CHIEF COMPLAINT: Abdominla Pain, Jaundice, Hypokalemia

PRESENT ILLNESS: This is a 63 year old male with obstructing ampullary mass. He
was transferred from [**Hospital6 33**] where he was admitted
on [**2119-8-22**]. His chief complaint was jaudice and epigastric pain.
His jaudice had been progressing over the preceeding week. He
also noted puritis, and light colored stool. He was referred to
[**Hospital1 18**] for ERCP. An ERCP revealed a fungating mass near the
ampulla. The ampulla could not be cannulated.

MEDICAL HISTORY: HTN, mild asthma, GERD, chronic LBP, ?NASH, s/p spinal fusion,
ETOH abuse, cirrhosis

MEDICATION ON ADMISSION: MS contin 100", Atenolol 100', HCTZ 25'

ALLERGIES: Aspirin

PHYSICAL EXAM: Gen: comfortable, nontoxic, jaundice significantly improved
Neck: supple, no cervical/superclavicular adenopathy
Lungs: CTAB
CV: regular rate and rhythm, no murmurs
Abd: Soft, nontender, nondistended

FAMILY HISTORY: Mother died at age 63 from CAD
Father died at age 85 from asbestos exposure.

SOCIAL HISTORY: No tobacco
one quart of rum/day
works in pest control
lives with son
Malignant neoplasm of ampulla of vater,Hemorrhage complicating a procedure,Other and unspecified alcohol dependence, unspecified,Obstruction of bile duct
Mal neo ampulla of vater,Hemorrhage complic proc,Alcoh dep NEC/NOS-unspec,Obstruction of bile duct
Admission Date:  [**2119-8-25**]              Discharge Date:   [**2119-9-5**]

Date of Birth:  [**2056-3-28**]             Sex:   M

Service: SURGERY

Allergies:
Aspirin

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Abdominla Pain, Jaundice, Hypokalemia

Major Surgical or Invasive Procedure:
ERCP
CT Guided [**Name (NI) **] (PTBD)
Right Chest Tube (VATS)


History of Present Illness:
This is a 63 year old male with obstructing ampullary mass. He
was transferred from [**Hospital6 33**] where he was admitted
on [**2119-8-22**]. His chief complaint was jaudice and epigastric pain.
His jaudice had been progressing over the preceeding week. He
also noted puritis, and light colored stool. He was referred to
[**Hospital1 18**] for ERCP. An ERCP revealed a fungating mass near the
ampulla. The ampulla could not be cannulated.

Past Medical History:
HTN, mild asthma, GERD, chronic LBP, ?NASH, s/p spinal fusion,
ETOH abuse, cirrhosis

Social History:
No tobacco
one quart of rum/day
works in pest control
lives with son

Family History:
Mother died at age 63 from CAD
Father died at age 85 from asbestos exposure.

Physical Exam:
Gen: comfortable, nontoxic, jaundice significantly improved
Neck: supple, no cervical/superclavicular adenopathy
Lungs: CTAB
CV: regular rate and rhythm, no murmurs
Abd: Soft, nontender, nondistended

Pertinent Results:
[**2119-8-25**] 04:57PM BLOOD WBC-9.1 RBC-3.51* Hgb-10.6* Hct-31.7*
MCV-90 MCH-30.3 MCHC-33.6 RDW-15.3 Plt Ct-246
[**2119-8-28**] 06:17PM BLOOD WBC-9.5 RBC-2.76* Hgb-8.5* Hct-25.6*
MCV-93 MCH-30.9 MCHC-33.3 RDW-15.7* Plt Ct-269
[**2119-8-28**] 10:48PM BLOOD WBC-11.1* RBC-2.64* Hgb-8.3* Hct-23.3*
MCV-88 MCH-31.3 MCHC-35.4* RDW-16.2* Plt Ct-249
[**2119-8-29**] 01:15AM BLOOD WBC-10.0 RBC-2.52* Hgb-7.9* Hct-22.3*
MCV-89 MCH-31.4 MCHC-35.4* RDW-16.1* Plt Ct-223
[**2119-9-5**] 06:36AM BLOOD Hct-29.4*
[**2119-8-25**] 04:57PM BLOOD ALT-159* AST-189* AlkPhos-610* Amylase-31
TotBili-17.9*
[**2119-9-5**] 06:36AM BLOOD ALT-78* AST-118* AlkPhos-216*
TotBili-16.8*

CHEST (PRE-OP PA & LAT)  [**2119-8-27**] 4:53 PM
FINDINGS: PA and lateral views of the chest demonstrates some
mild compressive changes at both bases. The cardiac and
mediastinal silhouettes are normal. There is no infiltrate or
effusion. The right humerus is slightly low in the glenoid
fossa. It is unclear if this is positional or if there is slight
inferior dislocation.

CTA ABD W&W/O C & RECONS  [**2119-8-27**] 10:48 AM
IMPRESSION: Almost circumferential mass in the second portion of
the duodenum with resulting intrahepatic and pancreatic duct
dilatation secondary to the ampullary obstruction. Multiple
areas of low attenuation in the liver, which are non-specific in
appearance but are concerning for metastatic disease given the
presence of a duodenal mass. Few prominent para-aortic and caval
nodes are alos concerning for spread of disease.

[**Numeric Identifier 69479**] INTRO PERC TRANHEPATIC CATH  [**2119-8-28**] 7:49 AM
IMPRESSION: Successful placement of an 8-French percutaneous
transhepatic biliary drainage catheter into the left biliary
system with the pigtail coiled into the common bile duct.

CHEST (PORTABLE AP)  [**2119-8-29**] 6:33 AM
Large right pleural fluid collection which decreased between
5:43 p.m. and 9:51 p.m. following insertion of a right basal
tube has not changed in volume subsequently. Mediastinum is
midline indicating a degree of atelectasis corresponding to the
pleural fluid volume. Left lung clear. Heart size normal. No
pneumothorax. A drainage catheter projects over the upper
abdominal midline but its precise location cannot be determined
on this study. No substantial pneumoperitoneum is demonstrated.

CHEST (PORTABLE AP)  [**2119-8-31**] 3:47 PM
FINDINGS: AP single view of the chest has been obtained with
patient in marked lordotic position. The previously described
two right-sided chest tubes remain in unchanged position. No
pneumothorax has developed since the preceding examination
obtained 4 hours earlier. Mediastinal and cardiac contours
unchanged with no evidence of CHF. Right-sided suprahilar
mediastinal prominence, unchanged.

Brief Hospital Course:
63 year old male with epigastric pain and jaundice due to a 4.8
cm pancreatic head mass and failed ERCP decompression on
[**2119-8-25**]. Prior to the [**Date Range 19843**] placement, he received 4 units of
FFP for an elevated INR of 2.0. He then proceeded with placement
of a biliary [**Date Range 19843**] via percutaneous transhepatic cholangiogram
on [**2119-8-28**]. Radiology confirmed the presence of a left biliary
system drainage catheter draining CBD. Post-ERCP, he developed
large right hemothorax. His O2 sats dropped to 90% and his BP
was 90/60. His HCT dropped from 26 to 22. A chest tube placed
was promptly placed and it drained serosanguinous fluid. He was
transferred to the SICU for monitoring of hypotension. He was
transfused x 4 with PRBC. A CT confirmed thoracic placement of
chest tube.
On [**2119-8-30**] he had a VATS with the Thoracic service. A second
chest tube was placed. A HCT after the procedure was 32.8. He
continued to do well after evacuation of the clotted hemothorax
and was transferred out of the ICU on [**2119-8-31**].
On [**2119-9-1**], he had both CT D/C'd without incident. Over the next
few days he improved markedly. By the time of discharge was
tolerating a regular diet, his [**Date Range 19843**] was collecting
approximately 300cc of bile each day, he was ambulating well,
and his pain was well-controlled.

Pathology:
Pathology results revealed an invasive adenocarcinoma.

Medications on Admission:
MS contin 100", Atenolol 100', HCTZ 25'

Discharge Medications:
1. OxyContin 80 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO twice a day.
Disp:*60 Tablet Sustained Release 12HR(s)* Refills:*2*
2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed for Wheeze.
Disp:*1 vial/aerosol* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
 Obstructive Jaundice
Pancreatic Head Mass
Right Hemothorax


Discharge Condition:
Good


Discharge Instructions:
* Increasing pain
* Fever (>101.5 F) or Vomiting
* Inability to pass gas or stool
* Other symptoms concerning to you

Please take all your medications as ordered. Restart previous
medications.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in 2 weeks. Call ([**Telephone/Fax (1) 15807**] to schedule.



Completed by:[**2119-9-12**]
{'Malignant neoplasm of ampulla of vater,Hemorrhage complicating a procedure,Other and unspecified alcohol dependence, unspecified,Obstruction of bile duct'}


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: Abdominla Pain, Jaundice, Hypokalemia

PRESENT ILLNESS: This is a 63 year old male with obstructing ampullary mass. He
was transferred from [**Hospital6 33**] where he was admitted
on [**2119-8-22**]. His chief complaint was jaudice and epigastric pain.
His jaudice had been progressing over the preceeding week. He
also noted puritis, and light colored stool. He was referred to
[**Hospital1 18**] for ERCP. An ERCP revealed a fungating mass near the
ampulla. The ampulla could not be cannulated.

MEDICAL HISTORY: HTN, mild asthma, GERD, chronic LBP, ?NASH, s/p spinal fusion,
ETOH abuse, cirrhosis

MEDICATION ON ADMISSION: MS contin 100", Atenolol 100', HCTZ 25'

ALLERGIES: Aspirin

PHYSICAL EXAM: Gen: comfortable, nontoxic, jaundice significantly improved
Neck: supple, no cervical/superclavicular adenopathy
Lungs: CTAB
CV: regular rate and rhythm, no murmurs
Abd: Soft, nontender, nondistended

FAMILY HISTORY: Mother died at age 63 from CAD
Father died at age 85 from asbestos exposure.

SOCIAL HISTORY: No tobacco
one quart of rum/day
works in pest control
lives with son 

### Response:
{'Malignant neoplasm of ampulla of vater,Hemorrhage complicating a procedure,Other and unspecified alcohol dependence, unspecified,Obstruction of bile duct'}
