CHIEF COMPLAINT: Renal angiomyolipoma.

PRESENT ILLNESS: She is a 70-year-old woman with pain in the right lower quadrant
that has subsequently gotten worse over the day. She was taken
to [**Hospital 1474**] Hospital where a CT scan showed a right renal mass.
Then, at that point, it was discovered that ten years ago she
was diagnosed with angiomyolipoma, however, she had been
asymptomatic until this day, [**2137-8-13**]. She was subsequently
brought to [**Hospital1 **] for further care. She has no
history of any renal procedures or surgeries. She was
re-admitted on [**2137-8-26**], for her planned surgery. She no
longer had any further imaging since [**2123**] and then
presented to our emergency room with acute abdominal pain and an
enlarging retroperitoneal hematoma and a large 8 cm x 9 cm
angiomyolipoma.  As a result, she was stabilized by
angioembolization of her right upper pole of the kidney and
after approximately 1 week, she was brought back for a right
radical nephrectomy, because of the large right angiomyolipoma.

MEDICAL HISTORY: PAST MEDICAL HISTORY:  Diabetes mellitus type 2,
hypertension, rheumatoid arthritis.

MEDICATION ON ADMISSION: Metformin b.i.d., verapamil 80
t.i.d., sulfazine b.i.d., 81 mg aspirin daily, and ibuprofen
600 mg b.i.d. to t.i.d.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: no apparent distress, patient is talkative and [**Last Name (un) 664**]
Neuro: orientated to time, person and place; there are no
obvious neurological symptoms
Cardiovascular: patient has a regular rate and rhythm.
GIT: appendenctomy scar; and hernia scar in right lower
quadrant.
There is some tenderness in the right upper quadrant w/ deep
palpation. Also there is a palpable right retroperitoneal mass.
Extremities: warm, well-perfused, no obvious skin lesions
present.

FAMILY HISTORY: Her mother died of ovarian cancer.

SOCIAL HISTORY: No history of smoking or heavy drinking.
Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Chronic diastolic heart failure,Rheumatoid arthritis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Benign neoplasm kidney,Hemoperitoneum,Chr diastolic hrt fail,Rheumatoid arthritis,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2137-8-26**]              Discharge Date:   [**2137-8-31**]

Date of Birth:  [**2066-8-20**]             Sex:   F

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6157**]
Chief Complaint:
Renal angiomyolipoma.

Major Surgical or Invasive Procedure:
Right nephrectomy.


History of Present Illness:
She is a 70-year-old woman with pain in the right lower quadrant
that has subsequently gotten worse over the day. She was taken
to [**Hospital 1474**] Hospital where a CT scan showed a right renal mass.
Then, at that point, it was discovered that ten years ago she
was diagnosed with angiomyolipoma, however, she had been
asymptomatic until this day, [**2137-8-13**]. She was subsequently
brought to [**Hospital1 **] for further care. She has no
history of any renal procedures or surgeries. She was
re-admitted on [**2137-8-26**], for her planned surgery. She no
longer had any further imaging since [**2123**] and then
presented to our emergency room with acute abdominal pain and an
enlarging retroperitoneal hematoma and a large 8 cm x 9 cm
angiomyolipoma.  As a result, she was stabilized by
angioembolization of her right upper pole of the kidney and
after approximately 1 week, she was brought back for a right
radical nephrectomy, because of the large right angiomyolipoma.


Past Medical History:
PAST MEDICAL HISTORY:  Diabetes mellitus type 2,
hypertension, rheumatoid arthritis.

PAST SURGICAL HISTORY:  Hernia repair and appendectomy when
she was approximately 3 years old.


Social History:
No history of smoking or heavy drinking.


Family History:
Her mother died of ovarian cancer.


Physical Exam:
General: no apparent distress, patient is talkative and [**Last Name (un) 664**]
Neuro: orientated to time, person and place; there are no
obvious neurological symptoms
Cardiovascular: patient has a regular rate and rhythm.
GIT: appendenctomy scar; and hernia scar in right lower
quadrant.
There is some tenderness in the right upper quadrant w/ deep
palpation. Also there is a palpable right retroperitoneal mass.
Extremities: warm, well-perfused, no obvious skin lesions
present.

Pertinent Results:
[**2137-8-29**] 07:00AM BLOOD WBC-8.8 RBC-3.46* Hgb-10.2* Hct-31.2*
MCV-90 MCH-29.5 MCHC-32.8 RDW-14.6 Plt Ct-514*
[**2137-8-28**] 05:01PM BLOOD Hct-30.1*
[**2137-8-28**] 03:03AM BLOOD WBC-10.0 RBC-2.96* Hgb-9.0* Hct-25.9*
MCV-88 MCH-30.5 MCHC-34.8 RDW-14.6 Plt Ct-371
[**2137-8-27**] 02:25AM BLOOD WBC-10.9 RBC-3.67* Hgb-11.1* Hct-32.2*
MCV-88 MCH-30.2 MCHC-34.4 RDW-14.7 Plt Ct-445*
[**2137-8-29**] 07:00AM BLOOD Plt Ct-514*
[**2137-8-29**] 07:00AM BLOOD Glucose-153* UreaN-6 Creat-0.7 Na-138
K-4.3 Cl-103 HCO3-27 AnGap-12
[**2137-8-28**] 03:03AM BLOOD Glucose-109* UreaN-9 Creat-0.8 Na-133
K-3.7 Cl-103 HCO3-23 AnGap-11
[**2137-8-29**] 07:00AM BLOOD Calcium-8.3* Phos-2.7 Mg-2.1
[**2137-8-26**] 07:38PM BLOOD Glucose-162* Lactate-2.1* Na-137 K-4.0
[**2137-8-26**] 07:38PM BLOOD Hgb-10.8* calcHCT-32

Brief Hospital Course:
Mrs. [**Known lastname 67782**] was admitted under the Urology service on [**2137-8-26**] for her planned surgery. She underwent the standard
protocol to be prepared for her procedure. During the surgery,
there were no complications. The
patient tolerated the procedure well. Because of her age and the
amount of blood loss, she remained intubated and was taken to
the intensive care unit for overnight observation. However
hemodynamically, she remained stable. In the recovery room, she
continued to do well and her pain was well-controlled. She was
brought to the floor once a bed was available for furhur care.
On the floor, she did well from a urology point of view.
However, there was some difficult with controlling her blood
pressure. Previously, she had been prescribed verapamil for
blood pressure control, but as an inpatient, it was reccomended
for her to switch to captopril. This was started once she able
to tolerate PO's, however, her blood pressure remained
uncontrolled, and she required some doses of IV hydralazine
during her stay. As per a medicine consult, she was then
switched to lisinopril, and this seemed to have regulated her
blood pressure better, but the patient was advised to
immediately follow-up with her primary care physician in regards
to monitoring her BP and dosage of her medication. In addition,
she was discharged with a visiting nurse for regular BP checks
until she is able to visit her PCP. [**Name10 (NameIs) **], the patient was
advised to repeat her CT scan in regards to the pulmonary
nodules discovered on her previous scann (in 3 months time).

Pathology report:
Specimen was the kidney and adrenal gland, right, nephrectomy:
with the following diagnoses:
A. Angiomyolipoma.
B.  Peri-renal hematoma.
C.  Blood vessels with embolic material.
D.  Renal vein with organized thrombus.
E.  Renal parenchymal infarct.
F.  Unremarkable adrenal gland.

Of note, her CT chest scan had the following report:
1.  No evidence of pulmonary embolism.
2.  Bilateral small pleural effusions.
3.  There are several small pulmonary nodules bilaterally, the
largest which
measures 8 x 7 mm.  Additionally, there is a prominence of a
subcarinal lymph
node. In the absence of a known primary malignancy, followup
evaluation within
three months should be obtained to assess for any interval
change.


Medications on Admission:
Metformin b.i.d., verapamil 80
t.i.d., sulfazine b.i.d., 81 mg aspirin daily, and ibuprofen
600 mg b.i.d. to t.i.d.


Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*1*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*20 Capsule(s)* Refills:*1*
3. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day: It
is important for you to follow-up with your PCP as soon as
possible in regards to your blood pressure medication and
monitoring BP levels.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Right angiomyolipoma.


Discharge Condition:
Stable.


Discharge Instructions:
The pain medicine you are given can make you drowsy. Do not
drive or operate heavy machinery while on medication.

We advise for you to follow-up with your PCP as soon as possible
for a regular blood pressure check and to adjust your blood
pressure medication accordingly. In addition, we reccomend a
follow-up chest CT scan in 3 months time.

If increased pain, numbness, fingers become cold, fevers,
redness call physician or return to the hospital.

Followup Instructions:
Please arrange a follow-up appointment with Dr. [**First Name (STitle) **] [**Last Name (NamePattern4) 8918**],
M.D. The phone number is: ([**Telephone/Fax (1) 4230**].

We advise for you to follow-up with your PCP as soon as possible
for a regular blood pressure check and to adjust your blood
pressure medication accordingly. In addition, we reccomend a
follow-up chest CT scan in 3 months time (due to the finding of
pulmonary nodules on the last CT scan).



Completed by:[**2137-9-3**]
{'Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Chronic diastolic heart failure,Rheumatoid arthritis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Renal angiomyolipoma.

PRESENT ILLNESS: She is a 70-year-old woman with pain in the right lower quadrant
that has subsequently gotten worse over the day. She was taken
to [**Hospital 1474**] Hospital where a CT scan showed a right renal mass.
Then, at that point, it was discovered that ten years ago she
was diagnosed with angiomyolipoma, however, she had been
asymptomatic until this day, [**2137-8-13**]. She was subsequently
brought to [**Hospital1 **] for further care. She has no
history of any renal procedures or surgeries. She was
re-admitted on [**2137-8-26**], for her planned surgery. She no
longer had any further imaging since [**2123**] and then
presented to our emergency room with acute abdominal pain and an
enlarging retroperitoneal hematoma and a large 8 cm x 9 cm
angiomyolipoma.  As a result, she was stabilized by
angioembolization of her right upper pole of the kidney and
after approximately 1 week, she was brought back for a right
radical nephrectomy, because of the large right angiomyolipoma.

MEDICAL HISTORY: PAST MEDICAL HISTORY:  Diabetes mellitus type 2,
hypertension, rheumatoid arthritis.

MEDICATION ON ADMISSION: Metformin b.i.d., verapamil 80
t.i.d., sulfazine b.i.d., 81 mg aspirin daily, and ibuprofen
600 mg b.i.d. to t.i.d.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: no apparent distress, patient is talkative and [**Last Name (un) 664**]
Neuro: orientated to time, person and place; there are no
obvious neurological symptoms
Cardiovascular: patient has a regular rate and rhythm.
GIT: appendenctomy scar; and hernia scar in right lower
quadrant.
There is some tenderness in the right upper quadrant w/ deep
palpation. Also there is a palpable right retroperitoneal mass.
Extremities: warm, well-perfused, no obvious skin lesions
present.

FAMILY HISTORY: Her mother died of ovarian cancer.

SOCIAL HISTORY: No history of smoking or heavy drinking. 

### Response:
{'Benign neoplasm of kidney, except pelvis,Hemoperitoneum (nontraumatic),Chronic diastolic heart failure,Rheumatoid arthritis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
