1S2, No M/R/G
    Abd: Soft, tender to deep palpation, no rebound/guarding, BS
active
    Ext: No E/C/C   Pulses palable throughout


Pertinent Results:
Admission labs:
[**2148-11-17**] 07:00AM BLOOD WBC-8.3 RBC-3.73* Hgb-9.2* Hct-28.9*
MCV-77* MCH-24.8* MCHC-32.0 RDW-15.6* Plt Ct-354
[**2148-11-17**] 07:00AM BLOOD Neuts-51.0 Lymphs-40.6 Monos-4.5 Eos-3.5
Baso-0.4
[**2148-11-17**] 07:00AM BLOOD Hypochr-2+ Microcy-2+
[**2148-11-17**] 07:00AM BLOOD Plt Ct-354
[**2148-11-17**] 02:50PM BLOOD PT-14.1* PTT-30.2 INR(PT)-1.3
[**2148-11-17**] 07:00AM BLOOD Glucose-101 UreaN-27* Creat-0.5 Na-137
K-5.4* Cl-104 HCO3-26 AnGap-12
[**2148-11-17**] 07:00AM BLOOD ALT-10 AST-29 AlkPhos-57 Amylase-55
TotBili-0.5
[**2148-11-17**] 07:00AM BLOOD Lipase-22
[**2148-11-18**] 10:40AM BLOOD Calcium-8.4 Phos-4.0 Mg-1.8

CT A/P ([**11-17**]): No evidence of obstruction or leak. The extruded
stomach is distended and fluid filled, which is an abnormal
finding in this post-operative patient.

Discharge labs:

[**2148-11-21**] 05:10AM BLOOD WBC-6.4 RBC-3.74* Hgb-9.9* Hct-30.0*
MCV-80* MCH-26.6* MCHC-33.1 RDW-16.1* Plt Ct-259
[**2148-11-21**] 05:10AM BLOOD Plt Ct-259
[**2148-11-20**] 05:20AM BLOOD Glucose-75 UreaN-5* Creat-0.4 Na-141
K-4.0 Cl-107 HCO3-25 AnGap-13
[**2148-11-20**] 05:20AM BLOOD Calcium-8.4 Phos-4.1 Mg-2.0

Brief Hospital Course:
1. GI bleed: Pt admitted to floor, started on IVFs, protonix,
with close Hct monitoring.  On the floor, she had a large BM and
BRBPR that was concerning for rebleeding.  Her Hct was not
appropriately increasing following transfusions, and she was
evaluated for possible MICU transfer.  During this time, she was
followed by surgery, who did not intervene, and GI, who felt
that the bleed was likely from para-anastamotic ulcers, and took
her to the endoscopy lab for EGD. She spent 1 night in the MICU
for observation, and was then transferred back to the floor.
Her Hct was stable following, and her abdominal exam was benign
throughout the admission.  GI ultimately decided to have pt go
out on [**Hospital1 **] protonix and sucralfate, with trial of ursodiol and
encouraged to stop smoking.  Per GI, she may ultimately a
surgical revision.

2. Pain control: Felt to have a possible element of anxiety.
She was given morphine, as well as oxycodone and oxycontin
throughout.

3. Anxiety: Persistent insomnia unrelieved with ambien or
ativan.

4. Hx of PE: No events. Placed on pneumoboots.


Medications on Admission:
Advair diskus, Albuterol INH, Ferrous Sulfate, Axert, Loratidane


Discharge Medications:
1. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
3. Fexofenadine HCl 60 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for allergy symptoms.
4. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Morphine Sulfate 15 mg Tablet Sig: 1-2 Tablets PO Q4-6H
(every 4 to 6 hours) as needed for pain.
Disp:*112 Tablet(s)* Refills:*0*
7. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
GI bleed


Discharge Condition:
Stable

Discharge Instructions:
If any blood in stool, dark or black stools, severe abdominal
pain, lightheadedness, or loss of consciousness,  go to the
Emergency room.

Followup Instructions:
Follow up with Dr. [**First Name4 (NamePattern1) 12589**] [**Last Name (NamePattern1) 12590**] or with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**] in [**2-1**]
weeks (Call [**Telephone/Fax (1) 1954**] for appt)
Follow up with primary care clinic in 2 weeks, re-check Hct at
that time.
Please re-contact your [**Hospital6 13753**] surgeon about
re-evaluation.
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, 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

PRESENT ILLNESS: 24F s/p gastric bypass (roux-en-Y) in [**7-2**] c/b PE and UGIB with
IVC fliter placement, presents with 3 days of progressive
worsening abdominal pain.  The pain was most severe last night,
when the patient became nauseous and lightheaded, and almost
passed out.  She had no LOC, vomiting, F/C/D.  In the ED,
underwent EGD that showed evidence of ulceration with overlying
clot at the gastrojejunostomy site, with surrounding erythema,
friability, and few erosions.  The area was injected with 5cc of
epinephrine and electrocaudery was applied.  She had several
tarry BMs in the ED, had a Hct drop to 24, and was transfused
PRBCs.
*
Of note, the patient was previously hospitalized in [**3-3**] for
acute abdominal pain, with EGD that showed para-anastomotic
ulceration and concern that residual gastric antrum was
remaining from the bypass.  She was followed medically, which
required high doses of narcotics.

MEDICAL HISTORY: Gastric bypass--c/b PE and UGIB, IVC filter placed
     Asthma
     Back pain
     Obesity
     Fibroadenoma
     Peri-rectal abscess

MEDICATION ON ADMISSION: Advair diskus, Albuterol INH, Ferrous Sulfate, Axert, Loratidane

ALLERGIES: Keflex / Augmentin

PHYSICAL EXAM: V: T 97.7   BP 110/64   HR 78    R 18
*
PE: G: Obese female, resting in NAD, AAOx3
    HEENT: MMM
    Lungs: CTA, BL BS, No W/R/C
    CV: RRR, S1S2, No M/R/G
    Abd: Soft, tender to deep palpation, no rebound/guarding, BS
active
    Ext: No E/C/C   Pulses palable throughout

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Ms. [**Known lastname 6633**] has a 2 year-old daughter who is
currently staying with her mother.  She denies any alcohol or
drug use.  She is on disability.  She use to a [**Company 22795**].
She reports that she denies any smoking, although D/C summary
from past admission notes that she was going outside to smoke
during the admission. 

### Response:
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other specified complications of procedures not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Asthma, unspecified type, unspecified'}
