CHIEF COMPLAINT: GE junction adenocarcinoma

PRESENT ILLNESS: Mrs [**Known lastname 89777**] is very pleasant 77 y/o lady who is s/p laparoscopic
jejunostomy tube placement on [**2152-5-12**] for stage IIIa
adenocarcinoma of the gastroesophageal juction . She is s/p
chemo-radiation therapy [**Month (only) 958**]-[**2152-4-21**]. Received 5  cycles of
carboplatin and taxol, last dose on [**2152-4-24**] and had her last
radiation treatment [**2152-5-3**]. She is currently doing well,
tolerating J tube feedings at night and taking some POs during
the day. She still complains of poor appetite and odynophagia.
She presents for surgical resection.

MEDICAL HISTORY: Esophageal adenocarcinoma
Hypercholesterolemia
Hypertension
Diverticulosis

MEDICATION ON ADMISSION: Medications - Prescription
ATENOLOL -  (Prescribed by Other Provider) - 50 mg Tablet - 1
Tablet(s) by mouth daily
NIFEDIPINE -  (Prescribed by Other Provider) - 30 mg Tablet
Extended Rel 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 Capsule(s) by mouth twice a day
PRAVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vital signs: T 99.3 P 93 BP 126/60 RR 18 02 94% RA

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She is a widow with 2 daughters. [**Name (NI) **] husband passed away of lung
cancer.  She has never smoked, but has been exposed to
secondhand smoking.  Occasional wine drinker.  She is an Italian
and she is a retired seamstress.
Malignant neoplasm of cardia,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Diarrhea
Mal neo stomach cardia,Pleural effusion NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Dvrtclo colon w/o hmrhg,Diarrhea
Admission Date:  [**2152-6-23**]              Discharge Date:   [**2152-7-4**]

Date of Birth:  [**2074-7-30**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
GE junction adenocarcinoma

Major Surgical or Invasive Procedure:
[**2152-6-23**]: OPERATION:
1. EGD.
2. Diagnostic laparoscopy.
3. Laparotomy, total gastrectomy.
4. D2 lymphadenectomy.
5. Roux-en-Y esophagojejunostomy.
6. Feeding jejunostomy.


History of Present Illness:
Mrs [**Known lastname 89777**] is very pleasant 77 y/o lady who is s/p laparoscopic
jejunostomy tube placement on [**2152-5-12**] for stage IIIa
adenocarcinoma of the gastroesophageal juction . She is s/p
chemo-radiation therapy [**Month (only) 958**]-[**2152-4-21**]. Received 5  cycles of
carboplatin and taxol, last dose on [**2152-4-24**] and had her last
radiation treatment [**2152-5-3**]. She is currently doing well,
tolerating J tube feedings at night and taking some POs during
the day. She still complains of poor appetite and odynophagia.
She presents for surgical resection.

Past Medical History:
Esophageal adenocarcinoma
Hypercholesterolemia
Hypertension
Diverticulosis

Social History:
She is a widow with 2 daughters. [**Name (NI) **] husband passed away of lung
cancer.  She has never smoked, but has been exposed to
secondhand smoking.  Occasional wine drinker.  She is an Italian
and she is a retired seamstress.


Family History:
non-contributory

Physical Exam:
Vital signs: T 99.3 P 93 BP 126/60 RR 18 02 94% RA

Constitutional: No acute distress
Neuro: Alert and oriented to person, place and time
Cardiac: Regular rate and rhythm; No murmurs, rubs, gallops
Lungs: Clear to auscultation, bilaterally; no respiratory
distress
Abd: Soft, minimally tender to palpation, non-distended, no
rebound tenderness/ guarding
Wound: Abd midline incision clean, dry, intact. no erythema
Ext: No edema
Neuro: awake, alert oriented


Pertinent Results:
[**2152-7-1**]
CHEST (PORTABLE AP) FINDINGS: Comparison is made to the previous
study from [**2152-6-30**]. There has been decrease in the
left-sided pleural effusion following the thoracentesis. No
pneumothorax is seen. There is a left-sided Port-A-Cath with the
distal tip ends within the brachiocephalic vein as seen on the
previous CT scan. There is a persistent left retrocardiac
opacity. No pneumothoraces are present.

CT CHEST W/CONTRAST & CT ABD & PELVIS WITH CONTRAST:
IMPRESSION: 1. Left peripheral subcapsular fluid collection
exerting mass effect resulting in mild intrahepatic ductal
dilatation. This appearance could reflect hematoma from injury
to the liver from retraction during surgery. Alternatively this
could reflect developing abscess. While replaced left hepatic
artery was ligated for the purpose of gastrectomy this is
unlikely to cause significant ischemic insult given the presence
of in tact portal venous supply.  2. Status post gastrectomy
with Roux-en-Y reconstruction and esophagojejunostomy with
intact anastomoses. 3. Bilateral pleural effusions. 4.
Port-A-Cath with tip terminating in the left brachiocephalic
vein.

[**2152-6-27**]
ESOPHAGUS: IMPRESSION: No evidence of leak or obstruction

[**2152-7-4**] WBC-7.1 RBC-2.75* Hgb-8.3* Hct-26.0 Plt Ct-403
[**2152-7-3**] WBC-8.1 RBC-2.83* Hgb-8.6* Hct-26.8 Plt Ct-381
[**2152-7-2**] WBC-7.3 RBC-2.65* Hgb-8.1* Hct-25.5 Plt Ct-377
[**2152-6-23**] WBC-11.1* RBC-3.31* Hgb-11.2* Hct-31. Plt Ct-207

[**2152-7-4**] Glucose-133* UreaN-15 Creat-0.5 Na-138 K-5.0 Cl-101
HCO3-26
[**2152-7-3**] Glucose-134* UreaN-16 Creat-0.6 Na-140 K-4.6 Cl-102
HCO3-27
[**2152-7-2**] Glucose-133* UreaN-18 Creat-0.5 Na-138 K-4.5 Cl-101
HCO3-24
[**2152-6-23**] Glucose-127* UreaN-24* Creat-0.7 Na-139 K-4.7 Cl-105
HCO3-22
[**2152-7-3**] ALT-81* AST-24 AlkPhos-200* TotBili-0.2
[**2152-7-3**] Calcium-8.5 Phos-2.6* Mg-2.1

[**2152-7-4**] ALT-63* AST-30 AlkPhos-174* TotBili-0.2
[**2152-7-3**] ALT-81* AST-24 AlkPhos-200* TotBili-0.2
[**2152-7-4**] Glucose-133* UreaN-15 Creat-0.5 Na-138 K-5.0 Cl-101
HCO3-26
[**2152-7-2**] ALT-105* AST-23 LD(LDH)-273* AlkPhos-220* TotBili-0.3
[**2152-7-1**] ALT-130* AST-27 LD(LDH)-273* AlkPhos-239* TotBili-0.4

Micro:  [**2152-7-1**] pleura gram 2+PMNs, no orgs. WBC 275 RBC 1875
BC x 6 NGTD
Urine Cx no growth


Brief Hospital Course:
Ms. [**Known lastname 89777**] was taken to the operating room by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
and Dr. [**Last Name (STitle) **] on [**2152-6-23**], where the patient underwent EGD,
diagnostic laparoscopy, laparotomy, total gastrectomy, D2
lymphadenectomy, Roux-en-Y esophagojejunostomy, and feeding
jejunostomy. She was recovered in the TSICU NPO with IVF and NGT
to LCWS. Along with this she had Foley, 2 [**Doctor Last Name 406**] drains on right
left to anastomosis, CT, and epidural.
POD 1 she was transferred to the floor. Below is a system review
of her hospital course:

Neuro/Pain: An epidural was placed preoperatively and dc'd on
[**2152-6-29**]. PCA Dilaudid was dc'd [**2152-6-30**] and switched to Roxicet
via j-tube which was effective in pain control.

Pulm: The patient was extubated in the operating room.
Aggressive pulmonary toilet continued throughout her stay.
Serial chest X-ray's were followed. Her chest tube was dc'd [**6-29**].
A left sided bulb near the anastomosis was dc'd on [**6-30**] (left).

CV: She remained in NSR, hemodynamically stable. On [**6-9**] with ambulating. Her IV metoprolol was then changed to
metoprolol 25 mg po tid. On discharge her home dose atenolol was
restarted. Her HR was stable in the 70's without ectopy.  Blood
pressure 120-140's.  Her home dose nifedipine 30 mg daily was
not restarted.

GI: She remained NPO with IVF for hydration and NGT to LCWS. NGT
was dc'd on [**2152-6-27**] until she passed her barium. Gastrectomy diet
started. Pt tolerated clear liquids.
Tube feedings were started slowly on [**2152-6-27**] at 20 ml/hr, and
advanced to Isosource at 40 ml/hr x 24 hr (goal) on [**2152-6-29**].
Initially the patient was distended but this resolved after BM
[**6-28**].  On [**2152-7-1**] the patient developed diffuse epigastric pain.
A chest/ abdominal CT scan was significant for a left peripheral
subcapsular fluid collection exerting mass effect resulting in
mild intrahepatic ductal dilatation possibly reflecting a
hematoma.  At this time, her LFTs were elevated, but trend ed
downward throughout the remainder of her hospitalization without
intervention and her pain gradually improved.

Renal/GU: Electrolytes were checked and replete. Her renal
function remained within normal range. The Foley was removed
with good urine output.

ID: She had intermittent fevers with no leukocytosis. Pan
cultures were negative to date. A Chest CT and Pelvic CT was
done which showed a Left peripheral subcapsular fluid collection
exerting mass effect resulting in mild intrahepatic ductal
dilatation.

Dispo: PT evaluated the patient and recommended rehab; please
see page 3 for details. She was deemed stable for transfer to
[**Hospital **] Rehab Hospital [**Telephone/Fax (1) 89778**] on [**2152-7-4**]. She will
follow-up with Dr. [**First Name (STitle) **] as an outpatient.


Medications on Admission:
Medications - Prescription
ATENOLOL -  (Prescribed by Other Provider) - 50 mg Tablet - 1
Tablet(s) by mouth daily
NIFEDIPINE -  (Prescribed by Other Provider) - 30 mg Tablet
Extended Rel 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 Capsule(s) by mouth twice a day
PRAVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth daily

Medications - OTC
CALCIUM CARBONATE-VITAMIN D3 -  (Prescribed by Other Provider) -
600 mg-400 unit Tablet - 1 Tablet(s) by mouth twice a day
MULTIVITAMIN -  (Prescribed by Other Provider) -   Tablet - 1
Tablet(s) by mouth daily


Discharge Medications:
1. Roxicet 5-325 mg/5 mL Solution [**First Name (STitle) **]: [**5-30**] ml PO every [**4-26**]
hours as needed for pain.
2. phenol 1.4 % Aerosol, Spray [**Month/Day (3) **]: One (1) Spray Mucous
membrane PRN (as needed) as needed for sore throat.
3. bisacodyl 10 mg Suppository [**Month/Day (3) **]: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
4. docusate sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Ten (10) ml PO twice a
day.
5. acetaminophen 650 mg/20.3 mL Solution [**Month/Day (3) **]: Twenty (20) mL PO
Q6H (every 6 hours) as needed for pain,fever.
6. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve [**Month/Day (3) **]: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.
7. pravastatin 20 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO once a day.
8. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] once a day.
9. atenolol 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day: hold
for HR < 60 SBP < 110.
10. calcium citrate-vitamin D3 500 mg calcium -400 unit Tablet,
Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable PO twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 19504**] of [**Location (un) 30940**] - [**Location (un) 30940**]

Discharge Diagnosis:
Esophageal adenocarcinoma
Hypercholesterolemia
Hypertension
Diverticulosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath
-Difficult or painful swallowing
-Increased abdominal pain, nausea or vomiting (Please give
anti-nausea medications as needed)
-Abdominal incision develops drainage

J-tube: call immediately should tube fall out.
-Flush with 50 mL of water every 8 hours, before and after
starting tube feeds
-NO MEDICATIONS VIA J-Tube

Pain:
-Acetaminophen 650 mg every 8 hours as needed for pain
-Roxicet [**5-30**] mL every 4-6 hours as needed for pain

Activity
-Shower daily. Wash incision with mild soap & water, rinse, pat
dry
-Steri-strips remove in 10 days or sooner should they start to
fall off
-No tub bathing, swimming or hot tubs until incision healed
-Walk 4-5 times a day increase time and distance as tolerates

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD Phone:[**0-0-**]
Date/Time:[**2152-7-13**] 10:30 on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical
Center [**Location (un) 24**]

Chest X-Ray on the [**Location (un) **] Radiology 30 minutes prior to this
appointment



Completed by:[**2152-7-4**]
{'Malignant neoplasm of cardia,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Diarrhea'}


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: GE junction adenocarcinoma

PRESENT ILLNESS: Mrs [**Known lastname 89777**] is very pleasant 77 y/o lady who is s/p laparoscopic
jejunostomy tube placement on [**2152-5-12**] for stage IIIa
adenocarcinoma of the gastroesophageal juction . She is s/p
chemo-radiation therapy [**Month (only) 958**]-[**2152-4-21**]. Received 5  cycles of
carboplatin and taxol, last dose on [**2152-4-24**] and had her last
radiation treatment [**2152-5-3**]. She is currently doing well,
tolerating J tube feedings at night and taking some POs during
the day. She still complains of poor appetite and odynophagia.
She presents for surgical resection.

MEDICAL HISTORY: Esophageal adenocarcinoma
Hypercholesterolemia
Hypertension
Diverticulosis

MEDICATION ON ADMISSION: Medications - Prescription
ATENOLOL -  (Prescribed by Other Provider) - 50 mg Tablet - 1
Tablet(s) by mouth daily
NIFEDIPINE -  (Prescribed by Other Provider) - 30 mg Tablet
Extended Rel 24 hr - 1 Tablet(s) by mouth daily
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 Capsule(s) by mouth twice a day
PRAVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vital signs: T 99.3 P 93 BP 126/60 RR 18 02 94% RA

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She is a widow with 2 daughters. [**Name (NI) **] husband passed away of lung
cancer.  She has never smoked, but has been exposed to
secondhand smoking.  Occasional wine drinker.  She is an Italian
and she is a retired seamstress. 

### Response:
{'Malignant neoplasm of cardia,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Diarrhea'}
