CHIEF COMPLAINT: Gastric cancer

PRESENT ILLNESS: Pt is an 82yo M with gastric cancer who initially presented with
dysphagia, dyspepsia, weight loss (15 pounds over the last
several months) and early satiety accompanied by a general
decline in overall appetite. He denies any change in his bowel
habits including diarrhea or constipation. He had a workup on
[**2199-8-8**] with UGI AIR W/O KUB and tissue path on [**2199-8-21**] which
showed a well differentiated adenocarcinoma of the stomach
specimen.

MEDICAL HISTORY: HTN
Osteoarthritis of L knee and R shoulder - s/p TKR [**2196-2-9**]
Tonsillectomy
Appendectomy
Bilateral cataract excision.

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - one Tablet(s) by mouth daily Start
with
one tab daily
RANITIDINE HCL [ZANTAC] - 150 mg Tablet - one Tablet(s) by mouth
Twice daily
Medications - OTC
ASPIRIN - 81 mg Tablet - one Tablet(s) by mouth daily
MULTIVITAMIN -  (OTC) -   Tablet - 1 Tablet(s) by mouth daily
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] -  (OTC) - 20 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 97.1 P 83 BP 108/70 RR 18 SaO2 95% 3L NC
General: Well-developed, appears much younger than his stated
age
HEENT: NCAT, PERRL, EOMI, VFFTC, TMs clear, no oral lesions,
nares patent
Neck: Supple, no thyromegaly
Chest: CTAB
Heart: RRR, no M/R/G
Abdomen: +BS, soft NT/ND, no masses or organomegaly
Ext: no C/C/E, old scar from TKR
Neuro: AOx3, motor/sensation intact, unsteady gait

FAMILY HISTORY: Family history is notable for a son who died of lung cancer.

SOCIAL HISTORY: 50-year smoking history but stopped over 25 years ago.  He is
retired.
Malignant neoplasm of other specified sites of stomach,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Unspecified essential hypertension,Hypoxemia
Malig neopl stomach NEC,Mal neo lymph intra-abd,Hypertension NOS,Hypoxemia
Admission Date:  [**2199-9-13**]              Discharge Date:   [**2199-9-23**]

Date of Birth:  [**2117-5-13**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Gastric cancer

Major Surgical or Invasive Procedure:
Total gastrectomy of the Roux-en-Y reconstruction and feeding
jejunostomy

History of Present Illness:
Pt is an 82yo M with gastric cancer who initially presented with
dysphagia, dyspepsia, weight loss (15 pounds over the last
several months) and early satiety accompanied by a general
decline in overall appetite. He denies any change in his bowel
habits including diarrhea or constipation. He had a workup on
[**2199-8-8**] with UGI AIR W/O KUB and tissue path on [**2199-8-21**] which
showed a well differentiated adenocarcinoma of the stomach
specimen.

Past Medical History:
HTN
Osteoarthritis of L knee and R shoulder - s/p TKR [**2196-2-9**]
Tonsillectomy
Appendectomy
Bilateral cataract excision.

Social History:
50-year smoking history but stopped over 25 years ago.  He is
retired.


Family History:
Family history is notable for a son who died of lung cancer.

Physical Exam:
Vitals: T 97.1 P 83 BP 108/70 RR 18 SaO2 95% 3L NC
General: Well-developed, appears much younger than his stated
age
HEENT: NCAT, PERRL, EOMI, VFFTC, TMs clear, no oral lesions,
nares patent
Neck: Supple, no thyromegaly
Chest: CTAB
Heart: RRR, no M/R/G
Abdomen: +BS, soft NT/ND, no masses or organomegaly
Ext: no C/C/E, old scar from TKR
Neuro: AOx3, motor/sensation intact, unsteady gait

Pertinent Results:
[**2199-9-14**] 06:10AM BLOOD WBC-16.9*# RBC-3.66* Hgb-11.5* Hct-32.9*
MCV-90 MCH-31.4 MCHC-35.0 RDW-14.2 Plt Ct-239
[**2199-9-14**] 06:10AM BLOOD Plt Ct-239
[**2199-9-14**] 06:10AM BLOOD Glucose-137* UreaN-29* Creat-1.1 Na-135
K-4.7 Cl-100 HCO3-28 AnGap-12
[**2199-9-14**] 06:10AM BLOOD Calcium-8.6 Phos-4.8*# Mg-1.9

Pathology [**2199-9-13**]
Stomach, resection (A-AJ):
Poorly differentiated adenocarcinoma, see synoptic report.

Jejunal donut (AJ-[**Doctor Last Name **]):
Small bowel with no malignancy  identified.

Esophageal donut (AK):
Esophagus with no malignancy identified.

[**2199-9-15**] CTA CHEST W&W/O C&RECONS, NON-CORONARY

1. No evidence of aortic dissection or pulmonary embolism. No
pneumonia.
Small-to-moderate bilateral simple pleural effusions and
adjacent compression
atelectasis within the lower lobes.

2. Post-surgical changes status post subtotal gastrectomy
including moderate
amount of pneumoperitoneum, extension of air superiorly
resulting in mild
pneumomediastinum, and small free fluid collections within the
visualized
upper abdomen.

3. Emphysema. New 3 mm nodule along the right minor fissure
likely
represents a benign intraparenchymal lymph node. Given
underlying emphysema,
would consider a one-year followup CT to document stability.

4. Mildly dilated main pulmonary artery likely related to
underlying
pulmonary arterial hypertension.

[**2199-9-15**] CT HEAD W/O CONTRAST

No evidence of infarction or hemorrhage.

[**2199-9-17**] BAS/UGI W/KUB
1. No evidence of anastomotic leak.
2. Aspiration with thin barium, this can be further evaluated
with dedicated video fluoroscopic swallowing study as clinically
indicated.

[**2199-9-18**] VIDEO OROPHARYNGEAL SWALLOW

Aspiration with thin liquids, with mild-to-moderate dysphagia.


Brief Hospital Course:
Pt is an 82yo M with gastric cancer who initially presented with
dysphagia, dyspepsia, weight loss (15 pounds over the last
several months) and early satiety accompanied by a general
decline in overall appetite.  He had a workup on [**2199-8-8**] with
UGI AIR W/O KUB and tissue path on [**2199-8-21**] which showed a well
differentiated adenocarcinoma of the stomach.  Pt had a total
gastrectomy of the Roux-en-Y reconstruction and a feeding
jejunostomy performed on [**2199-9-13**] without complication.  On [**2199-9-14**]
the pt triggered on the floor for hypoxia (SaO2 low 80's) and
was transferred to the TSICU.  Pt had post-procedure epidural in
place and both the primary team and pain service felt that it
should be left in place.  CTA on [**9-15**] did not show any evidence
of pulmonary embolism, aortic dissection or pneumonia.  On [**9-15**]
pt developed dysarthria and hoarseness.  Neuro and ENT consults
did not reveal an acute cause; there were no laryngeal injuries
seen on laryngoscopy.  CT head on [**9-16**] was negative for acute
processes.  Tube feeds were initiated and tolerated, epidural
was discontinued on [**9-18**].  Pt attempted to tolerate nectar
thickened liquids but experienced severe epigastric pain.  Pain
improved on viscous lidocaine but pt declined oral feeding in
favor of tube feeds.  Pt was discharged on [**9-23**] with home
services for home PT and continued tube feeds.



Medications on Admission:
ATENOLOL - 25 mg Tablet - one Tablet(s) by mouth daily Start
with
one tab daily
RANITIDINE HCL [ZANTAC] - 150 mg Tablet - one Tablet(s) by mouth
Twice daily
Medications - OTC
ASPIRIN - 81 mg Tablet - one Tablet(s) by mouth daily
MULTIVITAMIN -  (OTC) -   Tablet - 1 Tablet(s) by mouth daily
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] -  (OTC) - 20 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily


Discharge Medications:
1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
2. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
Disp:*180 Tablet(s)* Refills:*0*
3. Oxycodone 5 mg/5 mL Solution Sig: Five (5) mL PO Q4H (every 4
hours) as needed for 4 weeks.
Disp:*600 mL* Refills:*0*
4. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times
a day) as needed for epigastric discomfort.
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
6. Lidocaine HCl 2 % Solution Sig: Twenty (20) ML Mucous
membrane QID (4 times a day) for 4 weeks.
Disp:*2240 ML(s)* Refills:*0*
7. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2
times a day) for 4 weeks.
Disp:*560 mL* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Gastric adenocarcinoma
Post- operative hypoxemia

Discharge Condition:
Stable


Discharge Instructions:
You were treated for stomach cancer with surgery and had a tube
placed to help you feed.  You will need to go home with your
tube to continue your feedings.  You will also go home with
oxygen to help you breath better.  You should continue to take
your home medications.  In addition you will be given medication
to help with your pain.  These medications will make you drowsy.
 You should call your doctor or return to the ED for worsening
pain, fever, chills, chest pain, shortness of breath, nausea,
vomiting or any other concerning symptoms.

Followup Instructions:
Please call Dr. [**Last Name (STitle) **] to schedule a follow-up appointment
within a couple of weeks.  You should also keep your appointment
with Dr. [**Last Name (STitle) **].



Completed by:[**2199-9-25**]
{'Malignant neoplasm of other specified sites of stomach,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Unspecified essential hypertension,Hypoxemia'}


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 cancer

PRESENT ILLNESS: Pt is an 82yo M with gastric cancer who initially presented with
dysphagia, dyspepsia, weight loss (15 pounds over the last
several months) and early satiety accompanied by a general
decline in overall appetite. He denies any change in his bowel
habits including diarrhea or constipation. He had a workup on
[**2199-8-8**] with UGI AIR W/O KUB and tissue path on [**2199-8-21**] which
showed a well differentiated adenocarcinoma of the stomach
specimen.

MEDICAL HISTORY: HTN
Osteoarthritis of L knee and R shoulder - s/p TKR [**2196-2-9**]
Tonsillectomy
Appendectomy
Bilateral cataract excision.

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - one Tablet(s) by mouth daily Start
with
one tab daily
RANITIDINE HCL [ZANTAC] - 150 mg Tablet - one Tablet(s) by mouth
Twice daily
Medications - OTC
ASPIRIN - 81 mg Tablet - one Tablet(s) by mouth daily
MULTIVITAMIN -  (OTC) -   Tablet - 1 Tablet(s) by mouth daily
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] -  (OTC) - 20 mg Tablet,
Delayed Release (E.C.) - 1 Tablet(s) by mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 97.1 P 83 BP 108/70 RR 18 SaO2 95% 3L NC
General: Well-developed, appears much younger than his stated
age
HEENT: NCAT, PERRL, EOMI, VFFTC, TMs clear, no oral lesions,
nares patent
Neck: Supple, no thyromegaly
Chest: CTAB
Heart: RRR, no M/R/G
Abdomen: +BS, soft NT/ND, no masses or organomegaly
Ext: no C/C/E, old scar from TKR
Neuro: AOx3, motor/sensation intact, unsteady gait

FAMILY HISTORY: Family history is notable for a son who died of lung cancer.

SOCIAL HISTORY: 50-year smoking history but stopped over 25 years ago.  He is
retired. 

### Response:
{'Malignant neoplasm of other specified sites of stomach,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Unspecified essential hypertension,Hypoxemia'}
