CHIEF COMPLAINT: Abdominal pain, back pain, weakness, LE numbness, transfer for
cath to [**Hospital1 18**]

PRESENT ILLNESS: Briefly, this pt is a 77M with a history of NIDDM, HTN, who
presented to [**Hospital1 1474**] on [**10-19**] with the complaint of low back
pain, weakness/numbness in the legs, abdominal pain, and
constipation. The patient reports that he has had LBP for
several years, although it has gotten much worse in the last few
days. Pt endores a 40 lb weight loss over the past several
years, although he has not been trying to lose weight. The
patient also endorses dark/black stools, but reports no bloody
stools. The patient had not been taking any medications, and had
not seen his PCP in several years.
.
The patient was found to be profoundly anemic at the outside
hospital with a hematocrit of 23, potassium was 6.7. A CT scan
of the abdomen showed a 5-6cm area of very thickened colon with
luminal narrowing with several small adjacent lymph nodes. An
EKG was done which showed ST depressions in the precordial
leads. Tr was slightly elevated, CK-MB was flat. While it was
likely that the ST-T changes occurred in the setting of his
profound anemia with likely demand ischemia, the patient was
transferred to [**Hospital1 18**] for cardiac catheterization.

MEDICAL HISTORY: 1. NIDDM, not on meds
2. Low back pain

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission
GEN: thin disheveled man in NAD. Comfortable, lying in bed.
HEENT: anicteric, pink conjunctivae. PERRLA, EOMI, OP clear,
MMM, poor dentition.
NECK: supple. No LAD, JVD not assessed as lying flat.
COR: very distant heart sounds. No distinct murmur appreciated
CHEST: anterior exam reveals faint crackles in dependent fields.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits.
Malignant neoplasm of ascending colon,Other second degree atrioventricular block,Congestive heart failure, unspecified,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Family history of ischemic heart disease,Old myocardial infarction
Malig neo ascend colon,Av block-2nd degree NEC,CHF NOS,Prim pulm hypertension,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Cardiac dysrhythmias NEC,Hypertension NOS,Anemia NOS,Drug dermatitis NOS,History of tobacco use,Fam hx-ischem heart dis,Old myocardial infarct
Name:  [**Known lastname 11249**],[**Known firstname **] J                    Unit No:   [**Numeric Identifier 11250**]

Admission Date:  [**2122-10-22**]              Discharge Date:   [**2122-11-11**]

Date of Birth:  [**2045-5-16**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2800**]
Addendum:
He was unable to void s/p d/cing foley and he was sent to rehab
with a foley in place.

Brief Hospital Course:
He was unable to void s/p d/cing foley and he was sent to rehab
with a foley in place.

Discharge Disposition:
Extended Care

Facility:
[**Hospital 4426**] Rehab & Nursing Center - [**Hospital1 3983**]

                             [**First Name11 (Name Pattern1) 399**] [**Last Name (NamePattern4) 2801**] MD [**MD Number(1) 401**]

Completed by:[**2122-11-11**]

Admission Date:  [**2122-10-22**]              Discharge Date:   [**2122-11-11**]

Date of Birth:  [**2045-5-16**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Abdominal pain, back pain, weakness, LE numbness, transfer for
cath to [**Hospital1 18**]

Major Surgical or Invasive Procedure:
Cardiac catheterization
Right colectomy
Pacemaker placement


History of Present Illness:
Briefly, this pt is a 77M with a history of NIDDM, HTN, who
presented to [**Hospital1 1474**] on [**10-19**] with the complaint of low back
pain, weakness/numbness in the legs, abdominal pain, and
constipation. The patient reports that he has had LBP for
several years, although it has gotten much worse in the last few
days. Pt endores a 40 lb weight loss over the past several
years, although he has not been trying to lose weight. The
patient also endorses dark/black stools, but reports no bloody
stools. The patient had not been taking any medications, and had
not seen his PCP in several years.
.
The patient was found to be profoundly anemic at the outside
hospital with a hematocrit of 23, potassium was 6.7. A CT scan
of the abdomen showed a 5-6cm area of very thickened colon with
luminal narrowing with several small adjacent lymph nodes. An
EKG was done which showed ST depressions in the precordial
leads. Tr was slightly elevated, CK-MB was flat. While it was
likely that the ST-T changes occurred in the setting of his
profound anemia with likely demand ischemia, the patient was
transferred to [**Hospital1 18**] for cardiac catheterization.


Past Medical History:
1. NIDDM, not on meds
2. Low back pain


Social History:
lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits.

Family History:
Noncontributory

Physical Exam:
On Admission
GEN: thin disheveled man in NAD. Comfortable, lying in bed.
HEENT: anicteric, pink conjunctivae. PERRLA, EOMI, OP clear,
MMM, poor dentition.
NECK: supple. No LAD, JVD not assessed as lying flat.
COR: very distant heart sounds. No distinct murmur appreciated
CHEST: anterior exam reveals faint crackles in dependent fields.

ABD: soft, NT, ND. NABS. No masses or HSM appreciated
EXT: w/wp. No edema. DP pulses dopplerable
NEURO: AA&Ox3. CN II-XII intact. Sensory exam reveals decreased
sensation over great toe bilaterally. [**Last Name (un) 938**] strength decreased
symmetrically 4-/5. Dorsiflexion 4+/5 bilaterally.
Plantarflexion [**5-7**] bilaterally. Hip flexion not assessed as
patient lying flat after cath.


Pertinent Results:
[**2122-11-10**] 01:20PM BLOOD WBC-11.7* RBC-4.72 Hgb-12.4* Hct-37.9*
MCV-80* MCH-26.3* MCHC-32.8 RDW-16.5* Plt Ct-637*
[**2122-11-9**] 05:02AM BLOOD WBC-7.8 RBC-4.02* Hgb-10.9* Hct-32.9*
MCV-82 MCH-27.0 MCHC-33.0 RDW-16.6* Plt Ct-543*
[**2122-11-8**] 04:55AM BLOOD WBC-7.9 RBC-3.96* Hgb-10.8* Hct-32.6*
MCV-82 MCH-27.3 MCHC-33.1 RDW-16.4* Plt Ct-520*
[**2122-11-7**] 05:30AM BLOOD WBC-7.7 RBC-4.10* Hgb-11.0* Hct-33.3*
MCV-81* MCH-26.7* MCHC-33.0 RDW-16.4* Plt Ct-455*
[**2122-10-23**] 06:35AM BLOOD WBC-12.8* RBC-3.95* Hgb-10.2* Hct-31.3*
MCV-79* MCH-25.8* MCHC-32.6 RDW-16.4* Plt Ct-506*
[**2122-10-22**] 10:08PM BLOOD WBC-14.2* RBC-3.98* Hgb-10.3* Hct-31.6*
MCV-79* MCH-25.9* MCHC-32.6 RDW-16.3* Plt Ct-488*
[**2122-10-22**] 12:30PM BLOOD WBC-12.0* RBC-4.06* Hgb-10.3* Hct-32.6*
MCV-80* MCH-25.4* MCHC-31.7 RDW-16.4* Plt Ct-521*
[**2122-11-3**] 07:20AM BLOOD WBC-7.9 RBC-4.44*# Hgb-11.7*# Hct-35.0*
MCV-79* MCH-26.4* MCHC-33.5 RDW-16.0* Plt Ct-415
[**2122-11-2**] 10:00PM BLOOD Hct-35.0*
[**2122-11-2**] 11:30AM BLOOD Hct-32.2*
[**2122-11-2**] 06:35AM BLOOD WBC-8.2 RBC-3.38* Hgb-8.8* Hct-26.5*
MCV-78* MCH-26.0* MCHC-33.2 RDW-16.0* Plt Ct-392
[**2122-11-1**] 08:00AM BLOOD WBC-6.7 RBC-3.75* Hgb-9.8* Hct-29.9*
MCV-80* MCH-26.2* MCHC-32.9 RDW-16.3* Plt Ct-393
[**2122-10-30**] 02:06AM BLOOD WBC-8.7 RBC-3.84* Hgb-10.0* Hct-30.9*
MCV-80* MCH-25.9* MCHC-32.3 RDW-16.3* Plt Ct-458*
[**2122-10-29**] 06:10AM BLOOD WBC-11.2* RBC-4.24* Hgb-10.8* Hct-33.8*
MCV-80* MCH-25.5* MCHC-32.0 RDW-16.2* Plt Ct-507*
[**2122-11-10**] 01:20PM BLOOD PT-13.0 INR(PT)-1.1
[**2122-11-5**] 02:32AM BLOOD PT-14.1* PTT-34.2 INR(PT)-1.3
[**2122-11-3**] 07:20AM BLOOD PT-13.3 PTT-31.0 INR(PT)-1.2
[**2122-11-2**] 06:35AM BLOOD PT-14.0* PTT-41.2* INR(PT)-1.3
[**2122-11-1**] 08:00AM BLOOD PT-14.0* PTT-33.5 INR(PT)-1.3
[**2122-10-31**] 06:18AM BLOOD PT-13.5* PTT-33.9 INR(PT)-1.2
[**2122-10-25**] 05:41AM BLOOD PT-13.8* PTT-29.4 INR(PT)-1.3
[**2122-10-22**] 12:30PM BLOOD PT-14.7* PTT-30.0 INR(PT)-1.5
[**2122-11-10**] 01:20PM BLOOD Glucose-123* UreaN-6 Na-139 K-4.5 Cl-103
HCO3-28 AnGap-13
[**2122-11-9**] 05:02AM BLOOD Glucose-87 UreaN-6 Creat-0.8 Na-138 K-4.0
Cl-104 HCO3-26 AnGap-12
[**2122-11-8**] 04:55AM BLOOD Glucose-100 UreaN-5* Creat-0.7 Na-138
K-4.4 Cl-103 HCO3-24 AnGap-15
[**2122-11-7**] 05:30AM BLOOD Glucose-138* UreaN-6 Creat-0.6 Na-137
K-3.9 Cl-103 HCO3-26 AnGap-12
[**2122-11-6**] 06:35AM BLOOD Glucose-192* UreaN-9 Creat-0.8 Na-136
K-4.5 Cl-103 HCO3-25 AnGap-13
[**2122-11-5**] 02:32AM BLOOD Glucose-81 UreaN-8 Creat-0.8 Na-137 K-4.4
Cl-104 HCO3-21* AnGap-16
[**2122-10-25**] 05:10PM BLOOD Glucose-127* UreaN-14 Creat-0.9 Na-136
K-4.4 Cl-101 HCO3-21* AnGap-18
[**2122-10-25**] 05:41AM BLOOD Glucose-108* UreaN-15 Creat-1.0 Na-140
K-4.3 Cl-101 HCO3-26 AnGap-17
[**2122-10-24**] 05:58AM BLOOD Glucose-148* UreaN-17 Creat-1.1 Na-139
K-4.1 Cl-104 HCO3-24 AnGap-15
[**2122-10-23**] 06:35AM BLOOD Glucose-172* UreaN-18 Creat-0.9 Na-140
K-4.2 Cl-103 HCO3-21* AnGap-20
[**2122-10-22**] 12:30PM BLOOD Glucose-156* UreaN-22* Creat-1.0 Na-142
K-4.1 Cl-107 HCO3-24 AnGap-15
[**2122-11-4**] 08:21AM BLOOD CK(CPK)-57
[**2122-11-3**] 04:21PM BLOOD CK(CPK)-46
[**2122-10-26**] 05:30AM BLOOD TotBili-1.1
[**2122-10-25**] 05:41AM BLOOD ALT-18 AST-17 LD(LDH)-258* AlkPhos-92
TotBili-1.2
[**2122-10-24**] 05:58AM BLOOD CK(CPK)-50
[**2122-10-23**] 06:35AM BLOOD ALT-33 AST-16 LD(LDH)-231 AlkPhos-96
TotBili-1.9*
[**2122-10-22**] 12:30PM BLOOD ALT-45* AST-27 AlkPhos-99 TotBili-1.9*
[**2122-11-4**] 08:21AM BLOOD CK-MB-NotDone cTropnT-0.22*
[**2122-11-3**] 11:52PM BLOOD CK-MB-NotDone cTropnT-0.26*
[**2122-11-3**] 04:21PM BLOOD CK-MB-NotDone cTropnT-0.26*
[**2122-11-9**] 05:02AM BLOOD Calcium-7.8* Phos-2.4* Mg-1.8
[**2122-11-8**] 04:55AM BLOOD Calcium-7.4* Phos-2.4* Mg-1.8
[**2122-11-6**] 06:35AM BLOOD Calcium-7.5* Phos-2.5* Mg-2.0
[**2122-11-5**] 02:32AM BLOOD Calcium-8.0* Phos-3.6 Mg-1.9
[**2122-10-25**] 05:10PM BLOOD Calcium-7.7* Phos-2.6* Mg-2.0
[**2122-11-5**] 02:54AM BLOOD Type-ART pO2-81* pCO2-41 pH-7.36
calHCO3-24 Base XS--1
[**2122-11-4**] 06:12AM BLOOD Type-ART pO2-123* pCO2-40 pH-7.36
calHCO3-24 Base XS--2
[**2122-11-3**] 03:26PM BLOOD Type-ART pO2-361* pCO2-31* pH-7.44
calHCO3-22 Base XS--1
[**2122-10-22**] 12:40PM BLOOD Type-ART O2 Flow-2 pO2-79* pCO2-37
pH-7.42 calHCO3-25 Base XS-0 Comment-NC
[**2122-10-22**] 12:16PM BLOOD Type-ART pO2-68* pCO2-37 pH-7.41
calHCO3-24 Base XS-0
[**2122-11-3**] 03:26PM BLOOD Glucose-133* Lactate-1.5 Na-136 K-3.9
Cl-109
[**2122-11-5**] 02:54AM BLOOD freeCa-1.21

Brief Hospital Course:
After transfer pt underwent cardiac cath.  Found severe 3 vessel
disease - no intervention undertaken.  EF was 20-30%.  Decision
was made to have colectomy to avoid further blood loss.  ECG
showed wenkebach heart block.  Pacemaker was placed on [**10-29**]
without complications for block. Swan was placed in cath lab on
[**10-29**] and pt was tx to CCU for obs afterwards.   O/N he had temp
to 101.4.  Started on Levo/Flag/vanc.  Surgery was postponed.
Swan was pulled and he was sent back to the med service.  AM
[**2122-11-3**] he had swan put in and then underwent R colectomy w/o
complications.  Went to ICU post op for monitoring.  He was
given fluids post-op did well, diet was advanced as tol, pain
was well controlled.  On [**11-10**] he had a perm pacemaker put in by
EP  He had a BM on [**2122-11-11**] and had his foley cath removed.  EP
adjusted pacemaker as needed throughout visit.  He was in good
condition for d/c to rehab on [**2122-11-11**].

Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
2. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
4. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed.
6. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Medications
Insulin sliding scale


Discharge Disposition:
Extended Care

Facility:
[**Hospital 66**] Rehab & Nursing Center - [**Hospital1 392**]

Discharge Diagnosis:
Colon Mass
Coronary artery disease
Non insulin dependent diabetes
Hypertension

Discharge Condition:
Good


Discharge Instructions:
If you have fever >101, severe pain, persistent diarrhea or
vomiting, blood or discharge draining from wound, or anything
that causes you concern, please call or return.
Follow-up with heme-onc
Follow-up with Dr. [**First Name (STitle) **]

Followup Instructions:
Call Dr. [**First Name (STitle) **] for an appointment ([**Telephone/Fax (1) 3618**]
Call hematology and oncology for an appointment ([**Telephone/Fax (1) 14703**]
Provider: [**Last Name (NamePattern4) **]. [**First Name11 (Name Pattern1) 275**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Phone:[**Telephone/Fax (1) 2207**]
Date/Time:[**2122-11-23**] 2:00
{'Malignant neoplasm of ascending colon,Other second degree atrioventricular block,Congestive heart failure, unspecified,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Family history of ischemic heart disease,Old myocardial infarction'}


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, back pain, weakness, LE numbness, transfer for
cath to [**Hospital1 18**]

PRESENT ILLNESS: Briefly, this pt is a 77M with a history of NIDDM, HTN, who
presented to [**Hospital1 1474**] on [**10-19**] with the complaint of low back
pain, weakness/numbness in the legs, abdominal pain, and
constipation. The patient reports that he has had LBP for
several years, although it has gotten much worse in the last few
days. Pt endores a 40 lb weight loss over the past several
years, although he has not been trying to lose weight. The
patient also endorses dark/black stools, but reports no bloody
stools. The patient had not been taking any medications, and had
not seen his PCP in several years.
.
The patient was found to be profoundly anemic at the outside
hospital with a hematocrit of 23, potassium was 6.7. A CT scan
of the abdomen showed a 5-6cm area of very thickened colon with
luminal narrowing with several small adjacent lymph nodes. An
EKG was done which showed ST depressions in the precordial
leads. Tr was slightly elevated, CK-MB was flat. While it was
likely that the ST-T changes occurred in the setting of his
profound anemia with likely demand ischemia, the patient was
transferred to [**Hospital1 18**] for cardiac catheterization.

MEDICAL HISTORY: 1. NIDDM, not on meds
2. Low back pain

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission
GEN: thin disheveled man in NAD. Comfortable, lying in bed.
HEENT: anicteric, pink conjunctivae. PERRLA, EOMI, OP clear,
MMM, poor dentition.
NECK: supple. No LAD, JVD not assessed as lying flat.
COR: very distant heart sounds. No distinct murmur appreciated
CHEST: anterior exam reveals faint crackles in dependent fields.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits. 

### Response:
{'Malignant neoplasm of ascending colon,Other second degree atrioventricular block,Congestive heart failure, unspecified,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Anemia, unspecified,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Family history of ischemic heart disease,Old myocardial infarction'}
