CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: This is a 37 F w/ PMH of chronic pancreatitis who presents with
what feels to her like another episode of the same. Two-weeks
ago, she finished a course of TPN and had transitioned to taking
orals. She did well for a week in which she did not need any
pain medicine. Then, on Tuesday (3-days ago), she began to feel
nauseated, vomit and have increasing abdominal pain. Last threw
up yesterday. Last urinated early this morning. Her abd pain is
sharp and shoots to the back. + chills but no fevers (she says
she is always cold). Last was hospitalized in [**Month (only) 956**].
.
ROS:
(+) HA over the past couple of days; + diarrhea this am.
(-) Denies sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.
.
On arrival to the floor, vitals 96.8, 80/50, 69, 16, 96% on RA.
Came up to 90s systolic with NS boluses (2L) but came back to
the 80s systolic. It appears that her BP always runs in 80s/90s
systolic range but she described feeling "clammy" "tingly" and
lightheaded with this pressure. Given blood pressure and
patient's symptoms, decision made to transfer to MICU. Received
2 L LR boluses by the time she reached MICU. Mildly hypoxic on
presentation to MICU.

MEDICAL HISTORY: 1) chronic pancreatitis - unclear how chronic this is. She was
diagnosed at age 18 years (attributed to Sulfa or Tegretol), but
has been admitted several times since then with flares, etiology
is unclear
- [**6-/2123**] [**Name2 (NI) 60478**]: Mild dilation of distal CBD (8 mm) without other
evidence of biliary ductal dilatation or intraluminal calculus.
Possible atypical anatomy of pancreatic duct, with ducts
extending to both minor and major papillae. No dilation of
pancreatic duct. No signal abnormality within or around the
pancreas to suggest pancreatitis.
2) Peptic ulcer disease
3) Chronic abdominal pain: prior work-up in [**2123**] negative except
for elevated lipase, possibly related to chronic pancreatitis.
Negative abdominal CT scan, negative abdominal MRI, negative
flexible sigmoidoscopy, negative SBFT, negative X-lap, [**Doctor First Name **] (-),
RF (-), urine porphyria (-), HIV (-)
4) h/o endometritis
5) s/p cholecystectomy and appendectomy in [**2121**]
6) PTSD/anxiety/depression: psychiatrist Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: Ativan 1 mg qid (was taking until Tuesday)
Celexa 40 mg po qam
Creon 20 2 caps po before meals and 1 cap po before snacks
Lovenox 40 mg sc bid (for a DVT in R arm)
Oxycodone 10 mg [**Hospital1 **]
Risperidal 2 mg po qhs
Seroquel 25 mg po qhs
Trazodone 25 mg po qhs

ALLERGIES: Sulfonamides / Tegretol / Droperidol / Haldol / Reglan

PHYSICAL EXAM: VS - 96.6, 79-94, 90-94/56-66, 15-22, 97-98% 4L NC
HEENT - dry MM, + skin tenting over forehead, OP dry
LUNGS - CTA
HEART - RRR, S1, S2, no rmg
ABD - rigid, non distended, tender over epigastrium, RLQ, BS
minimal
EXT - atrophic muscles, no edema, warm
NEURO - A*O*3

FAMILY HISTORY: no pancreas issues; paternal uncle diagnosed with colon Ca in
60s, paternal aunt with [**Name (NI) 3685**] in 40's, cousin with ? lymphoma;
PGM and PGF died of cancer of unknown causes

SOCIAL HISTORY: Lives with her Mother and son. Smokes 1 ppd and has smoked since
age 15 (at times up to 2-3 packs per day). Denies aclohol or
other drug use
Acute pancreatitis,Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Volume depletion, unspecified,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, without mention of obstruction
Acute pancreatitis,Food/vomit pneumonitis,Hypoxemia,Volume depletion NOS,Posttraumatic stress dis,Depressive disorder NEC,Hx-ven thrombosis/embols,Chronic peptic ulcer NOS
Admission Date:  [**2130-6-9**]              Discharge Date:   [**2130-6-14**]

Date of Birth:  [**2093-4-6**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfonamides / Tegretol / Droperidol / Haldol / Reglan

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is a 37 F w/ PMH of chronic pancreatitis who presents with
what feels to her like another episode of the same. Two-weeks
ago, she finished a course of TPN and had transitioned to taking
orals. She did well for a week in which she did not need any
pain medicine. Then, on Tuesday (3-days ago), she began to feel
nauseated, vomit and have increasing abdominal pain. Last threw
up yesterday. Last urinated early this morning. Her abd pain is
sharp and shoots to the back. + chills but no fevers (she says
she is always cold). Last was hospitalized in [**Month (only) 956**].
.
ROS:
(+) HA over the past couple of days; + diarrhea this am.
(-) Denies sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.
.
On arrival to the floor, vitals 96.8, 80/50, 69, 16, 96% on RA.
Came up to 90s systolic with NS boluses (2L) but came back to
the 80s systolic. It appears that her BP always runs in 80s/90s
systolic range but she described feeling "clammy" "tingly" and
lightheaded with this pressure. Given blood pressure and
patient's symptoms, decision made to transfer to MICU. Received
2 L LR boluses by the time she reached MICU. Mildly hypoxic on
presentation to MICU.


Past Medical History:
1) chronic pancreatitis - unclear how chronic this is. She was
diagnosed at age 18 years (attributed to Sulfa or Tegretol), but
has been admitted several times since then with flares, etiology
is unclear
- [**6-/2123**] [**Name2 (NI) 60478**]: Mild dilation of distal CBD (8 mm) without other
evidence of biliary ductal dilatation or intraluminal calculus.
Possible atypical anatomy of pancreatic duct, with ducts
extending to both minor and major papillae. No dilation of
pancreatic duct. No signal abnormality within or around the
pancreas to suggest pancreatitis.
2) Peptic ulcer disease
3) Chronic abdominal pain: prior work-up in [**2123**] negative except
for elevated lipase, possibly related to chronic pancreatitis.
Negative abdominal CT scan, negative abdominal MRI, negative
flexible sigmoidoscopy, negative SBFT, negative X-lap, [**Doctor First Name **] (-),
RF (-), urine porphyria (-), HIV (-)
4) h/o endometritis
5) s/p cholecystectomy and appendectomy in [**2121**]
6) PTSD/anxiety/depression: psychiatrist Dr. [**Last Name (STitle) **]


Social History:
Lives with her Mother and son. Smokes 1 ppd and has smoked since
age 15 (at times up to 2-3 packs per day). Denies aclohol or
other drug use


Family History:
no pancreas issues; paternal uncle diagnosed with colon Ca in
60s, paternal aunt with [**Name (NI) 3685**] in 40's, cousin with ? lymphoma;
PGM and PGF died of cancer of unknown causes

Physical Exam:
VS - 96.6, 79-94, 90-94/56-66, 15-22, 97-98% 4L NC
HEENT - dry MM, + skin tenting over forehead, OP dry
LUNGS - CTA
HEART - RRR, S1, S2, no rmg
ABD - rigid, non distended, tender over epigastrium, RLQ, BS
minimal
EXT - atrophic muscles, no edema, warm
NEURO - A*O*3


Pertinent Results:
CT ABDOMEN WITH CONTRAST: No focal hepatic mass or intrahepatic
biliary duct dilatation is evident. The pancreas appears within
normal limits for size and is without calcifications on this
single-phase examination; while attenuation is homogeneous,
evaluation for pancreatic necrosis is limited. No peripancreatic
fluid collection is identified. The adrenal glands and spleen
appear unremarkable. The splenic vein appears patent.
Cholecystectomy has been performed. Note is made of bilateral
atelectasis and small pleural effusions.

CT PELVIS WITH CONTRAST: A Foley catheter and intraluminal air
resides within the distended bladder. No enlarged lymph nodes
are identified. A moderate amount of free fluid is within the
pelvis. Visualized bowel loops appear unremarkable.


Brief Hospital Course:
1) Pancreatitis/Abdominal pain: Pt was initially taken to the
MICU out of concern for hypotension, and she responded to fluid
bolues. After stabilization of blood pressure, she was called
out to floor. She continued to have abdominal pain, CT was
negative for abscess, pseudocyst, or stranding around pancreas.
She was started on diluadid PCA which controlled her pain, and
was then transitioned to oral pain meds.  She was able to sit up
in a chair and advanced diet without nausea or worsening of
abdominal pain.  She was followed by gastroenterology team
throughout her course. On discharge, she had tolerated full
diet. She was discharged with oxycodone SR until her f/u with
PCP.
.
2) PNA: Patient was noted on CXR to have RLL infiltrate, cough,
and very low grade fever. She was started on levaquin with plans
for 7 day course.
.
3) FEN: Nutrition was consulted for poor PO intake. TPN was
deferred as it was felt that patient should continue to try to
use her GI tract as much as possible. Patient was given
information to follow-up with nutritionist as an outpatient, and
she will continue to use Boost supplements.
.
4) Hx of UE DVT: patient continued lovenox injections and will
have 4 more days after discharge until she completes her
predesignated course.


Medications on Admission:
Ativan 1 mg qid (was taking until Tuesday)
Celexa 40 mg po qam
Creon 20 2 caps po before meals and 1 cap po before snacks
Lovenox 40 mg sc bid (for a DVT in R arm)
Oxycodone 10 mg [**Hospital1 **]
Risperidal 2 mg po qhs
Seroquel 25 mg po qhs
Trazodone 25 mg po qhs


Discharge Medications:
1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
[**Hospital1 **] (2 times a day): You will have completed your course of this
medicine on [**2130-6-18**].
Disp:*8 syringe* Refills:*0*
2. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q 8H (Every 8
Hours). Tablet(s)
3. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
5. Risperidone 2 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

6. Risperidone 2 mg Tablet Sig: One (1) Tablet PO Q AM ().
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q24H
(every 24 hours) for 7 days.
Disp:*21 Tablet(s)* Refills:*0*
9. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO twice a day for 14 days.
Disp:*14 Tablet Sustained Release 12 hr(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
Centrus Home Care

Discharge Diagnosis:
Primary:
pancreatitis
poor nutrition
left upper extremity deep vein thrombosis

Secondary:
peptic ulcer disease
PTSD
depression


Discharge Condition:
stable, pain improved, tolerating food well


Discharge Instructions:
You have pancreatitis, low blood pressure, and poor food intake,
which is now resolved. You also may have a mild pneumonia for
which you will need antibiotics.
.
Please call your primary doctor if you have any worsening pain,
fever, chills, nausea vomiting, inability to eat,
lightheadedness, or any other concerning symptoms.
.
Please take all medications as prescribed.
1) We have started you on 7 days of an antibiotic called
Levaquin.
2) We have given you a prescrition for pain medications which
should be adequate for until you go to your primary MD's office.
3) You only need to inject the Lovenox for 4 more days and then
you will have completed your recommended course
.
Please attend all follow-up appointments.

Followup Instructions:
Please attend your appointment with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RN, CS
Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2130-7-5**] 9:40AM. Your primary care
physician's office will be in charge of your pain medications.
.
Please call [**Telephone/Fax (1) 99088**] to make an appointment to meet a
nutritionist to help with your weight loss and diet.
{'Acute pancreatitis,Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Volume depletion, unspecified,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, without mention of obstruction'}


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: This is a 37 F w/ PMH of chronic pancreatitis who presents with
what feels to her like another episode of the same. Two-weeks
ago, she finished a course of TPN and had transitioned to taking
orals. She did well for a week in which she did not need any
pain medicine. Then, on Tuesday (3-days ago), she began to feel
nauseated, vomit and have increasing abdominal pain. Last threw
up yesterday. Last urinated early this morning. Her abd pain is
sharp and shoots to the back. + chills but no fevers (she says
she is always cold). Last was hospitalized in [**Month (only) 956**].
.
ROS:
(+) HA over the past couple of days; + diarrhea this am.
(-) Denies sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.
.
On arrival to the floor, vitals 96.8, 80/50, 69, 16, 96% on RA.
Came up to 90s systolic with NS boluses (2L) but came back to
the 80s systolic. It appears that her BP always runs in 80s/90s
systolic range but she described feeling "clammy" "tingly" and
lightheaded with this pressure. Given blood pressure and
patient's symptoms, decision made to transfer to MICU. Received
2 L LR boluses by the time she reached MICU. Mildly hypoxic on
presentation to MICU.

MEDICAL HISTORY: 1) chronic pancreatitis - unclear how chronic this is. She was
diagnosed at age 18 years (attributed to Sulfa or Tegretol), but
has been admitted several times since then with flares, etiology
is unclear
- [**6-/2123**] [**Name2 (NI) 60478**]: Mild dilation of distal CBD (8 mm) without other
evidence of biliary ductal dilatation or intraluminal calculus.
Possible atypical anatomy of pancreatic duct, with ducts
extending to both minor and major papillae. No dilation of
pancreatic duct. No signal abnormality within or around the
pancreas to suggest pancreatitis.
2) Peptic ulcer disease
3) Chronic abdominal pain: prior work-up in [**2123**] negative except
for elevated lipase, possibly related to chronic pancreatitis.
Negative abdominal CT scan, negative abdominal MRI, negative
flexible sigmoidoscopy, negative SBFT, negative X-lap, [**Doctor First Name **] (-),
RF (-), urine porphyria (-), HIV (-)
4) h/o endometritis
5) s/p cholecystectomy and appendectomy in [**2121**]
6) PTSD/anxiety/depression: psychiatrist Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: Ativan 1 mg qid (was taking until Tuesday)
Celexa 40 mg po qam
Creon 20 2 caps po before meals and 1 cap po before snacks
Lovenox 40 mg sc bid (for a DVT in R arm)
Oxycodone 10 mg [**Hospital1 **]
Risperidal 2 mg po qhs
Seroquel 25 mg po qhs
Trazodone 25 mg po qhs

ALLERGIES: Sulfonamides / Tegretol / Droperidol / Haldol / Reglan

PHYSICAL EXAM: VS - 96.6, 79-94, 90-94/56-66, 15-22, 97-98% 4L NC
HEENT - dry MM, + skin tenting over forehead, OP dry
LUNGS - CTA
HEART - RRR, S1, S2, no rmg
ABD - rigid, non distended, tender over epigastrium, RLQ, BS
minimal
EXT - atrophic muscles, no edema, warm
NEURO - A*O*3

FAMILY HISTORY: no pancreas issues; paternal uncle diagnosed with colon Ca in
60s, paternal aunt with [**Name (NI) 3685**] in 40's, cousin with ? lymphoma;
PGM and PGF died of cancer of unknown causes

SOCIAL HISTORY: Lives with her Mother and son. Smokes 1 ppd and has smoked since
age 15 (at times up to 2-3 packs per day). Denies aclohol or
other drug use 

### Response:
{'Acute pancreatitis,Pneumonitis due to inhalation of food or vomitus,Hypoxemia,Volume depletion, unspecified,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, without mention of obstruction'}
