CHIEF COMPLAINT: Abdominal pain & weight loss.

PRESENT ILLNESS: This 76-year-old Russian-speaking gentleman recently presented
with chronic abdominal pain which was progressive over the last
2 months. He had lost weight from this. He had a general failure
to thrive over this period time. He was not
yet jaundiced. He was worked up and found to have a pancreatic
head mass. This furthermore was biopsied through endoscopic
means and found to be an adenocarcinoma. He presented to Dr.
[**First Name (STitle) **] from Medical Oncology for consideration of chemotherapy
and radiation therapy given the large size of this mass. Dr.
[**First Name (STitle) **] requested an opinion regarding potential resectability.
Mr. [**Known lastname **] was admitted for surgical intervention, probable
Whipple pancreaticoduodenectomy versus palliative bypass surgery
depending on the resectability of the tumor.

MEDICAL HISTORY: PMHx: Type II DM, HTN, hypercholesterolemia, GERD, BPH, CAD with
h/o MI.
.
PSHx: Vocal cord cancer diagnosed [**2140**] (SCC) s/p surgery,
partial colectomy [**2129**], CAD with h/o MI s/p CABG, s/p appy, s/p
laparoscopic cholecytectomy.

MEDICATION ON ADMISSION: 1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
2. Colace 100mg 1 cap PO BID
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Ativan

PHYSICAL EXAM: [**2147-8-11**] Pre-Admission Physical:
On physical exam, his abdomen is soft, moderately distended, but
nontender.  There is no mass effect to be appreciated.  There is
no evidence of hernias or infections in his incisions, which
include a median sternotomy incision as well as a right
paramedian incision.  His inguinal and genital region shows no
evidence of any masses or any hernias.  His rectal exam was
deferred today.  The remainder of his physical exam is entirely
normal.
.
At Discharge:
VS: AVSS
GEN: Thin male in NAD.
HEENT: Sclerae clear. O-P clear.
NECK: Supple.
LUNGS: CTA(B).
COR: RRR
ABD: Midline incision with steri-strips c/d/i. 2 small areas of
wound breakdown packed with wet-to-dry dressing. No erythema or
induration, no purulence from wound. Prior (R)LQ JP drain
(discontinued) site healing with DSD. Appropriately tender to
palpation along incision, otherwise soft/NT/ND.
GU: Foley d/c'ed prior to discharge and patient voiding without
difficulty. Negative CVAT.
EXTREM: No c/c/e.
NEURO: A+Ox3. Non-focal.

FAMILY HISTORY: Denies CAD or lung cancer.

SOCIAL HISTORY: Primary language is Russian. Lives in [**Location 2312**] with his wife.
[**Name (NI) 3003**] tobacco -100 pack-years. No ETOH. Retired barber in
[**Country 532**].
Malignant neoplasm of head of pancreas,Obstruction of bile duct,Disruption of external operation (surgical) wound,Acquired hypertrophic pyloric stenosis,Peritoneal adhesions (postoperative) (postinfection),Adult failure to thrive,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Old myocardial infarction,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other alteration of consciousness
Mal neo pancreas head,Obstruction of bile duct,Disrup-external op wound,Acq pyloric stenosis,Peritoneal adhesions,Failure to thrive-adult,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,BPH w urinary obs/LUTS,Oth spcf retention urine,Old myocardial infarct,Aortocoronary bypass,Cor ath unsp vsl ntv/gft,Abn react-anastom/graft,Mth sus Stph aur els/NOS,Other alter consciousnes
Admission Date:  [**2147-8-17**]              Discharge Date:   [**2147-8-29**]

Date of Birth:  [**2071-2-2**]             Sex:   M

Service: SURGERY

Allergies:
Ativan

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Abdominal pain & weight loss.

Major Surgical or Invasive Procedure:
[**2147-8-17**]:
1. Exploratory laparotomy.
2. Double bypass consisting of Roux-en-Y
    choledochojejunostomy and gastroenterostomy.
3. Celiac lymph node biopsy for staging.
4. Placement of CyberKnife gold fiducial seeds.
5. Extended adhesiolysis.

History of Present Illness:
This 76-year-old Russian-speaking gentleman recently presented
with chronic abdominal pain which was progressive over the last
2 months. He had lost weight from this. He had a general failure
to thrive over this period time. He was not
yet jaundiced. He was worked up and found to have a pancreatic
head mass. This furthermore was biopsied through endoscopic
means and found to be an adenocarcinoma. He presented to Dr.
[**First Name (STitle) **] from Medical Oncology for consideration of chemotherapy
and radiation therapy given the large size of this mass. Dr.
[**First Name (STitle) **] requested an opinion regarding potential resectability.
Mr. [**Known lastname **] was admitted for surgical intervention, probable
Whipple pancreaticoduodenectomy versus palliative bypass surgery
depending on the resectability of the tumor.

Past Medical History:
PMHx: Type II DM, HTN, hypercholesterolemia, GERD, BPH, CAD with
h/o MI.
.
PSHx: Vocal cord cancer diagnosed [**2140**] (SCC) s/p surgery,
partial colectomy [**2129**], CAD with h/o MI s/p CABG, s/p appy, s/p
laparoscopic cholecytectomy.

Social History:
Primary language is Russian. Lives in [**Location 2312**] with his wife.
[**Name (NI) 3003**] tobacco -100 pack-years. No ETOH. Retired barber in
[**Country 532**].


Family History:
Denies CAD or lung cancer.

Physical Exam:
[**2147-8-11**] Pre-Admission Physical:
On physical exam, his abdomen is soft, moderately distended, but
nontender.  There is no mass effect to be appreciated.  There is
no evidence of hernias or infections in his incisions, which
include a median sternotomy incision as well as a right
paramedian incision.  His inguinal and genital region shows no
evidence of any masses or any hernias.  His rectal exam was
deferred today.  The remainder of his physical exam is entirely
normal.
.
At Discharge:
VS: AVSS
GEN: Thin male in NAD.
HEENT: Sclerae clear. O-P clear.
NECK: Supple.
LUNGS: CTA(B).
COR: RRR
ABD: Midline incision with steri-strips c/d/i. 2 small areas of
wound breakdown packed with wet-to-dry dressing. No erythema or
induration, no purulence from wound. Prior (R)LQ JP drain
(discontinued) site healing with DSD. Appropriately tender to
palpation along incision, otherwise soft/NT/ND.
GU: Foley d/c'ed prior to discharge and patient voiding without
difficulty. Negative CVAT.
EXTREM: No c/c/e.
NEURO: A+Ox3. Non-focal.

Pertinent Results:
On Admission:

[**2147-8-17**] 04:24PM   POTASSIUM-4.1
[**2147-8-17**] 04:24PM   CK(CPK)-103
[**2147-8-17**] 04:24PM   CK-MB-4 cTropnT-<0.01
[**2147-8-17**] 04:24PM   MAGNESIUM-1.6
[**2147-8-17**] 04:24PM   HCT-35.2*
[**2147-8-17**] 12:39PM   TYPE-ART PO2-268* PCO2-48* PH-7.34* TOTAL
CO2-27 BASE XS-0
[**2147-8-17**] 12:39PM   GLUCOSE-148* LACTATE-0.8 NA+-137 K+-3.8
CL--101
[**2147-8-17**] 12:39PM   HGB-12.1* calcHCT-36
[**2147-8-17**] 12:39PM   freeCa-1.15
.
Prior to Discharge:

[**2147-8-21**] 11:09AM BLOOD WBC-8.4 RBC-3.36* Hgb-10.4* Hct-30.3*
MCV-90 MCH-30.8 MCHC-34.2 RDW-13.4 Plt Ct-193
[**2147-8-21**] 11:09AM BLOOD Plt Ct-193
[**2147-8-21**] 11:09AM BLOOD Glucose-112* UreaN-8 Creat-0.7 Na-138
K-4.0 Cl-102 HCO3-30 AnGap-10
[**2147-8-18**] 04:07AM BLOOD CK(CPK)-484*
[**2147-8-21**] 10:16PM BLOOD Calcium-7.7* Phos-3.5# Mg-1.9
.
[**2147-8-17**] Pathology:
SPECIMEN SUBMITTED: NODE OF IMPORTANCE.
DIAGNOSIS: Metastatic mucin-producing adenocarcinoma involving
lymph node and fibroadipose tissue, consistent with
pancreatico-biliary origin.

Clinical:  Pancreatic cancer, node of importance.
Gross:

The specimen is received fresh from the OR for frozen section
diagnosis labeled with the patient's name, "[**Known lastname **], [**Known firstname 95696**]" the
medical record number and additionally "node of importance."
The diagnosis per Dr. [**Last Name (STitle) **] is " Adenocarcinoma; no lymph nodal
tissue clearly identified".  The specimen consists of piece of
fatty tissue measuring 3 x 2 x 1 cm.  Upon examining it for
lymph nodes, two have been identified.  One lymph node is
separate from the rest of the specimen and will be designated
lymph node 1.  The other lymph node is attached to the fatty
tissue and will be designated lymph node 2.   Both lymph nodes
are represented on the frozen section.  The specimen is entirely
submitted as follows:  A = frozen section remnant containing
lymph nodes 1 and 2, B = remainder of lymph node 1, C-E =
remaining fatty tissue.
.
[**2147-8-17**] ECG:
Sinus rhythm. Non-diagnostic inferior Q waves. Diffuse ST-T
waves. Compared to the previous tracing of [**2147-8-11**] ST-T wave
changes are new.
  Intervals Axes:
Rate PR QRS QT/QTc P QRS T
80 124 88 [**Telephone/Fax (3) 95697**]1 147
.
[**2147-8-17**] CXR:
IMPRESSION: No acute cardiopulmonary process.
[**2147-8-26**] CXR:
Impression: mild [**Hospital1 **]-basilar atelectasis

Brief Hospital Course:
The patient was admitted to the General Surgical Service for
evaluation of the aforementioned problem.  On [**2147-8-17**], the
patient underwent exploratory laparotomy, double bypass
consisting of Roux-en-Y, choledochojejunostomy and
gastroenterostomy, celiac lymph node biopsy for staging,
placement of CyberKnife gold fiducial seeds, extended
adhesiolysis, which went well without complication (reader
referred to the Operative Note for details). In the PACU, the
patient experienced tachycardia, low urine output, and
hypotesion, for which he received a total of 1 liter in fluid
boluses and albumin with good response. Cardiac enzymes were
negative. EKG without ectopy or arrythmia. Later, the patient
was transferred to the floor NPO with an NG tube, on IV fluids,
with a foley catheter and a JP drain in place. He received a
single dose of intra-thecal morphine prior to surgery with good
pain control on POD#0. The patient was hemodynamically stable.
.
Post-operative pain was initially well controlled with the
intra-thecal morphine on POD#0 and then a Dilaudid PCA
thereafter, which was converted to oral pain medication when
tolerating clear liquids. The NG tube and foley catheter were
discontinued on POD#4. Unfortunately, the patient was unable to
void and the foley catheter was replaced. The patient has a
history of BPH. Home dose of Flomax was restarted. On POD#6, the
foley was again discontinued, again the patient was unable to
void, and the foley was replaced. Urology was consulted. As per
their recommendations, the foley was maintained in place until
POD 11, when the patient was again having urinary tract pain. A
U/A was sent and negative for infection and at the patient's
request the catheter again d/c'ed for a voiding trial. He was
again unable to pass urine and the catheter re-inserted, he was
sent home on his BPH meds with urology follow up as an
outpatient. The patient was started on sips of clears on POD#5,
which was progressively advanced as tolerated to a regular diet
by POD#6. The JP was discontinued on POD#7.
.
During this hospitalization, the patient ambulated early and
frequently, was adherent with respiratory toilet and incentive
spirrometry, and actively participated in the plan of care. The
patient received subcutaneous heparin and venodyne boots were
used during this stay. The patient's blood sugar was monitored
regularly throughout the stay; sliding scale insulin was
administered when indicated. When tolerating clears, he was
restarted on his home hypoglycemic medications, with the
exception of Januvia, which is not formulary.
.
Overnight on POD#3, the patient became agitated and exhibited
sundowning behavior. His experienced similar symptoms for the
next few nights. The Psychiatric Clinical Nurse Specialist and
Socail Worker were consulted. He received Haldol PRN and
re-orientation. As his recovery progressed, this behavior
improved.
.
On POD 7 the patient was noted to have 2 small areas of wound
breakdown around the incision line, in these areas the staples
were removed and small pieces of saline soaked gauze was used to
pack them sterily. A wound culture grew MSSA and he was started
on levoquin. The areas were packed for the remainder of his stay
and he was discharged on 5 days of levoquin with VNA for wet-to
dry packing changes.
.
At the time of discharge on POD 12, the patient was doing well,
afebrile with stable vital signs.  The patient was tolerating a
regular diet, although with poor appetite, ambulating, and pain
was well controlled. The foley catheter was in place and patent.
He was discharged to an extended care facility. The patient
received discharge teaching and follow-up instructions with
understanding verbalized and agreement with the discharge plan.

Medications on Admission:
1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
2. Colace 100mg 1 cap PO BID
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Januvia 100 mg Tablet Sig: One (1) Tablet PO once a day.
12. ASA 81mg 1 tab PO daily
13. Nitroglygerin 0.4mg SL Q15minutes x3 PRN for chest pain
14. Insulin Regular Human 100 unit/mL Solution Sig: 2-12 units
Injection As directed per Regular Insulin SlidingScale.

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for fever or pain.
2. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
10. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Ipratropium Bromide 0.02 % Solution Sig: One (1) puff
Inhalation Q6H (every 6 hours) as needed for SOB/cough/wheeze.
13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain: Rx in Russian please.
Disp:*50 Tablet(s)* Refills:*0*
14. Januvia 100 mg Tablet Sig: One (1) Tablet PO once a day.
15. Insulin Regular Human 100 unit/mL Solution Sig: 2-12 units
Injection As directed per Regular Insulin SlidingScale.
16. Dronabinol 2.5 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) for 2 weeks.
Disp:*42 Capsule(s)* Refills:*0*
17. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] house

Discharge Diagnosis:
1. Pancreatic cancer.
2. Obstruction of the bile duct.
3. Gastric outlet obstruction.
4. Dense intraoperative adhesions.
5. Urinary retention
6. Type II DM


Discharge Condition:
Good


Discharge Instructions:
Please call your doctor or nurse practitioner or return to the
Emergency  Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down 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.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours.  Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
You will be discharged with a foley catheter in place and a leg
bag - you were instructed in its use by nursing staff - you will
follow up with urology as an outpatient in [**11-18**] weeks. Please
call their office for an appointment.

Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**3-26**] lbs until you follow-up with your
surgeon.

Avoid driving or operating heavy machinery while taking pain
medications.

Incision Care:
- You will have wet-to-dry packing changes of the incision site
on your abdomen, as have been done in the hospital. A visiting
nurse will help you with this. It is important to keep this area
clean and change the dressing 2x/day.
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD (Surgery). Phone: ([**Telephone/Fax (1) 2828**].
Date/Time: [**2147-9-8**] at 9:15am. Location: [**Hospital Ward Name 23**] 3, [**Hospital Ward Name 516**].
.
You will need to follow up with Urology as an outpatient at
8:45am [**9-6**], this is with Dr [**Last Name (STitle) 986**]. This is located on
[**Hospital Ward Name 23**] 3 on the [**Hospital Ward Name **].
.
You have an appointment with Radiation oncology  at 9:30am on
[**8-31**] (THURSDAY). This is in the [**Hospital Ward Name 516**] [**Hospital Ward Name **]
building at [**Location (un) **] in the basement. You can call
[**Telephone/Fax (1) 9710**] with any questions.
.
Please call ([**Telephone/Fax (1) 1921**] to arrange a follow-up appointment
with Dr. [**Last Name (STitle) 13959**] (PCP) in [**12-20**] weeks.
.
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2147-9-13**]
9:00



Completed by:[**2147-8-29**]
{'Malignant neoplasm of head of pancreas,Obstruction of bile duct,Disruption of external operation (surgical) wound,Acquired hypertrophic pyloric stenosis,Peritoneal adhesions (postoperative) (postinfection),Adult failure to thrive,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Old myocardial infarction,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other alteration of consciousness'}


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: Abdominal pain & weight loss.

PRESENT ILLNESS: This 76-year-old Russian-speaking gentleman recently presented
with chronic abdominal pain which was progressive over the last
2 months. He had lost weight from this. He had a general failure
to thrive over this period time. He was not
yet jaundiced. He was worked up and found to have a pancreatic
head mass. This furthermore was biopsied through endoscopic
means and found to be an adenocarcinoma. He presented to Dr.
[**First Name (STitle) **] from Medical Oncology for consideration of chemotherapy
and radiation therapy given the large size of this mass. Dr.
[**First Name (STitle) **] requested an opinion regarding potential resectability.
Mr. [**Known lastname **] was admitted for surgical intervention, probable
Whipple pancreaticoduodenectomy versus palliative bypass surgery
depending on the resectability of the tumor.

MEDICAL HISTORY: PMHx: Type II DM, HTN, hypercholesterolemia, GERD, BPH, CAD with
h/o MI.
.
PSHx: Vocal cord cancer diagnosed [**2140**] (SCC) s/p surgery,
partial colectomy [**2129**], CAD with h/o MI s/p CABG, s/p appy, s/p
laparoscopic cholecytectomy.

MEDICATION ON ADMISSION: 1. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
2. Colace 100mg 1 cap PO BID
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Ativan

PHYSICAL EXAM: [**2147-8-11**] Pre-Admission Physical:
On physical exam, his abdomen is soft, moderately distended, but
nontender.  There is no mass effect to be appreciated.  There is
no evidence of hernias or infections in his incisions, which
include a median sternotomy incision as well as a right
paramedian incision.  His inguinal and genital region shows no
evidence of any masses or any hernias.  His rectal exam was
deferred today.  The remainder of his physical exam is entirely
normal.
.
At Discharge:
VS: AVSS
GEN: Thin male in NAD.
HEENT: Sclerae clear. O-P clear.
NECK: Supple.
LUNGS: CTA(B).
COR: RRR
ABD: Midline incision with steri-strips c/d/i. 2 small areas of
wound breakdown packed with wet-to-dry dressing. No erythema or
induration, no purulence from wound. Prior (R)LQ JP drain
(discontinued) site healing with DSD. Appropriately tender to
palpation along incision, otherwise soft/NT/ND.
GU: Foley d/c'ed prior to discharge and patient voiding without
difficulty. Negative CVAT.
EXTREM: No c/c/e.
NEURO: A+Ox3. Non-focal.

FAMILY HISTORY: Denies CAD or lung cancer.

SOCIAL HISTORY: Primary language is Russian. Lives in [**Location 2312**] with his wife.
[**Name (NI) 3003**] tobacco -100 pack-years. No ETOH. Retired barber in
[**Country 532**]. 

### Response:
{'Malignant neoplasm of head of pancreas,Obstruction of bile duct,Disruption of external operation (surgical) wound,Acquired hypertrophic pyloric stenosis,Peritoneal adhesions (postoperative) (postinfection),Adult failure to thrive,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Other specified retention of urine,Old myocardial infarction,Aortocoronary bypass status,Coronary atherosclerosis of unspecified type of vessel, native or graft,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other alteration of consciousness'}
