CHIEF COMPLAINT: Abdominal Pain

PRESENT ILLNESS: This is a 65 year old male transferred from [**Hospital3 **]. He
underwent a left laparoscopic nephrectomy on [**10-21**] for renal
cell carcinoma. His post-op course was complicated by acute
tubular necrosis, gastritis/bleeding peptic ulcer, LLL
pneumonia, and pancreatitis. The patient received 2 units of
PRBCs on POD 8 for low HCT. Abd CT on POD 9 revealed
peripancreatic fluid collection concerning for possible
disruption of the pancreatic duct.
On transfer, he complained of [**10-8**] sharp abdominal pain in
bilat. lower quadrant of abdomen.

MEDICAL HISTORY: recently diagnosed L RCC, depression, HTN, herniated disc,
spinal stenosis, chronic back pain, nephrolithiasis, R knee DJD

MEDICATION ON ADMISSION: trazodone, celebrex, lorazepam

ALLERGIES: Demerol

PHYSICAL EXAM: 97.8, 81, 136/70, 20, 94% RA
Gen: Anxious, NAD, uncomfortable secondary to abdominal pain.
CV: RRR, no M/R/G
Chest: decreased breath sounds bilat.
Abd: soft, distended, tender on palpation to bilat. lower
quadrants and left flank. 6 cm midline abd incision intact with
steri strips. 3 intact lap site incisions on let abd covered
with steri strips, +typany, no rebound, no guarding.
Ext: warm, 1+ EDEMA, stage 1 sore on coccyx

FAMILY HISTORY: NC

SOCIAL HISTORY: Divorced
Lives with daughter in [**Name (NI) **]
Smokes 1-1.5 ppd x 50 years
No EtOH
No DOA
Acute pancreatitis,Unspecified protein-calorie malnutrition,Unspecified septicemia,Sepsis,Personal history of malignant neoplasm of kidney
Acute pancreatitis,Protein-cal malnutr NOS,Septicemia NOS,Sepsis,Hx of kidney malignancy
Admission Date:  [**2194-10-30**]              Discharge Date:   [**2194-11-24**]

Date of Birth:  [**2129-5-5**]             Sex:   M

Service: SURGERY

Allergies:
Demerol

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
Abdominal Pain

Major Surgical or Invasive Procedure:
CT guided Drainage left upper quadrant catheter placement into a
large abdominal and pelvic pancreatic fluid collection, with
drainage of 2250 cc.
.
8 French catheter into a perisplenic fluid collection and
exchange of a second catheter into the left paracolic fluid
collection, with no significant residual fluid identified on
post-procedure images
.
PICC
.
Successful repositioning of peripancreatic catheter to a
position more closely approximating the pancreatic tail


History of Present Illness:
This is a 65 year old male transferred from [**Hospital3 **]. He
underwent a left laparoscopic nephrectomy on [**10-21**] for renal
cell carcinoma. His post-op course was complicated by acute
tubular necrosis, gastritis/bleeding peptic ulcer, LLL
pneumonia, and pancreatitis. The patient received 2 units of
PRBCs on POD 8 for low HCT. Abd CT on POD 9 revealed
peripancreatic fluid collection concerning for possible
disruption of the pancreatic duct.
On transfer, he complained of [**10-8**] sharp abdominal pain in
bilat. lower quadrant of abdomen.

Past Medical History:
recently diagnosed L RCC, depression, HTN, herniated disc,
spinal stenosis, chronic back pain, nephrolithiasis, R knee DJD

PSH: L nephrectomy & adrenalectomy ([**10-21**]), 2 R knee surgeries,
L knee surgery


Social History:
Divorced
Lives with daughter in [**Name (NI) **]
Smokes 1-1.5 ppd x 50 years
No EtOH
No DOA

Family History:
NC

Physical Exam:
97.8, 81, 136/70, 20, 94% RA
Gen: Anxious, NAD, uncomfortable secondary to abdominal pain.
CV: RRR, no M/R/G
Chest: decreased breath sounds bilat.
Abd: soft, distended, tender on palpation to bilat. lower
quadrants and left flank. 6 cm midline abd incision intact with
steri strips. 3 intact lap site incisions on let abd covered
with steri strips, +typany, no rebound, no guarding.
Ext: warm, 1+ EDEMA, stage 1 sore on coccyx

Pertinent Results:
[**2194-10-30**] 10:22PM BLOOD WBC-21.0* RBC-4.38* Hgb-10.7* Hct-32.6*
MCV-74* MCH-24.4* MCHC-32.8 RDW-15.9* Plt Ct-387
[**2194-11-3**] 05:04AM BLOOD WBC-14.6* RBC-3.94* Hgb-9.6* Hct-29.0*
MCV-74* MCH-24.3* MCHC-33.0 RDW-16.5* Plt Ct-341
[**2194-11-6**] 05:42AM BLOOD WBC-8.3 RBC-4.10* Hgb-10.1* Hct-30.2*
MCV-74* MCH-24.7* MCHC-33.5 RDW-16.5* Plt Ct-373
[**2194-11-7**] 04:12AM BLOOD Glucose-143* UreaN-21* Creat-1.2 Na-134
K-4.5 Cl-98 HCO3-32 AnGap-9
[**2194-11-4**] 11:05AM BLOOD ALT-25 AST-37 AlkPhos-191* Amylase-170*
TotBili-1.6*
[**2194-11-6**] 05:42AM BLOOD ALT-16 AST-16 AlkPhos-151* Amylase-171*
TotBili-0.6
[**2194-10-30**] 10:22PM BLOOD Lipase-220*
[**2194-11-4**] 11:05AM BLOOD Lipase-288*
[**2194-11-6**] 05:42AM BLOOD Lipase-184*
.
CT GUIDANCE DRAINAGE  [**2194-10-31**] 1:43 PM
IMPRESSION:
1. Patient is status post left upper quadrant catheter placement
into a large abdominal and pelvic pancreatic fluid collection,
with drainage of 2250 cc.
.
CT PELVIS W/CONTRAST  [**2194-11-2**] 8:07 AM
IMPRESSION:
1. Interval increase in volume of fluid, which extends from the
pancreatic tail into the left renal fossa and along the left
pericolic gutter.
2. Inflammatory changes around the pancreatic tail causes
thrombosis of the splenic vein in this region. Splenic artery
appears patent.
3. Findings compatible with pancreatitis. Poor enhancement of
the pancreatic tail could reflect parenchymal necrosis.
4. No change in bilateral pleural effusions, left greater than
right.
5. 2 mm right middle lobe pulmonary nodule redemonstrated for
which no additional followup is needed in a patient without
history of malignancy or risk factors for lung cancer.
.
ERCP [**2194-11-3**]
Cannulation: Cannulation of the pancreatic duct was performed
with a sphincterotome using a free-hand technique.

Pancreas: The pancreatic duct appeared normal in the area of the
head and body. A post surgical leak was noted in the area of the
tail.
Procedures: A 8 mc by 7 Fr Zimmon single pigtail pancreatic
stent was placed successfully to resolve the leak.

Impression: 1. Normal major papilla
2. Cannulation of the pancreatic duct was performed with a
sphincterotome using a free-hand technique.
3. The pancreatic duct appeared normal in the area of the head
and body. A post surgical leak was noted in the area of the
tail.
4. A 8 mc by 7 Fr Zimmon single pigtail pancreatic stent was
placed successfully to resolve the leak.
Recommendations: 1. Return to Surgery service/ Dr [**Last Name (STitle) 468**]
2. NPO till recovery then start clears and advance as tolerated
3. ERCP in 3 weeks to remove the PD stent.
.
CT CHANGE PERCUTANEOUS TUBE  [**2194-11-6**] 10:10 AM
IMPRESSION:
1. Patient status post placement of a new 8 French catheter into
a perisplenic fluid collection and exchange of a second catheter
into the left paracolic fluid collection, with no significant
residual fluid identified on post-procedure images.
2. Unchanged bilateral pleural effusions with adjacent
atelectasis.
3. Multiple non-obstructing right renal calculi measuring up to
9 mm.

.
CT ABDOMEN W/CONTRAST  [**2194-11-11**] 9:43 AM
IMPRESSION:
1. Two drainage catheters in the left mid abdomen as described.
The paraspinal catheter is draining the pancreatic tail
collection, which has decreased in size since its placement on
[**11-6**]. The left flank catheter is situated within a nearly
completely obliterated fluid collection. No new drainable fluid
collections identified.
2. Otherwise, unchanged internal pancreatic drain, and distended
gallbladder with a focal area of hyperattenuation.
3. Improved pleural effusions, right more so than left.
.

CT PERITINEAL DRAIN EXCLUDING APPENDICEAL  [**2194-11-16**] 6:20 PM
IMPRESSION: Successful CT-guided placement of an 8 French
catheter into a recurrent perisplenic fluid collection.
Approximately 100 cc were aspirated and a sample was submitted
for chemistry and microbiology analysis.
.
CT FISTULOGRAM S&I  [**2194-11-21**] 4:34 PM
IMPRESSION: Successful repositioning of peripancreatic catheter
to a position more closely approximating the pancreatic tail.


Brief Hospital Course:
This is a 65 year old male with pancreatitis and peripancreatic
fluid collection on CT, s/p left nephrectomy for [**Hospital 111254**]
transferred from [**Hospital3 **].

Peripancratic fluid collection: A CT showed a large fluid
collection and on [**10-31**] had CT guided drainage placement into a
large abdominal and pelvic pancreatic fluid collection, with
drainage of 2250 cc.

His drain was accidently self D/C'd and he required a new drain
on [**11-2**].  Thereafter, a 10 French pigtail catheter was inserted
directly into the collection utilizing a trocar technique.
Approximately 350 cc of opaque beige colored fluid was aspirated
and sent for Gram stain and culture.

He went for ERCP on [**11-3**] and the pancreatic duct appeared normal
in the area of the head and body. A post surgical leak was noted
in the area of the tail.
Procedures: A 8 mc by 7 Fr Zimmon single pigtail pancreatic
stent was placed successfully to resolve the leak.

Then on [**2194-11-6**] he had placement of a new 8 French catheter
into a perisplenic fluid collection and exchange of a second
catheter into the left paracolic fluid collection, with no
significant residual fluid identified on post-procedure images.

The drains continued to put out thick brown/maroon fluid. The
output decreased with time.

A CT was obtained on [**11-11**]. Two drainage catheters in the left
mid abdomen as described. The paraspinal catheter is draining
the pancreatic tail collection, which has decreased in size
since its placement on [**11-6**]. The left flank catheter is
situated within a nearly completely obliterated fluid
collection. No new drainable fluid collections identified.
Otherwise, unchanged internal pancreatic drain, and distended
gallbladder with a focal area of hyperattenuation. Improved
pleural effusions, right more so than left.

FEN: HE was NPO with IVFs. A PICC line was placed and TPN was
initiated. He continued on TPN.
After the CT on [**11-11**], we advanced his diet and monitored his
drain output. He was tolerating a diet, not complaining of
increasing abdominal pain.
We monitored his drain output and then the more superior drain
was removed on [**11-14**]. On [**11-16**], he became hypotensive and septic
due to an increase in the fluid collection and went for
CT-guided placement of an 8 French catheter into a recurrent
perisplenic fluid collection. Approximately 100 cc were
aspirated and a sample was submitted for chemistry and
microbiology analysis. On [**11-21**] he went for successful
repositioning of peripancreatic catheter to a position more
closely approximating the pancreatic tail.

Cultures grew [**Female First Name (un) **] ALBICANS, PRESUMPTIVE IDENTIFICATION.
SPARSE GROWTH.
      CORYNEBACTERIUM SPECIES (DIPHTHEROIDS).    RARE GROWTH.
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    RARE GROWTH.
He was treated with  Imipenem and Fluconazole IV. He will go
home with Levofloxacin for 1 week.

He will return to clinic in 2 weeks for a CT scan.


Medications on Admission:
trazodone, celebrex, lorazepam

Discharge Medications:
1. PT Device
Bilateral neoprene knee sleeve.
Osteoarthritis
2. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
3. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily) for 1 months.
Disp:*30 Patch 24 hr(s)* Refills:*0*
4. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for inability to sleep.
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*60 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed. Tablet(s)
8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for anxiety.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 269**] Home Health & Hospice Services, Inc.

Discharge Diagnosis:
Pancreatitis
Peripancreatic fluid collection
Malnutrition
Sepsis
Hypotension


Discharge Condition:
Good
Tolerating a diet
Pain well controlled
Drains in place


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please take any new meds as ordered.
* Continue to amubulate several times per day.
* Continue to eat several, small meals through-out the day.
* You are going home with your drains in place. Continue with
drain care, including flushing drains 3-4x/day.


Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] [**Name (STitle) **], ERCP, for stent removal.
Call ([**Telephone/Fax (1) 10532**] to schedule this appointment.
Please follow-up with Dr. [**Last Name (STitle) 468**] in 2 weeks. Call [**Telephone/Fax (1) 2835**]
with questions or concerns.
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2194-12-8**]. Arrive
at 9:30am. [**Hospital Unit Name **] [**Location (un) 470**].
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 476**] Date/Time:[**2194-12-8**]
11:15



Completed by:[**2194-11-24**]
{'Acute pancreatitis,Unspecified protein-calorie malnutrition,Unspecified septicemia,Sepsis,Personal history of malignant neoplasm of kidney'}


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 65 year old male transferred from [**Hospital3 **]. He
underwent a left laparoscopic nephrectomy on [**10-21**] for renal
cell carcinoma. His post-op course was complicated by acute
tubular necrosis, gastritis/bleeding peptic ulcer, LLL
pneumonia, and pancreatitis. The patient received 2 units of
PRBCs on POD 8 for low HCT. Abd CT on POD 9 revealed
peripancreatic fluid collection concerning for possible
disruption of the pancreatic duct.
On transfer, he complained of [**10-8**] sharp abdominal pain in
bilat. lower quadrant of abdomen.

MEDICAL HISTORY: recently diagnosed L RCC, depression, HTN, herniated disc,
spinal stenosis, chronic back pain, nephrolithiasis, R knee DJD

MEDICATION ON ADMISSION: trazodone, celebrex, lorazepam

ALLERGIES: Demerol

PHYSICAL EXAM: 97.8, 81, 136/70, 20, 94% RA
Gen: Anxious, NAD, uncomfortable secondary to abdominal pain.
CV: RRR, no M/R/G
Chest: decreased breath sounds bilat.
Abd: soft, distended, tender on palpation to bilat. lower
quadrants and left flank. 6 cm midline abd incision intact with
steri strips. 3 intact lap site incisions on let abd covered
with steri strips, +typany, no rebound, no guarding.
Ext: warm, 1+ EDEMA, stage 1 sore on coccyx

FAMILY HISTORY: NC

SOCIAL HISTORY: Divorced
Lives with daughter in [**Name (NI) **]
Smokes 1-1.5 ppd x 50 years
No EtOH
No DOA 

### Response:
{'Acute pancreatitis,Unspecified protein-calorie malnutrition,Unspecified septicemia,Sepsis,Personal history of malignant neoplasm of kidney'}
