CHIEF COMPLAINT: Pancreatic cystic neoplasm.

PRESENT ILLNESS: Mrs. [**Known lastname 14893**] is a 61-year-old woman with multiple medical
problems, one of which is chronic abdominal pain. She had some
type of surgery for a cystic
lesion in her pancreas several years ago which I think was on
the basis of an incorrect diagnosis as a pancreatic pseudocyst.
She has persisted with this cystic neoplasm in her central
pancreas which indicates that a pancreatic
pseudocyst was not an accurate diagnosis. Although we have
followed her pseudocyst serially with imaging and found that it
has not changed in its size or anatomical configuration, it is
clearly obstructing the outflow from the left pancreas where the
pancreatic duct is dilated. We have no other reason
for her abdominal pain. She has had numerous issues in the past
few months, perhaps the most significant of which was coronary
artery disease necessitating coronary artery bypass grafting.
She also is morbidly obese and has had multiple
prior abdominal operations. As an attempt to eradicate her pain,
I recommended resection of this pancreatic cystic neoplasm.

MEDICAL HISTORY: :anxiety, HOCM, cystic pancreatic mass, chronic pain, asthma,
HTN, SVT with stress/anxiety, hyperthyroid, hiatal hernia,
arthritis, [**Doctor First Name **]
.
PSx: CABG [**12-29**] ,Roux-en-Y
cystojejunostomy

MEDICATION ON ADMISSION: wellbutrin 300mg AM, lasix 40 AM, ,fosamax, vitamin D 5000 AM,
B6, ASA, Kcl 60 AM; synthroid 200mcg PM, T3 21mg PM, toprol XL
100 PM, effexor 300 PM, prilosec 40 PM, lipitor 80 PM, Ativan
2mg HS, risperdal 1 HS, ambien 1 HS, metolazone 5 PRN, fiorinal
PRN, advair 250/50 PRN, albuterol PRN, T3 for HA, vicodin PRN,
percocet PRN, theophyilline PRN

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: VSS - 63, 136/78, 97%, 250 lbs.
Gen: pleasant, A+O x 3
CV: RR, S1, S2
Chest: CTA bilat.
Abd: Obese, soft, nontender, nondistended.
Ext: +2 pulses bilat.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Benign neoplasm of pancreas, except islets of Langerhans,Hypovolemia,Chronic pancreatitis,Unspecified acquired hypothyroidism,Other chronic nonalcoholic liver disease,Aortocoronary bypass status,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Morbid obesity
Benign neoplasm pancreas,Hypovolemia,Chronic pancreatitis,Hypothyroidism NOS,Chronic liver dis NEC,Aortocoronary bypass,Hypertension NOS,Asthma NOS,Morbid obesity
Admission Date:  [**2118-3-24**]              Discharge Date:   [**2118-4-1**]

Date of Birth:  [**2056-5-13**]             Sex:   F

Service: SURGERY

Allergies:
Ciprofloxacin

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
Pancreatic cystic neoplasm.


Major Surgical or Invasive Procedure:
subtotal Pancreatectomy with Splenectomy
Lysis Of Adhesions
Open Wedge Liver Biopsy
Small Bowel Resection


History of Present Illness:
Mrs. [**Known lastname 14893**] is a 61-year-old woman with multiple medical
problems, one of which is chronic abdominal pain. She had some
type of surgery for a cystic
lesion in her pancreas several years ago which I think was on
the basis of an incorrect diagnosis as a pancreatic pseudocyst.
She has persisted with this cystic neoplasm in her central
pancreas which indicates that a pancreatic
pseudocyst was not an accurate diagnosis. Although we have
followed her pseudocyst serially with imaging and found that it
has not changed in its size or anatomical configuration, it is
clearly obstructing the outflow from the left pancreas where the
pancreatic duct is dilated. We have no other reason
for her abdominal pain. She has had numerous issues in the past
few months, perhaps the most significant of which was coronary
artery disease necessitating coronary artery bypass grafting.
She also is morbidly obese and has had multiple
prior abdominal operations. As an attempt to eradicate her pain,
I recommended resection of this pancreatic cystic neoplasm.

Past Medical History:
:anxiety, HOCM, cystic pancreatic mass, chronic pain, asthma,
HTN, SVT with stress/anxiety, hyperthyroid, hiatal hernia,
arthritis, [**Doctor First Name **]
.
PSx: CABG [**12-29**] ,Roux-en-Y
cystojejunostomy


Physical Exam:
VSS - 63, 136/78, 97%, 250 lbs.
Gen: pleasant, A+O x 3
CV: RR, S1, S2
Chest: CTA bilat.
Abd: Obese, soft, nontender, nondistended.
Ext: +2 pulses bilat.

Pertinent Results:
[**2118-3-29**] 06:45AM BLOOD WBC-9.2 RBC-3.46* Hgb-10.1* Hct-30.6*
MCV-89 MCH-29.3 MCHC-33.1 RDW-15.7* Plt Ct-264
[**2118-3-29**] 06:45AM BLOOD Glucose-122* UreaN-9 Creat-0.5 Na-141
K-3.6 Cl-103 HCO3-33* AnGap-9
[**2118-3-29**] 06:45AM BLOOD Calcium-8.8 Phos-3.2 Mg-1.8
.
SPECIMEN SUBMITTED:  LIVER BX, SMALL BOWEL, DISTAL PANCREAS AND
SPLEEN, BOWEL, PANCREATIC CYSTIC TUMOR.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2118-3-24**] [**2118-3-24**] [**2118-3-31**] DR. [**Last Name (STitle) **]. [**Doctor Last Name **]/mrr??????

DIAGNOSIS:



1.  Pancreas and duodenum, partial pancreaticoduodenectomy
(A-R):

1.  Microcystic serous cystadenoma, 4.6 x 4.4 x 2.4 cm,
completely-excised.

2.  Pancreatic intraepithelial neoplasia 1.

3.  Six lymph nodes, no malignancy identified.

4.  Unremarkable duodenum.

2.  Distal pancreas and spleen, distal pancreatico splenectomy
(S-V):

1.  Pancreatic intraepithelial neoplasia 1.

2.  Chronic pancreatitis.

3.  Benign spleen with focal hemorrhage.

4.  Six lymph nodes, no malignancy identified.

3.  Small bowel (W-Y):

No diagnostic abnormalities recognized.

4.  :Bowel" (Z-AA):

Small bowel, no diagnostic abnormalities recognized.

5.  Liver, wedge biopsy (AB):

1.  Moderate microvesicular steatosis including approximately
30% of liver parenchyma (score 1).

2.  Rare lobular inflammatory foci including neutrophils (score
2).

3.  Scattered balloon cells (score 1).

4.  Focal minimal central lobular fibrosis seen on trichrome
stain (stage 1).

5.  Iron stain shows mild iron deposition in Kupffer cells.

.
Cardiology Report ECHO Study Date of [**2118-3-24**]

Conclusions:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is
seen in the body of the left atrium or left atrial appendage. No
atrial septal
defect or patent foramen ovale is seen by 2D, color Doppler or
saline contrast
with maneuvers. Left ventricular wall thicknesses and cavity
size are normal.
There is no left ventricular outflow obstruction at rest or with
Valsalva.
There was no change in the left ventricular outflow tract
gradient with
Valsalva maneuver. Right ventricular chamber size and free wall
motion are
normal. There are simple atheroma in the descending thoracic
aorta. There are
three aortic valve leaflets. The aortic valve leaflets are
moderately
thickened. There is mild aortic valve stenosis (area
1.2-1.9cm2). Trace aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened.
Mild to moderate ([**11-23**]+) mitral regurgitation is seen. There is
no pericardial
effusion.
.




Brief Hospital Course:
She was admitted on [**2118-3-24**] and went to the OR for:
1.  Subtotal (80%) pancreatectomy with splenectomy.
2.  Small bowel resection.
3.  Mobilization of splenic flexure of colon.
4.  Extensive lysis of adhesions.
5.  Open wedge liver biopsy.

Post-op Hypovolemia: She received two 500cc fluid boluses
overnight in the SICU for hypotension and low urine output. Her
urine output remained at 20-40cc/hr in the SICU.

On POD 3, she received IV Lasix and had a good response with
increased urine output. She was now back on her home Lasix dose
and her peripheral edema was improving.

GI/Abd: Her abdomen was tender and her dressing was intact over
the incision. She had a NGT, was NPO with IVF. Her wicks were
removed on POD 2. she had minimal drainage from the left side of
her wound. There was no erythema or infection. The staples were
left in place and will be removed at her follow-up appointment.

The NGT was removed on POD 3. She was started on sips on POD 4.
Her diet was slowly advanced over the next few days. She
complained of gas pains, that resolved with a suppository and
bowel movement.  She was able to tolerate regular diet at time
of discharge. She was ambulating and safe to go home.

Pain: She was having considerable pain post-operatively. She was
followed by the pain team. Given the pt's hx of chronic pain and
chronic opioid use (was on Percocet (7.5mg), Vicodin, opana at
home), she had increased requirements on pain medications. Since
she seemed to be having trouble using the PCA, per the pain
service was started on a Duragesic patch of 100mcg q 72 hrs. She
may also use the Dilaudid PCA as an adjunct to that. She seemed
to be pretty sedated and having confusion. The patch and PCA
were stopped and she was ordered for Toradol. Toradol controlled
her pain.

Resp: She remained on the Ventilator overnight in the SICU. She
was extubated the next day at 1300. She was initially
tachypneic, and with asthma at baseline. We were able to
successfully wean her off the O2 and she had no respiratory
issues.

Neuro: She was weepy and very anxious and confused with visual
hallucinations and at times argumentative.. She received Ativan
and was frequently reoriented. She received Haldol x 2 the night
of [**4-4**] with good effect.

Vaccines: she received Vaccines x 3 on POD 3.


Medications on Admission:
wellbutrin 300mg AM, lasix 40 AM, ,fosamax, vitamin D 5000 AM,
B6, ASA, Kcl 60 AM; synthroid 200mcg PM, T3 21mg PM, toprol XL
100 PM, effexor 300 PM, prilosec 40 PM, lipitor 80 PM, Ativan
2mg HS, risperdal 1 HS, ambien 1 HS, metolazone 5 PRN, fiorinal
PRN, advair 250/50 PRN, albuterol PRN, T3 for HA, vicodin PRN,
percocet PRN, theophyilline PRN

Discharge Medications:
1. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days: Twice/day for 5 days, then resume once/day
dose.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed for 2 weeks.
Disp:*35 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**First Name5 (NamePattern1) 5871**] [**Last Name (NamePattern1) 269**]

Discharge Diagnosis:
Pancreatic Cystic Mass
Post-op Delerium


Discharge Condition:
Good.
Incision C/D/I with minimal clear pink drainage from left side
of wound.
Pain controlled
A+O x 3


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:

* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomitting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomitting,
diarrhea or other reasons. Signs of dehydration include dry
mouth, rapid heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
=
=
=
=
=
================================================================
Please resume all regular home medications and take any new meds
as ordered. Take Lasix 40mg 2x/day for 5 days, then resume
1x/day dose.
.
Continue to ambulate several times per day.
.
You may shower and wash your incision. Pat dry and keep clean
and dry. Monitor for signs of infection.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 468**] in 2 weeks. Call ([**Telephone/Fax (1) 27734**] to schedule an appointment.



Completed by:[**2118-4-1**]
{'Benign neoplasm of pancreas, except islets of Langerhans,Hypovolemia,Chronic pancreatitis,Unspecified acquired hypothyroidism,Other chronic nonalcoholic liver disease,Aortocoronary bypass status,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Morbid obesity'}


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: Pancreatic cystic neoplasm.

PRESENT ILLNESS: Mrs. [**Known lastname 14893**] is a 61-year-old woman with multiple medical
problems, one of which is chronic abdominal pain. She had some
type of surgery for a cystic
lesion in her pancreas several years ago which I think was on
the basis of an incorrect diagnosis as a pancreatic pseudocyst.
She has persisted with this cystic neoplasm in her central
pancreas which indicates that a pancreatic
pseudocyst was not an accurate diagnosis. Although we have
followed her pseudocyst serially with imaging and found that it
has not changed in its size or anatomical configuration, it is
clearly obstructing the outflow from the left pancreas where the
pancreatic duct is dilated. We have no other reason
for her abdominal pain. She has had numerous issues in the past
few months, perhaps the most significant of which was coronary
artery disease necessitating coronary artery bypass grafting.
She also is morbidly obese and has had multiple
prior abdominal operations. As an attempt to eradicate her pain,
I recommended resection of this pancreatic cystic neoplasm.

MEDICAL HISTORY: :anxiety, HOCM, cystic pancreatic mass, chronic pain, asthma,
HTN, SVT with stress/anxiety, hyperthyroid, hiatal hernia,
arthritis, [**Doctor First Name **]
.
PSx: CABG [**12-29**] ,Roux-en-Y
cystojejunostomy

MEDICATION ON ADMISSION: wellbutrin 300mg AM, lasix 40 AM, ,fosamax, vitamin D 5000 AM,
B6, ASA, Kcl 60 AM; synthroid 200mcg PM, T3 21mg PM, toprol XL
100 PM, effexor 300 PM, prilosec 40 PM, lipitor 80 PM, Ativan
2mg HS, risperdal 1 HS, ambien 1 HS, metolazone 5 PRN, fiorinal
PRN, advair 250/50 PRN, albuterol PRN, T3 for HA, vicodin PRN,
percocet PRN, theophyilline PRN

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: VSS - 63, 136/78, 97%, 250 lbs.
Gen: pleasant, A+O x 3
CV: RR, S1, S2
Chest: CTA bilat.
Abd: Obese, soft, nontender, nondistended.
Ext: +2 pulses bilat.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Benign neoplasm of pancreas, except islets of Langerhans,Hypovolemia,Chronic pancreatitis,Unspecified acquired hypothyroidism,Other chronic nonalcoholic liver disease,Aortocoronary bypass status,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Morbid obesity'}
