CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 89 year-old
female with a past medical history of colon cancer status
post right colectomy who underwent CT guided biopsy of a
liver lesion, which was subsequently confirmed to be a
metastatic colon CA at an outside hospital.  Post procedure
the patient's hematocrit dropped to 23 and then to 18 on the
morning of admission to [**Hospital1 69**].
She was reportedly at that time normotensive and not
tachycardic.  CT scan at that time revealed free
intraperitoneal blood in both pericolic gutters.  The patient
was emergently transferred to [**Hospital1 188**] Emergency Department and she arrived awake, alert and
in no acute distress.  Vital signs were all within normal
limits.  The patient had a third unit of packed red blood
cells running upon arrival.

MEDICAL HISTORY: 1.  Colon cancer.
2.  Anemia.
3.  Organic brain syndrome, not otherwise specified.

MEDICATION ON ADMISSION: 1.  Multivitamin.
2.  Colace 100 mg po b.i.d.
3.  Lopressor 50 mg po b.i.d.
4.  Aldomet 250 mg po b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hematoma complicating a procedure,Malignant neoplasm of liver, secondary,Hemoperitoneum (nontraumatic),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of large intestine,Anemia, unspecified,Unspecified nonpsychotic mental disorder following organic brain damage
Hematoma complic proc,Second malig neo liver,Hemoperitoneum,Abn react-surg proc NEC,Hx of colonic malignancy,Anemia NOS,Nonpsychot brain syn NOS
Admission Date:  [**2154-11-22**]     Discharge Date:  [**2154-11-28**]


Service:  HEPATOBILIARY SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is an 89 year-old
female with a past medical history of colon cancer status
post right colectomy who underwent CT guided biopsy of a
liver lesion, which was subsequently confirmed to be a
metastatic colon CA at an outside hospital.  Post procedure
the patient's hematocrit dropped to 23 and then to 18 on the
morning of admission to [**Hospital1 69**].
She was reportedly at that time normotensive and not
tachycardic.  CT scan at that time revealed free
intraperitoneal blood in both pericolic gutters.  The patient
was emergently transferred to [**Hospital1 188**] Emergency Department and she arrived awake, alert and
in no acute distress.  Vital signs were all within normal
limits.  The patient had a third unit of packed red blood
cells running upon arrival.

PAST MEDICAL HISTORY:
1.  Colon cancer.
2.  Anemia.
3.  Organic brain syndrome, not otherwise specified.

PAST SURGICAL HISTORY:  Right colectomy.

MEDICATIONS ON ADMISSION:
1.  Multivitamin.
2.  Colace 100 mg po b.i.d.
3.  Lopressor 50 mg po b.i.d.
4.  Aldomet 250 mg po b.i.d.

ALLERGIES:  No known drug allergies.

PERTINENT LABORATORIES ON ADMISSION:  The patient had a white
blood cell count of 21.1, hematocrit 31.8, platelets 117,
sodium 145, potassium 3.6, chloride 107, bicarb 25, BUN 18,
creatinine 1.0, glucose 109, PT 13, INR 1.1, PTT 25.3.  ALT
61, AST 79, alkaline phosphatase 100, total bilirubin 3.2.

PHYSICAL EXAMINATION:  On physical examination the patient
was alert and in no acute distress.  The patient was
afebrile.  Heart rate 75.  Blood pressure 158/82.
Respiratory rate 15.  Sating 96% on room air.  Heart was
regular rate and rhythm.  Lungs were clear to auscultation
bilaterally.  Abdomen was soft, mildly distended, positive
right upper quadrant tenderness and positive bowel sounds.
No guarding or rebound were noted.  Extremities were warm and
well perfuse.

HOSPITAL COURSE:  The patient was admitted to the Blue
Surgery Service, but was admitted to the Surgical Intensive
Care Unit on [**2154-11-22**] for close monitoring.  The patient had
a cordis central line placed in the left subclavian as well
as a right radial arterial line placed.  The patient was also
started on Unasyn for empiric coverage.  On hospital day
number two [**2154-11-23**] the patient's hematocrit remained stable
at 33, total bilirubin was 2.3.  Repeat CT on that day
revealed large amounts of intraabdominal free fluid and a
subcapsular liver hematoma.  Findings were consistent with
the patient's known history of hemoperitoneum status post
liver biopsy and appeared stable compared to the outside CT
three days prior.  There is no evidence of active
extravasation at the time of examination.  Incidentally the
patient had multiple low attenuation lesions within the right
lobe of the liver.  On hospital day number three [**2154-11-24**] the
patient's hematocrit remained stable at 30.6 and was
transferred to the floor.  On hospital day number four Unasyn
was discontinued. The patient's hematocrit remained stable at
31.9 and belly examination was benign.  Pathology from the
outside hospital revealed a well differentiated
adenocarcinoma consistent with primary disease.  On hospital
day number four [**2154-11-25**] the patient's left subclavian cordis
was switched over a wire to the triple lumen central line by
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  Subsequent chest x-ray revealed proper
placement of the line. In addition on hospital day number
four [**2154-11-25**] the patient received a CT of the chest to
examine possibilities of metastatic pulmonary disease, which
revealed no evidence of pulmonary metastases, but extensive
respiratory motion as well as a basilar atelectatic change,
small pleural effusions, limited the assessment for a very
small lesions.  Also of note there was increased number of
lymph nodes in the mediastinum and in particular lymph node
on the left upper paratracheal lesion just below the left
lobe of the thyroid gland, which was slightly enlarged by CT
criteria.  Also of note was persistent subcapsular hematoma,
hemoperitoneum and a heterogenous hemorrhagic liver lesions
previously noted.  Also of note tracheobronchomalacia.  The
patient was doing well at this time tolerating a regular
diet.  Belly examination continued to be unremarkable.  The
patient was seen by physical therapy and cleared for home.

Of note, the patient's total bilirubin increased from 2.5 on
[**2154-11-25**] to 4.4 on [**2154-11-26**], but began to trend down on
hospital day six [**2154-11-27**] down to 3.7.  This change was most
likely due to blood transfusion reactions.  In addition, the
patient had a C-diff times two, which were both negative and
no antibiotics were started.  On [**2154-11-28**] the patient was
deemed well enough to go home with a benign belly and a
stable hematocrit at around 31.9.

DISCHARGE STATUS:  To home with services.

DISCHARGE DIAGNOSES:
1.  Subcapsular hematoma of the liver status post liver
biopsy.
2.  Hemoperitoneum status post liver biopsy.
3.  Colon cancer metastatic to the liver.
4.  Organic brain syndrome not otherwise specified.

DISCHARGE MEDICATIONS:
1.  Multivitamins.
2.  Protonix 40 mg po q day.
3.  Metoprolol 50 mg po b.i.d.
4.  Aldomet 250 mg po b.i.d.

FOLLOW UP PLANS:  Please follow up with Dr. [**Last Name (STitle) **] in one to
two weeks.
[**Doctor First Name **] Seminara, R.N. has given patient a follow-up appointment.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.  02-366

Dictated By:[**Name8 (MD) 7190**]

MEDQUIST36

D:  [**2154-11-28**]  07:32
T:  [**2154-11-28**]  09:02
JOB#:  [**Job Number 44124**]
{'Hematoma complicating a procedure,Malignant neoplasm of liver, secondary,Hemoperitoneum (nontraumatic),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of large intestine,Anemia, unspecified,Unspecified nonpsychotic mental disorder following organic brain damage'}


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: 

PRESENT ILLNESS: The patient is an 89 year-old
female with a past medical history of colon cancer status
post right colectomy who underwent CT guided biopsy of a
liver lesion, which was subsequently confirmed to be a
metastatic colon CA at an outside hospital.  Post procedure
the patient's hematocrit dropped to 23 and then to 18 on the
morning of admission to [**Hospital1 69**].
She was reportedly at that time normotensive and not
tachycardic.  CT scan at that time revealed free
intraperitoneal blood in both pericolic gutters.  The patient
was emergently transferred to [**Hospital1 188**] Emergency Department and she arrived awake, alert and
in no acute distress.  Vital signs were all within normal
limits.  The patient had a third unit of packed red blood
cells running upon arrival.

MEDICAL HISTORY: 1.  Colon cancer.
2.  Anemia.
3.  Organic brain syndrome, not otherwise specified.

MEDICATION ON ADMISSION: 1.  Multivitamin.
2.  Colace 100 mg po b.i.d.
3.  Lopressor 50 mg po b.i.d.
4.  Aldomet 250 mg po b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hematoma complicating a procedure,Malignant neoplasm of liver, secondary,Hemoperitoneum (nontraumatic),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of large intestine,Anemia, unspecified,Unspecified nonpsychotic mental disorder following organic brain damage'}
