CHIEF COMPLAINT: 1-2days jaudice, nausea and mild RUQ on palpation on [**2187-8-15**]

PRESENT ILLNESS: This a 43 year old female with metastatic breast cancer, to
liver, lung, brain, and bone who presented with 1-2days jaudice,
nausea and mild RUQ on palpation on [**2187-8-15**]. In the ED, a RUQ U/S
was unable to identify the CBD but it did show dilatation of the
pancreatic duct which was suspcious for CBD stone. ERCP with
stent placement was performed on [**2187-8-16**]. Patient was treated
with IV Ciprofloxacin and stable on the OMED service until the
early am of [**2187-8-19**] when patient was found to be hypotensive to
SBP 70s, hypothermic to 95, with a rising lactate of 4.2.
Patient received 3L IVF boluses and blood pressure remained
fluid responsive.
.
Patient reported feeling the worst of her stay this am but
denies localizing symptoms. She denies RUQ pain, fevers, chills,
nausea, vomiting, cough, urinary urgency or frequency, dysuria,
or SOB. No HA or confusion. Of note, she has chronic back pain
that is unchanged from baseline.
.

MEDICAL HISTORY: Breast cancer - as above
S/p cholecystectomy
Chronic Back Pain L4 compression fracture

MEDICATION ON ADMISSION: Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg PRN
.
Meds on transfer:
Ciprofloxacin  400mg IV Q12H
Albuterol nebs Q6H prn
Chlorhexidine oral rinse [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Heparin SC TID
Hydrocortisone 100mg IV Q8H
Ipratropium Neb Q6H prn
Magnesium sliding scale
Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg Q4H prn
Pantoprazole 40mg po Q24H
Zosyn 4.5mg IV Q8H day#1 [**8-19**]
Potassium sliding scale
Prochlorperazine 10mg Q6H prn
Senna 1 tab po BID
Vancomycin 1000 mg IV Q 12H D#1 [**8-19**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.3 BP:138/49 HR:112 RR:26 O2Sat: 98% on 4L

FAMILY HISTORY: PGM had breast cancer in her 70s
Mother and Father have hyperlipidemia

SOCIAL HISTORY: She lives with her husband and two children.
Previously worked as a hostess. Tob: 20 pack-yr, quit 10 yrs ago
Malignant neoplasm of liver, secondary,Acute respiratory failure,Secondary malignant neoplasm of brain and spinal cord,Pathologic fracture of vertebrae,Unspecified septicemia,Severe sepsis,Septic shock,Obstruction of bile duct,Other specified aplastic anemias,Acute and subacute necrosis of liver,Personal history of malignant neoplasm of breast,Neoplasm related pain (acute) (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Second malig neo liver,Acute respiratry failure,Sec mal neo brain/spine,Path fx vertebrae,Septicemia NOS,Severe sepsis,Septic shock,Obstruction of bile duct,Aplastic anemias NEC,Acute necrosis of liver,Hx of breast malignancy,Neoplasm related pain,Adv eff antineoplastic
Admission Date:  [**2187-8-15**]              Discharge Date:   [**2187-8-22**]

Date of Birth:  [**2143-11-3**]             Sex:   F

Service: EMERGENCY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2565**]
Chief Complaint:
1-2days jaudice, nausea and mild RUQ on palpation on [**2187-8-15**]

Major Surgical or Invasive Procedure:
ERCP with stent placement was performed on [**2187-8-16**]

History of Present Illness:
This a 43 year old female with metastatic breast cancer, to
liver, lung, brain, and bone who presented with 1-2days jaudice,
nausea and mild RUQ on palpation on [**2187-8-15**]. In the ED, a RUQ U/S
was unable to identify the CBD but it did show dilatation of the
pancreatic duct which was suspcious for CBD stone. ERCP with
stent placement was performed on [**2187-8-16**]. Patient was treated
with IV Ciprofloxacin and stable on the OMED service until the
early am of [**2187-8-19**] when patient was found to be hypotensive to
SBP 70s, hypothermic to 95, with a rising lactate of 4.2.
Patient received 3L IVF boluses and blood pressure remained
fluid responsive.
.
Patient reported feeling the worst of her stay this am but
denies localizing symptoms. She denies RUQ pain, fevers, chills,
nausea, vomiting, cough, urinary urgency or frequency, dysuria,
or SOB. No HA or confusion. Of note, she has chronic back pain
that is unchanged from baseline.
.

Onc History:
Recurrent breast CA dx'd [**2181**] tx'd w/ lumpectomy/XRT/ CA.
[**7-17**]: XRT for osseous disease. She then rec'd wkly taxol/[**Doctor Last Name **]/
herceptin until markers went down to normal range. She was on
q3w Herceptin from [**12/2184**] - [**4-/2186**], when she developed brain
mets and consented to trial 06-356 combining Lapatinib 1000mg QD
with whole brain radiation then Lapatinib with weekly Herceptin.
She progressed and was changed to Xeloda- Lapatanib
w/progression. After cyberknife she was tx'd w/
Herceptin/Navelbine for 4 doses. Recent Brain MRI shows 2 small
new lesions for which she had Cyberknife tx.
In [**Month (only) 116**] she Avastin/ Gemzar therapy but developed thigh pain and
impending femur fx was discovered requiring surgery and XRT to
right leg. Recent MRI with 3 new small brain lesions, s/p
cyberknife to brain [**6-19**]. Known L4 compression fracture, being
evaluated for XRT.


Past Medical History:
Breast cancer - as above
S/p cholecystectomy
Chronic Back Pain L4 compression fracture

Social History:
She lives with her husband and two children.
Previously worked as a hostess. Tob: 20 pack-yr, quit 10 yrs ago


Family History:
PGM had breast cancer in her 70s
Mother and Father have hyperlipidemia

Physical Exam:
Vitals: T: 97.3 BP:138/49 HR:112 RR:26 O2Sat: 98% on 4L

GEN: Chronically ill appearing female, hirsuit, obese
HEENT: EOMI, PERRL, + sclera icterous, no epistaxis or
rhinorrhea, DMM
NECK: unable to assess JVD [**1-13**] neck girth, carotid pulses brisk,
no bruits, no cervical lymphadenopathy, trachea midline
COR: Tachy, regular, HS distant no M/G/R, normal S1 S2, radial
pulses +1
PULM: Expiratory wheezes, BS distant, decreased BS at right base

ABD: Soft, +RUQ TTP, ND, +BS, no rebound or guarding
EXT: 2+ pitting edema to sacrum. No C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. Attention
intact - spells world backwards. CN II ?????? XII grossly intact.
Moves all 4 extremities. Generalized weakness but strength 4+/5
in upper and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. Unable to assess gait.
SKIN: + jaundice, no cyanosis, or gross dermatitis. +
ecchymoses.


Pertinent Results:
On Admission:

[**2187-8-15**] 03:05PM   WBC-2.6* RBC-2.92* HGB-9.2* HCT-27.6* MCV-95#
MCH-31.7 MCHC-33.4 RDW-20.8*
[**2187-8-15**] 03:05PM   NEUTS-47* BANDS-21* LYMPHS-10* MONOS-16*
EOS-4 BASOS-0 ATYPS-0 METAS-1* MYELOS-1* NUC RBCS-1*
[**2187-8-15**] 03:05PM   PLT SMR-VERY LOW PLT COUNT-71*
[**2187-8-15**] 03:05PM   GLUCOSE-63* UREA N-11 CREAT-0.3* SODIUM-136
POTASSIUM-3.0* CHLORIDE-93* TOTAL CO2-31 ANION GAP-15
[**2187-8-15**] 03:05PM   ALT(SGPT)-49* AST(SGOT)-101* ALK PHOS-747*
TOT BILI-15.8* DIR BILI-12.2* INDIR BIL-3.6
[**2187-8-15**] 03:05PM   ALBUMIN-2.7* CALCIUM-8.3* PHOSPHATE-3.6
MAGNESIUM-1.8
[**2187-8-15**] 03:05PM   LIPASE-145*
[**2187-8-15**] 03:15PM   LACTATE-2.3*

RUQ ultrasound - Limited examination, but no evidence of biliary
ductal
dilatation.


Brief Hospital Course:
On transfer to the [**Hospital Unit Name 153**]
# Hypotension - Patient met SIRS criteria with T < 96 and SBP<70
on the floor prior to transfer which resolved with 3L IVF bolus
and broadening of antibitoics to include vancomycin and zosyn.
Likely source is biliary duct obstruction but also has
long-standin effusion and line as possible sources. Patient with
right porta-cath as only access. No central venous line placed
as patient's goal of care were clarified. Initially on pressors
and IV fluid boluses to maintain adequate MAP and urine output.
decision to d/c once clear that patient was CMO given widely
metastatic breast CA.  Patient was started on IV morphine drip.
Antibiotics were continued for comfort. Other unnecessary
medications/diagnostic studies were discontinued. family was all
around and present and patient passed away [**2187-8-21**].

Medications on Admission:
Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg PRN
.
Meds on transfer:
Ciprofloxacin  400mg IV Q12H
Albuterol nebs Q6H prn
Chlorhexidine oral rinse [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Heparin SC TID
Hydrocortisone 100mg IV Q8H
Ipratropium Neb Q6H prn
Magnesium sliding scale
Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg Q4H prn
Pantoprazole 40mg po Q24H
Zosyn 4.5mg IV Q8H day#1 [**8-19**]
Potassium sliding scale
Prochlorperazine 10mg Q6H prn
Senna 1 tab po BID
Vancomycin 1000 mg IV Q 12H D#1 [**8-19**]


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
metastatic breast cancer

Discharge Condition:
death

Discharge Instructions:
NA

Followup Instructions:
NA


Completed by:[**2187-8-22**]
{'Malignant neoplasm of liver, secondary,Acute respiratory failure,Secondary malignant neoplasm of brain and spinal cord,Pathologic fracture of vertebrae,Unspecified septicemia,Severe sepsis,Septic shock,Obstruction of bile duct,Other specified aplastic anemias,Acute and subacute necrosis of liver,Personal history of malignant neoplasm of breast,Neoplasm related pain (acute) (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}


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: 1-2days jaudice, nausea and mild RUQ on palpation on [**2187-8-15**]

PRESENT ILLNESS: This a 43 year old female with metastatic breast cancer, to
liver, lung, brain, and bone who presented with 1-2days jaudice,
nausea and mild RUQ on palpation on [**2187-8-15**]. In the ED, a RUQ U/S
was unable to identify the CBD but it did show dilatation of the
pancreatic duct which was suspcious for CBD stone. ERCP with
stent placement was performed on [**2187-8-16**]. Patient was treated
with IV Ciprofloxacin and stable on the OMED service until the
early am of [**2187-8-19**] when patient was found to be hypotensive to
SBP 70s, hypothermic to 95, with a rising lactate of 4.2.
Patient received 3L IVF boluses and blood pressure remained
fluid responsive.
.
Patient reported feeling the worst of her stay this am but
denies localizing symptoms. She denies RUQ pain, fevers, chills,
nausea, vomiting, cough, urinary urgency or frequency, dysuria,
or SOB. No HA or confusion. Of note, she has chronic back pain
that is unchanged from baseline.
.

MEDICAL HISTORY: Breast cancer - as above
S/p cholecystectomy
Chronic Back Pain L4 compression fracture

MEDICATION ON ADMISSION: Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg PRN
.
Meds on transfer:
Ciprofloxacin  400mg IV Q12H
Albuterol nebs Q6H prn
Chlorhexidine oral rinse [**Hospital1 **]
Colace 100mg [**Hospital1 **]
Heparin SC TID
Hydrocortisone 100mg IV Q8H
Ipratropium Neb Q6H prn
Magnesium sliding scale
Oxycontin 10mg [**Hospital1 **]
Oxycodone 5mg Q4H prn
Pantoprazole 40mg po Q24H
Zosyn 4.5mg IV Q8H day#1 [**8-19**]
Potassium sliding scale
Prochlorperazine 10mg Q6H prn
Senna 1 tab po BID
Vancomycin 1000 mg IV Q 12H D#1 [**8-19**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.3 BP:138/49 HR:112 RR:26 O2Sat: 98% on 4L

FAMILY HISTORY: PGM had breast cancer in her 70s
Mother and Father have hyperlipidemia

SOCIAL HISTORY: She lives with her husband and two children.
Previously worked as a hostess. Tob: 20 pack-yr, quit 10 yrs ago 

### Response:
{'Malignant neoplasm of liver, secondary,Acute respiratory failure,Secondary malignant neoplasm of brain and spinal cord,Pathologic fracture of vertebrae,Unspecified septicemia,Severe sepsis,Septic shock,Obstruction of bile duct,Other specified aplastic anemias,Acute and subacute necrosis of liver,Personal history of malignant neoplasm of breast,Neoplasm related pain (acute) (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
