CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Pt is 78 y/o F with h/o atrial fibrillation on coumadin and h/o
of GIST s/p excision and partial gastrectomy in [**2143**] who later
developed local recurrence and omental metastasis s/p resection
of omental mass in [**3-/2153**] and now presents today with 3 day
history of dull epigastric abdominal pain.  Pt had CT scan at
OSH showing intraperitoneal bleeding and pt was subsequently
transferred to [**Hospital1 18**] for further management.  At OSH, pt had BP
in 90s, hct 23.5 and inr 4.0.  Pt denies fevers, chills,
nausea/vomiting, or diarrhea

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

MEDICATION ON ADMISSION: Coumadin 4 mg Mon
Coumadin 3 mg TueWedFriSatSun
Coumadin 5 mg [**Last Name (un) **]
Metoprolol 25 mg daily
amiodarone 200 mg daily
levothyroxine 200 mcg daily
istalol 0.5% 1 drop each eye [**Hospital1 **]
lumigan 0.03% 1 drop each eye daily
furosemide 80 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98  P 70  BP 112/64  R 20  SaO2 98% RA
Gen: no acute distress
heent: no scleral icterus
neck: supple
Lungs: clear
heart: regular rate and rhythm
abd: soft,no tender,  nondistended, no guarding, nonrigid
Extrem: no edema

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative
Hemoperitoneum (nontraumatic),Malignant neoplasm of connective and other soft tissue of abdomen,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anticoagulants causing adverse effects in therapeutic use,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of malignant neoplasm of large intestine
Hemoperitoneum,Mal neo soft tis abdomen,CHF NOS,Mental disor NEC oth dis,Atrial fibrillation,Long-term use anticoagul,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Hypertension NOS,Pure hypercholesterolem,Adv eff anticoagulants,Hx TIA/stroke w/o resid,Post-proc states NEC,Hx of colonic malignancy
Admission Date:  [**2153-7-29**]              Discharge Date:   [**2153-8-1**]

Date of Birth:  [**2074-11-10**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is 78 y/o F with h/o atrial fibrillation on coumadin and h/o
of GIST s/p excision and partial gastrectomy in [**2143**] who later
developed local recurrence and omental metastasis s/p resection
of omental mass in [**3-/2153**] and now presents today with 3 day
history of dull epigastric abdominal pain.  Pt had CT scan at
OSH showing intraperitoneal bleeding and pt was subsequently
transferred to [**Hospital1 18**] for further management.  At OSH, pt had BP
in 90s, hct 23.5 and inr 4.0.  Pt denies fevers, chills,
nausea/vomiting, or diarrhea

Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

PAST ONCOLOGIC HISTORY:
- Mrs. [**Known lastname 13755**] initially presented [**2143-9-2**] with abdominal

pain. At that time, she was found to have a large mass in her
abdomen.
- On [**2143-9-6**], she underwent an incomplete resection of this
tumor. It was found to be increasing in size and she was treated

on Gleevec from [**1-/2145**] to 12/[**2146**]. At that time, she stopped it

as she was having some side effects from this therapy, most
notably severe cramping. On the Gleevec, her tumor had decreased

in size. However, the mass grew while she was off the Gleevec
and she was restarted on it again in 07/[**2149**]. She was restarted

at 200mg daily to avoid issues with cramping.
- On [**2151-6-29**] she had a CT scan which showed new liver lesions
which were concerning. An ultrasound was obtained [**2151-7-13**] which

showed these lesions and raised concern for metastatic disease.

- She was increased from Gleevec 200mg daily to 400mg daily on
[**2151-9-8**].
- She had stable CT scans and the liver lesions were determined

to be cysts, she was decreased from 400mg daily to 200mg daily
due to nausea on [**2152-4-5**].
-CT scan [**10/2152**] there was increase in size of a right upper
mesenteric nodule with no other enlarging disease. Her case was
discussed previously and surgery is an option. At this time she
is interested in trying 400mg Gleevec to see if this
controls/shrinks this mass. If the mass continues to enlarge she
would consider surgery.


Social History:
Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative


Family History:
No family history of cancer, lung disease or heart disease. +
for DM.

Physical Exam:
T 98  P 70  BP 112/64  R 20  SaO2 98% RA
Gen: no acute distress
heent: no scleral icterus
neck: supple
Lungs: clear
heart: regular rate and rhythm
abd: soft,no tender,  nondistended, no guarding, nonrigid
Extrem: no edema


Pertinent Results:
[**2153-7-29**] 03:20PM BLOOD WBC-5.9 RBC-2.63*# Hgb-7.8*# Hct-23.5*#
MCV-90 MCH-29.9 MCHC-33.4 RDW-16.6* Plt Ct-215
[**2153-7-29**] 03:20PM BLOOD Plt Ct-215
[**2153-7-29**] 03:33PM BLOOD Hgb-8.1* calcHCT-24

[**2153-7-30**] 02:30AM BLOOD Glucose-109* UreaN-24* Creat-1.1 Na-143
K-3.6 Cl-106 HCO3-27 AnGap-14

[**2153-7-30**] 02:30AM BLOOD WBC-5.6 RBC-3.03* Hgb-9.1* Hct-26.8*
MCV-89 MCH-30.0 MCHC-33.8 RDW-17.1* Plt Ct-214
[**2153-7-30**] 06:02AM BLOOD Hct-27.4*

[**2153-7-31**] 03:57AM BLOOD WBC-5.4 RBC-3.42* Hgb-9.9* Hct-29.8*
MCV-87 MCH-29.0 MCHC-33.3 RDW-16.9* Plt Ct-206
[**2153-7-31**] 11:52AM BLOOD Hct-25.1*
[**2153-7-31**] 04:10PM BLOOD Hct-28.8*
[**2153-8-1**] 06:35AM BLOOD WBC-4.6 RBC-3.35* Hgb-10.0* Hct-30.2*
MCV-90 MCH-30.0 MCHC-33.3 RDW-16.8* Plt Ct-252

Brief Hospital Course:
78 years old female with dx of GIST tumor, anticoagulated for
Afib admitted wth intraabdominal bleeding on [**7-29**] Patient was
admitted to SICU. Transfused 2u PRBC and 1u FFP.

Neurologic:
- Intact, mentating well. Continue to follow
- Adequate pain control with dilaudid IV PRN Then switched to Po
pain medication.
Cardiovascular:
- Clinically stable
- Maintain SBP>90, Continous monitoring showed heart rate
control.
- continue to follow Hct and coags
Pulmonary:
- Clinically stable, breathing room air
- No respiratory distress.
Gastrointestinal / Abdomen:
- GIST tumor s/p multiple resections with blood collection in
abdomen
- No surgical intervention at this time unless change in
clinical picture
Nutrition:
- NPO during HD 1 and 2. The restarted on Clears on HD3 advanced
to regular cardiac healthy diet on HD4. Patient tolerate the
diet, no abdominal pain or distention.
Renal:
- Stable. Urine out up was monitored with foley. On HD 4 foley
was d/c and patient voided.
Hematology:
- Anemia secondary to likely bleeding in abdomen
- INR 4.0,  2uFFP and 10mg vit K was given on [**7-29**]
- Transfused 2uPRBC, and follow Hct which remined stable for the
rest of her hospitalization.
Endocrine:
Insuline SS, f/u blood sugars
DVT profilaxis with pneumatic boots


Medications on Admission:
Coumadin 4 mg Mon
Coumadin 3 mg TueWedFriSatSun
Coumadin 5 mg [**Last Name (un) **]
Metoprolol 25 mg daily
amiodarone 200 mg daily
levothyroxine 200 mcg daily
istalol 0.5% 1 drop each eye [**Hospital1 **]
lumigan 0.03% 1 drop each eye daily
furosemide 80 mg daily

gleevec 200 mg daily
CaCO3 650 mg [**Hospital1 **]
cholecalciferol 1000 units daily
januvia 100 mg daily


Discharge Medications:
1. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
2. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
3. levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Lumigan 0.03 % Drops Sig: One (1)  Ophthalmic once a day: 1
drop.
5. furosemide 80 mg Tablet Sig: One (1) Tablet PO once a day.
6. cholecalciferol (vitamin D3) 1,000 unit Capsule Sig: One (1)
Capsule PO once a day.
7. sitagliptin 100 mg Tablet Sig: One (1) Tablet PO once a day.



Discharge Disposition:
Home

Discharge Diagnosis:
History of Atrial Fibrilation on coumadin presents with
intraperitoneal bleeding from GIST tumors in setting of
anticoagulation

Heart Failure with preserved EF
Diabetes Mellitus
Hypercholesterolemia
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Please schedule an appointment with your PCP within [**Name Initial (PRE) **] week to
restart medications (Coumadin and Gleevec) and f/u INR. Please
take any new medications as prescribed.
Please take the prescribed analgesic medications as needed. You
may not drive or heavy machinery while taking narcotic analgesic
medications. You may also take acetaminophen (Tylenol) as
directed, but do not exceed 4000 mg in one day.
Please get plenty of rest, continue to walk several times per
day, and drink adequate amounts of fluids. Avoid strenuous
physical activity and refrain from heavy lifting greater than
10lbs., until you follow-up with your surgeon, who will instruct
you further regarding activity restrictions. Please also
follow-up with your primary care physician.


Followup Instructions:
PLease schedule a follow up appointment with Dr. [**Last Name (STitle) **].
Phone number: ([**Telephone/Fax (1) 1483**]

Please schedule an appointment with PCP within [**Name Initial (PRE) **] week.

Provider: [**Name10 (NameIs) **] DENSITY TESTING Phone:[**Telephone/Fax (1) 4586**]
Date/Time:[**2153-8-3**] 1:00
Provider: [**Name10 (NameIs) 3150**],[**Name11 (NameIs) **] MD Phone:[**Telephone/Fax (1) 11133**]
Date/Time:[**2153-8-24**] 3:00
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2153-10-31**]
11:20



Completed by:[**2153-8-1**]
{'Hemoperitoneum (nontraumatic),Malignant neoplasm of connective and other soft tissue of abdomen,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anticoagulants causing adverse effects in therapeutic use,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of malignant neoplasm of large intestine'}


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: Abdominal pain

PRESENT ILLNESS: Pt is 78 y/o F with h/o atrial fibrillation on coumadin and h/o
of GIST s/p excision and partial gastrectomy in [**2143**] who later
developed local recurrence and omental metastasis s/p resection
of omental mass in [**3-/2153**] and now presents today with 3 day
history of dull epigastric abdominal pain.  Pt had CT scan at
OSH showing intraperitoneal bleeding and pt was subsequently
transferred to [**Hospital1 18**] for further management.  At OSH, pt had BP
in 90s, hct 23.5 and inr 4.0.  Pt denies fevers, chills,
nausea/vomiting, or diarrhea

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

MEDICATION ON ADMISSION: Coumadin 4 mg Mon
Coumadin 3 mg TueWedFriSatSun
Coumadin 5 mg [**Last Name (un) **]
Metoprolol 25 mg daily
amiodarone 200 mg daily
levothyroxine 200 mcg daily
istalol 0.5% 1 drop each eye [**Hospital1 **]
lumigan 0.03% 1 drop each eye daily
furosemide 80 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98  P 70  BP 112/64  R 20  SaO2 98% RA
Gen: no acute distress
heent: no scleral icterus
neck: supple
Lungs: clear
heart: regular rate and rhythm
abd: soft,no tender,  nondistended, no guarding, nonrigid
Extrem: no edema

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative 

### Response:
{'Hemoperitoneum (nontraumatic),Malignant neoplasm of connective and other soft tissue of abdomen,Congestive heart failure, unspecified,Other persistent mental disorders due to conditions classified elsewhere,Atrial fibrillation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anticoagulants causing adverse effects in therapeutic use,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of malignant neoplasm of large intestine'}
