CHIEF COMPLAINT: Obstructive jaundice

PRESENT ILLNESS: Patient is an 87 year old female who was transferred from [**Hospital 5279**]
Hospital, [**Location (un) 3844**], to [**Hospital1 **] on [**2135-1-29**].
She has experienced a 40-lb weight loss over the past year with
a steadily decreasing appetite. In [**Month (only) **], she developed a
thrombus in the left internal jugular vein and was treated with
warfarin. She became supratherapeutic on warfarin and was
reversed with vitamin [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] then suffered what was believed to
be an embolic stroke on [**2135-1-13**] requiring hospital admission.
She had only minor neurologic deficits and was discharged a few
days later on warfarin. She then had melena as well as coffee
ground emesis and was readmitted to the hospital [**2135-1-25**].
During that admission, she was diagnosed with acute renal
failure, and obstructive jaundice with a mass in the pancreatic
head and a liver mass. Attempt at ERCP was made with inability
to cannulate the bile duct. She was transferred to [**Hospital1 18**] for
further care.

MEDICAL HISTORY: CVA
Left IJ thrombus
Cholelithiasis
Pancreatic head mass, liver mass
AAA 3.8cm
HTN
GI bleed on warfarin
Recent ([**1-5**]) acute renal failure

MEDICATION ON ADMISSION: Atenolol, vasotec, warfarin, lactulose, dulcolax

ALLERGIES: Lipitor

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Daughter with pulmonary fibrosis
Son with lung cancer (smoker), pt unaware
Mother died in childbirth, father died unknown cause

SOCIAL HISTORY: Lives with daughter, works part-time assembling circuit boards
No EtOH, no tobacco
Secondary malignant neoplasm of other digestive organs and spleen,Malignant neoplasm of head of pancreas,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Cholangitis,Hypovolemia,Disseminated candidiasis,Acquired hypertrophic pyloric stenosis,Personal history of other diseases of circulatory system,Unspecified essential hypertension
Sec mal neo GI NEC,Mal neo pancreas head,Ac kidny fail, tubr necr,Septicemia NOS,Severe sepsis,Acute respiratry failure,Cholangitis,Hypovolemia,Disseminated candidiasis,Acq pyloric stenosis,Hx-circulatory dis NEC,Hypertension NOS
Admission Date:  [**2135-1-29**]              Discharge Date:   [**2135-2-7**]


Service: SURGERY

Allergies:
Lipitor

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Obstructive jaundice

Major Surgical or Invasive Procedure:
ERCP
PTC stent


History of Present Illness:
Patient is an 87 year old female who was transferred from [**Hospital 5279**]
Hospital, [**Location (un) 3844**], to [**Hospital1 **] on [**2135-1-29**].
She has experienced a 40-lb weight loss over the past year with
a steadily decreasing appetite. In [**Month (only) **], she developed a
thrombus in the left internal jugular vein and was treated with
warfarin. She became supratherapeutic on warfarin and was
reversed with vitamin [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] then suffered what was believed to
be an embolic stroke on [**2135-1-13**] requiring hospital admission.
She had only minor neurologic deficits and was discharged a few
days later on warfarin. She then had melena as well as coffee
ground emesis and was readmitted to the hospital [**2135-1-25**].
During that admission, she was diagnosed with acute renal
failure, and obstructive jaundice with a mass in the pancreatic
head and a liver mass. Attempt at ERCP was made with inability
to cannulate the bile duct. She was transferred to [**Hospital1 18**] for
further care.

Past Medical History:
CVA
Left IJ thrombus
Cholelithiasis
Pancreatic head mass, liver mass
AAA 3.8cm
HTN
GI bleed on warfarin
Recent ([**1-5**]) acute renal failure

Social History:
Lives with daughter, works part-time assembling circuit boards
No EtOH, no tobacco

Family History:
Daughter with pulmonary fibrosis
Son with lung cancer (smoker), pt unaware
Mother died in childbirth, father died unknown cause

Physical Exam:
On admission:

T 97.4  HR 63  BP 100/60  RR 18  SaO2 95% room air  FS=159
Alert, oriented, clear speech
PERRL, +scleral icterus
Upper dentures
Palpable cord left IJ, no JVD, no LAD
Lungs clear and equal b/l
Heart RRR, nl S1S2, no M/G/R
Abd soft, NTND, +BS
Ext with multiple bruises on arms, right leg weaker than left,
warm 1+edema b/l feet, strong pulses throughout

Pertinent Results:
Transfer labs ([**1-29**]):
WBC 19.5
AST 209, ALT 67, AP 567, T bili 8.9, Albumin 1.7
CA [**47**]-9 ([**1-28**])=1552, Alpha fetoprotein ([**1-28**])=10.6

Brief Hospital Course:
The patient was accepted by Dr. [**Last Name (STitle) **] (Gold Surgery service)
on [**2135-1-29**] and transferred to the intensive care unit on
hospital day 2 due to oliguria in the setting of obstructive
jaundice, concerning for sepsis. She underwent ERCP on [**2135-1-30**]
again with inability to cannulate the bile duct. She then had an
8 French internal/external biliary drainage catheter placed to
decompress the long segment common bile duct stricture by
Interventional Radiology. A PICC line was placed and TPN
initiated due the patient's poor nutritional status (albumin 1.7
on transfer). She was volume resuscitated per the Nephrology
team (low FeNa) with slow improvement in her urine output. A
family meeting was held with Dr. [**Last Name (STitle) **] to discuss the
patient's likely metastatic pancreatic cancer and poor
prognosis. It was agreed to place internal stents in the biliary
tree and a duodenal stent in an effort to successfully advance
the patient's diet and discharge her from the hospital as soon
as possible.  Patient had IR placed internal biliary stent on
[**2-2**].  However, she became septic over a period of next couple of
days.  She required cardiovascular support with pressors, she
needed intubated for respiratory support and she stopped making
urine.  Renal service was consulted who stated that she was too
unstable for HD.  In light of both multi-organ failure and poor
prognosis from likely metastatic pancreatic tumor, a family
meeting was held.  Patient was made DNR/DNI then CMO on [**2-7**].
She expired at 1:10 pm on [**2135-2-7**].

Medications on Admission:
Atenolol, vasotec, warfarin, lactulose, dulcolax

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Metastatic cancer
Acute renal failure
Subclavian vein thrombus
Cerebral vascular accident
Cholelithiasis
Gastroentestinal bleed
Abdominal aortic aneurysm
Hypertension
Respiratory failure

Discharge Condition:
Death


Completed by:[**2135-2-7**]
{'Secondary malignant neoplasm of other digestive organs and spleen,Malignant neoplasm of head of pancreas,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Cholangitis,Hypovolemia,Disseminated candidiasis,Acquired hypertrophic pyloric stenosis,Personal history of other diseases of circulatory system,Unspecified essential hypertension'}


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: Obstructive jaundice

PRESENT ILLNESS: Patient is an 87 year old female who was transferred from [**Hospital 5279**]
Hospital, [**Location (un) 3844**], to [**Hospital1 **] on [**2135-1-29**].
She has experienced a 40-lb weight loss over the past year with
a steadily decreasing appetite. In [**Month (only) **], she developed a
thrombus in the left internal jugular vein and was treated with
warfarin. She became supratherapeutic on warfarin and was
reversed with vitamin [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] then suffered what was believed to
be an embolic stroke on [**2135-1-13**] requiring hospital admission.
She had only minor neurologic deficits and was discharged a few
days later on warfarin. She then had melena as well as coffee
ground emesis and was readmitted to the hospital [**2135-1-25**].
During that admission, she was diagnosed with acute renal
failure, and obstructive jaundice with a mass in the pancreatic
head and a liver mass. Attempt at ERCP was made with inability
to cannulate the bile duct. She was transferred to [**Hospital1 18**] for
further care.

MEDICAL HISTORY: CVA
Left IJ thrombus
Cholelithiasis
Pancreatic head mass, liver mass
AAA 3.8cm
HTN
GI bleed on warfarin
Recent ([**1-5**]) acute renal failure

MEDICATION ON ADMISSION: Atenolol, vasotec, warfarin, lactulose, dulcolax

ALLERGIES: Lipitor

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Daughter with pulmonary fibrosis
Son with lung cancer (smoker), pt unaware
Mother died in childbirth, father died unknown cause

SOCIAL HISTORY: Lives with daughter, works part-time assembling circuit boards
No EtOH, no tobacco 

### Response:
{'Secondary malignant neoplasm of other digestive organs and spleen,Malignant neoplasm of head of pancreas,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Cholangitis,Hypovolemia,Disseminated candidiasis,Acquired hypertrophic pyloric stenosis,Personal history of other diseases of circulatory system,Unspecified essential hypertension'}
