CHIEF COMPLAINT: s/p 11 hour Cystectomy

PRESENT ILLNESS: A 77 year old gentleman with a history of high grade
transitional cell carcinoma of the bladder diagnosed [**11-12**] after
episodes of gross hematuria. His metastatic work up has been
negative thus far. He is currently s/p an 11 hour radical
cystoprostatectomy with regional node dissection and ileal
conduit.
.
His 11-hour operative course was significant for ~1800mL of
blood loss, 8 liters of Crystalloid, 500mL of albumin and 2
units of pRBCs.

MEDICAL HISTORY: TIAs, R Carotid Endarterectomy [**2176-3-22**]
Obstructive Sleep Apnea
Duodenal Ulcer
Hypertension
Gout
Glaucoma

MEDICATION ON ADMISSION: Lumigan 0.03% 1 gtt OU QHS
Alphagan 0.15% 1 gtt OU [**Hospital1 **]
HCTZ 12.5mg PO Daily
Lisinopril 20mg PO Daily
Metoprolol 12.5mg PO BID
Ranitidine 150mg PO BID
Simvastatin 20mg PO Daily
MVI 1 tab PO daily
Vitamin C 1g PO Daily
B Complex 1 tab PO Daily
Calcium + Vit D3 500mg/200International Units PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of GU Cancer

SOCIAL HISTORY: The patient is married and lives with his wife in [**Location (un) 55**].
He has a history of smoking approximately 50 pack years,
quitting in 05/93.  He drinks
alcohol occasionally.
Malignant neoplasm of other specified sites of bladder,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Hyperpotassemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Gout, unspecified
Malig neo bladder NEC,Acute kidney failure NOS,Delirium d/t other cond,Surg compl-urinary tract,Hyperpotassemia,Hypertension NOS,Obstructive sleep apnea,Hx TIA/stroke w/o resid,Gout NOS
Admission Date:  [**2176-4-16**]              Discharge Date:   [**2176-5-1**]

Date of Birth:  [**2099-4-1**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1232**]
Chief Complaint:
s/p 11 hour Cystectomy

Major Surgical or Invasive Procedure:
s/p 11 hour Cystectomy

History of Present Illness:
A 77 year old gentleman with a history of high grade
transitional cell carcinoma of the bladder diagnosed [**11-12**] after
episodes of gross hematuria. His metastatic work up has been
negative thus far. He is currently s/p an 11 hour radical
cystoprostatectomy with regional node dissection and ileal
conduit.
.
His 11-hour operative course was significant for ~1800mL of
blood loss, 8 liters of Crystalloid, 500mL of albumin and 2
units of pRBCs.

Past Medical History:
TIAs, R Carotid Endarterectomy [**2176-3-22**]
Obstructive Sleep Apnea
Duodenal Ulcer
Hypertension
Gout
Glaucoma


Social History:
The patient is married and lives with his wife in [**Location (un) 55**].
He has a history of smoking approximately 50 pack years,
quitting in 05/93.  He drinks
alcohol occasionally.


Family History:
No family history of GU Cancer

Pertinent Results:
[**2176-4-30**] 07:05AM BLOOD WBC-15.6*# RBC-3.18* Hgb-9.8* Hct-29.2*
MCV-92 MCH-30.8 MCHC-33.6 RDW-14.4 Plt Ct-578*
[**2176-4-30**] 07:05AM BLOOD Glucose-147* UreaN-16 Creat-0.9 Na-138
K-4.4 Cl-103 HCO3-27 AnGap-12
[**2176-4-17**] 10:00PM BLOOD Albumin-2.6* Calcium-7.7* Phos-1.5*#
Mg-1.7

Brief Hospital Course:
The patient was admitted to the Urology service after undergoing
cystectomy and creation of an ileal conduit on [**2176-4-16**].  Please
see the dictated operative note for details.  He was initially
admitted to the ICU, where he was kept intubated overnight and
extubated in the AM.  His ICU course was essentially
uncomplicated.  He did have one night of delirium and confusion
that required administration of haldol.  This resolved in the AM
and did not occur again in his hospitalizion.

He was transferred to the floor, where he he progressed well,
slowly advancing his diet after passage of flatus and ambulating
with the help of PT.  On [**2176-4-21**], he was noted to have
significant drainage of clear serous fluid from the lower aspect
of his midline abdominal wound.  An ostomy bag was placed over
the wound, with output > 1L/day.  This fluid was sent for
creatinine, which was noted to be significantly elevated, highly
suspicious for urine leak.  A CT Urogram was performed on
[**2176-4-22**] which demonstrated extravasation of contrast around the
ileal conduit.  The exact location of the leak could not be
localized.

On [**2176-4-23**], a loop-o-gram was performed under fluouroscopy in an
attempt to localize the urine leak.  Unfortunately, the leak
could not be localized.  On [**2176-4-24**], a left antegrade
nephrostogram was performed, which demonstrated that the left
ureteroileal anastamosis was intact and without a leak.  The
scan did demonstrate a persistent extravasation of contrast
which once again, could not be localized.

On [**2176-4-26**], repeat L antegrade nephrostogram and L PCN removal
was performed, which again demonstrated a leak that could not be
localized.  A urethral catheter was placed to drain the
abdominal cavity.  At first, this drained significantly, and the
fluid was sent for creatinine, which was consistent with urine.
A catheter was also placed into the ileal loop to decompress the
loop.  This drained significantly, and also significantly
reduced the amount of drainage from the abdominal drain.  In
fact, creatinine checks of the abdominal drain after catheter
decompression of the loop were NOT consistent with urine (all
creatinines were <1.5).

The patient's urine leak was therefore managed conservatively
with catheter decompression of the loop.  Multiple CT Urograms
were performed to evaluate the urine leak, which reduced
significantly before discharge.  The ostomy appliance was
changed before discharge, and the catheter in the urostomy was
replaced and sutured to the ostomy appliance.  Strict
instructions were given to the rehab facility not to manipulate
the ostomy appliance or the catheter decompressing the loop.  Of
onte, three days before discharge, the output from the pt's
abdominal drain appeared milky.  It was sent for triglycerides,
which was elevated > 110, consistent with a small chylous leak.
However, the volume of leak/day was significantly < 500 cc, and
was therefore considered not to be clinically significant.
Nevertheless, the patient was instructed to eat a low-fat diet
high in medium-chain triglycerides.  Before discharge, the
patient completed a seven day course of ceftriaxone for empiric
prophylaxis against forming infected fluid collections in the
pelvis.  The pt remained afebrile throughout his
hospitalization.  On discharge to rehab, he was walking without
difficulty, including traversing stairs, his urostomy was
draining well with catheter decompression, and his urethral
catheter was removed.  He was given instructions to call Dr. [**Doctor Last Name 5752**] office to arrange a f/u appt the tuesday after
discharge, at which point his ostomy appliance would be changed
with the help of the ostomy nurse.

Medications on Admission:
Lumigan 0.03% 1 gtt OU QHS
Alphagan 0.15% 1 gtt OU [**Hospital1 **]
HCTZ 12.5mg PO Daily
Lisinopril 20mg PO Daily
Metoprolol 12.5mg PO BID
Ranitidine 150mg PO BID
Simvastatin 20mg PO Daily
MVI 1 tab PO daily
Vitamin C 1g PO Daily
B Complex 1 tab PO Daily
Calcium + Vit D3 500mg/200International Units PO BID


Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
3. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
4. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours).
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
Bladder cancer


Discharge Condition:
stable


Discharge Instructions:
Rehab:
1. Please do not manipulate the foley catheter that is in his
ileal conduit - this is essential to his treatment and should
not be manipulated.  His ostomy appliance will be changed at his
next urology outpatient appointment.  Please do not change it
until then, or unless there is an emergency.
2. Please walk with patient daily at last four times.
3. Please keep the ostomy bag to gravity drainage to a foley bag
at all times unless the pt is being transported.
4. Please call if there is any drainage from his midline
abdominal wound.
5. Please call if the pt's creatinine is increasing > 1.2, as
this may be an indication of an ongoing urine leak
6. Please check the pt's serum creatinine every other day.

-Please resume all home meds

-Do not drive while taking oxycodone. Please take Tylenol in
addition to oxycodone, and transition to Tylenol as pain
improves.

-You may shower, but do not immerse incision, no tub
baths/swimming.

-Small white steri-strips bandages will fall off in [**4-11**] days,
you may remove at that time if irritating.

-Call if incision becomes markedly more red, swollen, or begins
to drain purulent fluid, or for fever more than 101.5.


Followup Instructions:
Contact Dr.[**Name2 (NI) **] office to arrange a follow up appointment
shortly after discharge.



Completed by:[**2176-5-1**]
{'Malignant neoplasm of other specified sites of bladder,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Hyperpotassemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Gout, 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: s/p 11 hour Cystectomy

PRESENT ILLNESS: A 77 year old gentleman with a history of high grade
transitional cell carcinoma of the bladder diagnosed [**11-12**] after
episodes of gross hematuria. His metastatic work up has been
negative thus far. He is currently s/p an 11 hour radical
cystoprostatectomy with regional node dissection and ileal
conduit.
.
His 11-hour operative course was significant for ~1800mL of
blood loss, 8 liters of Crystalloid, 500mL of albumin and 2
units of pRBCs.

MEDICAL HISTORY: TIAs, R Carotid Endarterectomy [**2176-3-22**]
Obstructive Sleep Apnea
Duodenal Ulcer
Hypertension
Gout
Glaucoma

MEDICATION ON ADMISSION: Lumigan 0.03% 1 gtt OU QHS
Alphagan 0.15% 1 gtt OU [**Hospital1 **]
HCTZ 12.5mg PO Daily
Lisinopril 20mg PO Daily
Metoprolol 12.5mg PO BID
Ranitidine 150mg PO BID
Simvastatin 20mg PO Daily
MVI 1 tab PO daily
Vitamin C 1g PO Daily
B Complex 1 tab PO Daily
Calcium + Vit D3 500mg/200International Units PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of GU Cancer

SOCIAL HISTORY: The patient is married and lives with his wife in [**Location (un) 55**].
He has a history of smoking approximately 50 pack years,
quitting in 05/93.  He drinks
alcohol occasionally. 

### Response:
{'Malignant neoplasm of other specified sites of bladder,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Urinary complications, not elsewhere classified,Hyperpotassemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Gout, unspecified'}
