CHIEF COMPLAINT: known large hepatic cyst with progressive increase in shortness
of breath over the past year

PRESENT ILLNESS: 75-year-old female with a known large hepatic cyst who has had
progressive increase in shortness of breath over the past year.
In [**2123-6-23**], a report documented a 12 cm septated cyst in the
liver along with a 1.7 cm gallstone. A CT on [**2126-12-5**]
demonstrated that the cyst had increased in size to
19 cm. CT on [**2128-8-26**] demonstrated a large cyst occupying
much of the right lobe of the liver measuring 21.2 x 13.6 cm.
Thin septations were noted. There was elevation of the right
hemidiaphragm. Preoperatively the patient has a documented low
pulse Ox.  It should be noted that preoperatively her O2 sats
were noted to be approximately 86% with a pO2 of 56 on room air.

MEDICAL HISTORY: hypertension, hyperlipidemia, urinary incontinence, spinal
fusion, ovarian cysts, the hepatic cyst and osteoporosis.
.
past surgical history is significant for back surgery
approximately 40 years ago. hysterectomy at age 33, appendectomy
at age 33, tonsillectomy as a child.

MEDICATION ON ADMISSION: alendronate 70 mg 1xweek,atenolol 25',simvastatin 20',
solifenacin 2 qod, advair'', calcium- vit d3, omega 3 fatty acid

ALLERGIES: Cipro / Macrodantin

PHYSICAL EXAM: Post Op Exam: ICU intubated and sedated
VS: 97.5, 74, 88/51 - 159/72, 16 100% on CMV/Assist
General: NAD, intubated/sedated
Card: RRR, No murmur
Lungs: Right diminished throughout
Abd: soft, non-distended, dressing c/d/i
Extr: No edema
Neuro: sedated

FAMILY HISTORY: mother who died at age 81 of a CVA. Father died at age 49 of
heart disease

SOCIAL HISTORY: Married, retired bookkeeper, She has two to three glasses of
wine per week socially.  She has no history of smoking, IV drug
use, marijuana use, blood
transfusions, tattoos, or hepatitis. She has pierced ears.
Other specified disorders of liver,Acute pancreatitis,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Osteoporosis, unspecified,Peritoneal adhesions (postoperative) (postinfection),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Urinary incontinence, unspecified,Arthrodesis status,Acquired absence of both cervix and uterus,Laparoscopic surgical procedure converted to open procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Liver disorders NEC,Acute pancreatitis,Iatrogenic pneumothorax,Ac posthemorrhag anemia,Cholelithiasis NOS,Osteoporosis NOS,Peritoneal adhesions,Hypertension NOS,Hyperlipidemia NEC/NOS,Urinary incontinence NOS,Arthrodesis status,Acq absnce cervix/uterus,Lap surg convert to open,Abn react-surg proc NEC
Admission Date:  [**2128-11-26**]              Discharge Date:   [**2128-12-6**]

Date of Birth:  [**2053-4-27**]             Sex:   F

Service: SURGERY

Allergies:
Cipro / Macrodantin

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
known large hepatic cyst with progressive increase in shortness
of breath over the past year

Major Surgical or Invasive Procedure:
[**2128-11-26**]: Laparoscopic converted to open hepatic cyst unroofing,
cholecystectomy, repair of diaphragm with [**Doctor Last Name 4726**]-Tex patch; Chest
tube placement.
[**2128-12-2**]: ERCP


History of Present Illness:
75-year-old female with a known large hepatic cyst who has had
progressive increase in shortness of breath over the past year.
In [**2123-6-23**], a report documented a 12 cm septated cyst in the
liver along with a 1.7 cm gallstone. A CT on [**2126-12-5**]
demonstrated that the cyst had increased in size to
19 cm. CT on [**2128-8-26**] demonstrated a large cyst occupying
much of the right lobe of the liver measuring 21.2 x 13.6 cm.
Thin septations were noted. There was elevation of the right
hemidiaphragm. Preoperatively the patient has a documented low
pulse Ox.  It should be noted that preoperatively her O2 sats
were noted to be approximately 86% with a pO2 of 56 on room air.


Past Medical History:
hypertension, hyperlipidemia, urinary incontinence, spinal
fusion, ovarian cysts, the hepatic cyst and osteoporosis.
.
past surgical history is significant for back surgery
approximately 40 years ago. hysterectomy at age 33, appendectomy
at age 33, tonsillectomy as a child.

Social History:
Married, retired bookkeeper, She has two to three glasses of
wine per week socially.  She has no history of smoking, IV drug
use, marijuana use, blood
transfusions, tattoos, or hepatitis. She has pierced ears.


Family History:
mother who died at age 81 of a CVA. Father died at age 49 of
heart disease

Physical Exam:
Post Op Exam: ICU intubated and sedated
VS: 97.5, 74, 88/51 - 159/72, 16 100% on CMV/Assist
General: NAD, intubated/sedated
Card: RRR, No murmur
Lungs: Right diminished throughout
Abd: soft, non-distended, dressing c/d/i
Extr: No edema
Neuro: sedated

Pertinent Results:
Immediatelypost op: [**2128-11-26**]
WBC-16.1*# RBC-3.28* Hgb-10.6*# Hct-31.3*# MCV-95 MCH-32.2*
MCHC-33.8 RDW-15.1 Plt Ct-182
PT-18.0* PTT-29.5 INR(PT)-1.6*
Glucose-105* UreaN-19 Creat-0.8 Na-142 K-4.3 Cl-114* HCO3-15*
AnGap-17
ALT-302* AST-506* LD(LDH)-597* AlkPhos-63 TotBili-2.4*
Albumin-2.7* Calcium-8.9 Phos-5.1* Mg-1.3*
[**2128-12-3**] Lipase-4370*  [**2128-12-6**] Lipase-122*
[**2128-12-3**] Amylase 2933  [**2128-12-6**] Amylase-120*
At Discharge:
WBC-7.3 RBC-3.47* Hgb-11.1* Hct-31.6* MCV-91 MCH-32.1*
MCHC-35.3* RDW-15.7* Plt Ct-194
PT-12.1 PTT-22.6 INR(PT)-1.0
Glucose-86 UreaN-6 Creat-0.5 Na-134 K-3.8 Cl-98 HCO3-29 AnGap-11
ALT-45* AST-28 AlkPhos-115*  TotBili-1.0
Albumin-2.9* Calcium-8.5 Phos-2.8 Mg-1.9
ALT-72* AST-48* AlkPhos-104 Amylase-2933* TotBili-0.7

Brief Hospital Course:
75 y/o taken to the OR with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for resection of
the known hepatic cyst. At the time of exploration with the
laparoscope, there were dense adhesions in the abdomen that
precluded additional placement of ports safely and therefore she
was converted to an open cystectomy. The cyst was densely
adherent and involved the diaphragm. She had a solitary
gallstone. She had dense adhesions in the right upper
quadrant. The cyst contained approximately 3 liters of clear
fluid. During the procedure, there was a defect in the
lateral-most aspect of the right diaphragm and there was an
injury to a small portion of the right lower lobe of the lung
with some air leak. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] surgery was
consulted during the procedure and it was recommended that a
chest tube be placed. The lung was densely adherent to the
diaphragm. She tolerated the procedure, however she was not
extubated, and was transferred to the SICU post operatively. The
cyst pathology was Benign mesothelial inclusion cyst.
The patient was extubated on POD 1, the chest tube was removed
on POD 3 and she remained in the SICU until POD 3 and she was
transferred to [**Hospital Ward Name 121**] 10.
On POD 4 the lateral JP drain was noted to appear bilious and
drain bilirubin was 11.2 (serum 0.7 same day). The following day
she was sent for an ERCP, The pancreatic duct was filled with
contrast, the course and caliber of the duct were normal with no
evidence of filling defects, masses, chronic pancreatitis or
other abnormalities. Cannulation of the biliary duct was
performed with a sphincterotome using a free-hand technique,
Extravasation of contrast was noted at the periphery of the
liver, consistent with bile leak. An 8cm by 10FR Cotton-[**Doctor Last Name **]
plastic biliary stent was placed successfully with excellent
drainage of bile and contrast.
Post ERCP day 1 she presented with nausea and abdominal pain and
amylase and lipase were noted to be significantly elevated to
2932 and 4370 respectively. She was kept NPO for 2 days and then
slowly advanced from clears to regular diet again.
Intra-op the patient received 2 units PRBC's and albumin, on POD
2 she received 2 units PRBCs and then 1 unit each on POD 4 and
5. Her hematocrit has remained stable since the last
transfusion.
The patient has tolerated regular diet, and calorie counts
indicate she is now getting adequate nutrition.
The patient was evaluated by physical therapy. She was minimally
active due to her shortness of breath prior to the surgery and
will be discharged with home PT. She has been ambulating with
assist.
Left ankle noted to be slightly swollen and a bit bruised in
appearance. Non-invasive studies were negative for DVT.
The patient is passing flatus and on a bowel regimen.
She is being sent home with the JP drain still in place.

Medications on Admission:
alendronate 70 mg 1xweek,atenolol 25',simvastatin 20',
solifenacin 2 qod, advair'', calcium- vit d3, omega 3 fatty acid

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain: Maximum 6 tablets daily.
2. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
3. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime.
5. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Inhalation Inhalation [**Hospital1 **] (2 times a day).
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Take for constipation and while using narcotic
pain medication.
7. solifenacin 5 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
8. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.

9. Calcium 500 With D 500 mg(1,250mg) -400 unit Tablet Sig: One
(1) Tablet PO once a day.
10. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
11. Omega-3 Fish Oil  Oral


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Hepatic cyst and cholelithiasis
diaphragmatic injury
Post ERCP pancreatitis


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


Discharge Instructions:
[**Hospital6 486**] has been arranged for home PT and Nursing
Please call Dr [**Last Name (STitle) 4727**] office at [**Telephone/Fax (1) 673**] for fever, chills,
nausea, vomiting, diarrhea, constipation, increased abdominal
pain, inability to take or keep down food, fluids or
medications.
Monitor the incision for redness, drainage or bleeding
No heavy lifting
No driving if taking narcotic pain medication
Drain and record drain output twice daily and as needed. Record
output and bring copy with you to your clinic visit. Call if the
drainage increases significantly, changes in color or develops a
foul odor. Do not allow drain to hang freely as it may pull out

Followup Instructions:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD, [**Telephone/Fax (1) 673**], Date/Time: [**2128-12-15**], 2:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2128-12-6**]
{'Other specified disorders of liver,Acute pancreatitis,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Osteoporosis, unspecified,Peritoneal adhesions (postoperative) (postinfection),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Urinary incontinence, unspecified,Arthrodesis status,Acquired absence of both cervix and uterus,Laparoscopic surgical procedure converted to open procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: known large hepatic cyst with progressive increase in shortness
of breath over the past year

PRESENT ILLNESS: 75-year-old female with a known large hepatic cyst who has had
progressive increase in shortness of breath over the past year.
In [**2123-6-23**], a report documented a 12 cm septated cyst in the
liver along with a 1.7 cm gallstone. A CT on [**2126-12-5**]
demonstrated that the cyst had increased in size to
19 cm. CT on [**2128-8-26**] demonstrated a large cyst occupying
much of the right lobe of the liver measuring 21.2 x 13.6 cm.
Thin septations were noted. There was elevation of the right
hemidiaphragm. Preoperatively the patient has a documented low
pulse Ox.  It should be noted that preoperatively her O2 sats
were noted to be approximately 86% with a pO2 of 56 on room air.

MEDICAL HISTORY: hypertension, hyperlipidemia, urinary incontinence, spinal
fusion, ovarian cysts, the hepatic cyst and osteoporosis.
.
past surgical history is significant for back surgery
approximately 40 years ago. hysterectomy at age 33, appendectomy
at age 33, tonsillectomy as a child.

MEDICATION ON ADMISSION: alendronate 70 mg 1xweek,atenolol 25',simvastatin 20',
solifenacin 2 qod, advair'', calcium- vit d3, omega 3 fatty acid

ALLERGIES: Cipro / Macrodantin

PHYSICAL EXAM: Post Op Exam: ICU intubated and sedated
VS: 97.5, 74, 88/51 - 159/72, 16 100% on CMV/Assist
General: NAD, intubated/sedated
Card: RRR, No murmur
Lungs: Right diminished throughout
Abd: soft, non-distended, dressing c/d/i
Extr: No edema
Neuro: sedated

FAMILY HISTORY: mother who died at age 81 of a CVA. Father died at age 49 of
heart disease

SOCIAL HISTORY: Married, retired bookkeeper, She has two to three glasses of
wine per week socially.  She has no history of smoking, IV drug
use, marijuana use, blood
transfusions, tattoos, or hepatitis. She has pierced ears. 

### Response:
{'Other specified disorders of liver,Acute pancreatitis,Iatrogenic pneumothorax,Acute posthemorrhagic anemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Osteoporosis, unspecified,Peritoneal adhesions (postoperative) (postinfection),Unspecified essential hypertension,Other and unspecified hyperlipidemia,Urinary incontinence, unspecified,Arthrodesis status,Acquired absence of both cervix and uterus,Laparoscopic surgical procedure converted to open procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
