CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: This is a 78 Russian-speaking lady with a history of GIST s/p
resection in [**2143**] with recurrence with omental metastasis s/p
resection [**3-/2153**] who reports sudden
onset dull, diffuse abdominal pain starting at 3 AM on the day
of presentation. She reports 1 episode of emesis near onset of
pain. Denies chest pain or shortness of breath, no change in
bowel habits and had a normal, non-bloody BM the previous day.
Of note, she was recently admitted [**Date range (1) 13759**] as a transfer from
an OSH for intraperitoneal bleeding from tumor in the setting of
an INR of 4.0 on coumadin for atrial fibrillation.  She received
a total of 2 units of blood and 1 unit of FFP, was stabilized,
then dc'd.  She has restarted her coumadin in the interim and
restarted on her Gleevac at 200 mg daily.

MEDICAL HISTORY: PMH: DM, HTN, HLD, paroxysmal Afib, CVA [**2136**], TIA [**2138**],
hypothyroidism, GIST (dx in [**2143**], treated with surgery and
multiple intermittent courses of Gleevac, doses adjusted due to
side effects

MEDICATION ON ADMISSION: gleevac 200', coumadin 3', januvia 25', diltiazem 150',
lasix 80', lisinopril 2.4', ambien 10', levothyroxine 200',
colace, senna

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: 97.6, 71, 116/70, 18, 96% RA
Gen: alert, russian speaking only, NAD
CV: irregularly irregular, no m/r/g
Pulm: mild crackles to bases otherwise CTAB
Abd: obese, soft, non-tender, non-distended, +BS
Ext: warm, 1+ LE edema, 2+dp/pt

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative
Hemoperitoneum (nontraumatic),Acute diastolic heart failure,Secondary malignant neoplasm of retroperitoneum and peritoneum,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of stomach
Hemoperitoneum,Ac diastolic hrt failure,Sec mal neo peritoneum,Atrial fibrillation,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Abnrml coagultion prfile,Long-term use anticoagul,Hx of gastric malignancy
Admission Date:  [**2153-8-19**]              Discharge Date:   [**2153-8-24**]

Date of Birth:  [**2074-11-10**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
Mesenteric and Celiac Angiogram ([**2153-8-20**])


History of Present Illness:
This is a 78 Russian-speaking lady with a history of GIST s/p
resection in [**2143**] with recurrence with omental metastasis s/p
resection [**3-/2153**] who reports sudden
onset dull, diffuse abdominal pain starting at 3 AM on the day
of presentation. She reports 1 episode of emesis near onset of
pain. Denies chest pain or shortness of breath, no change in
bowel habits and had a normal, non-bloody BM the previous day.
Of note, she was recently admitted [**Date range (1) 13759**] as a transfer from
an OSH for intraperitoneal bleeding from tumor in the setting of
an INR of 4.0 on coumadin for atrial fibrillation.  She received
a total of 2 units of blood and 1 unit of FFP, was stabilized,
then dc'd.  She has restarted her coumadin in the interim and
restarted on her Gleevac at 200 mg daily.

Past Medical History:
PMH: DM, HTN, HLD, paroxysmal Afib, CVA [**2136**], TIA [**2138**],
hypothyroidism, GIST (dx in [**2143**], treated with surgery and
multiple intermittent courses of Gleevac, doses adjusted due to
side effects

PSH: partial gastrectomy/GIST resection, [**2143**]; incisional hernia
repair, [**2144**]; GIST omental met resection, [**3-/2153**]


Social History:
Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative


Family History:
No family history of cancer, lung disease or heart disease. +
for DM.

Physical Exam:
VS: 97.6, 71, 116/70, 18, 96% RA
Gen: alert, russian speaking only, NAD
CV: irregularly irregular, no m/r/g
Pulm: mild crackles to bases otherwise CTAB
Abd: obese, soft, non-tender, non-distended, +BS
Ext: warm, 1+ LE edema, 2+dp/pt

Pertinent Results:
[**2153-8-24**] 07:35AM BLOOD WBC-6.2 RBC-3.81* Hgb-11.5* Hct-33.9*
MCV-89 MCH-30.1 MCHC-33.8 RDW-15.8* Plt Ct-196
[**2153-8-23**] 05:46AM BLOOD PT-12.6 PTT-23.8 INR(PT)-1.1
[**2153-8-24**] 07:35AM BLOOD Glucose-117* UreaN-20 Creat-1.1 Na-141
K-3.8 Cl-99 HCO3-34* AnGap-12
[**2153-8-24**] 07:35AM BLOOD Calcium-9.0 Phos-2.0* Mg-2.0

Brief Hospital Course:
Mrs [**Known lastname 13755**] was admitted to the surgical intensive care unit on
[**2153-8-19**] after presententing to the Emergency Room with severe
abdominal pain. A CT scan was performed on that occasion and
revealed marked progression of her GIST tumor as compared to
[**5-/2153**] and within this tumor an area of central hyperdensity in
a blush-like pattern was identified,concerning for active
intratumoral extravasation. There was also a moderate amount of
hyperdense free fluid consistent with intraperitoneal
hemorrhage.
The patient was made NPO, on IVF and a foley catheter was placed
for urine output monitoring. Overnight serial Hct were obtained
and she was given 2U of PRBC and 1U FFP.
On HD 2 since her INR continued to be high (1.9)she was given
10mg of Vit K IV. IR was consulted for possible embolization of
bleeding source. A selective angiogram was performed but no
bleeding source was identified at that time.
Between HD2 and 3 the patient's O2 requiremets increased and her
CXR showed minimally progressive pulmonary edema. Mrs [**Known lastname 13755**] is
on Lasix at home; she was therefore cautiously diuresed to
improve her respiratory status.
Overnight on HD2 and early morning on HD 3 she received a total
of 3 more Units os PRBC with good Hct response. An echo was also
performed on HD 3 and showed a mildly dilated L atrium, moderate
symmetric L ventricular hyperthrophy and a LVEF >50%. It did
show some moderate L diastolic dysfunction. The pulmonary artery
pressure was higher compared to previous examinations.
Mrs [**Known lastname 13755**] showed signs of improvement with decreasing O2
requirements and resolved abdominal pain on HD4. Her Hct had
remained stable around 30 on repeated checks and she was
therefore advanced to a clear liquid diet, which was well
tolerated and transferred to the regular floor later that night.

On HD5 the patient was advanced to a regular diet and her home
medications were resumed. Her foley catheter was discontinued
and she was able to void regularly. Physical therapy was
consulted for evaluation and she was cleared for home. She was
noted to desaturate to 86% while ambulating and would quickly
recover back to baseline of 96% on RA. She was given an
additional 80mg lasix which provided good diuresis. On HD#6 she
continued to do well, she was ambulating independently with her
walker, tolerating regular diet, and passing flatus. Her
anticoagulation use was discussed with her cardiologist who
recommended aspirin/plavix instead of coumadin. The surgery
service feels strongly about no further anticoagulation in this
patient, now with her second episode of life threatening
intra-abdominal bleeding. The patient was instructed to stop
taking her coumadin and follow up with her cardiologist in 1
week to discuss the treatment of her AFib at that time. This was
explained to the patient with the aid of the russian interpretor
and the patient expressed understanding and agreement of this
treatment plan. She was discharged home with her regular VNA
services.


Medications on Admission:
gleevac 200', coumadin 3', januvia 25', diltiazem 150',
lasix 80', lisinopril 2.4', ambien 10', levothyroxine 200',
colace, senna


Discharge Medications:
1. Gleevec 100 mg Tablet Sig: Two (2) Tablet PO once a day.
2. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic
DAILY (Daily).
3. Januvia 25 mg Tablet Sig: One (1) Tablet PO once a day.
4. diltiazem HCl 180 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily) as needed for a fib.

5. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO once a
day.
7. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily) as
needed for HTN.
8. Ambien 10 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. senna 8.6 mg Tablet Sig: One (1) Tablet PO 2-3 tabs per day
as needed for constipation.
11. bimatoprost 0.03 % Drops Sig: One (1) drop in left eye
Ophthalmic nightly ().


Discharge Disposition:
Home With Service

Facility:
Family Care Extended

Discharge Diagnosis:
intraabdominal hemorrhage
atrial fibrillation
Pulmonary edema
GIST
Diabetes
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to the surgery service for intra-abdominal
bleeding. You were treated with plasma to correct your INR and
blood transfusions to keep your blood levels normal. An
angiogram was done to indentify any bleeding blood vessel but it
did not locate one.
Do not take coumadin. You should call your cardiologist to make
an appointment in 1 week to discuss treatment options for your
atrial fibrillation.

Call your PCP or return to the Emergency Department for:
temperature greater than 101.4, chest pain, increasing shortness
of breath, wheezing, increasing leg swelling, weight gain of
3lbs or more, abdominal pain, inability to tolerate food or
drink, bloody or black tarry stools, blood in your urine, or any
other concerns.

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Followup Instructions:
Call Dr.[**Name (NI) 5103**] office to make an appointment in 1 week.

Provider: [**Name10 (NameIs) 191**] POST [**Hospital 894**] CLINIC Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2153-8-30**] 8:10

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2153-10-31**]
11:20

Provider: [**Name10 (NameIs) 3150**],[**Name11 (NameIs) **] MD Phone:[**Telephone/Fax (1) 11133**]
Date/Time:[**2153-11-9**] 2:30



Completed by:[**2153-8-25**]

Name:  [**Known lastname 2104**],[**Known firstname 2105**] Y                  Unit No:   [**Numeric Identifier 2106**]

Admission Date:  [**2153-8-19**]              Discharge Date:   [**2153-8-24**]

Date of Birth:  [**2074-11-10**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 203**]
Addendum:
Patient has significant congestive heart failure, diastolic
dysfunction, and developed pulmonary edema due to this
underlying process and the resuscitation and transfusions she
required.

Discharge Disposition:
Home With Service

Facility:
Family Care Extended

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 206**] MD [**MD Number(1) 207**]

Completed by:[**2153-10-13**]
{'Hemoperitoneum (nontraumatic),Acute diastolic heart failure,Secondary malignant neoplasm of retroperitoneum and peritoneum,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of stomach'}


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: Abdominal pain

PRESENT ILLNESS: This is a 78 Russian-speaking lady with a history of GIST s/p
resection in [**2143**] with recurrence with omental metastasis s/p
resection [**3-/2153**] who reports sudden
onset dull, diffuse abdominal pain starting at 3 AM on the day
of presentation. She reports 1 episode of emesis near onset of
pain. Denies chest pain or shortness of breath, no change in
bowel habits and had a normal, non-bloody BM the previous day.
Of note, she was recently admitted [**Date range (1) 13759**] as a transfer from
an OSH for intraperitoneal bleeding from tumor in the setting of
an INR of 4.0 on coumadin for atrial fibrillation.  She received
a total of 2 units of blood and 1 unit of FFP, was stabilized,
then dc'd.  She has restarted her coumadin in the interim and
restarted on her Gleevac at 200 mg daily.

MEDICAL HISTORY: PMH: DM, HTN, HLD, paroxysmal Afib, CVA [**2136**], TIA [**2138**],
hypothyroidism, GIST (dx in [**2143**], treated with surgery and
multiple intermittent courses of Gleevac, doses adjusted due to
side effects

MEDICATION ON ADMISSION: gleevac 200', coumadin 3', januvia 25', diltiazem 150',
lasix 80', lisinopril 2.4', ambien 10', levothyroxine 200',
colace, senna

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: 97.6, 71, 116/70, 18, 96% RA
Gen: alert, russian speaking only, NAD
CV: irregularly irregular, no m/r/g
Pulm: mild crackles to bases otherwise CTAB
Abd: obese, soft, non-tender, non-distended, +BS
Ext: warm, 1+ LE edema, 2+dp/pt

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative 

### Response:
{'Hemoperitoneum (nontraumatic),Acute diastolic heart failure,Secondary malignant neoplasm of retroperitoneum and peritoneum,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Abnormal coagulation profile,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of stomach'}
