CHIEF COMPLAINT: Tingling in legs

PRESENT ILLNESS: Pt is a 32 yo male, recently diagnosed with metastatic
gallbladder ca, who presented to the ED with LE numbness and
weakness. Pt was diagnosed with poorly differentiated
gallbladder cancer in [**8-29**] after he presented with painless
jaundice and 10 lb weight loss. Found to have cancer, with a
pancreatic mass, gallbladder fundus mass, and several liver
lesions as well as retroperitoneal lymphadenopathy on imaging.
Pt is getting palliative chemotherapy with gemcitabine (100
mg/m2) and cisplatin (20 mg/m2), three weeks on, one week off.
Pt began second cycle of chemotherapy on Thursday. Since chemo,
pt says that he has lower extremity pain. Today he points to
above his right knee and it is hard for him to describe exactly
what it feels like.

MEDICAL HISTORY: 1. anemia- low mcv with nml iron - likely anemia of chronic
disease
2. Malaria; multiple infections in past
3. s/p Appendectomy
4. H. Pylori- treated
5. UTI [**2163**]
6. Hepatitis B - low viral load; evidence of varices in lower
[**12-27**] of esophagus

MEDICATION ON ADMISSION: 1. dilaudid 4mg tid
2. fentanyl 25mcg q3d
3. ativan prn
4. compazine prn
5. cisplatin
6. gemcitabine

ALLERGIES: Bactrim

PHYSICAL EXAM: VS: T: 98.8; BP: 148/81; HR: 76; RR: 20; O2: 100% on RA
Gen: black male, appears nervous, in NAD.
HEENT: PERRLA; EOMI. OP clear without exudate. No blood.
CV: RRR S1S2. No M/R/G
Lungs: CTA b/l. Good air entry.
Abd: +BS. SOft, nt, nd
Ext: DP 2+. No edema.
Neuro: CN II-XII tested and intact. MS [**4-29**]. Sensation to soft
and sharp on LE was intact. Lower extremity: abduction,
adduction, hip flexion and extension all [**4-29**]. Patella no pain to
deep palpation.

FAMILY HISTORY: Positive for DM--both parents.  No cancer, heart disease. Ten
siblings - none with cancer

SOCIAL HISTORY: Pt is from [**Country **]. Moved to [**Location (un) 86**] 5 years ago. Worked at
7-eleven though not any more. No tobacco. No drugs. No EtOH for
many months.
Malignant neoplasm of gallbladder,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other specified disorders of stomach and duodenum
Malig neo gallbladder,Hpt B chrn wo cm wo dlta,Bleed esoph var oth dis,Ac posthemorrhag anemia,Second malig neo liver,Neuropathy due to drugs,Adv eff antineoplastic,Gastroduodenal dis NEC
Admission Date:  [**2167-11-1**]              Discharge Date:   [**2167-11-6**]

Date of Birth:  [**2137-3-18**]             Sex:   M

Service: MEDICINE

Allergies:
Bactrim

Attending:[**First Name3 (LF) 32198**]
Chief Complaint:
Tingling in legs

Major Surgical or Invasive Procedure:
Endoscopy with banding of varices


History of Present Illness:
Pt is a 32 yo male, recently diagnosed with metastatic
gallbladder ca, who presented to the ED with LE numbness and
weakness. Pt was diagnosed with poorly differentiated
gallbladder cancer in [**8-29**] after he presented with painless
jaundice and 10 lb weight loss. Found to have cancer, with a
pancreatic mass, gallbladder fundus mass, and several liver
lesions as well as retroperitoneal lymphadenopathy on imaging.
Pt is getting palliative chemotherapy with gemcitabine (100
mg/m2) and cisplatin (20 mg/m2), three weeks on, one week off.
Pt began second cycle of chemotherapy on Thursday. Since chemo,
pt says that he has lower extremity pain. Today he points to
above his right knee and it is hard for him to describe exactly
what it feels like.

Of note, upon arrival to the floor, pt was found to have a 5
point Hct drop over 3 days. He also had melanotic stools on the
floor. He was transfused 2 units of pRBCs, NG lavaged (cleared
after 200 cc) and transferred to the [**Hospital Unit Name 153**].

Past Medical History:
1. anemia- low mcv with nml iron - likely anemia of chronic
disease
2. Malaria; multiple infections in past
3. s/p Appendectomy
4. H. Pylori- treated
5. UTI [**2163**]
6. Hepatitis B - low viral load; evidence of varices in lower
[**12-27**] of esophagus


Social History:
Pt is from [**Country **]. Moved to [**Location (un) 86**] 5 years ago. Worked at
7-eleven though not any more. No tobacco. No drugs. No EtOH for
many months.

Family History:
Positive for DM--both parents.  No cancer, heart disease. Ten
siblings - none with cancer

Physical Exam:
VS: T: 98.8; BP: 148/81; HR: 76; RR: 20; O2: 100% on RA
Gen: black male, appears nervous, in NAD.
HEENT: PERRLA; EOMI. OP clear without exudate. No blood.
CV: RRR S1S2. No M/R/G
Lungs: CTA b/l. Good air entry.
Abd: +BS. SOft, nt, nd
Ext: DP 2+. No edema.
Neuro: CN II-XII tested and intact. MS [**4-29**]. Sensation to soft
and sharp on LE was intact. Lower extremity: abduction,
adduction, hip flexion and extension all [**4-29**]. Patella no pain to
deep palpation.

Pertinent Results:
Labs on admission:
CBC/Coags:
[**2167-11-1**] 08:00AM BLOOD WBC-3.2* RBC-2.89* Hgb-6.4* Hct-21.8*
MCV-75* MCH-22.0* MCHC-29.3* RDW-17.2* Plt Ct-268
[**2167-10-31**] 06:30PM BLOOD Neuts-84.7* Lymphs-8.8* Monos-6.0 Eos-0.5
Baso-0.1
[**2167-11-1**] 08:00AM BLOOD PT-14.6* PTT-25.8 INR(PT)-1.3

Chemistries:
[**2167-11-1**] 08:00AM BLOOD Glucose-90 UreaN-10 Creat-0.5 Na-135
K-3.7 Cl-104 HCO3-24 AnGap-11
[**2167-11-1**] 08:00AM BLOOD Calcium-8.7 Phos-3.4 Mg-1.5*
___________________________________
Labs on discharge:

[**2167-11-6**] 03:10PM BLOOD WBC-6.3 RBC-3.82* Hgb-9.1* Hct-27.7*
MCV-73* MCH-23.8* MCHC-32.9 RDW-18.2* Plt Ct-136*
[**2167-11-6**] 03:10PM BLOOD CK(CPK)-32*
[**2167-11-6**] 06:40AM BLOOD Calcium-8.8 Phos-2.7 Mg-1.4*
____________________________________
Urine:
[**2167-10-31**] 07:22PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.014
Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG
RBC-0 WBC-0 Bacteri-OCC Yeast-NONE Epi-0
 Creat-344 Na-77
Osmolal-702
_____________________________________



Brief Hospital Course:
Upon arrival to the floor, pt was found to have melanotic stools
with a 5 point HCT drop over previous few days, >10 points from
baseline. Because of known esophageal varices, hepatitis B, and
antral gastritis, he was NG Lavaged which cleared after 200 cc.
He was then transferred to the [**Hospital Unit Name 153**] while getting transfused
pRBCs (HCT 21) normal mid-30s.

1. GI bleed- Pt had an EGD where he was found to have multiple
grade II varices with erythema and oozing of blood.
Gastroenterology placed 5 bands successfully. He was started on
an octreotide drip x 5 days. He also started IV PPI,nadolol, and
sucralfate. In the ICU, pt was started on ciprofloxacin for SBP
prophylaxis because he had small amount of free fluid on
previous CT. However, when pt was transferred back to the
regular floor, upon discussion with GI, that was discontinued.

In the ICU, Hct was checked and pt was transferred back to the
floor when he was stable. Hct remained stable after the banding
procedure.

2. Anemia-
The acute anemia was from GIB. However, also likely to have
anemia of chronic disease from cancer. Usual Hct is mid-30s.

3. Oncology - Pt will receive palliative chemo on day of
discharge. Pt's oncologist will consider d/cing cisplatin
secondary to neuro symptoms, though quite atypical. Will defer
to primary oncology team.

4. LE pain-
The lower extremity pain was difficult to ascertain what was
happening. On PE sensation and strength were fully intact. Pt
was seen in ED initially by neurology and no focal deficits were
seen. His pain is not classical for cisplatin neuropathy but
could be related.  In speaking with pt's oncology, Dr.
[**Last Name (STitle) 150**], there appears to be a cultural communication issue,
in that it is difficult to really tell what the patient was
describing. At times, he described it as "soft."
Pt was started on gabapentin [**Hospital1 **] with relief.

5. F/E/N- Diet was slowly advanced post-procedure as tolerated.
Electrolytes were checked and repleted as necessary. Magnesium
needed to be repleted every day.

6. [**Name (NI) 946**] Pt was hyponatremic on the two days prior to
discharge (131-->126-->125). Urine lytes with Na 77 and Osm
>700. Suggesting sodium wasting vs. new SIADH which was
unlikely. Fluid restriction and sodium tablets were tried.

7. Prophylaxis: IV protonix, pneumoboots. Pt was ambulating.

8. Code- Full code. Primary oncology is broaching the subject.

Medications on Admission:
1. dilaudid 4mg tid
2. fentanyl 25mcg q3d
3. ativan prn
4. compazine prn
5. cisplatin
6. gemcitabine

Discharge Medications:
1. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
2. Zolpidem Tartrate 5 mg Tablet Sig: 1-2 Tablets PO HS (at
bedtime) as needed for sleep: Take as needed when you have
insomnia.
Disp:*30 Tablet(s)* Refills:*0*
3. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO twice a
day.
Disp:*60 Capsule(s)* Refills:*1*
4. Pantoprazole Sodium 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*
5. Fentanyl 25 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
Disp:*10 Patch 72HR(s)* Refills:*1*
6. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Upper gastroentestinal bleed
Lower extremity pain

Secondary diagnosis:
gallbladder cancer


Discharge Condition:
[**Name (NI) 14658**] Pt is without leg pain. His hematocrit is stable after the
banding procedure. His bowel movements do not have blood in
them. His sodium and magnesium are low.

Discharge Instructions:
-You will be going to chemotherapy on [**Hospital Ward Name **] 9 pm at 10 am
today.

-Please call your doctor or go to the emergency room if you have
leg weakness, feel dizzy, fevers, worsening of pain, or any
other health concern.

Followup Instructions:
You have an appointment with the gastroenterologists for a
repeat EGD on [**11-17**] on the [**Hospital Ward Name **] of [**Hospital3 **]. It
will be at 9:30 am but you should show up at 8:30 am. You will
receive instructions in the mail how to prepare.

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3281**], RN Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2167-11-12**] 11:30
Provider: [**Name Initial (NameIs) 4426**] 21  Date/Time:[**2167-11-12**] 11:30
Provider: [**Name10 (NameIs) 831**],[**Name11 (NameIs) **] HEMATOLOGY/ONCOLOGY-CC9 Where: [**Hospital 273**] HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2167-11-12**]
11:30


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 32201**]
{'Malignant neoplasm of gallbladder,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other specified disorders of stomach and duodenum'}


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: Tingling in legs

PRESENT ILLNESS: Pt is a 32 yo male, recently diagnosed with metastatic
gallbladder ca, who presented to the ED with LE numbness and
weakness. Pt was diagnosed with poorly differentiated
gallbladder cancer in [**8-29**] after he presented with painless
jaundice and 10 lb weight loss. Found to have cancer, with a
pancreatic mass, gallbladder fundus mass, and several liver
lesions as well as retroperitoneal lymphadenopathy on imaging.
Pt is getting palliative chemotherapy with gemcitabine (100
mg/m2) and cisplatin (20 mg/m2), three weeks on, one week off.
Pt began second cycle of chemotherapy on Thursday. Since chemo,
pt says that he has lower extremity pain. Today he points to
above his right knee and it is hard for him to describe exactly
what it feels like.

MEDICAL HISTORY: 1. anemia- low mcv with nml iron - likely anemia of chronic
disease
2. Malaria; multiple infections in past
3. s/p Appendectomy
4. H. Pylori- treated
5. UTI [**2163**]
6. Hepatitis B - low viral load; evidence of varices in lower
[**12-27**] of esophagus

MEDICATION ON ADMISSION: 1. dilaudid 4mg tid
2. fentanyl 25mcg q3d
3. ativan prn
4. compazine prn
5. cisplatin
6. gemcitabine

ALLERGIES: Bactrim

PHYSICAL EXAM: VS: T: 98.8; BP: 148/81; HR: 76; RR: 20; O2: 100% on RA
Gen: black male, appears nervous, in NAD.
HEENT: PERRLA; EOMI. OP clear without exudate. No blood.
CV: RRR S1S2. No M/R/G
Lungs: CTA b/l. Good air entry.
Abd: +BS. SOft, nt, nd
Ext: DP 2+. No edema.
Neuro: CN II-XII tested and intact. MS [**4-29**]. Sensation to soft
and sharp on LE was intact. Lower extremity: abduction,
adduction, hip flexion and extension all [**4-29**]. Patella no pain to
deep palpation.

FAMILY HISTORY: Positive for DM--both parents.  No cancer, heart disease. Ten
siblings - none with cancer

SOCIAL HISTORY: Pt is from [**Country **]. Moved to [**Location (un) 86**] 5 years ago. Worked at
7-eleven though not any more. No tobacco. No drugs. No EtOH for
many months. 

### Response:
{'Malignant neoplasm of gallbladder,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Polyneuropathy due to drugs,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other specified disorders of stomach and duodenum'}
