CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 57-year-old
African-American woman with hypertension who presents to the
Emergency Room with severe abdominal pain.  The patient
describes shoveling snow yesterday and the shovel got caught
and hit her in the lower abdomen with forceful blow.  Pain
has worsened since that time, and now involves the entire
abdomen without radiation, increased pain with movement.  No
nausea, vomiting.  She has had a fever to 102, now extremely
uncomfortable, passing flatus with normal bowel movements
yesterday, and today has diarrhea on the day of admission.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Denies tobacco and ethanol use.
Malignant neoplasm of ovary,Perforation of intestine,Unspecified peritonitis,Unspecified pleural effusion,Other and unspecified ovarian cyst,Unspecified essential hypertension,Anemia, unspecified
Malign neopl ovary,Perforation of intestine,Peritonitis NOS,Pleural effusion NOS,Ovarian cyst NEC/NOS,Hypertension NOS,Anemia NOS
Admission Date:  [**2146-11-18**]     Discharge Date:  [**2146-11-24**]

Date of Birth:   [**2089-7-24**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  Patient is a 57-year-old
African-American woman with hypertension who presents to the
Emergency Room with severe abdominal pain.  The patient
describes shoveling snow yesterday and the shovel got caught
and hit her in the lower abdomen with forceful blow.  Pain
has worsened since that time, and now involves the entire
abdomen without radiation, increased pain with movement.  No
nausea, vomiting.  She has had a fever to 102, now extremely
uncomfortable, passing flatus with normal bowel movements
yesterday, and today has diarrhea on the day of admission.

PAST MEDICAL HISTORY:  Hypertension.

PAST SURGICAL HISTORY:  Total abdominal hysterectomy.

MEDICATIONS:
1. Paxil 50 once a day.
2. Tenormin 50 mg once a day.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Denies tobacco and ethanol use.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 102.8, pulse
141, blood pressure 107/65, respiratory rate 21, O2
saturation is 96% on room air.  In general, ill appearing,
moaning, and panting.  Cardiovascular:  Tachycardic, no
murmurs.  Lungs are clear to auscultation bilaterally.
Abdomen is diffusely tender, positive guarding, nondistended
with no bowel sounds heard.  Extremities warm, 2+ dorsalis
pedis and posterior tibial pulses bilaterally.  Rectal
examination is guaiac negative, normal tone.  Pelvic
examination:  Bimanual within normal limits.

LABORATORIES ON PRESENTATION:  White count 14.9, hematocrit
39.0, platelets 392 with 10 bands.  Chem-7:  Sodium 135,
potassium 2.8, chloride 98, bicarb 21, BUN 23, creatinine
1.3, glucose 126, total bilirubin 0.6, amylase 53, alkaline
phosphatase 112, lipase 12.  Arterial blood gases obtained at
that time:  PH of 7.44, pCO2 of 32, pAO2 of 66, bicarb of 22,
base access of 0, lactate of 2.7.

Chest x-ray showed right effusion, no free air under the
diaphragm.

CT scan of the abdomen showed complex pelvic mass with free
fluid and small effusion.

At that time the patient was admitted to the Trauma Surgery
service after sustaining a blunt injury to her lower abdomen
now with peritonitis and complex pelvic mass on CT scan.  At
that point, differential diagnosis was hematoma, bowel
rupture, and ovarian cancer.  Patient was fluid resuscitated,
given antibiotics, and taken to the operating room for an
exploratory laparotomy.

In the operating room, the patient was found to have ovarian
cancer from gross inspection that was adhesed to the small
bowel.  There are also plaque-like lesions over the right
lobe of the liver.  An ex-lap was performed and the pelvic
mass is removed, ileocecectomy with enterocolic anastomosis
was performed, stapled, and peritoneal washings and liver
biopsy.  Estimated blood loss 1.5 liters.  Patient received 2
units of packed red blood cells in the operating room, and
received 11.5 liters of IV fluid.  Urine output during the
case was 510 cc.  There were no complications.

Patient was taken to the Intensive Care Unit intubated.  In
the Intensive Care Unit, the patient required ongoing volume
resuscitation with a base deficit of 5 secondary to third
spacing.  Ventilatory support was continued until metabolic
acidosis cleared, and the patient was weaned off the vent,
put on CPAP, and extubated on postoperative day #1.  The
patient was continued on Zosyn postoperatively, and on
postoperative day #2, had a white count of 9 and a
temperature of 38.1.

Patient was transferred to the floor on postoperative day #2
in good condition still with nasogastric tube in place
continuing to receive Zosyn.  On postoperative day #3, the
nasogastric tube was discontinued in the afternoon, and her
central venous line was discontinued.  Gyn/Onc was asked to
see and evaluate patient for future therapy.  Pulmonology was
consulted concerning the right pleural effusion in the
context of this complex ovarian mass, their recommendations
were for a P.A. and lateral chest x-ray with right and
lateral decube film which is performed, but it is elected not
to tap the effusion at that time.

Postoperative day #4, the patient was given sips of clears,
which she tolerated well.  Her Foley was discontinued, and
her white count was 8.4.  Her abdominal cultures had grown
out gram-positive rods.  The patient was also seen by Medical
Oncology, who favored not tapping the pleural effusion
because it would not change the current management, and they
would await the final pathology and complete staging after
the surgery, and discuss this with her as an outpatient.

On postoperative day #4, the patient finished her five day
course of Zosyn, still did not have any bowel movements or
flatus at that point, and was continued on sips.

Postoperative day #6, patient passed gas and quickly advanced
and tolerated a house diet, and discharged to home on
[**2146-11-24**].




                          [**Name6 (MD) 19851**] [**Name8 (MD) 19852**], M.D.  [**MD Number(1) 19853**]

Dictated By:[**Last Name (NamePattern1) 7241**]

MEDQUIST36

D:  [**2147-2-6**]  14:48
T:  [**2147-2-7**]  05:42
JOB#:  [**Job Number 97621**]
{'Malignant neoplasm of ovary,Perforation of intestine,Unspecified peritonitis,Unspecified pleural effusion,Other and unspecified ovarian cyst,Unspecified essential hypertension,Anemia, 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: 

PRESENT ILLNESS: Patient is a 57-year-old
African-American woman with hypertension who presents to the
Emergency Room with severe abdominal pain.  The patient
describes shoveling snow yesterday and the shovel got caught
and hit her in the lower abdomen with forceful blow.  Pain
has worsened since that time, and now involves the entire
abdomen without radiation, increased pain with movement.  No
nausea, vomiting.  She has had a fever to 102, now extremely
uncomfortable, passing flatus with normal bowel movements
yesterday, and today has diarrhea on the day of admission.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Denies tobacco and ethanol use. 

### Response:
{'Malignant neoplasm of ovary,Perforation of intestine,Unspecified peritonitis,Unspecified pleural effusion,Other and unspecified ovarian cyst,Unspecified essential hypertension,Anemia, unspecified'}
