CHIEF COMPLAINT: Chronic constipation.

PRESENT ILLNESS: The patient is a 77-year-old
female with hypertension and hypercholesterolemia who
presented with chronic constipation, malaise, weight loss and
anorexia for 6-7 months.  The patient was initially admitted
to [**Hospital6 1597**] on [**9-29**].  During that hospitalization
a CT scan of her abdomen was obtained which showed pelvic
mass, omental studding and chronic lung disease.  In
addition, KUB revealed small bowel obstruction.  She was
transferred to Obstetrics/Gynecology service at [**Hospital1 346**] on [**2154-10-1**] for possible laparotomy
and debulking.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
sensorineural hearing loss, villous adenoma removed during
colonoscopy in [**9-13**], status post bowel resection in [**2145**] for
incarcerated hernia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Secondary malignant neoplasm of small intestine including duodenum,Other specified intestinal obstruction,Acute respiratory failure,Pneumonia due to Pseudomonas,Cardiac complications, not elsewhere classified,Malignant neoplasm of ovary
Sec malig neo sm bowel,Intestinal obstruct NEC,Acute respiratry failure,Pseudomonal pneumonia,Surg compl-heart,Malign neopl ovary
Admission Date:  [**2154-10-1**]     Discharge Date:  [**2154-10-19**]

Date of Birth:   [**2077-3-14**]     Sex:  F

Service:  SICU

CHIEF COMPLAINT:  Chronic constipation.

HISTORY OF PRESENT ILLNESS:  The patient is a 77-year-old
female with hypertension and hypercholesterolemia who
presented with chronic constipation, malaise, weight loss and
anorexia for 6-7 months.  The patient was initially admitted
to [**Hospital6 1597**] on [**9-29**].  During that hospitalization
a CT scan of her abdomen was obtained which showed pelvic
mass, omental studding and chronic lung disease.  In
addition, KUB revealed small bowel obstruction.  She was
transferred to Obstetrics/Gynecology service at [**Hospital1 346**] on [**2154-10-1**] for possible laparotomy
and debulking.

PAST MEDICAL HISTORY:  Hypertension, hypercholesterolemia,
sensorineural hearing loss, villous adenoma removed during
colonoscopy in [**9-13**], status post bowel resection in [**2145**] for
incarcerated hernia.

MEDICATIONS:  On admission, Atenolol, Hydrochlorothiazide.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  On admission, generally somewhat
confused elderly cachectic female lying in bed.  Temperature
97.3, pulse 93, blood pressure 130/75, respiratory rate 16,
O2 saturation 97% on two liters nasal cannula.  Heart was
regular rate and rhythm.  Lungs were clear to auscultation
bilaterally.  There was an NG tube in place.  Abdomen was
soft, distended, with ventral mass, question of fluid shift
and decreased bowel sounds.  Extremities showed no edema, 2+
distal pulses, no cyanosis or clubbing.

LABORATORY DATA:  On admission white count 14.7, hematocrit
32.3, sodium 140, potassium 4.8, chloride 101, CO2 24, BUN
12, creatinine 0.6, glucose 86, albumin 2.8, calcium 9.3,
phosphorus 2.5, magnesium 1.8, INR 1.2, PTT 20.8.  Urinalysis
showed moderate blood, 30 protein, more than 80 ketones,
small bilirubin, negative nitrites and occasional bacteria.

HOSPITAL COURSE:  On [**2154-10-3**] the patient went to operating
room for tumor debulking.  She underwent omentectomy,
extensive tumor debulking, small bowel resection with
re-anastomosis, resection of sigmoid colon, total abdominal
hysterectomy and bilateral salpingo-oophorectomy, debulking
of the disease and colectomy with Hartmann's pouch as well as
drainage of the ascites.  During the surgery patient received
four units of packed red blood cells and 8 liters of
crystalloid.  Following the surgery the patient was
transferred to SICU for further management.

While in SICU she initially needed pressors for blood
pressure support.  The pressors were weaned off and
echocardiogram was obtained which revealed normal ejection
fraction and 4+ TR with no other significant valvular
disease.  She developed multiple atrial tachycardia for which
she required Lopressor intermittently for rate control.

While in the SICU the patient was noted to spike fevers up to
101.8.  She was pancultured and her sputum grew pseudomonas
aeruginosa for which she was started on Ceftazidime.  In
addition, she received Vancomycin and Flagyl course for
purulent discharge at the ostomy site.

For nutritional support throughout the hospitalization, the
patient was maintained on TPN.

Initially patient required full ventilatory support.  With
time she was slowly weaned off the vent and was extubated on
[**2154-10-16**].  According to the prior discussions with the patient
as well as some discussions with her family, the patient's
code status was changed to DNR/DNI.  Initial two days
following extubation the patient was ventilating relatively
well with good oxygenation.  Diuresis was continued for
presumed pulmonary edema.  On [**2154-10-18**] the patient was found to
be much less responsive and on ABG was found to be in acute
respiratory acidosis with PCO2 at 86.  The focus of her care
was shifted towards comfort measures to prolong her life, and
patient died on [**2154-10-19**] at 12:10.  The immediate cause of
death was hypoxia and hypercarbia.  Secondary causes of death
are pneumonia, congestive heart failure, and ovarian cancer.
The family was notified and request for autopsy was declined
by patient's daughter.

FINAL DIAGNOSIS:
1.  Hypoxic hypercarbic respiratory failure.
2.  Ovarian cancer.
3.  Anemia status post four units of packed red blood cell
transfusion.
4.  Congestive heart failure.
5.  Pseudomonas pneumonia.




                          DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 16-403

Dictated By:[**Last Name (NamePattern1) 1762**]

MEDQUIST36

D:  [**2154-10-19**]  18:52
T:  [**2154-10-27**]  18:06
JOB#:  [**Job Number **]
{'Secondary malignant neoplasm of small intestine including duodenum,Other specified intestinal obstruction,Acute respiratory failure,Pneumonia due to Pseudomonas,Cardiac complications, not elsewhere classified,Malignant neoplasm of ovary'}


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: Chronic constipation.

PRESENT ILLNESS: The patient is a 77-year-old
female with hypertension and hypercholesterolemia who
presented with chronic constipation, malaise, weight loss and
anorexia for 6-7 months.  The patient was initially admitted
to [**Hospital6 1597**] on [**9-29**].  During that hospitalization
a CT scan of her abdomen was obtained which showed pelvic
mass, omental studding and chronic lung disease.  In
addition, KUB revealed small bowel obstruction.  She was
transferred to Obstetrics/Gynecology service at [**Hospital1 346**] on [**2154-10-1**] for possible laparotomy
and debulking.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
sensorineural hearing loss, villous adenoma removed during
colonoscopy in [**9-13**], status post bowel resection in [**2145**] for
incarcerated hernia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Secondary malignant neoplasm of small intestine including duodenum,Other specified intestinal obstruction,Acute respiratory failure,Pneumonia due to Pseudomonas,Cardiac complications, not elsewhere classified,Malignant neoplasm of ovary'}
