CHIEF COMPLAINT: Rectosigmoid colon cancer

PRESENT ILLNESS: [**Known firstname **] is an 88-year-old female with a history of lower abdominal
pain, heme positive stool who initially did not want evaluation
and workup but then conceded to a sigmoidoscopy. Sigmoidoscopy
demonstrated a large rectosigmoid mass that was biopsied and
showed high-grade dysplasia with likely adenocarcinoma. CT scan
showed a large mass in the pelvis. She was seen in the hospital
and as an outpatient and offered low anterior resection with
possible
colostomy. Risks and benefits of the procedure were discussed.
Consent was reviewed and signed.

MEDICAL HISTORY: MONOCLONAL GAMMOPATHY
DEMENTIA
HYPERTENSION
? of ANGINA, STABLE- PERSANTINE THALLIUM NEGATIVE [**4-18**]
OSTEOARTHRITIS
BACK PAIN- S/P LUMBAR DISC [**Doctor First Name 147**].
S/P ARTHROPLASTY KNEE, TOTAL REPLACEMENT, BILAT
HEADACHE
ESOPHAGITIS, REFLUX
OSTEOPOROSIS
? of GOUT- LEFT GREAT TOE
ATOPIC DERMATITIS
S/P INGUINAL HERNIA REPAIR, BILAT
S/P TOTAL HYSTERECTOMY [**2075**]
S/P REMOVE GALLBLADDER
S/P REMOVAL OF APPENDIX
? of POLYMYALGIA RHEUMATICA
SHOULDER PAIN, RIGHT, CHRONIC
RESTLESS LEG SYNDROME
.
MEDS:
ATENOLOL TAB 100MG one tab po qd  \
FOSAMAX TABS 70 MG 1  tab po qweek
PROTONIX 40 MG Daily
MULTIVITAMIN one po qd
CALCIUM CARB CHW 500MG  2-3 per day
METROCREAM 0.75 % CREAM apply qd
DOXEPIN HCL 50 MG CAPS  1 cap po qhs
TRAMADOL HCL 50 MG 2 tabs po qd 4- 6 hours prn--not using
FUROSEMIDE TAB 20MG po qam
LISINOPRIL 5 MG TABS po qhs
REQUIP 2 MG TABS po 1 hour before bedtime
.
NKDA

MEDICATION ON ADMISSION: Lopressor 150', Mirtazapine 15', Prilosec 20', Trazadone 75', Ca
500''', Vit D, Colace 100', Fe, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
Gen: nad
CV: RRR
Chest: CTAb
Abd: S/ND, appropriately tender, surgical incision intact with
no signs of infection, stoma pink
Ext: WWP, non-tender

FAMILY HISTORY: unknown

SOCIAL HISTORY: Married.  Two sons who live in the area.  Currently at [**Location (un) 8220**] NH.  Pt is a holocaust survivor.
Malignant neoplasm of rectosigmoid junction,Perforation of intestine,Intestinal infection due to Clostridium difficile,Senile dementia with delirium,Paralytic ileus,Monoclonal paraproteinemia,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Osteoporosis, unspecified,Antidepressants causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic)
Mal neo rectosigmoid jct,Perforation of intestine,Int inf clstrdium dfcile,Senile delirium,Paralytic ileus,Monoclon paraproteinemia,Mental disor NEC oth dis,Hypertension NOS,Osteoporosis NOS,Adv eff antidepressants,Chr blood loss anemia
Admission Date:  [**2115-5-15**]              Discharge Date:   [**2115-5-26**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6346**]
Chief Complaint:
Rectosigmoid colon cancer

Major Surgical or Invasive Procedure:
1. Exploratory laparotomy
2. Low anterior resection
3. Hartmann's end colostomy
4. Feeding transgastric jejunostomy
5. Splenic flexure takedown

History of Present Illness:
[**Known firstname **] is an 88-year-old female with a history of lower abdominal
pain, heme positive stool who initially did not want evaluation
and workup but then conceded to a sigmoidoscopy. Sigmoidoscopy
demonstrated a large rectosigmoid mass that was biopsied and
showed high-grade dysplasia with likely adenocarcinoma. CT scan
showed a large mass in the pelvis. She was seen in the hospital
and as an outpatient and offered low anterior resection with
possible
colostomy. Risks and benefits of the procedure were discussed.
Consent was reviewed and signed.


Past Medical History:
MONOCLONAL GAMMOPATHY
DEMENTIA
HYPERTENSION
? of ANGINA, STABLE- PERSANTINE THALLIUM NEGATIVE [**4-18**]
OSTEOARTHRITIS
BACK PAIN- S/P LUMBAR DISC [**Doctor First Name 147**].
S/P ARTHROPLASTY KNEE, TOTAL REPLACEMENT, BILAT
HEADACHE
ESOPHAGITIS, REFLUX
OSTEOPOROSIS
? of GOUT- LEFT GREAT TOE
ATOPIC DERMATITIS
S/P INGUINAL HERNIA REPAIR, BILAT
S/P TOTAL HYSTERECTOMY [**2075**]
S/P REMOVE GALLBLADDER
S/P REMOVAL OF APPENDIX
? of POLYMYALGIA RHEUMATICA
SHOULDER PAIN, RIGHT, CHRONIC
RESTLESS LEG SYNDROME
.
MEDS:
ATENOLOL TAB 100MG one tab po qd  \
FOSAMAX TABS 70 MG 1  tab po qweek
PROTONIX 40 MG Daily
MULTIVITAMIN one po qd
CALCIUM CARB CHW 500MG  2-3 per day
METROCREAM 0.75 % CREAM apply qd
DOXEPIN HCL 50 MG CAPS  1 cap po qhs
TRAMADOL HCL 50 MG 2 tabs po qd 4- 6 hours prn--not using
FUROSEMIDE TAB 20MG po qam
LISINOPRIL 5 MG TABS po qhs
REQUIP 2 MG TABS po 1 hour before bedtime
.
NKDA

Social History:
Married.  Two sons who live in the area.  Currently at [**Location (un) 8220**] NH.  Pt is a holocaust survivor.


Family History:
unknown

Physical Exam:
AVSS
Gen: nad
CV: RRR
Chest: CTAb
Abd: S/ND, appropriately tender, surgical incision intact with
no signs of infection, stoma pink
Ext: WWP, non-tender

Pertinent Results:
[**2115-5-15**] 05:34PM BLOOD WBC-5.8 RBC-3.42* Hgb-10.5* Hct-30.9*
MCV-90 MCH-30.7 MCHC-34.0 RDW-15.5 Plt Ct-314#
[**2115-5-16**] 01:29AM BLOOD WBC-8.2 RBC-3.34* Hgb-10.4* Hct-29.9*
MCV-90 MCH-31.2 MCHC-34.9 RDW-15.9* Plt Ct-330
[**2115-5-17**] 04:50AM BLOOD WBC-8.7 RBC-3.17* Hgb-9.9* Hct-28.6*
MCV-90 MCH-31.2 MCHC-34.5 RDW-16.0* Plt Ct-312
[**2115-5-18**] 05:20AM BLOOD WBC-6.6 RBC-3.17* Hgb-10.2* Hct-28.8*
MCV-91 MCH-32.0 MCHC-35.3* RDW-15.8* Plt Ct-334
[**2115-5-19**] 06:00AM BLOOD WBC-4.9 RBC-3.13* Hgb-9.7* Hct-29.0*
MCV-93 MCH-30.9 MCHC-33.3 RDW-16.0* Plt Ct-305
[**2115-5-15**] 05:34PM BLOOD Glucose-146* UreaN-13 Creat-0.8 Na-140
K-3.9 Cl-108 HCO3-25 AnGap-11
[**2115-5-16**] 01:29AM BLOOD Glucose-124* UreaN-15 Creat-1.0 Na-139
K-4.1 Cl-107 HCO3-24 AnGap-12
[**2115-5-17**] 04:50AM BLOOD Glucose-102 UreaN-17 Creat-1.0 Na-139
K-3.9 Cl-106 HCO3-25 AnGap-12
[**2115-5-18**] 05:20AM BLOOD Glucose-133* UreaN-14 Creat-0.9 Na-139
K-3.2* Cl-104 HCO3-26 AnGap-12
[**2115-5-19**] 06:00AM BLOOD Glucose-123* UreaN-13 Creat-0.7 Na-141
K-4.2 Cl-104 HCO3-29 AnGap-12
[**2115-5-20**] 05:25AM BLOOD Glucose-120* UreaN-15 Creat-0.7 Na-141
K-3.9 Cl-104 HCO3-29 AnGap-12
[**2115-5-19**] 06:00AM BLOOD ALT-7 AST-20 AlkPhos-71 TotBili-0.4
[**2115-5-20**] 05:25AM BLOOD Calcium-8.3* Phos-3.0 Mg-1.8

Brief Hospital Course:
88F with pre-operative diagnosis of rectosigmoid cancer admitted
for scheduled, elective sigmoid colectomy.
Informed consent was obtained.
Pt tolerated the procedure well but was kept intubated and
admitted to the ICU overnight for anesthesia concerns and the pt
being slow to wake after general anesthesia.  Pt did well
overnight in the ICU with no issues.
On POD1 she was extubated with no complications. Her NGT was
also removed.  She was transferred to the floor.
Her bowel functions slowly returned to function and her diet was
advanced from sips to clears to regular diet as well as her
tubefeeds via the j-tube were advanced which she was tolerating
well.  She had several episodes of emesis but a f/u KUB showed
the G-J tube to be in place.  The G-tube balloon was reduced by
10cc for the possibility that that could be causing some mild
obstruction.  She had had no episodes of vomiting for greater
than 24hrs on the day of discharge.
The geriatric service was consulted and assisted us with her
care in terms of medications and sleep aids.  Of note, she
continued to be somewhat sleepy during her post-operative
course.  The geriatric service felt that this might be due to
her haldol, trazodone and/or remeron but they had no definite
explanation.  Haldol and trazodone were held and her remeron was
reduced then also d/c'ed.  Once all of these medications were
discontinued, she was much more alert and oriented equivalent to
her baseline.
Physical and occupational therapy evaluated the patient and
deemed her in need of rehab placement.
Of note, her stool was sent for c.diff which came back positive.
 Although she was afebrile and she did not have a white count,
she was started on flagyl given the positive cultures for a
course of 14 days.
On the day of discharge she was afebrile, VSS, incision CD&I,
and tolerating feeds and regular diet.

Medications on Admission:
Lopressor 150', Mirtazapine 15', Prilosec 20', Trazadone 75', Ca
500''', Vit D, Colace 100', Fe, MVI

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
2. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO once a day.
6. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Acetaminophen 160 mg/5 mL Solution Sig: Six [**Age over 90 1230**]y
(650) mg PO every 4-6 hours as needed for pain.
9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 10 days.
10. Lactobacillus Acidophilus     Capsule Sig: One (1) Capsule
PO twice a day for 10 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Rectosigmoid colon cancer


Discharge Condition:
stable


Discharge Instructions:
Call or come back in if you experience fevers, chills, [**Hospital6 **],
vomiting, increasing redness, increased swelling, bleeding or
purulent discharge from your incision, increasing pain, or any
other concerns.
You should only take pain medications as needed. Take stool
softeners to prevent constipation.
.
It is okay to shower but do not soak your wound. Do not immerse
your wound in water for at least 4 weeks postoperatively. Do not
lift greater than [**10-2**] lbs for 4 weeks.


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) 2819**] in [**6-27**] days.  Please call his office to
verify your appointment: ([**Telephone/Fax (1) 6347**]
{'Malignant neoplasm of rectosigmoid junction,Perforation of intestine,Intestinal infection due to Clostridium difficile,Senile dementia with delirium,Paralytic ileus,Monoclonal paraproteinemia,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Osteoporosis, unspecified,Antidepressants causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic)'}


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: Rectosigmoid colon cancer

PRESENT ILLNESS: [**Known firstname **] is an 88-year-old female with a history of lower abdominal
pain, heme positive stool who initially did not want evaluation
and workup but then conceded to a sigmoidoscopy. Sigmoidoscopy
demonstrated a large rectosigmoid mass that was biopsied and
showed high-grade dysplasia with likely adenocarcinoma. CT scan
showed a large mass in the pelvis. She was seen in the hospital
and as an outpatient and offered low anterior resection with
possible
colostomy. Risks and benefits of the procedure were discussed.
Consent was reviewed and signed.

MEDICAL HISTORY: MONOCLONAL GAMMOPATHY
DEMENTIA
HYPERTENSION
? of ANGINA, STABLE- PERSANTINE THALLIUM NEGATIVE [**4-18**]
OSTEOARTHRITIS
BACK PAIN- S/P LUMBAR DISC [**Doctor First Name 147**].
S/P ARTHROPLASTY KNEE, TOTAL REPLACEMENT, BILAT
HEADACHE
ESOPHAGITIS, REFLUX
OSTEOPOROSIS
? of GOUT- LEFT GREAT TOE
ATOPIC DERMATITIS
S/P INGUINAL HERNIA REPAIR, BILAT
S/P TOTAL HYSTERECTOMY [**2075**]
S/P REMOVE GALLBLADDER
S/P REMOVAL OF APPENDIX
? of POLYMYALGIA RHEUMATICA
SHOULDER PAIN, RIGHT, CHRONIC
RESTLESS LEG SYNDROME
.
MEDS:
ATENOLOL TAB 100MG one tab po qd  \
FOSAMAX TABS 70 MG 1  tab po qweek
PROTONIX 40 MG Daily
MULTIVITAMIN one po qd
CALCIUM CARB CHW 500MG  2-3 per day
METROCREAM 0.75 % CREAM apply qd
DOXEPIN HCL 50 MG CAPS  1 cap po qhs
TRAMADOL HCL 50 MG 2 tabs po qd 4- 6 hours prn--not using
FUROSEMIDE TAB 20MG po qam
LISINOPRIL 5 MG TABS po qhs
REQUIP 2 MG TABS po 1 hour before bedtime
.
NKDA

MEDICATION ON ADMISSION: Lopressor 150', Mirtazapine 15', Prilosec 20', Trazadone 75', Ca
500''', Vit D, Colace 100', Fe, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AVSS
Gen: nad
CV: RRR
Chest: CTAb
Abd: S/ND, appropriately tender, surgical incision intact with
no signs of infection, stoma pink
Ext: WWP, non-tender

FAMILY HISTORY: unknown

SOCIAL HISTORY: Married.  Two sons who live in the area.  Currently at [**Location (un) 8220**] NH.  Pt is a holocaust survivor. 

### Response:
{'Malignant neoplasm of rectosigmoid junction,Perforation of intestine,Intestinal infection due to Clostridium difficile,Senile dementia with delirium,Paralytic ileus,Monoclonal paraproteinemia,Other persistent mental disorders due to conditions classified elsewhere,Unspecified essential hypertension,Osteoporosis, unspecified,Antidepressants causing adverse effects in therapeutic use,Iron deficiency anemia secondary to blood loss (chronic)'}
