CHIEF COMPLAINT: Cecal Mass

PRESENT ILLNESS: [**Age over 90 **] year old man previously admitted with RLQ pain that started
acutely while straining. No radiation of pain. Pain got better
with ice packs. Had a restless night and this morning noticed
that the pain was worse on movement. Patient has a previously
known cecal mass identified on colonoscopy, and was discharged
home from his previous hospitalization with plan to return for
scheduled right colectomy

MEDICAL HISTORY: coronary artery disease status post CABG in [**2080**], subsequent
protected left main stenting in [**2100**], chronic atrial
fibrillation, tachy-brady syndrome, status post pacemaker
implantation in [**9-/2099**], Chronic renal insufficiency due to
renal
sclerosis, Iron def anemia

MEDICATION ON ADMISSION: Plavix 75 mg daily, aspirin 81 mg daily, Zocor 20mg daily,
Protonix 40 mg daily, Bumex 1 mg daily, calcitriol 0.25
mg daily, carvedilol 12.5 mg [**Hospital1 **]

ALLERGIES: Morphine Sulfate / Aspirin / Metoprolol / Levaquin

PHYSICAL EXAM: 97.9 97.9 70 120/52 16 97RA
NAD A&Ox3
CTAB
RRR
Abd soft, NTND
Wound cdi

FAMILY HISTORY: AFib, No colon cancer
GF: DM, stroke. Aunts, Uncles with DM. M died at 92. F: died at
72 of a tachycardia

SOCIAL HISTORY: Retired Internist. Lives in a retirement home. Independent
No ETOH/Tob
Malignant neoplasm of cecum,Chronic systolic heart failure,Atrial fibrillation,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Chronic kidney disease, unspecified,Renal sclerosis, unspecified,Nonspecific low blood pressure reading,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia, unspecified,Cardiac pacemaker in situ
Malignant neoplasm cecum,Chr systolic hrt failure,Atrial fibrillation,Lap surg convert to open,Peritoneal adhesions,Chronic kidney dis NOS,Renal sclerosis NOS,Low blood press reading,Crnry athrscl natve vssl,Status-post ptca,Iron defic anemia NOS,Status cardiac pacemaker
Admission Date:  [**2105-7-1**]              Discharge Date:   [**2105-7-5**]


Service: SURGERY

Allergies:
Morphine Sulfate / Aspirin / Metoprolol / Levaquin

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
Cecal Mass

Major Surgical or Invasive Procedure:
Laparoscopic converted to open right colectomy

History of Present Illness:
[**Age over 90 **] year old man previously admitted with RLQ pain that started
acutely while straining. No radiation of pain. Pain got better
with ice packs. Had a restless night and this morning noticed
that the pain was worse on movement. Patient has a previously
known cecal mass identified on colonoscopy, and was discharged
home from his previous hospitalization with plan to return for
scheduled right colectomy


Past Medical History:
coronary artery disease status post CABG in [**2080**], subsequent
protected left main stenting in [**2100**], chronic atrial
fibrillation, tachy-brady syndrome, status post pacemaker
implantation in [**9-/2099**], Chronic renal insufficiency due to
renal
sclerosis, Iron def anemia

Social History:
Retired Internist. Lives in a retirement home. Independent
No ETOH/Tob


Family History:
AFib, No colon cancer
GF: DM, stroke. Aunts, Uncles with DM. M died at 92. F: died at
72 of a tachycardia

Physical Exam:
97.9 97.9 70 120/52 16 97RA
NAD A&Ox3
CTAB
RRR
Abd soft, NTND
Wound cdi

Pertinent Results:
[**2105-7-1**] 09:46PM   WBC-8.7# RBC-3.76* HGB-12.6* HCT-37.4*
MCV-100* MCH-33.5* MCHC-33.6 RDW-16.6*

Brief Hospital Course:
Pt was taken to the operating room for a laparoscopic right
colectomy. The procedure was converted to open because of
difficult adhesions after a previous laparotomy. The remainder
of the procedure was performed without complication and the
patient recovered from anesthesia without difficulty in the
PACU. He was taken to the ICU overnight for observation and
transferred to the floor the following morning. His ICU stay was
significant only for low urine output which improved once the
patient was restarted on his bumex. The patient was seen by the
pain service, and his pain controlled with a PCA which was
converted to PO medications once he would tolerate these.
Additionally, he was seen by the cardiology service, but had no
acute cardiac issues at this time. He was maintained on sips/IVF
until he had return of bowel function at which time his diet was
advanced to regular. On POD 4, the patient was discharged to
rehab to continue his physical therapy. At the time of discharge
he was tolerating a general diet, his pain was well controlled
and his abdominal exam was benign.

Medications on Admission:
Plavix 75 mg daily, aspirin 81 mg daily, Zocor 20mg daily,
Protonix 40 mg daily, Bumex 1 mg daily, calcitriol 0.25
mg daily, carvedilol 12.5 mg [**Hospital1 **]

Discharge Medications:
1. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*2*
2. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*qs Tablet(s)* Refills:*2*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*qs Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*qs Tablet(s)* Refills:*2*
5. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO Q24H (every
24 hours).
Disp:*qs Capsule(s)* Refills:*2*
6. Bumetanide 0.5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*qs Tablet(s)* Refills:*2*
7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*qs Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
9. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q4H (every 4 hours)
as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*qs Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
lassell

Discharge Diagnosis:
Cecal Mass

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.
Incision Care:  Keep clean and dry.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
-If you have staples, they will be removed during at your follow
up appointment.

.
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 vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
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.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication.  You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to ambulate several times per day.
* No heavy ([**11-6**]  lbs) until your follow up appointment.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 1120**] in [**1-24**] weeks. Call ([**Telephone/Fax (1) 6316**] to make an appointment.

Please also keep the following scheduled appointments:

Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2105-11-26**]
3:00
Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2105-11-26**] 3:40
{'Malignant neoplasm of cecum,Chronic systolic heart failure,Atrial fibrillation,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Chronic kidney disease, unspecified,Renal sclerosis, unspecified,Nonspecific low blood pressure reading,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia, unspecified,Cardiac pacemaker in situ'}


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: Cecal Mass

PRESENT ILLNESS: [**Age over 90 **] year old man previously admitted with RLQ pain that started
acutely while straining. No radiation of pain. Pain got better
with ice packs. Had a restless night and this morning noticed
that the pain was worse on movement. Patient has a previously
known cecal mass identified on colonoscopy, and was discharged
home from his previous hospitalization with plan to return for
scheduled right colectomy

MEDICAL HISTORY: coronary artery disease status post CABG in [**2080**], subsequent
protected left main stenting in [**2100**], chronic atrial
fibrillation, tachy-brady syndrome, status post pacemaker
implantation in [**9-/2099**], Chronic renal insufficiency due to
renal
sclerosis, Iron def anemia

MEDICATION ON ADMISSION: Plavix 75 mg daily, aspirin 81 mg daily, Zocor 20mg daily,
Protonix 40 mg daily, Bumex 1 mg daily, calcitriol 0.25
mg daily, carvedilol 12.5 mg [**Hospital1 **]

ALLERGIES: Morphine Sulfate / Aspirin / Metoprolol / Levaquin

PHYSICAL EXAM: 97.9 97.9 70 120/52 16 97RA
NAD A&Ox3
CTAB
RRR
Abd soft, NTND
Wound cdi

FAMILY HISTORY: AFib, No colon cancer
GF: DM, stroke. Aunts, Uncles with DM. M died at 92. F: died at
72 of a tachycardia

SOCIAL HISTORY: Retired Internist. Lives in a retirement home. Independent
No ETOH/Tob 

### Response:
{'Malignant neoplasm of cecum,Chronic systolic heart failure,Atrial fibrillation,Laparoscopic surgical procedure converted to open procedure,Peritoneal adhesions (postoperative) (postinfection),Chronic kidney disease, unspecified,Renal sclerosis, unspecified,Nonspecific low blood pressure reading,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Iron deficiency anemia, unspecified,Cardiac pacemaker in situ'}
