CHIEF COMPLAINT: Nausea and vomiting

PRESENT ILLNESS: Ms. [**Known lastname 5796**] is a 74 yo G3P3 scheduled for TAH/BSO, debulking on
[**8-10**]
presenting to the ED with N/V after initiating her bowel prep
yesterday. She used approximately 1.5 of the 3 bottles of prep,
and since then has had continuous N/V of brown, coffee-grounds
emesis. She also reports diarrhea per the bowel prep, but denies
any blood in her stool; she has generalized mild abdominal
discomfort but denies specific areas of more severe pain.
Otherwise, she has had no significant changes to her health
since she saw Dr. [**Last Name (STitle) 5797**] in the office, and denies fevers and
chills, or any history of gastric ulcer, GERD, or GI bleeding.
She is passing flatus; uses laxatives at baseline for
constipation.

MEDICAL HISTORY: OB/GYNHx:
- PCOS
- G3P3, SVD x 3

MEDICATION ON ADMISSION: 1.  Plavix.
2.  Aspirin.
3.  Prednisone.  She has been on prednisone for approximately
one
month since her diagnosis of polymyalgia rheumatica and is
currently tapering.
4.  Felodipine.
5.  Lasix.
6.  Metoprolol.
7.  Alphagan eyedrops.
8.  Flaxseed.
9.  Calcium and vitamin D.
10.  Vicodin p.r.n. pain.
11.  Simvastatin.

ALLERGIES: Albuterol

PHYSICAL EXAM: On admission:
Vitals - T:97.4  BP:130/60  HR:92  RR:16  O2sat:100% r/a
General: NAD, appears mildly uncomfortable, vomits
intermittently
CV: RRR
Lungs: CTAB
Abdomen: faint bowel sounds present, significantly distended,
dull to percussion, diffuse discomfort with palpation but no
pain, no rebound/guarding
Ext: 2+ edema to mid-calf b/l, NT
Pelvic deferred in ED.

FAMILY HISTORY: Negative for ovarian, colon cancer, uterine cancer.  Paternal
grandmother had breast cancer but was alive to her mid 90s.

SOCIAL HISTORY: retired nurse, former 1.5 PPD smoker, quit >10 years ago, rare
alcohol use, denies using other drugs
Malignant neoplasm of peritoneum, unspecified,Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure with lesion of tubular necrosis,Gastroesophageal laceration-hemorrhage syndrome,Severe sepsis,Acute diastolic heart failure,Other specified intestinal obstruction,Malignant ascites,Candidal esophagitis,Unspecified pleural effusion,Drug induced neutropenia,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Polymyalgia rheumatica,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Helicobacter pylori [H. pylori]
Mal neo peritoneum NOS,E coli septicemia,Acute respiratry failure,Septic shock,Food/vomit pneumonitis,Ac kidny fail, tubr necr,Mallory-weiss syndrome,Severe sepsis,Ac diastolic hrt failure,Intestinal obstruct NEC,Malignant ascites,Candidal esophagitis,Pleural effusion NOS,Drug induced neutropenia,Adv eff antineoplastic,Gstr/ddnts NOS w/o hmrhg,Polymyalgia rheumatica,Hypertension NOS,Hyperlipidemia NEC/NOS,Status-post ptca,Helicobacter pylori
Admission Date:  [**2117-8-9**]              Discharge Date:   [**2117-8-30**]

Date of Birth:  [**2042-9-7**]             Sex:   F

Service: MEDICINE

Allergies:
Albuterol

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
Nausea and vomiting

Major Surgical or Invasive Procedure:
Paracentesis

History of Present Illness:
Ms. [**Known lastname 5796**] is a 74 yo G3P3 scheduled for TAH/BSO, debulking on
[**8-10**]
presenting to the ED with N/V after initiating her bowel prep
yesterday. She used approximately 1.5 of the 3 bottles of prep,
and since then has had continuous N/V of brown, coffee-grounds
emesis. She also reports diarrhea per the bowel prep, but denies
any blood in her stool; she has generalized mild abdominal
discomfort but denies specific areas of more severe pain.
Otherwise, she has had no significant changes to her health
since she saw Dr. [**Last Name (STitle) 5797**] in the office, and denies fevers and
chills, or any history of gastric ulcer, GERD, or GI bleeding.
She is passing flatus; uses laxatives at baseline for
constipation.

She initially was referred to Dr. [**Last Name (STitle) 5797**] because of abdominal
distension and CT notable for omental thickening and stranding,
large ascites, and an enlarged pelvic lymph node, 1.3cm.

In the ED she has been started on IVF and has received a dose of
Zofran, but is not feeling much better and is continuing to
intermittently vomit small amounts of coffee-grounds emesis.

Past Medical History:
OB/GYNHx:
- PCOS
- G3P3, SVD x 3

MedHx:
- polymyalgia rheumatica
- hypertension
- coronary artery disease s/p stent
- hyperlipidemia

SurgHx:
- cardiac cath
- tonsillectomy
- bilateral knee replacements

Social History:
retired nurse, former 1.5 PPD smoker, quit >10 years ago, rare
alcohol use, denies using other drugs


Family History:
Negative for ovarian, colon cancer, uterine cancer.  Paternal
grandmother had breast cancer but was alive to her mid 90s.


Physical Exam:
On admission:
Vitals - T:97.4  BP:130/60  HR:92  RR:16  O2sat:100% r/a
General: NAD, appears mildly uncomfortable, vomits
intermittently
CV: RRR
Lungs: CTAB
Abdomen: faint bowel sounds present, significantly distended,
dull to percussion, diffuse discomfort with palpation but no
pain, no rebound/guarding
Ext: 2+ edema to mid-calf b/l, NT
Pelvic deferred in ED.

Pelvic in office:
External genitalia unremarkable.  Vaginal mucosa smooth.  Cervix
is smooth.  On rectovaginal exam, mobile uterus is appreciated,
some irregularity consistent with mass is appreciated posterior
to the uterus in the adnexa.


Pertinent Results:
Labs on Admission:
.
[**2117-8-9**] 03:40AM   PT-11.3 PTT-24.2 INR(PT)-0.9
[**2117-8-9**] 03:40AM   PLT COUNT-348
[**2117-8-9**] 03:40AM   WBC-13.5* RBC-4.72 HGB-14.9 HCT-41.0 MCV-87
MCH-31.5 MCHC-36.3* RDW-15.9*
[**2117-8-9**] 03:40AM   NEUTS-94.9* LYMPHS-2.4* MONOS-2.5 EOS-0
BASOS-0.2
[**2117-8-9**] 03:40AM   GLUCOSE-213* UREA N-68* CREAT-2.4*
SODIUM-132* POTASSIUM-4.2 CHLORIDE-84* TOTAL CO2-32 ANION GAP-20
[**2117-8-9**] 03:40AM   CALCIUM-9.5 PHOSPHATE-5.3*# MAGNESIUM-4.3*
[**2117-8-9**] 08:00AM   ALT(SGPT)-38 AST(SGOT)-30 ALK PHOS-109* TOT
BILI-0.7
.
Pathology:
[**2117-8-10**] Peritoneal fluid:
Positive for malignant cells, consistent with adenocarcinoma.
Note: The neoplastic cells are immunoreactive for WT-1, EMA,
[**Last Name (un) **]-31, CK AE1/AE3, CK7. They are negative for calretinin, CEA
and CK20. P53 shows scattered nuclear staining (equivocal).

[**2117-8-10**] Paracentesis: POSITIVE FOR MALIGNANCY consistent with
adenocarcinoma.

.
Imaging:
[**2117-8-9**] KUB Upright: Almost gasless abdomen which could
represent known ascites. Limited assessment of bowel, but no
definitive evidence of small bowel obstruction.
.
[**2117-8-9**] CXR: No acute intrathoracic process. Hazy density
throughout the
visualized upper abdomen is likely due to known ascites.
.
[**2117-8-9**] Renal US: 1. Mild cortical thinning compatible with
atrophy but no evidence of hydronephrosis or stones. 2. Moderate
abdominal ascites.
.
[**2117-8-9**] LENIs: No evidence of deep venous thrombosis of the
bilateral lower extremities.
.
[**2117-8-12**] KUB: 1. Nonspecific bowel gas pattern. No evidence of
obstruction, ileus, or free air in the abdomen. 2. Retrocardiac
density possibly representing LLL atelectasis. Would suggest CXR
to better evaluate.
.
[**2117-8-14**] KUB: Generalized haziness over the abdomen suggests
ascites. Again seen are non-dilated loops of small bowel with
air-fluid levels. Some gas is seen in the hepatic flexure, but
overall there is paucity of bowel gas in the colon. This is a
nonspecific bowel gas pattern and followup is recommended.
.
[**2117-8-20**] Portable Ab: 1. No evidence of obstruction. 2. NG tube
with tip overlying the stomach. 3. Ascites.
.
[**2117-8-20**] Portable CXR: INDICATION: Respiratory failure
post-central line placement. FINDINGS: Comparison to a
radiograph performed five hours prior. The new right internal
jugular central venous catheter is in satisfactory position with
the distal tip projected over the lower SVC. Position of the
nasogastric and endotracheal tubes and right-sided peripherally
inserted central catheter are unchanged and satisfactory.
There is no evidence of pneumothorax, allowing for the
limitations of this supine radiograph. Moderately severe
interstitial pulmonary edema, cardiomegaly and small bilateral
pleural effusions are stable. bliteration
of the left medial hemidiaphragm is unchanged and suggests left
lower lobe
atelectasis. IMPRESSION: Satisfactory position of newly inserted
right internal jugular catheter with no evidence of
pneumothorax. Stable moderately severe interstitial pulmonary
edema. Satisfactory position
of endotracheal and nasogastric tubes and peripherally inserted
central venous catheter.

[**2117-8-23**] Portable Ab: 1. Non-specific bowel gas pattern with no
definite evidence of obstruction. 2. NG tube with its tip
overlying the stomach.
3. Findings compatible with ascites.
.
[**2117-8-25**] Portabl CXR: IMPRESSION: AP chest compared to [**8-24**] at
6:23 a.m.: Endotracheal tube ends at the thoracic inlet in
standard placement. Left subclavian line tip projects over the
mid SVC and nasogastric tube passes to the upper stomach. Mild
interstitial pulmonary edema may have improved slightly, small
left pleural effusion is stable. Right pleural effusion is
minimal, if any. Heart size normal. Mediastinal veins are normal
caliber.  No pneumothorax.
.
[**2117-8-26**] Abdomen supine: 1. Limited exam secondary to ascites. No
evidence of dilated loops of bowel. 2. Transverse colon
displaced inferiorly, question enlarged liver.
.
[**2117-8-27**] Ab US: 1. Non-distended gallbladder, with no evidence of
stones, sludge, or wall thickening. There is no evidence of
cholecystitis.
2. No focal hepatic lesions or intrahepatic biliary ductal
dilatation
detected. 3. The CBD is normal in caliber, measuring 4 mm. 4.
Large amount of ascites, demonstrated on prior ultrasound
examinations.
.
[**2117-8-28**] Renal US: 1. Extremely limited scan; however, no evidence
of hydronephrosis. 2. Perinephric space difficult to evaluate
due to bowel gas and large ascites. 3. Large amount of ascites.
.
[**2117-8-30**] Portable CXR: FINDINGS: In comparison with the study of
[**8-29**], there are slightly lower lung volumes but otherwise little
change. Continued enlargement of the cardiac silhouette with
some element of increased pulmonary venous pressure in a patient
with relatively low lung volumes. Monitoring and support devices
remain in place.


Brief Hospital Course:
Ms. [**Known lastname 5796**] was admitted to the gyn oncology service on [**8-9**].
Transfer to the medical oncology service took place on [**8-16**] for
chemotherapy.  Course will be reviewed by system:

# Cardiovascular:  She was continued on her home
anti-hypertensives and statin.  She was cardiovascularly stable
throughout her hospitalization

# Respiratory:  On admission she had a chest x-ray which was
clear without effusion or edema.  The following day she
developed an oxygen requirement.  Repeat chest x-ray showed
significant pulmonary edema.  She was started on IV lasix which
was titrated to her oxygen requirement.

# GI:  In the ED she had a gastric lavage, which cleared the
coffee grounds with 300 cc of fluid.  She was seen by GI who
preformed an EGD.  Their full report is in OMR.  Briefly her
study was significant for diffuse gastritis and esophagitis
without active bleeding.  Her hematocrit was stable.  Her H.
pylori was positive and GI biopsy revealed rare yeast concerning
for [**Female First Name (un) **] esophagitis.  She had no further upper GI bleeding
during this admission although she developed nausea and vomiting
on [**8-13**].  She was made NPO as there was concern of SBO secondary
to tumor obstruction.

# Renal: On admission, she was noted to be in acute renal
failure with a creatinine of 2.4.  A renal consult was called.
In their opinion, she had acute tubular necrosis on microscopic
urine exam.  She was given gentle fluids and her creatinine
decreased appropriately.  She was re-started on lasix as
described above.

# Oncology: She had a paracentesis with removal of 2L of ascites
on [**8-10**]. Cytology was inconclusive and she underwent repeat
paracentesis on [**8-12**] at which time 4L was removed.  Cytology at
this time confirmed malignant cells. She was given chemotherapy
on [**2117-8-17**] at which time she was showing signs of mild volume
overload, with trace to 1+ pitting dependent edema. She was
given prophylaxis for and monitored for tumor lysis syndrome and
her kidney function remained stable. She became profoundly
nauseated the day after chemotherapy, first with bileous emesis
and ultimately with bloody emesis. She also became significantly
volume overloaded in the setting of aggressive hydration with
bicarbonate, with portable CXR showing significant pulmonary
edema and her clinical exam showing substantial third spacing.

# Hematology: She had bilateral LENIs on admission which were
negative.  She received albumin on [**8-10**] and [**8-12**].

================
ICU Course: [**8-19**]
Patient was transferred to the ICU for respiratory distress from
increased pulmonary edema and an aspiration event.

# Respiratory Failure: Upon transfer, the patient was intubated
for hypoxemic respiratory failure. Spontaneous breathing trials
were completed, however mental status remained a barrier to
extubation. She failed multiple attempts to wean her to CPAP/PS
and thus remained on CMV until she was extubated according to
the family's wishes on [**2117-8-30**], made CMO, and started on a
morphine drip.

# Sinus arrest: The day of expiring, she had episodes of sinus
arrest with reflexive tachycardia and hypotension. Cardiology
deemed that the episodes were likely vagally induced - from
common vagal triggers, including suctioning and ventalator
manipulation - and recommended against emergent temporary wire
in the setting of her longterm prognosis.

# Hypotension / Sepsis / Lactic acidosis: The patient became
hypotensive on admission to the [**Hospital Unit Name 153**], requiring goal directed
therapy, including blood pressure supporting medications and
aggressive intravascular repletion with crystalloid and pRBCs.
Blood cultures grew gram negative rods (E.Coli). The patient was
treated with broad spectrum antibiotics for concern for sepsis
with Vanc/Cefepime/Flagyl as well as stress dose steroids in the
setting of known low dose steroids for polymyalgia rheumatica.
Patient was able to be weaned off vasopressors. Patient also had
elevated lactic acid, peaking at 5.3, which was initially
concerning for sepsis, however after resolution of sepsis,
lactic acidemia remained, with a nadir of 1.4. It was thought
that this was due to her intra-abdominal malignancy.

# Acute renal failure: UOP and renal function improved with goal
directed therapy.

# Transaminitis: Presented to the [**Hospital Unit Name 153**] with a mild transaminitis
that resolved after goal directed therapy.

# Nausea / bloody emesis: Transferred to the [**Hospital Unit Name 153**] following 36
hours of substantial nausea and vomiting following chemotherapy.
Prior to transfer, she was noted to have bloody emesis thought
to be due to [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 329**] [**Doctor Last Name **] tear. In the [**Hospital Unit Name 153**], the nausea and
emesis abated.

# SBO: Transferred to the [**Hospital Unit Name 153**] with a known obstruction of
cryptogenic origin. Multiple abdominal images were negative for
frank obstruction, but throughout the [**Initials (NamePattern4) 228**] [**Last Name (NamePattern4) 153**] course, the
patient did not have a significant bowel movement despite an
aggressive, progressive bowel regimen. It was thought that the
patient's constipation was due to mass effect from her primary
peritoneal cancer.

Medications on Admission:
1.  Plavix.
2.  Aspirin.
3.  Prednisone.  She has been on prednisone for approximately
one
month since her diagnosis of polymyalgia rheumatica and is
currently tapering.
4.  Felodipine.
5.  Lasix.
6.  Metoprolol.
7.  Alphagan eyedrops.
8.  Flaxseed.
9.  Calcium and vitamin D.
10.  Vicodin p.r.n. pain.
11.  Simvastatin.

Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired
{'Malignant neoplasm of peritoneum, unspecified,Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure with lesion of tubular necrosis,Gastroesophageal laceration-hemorrhage syndrome,Severe sepsis,Acute diastolic heart failure,Other specified intestinal obstruction,Malignant ascites,Candidal esophagitis,Unspecified pleural effusion,Drug induced neutropenia,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Polymyalgia rheumatica,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Helicobacter pylori [H. pylori]'}


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: Nausea and vomiting

PRESENT ILLNESS: Ms. [**Known lastname 5796**] is a 74 yo G3P3 scheduled for TAH/BSO, debulking on
[**8-10**]
presenting to the ED with N/V after initiating her bowel prep
yesterday. She used approximately 1.5 of the 3 bottles of prep,
and since then has had continuous N/V of brown, coffee-grounds
emesis. She also reports diarrhea per the bowel prep, but denies
any blood in her stool; she has generalized mild abdominal
discomfort but denies specific areas of more severe pain.
Otherwise, she has had no significant changes to her health
since she saw Dr. [**Last Name (STitle) 5797**] in the office, and denies fevers and
chills, or any history of gastric ulcer, GERD, or GI bleeding.
She is passing flatus; uses laxatives at baseline for
constipation.

MEDICAL HISTORY: OB/GYNHx:
- PCOS
- G3P3, SVD x 3

MEDICATION ON ADMISSION: 1.  Plavix.
2.  Aspirin.
3.  Prednisone.  She has been on prednisone for approximately
one
month since her diagnosis of polymyalgia rheumatica and is
currently tapering.
4.  Felodipine.
5.  Lasix.
6.  Metoprolol.
7.  Alphagan eyedrops.
8.  Flaxseed.
9.  Calcium and vitamin D.
10.  Vicodin p.r.n. pain.
11.  Simvastatin.

ALLERGIES: Albuterol

PHYSICAL EXAM: On admission:
Vitals - T:97.4  BP:130/60  HR:92  RR:16  O2sat:100% r/a
General: NAD, appears mildly uncomfortable, vomits
intermittently
CV: RRR
Lungs: CTAB
Abdomen: faint bowel sounds present, significantly distended,
dull to percussion, diffuse discomfort with palpation but no
pain, no rebound/guarding
Ext: 2+ edema to mid-calf b/l, NT
Pelvic deferred in ED.

FAMILY HISTORY: Negative for ovarian, colon cancer, uterine cancer.  Paternal
grandmother had breast cancer but was alive to her mid 90s.

SOCIAL HISTORY: retired nurse, former 1.5 PPD smoker, quit >10 years ago, rare
alcohol use, denies using other drugs 

### Response:
{'Malignant neoplasm of peritoneum, unspecified,Septicemia due to escherichia coli [E. coli],Acute respiratory failure,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure with lesion of tubular necrosis,Gastroesophageal laceration-hemorrhage syndrome,Severe sepsis,Acute diastolic heart failure,Other specified intestinal obstruction,Malignant ascites,Candidal esophagitis,Unspecified pleural effusion,Drug induced neutropenia,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Polymyalgia rheumatica,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Helicobacter pylori [H. pylori]'}
