CHIEF COMPLAINT: diarrhea

PRESENT ILLNESS: HPI (per Dr. [**First Name (STitle) **] [**Name (STitle) **]): Ms. [**Known lastname 28119**] is a 49 year old female s/p OLT
in [**5-/2142**] for
fulminant hepatitis due to unknown etiology c/b post-op biliary
stricture required multiple [**Year (4 digits) **] and stents. Patient was
recently admitted on [**2145-2-19**] for pan colitis and UTI and was
treated with Cipro and Flagyl. Her diarrhea resolved and she was
discharged on [**2145-2-24**] with Bactrim for her UTI. Two to three
days prior to this presentation, patient reported having
effusive diarrhea, almost every 2-3 hrs. She felt weak and
fatigue but denied any fever/chills/nausea/vomiting. She has
been trying to drink more fluid to keep up with her diarrhea but
admitted that she hasn't been doing enough. Patient was
evaluated in the ED, given Cipro/Flagyl and resuscitated with
IVF.

MEDICAL HISTORY: 1. Severe acute hepatitis in [**2134**] (with ascites, coagulopathy)
ultimately attributed to ditropan (diagnosis by exclusion after

MEDICATION ON ADMISSION: 

ALLERGIES: Mirtazapine

PHYSICAL EXAM: 97.9 97.1 82 142/78 18 94ra
NAD, A/Ox3
CTA anterior
RRR
soft, well healed scars, NT/ND
WWP

FAMILY HISTORY: Mother with stroke at age 45. Maternal aunt with diabetes
mellitus. No family history of GI disorders (IBD, celiac, etc.)

SOCIAL HISTORY: Tobacco - quit [**9-/2136**]; smoked 1PPD for 20 years.
Alcohol - Not in several months; previous had approximately 1
glass of wine per month.
Drugs - Remote hx of marijuana use; no drug use recently.
Married, has two children ages 10 and 11 at home. On disability.
Intestinal infection due to Clostridium difficile,Unspecified septicemia,Pneumonia, organism unspecified,Liver replaced by transplant,Sepsis,Universal ulcerative (chronic) colitis,Multiple sclerosis
Int inf clstrdium dfcile,Septicemia NOS,Pneumonia, organism NOS,Liver transplant status,Sepsis,Univrsl ulcertve colitis,Multiple sclerosis
Admission Date:  [**2145-3-29**]              Discharge Date:   [**2145-4-3**]

Date of Birth:  [**2095-6-24**]             Sex:   F

Service: SURGERY

Allergies:
Mirtazapine

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
diarrhea

Major Surgical or Invasive Procedure:
N/A


History of Present Illness:
HPI (per Dr. [**First Name (STitle) **] [**Name (STitle) **]): Ms. [**Known lastname 28119**] is a 49 year old female s/p OLT
in [**5-/2142**] for
fulminant hepatitis due to unknown etiology c/b post-op biliary
stricture required multiple [**Year (4 digits) **] and stents. Patient was
recently admitted on [**2145-2-19**] for pan colitis and UTI and was
treated with Cipro and Flagyl. Her diarrhea resolved and she was
discharged on [**2145-2-24**] with Bactrim for her UTI. Two to three
days prior to this presentation, patient reported having
effusive diarrhea, almost every 2-3 hrs. She felt weak and
fatigue but denied any fever/chills/nausea/vomiting. She has
been trying to drink more fluid to keep up with her diarrhea but
admitted that she hasn't been doing enough. Patient was
evaluated in the ED, given Cipro/Flagyl and resuscitated with
IVF.

ROS:
(+): per HPI, chronic headache, generalized fatigue/weakness
(-): change in vision, sob, chest pain, dyspnea, abdominal pain,
nausea, vomiting, dysuria.

Past Medical History:
1. Severe acute hepatitis in [**2134**] (with ascites, coagulopathy)
ultimately attributed to ditropan (diagnosis by exclusion after

workup including: hep a,b,c serologies, ebv, cmv, hsv
serologies, cerulosplasmin, 24 hr urine [**Last Name (LF) 32276**], [**First Name3 (LF) **], [**Last Name (un) 15412**] was
negative and liver bx with bridging necrosis but no viral
cytopathic changes or fatty change). Initially, liver function
improved with no specific intervention, but a recurrent episode

of fulminant hepatitis led to OLT in [**2142-5-3**], complicated by
stenosis of the bile duct anastomosis in [**2142-6-3**], which
required stenting.
2. Multiple sclerosis, primary progressive, diagnosed in [**2133**].
3. Status post C-section.


Social History:
Tobacco - quit [**9-/2136**]; smoked 1PPD for 20 years.
Alcohol - Not in several months; previous had approximately 1
glass of wine per month.
Drugs - Remote hx of marijuana use; no drug use recently.
Married, has two children ages 10 and 11 at home. On disability.

Family History:
Mother with stroke at age 45. Maternal aunt with diabetes
mellitus. No family history of GI disorders (IBD, celiac, etc.)

Physical Exam:
97.9 97.1 82 142/78 18 94ra
NAD, A/Ox3
CTA anterior
RRR
soft, well healed scars, NT/ND
WWP

Pertinent Results:
LABS:

[**2145-3-29**]

      12.2         137  103  19
11.8 >----< 165    -------------< 112
      34.7         3.7  25   .7

Tacro 6.1

[**2145-4-3**]

      10.8         141  114  17
 5.5 >----< 194    -------------< 94
      30.5         3.5  23   .8

Tacro 9.4

IMAGING:
CT scan w/o contrast   Date: [**2145-3-29**]
IMPRESSION:
1. Right lower lobe pneumonia.
2. Pancolitis.
3. Mild peripancreatic fluid adjacent to the tail; please
correlate
clinically for pancreatitis.
4. 6-mm right renal lower pole hypodensity increased in size
from [**2142**] study may represent an enlarging simple renal cyst;
however, attention to this lesion is advised on followup
imaging.

MICRO:
FECAL CULTURE (Final [**2145-3-31**]):    NO SALMONELLA OR SHIGELLA
FOUND.

CAMPYLOBACTER CULTURE (Final [**2145-3-31**]):    NO CAMPYLOBACTER
FOUND.

OVA + PARASITES (Final [**2145-3-30**]):
NO OVA AND PARASITES SEEN.
FEW POLYMORPHONUCLEAR LEUKOCYTES.

CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2145-3-30**]):

FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA. (Reference
Range-Negative).
A positive result in a recently treated patient is of uncertain
significance unless the patient is currently symptomatic
(relapse).


Brief Hospital Course:
The patient was admitted to the Tranplant Surgical Service for
evaluation and treatment of large volume watery stool.

Neuro: The patient received dilaudid with good effect and
adequate pain control.  When tolerating oral intake, the patient
was transitioned to oral pain medications.

CV: The patient remained stable from a cardiovascular
standpoint; vital signs were routinely monitored.

Pulmonary: The patient remained stable from a pulmonary
standpoint; vital signs were routinely monitored. Good pulmonary
toilet, and incentive spirometry were encouraged throughout
hospitalization. Supplemental oxygen was weaned gradually to
room air.

GI/GU/FEN: Diet was advanced when appropriate, which was well
tolerated.  Patient's intake and output were closely monitored,
and IV fluid was adjusted when necessary.  Electrolytes were
routinely followed, and repleted when necessary.

ID: The patient's white blood count and fever curves were
closely watched for signs of infection. Due to large volume
watery stool, stool cultures were sent which were positive for C
Difficile. PO Vancomycin was started empirically with subsequent
gradual decrease in stool output.

Endocrine: The patient's blood sugar was monitored throughout
his stay; insulin dosing was adjusted accordingly.

Hematology: The patient's complete blood count was examined
routinely; no transfusions were required.

Immunology: Tacrolimus was continued and levels monitored daily
with dosing adjustments as needed.

Prophylaxis: Venodyne boots were used during this stay; was
encouraged to get up and ambulate as early as possible.

Disposition: Pt worked extensively with physical therapy with a
plan to continue follow-up at her rehab facility.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.


Discharge Medications:
1. baclofen 10 mg Tablet Sig: Two (2) Tablet PO QAM (once a day
(in the morning)).
2. baclofen 10 mg Tablet Sig: One (1) Tablet PO LUNCH (Lunch).
3. baclofen 10 mg Tablet Sig: One (1) Tablet PO DINNER (Dinner).

4. baclofen 10 mg Tablet Sig: Four (4) Tablet PO QHS (once a day
(at bedtime)).
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
6. venlafaxine 37.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
7. pramipexole 0.125 mg Tablet Sig: One (1) Tablet PO Daily ().

8. loperamide 2 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
9. vancomycin 250 mg Capsule Sig: Two (2) Capsule PO Q6H (every
6 hours) for 2 weeks: 500 mg q6hours for 10 more days (through
[**4-12**]).
Disp:*136 Capsule(s)* Refills:*0*
10. venlafaxine 37.5 mg Tablet Sig: One (1) Tablet PO QHS (once
a day (at bedtime)).
11. vancomycin 250 mg Capsule Sig: One (1) Capsule PO every six
(6) hours for 7 days: To start [**4-13**]. 1 tab daily for 7 days.
12. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours). Capsule(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Primary Diagnosis:
C. difficile colitis
.
Secondary Diagnosis:
Multiple Sclerosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname 28119**],

It was a pleasure taking care of you during your
hospitalization. You were admitted to the hospital after
developing severe diarrhea. During your hospitalization, we
determined that your diarrhea was most likely secondary to a
Clostridium Difficile (C.diff) infection. You were hydrated and
started on an oral antibiotic, vancomycin. We recommend
continuing this antibiotic for a total of 3 weeks. Your diarrhea
has improved and we recommend that you follow up with Dr. [**Last Name (STitle) **]
in 2 weeks after discharge.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in 2 to 3 weeks after discharge.
Please see below for the dates of your next appointment:
Provider: [**Name10 (NameIs) **] [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2145-4-21**] 10:40
Provider: [**Name10 (NameIs) **] [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2145-8-11**] 10:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2145-4-3**]
{'Intestinal infection due to Clostridium difficile,Unspecified septicemia,Pneumonia, organism unspecified,Liver replaced by transplant,Sepsis,Universal ulcerative (chronic) colitis,Multiple sclerosis'}


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: diarrhea

PRESENT ILLNESS: HPI (per Dr. [**First Name (STitle) **] [**Name (STitle) **]): Ms. [**Known lastname 28119**] is a 49 year old female s/p OLT
in [**5-/2142**] for
fulminant hepatitis due to unknown etiology c/b post-op biliary
stricture required multiple [**Year (4 digits) **] and stents. Patient was
recently admitted on [**2145-2-19**] for pan colitis and UTI and was
treated with Cipro and Flagyl. Her diarrhea resolved and she was
discharged on [**2145-2-24**] with Bactrim for her UTI. Two to three
days prior to this presentation, patient reported having
effusive diarrhea, almost every 2-3 hrs. She felt weak and
fatigue but denied any fever/chills/nausea/vomiting. She has
been trying to drink more fluid to keep up with her diarrhea but
admitted that she hasn't been doing enough. Patient was
evaluated in the ED, given Cipro/Flagyl and resuscitated with
IVF.

MEDICAL HISTORY: 1. Severe acute hepatitis in [**2134**] (with ascites, coagulopathy)
ultimately attributed to ditropan (diagnosis by exclusion after

MEDICATION ON ADMISSION: 

ALLERGIES: Mirtazapine

PHYSICAL EXAM: 97.9 97.1 82 142/78 18 94ra
NAD, A/Ox3
CTA anterior
RRR
soft, well healed scars, NT/ND
WWP

FAMILY HISTORY: Mother with stroke at age 45. Maternal aunt with diabetes
mellitus. No family history of GI disorders (IBD, celiac, etc.)

SOCIAL HISTORY: Tobacco - quit [**9-/2136**]; smoked 1PPD for 20 years.
Alcohol - Not in several months; previous had approximately 1
glass of wine per month.
Drugs - Remote hx of marijuana use; no drug use recently.
Married, has two children ages 10 and 11 at home. On disability. 

### Response:
{'Intestinal infection due to Clostridium difficile,Unspecified septicemia,Pneumonia, organism unspecified,Liver replaced by transplant,Sepsis,Universal ulcerative (chronic) colitis,Multiple sclerosis'}
