CHIEF COMPLAINT: Intermucosal adenocarcinoma of the
gastroesophageal junction.

PRESENT ILLNESS: The patient is a 68 year-old
gentleman with a 25 year history of GERD. He was recently
diagnosed with intermucosal adenocarcinoma of his
gastroesophageal junction, in the setting of a Barrett's
esophagus.  The patient's preoperative work-up was negative
for any metastatic disease and therefore, he was deemed to be
suitable for a transhiatal esophagectomy.

MEDICAL HISTORY: GERD, recent dysphagia. Biopsy proven intramucosal AdenoCA and
[**Last Name (un) 865**] on EGD
PMH: HTN, Gout, SVT, BPH, basal cell CA
PSH: R ORIF, R IH, vasectomy

MEDICATION ON ADMISSION: atenolol, allopurinol, doxazocin, mvi, glucosamine, polaramine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: general: well appearing male in NAD s/p esophagectomy and
feeding J-tube.
HEENT: left neck incision well approx, no redness, no drainage.
Staples d/c'd. JP Drain d/c'd.
Chest: CTA bilat
Cor: RRR S1, S2
Abd: soft, NT, +BS. J-tube site benign. Abd incision intact, no
redness, no drainage. Every other staple d/c'd.
extrem: no C/C/E
neuro: intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: 
Malignant neoplasm of cardia,Unspecified pleural effusion,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Atrial fibrillation,Other iatrogenic hypotension,Esophageal reflux,Abdominal pain, unspecified site,Unspecified essential hypertension,Gout, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of other malignant neoplasm of skin,Other postprocedural status
Mal neo stomach cardia,Pleural effusion NOS,Accidental op laceration,Acc cut/hem in surgery,Atrial fibrillation,Iatrogenc hypotnsion NEC,Esophageal reflux,Abdmnal pain unspcf site,Hypertension NOS,Gout NOS,BPH w/o urinary obs/LUTS,Hx-skin malignancy NEC,Post-proc states NEC
Admission Date:  [**2158-6-5**]              Discharge Date:   [**2158-6-15**]

Date of Birth:  [**2089-5-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Intermucosal adenocarcinoma of the
gastroesophageal junction.


Major Surgical or Invasive Procedure:
TransHiatal Esophagecty, jejunostomy, pyloroplasty


History of Present Illness:
The patient is a 68 year-old
gentleman with a 25 year history of GERD. He was recently
diagnosed with intermucosal adenocarcinoma of his
gastroesophageal junction, in the setting of a Barrett's
esophagus.  The patient's preoperative work-up was negative
for any metastatic disease and therefore, he was deemed to be
suitable for a transhiatal esophagectomy.


Past Medical History:
GERD, recent dysphagia. Biopsy proven intramucosal AdenoCA and
[**Last Name (un) 865**] on EGD
PMH: HTN, Gout, SVT, BPH, basal cell CA
PSH: R ORIF, R IH, vasectomy


Family History:
non-contributory

Physical Exam:
general: well appearing male in NAD s/p esophagectomy and
feeding J-tube.
HEENT: left neck incision well approx, no redness, no drainage.
Staples d/c'd. JP Drain d/c'd.
Chest: CTA bilat
Cor: RRR S1, S2
Abd: soft, NT, +BS. J-tube site benign. Abd incision intact, no
redness, no drainage. Every other staple d/c'd.
extrem: no C/C/E
neuro: intact.

Pertinent Results:
CXR:
[**2158-6-9**]:  In comparison with study of earlier in the day, there
has
apparently been thorcentesis with removal of pleural fluid and a
more sharp
appearance of the right costophrenic angle. No evidence of
pneumothorax. No
change in the appearance of the mediastinum or left chest.


Brief Hospital Course:
Pt was admitted and taken to the OR for
Esophagogastroduodenoscopy,Transhiatal esophagectomy with
bilateral plasty and placement of a feeding jejunostomy tube.
Or course was uneventful. An epidural was placed for pain
control. An NGT, JP and chest tube were placed at the time of
surgery. Pt was admitted to SICU post op intubated for vent
support and hemodynamic monitoring and volume resusitation. Pt
was extubated on POD#1.
POD#2 trophic tube feeds started.Left chest tube placed to water
seal. NGT d/c'd.
POD#3 developed afib- unsuccessful rate control w/ lopressor.
Responded to amiodarone bolus and drip.
POD#4 CXR w/ progressive right effusion- tapped for 900cc old
bloody fluid.
POD#5 PICC line for amiodarone until taking po's. Tube feeds
slowly increased to goal. Epidural d/c'd and pain well
controlled w/ roxicet. Bowel regimen effective.
POD#6 c/o right upper quad pain- w/u neg for biliary disease.
POD#7 given trial of grape juice orally and no evidence of juice
in anastomotic JP drain.
POD#8 Diet advanced to clears and [**Last Name (un) 1815**] well. Did c/o
intermittant fullness and cramping. Tube feeds  held and given
laxative w/ good result and tube feeds were resumed.
POD#9 diet advancedto fulls. po meds were intiated and tube
feeds were advanced to goal.
POD#10 Pt abulating indep w/ RA sats 98%. d/c'd to home w/ vna
services for tube feed assistance.
d/c'd to home and will return for barium swallow before
advancing diet.

Medications on Admission:
atenolol, allopurinol, doxazocin, mvi, glucosamine, polaramine

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Last Name (un) **]: 5-10 MLs
PO Q4H (every 4 hours) as needed.
Disp:*420 ML(s)* Refills:*0*
2. Docusate Sodium 50 mg/5 mL Liquid [**Last Name (un) **]: One Hundred (100) mls
PO BID (2 times a day) as needed for constipation.
Disp:*420 mls* Refills:*2*
3. Lactulose 10 gram/15 mL Syrup [**Last Name (un) **]: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation.
Disp:*400 ML(s)* Refills:*1*
4. Doxazosin 1 mg Tablet [**Last Name (un) **]: Two (2) Tablet PO HS (at bedtime).

5. Allopurinol 100 mg Tablet [**Last Name (un) **]: Three (3) Tablet PO DAILY
(Daily).
6. Amiodarone 200 mg Tablet [**Last Name (un) **]: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
Disp:*30 Tablet,Rapid Dissolve, DR(s)* Refills:*2*
8. tube feeding
replete with fiber continuous at 90cc/hr
flush w/ 50cc water every 8hrs and before and after feeds and
medication.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
GERD, recent dysphagia. Biopsy proven intramucosal AdenoCA and
[**Last Name (un) 865**] on EGD
PMH: HTN, Gout, SVT, BPH, basal cell CA


Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] if you develop chest pain,
shortness of breath, nausea, vomiting, diarrhea, inability to
tolerate tube feeds or oral intake.
Continue on your tube feeds as directed and take full liquids by
mouth. No caffiene and no carbonation.
Flush your feeding tube with 50cc water before and after
medications and before and after feeding connect and disconnect.


if you feeding tube sutures break, tape your tube securely in
place and call the office [**Telephone/Fax (1) 170**] to have the sutures
replaced.
If you feeding tube falls out, save the tube and call the office
immediately. The tube needs to be replaced immediately because
the tract closes very quickly. You will need to come into the
office  to have the feeding tube replaced. Bring your old tube
w/ you when you come in.

Followup Instructions:
You have a follow up appointment with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4129**] NP/ Dr.
[**Last Name (STitle) **] on wednesday [**6-21**] on the [**Hospital Ward Name **] [**Hospital Ward Name 121**] building
[**Hospital1 **] one in the chest disease center at 1:30pm.
You have a barium swallow on [**6-21**]  at 11am on the [**Hospital Ward Name **] [**Hospital Ward Name 23**] clinical center [**Location (un) **] radiology. Stop your
tube feedings at midnight the night before.



Completed by:[**2158-6-15**]
{'Malignant neoplasm of cardia,Unspecified pleural effusion,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Atrial fibrillation,Other iatrogenic hypotension,Esophageal reflux,Abdominal pain, unspecified site,Unspecified essential hypertension,Gout, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of other malignant neoplasm of skin,Other postprocedural status'}


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: Intermucosal adenocarcinoma of the
gastroesophageal junction.

PRESENT ILLNESS: The patient is a 68 year-old
gentleman with a 25 year history of GERD. He was recently
diagnosed with intermucosal adenocarcinoma of his
gastroesophageal junction, in the setting of a Barrett's
esophagus.  The patient's preoperative work-up was negative
for any metastatic disease and therefore, he was deemed to be
suitable for a transhiatal esophagectomy.

MEDICAL HISTORY: GERD, recent dysphagia. Biopsy proven intramucosal AdenoCA and
[**Last Name (un) 865**] on EGD
PMH: HTN, Gout, SVT, BPH, basal cell CA
PSH: R ORIF, R IH, vasectomy

MEDICATION ON ADMISSION: atenolol, allopurinol, doxazocin, mvi, glucosamine, polaramine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: general: well appearing male in NAD s/p esophagectomy and
feeding J-tube.
HEENT: left neck incision well approx, no redness, no drainage.
Staples d/c'd. JP Drain d/c'd.
Chest: CTA bilat
Cor: RRR S1, S2
Abd: soft, NT, +BS. J-tube site benign. Abd incision intact, no
redness, no drainage. Every other staple d/c'd.
extrem: no C/C/E
neuro: intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of cardia,Unspecified pleural effusion,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Atrial fibrillation,Other iatrogenic hypotension,Esophageal reflux,Abdominal pain, unspecified site,Unspecified essential hypertension,Gout, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of other malignant neoplasm of skin,Other postprocedural status'}
