CHIEF COMPLAINT: Metastatic ocular melanoma to the liver

PRESENT ILLNESS: 42-year-old female who underwent a proton beam therapy for an
ocular
melanoma in [**2158**]. She had recurrence in [**2163**] and again received
proton beam irradiation. She has been followed by Dr.[**Last Name (STitle) **]
[**Name (STitle) 81582**] and on [**2167-11-17**] she was noted to have an
elevated alkaline phosphatase of 189. A CT scan on [**2167-12-31**] demonstrated a 4 cm mass in the dome of the liver in the
right lobe (segment 7, 8) and a second 5 cm lesion in segment 4b
(medial segment of the left lobe). The lesion in the medial
segment is sitting close to the confluence of the right and left
portal vein but there is no involvement of the portal vein
itself. Pre-op MRI of brain was negative, and chest CT
demonstrated no evidence of pulmonary metastases. She underwent
preoperative right portal vein embolization in anticipation of
performing a right hepatic trisegmentectomy. She had significant
hypertrophy of the left lateral segment by CT scan.

MEDICAL HISTORY: HTN, metastatic ocular melanoma
PSH: C-section '[**49**], L cataract, phtoablation x 2 melnoma eye,
s/p portal vein embolization [**2-1**], right hepatic lobectomy, CCY,
Roux-n-Y hepaticojejunostomy, portal vein thrombectomy [**2168-3-4**]

MEDICATION ON ADMISSION: Lisinopril 20QD, Cyclopentolate 1 drop OS QWK, Brimonidine 1
drop OS [**Hospital1 **]
Lasix 40QD, Potassium 2meq QD, CaCO3 1000BID, Tylenol 325prn

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Gentamicin

PHYSICAL EXAM: VS: 98.2, 115/50
NCAT, EOMI, moist mucous membranes
Neck supple without anterior or posterior LAD
Tachycardia, normal S1 and S2, no M/R/G
Decreased BS at R. base markedly different from the L. base
where
she is quite clear to auscultation
soft, distended, appropriately tender along the R. upper flank.
Wound C/D/I 2 JP drains in place
No CVAT
2+ peripheral edema, warm and well perfused.

FAMILY HISTORY: Mother age 77: HTN, Father age 79: HTN,stroke.
maternal grandmother died in her 90s and her paternal
grandmother also died in her 90s. Paternal grandfather died in
his 60s or 70s of an MI.  Maternal grandfather died of unknown
causes.

SOCIAL HISTORY: Married. Lives in Northern [**State 1727**] with husband and one son
Malignant neoplasm of liver, secondary,Portal vein thrombosis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Secondary malignant neoplasm of other specified sites,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of eye,Neoplasm related pain (acute) (chronic),Abdominal pain, other specified site,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Accidents occurring in residential institution,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Tachycardia, unspecified
Second malig neo liver,Portal vein thrombosis,Hemorrhage complic proc,Ac posthemorrhag anemia,Secondary malig neo NEC,Cholelithiasis NOS,Hx of eye malignancy,Neoplasm related pain,Abdmnal pain oth spcf st,Acc cut/hem in surgery,Accid in resident instit,Abn react-surg proc NEC,Tachycardia NOS
Admission Date:  [**2168-3-4**]              Discharge Date:   [**2168-3-15**]

Date of Birth:  [**2125-7-23**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamide Antibiotics) / Gentamicin

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Metastatic ocular melanoma to the liver

Major Surgical or Invasive Procedure:
[**2168-3-4**]: Extended right hepatic lobectomy, cholecystectomy,
anastomosis of left portal vein to main portal vein, portal vein
thrombectomy, Roux-en-Y hepaticojejunostomy to the left hepatic
duct and intraoperative ultrasound.


History of Present Illness:
42-year-old female who underwent a proton beam therapy for an
ocular
melanoma in [**2158**]. She had recurrence in [**2163**] and again received
proton beam irradiation. She has been followed by Dr.[**Last Name (STitle) **]
[**Name (STitle) 81582**] and on [**2167-11-17**] she was noted to have an
elevated alkaline phosphatase of 189. A CT scan on [**2167-12-31**] demonstrated a 4 cm mass in the dome of the liver in the
right lobe (segment 7, 8) and a second 5 cm lesion in segment 4b
(medial segment of the left lobe). The lesion in the medial
segment is sitting close to the confluence of the right and left
portal vein but there is no involvement of the portal vein
itself. Pre-op MRI of brain was negative, and chest CT
demonstrated no evidence of pulmonary metastases. She underwent
preoperative right portal vein embolization in anticipation of
performing a right hepatic trisegmentectomy. She had significant
hypertrophy of the left lateral segment by CT scan.

Past Medical History:
HTN, metastatic ocular melanoma
PSH: C-section '[**49**], L cataract, phtoablation x 2 melnoma eye,
s/p portal vein embolization [**2-1**], right hepatic lobectomy, CCY,
Roux-n-Y hepaticojejunostomy, portal vein thrombectomy [**2168-3-4**]


Social History:
Married. Lives in Northern [**State 1727**] with husband and one son

Family History:
Mother age 77: HTN, Father age 79: HTN,stroke.
maternal grandmother died in her 90s and her paternal
grandmother also died in her 90s. Paternal grandfather died in
his 60s or 70s of an MI.  Maternal grandfather died of unknown
causes.


Physical Exam:
VS: 98.2, 115/50
NCAT, EOMI, moist mucous membranes
Neck supple without anterior or posterior LAD
Tachycardia, normal S1 and S2, no M/R/G
Decreased BS at R. base markedly different from the L. base
where
she is quite clear to auscultation
soft, distended, appropriately tender along the R. upper flank.
Wound C/D/I 2 JP drains in place
No CVAT
2+ peripheral edema, warm and well perfused.


Pertinent Results:
On Admission: [**2168-3-4**]
WBC-11.8*# RBC-3.32* Hgb-10.4* Hct-29.7* MCV-90 MCH-31.4
MCHC-35.1* RDW-14.9 Plt Ct-164
PT-18.3* PTT-99.9* INR(PT)-1.7*
Glucose-153* UreaN-10 Creat-0.9 Na-139 K-5.3* Cl-104 HCO3-17*
AnGap-23*
ALT-880* AST-912* AlkPhos-30* TotBili-3.6*
Albumin-2.6* Calcium-9.0 Phos-5.1* Mg-1.9
On Discharge [**2168-3-15**]
WBC-12.8* RBC-3.18* Hgb-9.6* Hct-29.9* MCV-94 MCH-30.2 MCHC-32.1
RDW-16.3* Plt Ct-322
Glucose-109* UreaN-9 Creat-0.6 Na-136 K-3.4 Cl-101 HCO3-27
AnGap-11
ALT-111* AST-43* AlkPhos-140* TotBili-0.9
Albumin-2.2* Calcium-7.3* Phos-2.6* Mg-2.1



Brief Hospital Course:
42 y/o female with metastatic ocular melanoma who was taken to
the OR with Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for Extended right hepatic
lobectomy, cholecystectomy, anastomosis of left portal vein to
main portal vein, portal vein thrombectomy, Roux-en-Y
hepaticojejunostomy to the left hepatic duct and intraoperative
ultrasound. Per Dr [**Last Name (STitle) 37914**] note, at the time of exploration, she
had a large mass in the dome of the liver that was adherent and
superficially growing into the right hemidiaphragm. This
lesion was easily separated from the diaphragm and a small
portion of the fibrous portion of the diaphragm removed without
entering the right chest. There was a large amount of necrotic
tumor in the segment VIII mass. Ultrasound also
demonstrated the lesion in the medial segment of the left lobe.
No other lesions were seen in the left lateral segment.
This was a complicated surgery, she received 9000 mL of
crystalloid, 9 units of packed red cells, 1250 mL of albumin,
1000 mL of Hespan, 1 unit fresh frozen and made 1100 mL of
urine. Estimated blood loss was 5000 mL. She was transferred to
the SICU for initial post op management. Please see the op note
for surgical detail.
She received an additional 5 units of RBCs while in the SICU,
and the her Hct remained stable for the rest of the
hospitalization.
On POD 1 an ultrasound was obtained as liver enzymes bumped
significantly to the 3000-4000 range. The ultrasound showed
appropriate waveforms in the left portal
vein, which is patent. Limited waveforms of the left hepatic
artery appear
normal. There is no fluid collection or ascites. IMPRESSION:
Expected post-trisegmentectomy appearance of the left lobe of
the liver.
The liver enzymes started to trend down by POD 2 and continued
to do so throughout the hospitalization. Although not normal
they were much improved by day of discharge.
She was transferred to the regular surgical floor on POD 3.
Morphine dosing was backed down for oversedation. She was then
able to start working with PT, start taking POs with good
tolerance and having return of bowel function.
JP medial drain had around 400 cc output, lateral drain was
always less than 100.
A T tube cholangio was done on POD 10 showing contrast filling
the jejunostomy loop. The tip of the T-tube is directed away
from the biliary system and has likely been dislodged. No
extravasation of contrast was seen. The drain was capped.
The lateral drain was removed, the medial drain was left to JP
bulb drainage.
Of note, the biopsy revealed:
Liver, right lobe: Metastatic melanoma, extending to within 1 mm
of posterior resection margin.
Diaphragmatic nodule:  Metastatic melanoma.
The patient was discharged to a local hotel with VNA coverage as
they live in northern [**State 1727**].


Medications on Admission:
Lisinopril 20QD, Cyclopentolate 1 drop OS QWK, Brimonidine 1
drop OS [**Hospital1 **]
Lasix 40QD, Potassium 2meq QD, CaCO3 1000BID, Tylenol 325prn


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain: Limit to 7 tablets daily.
2. Cyclopentolate 1 % Drops Sig: One (1) Drop Ophthalmic 1X/WEEK
(SA).
3. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
4. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment Sig: One
(1) Appl Ophthalmic PRN (as needed).
5. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-25**]
Drops Ophthalmic PRN (as needed).
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO every 4-6 hours as needed for pain: Hold
for sedation.
Disp:*25 Tablet Sustained Release(s)* Refills:*0*
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO twice a day as needed for take away from
mealtime.
9. Lasix 20 mg Tablet Sig: Two (2) Tablet PO once a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for
8 days.
Disp:*8 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Metastatic ocular melanoma to the liver.


Discharge Condition:
Good/Stable


Discharge Instructions:
Please call Dr [**Last Name (STitle) 4727**] office at [**Telephone/Fax (1) 673**] for fever > 101,
chills, nausea, vomiting, increased abdominal pain, yellowing of
skin or eyes, inability to take or keep down food, fluids or
medications
Drink enough fluids to keep urine light yellow in color
Use nutritional supplements such as Ensure if you are not taking
enough calories
Monitor for sedation if taking pain meds
You may use up to two grams of Tylenol daily for pain control
No heavy lifting
Monitor incision for redness, drainage or bleeding. Call if the
incision starts putting out more drainage. You may keep a
dressing on to be changed at least once daily
Drain and record the JP drain output. Twice daily and more often
as needed. Report to Dr [**Last Name (STitle) 4727**] office if it gets more green in
color, develops a foul odor or gets cloudy. Bring a record of
drain output with you to your clinic visit next week.
Keep the Roux tube coiled and under a dressing to prevent
pulling
[**Month (only) 116**] shower. Change dressings post. Do not allow drains to hang
without support

Followup Instructions:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2168-3-23**]
2:20


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2168-3-24**]
{'Malignant neoplasm of liver, secondary,Portal vein thrombosis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Secondary malignant neoplasm of other specified sites,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of eye,Neoplasm related pain (acute) (chronic),Abdominal pain, other specified site,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Accidents occurring in residential institution,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Tachycardia, unspecified'}


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: Metastatic ocular melanoma to the liver

PRESENT ILLNESS: 42-year-old female who underwent a proton beam therapy for an
ocular
melanoma in [**2158**]. She had recurrence in [**2163**] and again received
proton beam irradiation. She has been followed by Dr.[**Last Name (STitle) **]
[**Name (STitle) 81582**] and on [**2167-11-17**] she was noted to have an
elevated alkaline phosphatase of 189. A CT scan on [**2167-12-31**] demonstrated a 4 cm mass in the dome of the liver in the
right lobe (segment 7, 8) and a second 5 cm lesion in segment 4b
(medial segment of the left lobe). The lesion in the medial
segment is sitting close to the confluence of the right and left
portal vein but there is no involvement of the portal vein
itself. Pre-op MRI of brain was negative, and chest CT
demonstrated no evidence of pulmonary metastases. She underwent
preoperative right portal vein embolization in anticipation of
performing a right hepatic trisegmentectomy. She had significant
hypertrophy of the left lateral segment by CT scan.

MEDICAL HISTORY: HTN, metastatic ocular melanoma
PSH: C-section '[**49**], L cataract, phtoablation x 2 melnoma eye,
s/p portal vein embolization [**2-1**], right hepatic lobectomy, CCY,
Roux-n-Y hepaticojejunostomy, portal vein thrombectomy [**2168-3-4**]

MEDICATION ON ADMISSION: Lisinopril 20QD, Cyclopentolate 1 drop OS QWK, Brimonidine 1
drop OS [**Hospital1 **]
Lasix 40QD, Potassium 2meq QD, CaCO3 1000BID, Tylenol 325prn

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Gentamicin

PHYSICAL EXAM: VS: 98.2, 115/50
NCAT, EOMI, moist mucous membranes
Neck supple without anterior or posterior LAD
Tachycardia, normal S1 and S2, no M/R/G
Decreased BS at R. base markedly different from the L. base
where
she is quite clear to auscultation
soft, distended, appropriately tender along the R. upper flank.
Wound C/D/I 2 JP drains in place
No CVAT
2+ peripheral edema, warm and well perfused.

FAMILY HISTORY: Mother age 77: HTN, Father age 79: HTN,stroke.
maternal grandmother died in her 90s and her paternal
grandmother also died in her 90s. Paternal grandfather died in
his 60s or 70s of an MI.  Maternal grandfather died of unknown
causes.

SOCIAL HISTORY: Married. Lives in Northern [**State 1727**] with husband and one son 

### Response:
{'Malignant neoplasm of liver, secondary,Portal vein thrombosis,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Secondary malignant neoplasm of other specified sites,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of malignant neoplasm of eye,Neoplasm related pain (acute) (chronic),Abdominal pain, other specified site,Accidental cut, puncture, perforation or hemorrhage during surgical operation,Accidents occurring in residential institution,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Tachycardia, unspecified'}
