CHIEF COMPLAINT: Recurrent gastrointestinal stromal tumor.

PRESENT ILLNESS: Mrs [**Known lastname 13755**] is s/p GIST resection in [**2143**] and was subsequently
treated with Gleevec [**Date range (1) 13756**], [**7-19**]-present. Recently she
has had some evidence of tumor
recurrence on a CT performed in [**2151-6-14**].  This was treated
with increasing doses of Gleevec, which she tolerated
marginally.  The growth has enlarged to some degree and options
were discussed the patient and she ultimately elected to undergo
surgery to have this removed.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

MEDICATION ON ADMISSION: Gleevec 400', Amiodarone 200', furosemide 80', levothyroxine 200
mcg', imatinib 400', potassium, warfarin with a goal INR of [**2-15**],
zolpidem PRN, docusate/senna prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: NAD, AOx3
CVS: RRR, no m/r/g
Resp: CTAB
Abd: soft, non distended, appropriately tender over surgical
incision. Incision c/d/i
Ext: WWP

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative
Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemoperitoneum (nontraumatic),Paralytic ileus,Malignant neoplasm of connective and other soft tissue of abdomen,Chronic systolic heart failure,Morbid obesity,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Hypovolemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other late effects of cerebrovascular disease,Dermatitis due to drugs and medicines taken internally,Muscle weakness (generalized),Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Personal history of antineoplastic chemotherapy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Sec mal neo peritoneum,Hemoperitoneum,Paralytic ileus,Mal neo soft tis abdomen,Chr systolic hrt failure,Morbid obesity,Hy kid NOS w cr kid I-IV,Atrial fibrillation,Hypovolemia,Hypothyroidism NOS,DMII wo cmp nt st uncntr,Late effect CV dis NEC,Drug dermatitis NOS,Muscle weakness-general,Chronic kidney dis NOS,Long-term use anticoagul,Hx antineoplastic chemo,Abn react-procedure NEC
Admission Date:  [**2153-3-6**]              Discharge Date:   [**2153-3-18**]

Date of Birth:  [**2074-11-10**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Recurrent gastrointestinal stromal tumor.

Major Surgical or Invasive Procedure:
Resection of recurrent gastrointestinal stromal tumor.


History of Present Illness:
Mrs [**Known lastname 13755**] is s/p GIST resection in [**2143**] and was subsequently
treated with Gleevec [**Date range (1) 13756**], [**7-19**]-present. Recently she
has had some evidence of tumor
recurrence on a CT performed in [**2151-6-14**].  This was treated
with increasing doses of Gleevec, which she tolerated
marginally.  The growth has enlarged to some degree and options
were discussed the patient and she ultimately elected to undergo
surgery to have this removed.

Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

PAST ONCOLOGIC HISTORY:
- Mrs. [**Known lastname 13755**] initially presented [**2143-9-2**] with abdominal

pain. At that time, she was found to have a large mass in her
abdomen.
- On [**2143-9-6**], she underwent an incomplete resection of this
tumor. It was found to be increasing in size and she was treated

on Gleevec from [**1-/2145**] to 12/[**2146**]. At that time, she stopped it

as she was having some side effects from this therapy, most
notably severe cramping. On the Gleevec, her tumor had decreased

in size. However, the mass grew while she was off the Gleevec
and she was restarted on it again in 07/[**2149**]. She was restarted

at 200mg daily to avoid issues with cramping.
- On [**2151-6-29**] she had a CT scan which showed new liver lesions
which were concerning. An ultrasound was obtained [**2151-7-13**] which

showed these lesions and raised concern for metastatic disease.

- She was increased from Gleevec 200mg daily to 400mg daily on
[**2151-9-8**].
- She had stable CT scans and the liver lesions were determined

to be cysts, she was decreased from 400mg daily to 200mg daily
due to nausea on [**2152-4-5**].
-CT scan [**10/2152**] there was increase in size of a right upper
mesenteric nodule with no other enlarging disease. Her case was
discussed previously and surgery is an option. At this time she
is interested in trying 400mg Gleevec to see if this
controls/shrinks this mass. If the mass continues to enlarge she
would consider surgery.


Social History:
Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative


Family History:
No family history of cancer, lung disease or heart disease. +
for DM.

Physical Exam:
Gen: NAD, AOx3
CVS: RRR, no m/r/g
Resp: CTAB
Abd: soft, non distended, appropriately tender over surgical
incision. Incision c/d/i
Ext: WWP

Pertinent Results:
[**2153-3-14**] 04:23AM BLOOD WBC-8.3 RBC-3.73* Hgb-11.3* Hct-34.6*
MCV-93 MCH-30.4 MCHC-32.7 RDW-16.4* Plt Ct-243
[**2153-3-15**] 05:15AM BLOOD WBC-5.4 RBC-3.02* Hgb-9.2* Hct-28.5*
MCV-95 MCH-30.3 MCHC-32.1 RDW-16.0* Plt Ct-212
[**2153-3-17**] 05:04AM BLOOD WBC-5.8 RBC-3.35* Hgb-10.3* Hct-31.4*
MCV-94 MCH-30.9 MCHC-33.0 RDW-15.5 Plt Ct-243
[**2153-3-18**] 05:05AM BLOOD WBC-5.9 RBC-3.65* Hgb-11.0* Hct-34.7*
MCV-95 MCH-30.1 MCHC-31.7 RDW-15.4 Plt Ct-274
[**2153-3-17**] 05:04AM BLOOD PT-12.8 PTT-24.6 INR(PT)-1.1
[**2153-3-17**] 05:04AM BLOOD Plt Ct-243
[**2153-3-18**] 05:05AM BLOOD PT-14.6* PTT-26.2 INR(PT)-1.3*
[**2153-3-18**] 05:05AM BLOOD Plt Ct-274
[**2153-3-15**] 05:15AM BLOOD Glucose-122* UreaN-25* Creat-1.3* Na-141
K-4.2 Cl-103 HCO3-32 AnGap-10
[**2153-3-16**] 04:32AM BLOOD Glucose-110* UreaN-24* Creat-1.4* Na-139
K-4.5 Cl-103 HCO3-30 AnGap-11
[**2153-3-17**] 05:04AM BLOOD Glucose-139* UreaN-19 Creat-1.1 Na-141
K-4.0 Cl-101 HCO3-34* AnGap-10
[**2153-3-18**] 05:05AM BLOOD Glucose-103* UreaN-18 Creat-1.2* Na-142
K-4.1 Cl-100 HCO3-36* AnGap-10
[**2153-3-7**] 11:57AM BLOOD CK(CPK)-135
[**2153-3-7**] 03:39PM BLOOD CK(CPK)-136
[**2153-3-7**] 11:39PM BLOOD CK(CPK)-145
[**2153-3-15**] 05:15AM BLOOD Calcium-8.4 Phos-3.0 Mg-2.2
[**2153-3-16**] 04:32AM BLOOD Calcium-8.4 Phos-2.7 Mg-2.1
[**2153-3-17**] 05:04AM BLOOD Calcium-8.7 Phos-2.7 Mg-2.0
[**2153-3-18**] 05:05AM BLOOD Calcium-8.9 Phos-3.3 Mg-1.9

Brief Hospital Course:
The patient was admitted to the west 3 surgery service with
abdominal pain secondary to intraperitoneal hemorrhage from
recurrent GIST. She was managed in the ICU upon admission. Her
initialy HCT upon admission was 21.6 and patient was given
2units of PRBCs and HCT increased to 25.4. The patient went to
IR for angiography to look for bleeding source, but this showed
no extravasation of blood from branches of the GDA. Serial HCTs
were monitored, which were stable. Patient was hemodynamically
stable and transferred to the floor on [**2153-3-9**]. On [**2153-3-10**],
patient was noted to have a diffuse, erythematous blanching rash
over her entire body, with confluence in several areas of the
trunk, face, and arms. Dermatology was consulted and recommended
a combination of benadryl, atarax, and clobetasol ointment. The
patient's rash improved dramatically over the next several days.
The patient went to the operating room on [**2153-3-13**] for an open
GIST tumor resection. (Please see operative report for further
details)

Post operatively:

Neuro: The patient received an epidural with good pain control.
When tolerating oral intake, the patient was transitioned to
oral pain oxycodone with standing tylenol. This regimen was
effective in controlling the patient's pain.
CV: The patient remained stable from a cardiovascular
standpoint; vital signs were routinely monitored.
Pulmonary: The patient has known CHF. During her hospital stay,
fluid balance was closely monitored to minimize fluid overload.
CXRs were performed post-op that showed vascular congestion that
improved during her stay. Home lasix dose was started on POD3.
Initially, patient did complain of more SOB, but this improved
greatly during her hospital course, and she was weaned off
oxygen. Good pulmonary toilet, early ambulation and incentive
spirometry were encouraged throughout hospitalization.
GI/GU/FEN: Post-operatively, the patient was made NPO with IV
fluids. Diet was slowly advanced when appropriate, which was
initially well tolerated and patient was on regular diet.
However, she began to have worsening distension on exam, but was
still passing small amounts of flatus. The patient was made NPO
again on [**2153-3-17**] and a KUB was performed that was consistent with
ileus. The patient began to start having plenty of flatus, so
diet was slowly readvanced, which she tolerated well.  Patient's
intake and output were closely monitored, and IV fluid was
adjusted when necessary.  Initially on POD1, the patient's uop
was low and required bolus, and the UOP responded appropriately.
Home lasix dose was started on POD3. Electrolytes were routinely
followed, and repleted when necessary. Foley was d/c'd on [**2153-3-16**]
and patient voided without problem.
ID: The patient's white blood count and fever curves were
closely watched for signs of infection, and there were none. The
patient's wound remained clean, dry, and intact.
Endocrine: The patient's blood sugar was monitored throughout
his stay; insulin dosing was adjusted accordingly.
Hematology: The patient's complete blood count was examined
routinely; no transfusions were required post-op.
Prophylaxis: The patient received subcutaneous heparin and
venodyne boots were used during this stay; was encouraged to get
up and ambulate as early as possible. Home coumadin dose was
restarted on [**2153-3-16**]. Physical therapy evaluated the patient and
determined that short term rehab was necessary to bring patient
back to her baseline.
At the time of discharge on [**2153-3-18**], 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.  The patient received discharge teaching
and follow-up instructions with understanding verbalized and
agreement with the discharge plan.


Medications on Admission:
Gleevec 400', Amiodarone 200', furosemide 80', levothyroxine 200
mcg', imatinib 400', potassium, warfarin with a goal INR of [**2-15**],
zolpidem PRN, docusate/senna prn


Discharge Medications:
1. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. levothyroxine 50 mcg Tablet Sig: Four (4) Tablet PO DAILY
(Daily).
3. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
4. hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
8. clobetasol 0.05 % Ointment Sig: Five (5) Appl Topical [**Hospital1 **] (2
times a day).
9. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed for itching.
10. Gleevec 400 mg Tablet Sig: One (1) Tablet PO once a day.
11. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day: goal
INR [**2-15**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
recurrent gastrointestinal stromal tumor

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down 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.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
.
General Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**5-22**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.
Incision Care:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water.  Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.


Followup Instructions:
Provider: [**Name10 (NameIs) 13757**] [**Name11 (NameIs) 13758**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2153-4-26**] 1:45

Please call the office to schedule an appointment with Dr.
[**Last Name (STitle) **] in [**1-14**] weeks



Completed by:[**2153-3-18**]

Name:  [**Known lastname 2104**],[**Known firstname 2105**] Y                  Unit No:   [**Numeric Identifier 2106**]

Admission Date:  [**2153-3-6**]              Discharge Date:   [**2153-3-18**]

Date of Birth:  [**2074-11-10**]             Sex:   F

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 203**]
Addendum:
The operative finding of blood in the abdomen was consistant
with a hemoperitoneum.

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 609**] for the Aged - [**Location (un) 1409**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 206**] MD [**MD Number(1) 207**]

Completed by:[**2153-4-27**]
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemoperitoneum (nontraumatic),Paralytic ileus,Malignant neoplasm of connective and other soft tissue of abdomen,Chronic systolic heart failure,Morbid obesity,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Hypovolemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other late effects of cerebrovascular disease,Dermatitis due to drugs and medicines taken internally,Muscle weakness (generalized),Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Personal history of antineoplastic chemotherapy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Recurrent gastrointestinal stromal tumor.

PRESENT ILLNESS: Mrs [**Known lastname 13755**] is s/p GIST resection in [**2143**] and was subsequently
treated with Gleevec [**Date range (1) 13756**], [**7-19**]-present. Recently she
has had some evidence of tumor
recurrence on a CT performed in [**2151-6-14**].  This was treated
with increasing doses of Gleevec, which she tolerated
marginally.  The growth has enlarged to some degree and options
were discussed the patient and she ultimately elected to undergo
surgery to have this removed.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
   - . Paroxysmal Atrial Fibrillation on coumadin
   - . Heart Failure with preserved EF
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
.
1. CVA in [**2136**]
2. TIA in [**2138**]
3. Hypertension
4. Hypothyroidism
5. Abdominal mass - GIST (diagnosed [**2143**]) s/p surgery,  on
Gleevec therapy, follows Dr. [**Last Name (STitle) 13754**] in Heme/Onc.
.

MEDICATION ON ADMISSION: Gleevec 400', Amiodarone 200', furosemide 80', levothyroxine 200
mcg', imatinib 400', potassium, warfarin with a goal INR of [**2-15**],
zolpidem PRN, docusate/senna prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: NAD, AOx3
CVS: RRR, no m/r/g
Resp: CTAB
Abd: soft, non distended, appropriately tender over surgical
incision. Incision c/d/i
Ext: WWP

FAMILY HISTORY: No family history of cancer, lung disease or heart disease. +
for DM.

SOCIAL HISTORY: Lives alone. Has 2 daughters. Moved from [**Country **] in [**2137**]. Has
grandchildren who visit her.
-Tobacco history:  negative
-ETOH:  negative
-Illicit drugs: negative 

### Response:
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemoperitoneum (nontraumatic),Paralytic ileus,Malignant neoplasm of connective and other soft tissue of abdomen,Chronic systolic heart failure,Morbid obesity,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Atrial fibrillation,Hypovolemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other late effects of cerebrovascular disease,Dermatitis due to drugs and medicines taken internally,Muscle weakness (generalized),Chronic kidney disease, unspecified,Long-term (current) use of anticoagulants,Personal history of antineoplastic chemotherapy,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
