CHIEF COMPLAINT: Transfer from OSH for gallstone pancreatitis

PRESENT ILLNESS: 83 year-old male with a history of ischemic cardiomyopathy (EF
10-20%), s/p mechanical AVR on coumadin [**2152**], s/p biventricular
ICD, HTN, HL, thrombocytosis, s/p CCY in the [**2162**] who
transferred from [**Hospital6 33**] with gallstone
pancreatitis. The patient states that 2 days prior to admission
he developed 5 episodes of soft, semi-formed, dark brown bowel
movements. He then developed epigastric abdominal pain without
radiation. The pain was rated [**5-11**], constant "irritating" pain
that was worse with movement. He denied worsening with food. He
stated he felt warm on occasions and some chills, but no fevers.
He also had some nausea, but no vomiting. He presented to [**Hospital **] ED today. At the OSH labs were remarkable for a lipase in
the 6566 and CT that showed gallstone pancreatitis. He was given
IVF at 150cc/hr, morphine & zofran and transferred to [**Hospital1 18**] for
further management. His INR was 2.5.

MEDICAL HISTORY: Mechanical Aortic Valve on coumadin since [**2152**]
Ischemic Cardiomyopathy (EF 10-20%)
BiVentricular ICD [**2177**]
Atrial Fibrllation
HTN/Hyperlipid
Thrombocytosis on hydroxyurea
BPH
s/p Cholecystectomy [**2162**]

MEDICATION ON ADMISSION: Coumadin 2.5mg daily
Hydroxyurea 500mg daily
ASA 81mg daily
Carvedilol 3.125 [**Hospital1 **]
Finasteride 5mg daily
Fluticasone 2 sprays daily
Folic Acid 1mg daily
Lasix 40mg daily
Lisinopril 20mg daily
Loratadine 10mg daily
Simvastatin 40mg qhs
Tamulosin 0.4mg daily
Albuterol/Ipratropium 2 puff q4:prn
.

ALLERGIES: Oxycodone

PHYSICAL EXAM: Vitals: 97.1 68 95/64 16 98%
GEN: non-toxic appearing, comfortable, no acute distress
HEENT: EOMI, PERRL, sclera mild icterus, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, mechanical heart sounds, III/VI SEM normal S1 S2
PULM: slight crackles at the bases, but otherwise clear
ABD: Soft, + epigastric tenderness, no RUQ pain -[**Doctor Last Name 515**] sign.
NT, ND, +BS,
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: Brother and daughter with DM
Father with HTN

SOCIAL HISTORY: He is a retired postal worker, widow and lives alone in a Senior
Center. He has one daughter. Performs all his ADLs. 1ppd x 15yrs
and quit at age 30. 2 drinks per week. No IVDU
Other and unspecified hyperlipidemia,Diarrhea,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cyst of kidney, acquired,Fitting and adjustment of automatic implantable cardiac defibrillator,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acute pancreatitis,Acute on chronic systolic heart failure,Obstruction of bile duct,Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Hyperosmolality and/or hypernatremia,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Other specified forms of chronic ischemic heart disease,Essential thrombocythemia,Unspecified essential hypertension,Atrial fibrillation
Hyperlipidemia NEC/NOS,Diarrhea,BPH w/o urinary obs/LUTS,Cyst of kidney, acquired,Ftng autmtc dfibrillator,Abn react-surg proc NEC,Heart valve replac NEC,Long-term use anticoagul,Acute pancreatitis,Ac on chr syst hrt fail,Obstruction of bile duct,Hemorrhage complic proc,Acute kidney failure NOS,Urin tract infection NOS,Ac posthemorrhag anemia,Hyperosmolality,Choledocholithiasis NOS,Chr ischemic hrt dis NEC,Essntial thrombocythemia,Hypertension NOS,Atrial fibrillation
Admission Date:  [**2180-12-8**]              Discharge Date:   [**2180-12-21**]

Date of Birth:  [**2097-6-8**]             Sex:   M

Service: MEDICINE

Allergies:
Oxycodone

Attending:[**First Name3 (LF) 7299**]
Chief Complaint:
Transfer from OSH for gallstone pancreatitis

Major Surgical or Invasive Procedure:
ERCP with CBD dilatation, balloon extraction of a small stone,
and sphincterotomy on [**2180-12-11**].


History of Present Illness:
83 year-old male with a history of ischemic cardiomyopathy (EF
10-20%), s/p mechanical AVR on coumadin [**2152**], s/p biventricular
ICD, HTN, HL, thrombocytosis, s/p CCY in the [**2162**] who
transferred from [**Hospital6 33**] with gallstone
pancreatitis. The patient states that 2 days prior to admission
he developed 5 episodes of soft, semi-formed, dark brown bowel
movements. He then developed epigastric abdominal pain without
radiation. The pain was rated [**5-11**], constant "irritating" pain
that was worse with movement. He denied worsening with food. He
stated he felt warm on occasions and some chills, but no fevers.
He also had some nausea, but no vomiting. He presented to [**Hospital **] ED today. At the OSH labs were remarkable for a lipase in
the 6566 and CT that showed gallstone pancreatitis. He was given
IVF at 150cc/hr, morphine & zofran and transferred to [**Hospital1 18**] for
further management. His INR was 2.5.

In the ED, 97.1 68 95/64 16 98%. The patient's labs were
significant for lipase of 2688, TBili 2.8 with otherwise normal
LFT. His Hct was 33.1, WBC 9.9 with normal differential and
lactate of 1.2.  He was empirically covered with Zosyn in the
ED. His creatinine was 1.3 on arrival. The OSH CT abd/pelvis was
re-read and showed a 6mm x 8mm calcified stone at the ampulla of
Vater resulting in dilation of the intra & extrahepatic ducts
and pancreatic duct. There was also a 24mm cystic lesion of the
uncinate process of the pancreas as well as a 8mm lesion in the
proximal body. He was given morphine & zofran for his pain and
nausea. He was given 1L IVF in the ED. ERCP was contact[**Name (NI) **] and
plan for ERCP when INR is 1.5 unless develops signs of
cholangitis at which point they would take him emergently.

Past Medical History:
Mechanical Aortic Valve on coumadin since [**2152**]
Ischemic Cardiomyopathy (EF 10-20%)
BiVentricular ICD [**2177**]
Atrial Fibrllation
HTN/Hyperlipid
Thrombocytosis on hydroxyurea
BPH
s/p Cholecystectomy [**2162**]


Social History:
He is a retired postal worker, widow and lives alone in a Senior
Center. He has one daughter. Performs all his ADLs. 1ppd x 15yrs
and quit at age 30. 2 drinks per week. No IVDU


Family History:
Brother and daughter with DM
Father with HTN


Physical Exam:
Vitals: 97.1 68 95/64 16 98%
GEN: non-toxic appearing, comfortable, no acute distress
HEENT: EOMI, PERRL, sclera mild icterus, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, mechanical heart sounds, III/VI SEM normal S1 S2
PULM: slight crackles at the bases, but otherwise clear
ABD: Soft, + epigastric tenderness, no RUQ pain -[**Doctor Last Name 515**] sign.
NT, ND, +BS,
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.



Pertinent Results:
.
Radiology
CT ABD & PELVIS WITH CONTRAST Study Date of [**2180-12-8**] 8:09 AM
IMPRESSION: 1. 8-mm stone in the ampulla of Vater with dilation
of the common bile duct and both pancreatic ducts, suggestive of
obstruction at the ampulla of Vater. 2. Multiple pancreatic
cysts, which given size should be evaluated with follow-up
ultrasound in 6 months. 3. Splenomegaly 4. Right 2.3-cm
parapelvic renal cyst which could be further evaluated with
ultrasound if it has not been evaluated previously. 5. Right
bladder diverticula. 6. Colonic diverticulosis without evidence
for inflammation.
.
ERCP Impression:
Cannulation of the biliary duct was performed with a
sphincterotome using a free-hand technique
A moderate diffuse dilation was seen at the biliary tree with
the CBD measuring 14 mm.
There was a filling defect in the distal CBD.
A sphincterotomy was performed in the 12 o'clock position using
a sphincterotome over an existing guidewire.
A small stone was extracted with a balloon catheter.
Excellent drainage of bile and contrast was noted

[**2180-12-8**] 07:10AM BLOOD WBC-9.9 RBC-4.19* Hgb-10.7* Hct-33.1*
MCV-79* MCH-25.6* MCHC-32.4 RDW-17.6* Plt Ct-365
[**2180-12-18**] 07:15AM BLOOD WBC-10.4 RBC-3.06* Hgb-7.9* Hct-24.5*
MCV-80* MCH-25.7* MCHC-32.2 RDW-18.8* Plt Ct-399
[**2180-12-21**] 08:05AM BLOOD WBC-7.7 RBC-3.05* Hgb-8.0* Hct-24.7*
MCV-81* MCH-26.2* MCHC-32.4 RDW-18.1* Plt Ct-432
[**2180-12-21**] 08:05AM BLOOD PT-22.2* PTT-34.8 INR(PT)-2.1*
[**2180-12-20**] 07:35AM BLOOD Glucose-94 UreaN-23* Creat-1.6* Na-137
K-3.3 Cl-102 HCO3-27 AnGap-11
[**2180-12-17**] 07:10AM BLOOD ALT-49* AST-47* AlkPhos-183* TotBili-2.6*
[**2180-12-20**] 07:35AM BLOOD ALT-26 AST-23 AlkPhos-122 TotBili-1.9*
[**2180-12-8**] 07:10AM BLOOD Lipase-2688*
[**2180-12-15**] 06:55AM BLOOD Lipase-76*
[**2180-12-8**] 07:10AM BLOOD Albumin-4.0 Iron-29*
[**2180-12-8**] 07:10AM BLOOD calTIBC-343 Hapto-99 Ferritn-81 TRF-264
[**2180-12-21**] 04:52PM BLOOD Hgb-8.8* calcHCT-26

Brief Hospital Course:
Mr. [**Known lastname 65584**] was admitted with gallstone pancreatitis and was
treated with IV antibiotics and bowel rest while his INR came
down over 48hrs.  He was taken for ERCP with stone extraction &
sphincterotomy on [**12-11**]. 24 hours after his procedure he was
restarted on anticoagulation given his mechanical aortic valve
and his post-procedure course was complicated by a slow GI bleed
and bile duct obstruction thought to be a post-sphincterotomy
site hematoma. Pt was treated with IV unasyn and supportive
care.  He had spontaneous resolution of bleeding after stopping
Aspirin and only required a single prbc transfusion.  He
developped volume overload after initial fluid resucitation due
to his baseline systolic CHF (EF 15%) and required IV diuresis.
He was maintained on carvedilol and a decreased dose of
lisinopril. His INR was maintained between [**1-4**] for his
mechanical valve and it was 2.1 on the day of discharge, hct was
26.  Pt was instructed to continue Coumadin 2.5mg daily with the
plan for follow up labs to be drawn on [**12-25**].  He was instructed
to stop taking Aspirin until he is seen in follow up by his
primary care physician.
.
# Pt was monitored on telemetry due to his ICD and baseline
ischemic CMP. He was noted to be having abnormal pacer spikes.
This was reviewed by EP consult team on [**12-8**] and they felt that
there was nothing to worry about but some adjustments were made
to sensing parameters on his device.
.
#Incidental findings on CT that will need follow-up, a letter
has been sent to PCP
1) Multiple pancreatic cysts - recommend f/u in 6 months
2) right parapelvic renal cyst, incompletely characterized but
likely simple cyst


Medications on Admission:
Coumadin 2.5mg daily
Hydroxyurea 500mg daily
ASA 81mg daily
Carvedilol 3.125 [**Hospital1 **]
Finasteride 5mg daily
Fluticasone 2 sprays daily
Folic Acid 1mg daily
Lasix 40mg daily
Lisinopril 20mg daily
Loratadine 10mg daily
Simvastatin 40mg qhs
Tamulosin 0.4mg daily
Albuterol/Ipratropium 2 puff q4:prn
.


Discharge Medications:
1. hydroxyurea 500 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
2. warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
3. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
8. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day.
11. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
12. Combivent 18-103 mcg/Actuation Aerosol Sig: [**12-3**]  Inhalation
every 4-6 hours as needed for shortness of breath or wheezing.
13. aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day: DO
NOT RESTART UNTIL YOU ARE SEEN BY YOUR PCP [**Last Name (NamePattern4) **] [**2180-12-26**].
14. Outpatient Lab Work
Please draw CBC, PT & INR on [**2180-12-25**] and forward results
to Dr. [**Last Name (STitle) 89521**] at fax # [**Telephone/Fax (1) 39969**]
15. ferrous sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Primary:
Gallstone Pancreatitis
Acute systolic CHF
Post sphincterotomy bleed


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
No pain with eating a regular diet and no abdominal tenderness
on physical exam.


Discharge Instructions:
You were admitted with abdominal pain and found to have
gallstone pancreatitis.  You were transferred to [**Hospital1 18**] on IV
antibiotics and taken for ERCP with stone removal and stenting
on [**12-11**]. Due to your mechanical heart valve we needed to restart
your anticoagulation after the procedure. Unfortunately, you
developed bleeding after your procedure and we had to keep you
hospitalized for a few more days. Eventually your bleeding
resolved but you did require a transfusion and we have started
you on Iron replacement to help rebuild your blood counts.  You
will need to monitor your stools daily and return to the
hospital if you note any significant bleeding.

Please continue taking the Coumadin 2.5mg daily and you will
have labs drawn on Monday [**12-25**] and the results will be forwarded
to Dr.[**Name (NI) 89522**] office.
.
We have made the following changes to your medications:
1. Do not take Aspirin until you are seen by your primary care
physician next week
2. We have decreased your Lisinopril to 5mg daily
3. Start taking Ferrous Sulfate 325mg daily

Otherwise, you should resume taking your medication as you were
taking it prior to admission.  Please make sure to call your PCP
tomorrow morning to reschedule your appointment with him


Followup Instructions:
Please call Dr.[**Doctor First Name 89523**] office tomorrow morning at [**Telephone/Fax (1) 89524**].  We had scheduled an appt for your on Tuesday [**12-19**]
at 12:15pm
but this will need to be rescheduled for early next week.
Address: [**Location (un) **], [**Apartment Address(1) 1427**], [**Location (un) **],[**Numeric Identifier 31449**]
Phone: [**Telephone/Fax (1) **]
{'Other and unspecified hyperlipidemia,Diarrhea,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cyst of kidney, acquired,Fitting and adjustment of automatic implantable cardiac defibrillator,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acute pancreatitis,Acute on chronic systolic heart failure,Obstruction of bile duct,Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Hyperosmolality and/or hypernatremia,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Other specified forms of chronic ischemic heart disease,Essential thrombocythemia,Unspecified essential hypertension,Atrial fibrillation'}


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: Transfer from OSH for gallstone pancreatitis

PRESENT ILLNESS: 83 year-old male with a history of ischemic cardiomyopathy (EF
10-20%), s/p mechanical AVR on coumadin [**2152**], s/p biventricular
ICD, HTN, HL, thrombocytosis, s/p CCY in the [**2162**] who
transferred from [**Hospital6 33**] with gallstone
pancreatitis. The patient states that 2 days prior to admission
he developed 5 episodes of soft, semi-formed, dark brown bowel
movements. He then developed epigastric abdominal pain without
radiation. The pain was rated [**5-11**], constant "irritating" pain
that was worse with movement. He denied worsening with food. He
stated he felt warm on occasions and some chills, but no fevers.
He also had some nausea, but no vomiting. He presented to [**Hospital **] ED today. At the OSH labs were remarkable for a lipase in
the 6566 and CT that showed gallstone pancreatitis. He was given
IVF at 150cc/hr, morphine & zofran and transferred to [**Hospital1 18**] for
further management. His INR was 2.5.

MEDICAL HISTORY: Mechanical Aortic Valve on coumadin since [**2152**]
Ischemic Cardiomyopathy (EF 10-20%)
BiVentricular ICD [**2177**]
Atrial Fibrllation
HTN/Hyperlipid
Thrombocytosis on hydroxyurea
BPH
s/p Cholecystectomy [**2162**]

MEDICATION ON ADMISSION: Coumadin 2.5mg daily
Hydroxyurea 500mg daily
ASA 81mg daily
Carvedilol 3.125 [**Hospital1 **]
Finasteride 5mg daily
Fluticasone 2 sprays daily
Folic Acid 1mg daily
Lasix 40mg daily
Lisinopril 20mg daily
Loratadine 10mg daily
Simvastatin 40mg qhs
Tamulosin 0.4mg daily
Albuterol/Ipratropium 2 puff q4:prn
.

ALLERGIES: Oxycodone

PHYSICAL EXAM: Vitals: 97.1 68 95/64 16 98%
GEN: non-toxic appearing, comfortable, no acute distress
HEENT: EOMI, PERRL, sclera mild icterus, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, mechanical heart sounds, III/VI SEM normal S1 S2
PULM: slight crackles at the bases, but otherwise clear
ABD: Soft, + epigastric tenderness, no RUQ pain -[**Doctor Last Name 515**] sign.
NT, ND, +BS,
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: Brother and daughter with DM
Father with HTN

SOCIAL HISTORY: He is a retired postal worker, widow and lives alone in a Senior
Center. He has one daughter. Performs all his ADLs. 1ppd x 15yrs
and quit at age 30. 2 drinks per week. No IVDU 

### Response:
{'Other and unspecified hyperlipidemia,Diarrhea,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cyst of kidney, acquired,Fitting and adjustment of automatic implantable cardiac defibrillator,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Heart valve replaced by other means,Long-term (current) use of anticoagulants,Acute pancreatitis,Acute on chronic systolic heart failure,Obstruction of bile duct,Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Hyperosmolality and/or hypernatremia,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Other specified forms of chronic ischemic heart disease,Essential thrombocythemia,Unspecified essential hypertension,Atrial fibrillation'}
