CHIEF COMPLAINT: Esophageal cancer

PRESENT ILLNESS: This is a 65 year old gentleman who has a history of known
Barrett's esophagus who has developed invasive carcinoma. He has
had reflux symptoms for years and surveillance biopsies in [**2186**]
revealed high-grade dysplasia. Endoscopic mucosal resection but
there was persistant invasive cancer. Endoscopic ultrasound
showed no dominant tumor mass, staging him at TxNoMo. He had a
PET scan demonstrating hypermetobolic uptake at the tumor site
but not elsewhere.

MEDICAL HISTORY: Diabetes Mellitus
Hypertension
Hyperlipidemia
CAD s/p CABG x 5 '[**84**]
Gangrenous omentum s/p ex-lap
GERD

MEDICATION ON ADMISSION: Aspirin 325 mg po qdaily
Lopressor 150 mg po qdaily
Protonix 40 mg po qdaily
lipitor 80 mg po qdaily
lisinopril 40 mg po qdaily
Glipizide 10 mg PO BID
Metformin 1000 mg po BID
Norvasc 5 mg po Qdaily
Prozac 20 mg po qdaily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: He smoked a pack and a half a day for 25 years, but quit 15
years ago. He is a recovering alcoholic with no recent binges.
Malignant neoplasm of cardia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Other and unspecified hyperlipidemia
Mal neo stomach cardia,CHF NOS,Crnry athrscl natve vssl,Barrett's esophagus,DMII wo cmp nt st uncntr,Hypertension NOS,Aortocoronary bypass,Hyperlipidemia NEC/NOS
Admission Date:  [**2188-2-19**]              Discharge Date:   [**2188-2-28**]

Date of Birth:  [**2122-11-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Esophageal cancer

Major Surgical or Invasive Procedure:
s/p transhiatal esophagectomy for adenocarcinoma of esophogas
[**2-19**]


History of Present Illness:
This is a 65 year old gentleman who has a history of known
Barrett's esophagus who has developed invasive carcinoma. He has
had reflux symptoms for years and surveillance biopsies in [**2186**]
revealed high-grade dysplasia. Endoscopic mucosal resection but
there was persistant invasive cancer. Endoscopic ultrasound
showed no dominant tumor mass, staging him at TxNoMo. He had a
PET scan demonstrating hypermetobolic uptake at the tumor site
but not elsewhere.


Past Medical History:
Diabetes Mellitus
Hypertension
Hyperlipidemia
CAD s/p CABG x 5 '[**84**]
Gangrenous omentum s/p ex-lap
GERD


Social History:
He smoked a pack and a half a day for 25 years, but quit 15
years ago. He is a recovering alcoholic with no recent binges.

Family History:
non-contributory

Physical Exam:
on admission:

Afebrile, vital signs stable, weight 217 pounds
Gen: well-developed middle-aged male
HEENT: moist mucous membranes, no scleral icterus
Neck:no lymphadenopathy in the neck
CV: RRR, no murmurs
Pulm: clear to auscultation bilaterally
Abd: soft, NT/ND, normoactive bowel sounds
Extr: warm, well-perfused
Neuro: grossly intact


Pertinent Results:
[**2188-2-19**] 03:26PM BLOOD WBC-10.3 RBC-3.89* Hgb-11.7* Hct-32.3*
MCV-83 MCH-30.2 MCHC-36.4* RDW-14.2 Plt Ct-256
[**2188-2-20**] 02:20AM BLOOD WBC-12.2* RBC-3.82* Hgb-11.3* Hct-32.4*
MCV-85 MCH-29.6 MCHC-34.9 RDW-14.4 Plt Ct-238
[**2188-2-21**] 01:55AM BLOOD WBC-15.3* RBC-3.63* Hgb-10.7* Hct-30.4*
MCV-84 MCH-29.3 MCHC-35.0 RDW-14.4 Plt Ct-193
[**2188-2-22**] 03:08AM BLOOD WBC-14.7* RBC-3.48* Hgb-10.2* Hct-29.6*
MCV-85 MCH-29.4 MCHC-34.5 RDW-14.3 Plt Ct-214
[**2188-2-23**] 05:37AM BLOOD WBC-13.0* RBC-3.64* Hgb-10.9* Hct-31.4*
MCV-86 MCH-29.9 MCHC-34.7 RDW-14.6 Plt Ct-255
[**2188-2-24**] 05:30AM BLOOD WBC-11.1* RBC-3.77* Hgb-11.2* Hct-32.6*
MCV-86 MCH-29.7 MCHC-34.3 RDW-14.4 Plt Ct-271
[**2188-2-25**] 09:47AM BLOOD WBC-13.2* RBC-3.83* Hgb-11.3* Hct-32.9*
MCV-86 MCH-29.4 MCHC-34.2 RDW-14.7 Plt Ct-300
[**2188-2-27**] 08:30AM BLOOD WBC-11.1* RBC-3.77* Hgb-11.1* Hct-32.7*
MCV-87 MCH-29.6 MCHC-34.0 RDW-15.0 Plt Ct-346
[**2188-2-19**] 03:26PM BLOOD PT-14.5* PTT-24.4 INR(PT)-1.3*
[**2188-2-21**] 01:55AM BLOOD Glucose-148* UreaN-13 Creat-1.0 Na-137
K-3.6 Cl-102 HCO3-26 AnGap-13
[**2188-2-22**] 03:08AM BLOOD Glucose-113* UreaN-17 Creat-0.9 Na-141
K-4.0 Cl-104 HCO3-28 AnGap-13
[**2188-2-24**] 05:30AM BLOOD Glucose-144* UreaN-19 Creat-0.7 Na-142
K-4.1 Cl-108 HCO3-25 AnGap-13
[**2188-2-26**] 08:04AM BLOOD Glucose-185* UreaN-19 Creat-0.8 Na-141
K-4.2 Cl-104 HCO3-27 AnGap-14
[**2188-2-27**] 08:30AM BLOOD Glucose-180* UreaN-17 Creat-0.8 Na-139
K-4.8 Cl-104 HCO3-27 AnGap-13
[**2188-2-19**] 03:26PM BLOOD Albumin-3.3* Calcium-8.5 Phos-6.2*
Mg-1.0* Iron-105
[**2188-2-26**] 08:04AM BLOOD Calcium-9.0 Phos-2.7 Mg-1.5*
[**2188-2-27**] 08:30AM BLOOD Calcium-8.8 Phos-2.9 Mg-1.7

RADIOLOGY:

[**2-19**] post-op CXR: The patient is status post transhiatal
esophagectomy. The tip of the endotracheal tube is identified 2
cm above the carina. The right jugular Swan-Ganz catheter
terminates in the right main PA. A nasogastric tube terminates
in the intrathoracic stomach.
There is mild congestive heart failure with cardiomegaly. Patchy
atelectasis is seen at the lung bases. There is no evidence of
pneumothorax.

[**2-21**] CXR: Cardiac and mediastinal contours are stable. There has
been removal of a nasogastric tube. Surgical drains remain in
place in the upper mediastinum.
There is an air collection present adjacent to the drain which
may relate to air within the proximal neoesophagus or
postoperative extraluminal air
collection. There is mild perihilar haziness suggestive of mild
perihilar
edema, and note is made of small bilateral pleural effusions,
slightly
improved in the interval.

[**2-26**] Barrium Swallow eval: Barium passes freely through the
esophagus. An
end-to-side anastomosis is noted within the upper mediastinum.
There is no
evidence of anastomotic leak. A drain is seen within the
superior
mediastinum.
IMPRESSION: No evidence of anastomotic leak.

PATHOLOGY:
I. Esophagogastrectomy (A-AH,CA-CK ):

1. Barrett's esophagus with extensive low grade and foci of high
grade glandular dysplasia (see note).
2. Hiatal hernia.
3. Gastric segment and regional lymph nodes, within normal
limits.
4. Esophageal squamous epithelium at proximal margin and gastric
corpus mucosa at distal margin.
5. There is no carcinoma.



II. Left gastric lymph nodes (BA-BK):

1. Hyperplasia of lymph nodes.
2. No tumor.
Note: The glandular dysplasia is low grade in the more proximal
part of the esophageal segment, and high grade in the lower
part.  The entire columnar-lined esophagus is sampled, and there
is no residual carcinoma.


Brief Hospital Course:
This is a 65 year old gentleman with high-grade Barrett's
esophagus with adenocarcinoma who presented for esophagectomy.
He underwent transhiatal esophagectomy without complication on
[**2188-2-19**] (please see the operative note of Dr. [**First Name (STitle) **] [**Doctor Last Name **] for
full details). He had an uncomplicated post-operative course. He
was extubated on post-operative day 1 and diuresed gently. He
received perioperative antibiotics. Tube feeds were started on
post-op day 2. His pain was well controlled with an epidural
catheter. The patient accidentally removed his nasogastric tube
on post-op day 2. He had flatus on post-op day 5 and tube feeds
were advanced to goal. He underwent a swallow eval on post-op
day 7 which he passed and a diet was started; he was tolerating
a regular diet by post-op day 8 and had good pain control on
oral pain medications. His JP drain and staples were removed on
post-op day 8. He was discharged to home on post-op day 9 with
planned visiting nurse [**First Name (Titles) **] [**Last Name (Titles) **] with tube feeding. Allq
uestions were answered to his satisfaction upon discharge.

Medications on Admission:
Aspirin 325 mg po qdaily
Lopressor 150 mg po qdaily
Protonix 40 mg po qdaily
lipitor 80 mg po qdaily
lisinopril 40 mg po qdaily
Glipizide 10 mg PO BID
Metformin 1000 mg po BID
Norvasc 5 mg po Qdaily
Prozac 20 mg po qdaily

Discharge Medications:
1. tube feeding
probalance 80cc/hr x24hours, cycle as per tolerance
[**5-28**] cans/day
2. tube feeding supplies
kangaroo pump
iv pole
feeding bags
60cc catheter tip syringes
tube feeding extension tubing
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day): crush and take by mouth.
Disp:*120 Tablet(s)* Refills:*1*
5. Fluoxetine 20 mg/5 mL Solution Sig: Five (5) cc PO DAILY
(Daily).
Disp:*100 cc* Refills:*2*
6. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*1*
8. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*1*
9. Glipizide 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*1*
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
12. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed.
Disp:*120 ML(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Diabetes Mellitus, Hypertension, Hyperlipidemia, Coronary artery
disease, s/p Coronary artert bypass graft x 5 '[**84**], gangrenous
omentum s/p exploratory-laparoscopy, Gastric esophogeal reflux
disease, [**1-28**]- cardiac ejection fraction 37%, adenocarcinoma of
esophogas

Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**]/Thoracic Surgery office ([**Telephone/Fax (1) 170**])
for:fever, shortness of breath, chest pain, difficulty
swallowing, excessive nausea, vommitting, J- tube clogging and
inability to unclog w/ cola, meat tenderizer, redness, drainage
and new pain at j-tube site or incision site.
REsume regular medications as listed in discharge instructions.
You may shower when you return home.
Change j-tube dressing every day-keep dressing dry, change if
wet.
TUBE FEEDING-ProBalance formula- cycle schedule
110cc/hr for 18 hours/day; 120cc/hr for 16 hours/day; 140cc/hr
for 14 hours/day; 160cc/hr for 12 hours/day.
VNA Services-[**Last Name (un) 2646**] VNA- [**Telephone/Fax (2) 62697**]
Tube feeding support with-[**Telephone/Fax (1) 43291**]


Followup Instructions:
Call Dr.[**Doctor Last Name 4738**]/Thoracic Surgery office ([**Telephone/Fax (1) 170**]) for
appointment in [**10-4**] days.



Completed by:[**2188-2-28**]
{"Malignant neoplasm of cardia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Other and unspecified hyperlipidemia"}


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: Esophageal cancer

PRESENT ILLNESS: This is a 65 year old gentleman who has a history of known
Barrett's esophagus who has developed invasive carcinoma. He has
had reflux symptoms for years and surveillance biopsies in [**2186**]
revealed high-grade dysplasia. Endoscopic mucosal resection but
there was persistant invasive cancer. Endoscopic ultrasound
showed no dominant tumor mass, staging him at TxNoMo. He had a
PET scan demonstrating hypermetobolic uptake at the tumor site
but not elsewhere.

MEDICAL HISTORY: Diabetes Mellitus
Hypertension
Hyperlipidemia
CAD s/p CABG x 5 '[**84**]
Gangrenous omentum s/p ex-lap
GERD

MEDICATION ON ADMISSION: Aspirin 325 mg po qdaily
Lopressor 150 mg po qdaily
Protonix 40 mg po qdaily
lipitor 80 mg po qdaily
lisinopril 40 mg po qdaily
Glipizide 10 mg PO BID
Metformin 1000 mg po BID
Norvasc 5 mg po Qdaily
Prozac 20 mg po qdaily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: He smoked a pack and a half a day for 25 years, but quit 15
years ago. He is a recovering alcoholic with no recent binges. 

### Response:
{"Malignant neoplasm of cardia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Other and unspecified hyperlipidemia"}
