CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 66 year-old man with metastatic lung adenocarcinoma, currently
neutropenic (s/p Navelbine on [**5-4**]), presenting with 1 week of
intermittent RUQ pain and vomiting, found to have acute
gallstone pancreatitis. Transferred to the [**Hospital Unit Name 153**] for evaluation
and management of hypotension.
.
In the ED, initial vs were: pain 8, 100.7, 114, 114/59, 18, 98%
RA. Labs were notable for WBC of 0.5, Cr of 2 (Bl 1.8), and
significant transaminitis (AST 1266, ALT 643, AlkP 333, LDH
1235, T bili 1.5). Lipase was 3360. CT A/P revealed findings
concerning for gallstone pancreatitis with 16mm distal CBD
dilation. Advanced endoscopy was consulted and decided to
perform ERCP in AM. Additionally, sBPs fell to the 70s and
improved to the 90s after a total of 6L NS. Per record, made 280
cc of UOP. Blood cultures were obtained. He was given Vancomycin
and Zosyn. No CVC was placed because he has a port for access.
.
On presentation to the [**Hospital Unit Name 153**] the patient appeared comfortable and
was answering questions appropriately. He confirmed recent
abdominal pain, vomiting, and rigors. Denied hematemesis,
hematochezia, or melena.
.
Review of sytems:
(+) Per HPI, + hx of neuropathy
(-) Denies fever, chills, night sweats. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denied cough, shortness of
breath. Denied chest pain or tightness, palpitations. Denied
diarrhea, constipation. No dysuria. Denied arthralgias or
myalgias or rashes.

MEDICAL HISTORY: Past Medical History:
-Metastatic Lung Cancer
-Chronic Obstructive Pulmonary Disease
-Fe deficiency Anemia
-Erosive Gastritis
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease
-Diverticulosis
-Hypercholesterolemia
-AAA repair
.
Onc Hx (abbreviated)
-LUL lung mass seen on CXR in [**12-8**]?, with multiple small
contralateral metastases seen on following CT
-CT-guided Bx at [**Hospital1 756**] on [**1-8**] showed well-differentiated
adenocarcinoma with acinar and solid features
-Has underwent three different chemotherapuetic regimens and
currently on his 4th- Navelbine (last received on [**2179-5-4**])

MEDICATION ON ADMISSION: (per records; Pt reports he only takes statin, omeprazole)
-Dexamethasone 8 mg [**Hospital1 **] day prior to, on, and after chemo
-Folic acid 1 mg daily
-Lorazepam 1 mg q6 for nausea or insomnia
-Omeprazole 20 mg daily
-Zofran 8 mg q8 PRN nausea
-Oxycodone 5 mg q4h for pain
-Prochlorperazine 10 mg q6h for nausea
-Simvastatin 80 mg daily (in am)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: 98.6, 109/56, 83, 97% RA
General: well-nourished, alert, oriented, no acute distress
HEENT: PERRL, sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear to auscultation anteriorly, no wheezes, rales,
rhonchi
CV: regular rate and rhythm, normal S1 + S2, + SEM best heard at
LUSB, radiating to clavicle and carotids b/l
Abdomen: soft, bowel sounds present, diffuse tenderness with
voluntary guarding to palpation on R side and epigastrium
GU: + foley
Ext: warm, well perfused, trace non-pitting LE edema, clubbed
fingernails
Neuro: moves all extremities, face symmetric, gait not observed

FAMILY HISTORY: -Mother had some type of cancer. No family hx of pancreatitis.

SOCIAL HISTORY: -Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None
Other septicemia due to gram-negative organisms,Acute pancreatitis,Acute kidney failure, unspecified,Cholangitis,Malignant neoplasm of upper lobe, bronchus or lung,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Neutropenia, unspecified,Personal history of tobacco use,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Anemia in neoplastic disease,Other malignant neoplasm without specification of site
Gram-neg septicemia NEC,Acute pancreatitis,Acute kidney failure NOS,Cholangitis,Mal neo upper lobe lung,Chronic kidney dis NOS,Chr airway obstruct NEC,Severe sepsis,Choledocholithiasis NOS,Elev transaminase/ldh,Neutropenia NOS,History of tobacco use,Hy kid NOS w cr kid I-IV,Periph vascular dis NOS,Pure hypercholesterolem,Anemia in neoplastic dis,Malignant neoplasm NOS
Admission Date:  [**2179-5-14**]              Discharge Date:   [**2179-5-20**]

Date of Birth:  [**2112-10-21**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Attending Info 87299**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
ERCP

History of Present Illness:
66 year-old man with metastatic lung adenocarcinoma, currently
neutropenic (s/p Navelbine on [**5-4**]), presenting with 1 week of
intermittent RUQ pain and vomiting, found to have acute
gallstone pancreatitis. Transferred to the [**Hospital Unit Name 153**] for evaluation
and management of hypotension.
.
In the ED, initial vs were: pain 8, 100.7, 114, 114/59, 18, 98%
RA. Labs were notable for WBC of 0.5, Cr of 2 (Bl 1.8), and
significant transaminitis (AST 1266, ALT 643, AlkP 333, LDH
1235, T bili 1.5). Lipase was 3360. CT A/P revealed findings
concerning for gallstone pancreatitis with 16mm distal CBD
dilation. Advanced endoscopy was consulted and decided to
perform ERCP in AM. Additionally, sBPs fell to the 70s and
improved to the 90s after a total of 6L NS. Per record, made 280
cc of UOP. Blood cultures were obtained. He was given Vancomycin
and Zosyn. No CVC was placed because he has a port for access.
.
On presentation to the [**Hospital Unit Name 153**] the patient appeared comfortable and
was answering questions appropriately. He confirmed recent
abdominal pain, vomiting, and rigors. Denied hematemesis,
hematochezia, or melena.
.
Review of sytems:
(+) Per HPI, + hx of neuropathy
(-) Denies fever, chills, night sweats. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denied cough, shortness of
breath. Denied chest pain or tightness, palpitations. Denied
diarrhea, constipation. No dysuria. Denied arthralgias or
myalgias or rashes.

Past Medical History:
Past Medical History:
-Metastatic Lung Cancer
-Chronic Obstructive Pulmonary Disease
-Fe deficiency Anemia
-Erosive Gastritis
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease
-Diverticulosis
-Hypercholesterolemia
-AAA repair
.
Onc Hx (abbreviated)
-LUL lung mass seen on CXR in [**12-8**]?, with multiple small
contralateral metastases seen on following CT
-CT-guided Bx at [**Hospital1 756**] on [**1-8**] showed well-differentiated
adenocarcinoma with acinar and solid features
-Has underwent three different chemotherapuetic regimens and
currently on his 4th- Navelbine (last received on [**2179-5-4**])

Social History:
-Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None


Family History:
-Mother had some type of cancer. No family hx of pancreatitis.


Physical Exam:
Admission Physical Exam:
Vitals: 98.6, 109/56, 83, 97% RA
General: well-nourished, alert, oriented, no acute distress
HEENT: PERRL, sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear to auscultation anteriorly, no wheezes, rales,
rhonchi
CV: regular rate and rhythm, normal S1 + S2, + SEM best heard at
LUSB, radiating to clavicle and carotids b/l
Abdomen: soft, bowel sounds present, diffuse tenderness with
voluntary guarding to palpation on R side and epigastrium
GU: + foley
Ext: warm, well perfused, trace non-pitting LE edema, clubbed
fingernails
Neuro: moves all extremities, face symmetric, gait not observed

Discharge Physical Exam:
VS: Tm 99.3, Tc 98.3, BP 110/70, HR 78, RR 20, 95%RA
General: well-nourished, alert, oriented, no acute distress
HEENT: PERRL, sclera anicteric, MM mildly dry, oropharynx clear

Neck: supple, JVP not elevated, no LAD
Lungs: clear to auscultation anteriorly, few scattered wheezes
CV: regular rate and rhythm, normal S1 + S2, + SEM best heard at
LUSB, radiating to clavicle and carotids b/l
Abdomen: soft, bowel sounds present, No TTP
Ext: warm, well perfused, trace non-pitting LE edema, clubbed
fingernails


Pertinent Results:
Admission labs [**2179-5-14**]
-WBC-0.5* RBC-3.67* Hgb-10.5* Hct-31.7* MCV-86 MCH-28.6
MCHC-33.2 RDW-17.6* Plt Ct-187 Neuts-74.2* Lymphs-21.1 Monos-3.2
Eos-0.7 Baso-0.8
-PT-12.7 PTT-30.9 INR(PT)-1.1
-Glucose-87 UreaN-43* Creat-2.0* Na-139 K-3.8 Cl-106 HCO3-24
AnGap-13
-ALT-643* AST-1266* LD(LDH)-1235* AlkPhos-333* TotBili-1.5
-Lipase-3360*
-cTropnT-<0.01
-Albumin-3.5 Calcium-8.6 Phos-2.7 Mg-1.4* Cholest-130
-Triglyc-116 HDL-34 CHOL/HD-3.8 LDLcalc-73
-Lactate-1.2
-freeCa-1.08*
.
[**5-14**] Abdominal xray: No signs of ileus or obstruction. No signs
of free air below the right hemidiaphragm
.
[**5-14**] CT A/P: 1. Marked extra-hepatic biliary ductal dilation to
1.6 cm with mild-to-moderate intra-hepatic biliary ductal
dilation with high-density material within the distal CBD with
pancreatitis in the head and neck, raising the question of
gallstone pancreatitis. Consultation with ERCP service is
recommended. The gallbladder is moderately distended without
other secondary findings of acute cholecystitis noted. 2. Known
metastatic lung cancer with partially visualized probable
metastases within the right lower lobe and left lower lobe.
Small left pleural effusion and trace right pleural effusion.
Periosteal reaction in femoral shafts likely secondary to
hypertrophic pulmonary osteoarthropathy. 3. Moderate-to-severe
colonic diverticulosis with no findings of acute diverticulitis.
No pneumoperitoneum.
.
[**5-14**] CXR:
. Increasing mild vascular congestion and bilateral pleural
effusions, left
greater than right.
2. Decreased density of left upper lobe and left lower lobe
opacities.
3. Stable position of right Port-A-Cath. No pneumothorax.
4. Multiple subcentimeter nodules in the right lung.

[**2179-5-15**] ERCP report: Impression: Stone fragments and sludge in
the biliary tree. Full cholangiogram not obtained given
cholangitis.
Normal limited pancreatogram.
A biliary sphincterotomy was performed.
Stone fragments and sludge were removed using a balloon.
A biliary stent was placed.
Normal pancreatic duct
(sphincterotomy, stent placement, stone extraction)
Otherwise normal ercp to third part of the duodenum

[**2179-5-18**] Echo:
Conclusions
The left atrium is mildly dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF 60%). Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) are mildly thickened
but aortic stenosis is not present. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. Trivial mitral regurgitation is seen.
There is no pericardial effusion.

RUQ U/S [**2179-5-18**]: IMPRESSION:
1. No evidence of gallstone.
2. Thickened and hyperemic gallbladder wall and mildly distended
gallbladder. This could reflect secondary inflammatory changes
from pancreatitis, though clinical correlation is suggested and
HIDA scan could be performed for further clarification if
indicated.
3. No evidence of choledocholithiasis, though presence of air
within much of the extrahepatic biliary system limits
assessment.
4. Right pleural effusion.


Brief Hospital Course:
66 yo M with NSCLC s/p recent chemo, now neutropenic, presenting
with abdominal pain and found to have acute pancreatitis,
transferred to the [**Hospital Unit Name 153**] initially for hypotension.
.
S/p gallbladder pancreatitis: Patient presented with hypotension
and sepsis which resolved with significant IV fluids (10L on
night of admission).  He also preseted with a lipase of 3360 and
findings on CT suggestive of gallstone etiology (1.6 cm CBD
dilation, distended gallbladder, and new transaminitis). Other
etiologies entertained, but highly unlikely included alcoholic,
chemotherapy-induced, or hypertriglyceridemia (labs normal).
[**Last Name (un) 5063**] criteria on admission was difficult to calculate
correctly given neutropenia; however, he had at least 3 points
predicting a mortality of 15-20%.  Advanced Endoscopy was
consulted and an ERCP with sphincterotomy was performed on [**5-15**]
and plastic stent was placed wo complication.  LFTs continued
trending down and  abdominal pain improved after stent placed.
Pt started liquids [**5-16**] and regular soft diet [**5-18**].  Surgery was
consulted to determine if pt would benefit from prophylactic
CCY.  They wanted a RUQ US to determine if there were residual
gallstones and pt might benefit from a perc chol tube.  RUQ U/S
showed no gallstones so surgery decided they would not place a
decompressiont tube, and already decided he wasn't a surgical
candidate for CCY. Lipase was downtrending from 3360 to 123 from
[**5-14**] to [**5-18**].  Patient sent to rehab tolerating a regular diet
without abdominal pain.
.
# Enterobacter baceteremia - patient presented with hypotension
and sepsis. His BCx on [**5-14**] returned positive for ENTEROBACTER
AEROGENES, that was acutely cipro sensitive.  His sepsis is now
resolved. He was on zosyn intially, narrowed to cipro/flagyl,
then just cipro on [**5-17**] when his BCx sensitivities returned.  He
needs a 14 day total course, with at least 10 days of IV cipro
for full treatment.  He will go to rehab to finish 10 days of
IV, which finishes on [**5-25**], then start PO cipro on [**5-26**], to
finish [**5-29**].
.
# Transaminitis:  Likely secondary to his acute gallstone
pancreatitis. Other possible etiologies include recent
chemotherapy or other toxic medications (such as his outpatient
statin). He denied any recent consumption of acetaminophen. We
trended his LFTs, which improved post-procedure, and held his
Simvastatin during the hospitalization and also at discharge as
pt's life expectancy is 6 months and the benefit of simvastatin
is over the course of many years.

# Systolic Ejection Murmur: Best heard at LUSB, radiating to the
clavicle and carotids bilaterally, concerning for aortic
stenosis. No prior echo was available. We obtained a TTE, which
showed no AS.  Therefore, likely a flow murmur in the setting of
lots of fluids.
.
# Anemia: Known Fe deficiency thought to be [**3-3**] gastritis from
NSAID use for pain control of arthritis. But also in the setting
of pancytopenia so may be secondary to marrow suppression.  He
has no s/sx of bleeding on exam throughout this admission, so we
continued him on a PPI.
.
# CKI: Baseline Cr is 1.8-1.9. Currently 2.1, even with
aggressive hydration.  This will need monitoring as an
outpatient.

# Metastatic Adenocarcinoma of the Lung: Received Navelbine on
[**2179-5-4**]. He was neutropenic on presentation and per his Primary
Oncologist, Neupogen was not indicated during the nadir of his
cell counts. Further management was deferred to the outpatient
setting.
.
Code: Full Code (per outpatient Onc note "he would not want any
prolonged period of intubation or any other interventions that
would prolong his life in a dependent position unable to care
for himself")


Medications on Admission:
(per records; Pt reports he only takes statin, omeprazole)
-Dexamethasone 8 mg [**Hospital1 **] day prior to, on, and after chemo
-Folic acid 1 mg daily
-Lorazepam 1 mg q6 for nausea or insomnia
-Omeprazole 20 mg daily
-Zofran 8 mg q8 PRN nausea
-Oxycodone 5 mg q4h for pain
-Prochlorperazine 10 mg q6h for nausea
-Simvastatin 80 mg daily (in am)


Discharge Medications:
1. morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
2. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea.
3. prochlorperazine maleate 10 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for nausea.
4. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. ciprofloxacin in D5W 400 mg/200 mL Piggyback Sig: One (1)
Intravenous Q12H (every 12 hours): last day is [**5-25**], then pt can
switch to PO cipro [**5-26**] for 4 days to finish a 14 day course.
6. lorazepam 1 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for nausea or insomnia.
7. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
8. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day:
Patient may refuse.
10. bisacodyl 5 mg Tablet Sig: One (1) Tablet PO once a day as
needed for constipation.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location (un) 2199**]

Discharge Diagnosis:
Primary: Gallstone pancreatitis
Secondary: Metastatic Lung adenocarcinoma


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


Discharge Instructions:
Dear Mr. [**Known lastname **],

You were seen in the hospital for abdominal pain and vomiting,
and were found to have gallstone pancreatitis.  You were treated
with an ERCP during which a biliary stent was placed, and your
symtoms improved.  Once you were able to tolerate a regular
diet, we sent you to a rehabilitation facility to finish your
intravenous antibiotics course.

We made the following changes to your medications:
1) We STARTED you on MORPHINE SULFATE IR 15mg b mouth every 6
hours as needed for pain.
2) We STOPPED your OXYCODONE.
3) We STOPPED your SIMVASTATIN.
4) We STOPPED your OMEPRAZOLE.
5) We STARTED you on PANTOPRAZOLE 40mg once a day by mouth.
6) We STARTED you on CIPROFLOXACIN IV 400mg every 12hours until
[**5-25**].  On [**5-26**] you will start taking CIPROFLOXACIN 500mg every
12hours by mouth, until [**5-29**], when your antibiotics course will
finish.
7) We STARTED you on DOCUSATE 100mg by mouth twice a day.
8) We STARTED you on SENNA 8.6mg twice a day by mouth for
contipation.  You can stop taking this if you have loose stools.
9) We STARTED you on BISACODYL 5mg once a day as needed for
constipation.

If you experience any of the below listed Danger Signs, please
alert your doctor at your rehab facility or go to the nearest
Emergency Room.

It was a pleasure taking care of you on this hospitalization.

Followup Instructions:
PLEASE NOTE MR [**Known lastname **] ARRIVED AT [**Location (un) **] AND DECIDED HE WOULD
RATHER BE AT HOME. HE CALLED HIS OUTPATIENT ONCOLOGIST DR
[**First Name (STitle) **] WHO ARRANGED FOR HIM TO COMPLETE THE COURSE OF
ANTIBIOTICS ORALLY INSTEAD. HE HAS BEEN TOLERATING PO AND HAS NO
SYMPTOMS OF PANCREATITIS ON DISCHARGE.

Department: Primary Care
Name: Dr. [**Last Name (STitle) **] [**Name (STitle) 2405**]
When: Please discuss with the staff at the facility a follow up
appointment with your PCP when you are ready for discharge.
Location: [**Hospital1 641**]
Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 3468**]

Department: Hematology/ Oncology
Name: Dr. [**Last Name (STitle) **] [**Name (STitle) 2405**]
When: Tuesday [**2179-5-25**] at 12:30 PM
Location: [**Hospital1 641**]
Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 3468**]

Department: ENDO SUITES
When: THURSDAY [**2179-6-17**] at 12:00 PM

Department: DIGESTIVE DISEASE CENTER
When: THURSDAY [**2179-6-17**] at 12:00 PM
With: [**Name6 (MD) 1948**] [**Last Name (NamePattern4) 1949**], MD [**Telephone/Fax (1) 463**]
Building: [**First Name8 (NamePattern2) **] [**Hospital Ward Name 1950**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 1951**]
Campus: EAST     Best Parking: Main Garage


                             [**Name6 (MD) 17666**] [**Name8 (MD) **] MD [**MD Number(2) 87301**]
{'Other septicemia due to gram-negative organisms,Acute pancreatitis,Acute kidney failure, unspecified,Cholangitis,Malignant neoplasm of upper lobe, bronchus or lung,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Neutropenia, unspecified,Personal history of tobacco use,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Anemia in neoplastic disease,Other malignant neoplasm without specification of site'}


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: 66 year-old man with metastatic lung adenocarcinoma, currently
neutropenic (s/p Navelbine on [**5-4**]), presenting with 1 week of
intermittent RUQ pain and vomiting, found to have acute
gallstone pancreatitis. Transferred to the [**Hospital Unit Name 153**] for evaluation
and management of hypotension.
.
In the ED, initial vs were: pain 8, 100.7, 114, 114/59, 18, 98%
RA. Labs were notable for WBC of 0.5, Cr of 2 (Bl 1.8), and
significant transaminitis (AST 1266, ALT 643, AlkP 333, LDH
1235, T bili 1.5). Lipase was 3360. CT A/P revealed findings
concerning for gallstone pancreatitis with 16mm distal CBD
dilation. Advanced endoscopy was consulted and decided to
perform ERCP in AM. Additionally, sBPs fell to the 70s and
improved to the 90s after a total of 6L NS. Per record, made 280
cc of UOP. Blood cultures were obtained. He was given Vancomycin
and Zosyn. No CVC was placed because he has a port for access.
.
On presentation to the [**Hospital Unit Name 153**] the patient appeared comfortable and
was answering questions appropriately. He confirmed recent
abdominal pain, vomiting, and rigors. Denied hematemesis,
hematochezia, or melena.
.
Review of sytems:
(+) Per HPI, + hx of neuropathy
(-) Denies fever, chills, night sweats. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denied cough, shortness of
breath. Denied chest pain or tightness, palpitations. Denied
diarrhea, constipation. No dysuria. Denied arthralgias or
myalgias or rashes.

MEDICAL HISTORY: Past Medical History:
-Metastatic Lung Cancer
-Chronic Obstructive Pulmonary Disease
-Fe deficiency Anemia
-Erosive Gastritis
-Psoriasis and Psoriatic Arthritis
-Hypertension
-Osteoarthritis
-Peripheral Vascular Disease
-Diverticulosis
-Hypercholesterolemia
-AAA repair
.
Onc Hx (abbreviated)
-LUL lung mass seen on CXR in [**12-8**]?, with multiple small
contralateral metastases seen on following CT
-CT-guided Bx at [**Hospital1 756**] on [**1-8**] showed well-differentiated
adenocarcinoma with acinar and solid features
-Has underwent three different chemotherapuetic regimens and
currently on his 4th- Navelbine (last received on [**2179-5-4**])

MEDICATION ON ADMISSION: (per records; Pt reports he only takes statin, omeprazole)
-Dexamethasone 8 mg [**Hospital1 **] day prior to, on, and after chemo
-Folic acid 1 mg daily
-Lorazepam 1 mg q6 for nausea or insomnia
-Omeprazole 20 mg daily
-Zofran 8 mg q8 PRN nausea
-Oxycodone 5 mg q4h for pain
-Prochlorperazine 10 mg q6h for nausea
-Simvastatin 80 mg daily (in am)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: 98.6, 109/56, 83, 97% RA
General: well-nourished, alert, oriented, no acute distress
HEENT: PERRL, sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear to auscultation anteriorly, no wheezes, rales,
rhonchi
CV: regular rate and rhythm, normal S1 + S2, + SEM best heard at
LUSB, radiating to clavicle and carotids b/l
Abdomen: soft, bowel sounds present, diffuse tenderness with
voluntary guarding to palpation on R side and epigastrium
GU: + foley
Ext: warm, well perfused, trace non-pitting LE edema, clubbed
fingernails
Neuro: moves all extremities, face symmetric, gait not observed

FAMILY HISTORY: -Mother had some type of cancer. No family hx of pancreatitis.

SOCIAL HISTORY: -Divorced, two children
-Lives with sister, independent in ADLs
-Tobacco: quit 8 years ago
-ETOH: 1-2 drinks weekly at most, had 2 beers last night
-Illicits: None 

### Response:
{'Other septicemia due to gram-negative organisms,Acute pancreatitis,Acute kidney failure, unspecified,Cholangitis,Malignant neoplasm of upper lobe, bronchus or lung,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Calculus of bile duct without mention of cholecystitis, without mention of obstruction,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Neutropenia, unspecified,Personal history of tobacco use,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Anemia in neoplastic disease,Other malignant neoplasm without specification of site'}
