CHIEF COMPLAINT: abdominal pain
cecal carcinoma metastatic to liver

PRESENT ILLNESS: Mr. [**Known lastname 112071**] is a 61M with cecal cancer metastatic to the liver
undergoing chemotherapy and radiation (last chemo 1.5wks ago)
who presented to an OSH with SOB, lethargy and abdominal pain.
Per EMS reports, pt was hypotensive with BP as low as 91/46,
breathing between 22-24 satting 97-99% on 4L.

MEDICAL HISTORY: Cecal cancer metastatic to liver, diagnosed in [**2162-5-25**]

MEDICATION ON ADMISSION: 1. Betoptios ophthalmic solution 0.25% 1 gtt [**Hospital1 **] in each eye
2. Ciprofloxacin 500 mg PO BID
3. Oxycodone 5 mg PO q4hrs prn pain
4. Oxycontin 20 mg PO BID
5. Denavir topical prn
6. Compazine 10 mg PO QID prn nausea/vomiting

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:

FAMILY HISTORY: None

SOCIAL HISTORY: Pt. lives at home with wife, [**Name (NI) **] who is HCP [**Name (NI) **]:
[**Telephone/Fax (1) 112072**]).
Unspecified septicemia,Perforation of intestine,Acute kidney failure with lesion of tubular necrosis,Unspecified peritonitis,Malignant neoplasm of cecum,Malignant neoplasm of liver, secondary,Other ascites,Jaundice, unspecified, not of newborn,Acute posthemorrhagic anemia,Neutropenia, unspecified,Sepsis,Do not resuscitate status,Personal history of tobacco use,Abnormal coagulation profile,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Other specified disorders of peritoneum,Encounter for palliative care
Septicemia NOS,Perforation of intestine,Ac kidny fail, tubr necr,Peritonitis NOS,Malignant neoplasm cecum,Second malig neo liver,Ascites NEC,Jaundice NOS,Ac posthemorrhag anemia,Neutropenia NOS,Sepsis,Do not resusctate status,History of tobacco use,Abnrml coagultion prfile,Hx of irradiation,Hx antineoplastic chemo,Peritoneal disorder NEC,Encountr palliative care
Admission Date:  [**2162-7-25**]              Discharge Date:   [**2162-7-31**]

Date of Birth:  [**2100-8-20**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 4917**]
Chief Complaint:
abdominal pain
cecal carcinoma metastatic to liver

Major Surgical or Invasive Procedure:
diagnostic and therepeutic paracentesis

History of Present Illness:
Mr. [**Known lastname 112071**] is a 61M with cecal cancer metastatic to the liver
undergoing chemotherapy and radiation (last chemo 1.5wks ago)
who presented to an OSH with SOB, lethargy and abdominal pain.
Per EMS reports, pt was hypotensive with BP as low as 91/46,
breathing between 22-24 satting 97-99% on 4L.

In OSH [**Name (NI) **] pt. was tachycardic to the 150s, breathing 38 with a
BP of 86/30, satting 98% on nonrebreather. CT abdomen showed
ascites and  free air. Pt. received Levaquin and Zosyn as well
as 1.6L NS prior to transfer to [**Hospital1 18**].

In the ED, initial VS were: T 98.8 BP 99/68, P 129, 99% 3LNC. Pt
was bolused 3L NS in the ED and BP improved to low 100s/60s.

On arrival to the MICU, patient's VS: T 98.2, BP 133/97, P 130,
RR 25 96% 2LNC.

Past Medical History:
Cecal cancer metastatic to liver, diagnosed in [**2162-5-25**]


Social History:
Pt. lives at home with wife, [**Name (NI) **] who is HCP [**Name (NI) **]:
[**Telephone/Fax (1) 112072**]).


Family History:
None

Physical Exam:
ADMISSION PHYSICAL EXAM:

VITALS: 97.7, 109/68, 120, 24, 96% on 4L
GENERAL: Ill-appearing but comfortable, NAD
HEENT: PERRL, sclera are icteric
NECK: Supple, no JVD
LUNGS: CTAB on anterior exam
HEART: Tachycardic but regular, no murmurs
ABDOMEN: Obese, distended but soft, NT, NABS
EXTREMITIES: WWP, no edema, pedal pulses intact
NEUROLOGIC: Sleepy but arousable, A&Ox3, CNs grossly intact,
strength and sensation grossly intact


Pertinent Results:
ADMISSION LABS

[**2162-7-25**] 06:00PM ASCITES  TOT PROT-2.1 GLUCOSE-2 LD(LDH)-293
ALBUMIN-1.3
[**2162-7-25**] 06:00PM ASCITES  WBC-1675* RBC-1300* POLYS-92*
LYMPHS-1* MONOS-7*
[**2162-7-25**] 02:15PM URINE  HOURS-RANDOM CREAT-85 SODIUM-11
POTASSIUM-95 CHLORIDE-15 TOT PROT-128 PROT/CREA-1.5* albumin-3.5
alb/CREA-41.2*
[**2162-7-25**] 02:15PM URINE  OSMOLAL-471
[**2162-7-25**] 02:15PM URINE  COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.031
[**2162-7-25**] 02:15PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-MOD UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2162-7-25**] 02:15PM URINE  RBC-17* WBC-2 BACTERIA-NONE YEAST-NONE
EPI-5
[**2162-7-25**] 02:15PM URINE  AMORPH-FEW
[**2162-7-25**] 02:02PM   LD(LDH)-202
[**2162-7-25**] 04:53AM   GLUCOSE-73 UREA N-47* CREAT-1.6* SODIUM-136
POTASSIUM-5.1 CHLORIDE-102 TOTAL CO2-21* ANION GAP-18
[**2162-7-25**] 04:53AM   CALCIUM-7.8* PHOSPHATE-4.4 MAGNESIUM-2.1
[**2162-7-25**] 04:53AM   WBC-0.7* RBC-3.36* HGB-9.8* HCT-30.1* MCV-90
MCH-29.1 MCHC-32.5 RDW-20.5*
[**2162-7-25**] 04:53AM   PLT COUNT-106*
[**2162-7-25**] 12:03AM   LACTATE-6.9*
[**2162-7-24**] 11:50PM   GLUCOSE-79 UREA N-48* CREAT-1.5* SODIUM-135
POTASSIUM-5.0 CHLORIDE-98 TOTAL CO2-20* ANION GAP-22*
[**2162-7-24**] 11:50PM   estGFR-Using this
[**2162-7-24**] 11:50PM   ALT(SGPT)-43* AST(SGOT)-53* ALK PHOS-419* TOT
BILI-10.5*
[**2162-7-24**] 11:50PM   LIPASE-8
[**2162-7-24**] 11:50PM   proBNP-1103*
[**2162-7-24**] 11:50PM   ALBUMIN-2.2*
[**2162-7-24**] 11:50PM   WBC-.7* RBC-3.48* HGB-10.1* HCT-31.3* MCV-90
MCH-28.9 MCHC-32.1 RDW-20.6*
[**2162-7-24**] 11:50PM   NEUTS-51 BANDS-7* LYMPHS-16* MONOS-20* EOS-0
BASOS-0 ATYPS-3* METAS-2* MYELOS-0 PROMYELO-1* NUC RBCS-1*
[**2162-7-24**] 11:50PM   HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-1+
MACROCYT-1+ MICROCYT-1+ POLYCHROM-1+ OVALOCYT-1+ TEARDROP-1+
[**2162-7-24**] 11:50PM   PLT SMR-LOW PLT COUNT-130*
[**2162-7-24**] 11:50PM   PT-22.8* PTT-33.2 INR(PT)-2.2*

MICROBIOLOGY
[**2162-7-25**] 6:00 pm PERITONEAL FLUID

                            **FINAL REPORT [**2162-7-31**]**

   GRAM STAIN (Final [**2162-7-25**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      3+  (5-10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   FLUID CULTURE (Final [**2162-7-31**]):
      GRAM NEGATIVE ROD(S).    GROWING IN BROTH ONLY.
         UNABLE TO ISOLATE ORGANISM TO IDENTIFY FURTHER.
      ENTEROCOCCUS SP..
         Isolated from broth media only, INDICATING VERY LOW
NUMBERS OF
         ORGANISMS.

   ANAEROBIC CULTURE (Final [**2162-7-31**]):
      CLOSTRIDIUM SPECIES NOT C. PERFRINGENS OR C. SEPTICUM.
         RARE GROWTH.

IMAGING
CT Abd and Pelvis w/o contrast [**7-25**]:
1.  Limited study without IV contrast.  Small intraperitoneal
air and large ascites. Hemoperitoneum cannot be excluded given
the slightly increased density of fluid in the cul de sac. The
etiology of the free air is not
identified on this study. Per discussion with Dr. [**Last Name (STitle) **], the
patient does not have a history of recent paracentesis.
2.  Abnormal cecum consistent with known malignancy with liver
mestases,
peritoneal carcinomatosis and mesenteric and retroperitoneal
lymphadenopathy.
Correlate with prior imaging for interval change (not available
in our
system).
3.  Bone metastases with impression on the thecal sac,
particularly at L5.
Consider MRI if there is no recent MRI already performed.
Consider radiation oncology consult.


Brief Hospital Course:
61M with cecal carcinoma metastatic to the liver, s/p 2 weeks of
radiation and chemotherapy who presented with increased
shortness of breath, fatigue and abdominal pain who was found to
have bowel perforation with bacterial peritonitis.

The patient was admitted to the [**Hospital Unit Name 153**] with abdominal pain and was
found to have ascites and free air w/ sepsis. Diagnostic and
therepeutic paracentesis was preformed, results showed high
polys and gram negative rods, it was felt that he had a small
perforation in his GI tract leading to bacterial peritonitis. He
was not a surgical candidate. Goals of care were discussed with
the patient, and he became DNR, DNI. Discussions were initiated
with palliative care. He was given broad vanc/zosyn and fluid
resuscitated, including albumin. Once his BP was stablized he
was transferred to the floors. Palliative care was consulted and
recommended increasing morphine for pain control.   He has
worsening liver and kidney failure and his mental status
declined.  After conversations with his family, outpatient
providers, and the palliative care service, he was made comfort
measures only and passed away.

# Bowel perforation: Pt was found to have had a perforated bowel
and was initially started on broad spectrum abx. He was seen by
surgery, and due to his condition he was deemed to not be a
surgical candidate given his neutropenia and coagulopathy. Pt
was found to have gram negative rods growing in his peritonial
fluid.

# Sepsis: He was initially hypotensive in the setting of
presumed infection but his BP stablilized after fluid
resuscitation.

# Metastatic colon ca/pancytopenia- The patient is s/p 2 weeks
of radiation and chemotherapy for metastatic colon cancer.
Recent chemotherapy is likely the cause of his pancytopenia as
it did improve somewhat after treatment for sepsis.

# Liver Failure/ [**Name (NI) 112073**] Pt had severe jaundice
secondary to hyperbilirubimemia which is likely related to his
liver mets and biliary cholestasis which was previously
diagnosed.

# Coagulopathy- Secondary to hepatic mets. INR was elevated. No
evidence of bleeding was present.

# [**Last Name (un) 13160**] Pt had poor renal function which was intially thought to
be seondary to his hypotension and pre-renal etiology. However
after adequate volume resuscitation, his kidney function
continued to progressively decline.

#Death: Pt died on [**2162-7-31**]. Cause of death
Primary Diagnosis: Bowel Perforation
Secondary Diagnosis: Metastatic Cecal Carcinoma
PCP and outpatient oncologist were notified of his death.

Medications on Admission:
1. Betoptios ophthalmic solution 0.25% 1 gtt [**Hospital1 **] in each eye
2. Ciprofloxacin 500 mg PO BID
3. Oxycodone 5 mg PO q4hrs prn pain
4. Oxycontin 20 mg PO BID
5. Denavir topical prn
6. Compazine 10 mg PO QID prn nausea/vomiting


Discharge Medications:
Deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary Diagnosis: Bowel Perforation
Secondary Diagnosis: Metastatic Cecal Carcinoma


Discharge Condition:
Deceased

Discharge Instructions:
None

Followup Instructions:
None
{'Unspecified septicemia,Perforation of intestine,Acute kidney failure with lesion of tubular necrosis,Unspecified peritonitis,Malignant neoplasm of cecum,Malignant neoplasm of liver, secondary,Other ascites,Jaundice, unspecified, not of newborn,Acute posthemorrhagic anemia,Neutropenia, unspecified,Sepsis,Do not resuscitate status,Personal history of tobacco use,Abnormal coagulation profile,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Other specified disorders of peritoneum,Encounter for palliative care'}


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
cecal carcinoma metastatic to liver

PRESENT ILLNESS: Mr. [**Known lastname 112071**] is a 61M with cecal cancer metastatic to the liver
undergoing chemotherapy and radiation (last chemo 1.5wks ago)
who presented to an OSH with SOB, lethargy and abdominal pain.
Per EMS reports, pt was hypotensive with BP as low as 91/46,
breathing between 22-24 satting 97-99% on 4L.

MEDICAL HISTORY: Cecal cancer metastatic to liver, diagnosed in [**2162-5-25**]

MEDICATION ON ADMISSION: 1. Betoptios ophthalmic solution 0.25% 1 gtt [**Hospital1 **] in each eye
2. Ciprofloxacin 500 mg PO BID
3. Oxycodone 5 mg PO q4hrs prn pain
4. Oxycontin 20 mg PO BID
5. Denavir topical prn
6. Compazine 10 mg PO QID prn nausea/vomiting

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:

FAMILY HISTORY: None

SOCIAL HISTORY: Pt. lives at home with wife, [**Name (NI) **] who is HCP [**Name (NI) **]:
[**Telephone/Fax (1) 112072**]). 

### Response:
{'Unspecified septicemia,Perforation of intestine,Acute kidney failure with lesion of tubular necrosis,Unspecified peritonitis,Malignant neoplasm of cecum,Malignant neoplasm of liver, secondary,Other ascites,Jaundice, unspecified, not of newborn,Acute posthemorrhagic anemia,Neutropenia, unspecified,Sepsis,Do not resuscitate status,Personal history of tobacco use,Abnormal coagulation profile,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Other specified disorders of peritoneum,Encounter for palliative care'}
