CHIEF COMPLAINT: 

PRESENT ILLNESS: This 88[**Hospital 4622**] nursing home
patient with a history of Alzheimer's type dementia was
transported to the [**Hospital1 **] Emergency Department
on [**2200-11-20**] for workup of fever, change in mental status and
increasing abdominal distention.  The patient, at that time,
was complaining of abdominal pain.

MEDICAL HISTORY: The patient has a history of dementia
and osteoarthritis.  Medications include Fosamax, a
multivitamin and Tylenol.  She has no known drug allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of descending colon,Perforation of intestine,Renal failure, unspecified,Atrial fibrillation,Anemia, unspecified,Adult failure to thrive,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance
Mal neo descend colon,Perforation of intestine,Renal failure NOS,Atrial fibrillation,Anemia NOS,Failure to thrive-adult,Alzheimer's disease,Dementia w/o behav dist
Admission Date:  [**2200-11-20**]       Discharge Date:  [**2200-11-28**]


Service:  General Surgery

HISTORY OF PRESENT ILLNESS:  This 88[**Hospital 4622**] nursing home
patient with a history of Alzheimer's type dementia was
transported to the [**Hospital1 **] Emergency Department
on [**2200-11-20**] for workup of fever, change in mental status and
increasing abdominal distention.  The patient, at that time,
was complaining of abdominal pain.

PAST MEDICAL HISTORY:  The patient has a history of dementia
and osteoarthritis.  Medications include Fosamax, a
multivitamin and Tylenol.  She has no known drug allergies.

PHYSICAL EXAMINATION:  Initially, the patient was afebrile at
98.8.  Heart rate was 94, blood pressure was 134/65 and
respiratory rate was 28.  The patient appeared lethargic and
ill appearing.  She was alert and oriented x1.  Her pupils
were equal, round and reactive.  Mucous membranes were dry.
Neck was supple with no jugular venous distention and no
lymphadenopathy.  Lungs were clear bilaterally.  Her cardiac
exam revealed a regular rate and rhythm with no murmurs, rubs
or gallops.  Her abdomen was mildly distended.  The patient
had diffuse abdominal tenderness with some guarding.  The
patient did have rebound tenderness.  Rectal exam revealed
normal tone and was guaiac positive.  Extremities revealed no
clubbing, cyanosis or edema.

LABORATORY VALUES OF NOTE:  The patient had a white blood
cell count of 17.8 with 47 bands.  Her hematocrit was 30.8
and platelets were 472,000.  Routine chemistries revealed
mild renal failure with BUN of 55 and creatinine of 1.3.
Serum glucose was 241.  The patient's urinalysis was
negative.  EKG revealed atrial fibrillation at a rate of 100.
Chest x-ray showed a small amount of free air under the
diaphragm.  The patient was evaluated by abdominal CT scan
which revealed free air in the abdomen and evidence of a
perforated viscus.

HOSPITAL COURSE:  The patient was taken urgently to the
operating room and underwent an exploratory laparotomy.
Findings revealed a perforated left colon and an area
consistent with colon cancer.  The patient had a left
colectomy and colostomy with [**Doctor Last Name 3379**] pouch.  The attending
surgeon was Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **].  First assistant was
Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 16059**].  The procedure was done under general
endotracheal anesthesia.  Estimated blood loss was 150 cc.
There were no complications.  The patient had been started on
Ceftriaxone and Flagyl preoperatively.  The patient was
extubated in the operating room and sent to the Surgical
Intensive Care Unit in stable condition.

While in the SICU, on postoperative day one, the patient was
heavily sedated and minimally responsive.  The patient's
clinical course improved and, on postoperative day one, in
the evening, she was sent to the floor.

Several days after the surgery, some culture data was
finalized.  It was found that the patient had a positive
blood culture for Clostridium perfringens and a positive
abdominal culture for Bacteroides, both of which were covered
by the Ceftriaxone and Flagyl.

On postoperative days two and three, the patient was
receiving tube feedings through her nasogastric tube.  On
postoperative day four, the patient's nasogastric tube was
discontinued.  The patient was seen by the Speech and Swallow
Service in consultation who indicated that the patient was
safe to drink thin liquids.  The patient's diet was advanced
to sips.  The patient was also seen on postoperative day four
by the Nutrition Service for her history of poor p.o. intake
and weight loss.  Nutrition recommended that she have a
pureed diet with aspiration precautions; additionally, that
the patient be given Boost for increased calorie intake.  By
postoperative day six, the patient was passing flatus by the
colostomy, and her diet was advanced to clear liquids.  On
postoperative day seven, the patient's diet was further
advanced to pureed solids.  However, the patient was not
taking a large amount of p.o. intake and a Nutrition
consultation was requested to do calorie counts.

The patient's antibiotic course ended after seven days of
Flagyl and Ceftriaxone.  By postoperative day eight, there
was a small amount of stool output from the colostomy.
Arrangements were made through Case Management for transfer
of the patient back to [**Hospital3 **].

Upon discharge, the patient is in stable condition and ready
to be returned to the rehabilitation home.

DISCHARGE DIAGNOSES:  1.  Colon cancer.  2.  Perforated
colon.  3.  Status post sigmoid colectomy with colostomy and
[**Doctor Last Name 3379**] pouch.  4.  Alzheimer's type dementia.  5.  Failure
to thrive.

DISCHARGE MEDICATIONS:  The patient was put on a seven day
course of Augmentin at 875 mg p.o. b.i.d., Tylenol 650 mg
p.o. q6-8 hours p.r.n. pain and K-Phos 2 tablets p.o. b.i.d.
through [**2200-11-30**].  The patient will also require enterostomal
care and assistance with feedings at [**Hospital3 **].

DISCHARGE DIET:  Pureed solids with Boost supplementation.

The patient will follow up with Dr. [**Last Name (STitle) **] in his office
in three weeks.  Staples were removed from the incision prior
to discharge.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 6066**]

Dictated By:[**Name8 (MD) 36637**]
MEDQUIST36

D:  [**2200-11-28**]  08:18
T:  [**2200-11-28**]  08:22
JOB#:  [**Job Number **]
{"Malignant neoplasm of descending colon,Perforation of intestine,Renal failure, unspecified,Atrial fibrillation,Anemia, unspecified,Adult failure to thrive,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance"}


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: 

PRESENT ILLNESS: This 88[**Hospital 4622**] nursing home
patient with a history of Alzheimer's type dementia was
transported to the [**Hospital1 **] Emergency Department
on [**2200-11-20**] for workup of fever, change in mental status and
increasing abdominal distention.  The patient, at that time,
was complaining of abdominal pain.

MEDICAL HISTORY: The patient has a history of dementia
and osteoarthritis.  Medications include Fosamax, a
multivitamin and Tylenol.  She has no known drug allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Malignant neoplasm of descending colon,Perforation of intestine,Renal failure, unspecified,Atrial fibrillation,Anemia, unspecified,Adult failure to thrive,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance"}
