CHIEF COMPLAINT: Hemetemesis

PRESENT ILLNESS: Mr. [**Known lastname 6955**] is a 68 year old male who was diagnosed with
esophageal cancer and underwent He underwent concurrent
chemoradiation therapy with cisplatin and 5-FU and radiation
therapy under Dr. [**Last Name (STitle) 12354**].  He has undergone
post-treatment imaging with a PET scan that shows two foci of
uptake in the distal esophagus with no evidence of distant
disease on this study.  He is known to have a lytic lesion in
T11
and the day after our visit, underwent an MRI scan, which showed
no evidence of metastatic disease to the spine. A CT angiogram
was done [**10-3**] in light of his CAD This study showed no
atherosclerotic disease within
the celiac axis or gastroepiploic artery.  Finally, has also
undergone a coronary catheterization on [**12-3**].  This study
showed normal LV function with an occluded right coronary and
60%
mid LAD lesion. Based on his symptoms and imaging he was
admitted to the hospital for surgical resection.

MEDICAL HISTORY: PMH: HTN, HL, remote tobacco use, PVD, CAD, h/o MI in ([**2160**])

MEDICATION ON ADMISSION: metop tartrate 25", nortriptyline 20', omep 40 qam + 20qpm,
lucentis, lorazepam 0.5 q6h prn, citalopram 20', diltiazem ER
240', IMDUR ER 30', NTG 0.4 prn, crestor 40', MVI

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: BP: 149/69. Heart Rate: 60. Weight: 194.3. Height: 66.5. BMI:
30.9. Temperature: 98.1. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 100.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Cigarettes: [ ] never  [x] ex-smoker   [ ] current Pack-yrs:____
                       quit: _1882_____
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [x] Married  [ ] Single
Lives:          [ ] Alone    [x] w/ family  [ ] Other:
Malignant neoplasm of other specified part of esophagus,Pneumonia, organism unspecified,Other respiratory complications,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Atrial fibrillation,Other lymphedema,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status
Mal neo esophagus NEC,Pneumonia, organism NOS,Respiratory comp NEC,Abn react-anastom/graft,Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Esophageal reflux,Gstr/ddnts NOS w/o hmrhg,Atrial fibrillation,Other lymphedema,History of tobacco use,Status-post ptca
Name:  [**Known lastname 1799**],[**Known firstname **] B              Unit No:   [**Numeric Identifier 6602**]

Admission Date:  [**2178-12-30**]              Discharge Date:   [**2179-1-8**]

Date of Birth:  [**2110-2-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1999**]
Addendum:
Note additional doscharge meds

octreotide acetate  100 mcg/mL Solution  Sig:  One Hundred (100)
mcg Injection Q 12H (Every 12 Hours).

loperamide  2 mg Capsule  Sig:  One (1) Capsule PO QID (4 times
a day) as needed for diarrhea.

albuterol sulfate  2.5 mg /3 mL (0.083 %) Solution for
Nebulization  Sig:  One (1) Inhalation Q6H (every 6 hours).


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 2075**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2000**] MD [**MD Number(2) 2001**]

Completed by:[**2179-1-8**]

Admission Date:  [**2178-12-30**]              Discharge Date:   [**2179-1-8**]

Date of Birth:  [**2110-2-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Hemetemesis

Major Surgical or Invasive Procedure:
[**2178-12-30**]
1. Minimally-invasive esophagectomy with intrathoracic
   anastomosis.
2. Buttressing of intrathoracic anastomosis with
   pericardial fat.
3. Laparoscopic jejunostomy.
4. Esophagogastroduodenoscopy


History of Present Illness:
Mr. [**Known lastname 6955**] is a 68 year old male who was diagnosed with
esophageal cancer and underwent He underwent concurrent
chemoradiation therapy with cisplatin and 5-FU and radiation
therapy under Dr. [**Last Name (STitle) 12354**].  He has undergone
post-treatment imaging with a PET scan that shows two foci of
uptake in the distal esophagus with no evidence of distant
disease on this study.  He is known to have a lytic lesion in
T11
and the day after our visit, underwent an MRI scan, which showed
no evidence of metastatic disease to the spine. A CT angiogram
was done [**10-3**] in light of his CAD This study showed no
atherosclerotic disease within
the celiac axis or gastroepiploic artery.  Finally, has also
undergone a coronary catheterization on [**12-3**].  This study
showed normal LV function with an occluded right coronary and
60%
mid LAD lesion. Based on his symptoms and imaging he was
admitted to the hospital for surgical resection.


Past Medical History:
PMH: HTN, HL, remote tobacco use, PVD, CAD, h/o MI in ([**2160**])

PSH: Coronary angioplasty x2 [**2162**], angioplasty in [**2159**],
tonsillectomy as a child. bilateral CEA


Social History:
Cigarettes: [ ] never  [x] ex-smoker   [ ] current Pack-yrs:____
                       quit: _1882_____
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [x] Married  [ ] Single
Lives:          [ ] Alone    [x] w/ family  [ ] Other:


Family History:
non contributory

Physical Exam:
BP: 149/69. Heart Rate: 60. Weight: 194.3. Height: 66.5. BMI:
30.9. Temperature: 98.1. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 100.

GENERAL        [x] All findings normal
[ ] WN/WD  [ ] NAD  [ ] AAO  [ ] abnormal findings:

HEENT          [x] All findings normal
[ ] NC/AT   [ ] EOMI   [ ] PERRL/A   [ ] Anicteric
[ ] OP/NP mucosa normal     [ ] Tongue midline
[ ] Palate symmetric  [ ] Neck supple/NT/without mass
[ ] Trachea midline [ ] Thyroid nl size/contour
[ ] Abnormal findings:

RESPIRATORY    [x] All findings normal
[ ] CTA/P     [ ] Excursion normal     [ ] No fremitus
[ ] No egophony    [ ] No spine/CVAT
[ ] Abnormal findings:

CARDIOVASCULAR [x] All findings normal
[ ] RRR    [ ] No m/r/g    [ ] No JVD   [ ] PMI nl  [ ] No edema
[ ] Peripheral pulses nl    [ ] No abd/carotid bruit
[ ] Abnormal findings:

GI             [x] All findings normal
[ ] Soft    [ ] NT   [ ] ND  [ ] No mass/HSM   [ ] No hernia
[ ] Abnormal findings:

GU             [x] Deferred  [ ] All findings normal
[ ] Nl genitalia    [ ] Nl pelvic/testicular exam    [ ] Nl DRE
[ ] Abnormal findings:

NEURO          [x] All findings normal
[ ] Strength intact/symmetric    [ ] Sensation intact/ symmetric
[ ] Reflexes nl     [ ] No facial asymmetry [ ] Cognition intact
[ ] Cranial nerves intact   [ ] Abnormal findings:

MS             [x] All findings normal
[ ] No clubbing   [ ] No cyanosis   [ ] No edema   [ ] Gait nl
[ ] No tenderness  [ ] Tone/align/ROM nl   [ ] Palpation nl
[ ] Nails nl   [ ] Abnormal findings:

LYMPH NODES    [x] All findings normal
[ ] Cervical nl      [ ] Supraclavicular nl     [ ] Axillary nl
[ ] Inguinal nl   [ ] Abnormal findings:

SKIN           [x] All findings normal
[ ] No rashes/lesions/ulcers
[ ] No induration/nodules/tightening     [ ] Abnormal findings:

PSYCHIATRIC    [x] All findings normal
[ ] Nl judgment/insight    [ ] Nl memory   [ ] Nl mood/affect
[ ] Abnormal findings:


Pertinent Results:
[**2178-12-30**] 01:04PM   HGB-12.0* calcHCT-36 O2 SAT-98
[**2178-12-30**] 12:45PM   GLUCOSE-164* SODIUM-137 POTASSIUM-4.4
CHLORIDE-102 TOTAL CO2-26 ANION GAP-13
[**2178-12-30**] 12:45PM   CALCIUM-8.9 MAGNESIUM-1.9
[**2178-12-30**] 06:26PM   WBC-12.7*# RBC-3.75* HGB-11.2* HCT-32.6*
MCV-87 MCH-30.0 MCHC-34.5 RDW-18.3*

Pathology
SPECIMEN SUBMITTED: Esophagogastrectomy, Level 7 lymph nodes,
Gastric donut, Esophageal donut, Fundus.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2178-12-30**] [**2178-12-30**] [**2179-1-4**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 7001**]/tk??????
Previous biopsies:    [**-9/4552**]  Slides submitted for
consultation.
  [**Numeric Identifier 36895**]  CAROTID PLAQUE/bq/ip.
  [**-1/4166**]  CAROTID PLAQUE/tj/jd.

DIAGNOSIS:

I. Esophagus, esophagogastrectomy (A-AE):



          1. Residual intramucosal adenocarcinoma with adjuvant
therapy
effect, arising in a background of Barrett's esophagus with
dysplasia; see synoptic report.

          2. Five lymph nodes with no carcinoma seen (0/5;
majority of periesophageal and perigastric soft tissue is
submitted for lymph node evaluation).

 II. Level 7 lymph nodes, excisional biopsy (AF-AG):



          Twelve lymph nodes with no carcinoma seen (0/12).

 III. Gastric donut (AH):

 Gastric corpus segment with prominent cautery effect and no
carcinoma seen.

IV. Esophageal donut (AI-AJ):

 Squamous esophageal segment with no carcinoma seen.

V. Fundus, segmental resection (AK-[**Doctor Last Name **]):

 Gastric corpus segment with mild chronic active gastritis and
focal reactive changes, consistent with adjuvant therapy effect.


No carcinoma seen.

[**2179-1-2**] CTA :
1. No evidence for pulmonary embolus.
2. Gastric pull-through with no evidence for intrathoracic
abscess. There
is, however multiloculated regions of air identified along the
oblique and
horizontal fissures with a small less than 10% dependent
pneumothorax
identified on the right side.
3. Bilateral multifocal infiltrates within both lungs with
compressive
atelectasis noted at the lower lobes bilaterally. Findings may
be as a result of sequelae of infection.

[**2179-1-4**]
CXR :Region of consolidation in the axillary left upper lobe
which developed between [**1-2**] and [**1-3**] is still
present as are larger regions of heterogeneous opacification in
both lower lungs, all strongly suggestive of widespread
pneumonia, particularly the findings in the left lung since
esophagectomy typically entails considerable right basal
atelectasis. Right pleural tube in place. No pneumothorax or
appreciable pleural effusion.  Right subclavian infusion port
ends in the low SVC. Midline drain still in place. No
pneumothorax

[**2179-1-5**]
Ba swallow:
No leak,some expected holdup at the pylorus but without
obstruction.

[**2179-1-7**] 2:07 pm STOOL     CONSISTENCY: SOFT      Source: Stool.


                            **FINAL REPORT [**2179-1-8**]**

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2179-1-8**]):
      Feces negative for C.difficile toxin A & B by EIA.
           (Reference Range-Negative).




Brief Hospital Course:
Mr. [**Known lastname 6955**] was admitted to the hospital and taken to the
Operating Room where he underwent a minimally invasive
esophagectomy (see formal op note for details).  He tolerated
the procedure well and returned to the ICU in stable condition.
His pain was initially controlled with an epidural catheter and
he maintained stable hemodynamics.

His tube feedings were started on post op day #0 with replete
and unfortunately he had some cloudy drainage from his JP drain
by post op day 3 along with an elevated triglyceride level
indicating a thoracic duct leak.  At that point he was changed
to elemental feedings which he tolerated well and his JP
drainage cleared.

His pain got a bit worse and it was determined that the epidural
was not functioning therefore it was replaced. In the interim he
desaturated and a CTA was done which ruled out a PE.  He did
have some infiltrates on xray and therefore underwent vigorous
pulmonary toilet including chest PT and incentive spirometry.
His highest WBC was 11K on [**2179-1-2**].  He was started on
Vancomycin and Zosyn and gradually improved without any other
episodes of desaturation or fevers.  His epidural was eventually
removed and his pain was controlled with liquid oxycodone and
Tylenol.

Following transfer to the Surgical floor he had a barium swallow
done which confirmed no anastomotic leak and he subsequently
began a liquid diet.  Another trial of tube feedings with
Replete was done but unfortunately his JP drainage again became
cloudy.  Currently the plan is for him to continue feedings with
an elemental formula (Vivonex) and only clear liquids orally
until he is reevaluated by Dr. [**First Name (STitle) **].  He will also keep his JP
drain in place to gravity. His dressing should be changed daily
and prn as he has had a large amount of serous fluid draining
from around the drain site.

On [**2179-1-7**] he developed several episodes of diarrhea and a stool
for c difficile was sent which was negative.  His IV antibiotics
were stopped  and he was treated with Imodium with some effect.
His WBC was 10K and he remains afebrile.

The Physical Therapy service worked with him on many occasions
to help improve his mobility and increase his endurance.  He is
gradually improving and starting to ambulate independently.

After a long hospital stay he was discharged to rehab on [**2179-1-8**]
and will follow up with Dr. [**First Name (STitle) **] next week.


Medications on Admission:
metop tartrate 25", nortriptyline 20', omep 40 qam + 20qpm,
lucentis, lorazepam 0.5 q6h prn, citalopram 20', diltiazem ER
240', IMDUR ER 30', NTG 0.4 prn, crestor 40', MVI


Discharge Medications:
1. multivitamin     Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
2. nortriptyline 10 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
3. diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
4. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. oxycodone 5 mg/5 mL Solution Sig: 5-10 mls PO Q4H (every 4
hours) as needed for pain.
Disp:*500 mls* Refills:*0*
8. acetaminophen 650 mg/20.3 mL Solution Sig: Twenty (20) mls PO
Q6H (every 6 hours).
Disp:*500 mls* Refills:*2*
9. isosorbide dinitrate 30 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Tube feedings
Vivonex TEN at 100 mls/hr over 18 hours

Disp 7 boxes

Refills for 3 months
11. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 15289**]

Discharge Diagnosis:
Esophageal cancer
Paroxysmal atrial fibrillation
Thoracic duct leak
Pneumonia


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


Discharge Instructions:
Call Dr. [**Last Name (STitle) **] [**Name (STitle) **] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers greater than 101 or chills
-Increased shortness of breath, cough or chest pain
-Nausea, vomiting
-Increased abdominal pain
-Incision develops drainage
-JP drain will remain in place connected to bulb suction. Empty
daily and record output.  Bring the record with you to your next
appointment with Dr. [**First Name (STitle) **].

Pain
-Oxycodone liquid and tylenol as prescribed
-Take stool softners with narcotics but stop if diarrhea
develops

Activity
-Shower daily. Wash incision with mild soap & water, rinse, pat
dry
-No tub bathing, swimming or hot tub until incision healed
-No driving while taking narcotics
-No lifting greater than 10 pounds until seen
-Walk 4-5 times a day for 10-15 minutes increase to a Goal of 30
minutes daily

Diet:

Tube feeds: Vivonex Full Strength 100 mL cycled from 3pm to 9am

Flush J-tube with water every 8 hours with 10 mls of water,
before and after starting tube feeds and every day at noon.

Clear liquid diet until Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 36896**] liberalization.
Eat small frequent meals. Sit up in chair for all meals and
remain sitting for 30-45 minutes after meals

Daily weights: keep a log bring with you to your appointment

NO CARBONATED DRINKS

Danger signs

Fevers > 101 or chills
Increased shortness of breath, cough or chest pain
Incision develops drainage
Nausea, vomiting (take anti-nausea medication)
Increased abdominal pain

Call if J-tube falls out (save the tube and bring with you to
the hospital to be re-placed) or suture breaks


Followup Instructions:
Department: HEMATOLOGY/ONCOLOGY
When: THURSDAY [**2179-1-14**] at 4:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please report 30 minutes prior to your appointment to the
Radiology Department on the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical
Center for a chest xray.



Completed by:[**2179-1-8**]
{'Malignant neoplasm of other specified part of esophagus,Pneumonia, organism unspecified,Other respiratory complications,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Atrial fibrillation,Other lymphedema,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status'}


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: Hemetemesis

PRESENT ILLNESS: Mr. [**Known lastname 6955**] is a 68 year old male who was diagnosed with
esophageal cancer and underwent He underwent concurrent
chemoradiation therapy with cisplatin and 5-FU and radiation
therapy under Dr. [**Last Name (STitle) 12354**].  He has undergone
post-treatment imaging with a PET scan that shows two foci of
uptake in the distal esophagus with no evidence of distant
disease on this study.  He is known to have a lytic lesion in
T11
and the day after our visit, underwent an MRI scan, which showed
no evidence of metastatic disease to the spine. A CT angiogram
was done [**10-3**] in light of his CAD This study showed no
atherosclerotic disease within
the celiac axis or gastroepiploic artery.  Finally, has also
undergone a coronary catheterization on [**12-3**].  This study
showed normal LV function with an occluded right coronary and
60%
mid LAD lesion. Based on his symptoms and imaging he was
admitted to the hospital for surgical resection.

MEDICAL HISTORY: PMH: HTN, HL, remote tobacco use, PVD, CAD, h/o MI in ([**2160**])

MEDICATION ON ADMISSION: metop tartrate 25", nortriptyline 20', omep 40 qam + 20qpm,
lucentis, lorazepam 0.5 q6h prn, citalopram 20', diltiazem ER
240', IMDUR ER 30', NTG 0.4 prn, crestor 40', MVI

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: BP: 149/69. Heart Rate: 60. Weight: 194.3. Height: 66.5. BMI:
30.9. Temperature: 98.1. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 100.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Cigarettes: [ ] never  [x] ex-smoker   [ ] current Pack-yrs:____
                       quit: _1882_____
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [x] Married  [ ] Single
Lives:          [ ] Alone    [x] w/ family  [ ] Other: 

### Response:
{'Malignant neoplasm of other specified part of esophagus,Pneumonia, organism unspecified,Other respiratory complications,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Atrial fibrillation,Other lymphedema,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status'}
