CHIEF COMPLAINT: Epigastric pain which was determined to be pancreatitis

PRESENT ILLNESS: 63-year-old woman with history of EtOH abuse, hemochromatosis,
PUD, who was admitted on [**2138-4-29**] after a one period of
epigastric abdominal pain, nausea, vomiting, diarrhea found to
have clinical findings c/w acute pancreatitis.
.
At baseline the patient has nonbloody diarrhea and takes
antidiarrheal medications. One week ago she experienced
nonbilious, nonbloody vomiting once. She did not vomit again
until the night prior to admission when she experienced both RUQ
and LUQ abdominal pain, multiple nonbloody, watery bowel
movements, and nonbloody, bilious emeses. The nausea, vomiting,
abdominal pain lasted all night, prompting the patient to
present to the ED. She has never experienced this constellation
of symptoms before. She denies any fevers, chills, dyspnea,
chest pain.
.
On arrival to the ED, T 99, BP not auscultatable, HR 128, RR 26,
92% RA. Exam revealed orientation x 3, tachycardia, positive
femoral pulses, diffuse abdominal tenderness greatest in
epigastric area without any peritoneal sign, and negative
guaiac. Her initial labs were notable for lipase 1672, amylase
591, ALT 316, AST 115, AP 155, LDH 523, tbili 2.1, dbili 0.7.
WBC was 11, and Hct 51. A RUQ ultrasound revealed increase
echogenicity of the liver consistent with fatty infiltration,
but no cholecystitis, no gallstone.
She was diagnosed with likely alcoholic pancreatitis. A right IJ
sepsis central line was placed, and she received 4 L of NS in
the ED. BP rapidly improved to SBP 120s-130s. She was given
empiric levofloxacin and metronidazole and received keterolac
for pain control as she refused narcotics for fear of addiction.
Patient was then transferred to MICU for further management.
.
In the MICU she presented with a complicated course showing
acute pancreatitis with end organ damage likely secondary to
EtOH abuse. Her respiratory function decreased, her ABG showed
CO2 retention so that she was finally intubated on [**4-29**]. She
had to be continued on aggressive iv fluid therapy to stabilize
her blood pressure. She only had very low urine output at
10-20cc/h although her creatinine came back from 2.5 to her
baseline at 0.9. Despite continously improving laboratory
parameters continously her clinical presentation worsened over
time. Today she was supposed to get abdominal CT but just before
the transport she desaturated to 80% most likely caused by
volume overload. She responded to initial lasix 40mg iv but with
urine output of about 95cc over 4 hours. We were being consulted
for the further nutrition management of the patient.

MEDICAL HISTORY: * EtOH abuse: heavy drinking of [**1-21**] to whole bottle of wine per
day every day for 4-5 years; last drink reportedly on [**2138-4-24**].
* peptic ulcer disease: with frequent epigastric discomfort
after meals
* hemochromatosis: requiring therapeutic phlebotomy
* sleep apnea: per sleep study on [**2138-4-2**], patient should be
started on auto CPAP with a pressure ranging from 6-10 cm of
water; however she hasn't started using CPAP at home yet
* cognitive impairment

MEDICATION ON ADMISSION: quetiapine 50 mg PO qhs
aspirin 325 mg PO qday
clonazepam 0.5 mg PO bid
omeprazole 20 mg PO qday
venlafaxine 75 mg PO qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On arrival to ICU
VS: T 99.1, BP 133/51, HR 113, RR 25, 100% 4L NC
GEN: Elderly woman lying in bed, anxious-looking, awake, alert,
conversant
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP dry
and without lesion
NECK: Supple, no JVD
CV: tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, ND, diffusely tender (greatest at epigastric/RUQ), no
reboundtenderness, active bowel sounds, no HSM, no ecchymosis at
the flanks or periumbilical area
EXT: No c/c/e
SKIN: No rash

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Drinks 3/4 to 1 whole bottle of wine per day every day for [**2-22**]
years. No drug use. No tobacco. Retired. Lives with husband who
does not drink.
Acute pancreatitis,Unspecified septicemia,Other pulmonary insufficiency, not elsewhere classified,Other and unspecified infection due to central venous catheter,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other and unspecified alcohol dependence, continuous,Thrombocytopenia, unspecified
Acute pancreatitis,Septicemia NOS,Other pulmonary insuff,Oth/uns inf-cen ven cath,Acute kidney failure NOS,Urin tract infection NOS,Protein-cal malnutr NOS,Alcoh dep NEC/NOS-contin,Thrombocytopenia NOS
Admission Date:  [**2138-4-29**]              Discharge Date:   [**2138-5-22**]

Date of Birth:  [**2075-3-15**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name8 (NamePattern2) 812**]
Chief Complaint:
Epigastric pain which was determined to be pancreatitis

Major Surgical or Invasive Procedure:
CVL
Arterial line
endotracheal intubation
post-pyloric NG tube
Port-a-cath removal
PICC line placement


History of Present Illness:
63-year-old woman with history of EtOH abuse, hemochromatosis,
PUD, who was admitted on [**2138-4-29**] after a one period of
epigastric abdominal pain, nausea, vomiting, diarrhea found to
have clinical findings c/w acute pancreatitis.
.
At baseline the patient has nonbloody diarrhea and takes
antidiarrheal medications. One week ago she experienced
nonbilious, nonbloody vomiting once. She did not vomit again
until the night prior to admission when she experienced both RUQ
and LUQ abdominal pain, multiple nonbloody, watery bowel
movements, and nonbloody, bilious emeses. The nausea, vomiting,
abdominal pain lasted all night, prompting the patient to
present to the ED. She has never experienced this constellation
of symptoms before. She denies any fevers, chills, dyspnea,
chest pain.
.
On arrival to the ED, T 99, BP not auscultatable, HR 128, RR 26,
92% RA. Exam revealed orientation x 3, tachycardia, positive
femoral pulses, diffuse abdominal tenderness greatest in
epigastric area without any peritoneal sign, and negative
guaiac. Her initial labs were notable for lipase 1672, amylase
591, ALT 316, AST 115, AP 155, LDH 523, tbili 2.1, dbili 0.7.
WBC was 11, and Hct 51. A RUQ ultrasound revealed increase
echogenicity of the liver consistent with fatty infiltration,
but no cholecystitis, no gallstone.
She was diagnosed with likely alcoholic pancreatitis. A right IJ
sepsis central line was placed, and she received 4 L of NS in
the ED. BP rapidly improved to SBP 120s-130s. She was given
empiric levofloxacin and metronidazole and received keterolac
for pain control as she refused narcotics for fear of addiction.
Patient was then transferred to MICU for further management.
.
In the MICU she presented with a complicated course showing
acute pancreatitis with end organ damage likely secondary to
EtOH abuse. Her respiratory function decreased, her ABG showed
CO2 retention so that she was finally intubated on [**4-29**]. She
had to be continued on aggressive iv fluid therapy to stabilize
her blood pressure. She only had very low urine output at
10-20cc/h although her creatinine came back from 2.5 to her
baseline at 0.9. Despite continously improving laboratory
parameters continously her clinical presentation worsened over
time. Today she was supposed to get abdominal CT but just before
the transport she desaturated to 80% most likely caused by
volume overload. She responded to initial lasix 40mg iv but with
urine output of about 95cc over 4 hours. We were being consulted
for the further nutrition management of the patient.


Past Medical History:
* EtOH abuse: heavy drinking of [**1-21**] to whole bottle of wine per
day every day for 4-5 years; last drink reportedly on [**2138-4-24**].
* peptic ulcer disease: with frequent epigastric discomfort
after meals
* hemochromatosis: requiring therapeutic phlebotomy
* sleep apnea: per sleep study on [**2138-4-2**], patient should be
started on auto CPAP with a pressure ranging from 6-10 cm of
water; however she hasn't started using CPAP at home yet
* cognitive impairment

Social History:
Drinks 3/4 to 1 whole bottle of wine per day every day for [**2-22**]
years. No drug use. No tobacco. Retired. Lives with husband who
does not drink.


Family History:
noncontributory

Physical Exam:
On arrival to ICU
VS: T 99.1, BP 133/51, HR 113, RR 25, 100% 4L NC
GEN: Elderly woman lying in bed, anxious-looking, awake, alert,
conversant
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP dry
and without lesion
NECK: Supple, no JVD
CV: tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, ND, diffusely tender (greatest at epigastric/RUQ), no
reboundtenderness, active bowel sounds, no HSM, no ecchymosis at
the flanks or periumbilical area
EXT: No c/c/e
SKIN: No rash

Pertinent Results:
STUDIES:
* CXR [**2138-5-16**]: FRONTAL CHEST RADIOGRAPH: A left-sided internal
jugular central venous line has been removed. A right-sided PICC
line is seen with tip at the cavoatrial junction. There is an
increasing small right pleural effusion and atelectasis. There
is a stable small left-sided pleural effusion and left
retrocardiac opacity with air bronchograms representing
atelectasis or consolidation.
.
* RIGHT UPPER QUADRANT ULTRASOUND [**2138-5-10**]: A limited examination
was performed of the right upper quadrant, which showed a
distended gallbladder without evidence of wall thickening or
edema. No intra- or extra-hepatic biliary dilatation is
identified with the common bile duct measuring 4 mm. There is
likely a small amount of sludge within the gallbladder, without
evidence of echogenic or shadowing stones. There is a small
amount of ascites.
IMPRESSION: The gallbladder is not decompressed; however, there
is no
evidence of wall thickening or pericholecystic fluid to indicate
acute
cholecystitis.
.
TTE [**2138-5-19**]:The left atrium and right atrium are normal in
cavity size. The estimated right atrial pressure is 0-5 mmHg.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%) The estimated cardiac
index is normal (>=2.5L/min/m2). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. No masses or vegetations are seen on the
aortic valve. The mitral valve leaflets are structurally normal.
No mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.
IMPRESSION: No valvular pathology or pathologic flow identified.
Normal biventricular cavity sizes with preserved global and
regional biventricular systolic function.
If clinically suggested, the absence of a vegetation by 2D
echocardiography does not exclude endocarditis.
.
CT abdomen [**2138-5-2**]:
1. Extensive peripancreatic stranding and inflammatory change,
consistent
with acute pancreatitis. Without intravenous contrast, degree of
parenchymal enhancement cannot be assessed. However, no sign of
complication such as pseudocyst or abscess is noted.
2. Moderate bilateral pleural effusions, and associated
atelectasis.
3. Moderate ascites throughout the abdomen.
4. Dense material within the gallbladder. Given normal
appearance of the
gallbladder on ultrasound from three days prior, this is of
uncertain clinical significance. Could possibly represent
vicarious excretion of contrast, if this has been given. This
could simply represent concentrated bile.
5. Fatty liver.

Renal Ultrasound [**2138-5-7**]: 1. Patent renal veins.
2. Normal to minimally elevated resistive indices within both
kidneys as
above.

[**2138-4-29**] 07:03PM   LACTATE-2.1*
[**2138-4-29**] 05:01PM   LACTATE-2.7*
[**2138-4-29**] 04:45PM   GLUCOSE-165* UREA N-31* CREAT-1.5* SODIUM-140
POTASSIUM-4.5 CHLORIDE-113* TOTAL CO2-14* ANION GAP-18
[**2138-4-29**] 04:45PM   WBC-7.5 RBC-4.00* HGB-14.2 HCT-42.5 MCV-106*
MCH-35.6* MCHC-33.5 RDW-14.6
[**2138-4-29**] 04:45PM   NEUTS-88* BANDS-3 LYMPHS-8* MONOS-1* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2138-4-29**] 03:26PM   LACTATE-2.2*
[**2138-4-29**] 02:02PM   LACTATE-2.5*
[**2138-4-29**] 02:02PM   O2 SAT-79
[**2138-4-29**] 01:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2138-4-29**] 12:50PM   ALT(SGPT)-316* AST(SGOT)-115* LD(LDH)-523*
CK(CPK)-72 ALK PHOS-155* AMYLASE-591* TOT BILI-2.1* DIR
BILI-0.7* INDIR BIL-1.4
[**2138-4-29**] 12:50PM   LIPASE-1672*
[**2138-4-29**] 12:50PM   cTropnT-<0.01
[**2138-4-29**] 12:50PM   CK-MB-NotDone
[**2138-4-29**] 12:50PM   ALBUMIN-3.6 CALCIUM-7.7* PHOSPHATE-8.1*#
MAGNESIUM-2.3
[**2138-4-29**] 12:50PM   WBC-10.9# RBC-4.82# HGB-17.0*# HCT-50.9*#
MCV-106*# MCH-35.3* MCHC-33.4 RDW-14.5
[**2138-4-29**] 12:50PM   NEUTS-86* BANDS-7* LYMPHS-4* MONOS-2 EOS-1
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2138-4-29**] 12:50PM   PT-11.4 PTT-150* INR(PT)-0.9

Brief Hospital Course:
The patient is a 63yo female with history of EtOH abuse,PUD,
hemochromatosis, who was admitted [**2138-4-29**] after c/o abdominal
pain, nausea, vomiting and diarrhea x 1 day and diagnosed with
acute pancreatitis.
.
1. Pancreatitis: Thought to be due to pt's EToh abuse, no
gallstones noted on imaging, triglycerides were not elevated.
Pt's lipase on presentation was >1600, trended down normalizing
on [**2138-5-3**] after IVF hydration and bowel rest. She had a CVL
placed and had aggressive volume resuscitation the first day of
her hospital course that required ET intubation on day 2 of her
hospitalization. CT abdomen revealed no pseudocyst. Surgical
consultation felt that there was no indication for surgical
intervention.  She was initially covered with broad spectrum
antibiotics including, Vancomycin, Meropenam, after cx returned
negative except for micrococcus and she had clinical
improvement. Meropenam was discontinued and she was maintained
on Vancomycin for a full course of 14 days. She was never
hypotensive after initial fluid resuscitation in ED and did not
require pressors during this hospitalization. Her pain
medications were steadily decreased and at discharge, she is on
a Fentanyl patch 25 mcg/hr Q 72 hrs, Oxycodone 5mg PO Q4H PRN
and Tylenol (liquid) 650 mg PO Q6H PRN with good pain control.
Her AST, ALT, total bilirubin, amylase and lipase are all normal
at discharge.
.
2. Respiratory Failure: in the setting of fluid overload. After
pt's pancreatitis clinically stabilized, she was able to be
diuresed.  After several days of diuresis, her respiratory
status improved rapidly. She was extubated without complication
[**2138-5-15**].  She was stable for transfer to the regular medical
floor [**2138-5-16**]. At discharge, pt remains on 1L NC with O2
saturation 95%.  She should be weaned from O2 as able during her
stay at rehab.
.
3. Acute renal failure: Thought to be due to contrast
nephropathy. Renal U/S revealed no hydronephrosis. Renal
consulted and felt was c/w ATN.  Creatinine peaked at 3.5 on
[**5-7**] and trended down daily afterward. She was never oliguric.
Creatinine at d/c is 1.8 up from baseline 0.8 [**9-26**].  Pt is
having post-ATN diuresis.
.
4.Micrococcus bacteremia: 1 out of 2 bottles from ED on
admission. Port-a-cath removed by surgery [**2138-5-2**]. RIJ removed
[**5-6**], a-line resited [**5-7**]. Completed a 14 day course of
Vancomycin after all potentially infected lines had been
removed.
.
5. UTI- completed course of Ciprofloxacin.Urgency at d/c but no
dysuria.
.
6.Etoh abuse- She was initially on a CIWA without event. Social
work was consulted. Pt should be followed by social work at
rehab.  Importance of abstaining from all alcohol has been
reinforced with pt during her hospital stay. Pt also maintained
here on seroquel, venlafaxine and PRN trazodone for h/o
depression.
.
7. h/o Hemochromatosis - stable
.
8. [**Name (NI) 1069**] Pt with diarrhea as she has tried to advance her
diet here.  Pt has tested negative for C Diff toxin twice.
Diarrhea treated with immodium and thought to be due to pts
digestive system adapting after episode of pancreatitis.
.
9. [**Name (NI) 101554**] Pt kept on PPI in house
.
10. [**Name (NI) 101555**] Pt with murmur here in hospital recieved a negative
TTE.  No further studies were needed.

Medications on Admission:
quetiapine 50 mg PO qhs
aspirin 325 mg PO qday
clonazepam 0.5 mg PO bid
omeprazole 20 mg PO qday
venlafaxine 75 mg PO qday

Discharge Medications:
1. Acetaminophen 500 mg Capsule Sig: [**11-20**] Capsules PO every [**2-23**]
hours as needed for pain.
2. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
3. Quetiapine 50 mg Tablet Sig: One (1) Tablet PO at bedtime.
4. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times
a day) as needed for diarrhea.
8. Fentanyl 25 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
9. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
10. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
11. Venlafaxine 75 mg Tablet Sig: One (1) Tablet PO once a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital3 **]

Discharge Diagnosis:
Primary diagnosis:
Pancreatitis

Secondary diagnoses:
Acute Respiratory Distress Syndrome
Acute Renal Failure
Alcohol Abuse
Hemochromatosis
Diarrhea


Discharge Condition:
Fair, on 1 liter oxygen 95%


Discharge Instructions:
You were admitted to the hospital with a severe case of
pancreatitis.  During your hospital course, you required
intubation and the help of a respirator to breathe.  You are now
being discharged to [**Hospital 3058**] rehab so you can regain your
strength.  You should avoid all alcohol to prevent any
recurrence of your pancreatitis.

Please return to the hospital with any fevers, chills, shortness
of breath, chest pain, leg pain and/or swelling, dizziness or
increased abdominal pain.

Followup Instructions:
Please follow up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 333**]
[**Last Name (NamePattern1) 2472**]
Tues [**6-10**] at 10:45a


                             [**First Name8 (NamePattern2) **] [**Name6 (MD) **] [**Name8 (MD) **] MD, DMD [**MD Number(2) 821**]

Completed by:[**2138-5-22**]
{'Acute pancreatitis,Unspecified septicemia,Other pulmonary insufficiency, not elsewhere classified,Other and unspecified infection due to central venous catheter,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other and unspecified alcohol dependence, continuous,Thrombocytopenia, 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: Epigastric pain which was determined to be pancreatitis

PRESENT ILLNESS: 63-year-old woman with history of EtOH abuse, hemochromatosis,
PUD, who was admitted on [**2138-4-29**] after a one period of
epigastric abdominal pain, nausea, vomiting, diarrhea found to
have clinical findings c/w acute pancreatitis.
.
At baseline the patient has nonbloody diarrhea and takes
antidiarrheal medications. One week ago she experienced
nonbilious, nonbloody vomiting once. She did not vomit again
until the night prior to admission when she experienced both RUQ
and LUQ abdominal pain, multiple nonbloody, watery bowel
movements, and nonbloody, bilious emeses. The nausea, vomiting,
abdominal pain lasted all night, prompting the patient to
present to the ED. She has never experienced this constellation
of symptoms before. She denies any fevers, chills, dyspnea,
chest pain.
.
On arrival to the ED, T 99, BP not auscultatable, HR 128, RR 26,
92% RA. Exam revealed orientation x 3, tachycardia, positive
femoral pulses, diffuse abdominal tenderness greatest in
epigastric area without any peritoneal sign, and negative
guaiac. Her initial labs were notable for lipase 1672, amylase
591, ALT 316, AST 115, AP 155, LDH 523, tbili 2.1, dbili 0.7.
WBC was 11, and Hct 51. A RUQ ultrasound revealed increase
echogenicity of the liver consistent with fatty infiltration,
but no cholecystitis, no gallstone.
She was diagnosed with likely alcoholic pancreatitis. A right IJ
sepsis central line was placed, and she received 4 L of NS in
the ED. BP rapidly improved to SBP 120s-130s. She was given
empiric levofloxacin and metronidazole and received keterolac
for pain control as she refused narcotics for fear of addiction.
Patient was then transferred to MICU for further management.
.
In the MICU she presented with a complicated course showing
acute pancreatitis with end organ damage likely secondary to
EtOH abuse. Her respiratory function decreased, her ABG showed
CO2 retention so that she was finally intubated on [**4-29**]. She
had to be continued on aggressive iv fluid therapy to stabilize
her blood pressure. She only had very low urine output at
10-20cc/h although her creatinine came back from 2.5 to her
baseline at 0.9. Despite continously improving laboratory
parameters continously her clinical presentation worsened over
time. Today she was supposed to get abdominal CT but just before
the transport she desaturated to 80% most likely caused by
volume overload. She responded to initial lasix 40mg iv but with
urine output of about 95cc over 4 hours. We were being consulted
for the further nutrition management of the patient.

MEDICAL HISTORY: * EtOH abuse: heavy drinking of [**1-21**] to whole bottle of wine per
day every day for 4-5 years; last drink reportedly on [**2138-4-24**].
* peptic ulcer disease: with frequent epigastric discomfort
after meals
* hemochromatosis: requiring therapeutic phlebotomy
* sleep apnea: per sleep study on [**2138-4-2**], patient should be
started on auto CPAP with a pressure ranging from 6-10 cm of
water; however she hasn't started using CPAP at home yet
* cognitive impairment

MEDICATION ON ADMISSION: quetiapine 50 mg PO qhs
aspirin 325 mg PO qday
clonazepam 0.5 mg PO bid
omeprazole 20 mg PO qday
venlafaxine 75 mg PO qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On arrival to ICU
VS: T 99.1, BP 133/51, HR 113, RR 25, 100% 4L NC
GEN: Elderly woman lying in bed, anxious-looking, awake, alert,
conversant
HEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP dry
and without lesion
NECK: Supple, no JVD
CV: tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Soft, ND, diffusely tender (greatest at epigastric/RUQ), no
reboundtenderness, active bowel sounds, no HSM, no ecchymosis at
the flanks or periumbilical area
EXT: No c/c/e
SKIN: No rash

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Drinks 3/4 to 1 whole bottle of wine per day every day for [**2-22**]
years. No drug use. No tobacco. Retired. Lives with husband who
does not drink. 

### Response:
{'Acute pancreatitis,Unspecified septicemia,Other pulmonary insufficiency, not elsewhere classified,Other and unspecified infection due to central venous catheter,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Unspecified protein-calorie malnutrition,Other and unspecified alcohol dependence, continuous,Thrombocytopenia, unspecified'}
