CHIEF COMPLAINT: Pelvic mass

PRESENT ILLNESS: The patient is a 78 y.o. female who was referred for a 12.3 X 9
cm pelvic mass seen on CT [**2154-11-25**]. She has a h/o small bowel
obstruction in 8/99. At that time she underwent small bowel
resection and was found to have a gastrointestinal stromal tumor
of high malignant potential. She then developed liver recurrence
in [**2149**]. She was treated with chemoembolization and
radiofrequency ablation. She has currently been on Gleevac and
has a generally stable tumor in the liver. She presented to the
gynecology/oncology team for surgical management.

MEDICAL HISTORY: PMH: COPD, Bronchitis, SBO, gastrointestinal stroma tumor, gout,
portal HTN
PSH: Small bowel sarcoma s/p resection (99/01), mastecomy in
[**2152**] (pathology benign), partial liver resection [**2150**].
Gyn History: Last pap smear unknown. Last mammogram was normal
last year.
OB History: Negative

MEDICATION ON ADMISSION: Gleevac, Inderal, Diovan HCT, Ranitidine, Quinine sulfate,
Allopurinol, Iron pills, Combivant, Advair.

ALLERGIES: Aspirin

PHYSICAL EXAM: HEENT: sclerae anicteric, no LAD.
Lungs: scattered expiratory wheezes and distant breath sounds.
CV: RRR, no murmurs.
Breasts: no masses.
Abd: soft, NT, suggestion of a mass in the lower abdomen which
was difficult to define.
Pelvic exam: Normal vulva, vagina and cervix. Bimanual and
rectovaginal examination revealed a suggestion of a large pelvic
mass which again was difficult to define. This mass seemed to be
more anterior and high up in the pelvis. The rectum was
intrinsically normal and there was no cul-de-sac nodularity. The
uterus and adnexa were not separately palpable.
Extremities without edema.

FAMILY HISTORY: Brother with pancreatic cancer.

SOCIAL HISTORY: The patient does not smoke, but she is a former heavy smoker who
quit in [**2147**]. She drinks occasionally.
Secondary malignant neoplasm of other specified sites,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Candidiasis of other urogenital sites,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Diarrhea,Delirium due to conditions classified elsewhere,Other nonspecific abnormal serum enzyme levels
Secondary malig neo NEC,Acute kidney failure NOS,Chr airway obstruct NEC,Peritoneal adhesions,Candidias urogenital NEC,Hx of GI malignancy NOS,Diarrhea,Delirium d/t other cond,Abn serum enzy level NEC
Admission Date:  [**2154-12-16**]              Discharge Date:   [**2154-12-24**]

Date of Birth:  [**2076-3-19**]             Sex:   F

Service: OBSTETRICS/GYNECOLOGY

Allergies:
Aspirin

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

Major Surgical or Invasive Procedure:
Exploratory Laparotomy
Pelvic washings
Extensive lysis of adhesions
Radical resection of pelvic mass
Total abdominal hysterectomy
Bilateral salpingo-oophorectomy


History of Present Illness:
The patient is a 78 y.o. female who was referred for a 12.3 X 9
cm pelvic mass seen on CT [**2154-11-25**]. She has a h/o small bowel
obstruction in 8/99. At that time she underwent small bowel
resection and was found to have a gastrointestinal stromal tumor
of high malignant potential. She then developed liver recurrence
in [**2149**]. She was treated with chemoembolization and
radiofrequency ablation. She has currently been on Gleevac and
has a generally stable tumor in the liver. She presented to the
gynecology/oncology team for surgical management.

Past Medical History:
PMH: COPD, Bronchitis, SBO, gastrointestinal stroma tumor, gout,
portal HTN
PSH: Small bowel sarcoma s/p resection (99/01), mastecomy in
[**2152**] (pathology benign), partial liver resection [**2150**].
Gyn History: Last pap smear unknown. Last mammogram was normal
last year.
OB History: Negative

Social History:
The patient does not smoke, but she is a former heavy smoker who
quit in [**2147**]. She drinks occasionally.

Family History:
Brother with pancreatic cancer.

Physical Exam:
HEENT: sclerae anicteric, no LAD.
Lungs: scattered expiratory wheezes and distant breath sounds.
CV: RRR, no murmurs.
Breasts: no masses.
Abd: soft, NT, suggestion of a mass in the lower abdomen which
was difficult to define.
Pelvic exam: Normal vulva, vagina and cervix. Bimanual and
rectovaginal examination revealed a suggestion of a large pelvic
mass which again was difficult to define. This mass seemed to be
more anterior and high up in the pelvis. The rectum was
intrinsically normal and there was no cul-de-sac nodularity. The
uterus and adnexa were not separately palpable.
Extremities without edema.

Pertinent Results:
[**2154-12-16**] 11:57AM   WBC-4.2 RBC-3.46* HGB-10.9* HCT-32.3* MCV-93#
MCH-31.5 MCHC-33.8 RDW-15.1
[**2154-12-16**] 11:57AM   NEUTS-85* BANDS-0 LYMPHS-9* MONOS-4 EOS-2
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2154-12-16**] 11:57AM   ALBUMIN-2.4* CALCIUM-8.6 PHOSPHATE-5.8*#
MAGNESIUM-1.1*
[**2154-12-16**] 11:57AM   CK-MB-5 cTropnT-0.02*
[**2154-12-16**] 11:57AM   CK(CPK)-116
[**2154-12-16**] 11:57AM   GLUCOSE-184* UREA N-41* CREAT-1.6* SODIUM-137
POTASSIUM-4.5 CHLORIDE-109* TOTAL CO2-21* ANION GAP-12
[**2154-12-16**] 10:11PM   FIBRINOGE-271
[**2154-12-16**] 10:11PM   PLT COUNT-151
[**2154-12-16**] 10:11PM   PTT-24.4
[**2154-12-16**] 10:11PM   HCT-30.9*
[**2154-12-16**] 10:11PM   MAGNESIUM-2.6
[**2154-12-16**] 10:11PM   CK-MB-10 MB INDX-3.2 cTropnT-0.02*
[**2154-12-16**] 10:11PM   CK(CPK)-312*
[**2154-12-16**] 10:11PM   UREA N-41* CREAT-1.6* SODIUM-139
POTASSIUM-5.1

Brief Hospital Course:
On [**2154-12-16**] the patient underwent an exploratory laparotomy,
total abdominal hysterectomy, bilateral salpingo-oophorectomy,
radical resection of a pelvic mass, extensive lysis of
adhesions, and RIJ placement. She received 4500 LR and 3 units
PRBCs intraoperatively for a 1500ml blood loss. She also
experienced three episodes of desaturation to 73%.
Intraoperative findings included a large left adnexal mass with
extensive adhesions.  The mass was found to be sarcoma on frozen
section. Final pathology is pending.

Post-operative course:
HEME: The patient had a pre-operative HCT of 27, she received 2u
PRBC's intraoperatively for a ~1500 ml blood loss.  On POD#1 she
received an additional u PRBC for a HCT of 26.4. An additional 1
u PRBC (for a total of 5 units) was given on POD #2 for a HCT of
28.9. This raised her HCT to 35.5. It remained stable for the
remainder of her hospital stay.
Neuro: The patient became disoriented following the operation.
On POD #1 she was put on soft restraints to prevent her from
pulling out her lines. She was transferred to the unit on POD#1.
She was treated with Haldol for agitation.  Her pain continued
to be controlled with Dilaudid. Her agitation was felt to be due
to post-op delirium with pain medications from surgery and
resolved on POD#2 with minimization of narcotics. She was
transitioned to oral Oxycodone from Dilaudid on POD#3.
Respiratory: The patient had three episodes of acute
desaturation during the operation. She was maintained on
supplemental O2 post-operatively and her respiratoy status
remained stable. She had course breath sounds bilaterally and a
chest X-ray performed on POD #1 showed fluid overload she was
treated with Lasix. Incentive spirometry and aggressive
pulmonary toilet were encouraged. She also received chest PT.
The patient remained on home medications of Advair and Combivent
for her history of COPD.
Cardiovascular: Cardiac enzymes were checked post-operatively
due to the intra-operative desaturations and she ruled out for a
myocardial infarction. The patient had 2 episodes of rapid
ectopic beats on POD #2; these were asymptomatic and electolytes
were wnl. An echo showed likely normal LV systolic function,
trace aortic regurgitation, slightly thickened mitral valve with
mild mitral regurgitation and pulmonary artery hypertension.
Renal: The patient had low urine output post-operatively. She
was thought to have acute-on-chronic renal failure, with an FeNa
of <1%. Her urine ouput increased on POD #2 with administration
of fluids and Lasix. A urine analysis and culture were sent and
found to be positive for yeast. The patient was started on
fluconazole.  Her foley was D/C'd on POD#5 and the patient
experienced nocturia, similar to the symptoms she had prior to
the operation.
Gastrointestinal: The patient was started on a diet of clear
fluids and it was advanced as tolerated. She began experiencing
diarrhea over night on POD #3. Her C. Diff toxin was negative.
The diarrhea resolved on POD #6. The patient was found to be
slightly jaundiced with elevated LFT's on POD#4. These resolved
over her hospital course. The LFT elevation was thought to be
consistent with a brief hemolytic picture.

The patient's incision remained clean, dry and intact. By the
time of discharge the patient was tolerating a regular diet,
ambulating with assistance, voiding spontaneously, passing
flatus, and her pain was well-controlled.

Medications on Admission:
Gleevac, Inderal, Diovan HCT, Ranitidine, Quinine sulfate,
Allopurinol, Iron pills, Combivant, Advair.

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
2. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-8**]
Puffs Inhalation [**Hospital1 **] (2 times a day) as needed.
5. Quinine Sulfate 325 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
6. Albuterol Sulfate 0.083 % Solution Sig: [**12-8**]  Inhalation Q4-6H
(every 4 to 6 hours) as needed.
7. Imatinib Mesylate 100 mg Tablet Sig: Two (2) Tablet PO QAM
(once a day (in the morning)) as needed for sarcoma.
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
Two (2) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
9. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 14 days.
Disp:*14 Tablet(s)* Refills:*0*
10. Propranolol HCl 80 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
11. Valsartan 80 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
12. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
13. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Rehab & Nursing Center - [**Location (un) 47**]

Discharge Diagnosis:
Pelvic mass


Discharge Condition:
Good

Discharge Instructions:
1) No heavy lifting, exercise or intercourse for 8 weeks.
2) No Driving for 2 weeks.
3) Please call your doctor if you experience fever/chills,
nausea/vomiting, increasing abdominal pain, or other symptoms
that are concerning to you.

Followup Instructions:
1) Please call Dr.[**Name (NI) 2989**] office to have your staples removed in
1 week.

2) Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] B. GYN ONC PPS (SB) Where: GYN ONC PPS
(SB) Date/Time:[**2155-1-22**] 2:00

3) Provider: [**Name10 (NameIs) **] SCAN Where: [**Hospital6 29**] RADIOLOGY
Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2155-3-24**] 9:30

4) Provider: [**First Name11 (Name Pattern1) 396**] [**Last Name (NamePattern4) 397**], MD Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2155-3-24**] 10:30
{'Secondary malignant neoplasm of other specified sites,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Candidiasis of other urogenital sites,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Diarrhea,Delirium due to conditions classified elsewhere,Other nonspecific abnormal serum enzyme levels'}


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: The patient is a 78 y.o. female who was referred for a 12.3 X 9
cm pelvic mass seen on CT [**2154-11-25**]. She has a h/o small bowel
obstruction in 8/99. At that time she underwent small bowel
resection and was found to have a gastrointestinal stromal tumor
of high malignant potential. She then developed liver recurrence
in [**2149**]. She was treated with chemoembolization and
radiofrequency ablation. She has currently been on Gleevac and
has a generally stable tumor in the liver. She presented to the
gynecology/oncology team for surgical management.

MEDICAL HISTORY: PMH: COPD, Bronchitis, SBO, gastrointestinal stroma tumor, gout,
portal HTN
PSH: Small bowel sarcoma s/p resection (99/01), mastecomy in
[**2152**] (pathology benign), partial liver resection [**2150**].
Gyn History: Last pap smear unknown. Last mammogram was normal
last year.
OB History: Negative

MEDICATION ON ADMISSION: Gleevac, Inderal, Diovan HCT, Ranitidine, Quinine sulfate,
Allopurinol, Iron pills, Combivant, Advair.

ALLERGIES: Aspirin

PHYSICAL EXAM: HEENT: sclerae anicteric, no LAD.
Lungs: scattered expiratory wheezes and distant breath sounds.
CV: RRR, no murmurs.
Breasts: no masses.
Abd: soft, NT, suggestion of a mass in the lower abdomen which
was difficult to define.
Pelvic exam: Normal vulva, vagina and cervix. Bimanual and
rectovaginal examination revealed a suggestion of a large pelvic
mass which again was difficult to define. This mass seemed to be
more anterior and high up in the pelvis. The rectum was
intrinsically normal and there was no cul-de-sac nodularity. The
uterus and adnexa were not separately palpable.
Extremities without edema.

FAMILY HISTORY: Brother with pancreatic cancer.

SOCIAL HISTORY: The patient does not smoke, but she is a former heavy smoker who
quit in [**2147**]. She drinks occasionally. 

### Response:
{'Secondary malignant neoplasm of other specified sites,Acute kidney failure, unspecified,Chronic airway obstruction, not elsewhere classified,Peritoneal adhesions (postoperative) (postinfection),Candidiasis of other urogenital sites,Personal history of malignant neoplasm of gastrointestinal tract, unspecified,Diarrhea,Delirium due to conditions classified elsewhere,Other nonspecific abnormal serum enzyme levels'}
