CHIEF COMPLAINT: Failure to thrive

PRESENT ILLNESS: 79 yo M history gastric cancer s/p partial gastrectomy w/
Bilroth II reconstruction in [**4-29**] who presents with intolerance
to solid foods for 4-6 weeks.  Pt vomits one hour after eating
solid foods.  Pt has lost 20 pounds over 4-6 weeks.  Endoscopy
x2 has showed stricture at GJ junction and attempts to dilate
have failed.

MEDICAL HISTORY: Carcinoma of stomach, Stage IV (T2B PN3 PM0)
Upper Endoscopy w/ PEG [**7-30**]
Hemigastrectomy w. Billroth II anastomosis- [**2181-5-9**]
Witzel jejunostomy
Upper endoscopy- [**2181-5-22**]
BPH s/p TURP ([**3-29**])
s/p Disc Surgery x2 in [**2125**]'s
Osteoarthritis

MEDICATION ON ADMISSION: Reglan
Protonix 40 [**Hospital1 **]
Celexa 20 QD
Ambien 5 QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
Thin, dry.
Alert, oriented.
Sclera anicteric
No enlarged nodes.
Chest clear
Heart RRR, no murmur
No carotid bruit
Abd soft, flat, + BS. no masses. no incisional hernia. no groin
hernia.
no edema. J-tube in place.

FAMILY HISTORY: Father died at age 84 of "natural causes"
Mother died in her 60's of an MI
Brothers died of lung ca and alcoholism, both at age 51

SOCIAL HISTORY: Pt is retired.  Worked as a civilian in procurement for the Air
Force.  Pt has a 60 pack year tobacco history, and quit 30 years
ago.  Denies EtOH and drug use.  Pt is widowed, wife died 1.5
years ago of Multiple Sclerosis.  He has no children.
Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage complicating a procedure,Bladder neck obstruction,Unspecified protein-calorie malnutrition,Hyperpotassemia,Secondary malignant neoplasm of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Postgastric surgery syndromes,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Precipitous drop in hematocrit,Other specified disorders of biliary tract,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias
Malig neopl stomach NEC,Acq pyloric stenosis,Mal neo lymph intra-abd,Sec mal neo peritoneum,Hemorrhage complic proc,Bladder neck obstruction,Protein-cal malnutr NOS,Hyperpotassemia,Secondary malig neo NEC,Peritoneal adhesions,Postgastric surgery synd,Iatrogenc hypotnsion NEC,BPH w/o urinary obs/LUTS,Drop, hematocrit, precip,Dis of biliary tract NEC,Depressive disorder NEC,Cardiac dysrhythmias NEC
Admission Date:  [**2181-10-31**]              Discharge Date:   [**2181-11-21**]

Date of Birth:  [**2102-3-22**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4111**]
Chief Complaint:
Failure to thrive

Major Surgical or Invasive Procedure:
Exploratory laparotomy, lysis of adhesions, resection of
recurrent gastric cancer and gastrojejunostomy. Roux-en-Y
gastrojejunostomy and
jejunojejunostomy. Feeding jejunostomy.


History of Present Illness:
79 yo M history gastric cancer s/p partial gastrectomy w/
Bilroth II reconstruction in [**4-29**] who presents with intolerance
to solid foods for 4-6 weeks.  Pt vomits one hour after eating
solid foods.  Pt has lost 20 pounds over 4-6 weeks.  Endoscopy
x2 has showed stricture at GJ junction and attempts to dilate
have failed.

Past Medical History:
Carcinoma of stomach, Stage IV (T2B PN3 PM0)
Upper Endoscopy w/ PEG [**7-30**]
Hemigastrectomy w. Billroth II anastomosis- [**2181-5-9**]
Witzel jejunostomy
Upper endoscopy- [**2181-5-22**]
BPH s/p TURP ([**3-29**])
s/p Disc Surgery x2 in [**2125**]'s
Osteoarthritis

Social History:
Pt is retired.  Worked as a civilian in procurement for the Air
Force.  Pt has a 60 pack year tobacco history, and quit 30 years
ago.  Denies EtOH and drug use.  Pt is widowed, wife died 1.5
years ago of Multiple Sclerosis.  He has no children.

Family History:
Father died at age 84 of "natural causes"
Mother died in her 60's of an MI
Brothers died of lung ca and alcoholism, both at age 51

Physical Exam:
On admission:
Thin, dry.
Alert, oriented.
Sclera anicteric
No enlarged nodes.
Chest clear
Heart RRR, no murmur
No carotid bruit
Abd soft, flat, + BS. no masses. no incisional hernia. no groin
hernia.
no edema. J-tube in place.

Pertinent Results:
[**2181-10-31**] 10:00PM BLOOD WBC-5.6 RBC-4.65 Hgb-12.4* Hct-36.7*
MCV-79* MCH-26.8* MCHC-33.9 RDW-16.2* Plt Ct-283
[**2181-11-19**] 11:50AM BLOOD WBC-9.9 RBC-3.92* Hgb-12.0* Hct-35.5*
MCV-91 MCH-30.5 MCHC-33.6 RDW-16.5* Plt Ct-413
[**2181-10-31**] 10:00PM BLOOD PT-13.6* PTT-28.7 INR(PT)-1.2
[**2181-11-5**] 04:00PM BLOOD PT-14.2* PTT-30.3 INR(PT)-1.4
[**2181-11-5**] 04:00PM BLOOD Plt Ct-251
[**2181-11-19**] 11:50AM BLOOD Plt Ct-413
[**2181-10-31**] 10:00PM BLOOD Glucose-81 UreaN-16 Creat-0.7 Na-141
K-3.6 Cl-107 HCO3-25 AnGap-13
[**2181-11-20**] 04:19AM BLOOD Glucose-101 UreaN-23* Creat-0.5 Na-139
K-4.1 Cl-111* HCO3-21* AnGap-11
[**2181-10-31**] 10:00PM BLOOD ALT-25 AST-19 AlkPhos-111 Amylase-83
TotBili-0.5
[**2181-11-18**] 07:00AM BLOOD ALT-54* AST-39 AlkPhos-237* TotBili-2.1*

Cardiology Report ECHO Study Date of [**2181-11-20**]
Conclusions:
The left atrium is elongated. Left ventricular wall thicknesses
are normal.   The left ventricular cavity size is normal.
Overall left ventricular systolic  function is normal
(LVEF>55%). Tissue velocity imaging demonstrates an E/e' <8
suggesting a normal left ventricular filling pressure. Right
ventricular  chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened. There is no
aortic valve stenosis. No aortic  regurgitation is seen. The
mitral valve leaflets are mildly thickened. Mild  (1+) mitral
regurgitation is seen. The mitral regurgitation jet is eccentric
 and may be underestimated. The estimated pulmonary artery
systolic pressure is  normal. There is no pericardial effusion.





Brief Hospital Course:
Of note: this discahrge summary written from the patient chart.
This MD did not assume care until the last week of
hospitalization.

Pt transferred from [**Hospital3 **] for definitive treatment.
Pt arrived with NG tube in place which was not changed.
Nutritional status checked and tube feedings were optimized to
prepare for surgery in order to replace the 20lbs lost prior to
presentation.  Pt was ambulating and afebrile.  On HD9, [**2181-11-8**]
the patient was taken to the operating room by Dr. [**Last Name (STitle) 957**] for
the following:  1. Exploratory laparotomy, 2. lysis of
adhesions, 3. resection of recurrent gastric cancer and
gastrojejunostomy, 4. Roux-en-Y gastrojejunostomy, 5.
jejunojejunostomy, 6. Feeding jejunostomy, and 7.
Catheterization and placement of a Coude catheter because of
benign prostatic hypertrophy.  There were no complications and
the patient was transfered to floor from the PACU.  Tube feeds
were restarted on POD 1.

On [**2181-11-11**] the patient was noted to have a drop in hematocrit
from 30 to 24 with an INR of 1.7 on Lovenox.  JP drain output
was more serosangenous than previously.  Also patient had an
episode of emesis.  He was transfered to the ICU, transfused 1
unit PRC's & FFP, and monitored closely.  There was no source of
bleeding, and he was transfused several more units over the next
2 days for a hematocrit which continued to trend down.  On
[**2181-11-15**] the patient had a brief episode of narrow complex
tachycardia.  Cardiology did not see the need for an
antiarrythmic as the irregular heart beats were in the immediate
post-operative period.  Daily aspirin was started later per
their recommendations.  An Echo was later essentially normal.

On [**2181-11-16**] the patient was transfered back to the floor.  He
continued to be stable and sips were started on [**2181-11-17**]; diet
was slowly advanced.  TPN was given [**2102-11-12**] to improve nutional
status.  On [**2181-11-21**] the patient was tolerating a regular diet,
the JP drain was removed, and the patient was transfered to
rehab.  He is to continue on tube feeds at night in addition to
taking a regular diet.

Medications on Admission:
Reglan
Protonix 40 [**Hospital1 **]
Celexa 20 QD
Ambien 5 QHS

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*55 Tablet(s)* Refills:*0*
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) 5000
unit Injection [**Hospital1 **] (2 times a day).
5. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6
hours).
6. Glycerin (Adult) 3 g Suppository Sig: One (1) Suppository
Rectal DAILY (Daily).
Disp:*30 Suppository(s)* Refills:*2*
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

10. Terazosin 1 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
Disp:*60 Capsule(s)* Refills:*2*
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*2*
12. Loperamide 1 mg/5 mL Liquid Sig: 7.5 MLs PO bid ().
Disp:*450 ML(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 11057**] Nursing & Rehabilitation Center - [**Location (un) 3320**]

Discharge Diagnosis:
Gastric outlet obstruction, chronic and recurrent gastric
cancer.


Discharge Condition:
Good


Discharge Instructions:
Please resume your home medications. Take all new medications as
prescribed. Do not drive while taking narcotic pain medications.

You may eat a regular diet. You may resume your regular
activities.

Keep the dressing intact.  You may shower and pat the dressing.
No tub soaks until otherwise told by Dr. [**Last Name (STitle) 957**]. Please refrain
from heavy lifting for 4 weeks, unless otherwise directed.

Please call your physician or return to the hospital if you
experience:
- Fever (>101.5)
- Vomiting or Inability to eat or drink
- Redness or discharge from your wound
- Increasing pain
- Other symptoms concerning to you


Followup Instructions:
1. Please call Dr.[**Name (NI) 6275**] office for a follow-up appointment
for 2-3 weeks after discharge. ([**Telephone/Fax (1) 376**]

2. Please call Dr.[**Name (NI) 13919**] office (Urology) for a follow-up
appointment for 2-3 weeks after discharge. ([**Telephone/Fax (1) 4230**]
{'Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage complicating a procedure,Bladder neck obstruction,Unspecified protein-calorie malnutrition,Hyperpotassemia,Secondary malignant neoplasm of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Postgastric surgery syndromes,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Precipitous drop in hematocrit,Other specified disorders of biliary tract,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias'}


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: Failure to thrive

PRESENT ILLNESS: 79 yo M history gastric cancer s/p partial gastrectomy w/
Bilroth II reconstruction in [**4-29**] who presents with intolerance
to solid foods for 4-6 weeks.  Pt vomits one hour after eating
solid foods.  Pt has lost 20 pounds over 4-6 weeks.  Endoscopy
x2 has showed stricture at GJ junction and attempts to dilate
have failed.

MEDICAL HISTORY: Carcinoma of stomach, Stage IV (T2B PN3 PM0)
Upper Endoscopy w/ PEG [**7-30**]
Hemigastrectomy w. Billroth II anastomosis- [**2181-5-9**]
Witzel jejunostomy
Upper endoscopy- [**2181-5-22**]
BPH s/p TURP ([**3-29**])
s/p Disc Surgery x2 in [**2125**]'s
Osteoarthritis

MEDICATION ON ADMISSION: Reglan
Protonix 40 [**Hospital1 **]
Celexa 20 QD
Ambien 5 QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
Thin, dry.
Alert, oriented.
Sclera anicteric
No enlarged nodes.
Chest clear
Heart RRR, no murmur
No carotid bruit
Abd soft, flat, + BS. no masses. no incisional hernia. no groin
hernia.
no edema. J-tube in place.

FAMILY HISTORY: Father died at age 84 of "natural causes"
Mother died in her 60's of an MI
Brothers died of lung ca and alcoholism, both at age 51

SOCIAL HISTORY: Pt is retired.  Worked as a civilian in procurement for the Air
Force.  Pt has a 60 pack year tobacco history, and quit 30 years
ago.  Denies EtOH and drug use.  Pt is widowed, wife died 1.5
years ago of Multiple Sclerosis.  He has no children. 

### Response:
{'Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage complicating a procedure,Bladder neck obstruction,Unspecified protein-calorie malnutrition,Hyperpotassemia,Secondary malignant neoplasm of other specified sites,Peritoneal adhesions (postoperative) (postinfection),Postgastric surgery syndromes,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Precipitous drop in hematocrit,Other specified disorders of biliary tract,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias'}
