CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 57-year-old female,
who has a history of progressive abdominal pain due to
pancreatitis secondary to an enlarging cystic lesion in the
body of the pancreas.  The increasing size and radiographic
characteristics of the lesion suggested a cystic neoplasm
rather than a pseudocyst and an endoscopic ultrasound with
FNA biopsies was recently performed, which demonstrated
adenocarcinoma rather than mucinous cystadenoma.  Local nodes
obtained at the time were negative for malignancy, and the
patient therefore presented to this institution for an
elective pancreatectomy.

MEDICAL HISTORY: 1. Hypertension.
2. Pancreatitis.
3. Hypothyroidism.
4. Depression.
5. Hypercholesterolemia.
6. New onset insulin dependent-diabetes mellitus.
7. Pancreatic adenocarcinoma.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Penicillins.
2. Lipitor.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of other specified sites of pancreas,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tachycardia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified
Malig neo pancreas NEC,CHF NOS,Pneumonia, organism NOS,DMII wo cmp nt st uncntr,Tachycardia NOS,Hypertension NOS,Hypothyroidism NOS,Anemia NOS
Admission Date:  [**2176-12-26**]     Discharge Date:  [**2177-1-6**]

Date of Birth:   [**2119-8-3**]     Sex:  F

Service:  General Surgery Gold

HISTORY OF PRESENT ILLNESS:  Patient is a 57-year-old female,
who has a history of progressive abdominal pain due to
pancreatitis secondary to an enlarging cystic lesion in the
body of the pancreas.  The increasing size and radiographic
characteristics of the lesion suggested a cystic neoplasm
rather than a pseudocyst and an endoscopic ultrasound with
FNA biopsies was recently performed, which demonstrated
adenocarcinoma rather than mucinous cystadenoma.  Local nodes
obtained at the time were negative for malignancy, and the
patient therefore presented to this institution for an
elective pancreatectomy.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Pancreatitis.
3. Hypothyroidism.
4. Depression.
5. Hypercholesterolemia.
6. New onset insulin dependent-diabetes mellitus.
7. Pancreatic adenocarcinoma.

PAST SURGICAL HISTORY:
1. Status post cholecystectomy.
2. Status post appendectomy.

MEDICATIONS:
1. Levothyroxine 175 mcg p.o. q.d.
2. Hydrochlorothiazide 12.5 mg p.o. q.d.
3. Verapamil 240 mg p.o. q.d.
4. Lisinopril 20 mg p.o. q.d.
5. Amitriptyline 50 mg p.o. q.h.s.
6. Celexa 50 mg p.o. q.h.s.
7. Lescol 80 mg p.o. q.d.
8. Pancrease four tablets p.o. before meals.
9. Aspirin 81 mg p.o. q.d.
10. Humalog insulin 10 mg subQ q.a.m. and 10 mg subQ q.p.m.
11. NPH insulin 10 units subQ q.p.m.

ALLERGIES:
1. Penicillins.
2. Lipitor.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 99.1, blood
pressure 105/58, pulse 99, respirations 20.  General:
Patient is a mildly obese female, who appears her stated age
and is in no apparent distress.  HEENT:  Anicteric sclerae.
Clear oropharynx.  Moist mucous membranes.  Neck is supple
and nontender with no lymphadenopathy or masses.  Heart:
Regular rate and rhythm.  Lungs are clear to auscultation
bilaterally.  Abdomen:  Soft, obese, nontender, and
nondistended.  No palpable masses.  Rectal:  Normal tone,
fecal occult blood negative.  Extremities:  No cyanosis,
clubbing, or edema.

LABORATORIES:  The preoperative white blood cell count was
7.6 with a hematocrit of 40.6 and a platelet count of
296,000.

HOSPITAL COURSE:  On the date of admission, the patient was
taken to the operating room, where a subtotal pancreatectomy
along with a splenectomy were performed.  The estimated blood
loss for the procedure was approximately 600 cc.  Patient
tolerated this procedure well, and was discharged to the Post
Anesthesia Recovery Room in good condition with a nasogastric
tube, [**Location (un) 1661**]-[**Location (un) 1662**] drain, and a Foley catheter in place.
The patient's pain was controlled in the postoperative period
with an epidural catheter.

Given the patient's recent diagnosis of insulin
dependent-diabetes mellitus, the patient was placed on an
insulin drip in the immediate postoperative period and [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **] Diabetes consult was obtained.  The patient's sugars
remained tightly controlled in the 140s-160 range.  The
postoperative white blood cell count was 23.9, with a
hematocrit of 35.3, and a platelet count of 328,000.

The patient's early postoperative course was complicated by a
low grade temperature to 101.0 F on postoperative day two.
This was attributed to respiratory secretions and poor
pulmonary hygiene.  Her epidural catheter was removed and her
pain was then controlled with a PCA analgesic pump.  She also
was tachycardic to the 120s and was therefore placed on a
diltiazem drip.

On the evening of postoperative day two, the patient
developed respiratory distress with oxygenation in the low
80s and respiratory rate to the 30s.  Upon discussion with
Dr. [**Last Name (STitle) **], it seemed prudent to intubate patient given her
smoking history and her appearance of respiratory fatigue.
The post intubation chest x-ray demonstrated congestive heart
failure which was treated with intravenous diuretics.

On postoperative day three, the patient received 1 unit of
packed red blood cells for a hematocrit of 25.9%.  She also
had an elevated temperature to 101.2 F along with a
leukocytosis which is 28.5.  He was therefore started on
Levaquin prophylactically.  The white blood cell count
subsequently decreased to 18.8.  The left upper quadrant
[**Location (un) 1661**]-[**Location (un) 1662**] drain was removed on postoperative day four.
The insulin drip was weaned off on postoperative day five,
and she was subsequently started on a subcutaneous sliding
scale along with long-acting glargine.

She was started on sips on postoperative day six after being
extubated the evening on postoperative day five.  She was
subsequently advanced to a clear liquid diet on postoperative
day seven.  Given her splenectomy, the patient received a
triple vaccine on this day as well.  She was then transferred
to the floor.

On postoperative day eight, the patient was advanced to a
regular house diet, which she tolerated well and with stable
blood sugars.  She finished up a seven day course of Levaquin
for her presumed pneumonia on postoperative day nine.  Her
second [**Location (un) 1661**]-[**Location (un) 1662**] drain was removed on postoperative day
10, and patient was discharged to home on postoperative day
11 in good condition.

Final pathology from her surgery was read as invasive
pancreatic adenocarcinoma, T3 N0 MX.  The patient was
discharged to home with close followup by the [**Hospital **] [**Hospital 982**]
Clinic, and will be seeing her primary care doctor later in
the week.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  Patient was discharged to home.

DISCHARGE DIAGNOSES:
1. Pancreatic adenocarcinoma.
2. Hypertension.
3. Insulin dependent-diabetes mellitus.
4. History of pancreatitis.
5. Hypercholesterolemia.
6. Depression.
7. Hypothyroidism.
8. Status post subtotal pancreatectomy.
9. Status post splenectomy.

DISCHARGE MEDICATIONS:
1. Verapamil 40 mg p.o. t.i.d.
2. Glyburide 5 mg p.o. q.a.m.
3. Glyburide 2.5 mg p.o. q.p.m.
4. Pancrease four capsules p.o. t.i.d. with meals.
5. Levothyroxine 175 mcg p.o. q.d.
6. Amitriptyline 50 mg p.o. q.h.s.
7. Protonix 40 mg p.o. q.d.
8. Celexa 50 mg p.o. q.h.s.
9. Vicodin 5/500 1-2 tablets p.o. q.4-6h. prn pain.
10. Lisinopril 20 mg p.o. q.d.
11. Aspirin 325 mg p.o. q.d.

FOLLOW-UP PLANS:  The patient was instructed to followup with
Dr. [**Last Name (STitle) **] in approximately two weeks.  She also has an
appointment with the [**Hospital **] [**Hospital 982**] Clinic and will be
seeing her primary care provider at the end of this week.
The patient was instructed to followup sooner if she develops
fevers greater than 101.5 F, vomiting, or severe abdominal
pain.



                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  02.AAG

Dictated By:[**Last Name (NamePattern1) **]

MEDQUIST36

D:  [**2177-1-6**]  17:24
T:  [**2177-1-7**]  09:22
JOB#:  [**Job Number 50333**]
{'Malignant neoplasm of other specified sites of pancreas,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tachycardia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified'}


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: 

PRESENT ILLNESS: Patient is a 57-year-old female,
who has a history of progressive abdominal pain due to
pancreatitis secondary to an enlarging cystic lesion in the
body of the pancreas.  The increasing size and radiographic
characteristics of the lesion suggested a cystic neoplasm
rather than a pseudocyst and an endoscopic ultrasound with
FNA biopsies was recently performed, which demonstrated
adenocarcinoma rather than mucinous cystadenoma.  Local nodes
obtained at the time were negative for malignancy, and the
patient therefore presented to this institution for an
elective pancreatectomy.

MEDICAL HISTORY: 1. Hypertension.
2. Pancreatitis.
3. Hypothyroidism.
4. Depression.
5. Hypercholesterolemia.
6. New onset insulin dependent-diabetes mellitus.
7. Pancreatic adenocarcinoma.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Penicillins.
2. Lipitor.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of other specified sites of pancreas,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tachycardia, unspecified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Anemia, unspecified'}
