CHIEF COMPLAINT: The patient presents for resection of a known duodenal mass

PRESENT ILLNESS: Mr. [**Known lastname **] is a delightful, 68-year-old gentleman who had a
duodenal
adenocarcinoma identified by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on endoscopy.
This was biopsy proven. The patient had also suffered a
myocardial ischemic insult in late [**2113**] and has been placed on
anticoagulants, following successful deployment of a
coronary artery stent.

MEDICAL HISTORY: CAD
- s/p POBA of LAD '[**12**]
- s/p [**Year (2 digits) **] (Taxus) to mid LAD [**2114-10-26**]
- s/p re-look angiography [**2114-11-5**]
Asthma
COPD
HTN
Remote history of a fractured ankle
S/P hernia repair
S/P appendectomy
H/O kidney stones s/p lithotripsy
Sleep apnea
RBBB
H/O Beryllium exposure in [**2065**]

MEDICATION ON ADMISSION: Plavix 75', ASA 325', quinapril 40', HCTZ 25', Lasix 40',
amlodipine 5', Singulair 10', Zocor 20', albuterol 90 q4prn,
advair 250-50", ativan 0.5 prn, simvastatin 20', iron 325'

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: On day of admission:
Gen: alert and oriented
CVS: RRR
Pulm: CTA b/l
Abd: s/nt/nd/no masses palpable
Ext: no peripheral edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives w/wife, quit smoking 30 years ago drinks 4x/week ([**11-24**]
drinks).
.
CARDIAC RISK FACTORS:: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension
Malignant neoplasm of duodenum,Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Chronic cholecystitis,Anemia, unspecified,Morbid obesity,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants
Malignant neopl duodenum,Gastrointest hemorr NOS,Chronic obst asthma NOS,Chronic cholecystitis,Anemia NOS,Morbid obesity,Sleep apnea NOS,Crnry athrscl natve vssl,Status-post ptca,Long-term use anticoagul
Admission Date:  [**2114-12-28**]              Discharge Date:   [**2115-1-5**]

Date of Birth:  [**2046-12-4**]             Sex:   M

Service: SURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
The patient presents for resection of a known duodenal mass

Major Surgical or Invasive Procedure:
1. Pylorus-preserving pancreaticoduodenectomy (Whipple's
    procedure).
2. Open cholecystectomy.

History of Present Illness:
Mr. [**Known lastname **] is a delightful, 68-year-old gentleman who had a
duodenal
adenocarcinoma identified by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on endoscopy.
This was biopsy proven. The patient had also suffered a
myocardial ischemic insult in late [**2113**] and has been placed on
anticoagulants, following successful deployment of a
coronary artery stent.

Past Medical History:
CAD
- s/p POBA of LAD '[**12**]
- s/p [**Year (2 digits) **] (Taxus) to mid LAD [**2114-10-26**]
- s/p re-look angiography [**2114-11-5**]
Asthma
COPD
HTN
Remote history of a fractured ankle
S/P hernia repair
S/P appendectomy
H/O kidney stones s/p lithotripsy
Sleep apnea
RBBB
H/O Beryllium exposure in [**2065**]

Social History:
Lives w/wife, quit smoking 30 years ago drinks 4x/week ([**11-24**]
drinks).
.
CARDIAC RISK FACTORS:: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension


Social History:
Lives w/wife, quit smoking 30 years ago drinks 4x/week ([**11-24**]
drinks).



Family History:
Non-contributory.

Physical Exam:
On day of admission:
Gen: alert and oriented
CVS: RRR
Pulm: CTA b/l
Abd: s/nt/nd/no masses palpable
Ext: no peripheral edema

Pertinent Results:
[**2114-12-28**] 05:46PM   GLUCOSE-159* UREA N-15 CREAT-1.1 SODIUM-141
POTASSIUM-3.9 CHLORIDE-108 TOTAL CO2-25 ANION GAP-12
[**2114-12-28**] 05:46PM   CALCIUM-8.5 PHOSPHATE-3.8 MAGNESIUM-1.4*
[**2114-12-28**] 05:46PM   WBC-7.8 RBC-3.71* HGB-9.7* HCT-29.0* MCV-78*
MCH-26.3*# MCHC-33.6 RDW-18.8*
[**2114-12-28**] 05:46PM   PLT COUNT-218
[**2114-12-28**] 05:46PM   PT-14.1* INR(PT)-1.2*
[**2114-12-28**] 05:45PM   TYPE-ART PO2-133* PCO2-40 PH-7.40 TOTAL
CO2-26 BASE XS-0
[**2114-12-28**] 05:45PM   freeCa-1.20
.
Cardiology Report ECG Study Date of [**2114-12-30**]  8:11:58 PM

Sinus rhythm. Right bundle-branch block. Compared to the
previous tracing
there is no significant change.

Intervals Axes
Rate PR QRS QT/QTc P QRS T
85 150 148 390/433 36 -5 64

Pathology pending




Brief Hospital Course:
The patient underwent the above procedure and tolerated it well.
 He remained intubated following the procedure and was
transferred to the the ICU.  He had IVF for hydration, NGT and
foley catheter in place, with prn sedation.

[**12-29**] - the patient was successfully extubated, remained NPO with
IVF for hydration, PCA for pain control, NGT and foley in place,
transferred to the surgical floor for continued monitoring,
started on ASA per rectum and hep gtt at 500

[**12-30**] - continued hep gtt, NGT removed. Experienced mild nausea.
pain controlled.

[**12-31**] - diet advanced to sips, peripheral line placed, central
line removed, foley catheter removed at midnight, started
plavix, discontinued heparin drip. Single, brief episode of (L)
sided chest pain without radiation, dizziness, lightheadedness.
AVSS. EKG NSR w/o changes. CK 194, MB1, Troponin <0.1, HCT 28.9,
PTT 30.6. Sx resolved with Zofran. No further episodes of Chest
pain.

[**1-1**] - CVL discontinued, PIV placed. Diet advanced to clears
with c/o mild bloating, gassiness, relieved with stool
softeners. Pain remained well controlled. JP contined putting
out >400cc. JP amylase on [**1-2**] was 87.

[**1-3**] - Diet advanced to regular with good tolerability. (+)
flatus, but no bowel movement. Bowel regimen started. Pain
remained well controlled. Ambulating without assist. JP output
>350.

[**1-4**] - Patient experienced crampy abdominal pain in the morning,
but improved when patient got back on more routine schedule with
pain medication.  Tolerated diet w/o N/V. Ambulating with steady
gait. Improved activity tolerance.

[**1-5**] - At the time of discharge, the patient was doing well,
afebrile with stable vital signs.  The patient was tolerating a
regular diet, ambulating, voiding without assistance, and pain
was well controlled.  JP remained indwelling due to output >300.
Patient to go home with VNA services to manage and teach JP
care. During hospitalization, patient required regular sliding
scale insulin coverage for blood sugars in the 150-250 range.
Patient received insulin administration and glucose monitoring
teaching with good understanding. VNA will reinforce and monitor
insulin management as an outpatient.


Medications on Admission:
Plavix 75', ASA 325', quinapril 40', HCTZ 25', Lasix 40',
amlodipine 5', Singulair 10', Zocor 20', albuterol 90 q4prn,
advair 250-50", ativan 0.5 prn, simvastatin 20', iron 325'


Discharge Medications:
1. Plavix 75 mg Tablet Sig: One (1) Tablet PO at bedtime.
2. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Quinapril 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*2*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
9. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
10. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhlation Inhalation [**Hospital1 **] (2 times a day).
12. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q4H (every 4 hours) as needed.
13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
14. Zocor 20 mg Tablet Sig: One (1) Tablet PO at bedtime.
15. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for anxiety.
16. One Touch Ultra System Kit     Kit Sig: One (1) kit
Miscellaneous n/a.
Disp:*1 kit* Refills:*0*
17. One Touch UltraSoft Lancets     Misc Sig: n/a  Miscellaneous
n/a.
Disp:*1 box* Refills:*2*
18. One Touch Ultra Test     Strip Sig: n/a  In [**Last Name (un) 5153**] Test as
directed ACHS.
Disp:*100 test strips* Refills:*2*
19. Insulin Syringe-Needle U-100 [**11-23**] mL 29 x [**11-23**]  Syringe Sig:
n/a  Miscellaneous n/a: As directed for insulin injections.
Disp:*1 box* Refills:*0*
20. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ACHS PRN: Administer subcutaneously as directed per
insulin sliding scale.
Disp:*1 vial* Refills:*1*
21. Regular Insulin Sliding Scale
Fingerstick ACHS Regular Insulin SC Sliding Scale:

Glucose         Insulin Dose
0-60     mg/dL  ***[**Name8 (MD) **] M.D. immediately***
                Breakfast  Lunch   Dinner   Bedtime
61-120   mg/dL  0 Units  0 Units  0 Units  0 Units
121-150  mg/dL  2 Units  2 Units  2 Units  0 Units
151-180  mg/dL  4 Units  4 Units  4 Units  4 Units
181-210  mg/dL  6 Units  6 Units  6 Units  6 Units
211-240  mg/dL 10 Units 10 Units 10 Units  8 Units
241-280  mg/dL 12 Units 12 Units 12 Units 10 Units
> 280   mg/dL ***Notify M.D.immediately***


Discharge Disposition:
Home With Service

Facility:
Bayoda  VNA

Discharge Diagnosis:
1. Duodenal cancer.
2. Gastrointestinal bleeding with recurrent anemia.
3. Myocardial ischemia, status post coronary artery stent.
4. Severe obesity.
5. Sleep apnea.
6. Asthma
7. Hypertension


Discharge Condition:
Good


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons. Signs of dehydration include dry
mouth, rapid heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.

*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.

*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.

.

Incision Care:
-Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
.
JP Tube Monitoring/Care:
*Monitor for redness, increased drainage, bleeding, pus,
swelling, or pain at insertion site; if occurs, notify your VNA
nurse or call your doctor immediately.
*Keep area clean and dry. [**Month (only) 116**] place a gauze dressing over area
if some drainage continues. Your VNA nurse [**First Name (Titles) **] [**Last Name (Titles) 8146**] you on
specific care.


Followup Instructions:
Please call the office of Dr. [**Last Name (STitle) 468**] to arrange a follow up
appointment in 2 weeks at [**Telephone/Fax (1) 2835**]
{'Malignant neoplasm of duodenum,Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Chronic cholecystitis,Anemia, unspecified,Morbid obesity,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants'}


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: The patient presents for resection of a known duodenal mass

PRESENT ILLNESS: Mr. [**Known lastname **] is a delightful, 68-year-old gentleman who had a
duodenal
adenocarcinoma identified by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on endoscopy.
This was biopsy proven. The patient had also suffered a
myocardial ischemic insult in late [**2113**] and has been placed on
anticoagulants, following successful deployment of a
coronary artery stent.

MEDICAL HISTORY: CAD
- s/p POBA of LAD '[**12**]
- s/p [**Year (2 digits) **] (Taxus) to mid LAD [**2114-10-26**]
- s/p re-look angiography [**2114-11-5**]
Asthma
COPD
HTN
Remote history of a fractured ankle
S/P hernia repair
S/P appendectomy
H/O kidney stones s/p lithotripsy
Sleep apnea
RBBB
H/O Beryllium exposure in [**2065**]

MEDICATION ON ADMISSION: Plavix 75', ASA 325', quinapril 40', HCTZ 25', Lasix 40',
amlodipine 5', Singulair 10', Zocor 20', albuterol 90 q4prn,
advair 250-50", ativan 0.5 prn, simvastatin 20', iron 325'

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: On day of admission:
Gen: alert and oriented
CVS: RRR
Pulm: CTA b/l
Abd: s/nt/nd/no masses palpable
Ext: no peripheral edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives w/wife, quit smoking 30 years ago drinks 4x/week ([**11-24**]
drinks).
.
CARDIAC RISK FACTORS:: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension 

### Response:
{'Malignant neoplasm of duodenum,Hemorrhage of gastrointestinal tract, unspecified,Chronic obstructive asthma, unspecified,Chronic cholecystitis,Anemia, unspecified,Morbid obesity,Unspecified sleep apnea,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants'}
