CHIEF COMPLAINT: Abdominal pain, bloating.

PRESENT ILLNESS: Ms. [**Known lastname 19314**] is a 76 year-old female with metastatic breast
cancer on Femara and Megace, with a known duodenal mass followed
with serial CT scans status post non-diagnostic endoscopic
biopsy in [**2155**], who presents with a 5-day history of worsening
abdominal pain and bloating.
*
She describes vague abdominal discomfort worsening over the past
few days. She also describes associated bloating, and mild
nausea now resolved. She denies emesis, no change in bowel
habits. She has been able to eat over the past few days, albeit
with somewhat decreased appetite. No complaint of early satiety,
but overall mild anorexia. No fever or chills at home. She notes
some weight gain over the past few months, attributed to Megace
therapy. Of note, she was recently admitted for breast
cellulitis, resolved on Clindamycin therapy.
*
In ED, T 99.3, HR 91, BP 148/62, RR 18, Sat 95% on RA. CT scan
was remarkable for increase in duodenal mass, with ? hemorrhage.
She was seen by surgery, with impression of GIST with hemorragic
transformation versus metastatic breast cancer.

MEDICAL HISTORY: 1. Metastatic breast cancer.
- Infiltrating mucinous carcinoma ER positive, HER2/neu
negative, no lymphatic invasion, status post lumpectomy in [**2136**]
(right breast) and XRT.
- Status post lumpectomy in [**2154**] (left breast) and XRT.
- Metastatic disease diagnosed in [**2157**], placed on Femara and
Megace.
2. Duodenal mass, status post non-diagnostic endoscopic biopsy
in [**2155**], followed with serial CT scans. Slow increase in size
over the years.
3. Meningioma, status post excision X2
4. Dural AV fistula, status post coiling and multiple
embolizations.
5. Mild chronic renal insufficiency
6. Status post cholecystectomy in [**2155**]
7. Status post TAH/BSO
8. History of seizure disorder
9. History of HIT
10. Paget's disease.

MEDICATION ON ADMISSION: Femara 2.5 mg PO QD
Megace 40 mg PO BID
Lasix 20 mg PO BID
Calcium
MVI daily
Ambien 5 mg PO QHS:PRN

ALLERGIES: Codeine / Heparin Agents / Ciprofloxacin / Keflex / Ranitidine /
Gadolinium-Containing Agents / Amoxicillin / Vancomycin And
Derivatives / Dilantin / Iodine; Iodine Containing / Clindamycin

PHYSICAL EXAM: (at admission)
VITALS: Tm 99.3, HR 86, BP 143/56, RR 24, Sat 96% on RA.
GEN: Obese Caucasian female, in NAD.
HEENT: Anicteric. MMM.
NECK: JVP does not appear elevated.
RESP: CTAB, with few bibasilar crackles.
CVS: RRR. Normal S1, S2, No S3, S4.
GI: Obese abdomen. BS present. Fullness in epigastrium, with
mild diffuse tenderness, without rebound or guarding.
DRE: Performed by ED resident, stools g-.
EXT: Trace edema

FAMILY HISTORY: -Father (d 60yo) - lung cancer, smoker, ?stroke
-Mother (d [**Age over 90 **]yo) - unclear etiology of death
-No other history of cancer; no FHx of diabetes, HTN, seizures

SOCIAL HISTORY: Lives with her husband at home. Has no VNA but is interested in
home PT. Children and grandchildren live nearby.Ex-smoker, she
quit >20 years ago. No EtOH.
Neoplasm of uncertain behavior of stomach, intestines, and rectum,Malignant neoplasm of liver, secondary,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Personal history of malignant neoplasm of breast,Osteitis deformans without mention of bone tumor
Unc behav neo intestine,Second malig neo liver,Chronic kidney dis NOS,Urin tract infection NOS,Hx of breast malignancy,Osteitis deformans NOS
Admission Date:  [**2159-12-16**]              Discharge Date:   [**2159-12-26**]

Date of Birth:  [**2083-8-18**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Heparin Agents / Ciprofloxacin / Keflex / Ranitidine /
Gadolinium-Containing Agents / Amoxicillin / Vancomycin And
Derivatives / Dilantin / Iodine; Iodine Containing / Clindamycin

Attending:[**First Name3 (LF) 6195**]
Chief Complaint:
Abdominal pain, bloating.

Major Surgical or Invasive Procedure:
EGD with biopsy of duodenal mass
CT guided biopsy of duodenal mass


History of Present Illness:
Ms. [**Known lastname 19314**] is a 76 year-old female with metastatic breast
cancer on Femara and Megace, with a known duodenal mass followed
with serial CT scans status post non-diagnostic endoscopic
biopsy in [**2155**], who presents with a 5-day history of worsening
abdominal pain and bloating.
*
She describes vague abdominal discomfort worsening over the past
few days. She also describes associated bloating, and mild
nausea now resolved. She denies emesis, no change in bowel
habits. She has been able to eat over the past few days, albeit
with somewhat decreased appetite. No complaint of early satiety,
but overall mild anorexia. No fever or chills at home. She notes
some weight gain over the past few months, attributed to Megace
therapy. Of note, she was recently admitted for breast
cellulitis, resolved on Clindamycin therapy.
*
In ED, T 99.3, HR 91, BP 148/62, RR 18, Sat 95% on RA. CT scan
was remarkable for increase in duodenal mass, with ? hemorrhage.
She was seen by surgery, with impression of GIST with hemorragic
transformation versus metastatic breast cancer.


Past Medical History:
1. Metastatic breast cancer.
- Infiltrating mucinous carcinoma ER positive, HER2/neu
negative, no lymphatic invasion, status post lumpectomy in [**2136**]
(right breast) and XRT.
- Status post lumpectomy in [**2154**] (left breast) and XRT.
- Metastatic disease diagnosed in [**2157**], placed on Femara and
Megace.
2. Duodenal mass, status post non-diagnostic endoscopic biopsy
in [**2155**], followed with serial CT scans. Slow increase in size
over the years.
3. Meningioma, status post excision X2
4. Dural AV fistula, status post coiling and multiple
embolizations.
5. Mild chronic renal insufficiency
6. Status post cholecystectomy in [**2155**]
7. Status post TAH/BSO
8. History of seizure disorder
9. History of HIT
10. Paget's disease.


Social History:
Lives with her husband at home. Has no VNA but is interested in
home PT. Children and grandchildren live nearby.Ex-smoker, she
quit >20 years ago. No EtOH.


Family History:
-Father (d 60yo) - lung cancer, smoker, ?stroke
-Mother (d [**Age over 90 **]yo) - unclear etiology of death
-No other history of cancer; no FHx of diabetes, HTN, seizures

Physical Exam:
(at admission)
VITALS: Tm 99.3, HR 86, BP 143/56, RR 24, Sat 96% on RA.
GEN: Obese Caucasian female, in NAD.
HEENT: Anicteric. MMM.
NECK: JVP does not appear elevated.
RESP: CTAB, with few bibasilar crackles.
CVS: RRR. Normal S1, S2, No S3, S4.
GI: Obese abdomen. BS present. Fullness in epigastrium, with
mild diffuse tenderness, without rebound or guarding.
DRE: Performed by ED resident, stools g-.
EXT: Trace edema

(upon transfer to Medicine service [**12-21**])
97.9   80-118   102-135/56-83   RR 15-40  1605/700
Gen: lying in bed, pleasant, optimistic, somewhat tachypneic
iwth talking
HEENT: no LAD, MMM, NCAT
Cor: s1s2, I/VI systolic murmur heard best at LUSB nonradiating
Pulm: CTA R, mild wheeze on L [**12-3**] way up from base
Abd: distended, high pitched BS, tender to palpation
Ext: no c/c/e
skin: no rash

Pertinent Results:
admission labs:

GLUCOSE-119* UREA N-19 CREAT-1.1 SODIUM-137 POTASSIUM-4.0
CHLORIDE-101 TOTAL CO2-22
ALT(SGPT)-38 AST(SGOT)-39 ALK PHOS-221* AMYLASE-97 TOT BILI-0.9
LIPASE-140* ALBUMIN-3.8

WBC-10.1 RBC-3.76* HGB-11.6* HCT-32.8* MCV-87 MCH-30.8
MCHC-35.3* RDW-16.0*  PLT COUNT-350#
  - NEUTS-70.9* LYMPHS-20.8 MONOS-4.4 EOS-3.7 BASOS-0.2

UA: WBC 371, neg nitrites, mod leuks. mod bact.
U cx: contaminated

[**2159-12-16**] CT ABD: 1. Large mass arising from the third portion of
the duodenum with cystic and solid components has increased in
size since the prior exam. In addition, there is new stranding
around the mass and stranding extending into the paracolic
gutters bilaterally, right greater than left. The appearance is
suspicious for new hemorrhage into the mass. Edema is also a
possibility, though less likely. 2.  Extensive metastatic
disease within the liver, which appears to be worsened compared
to the prior exam. Comparison is limited, however, given the
lack of IV contrast. 3.  Coronary artery calcifications. 4.  [**1-4**]
mm right lower lobe nodule.

[**12-18**] CXR: Persistent elevation of the right hemidiaphragm, with
retrocardiac atelectasis vs. early pneumonia.

[**12-18**] ECHO: The left atrium is mildly dilated. Left ventricular
wall thickness, cavity size, and systolic function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Right ventricular chamber size and free wall motion are  normal.
The ascending aorta is mildly dilated. The aortic valve leaflets
 appear structurally normal with good leaflet excursion. No
aortic  regurgitation is seen. The mitral valve appears
structurally normal with  trivial mitral regurgitation. There is
no mitral valve prolapse. The estimated  pulmonary artery
systolic pressure is normal. There is no pericardial  effusion.


EGD biopsy of submucosal duodenal mass: nondiagnostic

CT-guided bx: nondiagnostic, blood only

Brief Hospital Course:
Ms. [**Known lastname 19314**] is a 76 year-old female with metastatic breast
cancer treated with Femara and Megace, with known duodenal and
liver masses, who presented with abdominal pain/bloating, and CT
showed increased size of duodenal mass with hemorrhagic
appearance.  On hospital day two she had new onset more severe
abdominal pain and was admitted to the surgical service, however
pain resolved, and she was not deemed to have a surgical
abdomen.  EGD was undertaken to perform biopsy of the submucosal
duodenal mass, which was nondiagnostic.  We then performed
CT-guided biopsy of the mass, the result of which was pending
when the patient was discharged but has since returned
nondiagnostic and blood only.  DIfferential diagnosis includes
gastrointestinal stromal tumor, metastatic breast cancer, versus
other malignancy.

Ms. [**Known lastname 19323**] hematocrit was stable throughout her hospital
stay.  Her abdominal pain was well controlled with 5-10 mg of
liquid oxycodone every 6 hours.  She was found to have
increasing edema and shortness of breath responsive to lasix
with oxygen saturations in the low 90s on room air.  She was
believed to be retianing water secondary to her megace, which
was subsequently discontinued.  She was maintained on lasix 40mg
PO qam and 20mg qafternoon.  Towards the end of her stay her
subjective dyspnea did not correlate to any decrease in oxygen
saturation and her ambulatory sat was consistently 94%.

On the last day of hospitalization the patient complained of
dysuria. UA was consistent with UTI, and the patient was
discharged with 5 days of Bactrim therapy. Urine culture was
pending at the time of discharge but has since returned
consistent with contamination.

We avoided heparin products given the patient's history of HIT
and kept the patient on pneumoboots.  She ate a regular low salt
diet throughout her stay.  We kept her on a bowel regimen given
her narcotics, and she frequently required bisacodyl
suppositories.

The patient was discharged to home with outpatient follow up
with Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 19324**].  She will continue femara as
well as her other medications and will stop megace.

Medications on Admission:
Femara 2.5 mg PO QD
Megace 40 mg PO BID
Lasix 20 mg PO BID
Calcium
MVI daily
Ambien 5 mg PO QHS:PRN


Discharge Medications:
1. Oxycodone 5 mg/5 mL Solution Sig: [**12-3**] teaspoons (5-10mL) PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*500 mL* Refills:*0*
2. Letrozole 2.5 mg Tablet Sig: One (1) Tablet PO qd () as
needed for breast CA.
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
Disp:*30 Tablet(s)* Refills:*2*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
once a day as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
9. Multivitamin     Capsule Sig: One (1) Capsule PO once a day.

10. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
primary:
metastatic breast cancer
duodenal mass
liver masses
UTI


Discharge Condition:
stable. O2 sat 93% RA. resting sat 95% RA. pain well controlled
with oxycodone. Has UTI.


Discharge Instructions:
Please take your medications as directed.

1. Please STOP taking your megace.

2. Please take your antibiotic for urine infection one pill
twice per day for the next 5 days.

3. Please continue your other medications, as well as Lasix 40mg
in the morning and 20mg after lunch time, and oxycodone every
4-6 hours when needed for pain.

4. Please use colace (docusate) twice per day to prevent
constipation and bisacodyl suppositories daily when needed for
constipation.

Please go to your follow up appointment with Dr. [**First Name (STitle) **] on
[**1-17**] at 10:20am.

Please call Dr. [**Last Name (STitle) 19324**] for a follow up appointment and for
your biopsy results in the next two weeks. [**Telephone/Fax (1) 19325**]

If you have increased abdominal pain, fever over 100.5, chills
or other concerning symptoms please call Dr. [**First Name (STitle) **] or come to
the emergency department.

Followup Instructions:
1.Please call Dr. [**Last Name (STitle) 19324**] for a follow up appointment in the
next 2 weeks. [**Telephone/Fax (1) 19325**]

2. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2160-1-17**] 10:20


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6198**] MD, [**MD Number(3) 6199**]

Completed by:[**2159-12-28**]
{'Neoplasm of uncertain behavior of stomach, intestines, and rectum,Malignant neoplasm of liver, secondary,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Personal history of malignant neoplasm of breast,Osteitis deformans without mention of bone tumor'}


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, bloating.

PRESENT ILLNESS: Ms. [**Known lastname 19314**] is a 76 year-old female with metastatic breast
cancer on Femara and Megace, with a known duodenal mass followed
with serial CT scans status post non-diagnostic endoscopic
biopsy in [**2155**], who presents with a 5-day history of worsening
abdominal pain and bloating.
*
She describes vague abdominal discomfort worsening over the past
few days. She also describes associated bloating, and mild
nausea now resolved. She denies emesis, no change in bowel
habits. She has been able to eat over the past few days, albeit
with somewhat decreased appetite. No complaint of early satiety,
but overall mild anorexia. No fever or chills at home. She notes
some weight gain over the past few months, attributed to Megace
therapy. Of note, she was recently admitted for breast
cellulitis, resolved on Clindamycin therapy.
*
In ED, T 99.3, HR 91, BP 148/62, RR 18, Sat 95% on RA. CT scan
was remarkable for increase in duodenal mass, with ? hemorrhage.
She was seen by surgery, with impression of GIST with hemorragic
transformation versus metastatic breast cancer.

MEDICAL HISTORY: 1. Metastatic breast cancer.
- Infiltrating mucinous carcinoma ER positive, HER2/neu
negative, no lymphatic invasion, status post lumpectomy in [**2136**]
(right breast) and XRT.
- Status post lumpectomy in [**2154**] (left breast) and XRT.
- Metastatic disease diagnosed in [**2157**], placed on Femara and
Megace.
2. Duodenal mass, status post non-diagnostic endoscopic biopsy
in [**2155**], followed with serial CT scans. Slow increase in size
over the years.
3. Meningioma, status post excision X2
4. Dural AV fistula, status post coiling and multiple
embolizations.
5. Mild chronic renal insufficiency
6. Status post cholecystectomy in [**2155**]
7. Status post TAH/BSO
8. History of seizure disorder
9. History of HIT
10. Paget's disease.

MEDICATION ON ADMISSION: Femara 2.5 mg PO QD
Megace 40 mg PO BID
Lasix 20 mg PO BID
Calcium
MVI daily
Ambien 5 mg PO QHS:PRN

ALLERGIES: Codeine / Heparin Agents / Ciprofloxacin / Keflex / Ranitidine /
Gadolinium-Containing Agents / Amoxicillin / Vancomycin And
Derivatives / Dilantin / Iodine; Iodine Containing / Clindamycin

PHYSICAL EXAM: (at admission)
VITALS: Tm 99.3, HR 86, BP 143/56, RR 24, Sat 96% on RA.
GEN: Obese Caucasian female, in NAD.
HEENT: Anicteric. MMM.
NECK: JVP does not appear elevated.
RESP: CTAB, with few bibasilar crackles.
CVS: RRR. Normal S1, S2, No S3, S4.
GI: Obese abdomen. BS present. Fullness in epigastrium, with
mild diffuse tenderness, without rebound or guarding.
DRE: Performed by ED resident, stools g-.
EXT: Trace edema

FAMILY HISTORY: -Father (d 60yo) - lung cancer, smoker, ?stroke
-Mother (d [**Age over 90 **]yo) - unclear etiology of death
-No other history of cancer; no FHx of diabetes, HTN, seizures

SOCIAL HISTORY: Lives with her husband at home. Has no VNA but is interested in
home PT. Children and grandchildren live nearby.Ex-smoker, she
quit >20 years ago. No EtOH. 

### Response:
{'Neoplasm of uncertain behavior of stomach, intestines, and rectum,Malignant neoplasm of liver, secondary,Chronic kidney disease, unspecified,Urinary tract infection, site not specified,Personal history of malignant neoplasm of breast,Osteitis deformans without mention of bone tumor'}
