CHIEF COMPLAINT: gastric adenocarcinoma

PRESENT ILLNESS: The patient is a 72 yo M, who initially presented w/ obstructing
choledocholithiasis [**8-30**] (CBD 2.0 cm), s/p ERCP + stent on
[**2197-9-11**] performed by [**Doctor First Name **] [**Doctor Last Name **]. During the procedure, the
patient was incidentally found to have a large antral ulcerated
tumor on ERCP. Biopsy was consistent with gastric (antral)
adenocarinoma. He is now presenting to [**Hospital Unit Name 153**] for post-operative
monitoring and management after undergoing subtotal gastrectomy,
D2 lymphadenectomy, CBD exploration, and choledochojejunostomy.

MEDICAL HISTORY: choledocholithiasis s/p ERCP + stent [**2197-9-11**], COPD, varicose
veins, ventral hernia repair in [**2191**]

MEDICATION ON ADMISSION: Protonix 40 mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: intubated sedated
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP= 8cm
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM, several incisions with
clean dressings, one JP drain
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: occ opens eyes and follows commands

FAMILY HISTORY: "stomach cancer" in his mother who died at age [**Age over 90 **]. His father
had laryngeal cancer

SOCIAL HISTORY: Born in [**Country 6257**]. Worked as a cleaning person in a factory, but
who is now retired. Long smoking history, 1 ppd recently. He
apparently is a former alcoholic, but after counseling 10 years
ago, his alcohol intake is much reduced. Current EtOH
consumptions unclear. 3 children who are all well.
Malignant neoplasm of pyloric antrum,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Obstructive chronic bronchitis with (acute) exacerbation,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Ventral, unspecified, hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Mal neo pyloric antrum,Gal&bil cal w/ac&ch w ob,Mal neo lymph intra-abd,Obs chr bronc w(ac) exac,Hemorrhage complic proc,Ac posthemorrhag anemia,Ventral hernia NOS,Peritoneal adhesions,Iatrogenc hypotnsion NEC,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2197-10-31**]              Discharge Date:   [**2197-11-11**]

Date of Birth:  [**2125-8-28**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
gastric adenocarcinoma

Major Surgical or Invasive Procedure:
s/p subtotal gastrectomy, D2 lymphadenectomy, CBD exploration,
and choledochojejunostomy

History of Present Illness:
The patient is a 72 yo M, who initially presented w/ obstructing
choledocholithiasis [**8-30**] (CBD 2.0 cm), s/p ERCP + stent on
[**2197-9-11**] performed by [**Doctor First Name **] [**Doctor Last Name **]. During the procedure, the
patient was incidentally found to have a large antral ulcerated
tumor on ERCP. Biopsy was consistent with gastric (antral)
adenocarinoma. He is now presenting to [**Hospital Unit Name 153**] for post-operative
monitoring and management after undergoing subtotal gastrectomy,
D2 lymphadenectomy, CBD exploration, and choledochojejunostomy.

Found densely adherent abdomen with difficult lysis of
adhesions. Gastric adenocardinoma in antrum, distal margin
negative on frozen section. Distal stomach, gallbladder, CBD
stones sent to pathology. The case ~12 hours. EBL 2700. Received
6000 Crystalloid, 1000 Albumin, 3 units pRBCs. UOP 500. Abx
Cefazolin 2g x4?, Flagyl. Initially got Metoprolol, later
required Neo briefly.
.
On arrival to [**Name (NI) 153**], pt. on AC 600/14/5/40%, satting 93%.
Sedation with Fentanyl 75, Midaz 2. No pressor requirement. Pt.
was agitated, Fentanyl increased to 100.

Past Medical History:
choledocholithiasis s/p ERCP + stent [**2197-9-11**], COPD, varicose
veins, ventral hernia repair in [**2191**]

Social History:
Born in [**Country 6257**]. Worked as a cleaning person in a factory, but
who is now retired. Long smoking history, 1 ppd recently. He
apparently is a former alcoholic, but after counseling 10 years
ago, his alcohol intake is much reduced. Current EtOH
consumptions unclear. 3 children who are all well.

Family History:
"stomach cancer" in his mother who died at age [**Age over 90 **]. His father
had laryngeal cancer

Physical Exam:
GENERAL: intubated sedated
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP= 8cm
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM, several incisions with
clean dressings, one JP drain
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: occ opens eyes and follows commands

Pertinent Results:
[**2197-10-31**] 07:27PM   TYPE-ART RATES-/11 TIDAL VOL-640 O2-50
PO2-225* PCO2-46* PH-7.41 TOTAL CO2-30 BASE XS-4
INTUBATED-INTUBATED VENT-CONTROLLED
[**2197-10-31**] 07:27PM   GLUCOSE-143* LACTATE-1.6 NA+-136 K+-4.4
CL--101

CXR [**2197-11-2**]: As compared to the previous examination, the
patient has been extubated. The nasogastric tube is in unchanged
position. The lung volumes have slightly decreased. The
pre-existing bilateral pleural effusions are slightly more
extensive than on the previous examination. Also slightly more
extensive are the pre-existing bilateral areas of atelectasis.
Unchanged evidence of mild pulmonary edema. No newly occurred
focal parenchymal opacities suggesting pneumonia. Unchanged
moderate cardiomegaly.


Brief Hospital Course:
 72 year old male with s/p subtotal gastrectomy, D2
lymphadenectomy, CBD exploration, and choledochojejunostomy  for
gastric antral CA.
[**11-1**] pt admitted to the [**Hospital Ward Name **] ICU post op.  He was kept
intubated, NPO/ IVF, PPI [**Hospital1 **], EBL was 2700 intraop given 3 untis
of pRBC, 1 L of albumin.  Epidural in place for pain control.
[**11-2**] Extubated , good urine ouput. Hct stable 28.9. Slight
hyppotension to 80s systolic wiht response to decresing the
epidural and 2 L of IVF bolus.
[**11-3**] Trophic tube feeds started. Jp drain removed. Transferred
out of the [**Hospital Unit Name 153**].
[**11-4**] Started on [**Last Name (LF) 84754**], [**First Name3 (LF) **] with norm gas pattern. Epidural
dcd.  Cefoxitan started for ? PNA on CXR.
[**11-5**] High NGT output 1600 cc - TF at 30 cc / hr.   PCa for pain
control.
[**11-6**] Febrile to 102.5 - pancultured. Nutrition consult.
[**11-7**] Tf at 60cc , sterted on cefoxitan. Dulcolax given.
Physical therapy consulted.
[**11-8**] NGT removed. Diarrhea.  C diff checked.  Foley removed. Tf
decreased to [**2-22**] stregth with  improvement in diarrhea. UGIB
with low gastric emptying.
[**Date range (1) 84755**] Fluids dcd.   started on sips to clears.
[**11-11**]: Advanced to regular diet, pain well controlled,
ambulating.  Dcd home with VNA, HHA and PT.

Medications on Admission:
Protonix 40 mg [**Hospital1 **]

Discharge Medications:
1. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for
wheezing.
Disp:*qs 1* Refills:*0*
2. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 6138**] Home Care Services

Discharge Diagnosis:
1. Gastric adenocarcinoma.
2. Common bile duct obstruction with cholelithiasis and
    choledocholithiasis


Discharge Condition:
VSS, toleratins a regular diet with supplements, pain well
controlled with po pain medications, ambulating without
assistance


Discharge Instructions:
General:

Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons.

* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.

*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.

*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.

.

Incision Care:
-Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Please call ([**Telephone/Fax (1) 5323**] to schedule follow up with Dr. [**Last Name (STitle) 519**]
for early next week - please call monday [**2197-11-13**]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2197-11-11**]
{'Malignant neoplasm of pyloric antrum,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Obstructive chronic bronchitis with (acute) exacerbation,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Ventral, unspecified, hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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: gastric adenocarcinoma

PRESENT ILLNESS: The patient is a 72 yo M, who initially presented w/ obstructing
choledocholithiasis [**8-30**] (CBD 2.0 cm), s/p ERCP + stent on
[**2197-9-11**] performed by [**Doctor First Name **] [**Doctor Last Name **]. During the procedure, the
patient was incidentally found to have a large antral ulcerated
tumor on ERCP. Biopsy was consistent with gastric (antral)
adenocarinoma. He is now presenting to [**Hospital Unit Name 153**] for post-operative
monitoring and management after undergoing subtotal gastrectomy,
D2 lymphadenectomy, CBD exploration, and choledochojejunostomy.

MEDICAL HISTORY: choledocholithiasis s/p ERCP + stent [**2197-9-11**], COPD, varicose
veins, ventral hernia repair in [**2191**]

MEDICATION ON ADMISSION: Protonix 40 mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: intubated sedated
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP= 8cm
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM, several incisions with
clean dressings, one JP drain
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: occ opens eyes and follows commands

FAMILY HISTORY: "stomach cancer" in his mother who died at age [**Age over 90 **]. His father
had laryngeal cancer

SOCIAL HISTORY: Born in [**Country 6257**]. Worked as a cleaning person in a factory, but
who is now retired. Long smoking history, 1 ppd recently. He
apparently is a former alcoholic, but after counseling 10 years
ago, his alcohol intake is much reduced. Current EtOH
consumptions unclear. 3 children who are all well. 

### Response:
{'Malignant neoplasm of pyloric antrum,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Obstructive chronic bronchitis with (acute) exacerbation,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Ventral, unspecified, hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
