CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 56-year-old woman with metastatic colorectal cancer, extensive
peritoneal mets presents with abdominal pain and distention for
2 days. The patient has known malignant ascites and has had
therapeutic paracentesis in the past. Two days prior to
admission, she started feeling her abdomen getting more
distended and painful, mostly on the right side. There was no
nausea or vomiting. No diarrhea or constipation. No fevers or
chills. She has poor PO intake and has been drinking most warm
water at home. With the persistent abdominal pain, she called
her oncologist's office and was advised to come to the ED.
.
Of note, knowing that her abdomen was getting distended and a
paracentesis might be needed, patient had stopped her daily
warfarin 4 mg 2 days prior to admission.
.
Her most recent chemotherapy was 6 days PTA with oxaplatin and
bevacizumab. She has also been taking capecitabine for months.
.
In the ED, T 98.4, HR 108, BP 135/77, RR 18, 100%RA. Her INR was
found to be 6.7. Hct 21 (from 30 last week). Abd/pel CT scan
showed extensive loculated ascites with possible new liver mets.
She received a total of 16 mg of IV morphine, also ondansetron,
and 5 mg of oral vitamin K.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, congestion. Denies
chest pain or tightness, palpitations. Denies cough, shortness
of breath, or wheezes. Denies nausea, vomiting, diarrhea,
constipation. No recent change in bowel or bladder habits. No
dysuria. Denies arthralgias or myalgias. Denies rashes or skin
breakdown. No numbness/tingling in extremities. No feelings of
depression or anxiety. All other review of systems negative.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
# Metastatic colon cancer:
- [**10/2097**]: found to have RLQ abscess, mass at ileocecal valve.
Bx showed invasive adenocarcinoma
- [**2098-1-2**]: right colectomy by Dr. [**First Name (STitle) **] [**Name (STitle) 99263**]. Path showed
moderately differentiated invasive adenocarcinoma measuring 7 cm
at ileocecal valve, no LVI, invading the subserosa; distant
margins negative but tumor present at radial margin; [**4-3**] lymph
nodes positive, stage (Stage IIIB) T3N1.
- [**Date range (3) 99264**]: FOLFOX6 x 5 cycles (10 weeks treatment)
- [**2098-4-30**]: RUE DVT DVT associated with portacath
- [**Date range (1) 99265**]: weekly 5FU/LV x 3
- [**Date range (1) 99266**]: admitted to [**Hospital1 112**] for enteritis related to chemo
- [**8-/2098**]/[**2098**]: weekly 5FU/LV
- [**4-/2099**]: colonoscopy negative
- [**10/2103**]: Abd/pel CT showed large ascites and left adnexal
mass; pelvic ultrasound with 2 large masses in the left adnexa,
multiple serosal implants and implants on endometrium and right
ovary
- [**11/2103**]: biopsy of omental mass with metastatic adenocarcinoma
consistent with colon primary; CEA normal; KRAS testing positive
for exon 2 mutation at codon 12 GGT>GCT
- [**12/2103**]: started treatment with weekly CPT-11
- [**1-/2104**]: weekly 5FU added
- [**3-/2104**]: progression of her disease. Pelvic mass spanning 23 x
13 cm. Started capecitabine, bevacizumab, oxaplitain.
.
OTHER MEDICAL HISTORY:
RUE DVT related to portacath

MEDICATION ON ADMISSION: lisinopril 5 mg daily
warfarin 4 mg daily
lorazepam 1 mg qhs prn anxiety/insomnia
omeprazole 20 mg daily
Doxepin 10-20 mg qhs

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 99.4, BP 102/64, HR 105, RR 16, 97%RA
GEN: middle-aged woman in NAD, AOx3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: Regular rhythm, normal rate, 3/6 systolic murmur heard
throughout precordium
Pulm: CTAB no crackles or wheezes
Abd: tense, distended, tympanic, diffusely tender but greatest
at RUQ and RLQ, BS present, no rebound/guarding
Extremities: no edema. DPs, PTs 2+.
Skin: no rashes or bruising

FAMILY HISTORY: Her mother might have had an aunt with cancer.

SOCIAL HISTORY: Lives alone. Retired in [**2103-11-25**] as school principal. Her
sister [**Name (NI) **] [**Name (NI) 99267**] ([**Telephone/Fax (1) 99268**]) and friend [**Name (NI) **] [**Name (NI) 15281**]
are her health care proxies.
Secondary malignant neoplasm of retroperitoneum and peritoneum,Unspecified septicemia,Perforation of intestine,Peritonitis (acute) generalized,Septic shock,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other specified intestinal obstruction,Malignant ascites,Delirium due to conditions classified elsewhere,Neoplasm related pain (acute) (chronic),Anemia, unspecified,Abnormal coagulation profile,Dehydration,Personal history of malignant neoplasm of large intestine,Personal history of antineoplastic chemotherapy,Acquired absence of intestine (large) (small),Personal history of venous thrombosis and embolism,Other drugs and medicinal substances causing adverse effects in therapeutic use
Sec mal neo peritoneum,Septicemia NOS,Perforation of intestine,Peritonitis (acute) gen,Septic shock,Severe sepsis,Ac kidny fail, tubr necr,Intestinal obstruct NEC,Malignant ascites,Delirium d/t other cond,Neoplasm related pain,Anemia NOS,Abnrml coagultion prfile,Dehydration,Hx of colonic malignancy,Hx antineoplastic chemo,Acquire absnce intestine,Hx-ven thrombosis/embols,Adv eff medicinal NEC
Admission Date:  [**2104-12-15**]              Discharge Date:   [**2104-12-25**]

Date of Birth:  [**2047-12-23**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
-paracentesis [**2104-12-17**]
-NG tube placement [**2104-12-21**]


History of Present Illness:
56-year-old woman with metastatic colorectal cancer, extensive
peritoneal mets presents with abdominal pain and distention for
2 days. The patient has known malignant ascites and has had
therapeutic paracentesis in the past. Two days prior to
admission, she started feeling her abdomen getting more
distended and painful, mostly on the right side. There was no
nausea or vomiting. No diarrhea or constipation. No fevers or
chills. She has poor PO intake and has been drinking most warm
water at home. With the persistent abdominal pain, she called
her oncologist's office and was advised to come to the ED.
.
Of note, knowing that her abdomen was getting distended and a
paracentesis might be needed, patient had stopped her daily
warfarin 4 mg 2 days prior to admission.
.
Her most recent chemotherapy was 6 days PTA with oxaplatin and
bevacizumab. She has also been taking capecitabine for months.
.
In the ED, T 98.4, HR 108, BP 135/77, RR 18, 100%RA. Her INR was
found to be 6.7. Hct 21 (from 30 last week). Abd/pel CT scan
showed extensive loculated ascites with possible new liver mets.
She received a total of 16 mg of IV morphine, also ondansetron,
and 5 mg of oral vitamin K.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, congestion. Denies
chest pain or tightness, palpitations. Denies cough, shortness
of breath, or wheezes. Denies nausea, vomiting, diarrhea,
constipation. No recent change in bowel or bladder habits. No
dysuria. Denies arthralgias or myalgias. Denies rashes or skin
breakdown. No numbness/tingling in extremities. No feelings of
depression or anxiety. All other review of systems negative.

Past Medical History:
ONCOLOGIC HISTORY:
# Metastatic colon cancer:
- [**10/2097**]: found to have RLQ abscess, mass at ileocecal valve.
Bx showed invasive adenocarcinoma
- [**2098-1-2**]: right colectomy by Dr. [**First Name (STitle) **] [**Name (STitle) 99263**]. Path showed
moderately differentiated invasive adenocarcinoma measuring 7 cm
at ileocecal valve, no LVI, invading the subserosa; distant
margins negative but tumor present at radial margin; [**4-3**] lymph
nodes positive, stage (Stage IIIB) T3N1.
- [**Date range (3) 99264**]: FOLFOX6 x 5 cycles (10 weeks treatment)
- [**2098-4-30**]: RUE DVT DVT associated with portacath
- [**Date range (1) 99265**]: weekly 5FU/LV x 3
- [**Date range (1) 99266**]: admitted to [**Hospital1 112**] for enteritis related to chemo
- [**8-/2098**]/[**2098**]: weekly 5FU/LV
- [**4-/2099**]: colonoscopy negative
- [**10/2103**]: Abd/pel CT showed large ascites and left adnexal
mass; pelvic ultrasound with 2 large masses in the left adnexa,
multiple serosal implants and implants on endometrium and right
ovary
- [**11/2103**]: biopsy of omental mass with metastatic adenocarcinoma
consistent with colon primary; CEA normal; KRAS testing positive
for exon 2 mutation at codon 12 GGT>GCT
- [**12/2103**]: started treatment with weekly CPT-11
- [**1-/2104**]: weekly 5FU added
- [**3-/2104**]: progression of her disease. Pelvic mass spanning 23 x
13 cm. Started capecitabine, bevacizumab, oxaplitain.
.
OTHER MEDICAL HISTORY:
RUE DVT related to portacath

Social History:
Lives alone. Retired in [**2103-11-25**] as school principal. Her
sister [**Name (NI) **] [**Name (NI) 99267**] ([**Telephone/Fax (1) 99268**]) and friend [**Name (NI) **] [**Name (NI) 15281**]
are her health care proxies.

Family History:
Her mother might have had an aunt with cancer.


Physical Exam:
VS: T 99.4, BP 102/64, HR 105, RR 16, 97%RA
GEN: middle-aged woman in NAD, AOx3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: Regular rhythm, normal rate, 3/6 systolic murmur heard
throughout precordium
Pulm: CTAB no crackles or wheezes
Abd: tense, distended, tympanic, diffusely tender but greatest
at RUQ and RLQ, BS present, no rebound/guarding
Extremities: no edema. DPs, PTs 2+.
Skin: no rashes or bruising

Pertinent Results:
[**2104-12-15**] 10:52AM   LACTATE-1.2
[**2104-12-15**] 10:35AM   GLUCOSE-121* UREA N-8 CREAT-0.7 SODIUM-137
POTASSIUM-3.4 CHLORIDE-102 TOTAL CO2-24 ANION GAP-14
[**2104-12-15**] 10:35AM   ALT(SGPT)-8 AST(SGOT)-12 LD(LDH)-230 ALK
PHOS-58 TOT BILI-0.3
[**2104-12-15**] 10:35AM   HAPTOGLOB-352*
[**2104-12-15**] 10:35AM   WBC-7.7 RBC-2.25* HGB-7.0* HCT-21.5* MCV-96
MCH-31.2 MCHC-32.7 RDW-18.7*
[**2104-12-15**] 10:35AM   NEUTS-81.6* LYMPHS-11.5* MONOS-6.3 EOS-0.2
BASOS-0.5
[**2104-12-15**] 10:35AM   PLT COUNT-283
[**2104-12-15**] 10:35AM   PT-59.3* PTT-91.7* INR(PT)-6.7*
[**2104-12-15**] 05:41PM URINE  COLOR-Yellow APPEAR-Clear SP
[**Last Name (un) 155**]->=1.035
[**2104-12-15**] 05:41PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-25
GLUCOSE-NEG KETONE-15 BILIRUBIN-SM UROBILNGN-NEG PH-6.5 LEUK-NEG
.
IMAGING:
# CXR [**2104-12-15**]: No acute intrathoracic process. No evidence of
pneumoperitoneum
.
# Abd/pel [**2104-12-15**]: (prelim) Massive loculated abdominal ascites
with complex components of peritoneal implants. Mildly distended
small bowel up to 3.3 cm in R hemiabdomen, without free air. Two
subcentimeter liver hypodensities, not fully characterized, but
concerning for mets. Much of colon compressed; mid upper abd
anastomosis within normal limits.

Brief Hospital Course:
56-year-old woman with metastatic colorectal cancer presents
with abdominal pain likely from worsening malignant ascites.
.
# Abdominal pain: Abd/pel CT showing worsening ascites and
possibly liver mets. Similar to prior episode that required
therapeutic paracentesis. Pt received paracentesos on [**12-17**] with
improvment in pain (2L off), and fluid culture was negative to
date so no concern for SBP.  She did not have peritoneal signs
on exam, but abdomen remained markedly distended and tender in
the upper quadrants.  Her pain was controlled with ocycontin and
PRN oxycodone.  On [**12-19**] pt noted to be vomitting and without BM
in almost a week.  Given increased distension, there was concern
for SBO and KUB showed partial obstruction likely [**2-26**] to
peritoneal mets. She was made NPO at this time and started on
IVF. NG tube was placed with improvement of symptoms with
decompression. She developed fevers and tachycardia and was
transferred to the ICU for concern for sepsis. She was started
on vanco and Zosyn for broad spectrum coverage. Her pain control
regimen was escalated to IV morphine.
.
# Anticoaguluation INR: INR 6.7 on admission, likely from
interaction between capecitabine and warfarin (on warfarin for
H/O of UE DVT).  Her INR was allowed to trend down in the
setting of parcentesis, and pt received 2 [**Location 16678**] prior to the
procedure.  The next day, pt was started on lovenox for her DVT
history. Lovenox was d/c in the ICU given elevated INR and
concern for bleeding.
.
# Anemia: Admission Hct was 21 which was down from 30 the prior
week.  She was guaiac negative and nowo history of BRBPR or
melena.  She received 2U of PRBC for 3 days from [**Date range (1) 29692**].
Initially she had poor Hct response but after her 2 Units on
[**12-18**] she had 6pt Hct increase from 22.5-->28.7.  Hct
subsequently trended back down but stabilized at ~25.  We feel
that her anemia is likely related to her chemo, as there was no
obvious bleeding and hemolysis labs were negative.
.
#ARF:  Pt noted to have a creatinine bump to 1.5 from 0.9 with
subsequent slow upward trend after this.  Initially thought to
be [**2-26**] volume depletion in the setting of poor PO intake and
vomitting.  Urine lytes revealed a FeNa of 0.1% further
supporting a pre-renal etiology and urine eosinophils were
negative.   On [**12-21**] pt was noted to have poor urine output, so
renal u/s obtained which showed No evidence of hydronephrosis.
Minimal prominence of left collecting system, similar to recent
CT. Her renal falure was ultimately felt to be most likely due
to a combination of prerenal and contrast induced nephropathy.
Medications were dosed appropriately for renal impairment.
NSAIDS and other nephrotoxic medications were avoided. Despite
this, her creatinine continued to elevate.
.
# Metastatic colorectal cancer: currently on [**Female First Name (un) **], oxaplatin, and
capecitabine. Disease has been progressing despite treatment.
.
# Goals of Care: A family meeting was held on [**2104-12-25**] with the
Ms. [**Known lastname 10793**] sister, her HCP, as well as other family members.
The decision was made to make the patient comfort measures only
and she was placed on a morphine drip. The patient passed away
at 1:05PM.

Medications on Admission:
lisinopril 5 mg daily
warfarin 4 mg daily
lorazepam 1 mg qhs prn anxiety/insomnia
omeprazole 20 mg daily
Doxepin 10-20 mg qhs

Discharge Medications:
Patient deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient deceased

Discharge Condition:
Patient deceased

Discharge Instructions:
Patient deceased

Followup Instructions:
Patient deceased
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Unspecified septicemia,Perforation of intestine,Peritonitis (acute) generalized,Septic shock,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other specified intestinal obstruction,Malignant ascites,Delirium due to conditions classified elsewhere,Neoplasm related pain (acute) (chronic),Anemia, unspecified,Abnormal coagulation profile,Dehydration,Personal history of malignant neoplasm of large intestine,Personal history of antineoplastic chemotherapy,Acquired absence of intestine (large) (small),Personal history of venous thrombosis and embolism,Other drugs and medicinal substances causing adverse effects in therapeutic use'}


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

PRESENT ILLNESS: 56-year-old woman with metastatic colorectal cancer, extensive
peritoneal mets presents with abdominal pain and distention for
2 days. The patient has known malignant ascites and has had
therapeutic paracentesis in the past. Two days prior to
admission, she started feeling her abdomen getting more
distended and painful, mostly on the right side. There was no
nausea or vomiting. No diarrhea or constipation. No fevers or
chills. She has poor PO intake and has been drinking most warm
water at home. With the persistent abdominal pain, she called
her oncologist's office and was advised to come to the ED.
.
Of note, knowing that her abdomen was getting distended and a
paracentesis might be needed, patient had stopped her daily
warfarin 4 mg 2 days prior to admission.
.
Her most recent chemotherapy was 6 days PTA with oxaplatin and
bevacizumab. She has also been taking capecitabine for months.
.
In the ED, T 98.4, HR 108, BP 135/77, RR 18, 100%RA. Her INR was
found to be 6.7. Hct 21 (from 30 last week). Abd/pel CT scan
showed extensive loculated ascites with possible new liver mets.
She received a total of 16 mg of IV morphine, also ondansetron,
and 5 mg of oral vitamin K.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, congestion. Denies
chest pain or tightness, palpitations. Denies cough, shortness
of breath, or wheezes. Denies nausea, vomiting, diarrhea,
constipation. No recent change in bowel or bladder habits. No
dysuria. Denies arthralgias or myalgias. Denies rashes or skin
breakdown. No numbness/tingling in extremities. No feelings of
depression or anxiety. All other review of systems negative.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
# Metastatic colon cancer:
- [**10/2097**]: found to have RLQ abscess, mass at ileocecal valve.
Bx showed invasive adenocarcinoma
- [**2098-1-2**]: right colectomy by Dr. [**First Name (STitle) **] [**Name (STitle) 99263**]. Path showed
moderately differentiated invasive adenocarcinoma measuring 7 cm
at ileocecal valve, no LVI, invading the subserosa; distant
margins negative but tumor present at radial margin; [**4-3**] lymph
nodes positive, stage (Stage IIIB) T3N1.
- [**Date range (3) 99264**]: FOLFOX6 x 5 cycles (10 weeks treatment)
- [**2098-4-30**]: RUE DVT DVT associated with portacath
- [**Date range (1) 99265**]: weekly 5FU/LV x 3
- [**Date range (1) 99266**]: admitted to [**Hospital1 112**] for enteritis related to chemo
- [**8-/2098**]/[**2098**]: weekly 5FU/LV
- [**4-/2099**]: colonoscopy negative
- [**10/2103**]: Abd/pel CT showed large ascites and left adnexal
mass; pelvic ultrasound with 2 large masses in the left adnexa,
multiple serosal implants and implants on endometrium and right
ovary
- [**11/2103**]: biopsy of omental mass with metastatic adenocarcinoma
consistent with colon primary; CEA normal; KRAS testing positive
for exon 2 mutation at codon 12 GGT>GCT
- [**12/2103**]: started treatment with weekly CPT-11
- [**1-/2104**]: weekly 5FU added
- [**3-/2104**]: progression of her disease. Pelvic mass spanning 23 x
13 cm. Started capecitabine, bevacizumab, oxaplitain.
.
OTHER MEDICAL HISTORY:
RUE DVT related to portacath

MEDICATION ON ADMISSION: lisinopril 5 mg daily
warfarin 4 mg daily
lorazepam 1 mg qhs prn anxiety/insomnia
omeprazole 20 mg daily
Doxepin 10-20 mg qhs

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T 99.4, BP 102/64, HR 105, RR 16, 97%RA
GEN: middle-aged woman in NAD, AOx3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: Regular rhythm, normal rate, 3/6 systolic murmur heard
throughout precordium
Pulm: CTAB no crackles or wheezes
Abd: tense, distended, tympanic, diffusely tender but greatest
at RUQ and RLQ, BS present, no rebound/guarding
Extremities: no edema. DPs, PTs 2+.
Skin: no rashes or bruising

FAMILY HISTORY: Her mother might have had an aunt with cancer.

SOCIAL HISTORY: Lives alone. Retired in [**2103-11-25**] as school principal. Her
sister [**Name (NI) **] [**Name (NI) 99267**] ([**Telephone/Fax (1) 99268**]) and friend [**Name (NI) **] [**Name (NI) 15281**]
are her health care proxies. 

### Response:
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Unspecified septicemia,Perforation of intestine,Peritonitis (acute) generalized,Septic shock,Severe sepsis,Acute kidney failure with lesion of tubular necrosis,Other specified intestinal obstruction,Malignant ascites,Delirium due to conditions classified elsewhere,Neoplasm related pain (acute) (chronic),Anemia, unspecified,Abnormal coagulation profile,Dehydration,Personal history of malignant neoplasm of large intestine,Personal history of antineoplastic chemotherapy,Acquired absence of intestine (large) (small),Personal history of venous thrombosis and embolism,Other drugs and medicinal substances causing adverse effects in therapeutic use'}
