CHIEF COMPLAINT: abd pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 51 y/o man with a history of metastatic cancer,
thought lung primary, who presents with 3-4 days of abdominal
pain. The patient was diagnosed with non-small cell metastatic
cancer to the brain, felt primary lung in the beginning of the
month. The patient reports one week of cough productive of
green-yellow sputum. He has had 3 days of "sharp" up to [**9-25**]
adbominal pain in a band-like distribution over his lower
abdomen, which he initially attributed to his coughing. The
patient also noted increased abdominal distension. Patient
denies n/v/f/c/CP/SOB. 6 loose non-bloody stools today. The
patient presented to [**Hospital3 **] [**6-4**], where a abdominal CT
demonstrated right-sided diverticultitis and a large pericardial
effusion. The patient was treated with ciprofloxacin and
metronidazole and transferred here [**1-18**] appointment for XRT.  Pt
initially admitted to [**Hospital Ward Name **] but found to have large
pericardial effusion c/b RV collapse on [**6-5**]. Transferred to
[**Hospital Ward Name **] for cardiac cath and drain placement and further
monitoring in the CCU.
.
Cardiac cath on [**6-5**] revealed: s/p pericardiocentesis - 1050cc
bloody fluid removed, equalization of RA and PP at 15mmHg. TTE
s/p procedure with no residual effusion. Pt transferred back to
floor on [**6-7**] and remained hemodynamically stable without pulsus
throughout remainder of hospitalization. Repeat TTE on [**6-7**]
without evidence of fluid reaccumulation. Tolerating PO, denies
CP, SOB at discharge

MEDICAL HISTORY: HTN
s/p appy
cervical disc disease

MEDICATION ON ADMISSION: Medications:
1. Ramipril 10 mg qd
2. Docusate Sodium 100 mg [**Hospital1 **]
3. Pantoprazole Sodium 40 mg qd
4. Nicotine 14 mg/24 hr qd
5. Phenytoin Sodium Extended 200 mg [**Hospital1 **]
6. Dexamethasone 6 mg q6h
7. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: 97.1 88 135/71 20 96%RA Pulsus [**10-28**]
GEN: WDWN, diaphoretic, obese, sleeps easily
HEENT: ATNC, PERRL, proptosis; EOMI, anicteric, MMM, OP with
thrush
CHEST: Diffuse exp wheezes
COR: distant heart sounds, RR, unable to assess JVP
ABD: Obese, distended, soft, nt, +BS
EXT: WWP no c/c/e
Skin: diffuse tattoos; erythema of face/scalp/upper chest [**1-18**]
radiation

FAMILY HISTORY: mom - lung cancer but never smoked, alive.  Kids healthy.
No strokes or seizures in the family.

SOCIAL HISTORY: does carpentry work, single, 4 kids, +tob 1ppdx 20 yrs, 2
drinks/week, no drug, denies IVDA.  + multiple tattoos.
Acute pericarditis, unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acute kidney failure, unspecified,Candidiasis of mouth,Diverticulitis of colon (without mention of hemorrhage),Unspecified essential hypertension,Tobacco use disorder,Other and unspecified disc disorder, cervical region,Cough
Acute pericarditis NOS,Mal neo bronch/lung NEC,Sec mal neo brain/spine,Acute kidney failure NOS,Thrush,Dvrtcli colon w/o hmrhg,Hypertension NOS,Tobacco use disorder,Disc dis NEC/NOS-cerv,Cough
Admission Date:  [**2147-6-5**]              Discharge Date:   [**2147-6-9**]

Date of Birth:  [**2096-5-11**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5341**]
Chief Complaint:
abd pain

Major Surgical or Invasive Procedure:
cardiac cath with pericardial drain placement [**2147-6-5**]

History of Present Illness:
Mr. [**Known lastname **] is a 51 y/o man with a history of metastatic cancer,
thought lung primary, who presents with 3-4 days of abdominal
pain. The patient was diagnosed with non-small cell metastatic
cancer to the brain, felt primary lung in the beginning of the
month. The patient reports one week of cough productive of
green-yellow sputum. He has had 3 days of "sharp" up to [**9-25**]
adbominal pain in a band-like distribution over his lower
abdomen, which he initially attributed to his coughing. The
patient also noted increased abdominal distension. Patient
denies n/v/f/c/CP/SOB. 6 loose non-bloody stools today. The
patient presented to [**Hospital3 **] [**6-4**], where a abdominal CT
demonstrated right-sided diverticultitis and a large pericardial
effusion. The patient was treated with ciprofloxacin and
metronidazole and transferred here [**1-18**] appointment for XRT.  Pt
initially admitted to [**Hospital Ward Name **] but found to have large
pericardial effusion c/b RV collapse on [**6-5**]. Transferred to
[**Hospital Ward Name **] for cardiac cath and drain placement and further
monitoring in the CCU.
.
Cardiac cath on [**6-5**] revealed: s/p pericardiocentesis - 1050cc
bloody fluid removed, equalization of RA and PP at 15mmHg. TTE
s/p procedure with no residual effusion. Pt transferred back to
floor on [**6-7**] and remained hemodynamically stable without pulsus
throughout remainder of hospitalization. Repeat TTE on [**6-7**]
without evidence of fluid reaccumulation. Tolerating PO, denies
CP, SOB at discharge

Past Medical History:
HTN
s/p appy
cervical disc disease


Social History:
does carpentry work, single, 4 kids, +tob 1ppdx 20 yrs, 2
drinks/week, no drug, denies IVDA.  + multiple tattoos.


Family History:
mom - lung cancer but never smoked, alive.  Kids healthy.
No strokes or seizures in the family.


Physical Exam:
PE:
VS: 97.1 88 135/71 20 96%RA Pulsus [**10-28**]
GEN: WDWN, diaphoretic, obese, sleeps easily
HEENT: ATNC, PERRL, proptosis; EOMI, anicteric, MMM, OP with
thrush
CHEST: Diffuse exp wheezes
COR: distant heart sounds, RR, unable to assess JVP
ABD: Obese, distended, soft, nt, +BS
EXT: WWP no c/c/e
Skin: diffuse tattoos; erythema of face/scalp/upper chest [**1-18**]
radiation


Pertinent Results:
[**2147-6-5**] 03:51PM   GLUCOSE-88 UREA N-21* CREAT-1.0 SODIUM-134
POTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-20* ANION GAP-17
[**2147-6-5**] 03:51PM   CK(CPK)-69
[**2147-6-5**] 03:51PM   CK-MB-NotDone cTropnT-<0.01
[**2147-6-5**] 03:51PM   CALCIUM-8.4 PHOSPHATE-5.6*# MAGNESIUM-1.9
[**2147-6-5**] 03:51PM   WBC-10.9 RBC-4.37* HGB-13.5* HCT-38.9* MCV-89
MCH-30.9 MCHC-34.7 RDW-12.9
[**2147-6-5**] 03:51PM   PLT COUNT-232
[**2147-6-5**] 03:51PM   PT-12.5 PTT-22.2 INR(PT)-1.0
[**2147-6-5**] 11:45AM OTHER BODY FLUID  TOT PROT-5.1 GLUCOSE-8
LD(LDH)-303 AMYLASE-13 ALBUMIN-3.3
[**2147-6-5**] 11:45AM OTHER BODY FLUID  WBC-[**Numeric Identifier 3374**]* HCT-16.0*
POLYS-44* BANDS-6* LYMPHS-8* MONOS-15* MESOTHELI-16*
MACROPHAG-11*
[**2147-6-5**] 11:35AM   TYPE-ART PO2-100 PCO2-50* PH-7.31* TOTAL
CO2-26 BASE XS--1 INTUBATED-NOT INTUBA
[**2147-6-5**] 11:35AM   HGB-13.5* calcHCT-41 O2 SAT-96
[**2147-6-5**] 10:00AM   PT-13.2 PTT-22.2 INR(PT)-1.2
[**2147-6-5**] 08:50AM   GLUCOSE-132* UREA N-23* CREAT-1.7*
SODIUM-132* POTASSIUM-4.9 CHLORIDE-94* TOTAL CO2-25 ANION GAP-18
[**2147-6-5**] 08:50AM   ALT(SGPT)-131* AST(SGOT)-25 ALK PHOS-125* TOT
BILI-0.5
[**2147-6-5**] 08:50AM   CALCIUM-9.3 PHOSPHATE-7.7*# MAGNESIUM-2.1
[**2147-6-5**] 08:50AM   WBC-12.1* RBC-4.38* HGB-13.3*# HCT-40.2
MCV-92 MCH-30.4 MCHC-33.1 RDW-13.3
[**2147-6-5**] 08:50AM   PLT COUNT-294
.....
Labs:
OSH:
128 92 13 128
4.1 24 0.8
Ca 8.8
Alb 3.2
TP 6.4
AST 33 ALT 163* Bili <0.5 Alk Phos 147*
Amylase/Lipase:WNL
WBC 15.7 Hct 43 Plt 284
N52/B13*/L15/E12*
.
EKG: (OSH) Sinsus tach R 125 right axis normal interals, TW flat
V1
.
CXR: b/l pulm nodules, lungs clear
.
CT abd (OSH): 1. Large pericardial effusion; 2. Pulmonary
metastatic disease; 3. Smal bilat pleural effusion; 4.
Unilateral enlargement of left adrenal gland; 5. Diverticulosiss
and equivocal but suspcious findings for diverticulitis; 6.
trace ascites
.
echo [**Hospital1 18**] [**2147-6-5**]:
Conclusions:
The left ventricular cavity size is normal. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. LVEF>55%. The RV cavity is unusually small.
There is a moderate to large sized pericardial effusion. There
is right ventricular diastolic collapse, consistent with
impaired fillling/tamponade physiology. There is signficant
mitral inflow
respirophasic variation. There is a echodense structure along
the apex which may represent a mass vs. fat.
.
.
Cardiac cath on [**6-5**] revealed: s/p pericardiocentesis - 1050cc
bloody fluid removed, equalization of RA and PP at 15mmHg. TTE
s/p procedure with no residual effusion, but marked septal
deformation toward LV
HD: RA: 16, RV: 50/24 (40/20), PA: 42/33(42/26), Wedge: 31(16)
CO:3.9-->7.1
CI:1.6-3.0


Brief Hospital Course:
A/P: 51 y/o man with recently diagnosed lung cancer with mets to
the brain who presents with abdominal pain and cough found to
have large pericardial effusion with RV collapse tx from [**Hospital Ward Name **] for cath and pericardial drain placement
.
##  Pericardial Effusion: Patient with large pericardial
effusion; likely malignant effusion but ddx includes viral
(given recent cold), bacterial, radiation induced, vs uremic.
S/p cardiac cath with drain placmement. 1L bloody fluid removed
which revealed a malignant effusion; repeat TTE on [**6-8**] without
evidence of fluid reaccumulation. Following discharge, he will
have a repeat TTE in about 2 weeks; sooner if he should develop
recurrent symptoms.
.
##ARF: Creatinine 1.7 pre-cath this morning with baseline 0.8. ?
[**1-18**] contrast CT at [**Location (un) **] vs prerenal. Creatinine normalized on
repeat labs without treatment.
..
##Diverticulitis: Patient appears well with benign abdominal
exam; afebrile and hemodynamically stable. No evidence of
abscess or perforation on abdominal CT reviewed with
radiologists. His diet was advanced through the course of his
hospitalization and he tolerated PO well; discharged to home
with ciprofloxacin and metronidazole to complete a 10 day course
of antibiotics.
.
##Cough/Wheeze: CXR without evidnece of PNA. Patient without
history of reactive airway disease. No evidence of failure.
Discharged to home with Albuterol and Atrovent MDI
.
##Oncology: Patient with non-small cell lung cancer metastatic
to the brain and ?adrenal met. Continued anti-epileptics,
steroids during hospitalization. Will continue to receive XRT as
outpatient and will return in ~ 2weeks for evaluation for
chemotherapy course for his NSCLC with Dr. [**Last Name (STitle) 3274**].
.
##FULL CODE throughout admission

Medications on Admission:
Medications:
1. Ramipril 10 mg qd
2. Docusate Sodium 100 mg [**Hospital1 **]
3. Pantoprazole Sodium 40 mg qd
4. Nicotine 14 mg/24 hr qd
5. Phenytoin Sodium Extended 200 mg [**Hospital1 **]
6. Dexamethasone 6 mg q6h
7. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every

4 to 6 hours) as needed.

Discharge Medications:
1. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
Disp:*2 MDI* Refills:*2*
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
Disp:*2 MDI* Refills:*2*
3. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a
day for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO three
times a day for 5 days.
Disp:*15 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pericardial effusion


Discharge Condition:
To home, feeling well, on RA

Discharge Instructions:
1. Please go to your XRT appointment on Monday [**6-12**]
.
2. Please follow-up with Dr. [**Last Name (STitle) 3274**] or Dr. [**First Name (STitle) **] in [**Hospital **]
clinic (they will call you with an appointment time)
.
3. Please obtain your repeat echocardiogram when you return in ~
2 weeks for your oncology appointment
.
4. Please continue taking the ciprofloxacin and metronidazole
for 5 more days (as directed) for treatmet of your
diverticulitis.
.
5. Use your albuterol and atrovent inhalers as directed

Followup Instructions:
1. Please go to your XRT appointment on Monday [**6-12**]
.
2. Please follow-up with Dr. [**Last Name (STitle) 3274**] or Dr. [**First Name (STitle) **] in [**Hospital **]
clinic (they will call you with an appointment time)
.
3. Please obtain your repeat echocardiogram when you return in ~
2 weeks for your oncology appointment (please call [**Telephone/Fax (1) 58347**];
[**Telephone/Fax (1) 1566**])
{'Acute pericarditis, unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acute kidney failure, unspecified,Candidiasis of mouth,Diverticulitis of colon (without mention of hemorrhage),Unspecified essential hypertension,Tobacco use disorder,Other and unspecified disc disorder, cervical region,Cough'}


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: abd pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 51 y/o man with a history of metastatic cancer,
thought lung primary, who presents with 3-4 days of abdominal
pain. The patient was diagnosed with non-small cell metastatic
cancer to the brain, felt primary lung in the beginning of the
month. The patient reports one week of cough productive of
green-yellow sputum. He has had 3 days of "sharp" up to [**9-25**]
adbominal pain in a band-like distribution over his lower
abdomen, which he initially attributed to his coughing. The
patient also noted increased abdominal distension. Patient
denies n/v/f/c/CP/SOB. 6 loose non-bloody stools today. The
patient presented to [**Hospital3 **] [**6-4**], where a abdominal CT
demonstrated right-sided diverticultitis and a large pericardial
effusion. The patient was treated with ciprofloxacin and
metronidazole and transferred here [**1-18**] appointment for XRT.  Pt
initially admitted to [**Hospital Ward Name **] but found to have large
pericardial effusion c/b RV collapse on [**6-5**]. Transferred to
[**Hospital Ward Name **] for cardiac cath and drain placement and further
monitoring in the CCU.
.
Cardiac cath on [**6-5**] revealed: s/p pericardiocentesis - 1050cc
bloody fluid removed, equalization of RA and PP at 15mmHg. TTE
s/p procedure with no residual effusion. Pt transferred back to
floor on [**6-7**] and remained hemodynamically stable without pulsus
throughout remainder of hospitalization. Repeat TTE on [**6-7**]
without evidence of fluid reaccumulation. Tolerating PO, denies
CP, SOB at discharge

MEDICAL HISTORY: HTN
s/p appy
cervical disc disease

MEDICATION ON ADMISSION: Medications:
1. Ramipril 10 mg qd
2. Docusate Sodium 100 mg [**Hospital1 **]
3. Pantoprazole Sodium 40 mg qd
4. Nicotine 14 mg/24 hr qd
5. Phenytoin Sodium Extended 200 mg [**Hospital1 **]
6. Dexamethasone 6 mg q6h
7. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: 97.1 88 135/71 20 96%RA Pulsus [**10-28**]
GEN: WDWN, diaphoretic, obese, sleeps easily
HEENT: ATNC, PERRL, proptosis; EOMI, anicteric, MMM, OP with
thrush
CHEST: Diffuse exp wheezes
COR: distant heart sounds, RR, unable to assess JVP
ABD: Obese, distended, soft, nt, +BS
EXT: WWP no c/c/e
Skin: diffuse tattoos; erythema of face/scalp/upper chest [**1-18**]
radiation

FAMILY HISTORY: mom - lung cancer but never smoked, alive.  Kids healthy.
No strokes or seizures in the family.

SOCIAL HISTORY: does carpentry work, single, 4 kids, +tob 1ppdx 20 yrs, 2
drinks/week, no drug, denies IVDA.  + multiple tattoos. 

### Response:
{'Acute pericarditis, unspecified,Malignant neoplasm of other parts of bronchus or lung,Secondary malignant neoplasm of brain and spinal cord,Acute kidney failure, unspecified,Candidiasis of mouth,Diverticulitis of colon (without mention of hemorrhage),Unspecified essential hypertension,Tobacco use disorder,Other and unspecified disc disorder, cervical region,Cough'}
