CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85 year old
woman who presents for a right hemicolectomy for resection of
carcinoma of the cecum.  The patient was initially found to
be anemic on routine physical examination by her primary care
physician and further workup included a colonoscopy which
revealed a mass in the cecum as well as diverticulosis.  The
mass was biopsied and revealed an adenoma with high grade
dysplasia.  The patient admits to intermittent melena, no
bright red blood per rectum.  She has mild constipation, no
diarrhea, no weight loss, no fevers or chills, no history of
chest pain, shortness of breath, dizziness, syncope, nausea
or vomiting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Breast cancer in the past which was resected and she had
a left mastectomy in [**2152**], and a right lumpectomy in [**2168**].

MEDICATION ON ADMISSION: 1.  Norvasc 5 mg p.o. q.d.
2.  Butoptic one to two drops to each eye b.i.d. for
prevention of glaucoma.
3.  Trusopt 2% one drop each eye for prevention of glaucoma
which runs in her family.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for thirty pack year history of
tobacco.  She quit fifteen years ago.  Socially ETOH, less
than two drinks per week.  She lives alone in [**Location (un) 686**].
Malignant neoplasm of cecum,Iron deficiency anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of tobacco use
Malignant neoplasm cecum,Iron defic anemia NOS,Adv eff opiates,Dvrtclo colon w/o hmrhg,Hypertension NOS,Hx of breast malignancy,History of tobacco use
Admission Date:  [**2178-1-7**]       Discharge Date:


Service:  GEN SURGER

HISTORY OF PRESENT ILLNESS:  The patient is an 85 year old
woman who presents for a right hemicolectomy for resection of
carcinoma of the cecum.  The patient was initially found to
be anemic on routine physical examination by her primary care
physician and further workup included a colonoscopy which
revealed a mass in the cecum as well as diverticulosis.  The
mass was biopsied and revealed an adenoma with high grade
dysplasia.  The patient admits to intermittent melena, no
bright red blood per rectum.  She has mild constipation, no
diarrhea, no weight loss, no fevers or chills, no history of
chest pain, shortness of breath, dizziness, syncope, nausea
or vomiting.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Breast cancer in the past which was resected and she had
a left mastectomy in [**2152**], and a right lumpectomy in [**2168**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Norvasc 5 mg p.o. q.d.
2.  Butoptic one to two drops to each eye b.i.d. for
prevention of glaucoma.
3.  Trusopt 2% one drop each eye for prevention of glaucoma
which runs in her family.

SOCIAL HISTORY:  Significant for thirty pack year history of
tobacco.  She quit fifteen years ago.  Socially ETOH, less
than two drinks per week.  She lives alone in [**Location (un) 686**].

REVIEW OF SYSTEMS:  On review of systems, she does get short
of breath upon walking one flight of stairs.  Otherwise, the
review of systems was noncontributory.

PHYSICAL EXAMINATION:  On physical examination, her
temperature was 97.8, heart rate 100, blood pressure 128/78,
respiratory rate 16, and she was saturating 96% in room air.
She is mildly obese, alert, oriented times three, pleasant in
no apparent distress.  The pupils are equal, round, and
reactive to light and accommodation.  Sclera were anicteric.
Mucous membranes were moist.  No lymphadenopathy.  The neck
was supple with no carotid bruits.  The lungs were clear to
auscultation bilaterally.  She had a regular rate and rhythm.
The abdomen was soft, nontender, protuberant, but
nondistended, positive bowel sounds.  She had no cyanosis,
clubbing or edema.  Her pulses were palpable bilaterally.

HOSPITAL COURSE:  The plan was for a right hemicolectomy. The
patient tolerated the procedure well, however, on transfer to
the floor from the Post Anesthesia Care Unit, the patient was
found to be unresponsive and almost apneic.  On workup, she
was found to be hypercarbic which was presumed to be most
likely due to narcotics from her epidural.  The epidural was
immediately capped and an electrocardiogram, chest x-ray were
done which were essentially within normal limits.  Once the
epidural was capped, the patient's respiratory rate increased
to 30 and she was saturating 91% on 50%.  She had bilateral
crackles at the bases and was tachycardic.

She was brought to the Post Anesthesia Care Unit for more
frequent and closer monitoring.  Her narcotics and epidural
were stopped.  The patient was closely monitored and her
oxygen saturations came up, however, she continued to have
respiratory difficulty and, on repeat blood gases although
there was some improvement, she was found to be acidotic and
still hypercarbic and breathing with difficulty.

Hence, after supportive therapy was maintained for a couple
of hours, the decision was made to intubate the patient and
transfer to the Intensive Care Unit.  She was extubated on
the following day, postoperative day two, tolerated
extubation well.

She had a slight temperature of 101.7 and remained slightly
tachycardic but that was her baseline and her oxygen
saturations remained within normal limits in the mid to low
90s which was around her baseline.  Her temperature came down
on its own.  The patient was transferred to the floor on
postoperative day number two.

On postoperative day number three, the patient did well.
However, that evening she awoke short of breath, denied any
chest pain, tingling in her arms, nausea, vomiting or
dizziness.  She was saturating 94% on four liters.  She did
have crackles at the bases bilaterally and some rhonchi.  The
decision was made to give her some Lasix in which case she
quickly responded and shortness of breath dissipated.
Another electrocardiogram was done which again was within
normal limits.

The patient did well the following.  Vital signs were all
stable.  She was saturating well.  Her nasogastric tube was
taken out and she was started on sips.  She continued to do
well.  On postoperative day five, she started to develop some
burping and had still not passed any flatus.  Her abdomen
became slightly distended.  She was kept NPO.  However, on
postoperative day six, she passed large amounts of stool and
decision was made to start her again on clears.  She
tolerated clears well.

On postoperative day seven, she was advanced to a soft
regular diet and was discharged to rehabilitation in stable
condition.  Her vital signs were all stable.  She was
afebrile.  A Clostridium difficile had been sent given she
had multiple loose bowel movements, which is still pending.
She will follow-up with Dr. [**Last Name (STitle) 957**].

DISCHARGE DIAGNOSIS:  Right hemicolectomy for cecal mass.

MEDICATIONS ON DISCHARGE:
1.  Trusopt 2% one drop O.U. t.i.d.
2.  Butoptic one to two drops O.U. t.i.d.
3.  Norvasc 5 mg p.o. q.d.
4.  Tylenol #3 one to two tablets p.o. q4-6hours p.r.n. pain.
5.  Zinc 220 mg p.o. q.d.
6.  Multivitamin.




                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4007**]

Dictated By:[**Last Name (NamePattern1) 2649**]
MEDQUIST36

D:  [**2178-1-15**]  10:08
T:  [**2178-1-15**]  10:19
JOB#:  [**Job Number 24811**] and [**Numeric Identifier 24812**]
{'Malignant neoplasm of cecum,Iron deficiency anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of tobacco use'}


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: 

PRESENT ILLNESS: The patient is an 85 year old
woman who presents for a right hemicolectomy for resection of
carcinoma of the cecum.  The patient was initially found to
be anemic on routine physical examination by her primary care
physician and further workup included a colonoscopy which
revealed a mass in the cecum as well as diverticulosis.  The
mass was biopsied and revealed an adenoma with high grade
dysplasia.  The patient admits to intermittent melena, no
bright red blood per rectum.  She has mild constipation, no
diarrhea, no weight loss, no fevers or chills, no history of
chest pain, shortness of breath, dizziness, syncope, nausea
or vomiting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Breast cancer in the past which was resected and she had
a left mastectomy in [**2152**], and a right lumpectomy in [**2168**].

MEDICATION ON ADMISSION: 1.  Norvasc 5 mg p.o. q.d.
2.  Butoptic one to two drops to each eye b.i.d. for
prevention of glaucoma.
3.  Trusopt 2% one drop each eye for prevention of glaucoma
which runs in her family.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for thirty pack year history of
tobacco.  She quit fifteen years ago.  Socially ETOH, less
than two drinks per week.  She lives alone in [**Location (un) 686**]. 

### Response:
{'Malignant neoplasm of cecum,Iron deficiency anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Unspecified essential hypertension,Personal history of malignant neoplasm of breast,Personal history of tobacco use'}
