CHIEF COMPLAINT: -Colon cancer

PRESENT ILLNESS: 70yF w/history of rectal bleeding. Colonoscopy reveals fungating
ulcerated mass at 25-30cc and biopsy c/w adenocarcinoma. Patient
presents for elective L colectomy.

MEDICAL HISTORY: -NIDDM
-HTN
-hypercholesterolemia
-s/p aortobifem [**2186**]
-pancreatic mass excision x 2 [**2172**]

MEDICATION ON ADMISSION: mavik 0.5', glyburide 25'', glucophage 1000'', lipitor 20', asa
81'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen elderly thin NAD
Heent perrl, eomi, nares patent, oropharynx clear
Neck supple no masses
CV rrr no m/r/g
Resp coarse BS bilaterally with scattered wheezes
Abd soft, NTND, midline incision c/d/i
Ext bilateral LE warm and well perfused with palpable DP pulses
bilaterally. Bilateral groin incision with mild erythema.
Neuro aao x 3

FAMILY HISTORY: CAD

SOCIAL HISTORY: former smoker, no EtOH, has son and daughter
Malignant neoplasm of sigmoid colon,Atherosclerosis of autologous vein bypass graft of the extremities,Peritoneal adhesions (postoperative) (postinfection),Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Family history of ischemic heart disease,Personal history of tobacco use
Mal neo sigmoid colon,Ath ext autologs bps gft,Peritoneal adhesions,Mal neo lymph intra-abd,CHF NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Fam hx-ischem heart dis,History of tobacco use
Admission Date:  [**2199-2-15**]              Discharge Date:   [**2199-3-2**]

Date of Birth:  [**2128-3-19**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
-Colon cancer

Major Surgical or Invasive Procedure:
-Sigmoid colectomy (removal of part of colon)
-Bilateral salphingo-oophorectomy (removal of both ovaries and
fallopian tubes)
-Aortobifem thrombectomy, bilateral


History of Present Illness:
70yF w/history of rectal bleeding. Colonoscopy reveals fungating
ulcerated mass at 25-30cc and biopsy c/w adenocarcinoma. Patient
presents for elective L colectomy.

Past Medical History:
-NIDDM
-HTN
-hypercholesterolemia
-s/p aortobifem [**2186**]
-pancreatic mass excision x 2 [**2172**]

Social History:
former smoker, no EtOH, has son and daughter

Family History:
CAD

Physical Exam:
Gen elderly thin NAD
Heent perrl, eomi, nares patent, oropharynx clear
Neck supple no masses
CV rrr no m/r/g
Resp coarse BS bilaterally with scattered wheezes
Abd soft, NTND, midline incision c/d/i
Ext bilateral LE warm and well perfused with palpable DP pulses
bilaterally. Bilateral groin incision with mild erythema.
Neuro aao x 3

Pertinent Results:
[**2199-3-1**] 05:30AM BLOOD WBC-8.0 RBC-4.07* Hgb-11.3* Hct-34.3*
MCV-84 MCH-27.8 MCHC-32.9 RDW-16.3* Plt Ct-383
[**2199-2-28**] 04:57AM BLOOD WBC-6.5 RBC-3.93* Hgb-11.2* Hct-33.0*
MCV-84 MCH-28.4 MCHC-33.9 RDW-16.2* Plt Ct-337
[**2199-2-27**] 04:31AM BLOOD WBC-9.3 RBC-4.49 Hgb-12.9 Hct-37.3 MCV-83
MCH-28.8 MCHC-34.7 RDW-16.3* Plt Ct-354
[**2199-3-2**] 09:10AM BLOOD PT-15.3* INR(PT)-1.4*
[**2199-3-1**] 05:30AM BLOOD Plt Ct-383
[**2199-3-1**] 05:30AM BLOOD PT-18.6* INR(PT)-1.8*
[**2199-2-28**] 04:57AM BLOOD Plt Ct-337
[**2199-2-28**] 04:57AM BLOOD PT-31.1* PTT-37.2* INR(PT)-3.3*
[**2199-3-1**] 05:30AM BLOOD Glucose-281* UreaN-15 Creat-0.4 Na-134
K-3.8 Cl-98 HCO3-25 AnGap-15
[**2199-2-28**] 04:57AM BLOOD Glucose-151* UreaN-10 Creat-0.4 Na-136
K-3.5 Cl-101 HCO3-28 AnGap-11
[**2199-2-27**] 04:31AM BLOOD Glucose-177* UreaN-14 Creat-0.4 Na-138
K-3.3 Cl-98 HCO3-30 AnGap-13
[**2199-2-28**] 04:57AM BLOOD Calcium-8.0* Phos-3.5 Mg-1.7
[**2199-2-27**] 04:31AM BLOOD Calcium-8.1* Phos-3.4 Mg-1.9
[**2199-2-26**] 03:33AM BLOOD Calcium-7.6* Phos-3.4 Mg-1.5*

Brief Hospital Course:
Patient was admitted and underwent an uncomplicated L colectomy.
She was transferred stable to the recovery room and then to the
floor. She slowly made progress, her NGT was discontinued and
her diet was slowly advanced. She was OOB with physical therapy.
A surveillance CT scan was performed on POD4 which was negative
for metastasis but did demonstrated incidentally a thrombosed L
ovarian vein as well as occlusion of the left limb of her
aortobifem graft. At this point in time, the patient was
asymptomatic from these findings, was out of bed and tolerating
her diet. On POD7, however, she did complain of bilateral leg
pain and weakness. She also developed acute shortness of breath
and worsening leg pain. She was transferred to the ICU and a CTA
chest was performed to r/o PE and also LE dopplers were
performed to evaluate the patency of her aortobifem graft. CTA
was negative for pulmonary embolism but her doppler study
demonstrated no flow through either common femoral artery. At
this time, her bilateral LE were noted to be mottled and cool. A
stat cardiology consult was obtained and the patient was cleared
for emergent surgery with the [**Month/Day/Year 1106**] team where she underwent
bilateral thrombectomy of her aortobifem graft. She was
transferred intubated and stable to the ICU and was started on
argatroban for anticoagulation. Laboratory tests revealed that
the patient was HIT- and her cardiac enzymes peaked on POD8/1
with a troponin of 0.20. Cardiology did follow the patient and
recommended conservative therapy with beta blockade and ace
inhibitors as soon as she could tolerate po's. Patient was
extubated on POD [**8-10**] and was supported with intermittent
diuresis and close monitoring. She was restarted on a regular
diet and transferred to the step down unit on POD [**9-10**] where she
did well and began intensive physical therapy.  The pt.
continued to improve and on POD [**10-12**] her INR was therapeutic and
the argatroban gtt was discontinued.  From this point the pt.
was maintained on coumadin.  Also the evening of POD [**10-12**] the
pt. experienced 'heartburn' for which the floor nurse got an EKG
that showed similar findings as were noted on previous EKGs done
during this admission.  The pt. was watched closely over the
next couple of days and by POD 13/6 the pt. was ready for
discharge to a rehab facility for further physical therapy.  By
this time the pt. had been afebrile with stable vitals, was
tolerating a regular diet and pain well controlled on po pain
medication, she was voiding well on her own, and had been
working extensively with physical therapy.  Cardiology had
cleared the patient and recommended outpatient follow up. She
was discharged to rehab and will follow up with her PCP for
coumadin dosing and will follow up with Dr.[**Last Name (STitle) **].

Medications on Admission:
mavik 0.5', glyburide 25'', glucophage 1000'', lipitor 20', asa
81'

Discharge Medications:
1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*30 Tablet(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).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
7. Warfarin 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] - [**Location (un) **]

Discharge Diagnosis:
-Colon cancer
-Aortobifem thrombosis bilaterally
-Congestive heart failure


Discharge Condition:
Good


Discharge Instructions:
-Please come to the emergency room if you have fever >101.4F,
nausea or vomiting, dizziness or weakness, persistent redness or
oozing from your surgical wounds, or shortness of breath.
-Please take all of your medications as directed, including your
anticoagulation
-Do not drive while taking pain medication
-every day you take pain medication you should take a stool
softener: colace, senna, dulcolax, and milk of mag are all good
options
-Keep your incisions clean and dry
-You may shower normally but no tub bathing or swimming for 6
weeks
-No heavy lifting (>telephone book) for 3 weeks
-Please keep up with your fluids while you are at home

Followup Instructions:
-Please follow up with Dr. [**Last Name (STitle) **] on Tuesday [**3-12**]. Call [**Telephone/Fax (1) 9946**] for appointment. Dr. [**Last Name (STitle) **] will recommend an oncologist
for you to see during your follow-up appointment.
-Follow up with your primary care physician.  [**Name10 (NameIs) **] will need to
follow-up your coumadin dosing to keep you INR 1.5-2.0.
-Please follow up with a cardiologist once you are discharged.
You can call Dr.[**Name (NI) 1565**] office at [**Telephone/Fax (1) 285**] if you would
like to see someone from [**Hospital1 18**] or any other cardiologist of your
choice.

- Provider: [**Name10 (NameIs) 20009**],[**Name11 (NameIs) 5557**] [**Name Initial (NameIs) **]. ([**First Name9 (NamePattern2) **] [**Location (un) **]) [**Location (un) **] INTERNAL
MEDICINE Date/Time:[**2199-4-22**] 9:00
- Provider: [**Name10 (NameIs) 1111**],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY (NHB)
Date/Time:[**2199-12-23**] 11:30
- Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 3627**] [**Name12 (NameIs) 3628**] [**Name12 (NameIs) **] [**Name12 (NameIs) 3628**] (NHB)
Date/Time:[**2199-12-23**] 11:00
**please call to confirm the above appointments**
{'Malignant neoplasm of sigmoid colon,Atherosclerosis of autologous vein bypass graft of the extremities,Peritoneal adhesions (postoperative) (postinfection),Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Family history of ischemic heart disease,Personal history of tobacco 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: -Colon cancer

PRESENT ILLNESS: 70yF w/history of rectal bleeding. Colonoscopy reveals fungating
ulcerated mass at 25-30cc and biopsy c/w adenocarcinoma. Patient
presents for elective L colectomy.

MEDICAL HISTORY: -NIDDM
-HTN
-hypercholesterolemia
-s/p aortobifem [**2186**]
-pancreatic mass excision x 2 [**2172**]

MEDICATION ON ADMISSION: mavik 0.5', glyburide 25'', glucophage 1000'', lipitor 20', asa
81'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen elderly thin NAD
Heent perrl, eomi, nares patent, oropharynx clear
Neck supple no masses
CV rrr no m/r/g
Resp coarse BS bilaterally with scattered wheezes
Abd soft, NTND, midline incision c/d/i
Ext bilateral LE warm and well perfused with palpable DP pulses
bilaterally. Bilateral groin incision with mild erythema.
Neuro aao x 3

FAMILY HISTORY: CAD

SOCIAL HISTORY: former smoker, no EtOH, has son and daughter 

### Response:
{'Malignant neoplasm of sigmoid colon,Atherosclerosis of autologous vein bypass graft of the extremities,Peritoneal adhesions (postoperative) (postinfection),Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Family history of ischemic heart disease,Personal history of tobacco use'}
