CHIEF COMPLAINT: pelvic mass

PRESENT ILLNESS: 55-year-old G2P0 with bilateral ovarian masses noted on CT
measuring 6-7 cm with densities within the anterior mesentery
and omentum (~2 cm).  Pt reports mild symptoms of pelvic
pressure, pain and bloating for several months.

MEDICAL HISTORY: MEDICAL HISTORY:  Mitral valve prolapse, reentry
supraventricular tachycardia (very infrequent epidsodes).
Stress echo two weeks ago was good per patient report.

MEDICATION ON ADMISSION: calcium

ALLERGIES: Bactrim

PHYSICAL EXAM: GENERAL:  Well nourished, well developed, in no acute distress.
HEENT:  Anicteric sclerae.
NECK:  No thyromegaly.
LYMPH NODES:  Complete lymph node exam negative.
CARDIOVASCULAR:  Regular rate and rhythm.
RESPIRATORY:  Clear to auscultation.
BREASTS:  No skin or soft tissue abnormalities noted.
ABDOMEN:  Soft with tenderness in the lower abdomen.  No rebound
or guarding.
EXTREMITIES:  No edema.
GENITOURINARY:  Complete rectovaginal exam significant for
adnexal masses appreciated by Dr. [**First Name (STitle) 1022**].

FAMILY HISTORY: Father died at 68 years of age with pancreatic cancer.

SOCIAL HISTORY: Recently married, works as a social worker, does not smoke,
drinks one glass of wine each day.
Malignant neoplasm of ovary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of genital organs,Paralytic ileus,Other iatrogenic hypotension,Other specified cardiac dysrhythmias
Malign neopl ovary,Mal neo lymph intra-abd,Sec mal neo peritoneum,Second malig neo genital,Paralytic ileus,Iatrogenc hypotnsion NEC,Cardiac dysrhythmias NEC
Admission Date:  [**2143-6-25**]              Discharge Date:   [**2143-7-3**]

Date of Birth:  [**2088-4-5**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Bactrim

Attending:[**First Name3 (LF) 7141**]
Chief Complaint:
pelvic mass

Major Surgical or Invasive Procedure:
[**2143-6-25**] Radical hysterectomy, BSO, lower anterior resection of
rectum with anastomosis, infracolic omentectomy, collection of
ascites, and pelvic and paraaortic lymphadenectomy for presumed
ovarian CA

History of Present Illness:
55-year-old G2P0 with bilateral ovarian masses noted on CT
measuring 6-7 cm with densities within the anterior mesentery
and omentum (~2 cm).  Pt reports mild symptoms of pelvic
pressure, pain and bloating for several months.

Past Medical History:
MEDICAL HISTORY:  Mitral valve prolapse, reentry
supraventricular tachycardia (very infrequent epidsodes).
Stress echo two weeks ago was good per patient report.

SURGICAL HISTORY:  Tonsillectomy, pilonidal cyst excision,
breast
biopsy which was benign.

GYN HISTORY:  Normal Paps, normal mammograms.  Last menstrual
period one week ago, normal.  Benign breast lump.

OB HISTORY:  SAB times two.


Social History:
Recently married, works as a social worker, does not smoke,
drinks one glass of wine each day.

Family History:
Father died at 68 years of age with pancreatic cancer.

Physical Exam:
GENERAL:  Well nourished, well developed, in no acute distress.
HEENT:  Anicteric sclerae.
NECK:  No thyromegaly.
LYMPH NODES:  Complete lymph node exam negative.
CARDIOVASCULAR:  Regular rate and rhythm.
RESPIRATORY:  Clear to auscultation.
BREASTS:  No skin or soft tissue abnormalities noted.
ABDOMEN:  Soft with tenderness in the lower abdomen.  No rebound
or guarding.
EXTREMITIES:  No edema.
GENITOURINARY:  Complete rectovaginal exam significant for
adnexal masses appreciated by Dr. [**First Name (STitle) 1022**].


Pertinent Results:
preliminary pathology: Stage IIIC ovarian CA involving bilateral
ovaries, uterus, rectum, lymphnodes (peri-aortic & pelvic), and
omentum.  Predominantly papillary serous with clear cell and
carcinosarcoma components.

[**2143-7-3**] 08:50AM BLOOD WBC-4.5 RBC-3.45* Hgb-10.7* Hct-31.3*
MCV-91 MCH-31.0 MCHC-34.1 RDW-12.5 Plt Ct-397

[**2143-6-26**] 03:22AM BLOOD CA125-251*

Brief Hospital Course:
Pt was admitted for debulking surgery for presumed ovarian CA -
please see op note for full details.

Her postoperative course was as follows by system.

1. SICU admission: pt was observed in the ICU on POD#0 to POD#1.
 She was initially hypotensive with a MAP of approximately 60.
Hct was stable and there were no other signs of postoperative
bleeding.  The hypotension was most likely secondary to
epidural.  This resolved by POD#1.

2. GI:  Given rectal anastomosis, pt was NPO until flatus.  Her
diet was advanced slowly starting on POD#5.  She was tolerating
pos well without nausea/vomiting at the time of discharge.

3. PAIN:  Postoperative pain was initially controlled with
epidural/PCA as per acute pain service recommendation given
extensive surgery.  She was transitioned to oral pain medication
when tolerating adequate pos.

4. ONC: ovarian CA.  Pt was counseled on prognosis and aggresive
histology.  She was presented at tumor board prior to discharge
and recommendations were discussed with her (see prior OMR note
for summary of recommendations).  Pt was referred to Dr.
[**Last Name (STitle) **] (MedOnc) for chemotherapy.

Medications on Admission:
calcium

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
2. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Stage IIIC Ovarian CA

Discharge Condition:
stable, tolerating pos, ambulating, voiding, and good pain
control

Discharge Instructions:
Call your doctor [**First Name (Titles) **] [**Last Name (Titles) **] > 100.5, inability to keep down food,
severe nausea/vomiting, draining from your incision or anything
that concerns you.  Do not drive for the next 2 wks, while
taking prescription pain meds or while having significant pain.
No exercise, intercourse or heavy lifting (>10 lbs) for 6 wks.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] B. GYN ONC PPS (SB) Where: GYN ONC PPS (SB)
Date/Time:[**2143-7-25**] 3:15

Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] B.  [**Telephone/Fax (1) 5777**]  Call to schedule
appointment for staple removal for approximately 2 wks from date
of surgery.

Provider: [**Name10 (NameIs) **], [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 32192**] (MEDICAL ONCOLOGY).  Call
to schedule appointment.
{'Malignant neoplasm of ovary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of genital organs,Paralytic ileus,Other iatrogenic hypotension,Other specified cardiac dysrhythmias'}


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: pelvic mass

PRESENT ILLNESS: 55-year-old G2P0 with bilateral ovarian masses noted on CT
measuring 6-7 cm with densities within the anterior mesentery
and omentum (~2 cm).  Pt reports mild symptoms of pelvic
pressure, pain and bloating for several months.

MEDICAL HISTORY: MEDICAL HISTORY:  Mitral valve prolapse, reentry
supraventricular tachycardia (very infrequent epidsodes).
Stress echo two weeks ago was good per patient report.

MEDICATION ON ADMISSION: calcium

ALLERGIES: Bactrim

PHYSICAL EXAM: GENERAL:  Well nourished, well developed, in no acute distress.
HEENT:  Anicteric sclerae.
NECK:  No thyromegaly.
LYMPH NODES:  Complete lymph node exam negative.
CARDIOVASCULAR:  Regular rate and rhythm.
RESPIRATORY:  Clear to auscultation.
BREASTS:  No skin or soft tissue abnormalities noted.
ABDOMEN:  Soft with tenderness in the lower abdomen.  No rebound
or guarding.
EXTREMITIES:  No edema.
GENITOURINARY:  Complete rectovaginal exam significant for
adnexal masses appreciated by Dr. [**First Name (STitle) 1022**].

FAMILY HISTORY: Father died at 68 years of age with pancreatic cancer.

SOCIAL HISTORY: Recently married, works as a social worker, does not smoke,
drinks one glass of wine each day. 

### Response:
{'Malignant neoplasm of ovary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of genital organs,Paralytic ileus,Other iatrogenic hypotension,Other specified cardiac dysrhythmias'}
