CHIEF COMPLAINT: Shortness of breath, abdominal distension

PRESENT ILLNESS: Patient is an 81 y/o M with metastatic NSCLC on Alimta, HTN,
CAD, COPD on home O2 and afib who presents with abdominal pain
and SOB. Per the patient's wife, over the last week he has
developed progressive abdominal distention and discomfort. The
pain is diffuse across his abdomen. He denies nausea or
vomiting. He has also had progressive SOB over the same period
of time. He has been using his nebulizer up to every 2 hours
with minimal relief. His wife reports that his appetite was
intially ok, however over the last few days his PO intake has
decreased and he did not eat anything for dinner last night. He
denies fever, chills, or cough. He also denies dysuria. He has
had constipation fo rwhich he took Milk of Magnesia tablets last
evening and today with his last BM this morning.
.
Of note the patient was recently admitted to [**Hospital1 18**] from
[**Date range (1) 14195**] for dyspnea. He was admitted to the MICU for tachypnea
to 50s and oxygen requirement. In the ICU, he required bipap
which was gradually weaned off to his home 2.5L NC with sats in
the 89-91 range. Patient
symptomatically felt better. A chest X-ray showed RUL infiltrate

MEDICAL HISTORY: 1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

MEDICATION ON ADMISSION: 1. Albuterol MDI prn
2. Citalopram 20 daily
3. Fluticasone-Salmeterol 250-50 [**Hospital1 **]
4. Folic Acid 1 mg daily
5. Combivent MDI, every four (4) hours as needed for shortness
of
breath or wheezing.
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
7. Nitroglycerin SL as needed as needed for chest pain.
8. Prochlorperazine 10 mg every eight hours as needed for
nausea.
9. Ambien 5 mg prn insomnia.
10. Calcium Carbonate 500 mg [**Hospital1 **]
11. Multivitamin Daily
12. Omeprazole 20 mg [**Hospital1 **]
13. Diltia XT 120 mg daily
14. Aspirin 325 mg daily
15. Prednisone taper completed on [**2-17**]
16. Insulin Aspart SS qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.2, BP 122/70, HR 97, RR 24, O2sat 93% on 4LNC, Wt 140
lbs,
Height 62"
GEN: Wearing NC, breathing with pursed lips on expiration.
HEENT: NC/AT.
NECK: Thin, suppple, no lymphadenopathy
PULM: Diffusely decreased breath sounds and air movement. No
crackles or wheezes.
CARD: RR, nl S1, Sl S2, II/VI systolic murmur RUSB
ABD: BS+, soft, NT, ND
EXT: Clubbing of fingernails on hands bilaterally, no LE edema
SKIN: No rashes
NEURO: Oriented x 3, non-focal exam
PSYCH: Patient upbeat with joking manner

FAMILY HISTORY: Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

SOCIAL HISTORY: He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure.
Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other pulmonary insufficiency, not elsewhere classified,Other ascites,Paralytic ileus,Intermediate coronary syndrome,Intestinal infection due to Clostridium difficile,Acidosis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Encounter for palliative care
Second malig neo liver,Pneumonia, organism NOS,Mal neo bronch/lung NEC,Other pulmonary insuff,Ascites NEC,Paralytic ileus,Intermed coronary synd,Int inf clstrdium dfcile,Acidosis,Crnry athrscl natve vssl,Old myocardial infarct,Atrial fibrillation,Chr airway obstruct NEC,Depend-supplement oxygen,Hx antineoplastic chemo,Long-term use steroids,Thoracic aortic aneurysm,Hypertension NOS,Hyperlipidemia NEC/NOS,Osteoarthros NOS-unspec,Encountr palliative care
Admission Date:  [**2164-2-20**]              Discharge Date:   [**2164-2-26**]

Date of Birth:  [**2082-4-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 5552**]
Chief Complaint:
Shortness of breath, abdominal distension

Major Surgical or Invasive Procedure:
Paracentesis

History of Present Illness:
Patient is an 81 y/o M with metastatic NSCLC on Alimta, HTN,
CAD, COPD on home O2 and afib who presents with abdominal pain
and SOB. Per the patient's wife, over the last week he has
developed progressive abdominal distention and discomfort. The
pain is diffuse across his abdomen. He denies nausea or
vomiting. He has also had progressive SOB over the same period
of time. He has been using his nebulizer up to every 2 hours
with minimal relief. His wife reports that his appetite was
intially ok, however over the last few days his PO intake has
decreased and he did not eat anything for dinner last night. He
denies fever, chills, or cough. He also denies dysuria. He has
had constipation fo rwhich he took Milk of Magnesia tablets last
evening and today with his last BM this morning.
.
Of note the patient was recently admitted to [**Hospital1 18**] from
[**Date range (1) 14195**] for dyspnea. He was admitted to the MICU for tachypnea
to 50s and oxygen requirement. In the ICU, he required bipap
which was gradually weaned off to his home 2.5L NC with sats in
the 89-91 range. Patient
symptomatically felt better. A chest X-ray showed RUL infiltrate

consistent with pneumonia. He continued solumedrol and Abx were

tapered to levaquin alone. He developed new onset a fib and was
started on diltiazem for rate control. He was discharged home on
prednisone taper and completed 7 day course of levofloxacin.
.
In the emergency department initial VS were BP 114/54 HR 108 RR
36 O2 sat 99% 4L. CT abdomen was performed and showed new
ascites and worsening of his liver and omental mets. Surgery
evaluated him for ? SBO. They did not see signs of obstruction,
felt that he had likely ileus from progressive metastatic
disease and is not a surgical candidate. NGT was placed for
comfort. Labs were notable for K 6.0 without EKG changes. He was
given D50 and insulin. He also received solumedrol 125mg IV,
vanco 1gm, zosyn 4.5gm, combivent nebs x2 and 2L NS.
.
Currently the patient states his breathing feels much better. He
continues to have some abdominal discomfort with exam. He denies
chest pain, fever, cough, nausea or vomiting. He reports that
the NGT is uncomfortable when he swallows.


Past Medical History:
1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

ONCOLOGIC HISTORY:
Mr. [**Known lastname 14194**] was in his USOH until [**2163-7-25**] when he
presented with hemoptysis and weight loss of 10 pounds over
previous 1-2 months. He had a CT scan of the chest on [**8-21**] and
it showed a 4.1 x 4.0 right hilar mass with subcarinal
lymphadenopathy, 19 mm right axillary lymph node as well as
multiple right lower lobe and left lower lobe nodules concerning
for lung cancer. On [**2163-8-28**], he was admitted to [**Hospital1 771**] with chest pain and ruled out for a
non-ST elevation MI. He was seen by the hematology-oncology
consult service while in the hospital and underwent FNA of the
right axillary lymph node, the pathology of which showed
nonsmall cell cancer, squamous cell type. He was discharged on
the third of [**Month (only) 359**] and then on [**2163-8-30**], he had a
bronchoscopy done for evaluation of his hemoptysis as well as
bronchial biopsy and the cytology confirmed metastatic nonsmall
cell lung cancer. He has subsequently completed 2 cycles of
Navelbine.

Social History:
He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure.


Family History:
Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

Physical Exam:
VS: T 97.2, BP 122/70, HR 97, RR 24, O2sat 93% on 4LNC, Wt 140
lbs,
Height 62"
GEN: Wearing NC, breathing with pursed lips on expiration.
HEENT: NC/AT.
NECK: Thin, suppple, no lymphadenopathy
PULM: Diffusely decreased breath sounds and air movement. No
crackles or wheezes.
CARD: RR, nl S1, Sl S2, II/VI systolic murmur RUSB
ABD: BS+, soft, NT, ND
EXT: Clubbing of fingernails on hands bilaterally, no LE edema
SKIN: No rashes
NEURO: Oriented x 3, non-focal exam
PSYCH: Patient upbeat with joking manner


Pertinent Results:
[**2164-2-19**] CT abdomen
Worsened metastatic disease with innumerable hepatic metastases,

enlarging and new implants adjacent to the stomach and spleen in
the omentum
and new ascites and omental deposits.

[**2164-2-20**] CTA chest
1. Progression of abdominal metastatic disease, partly
visualized and better
characterized on a CT from the prior day.

2. Right hilar mass with a similar degree of narrowing of
segmental pulmonary
arteries, but exerting greater mass effect on descending airways
serving the
right lower lobe, some of which are now occluded.

3. Patchy new peribronchovascular consolidation in the right
lower lobe, most
suspicious for post-obstructive pneumonia.

4. Interlobular septal thickening in each lower lobe, more
prominent on the
right than left. The appearance may reflect fluid overload or
lymphatic
congestion, but the possibility of lymphangitic carcinomatosis
on the
right should also be considered.

5. NG tube terminating in the stomach, but with the sidehole
near the GE
junction. If clinically indicated, it could be advanced to gain
better
purchase in the stomach.

[**2164-2-20**]
Successful paracentesis yielding two liters of clear amber
fluid.
Samples were sent to microbiology and cytology.


Brief Hospital Course:
81y/o M with metastatic non-small cell lung  cancer on
chemotherapy with Alimta last given on [**1-31**] who presents with
abdominal pain and SOB.
.
#. Shortness of breath:  This was likely multifactorial, with
contributions from COPD, extensive lung cancer disease burden,
possible post-obstructive pneumonia, and increased abdominal
girth. CTA chest negative for PE but showed tumor invasion of
bronchi and pulmonary artery. NG tube for decompression was
placed, vancomycin and zosyn were started, and he was given
standing nebulizer treatments and supplemental O2. He underwent
two 2-L paracenteses with some improvement in shortness of
breath. Several days into his hospital course he developed
episodes of chest pain and increased shortness of breath without
EKG changes, responsive to nitroglycerin and morphine. These
were thought to represent unstable angina with a possible
contribution from aspiration events.  Goals of care were
discussed with the palliative care team and eventually revised
to include comfort measures only.  Antibiotics were stopped.
Morphine was given to help with shortness of breath and
nitroglycerin as needed for comfort.
.
#. Abdominal distention: Found to have new ascites in setting of
worsening metastatic disease to liver and omentum. Also found to
have ileus in setting of this and combination of these is likely
contributing to his worsening discomfort. Surgery evaluated pt.
in ED and were not concerned for SBO. NGT was placed for
comfort.  He was found to have c diff, which was treated with PO
vanc and zosyn.  He underwent two 2-L paracenteses under
ultrasound guidance.  Antibiotics were stopped when goals of
care were revised to CMO.
.
#. Leukocytosis: WBC on admission 88K rose to >100k during this
admission, increased from 68K on [**2-10**]. This had been discussed
with heme/onc in the past and previously attributed to his
cancer.   The acute rise may have been related to infections (c
diff, possible pneumonia).  After goals of care were revised,
labs were no longer checked.
.
#. Non-small cell lung cancer: Widely metastatic with worsening
disease despite Alimta. Followed by Dr. [**Last Name (STitle) **]. Palliative
care assisted in discussions with the family and the goals of
care were revised to comfort when it became clear that no
further reasonable therapeutic options were available.  He
expired several days later.
.


Medications on Admission:
1. Albuterol MDI prn
2. Citalopram 20 daily
3. Fluticasone-Salmeterol 250-50 [**Hospital1 **]
4. Folic Acid 1 mg daily
5. Combivent MDI, every four (4) hours as needed for shortness
of
breath or wheezing.
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
7. Nitroglycerin SL as needed as needed for chest pain.
8. Prochlorperazine 10 mg every eight hours as needed for
nausea.
9. Ambien 5 mg prn insomnia.
10. Calcium Carbonate 500 mg [**Hospital1 **]
11. Multivitamin Daily
12. Omeprazole 20 mg [**Hospital1 **]
13. Diltia XT 120 mg daily
14. Aspirin 325 mg daily
15. Prednisone taper completed on [**2-17**]
16. Insulin Aspart SS qid


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
deceased

Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
deceased


Completed by:[**2164-2-26**]
{'Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other pulmonary insufficiency, not elsewhere classified,Other ascites,Paralytic ileus,Intermediate coronary syndrome,Intestinal infection due to Clostridium difficile,Acidosis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Encounter for palliative care'}


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: Shortness of breath, abdominal distension

PRESENT ILLNESS: Patient is an 81 y/o M with metastatic NSCLC on Alimta, HTN,
CAD, COPD on home O2 and afib who presents with abdominal pain
and SOB. Per the patient's wife, over the last week he has
developed progressive abdominal distention and discomfort. The
pain is diffuse across his abdomen. He denies nausea or
vomiting. He has also had progressive SOB over the same period
of time. He has been using his nebulizer up to every 2 hours
with minimal relief. His wife reports that his appetite was
intially ok, however over the last few days his PO intake has
decreased and he did not eat anything for dinner last night. He
denies fever, chills, or cough. He also denies dysuria. He has
had constipation fo rwhich he took Milk of Magnesia tablets last
evening and today with his last BM this morning.
.
Of note the patient was recently admitted to [**Hospital1 18**] from
[**Date range (1) 14195**] for dyspnea. He was admitted to the MICU for tachypnea
to 50s and oxygen requirement. In the ICU, he required bipap
which was gradually weaned off to his home 2.5L NC with sats in
the 89-91 range. Patient
symptomatically felt better. A chest X-ray showed RUL infiltrate

MEDICAL HISTORY: 1) CAD s/p MI in [**2140**] by EKG diagnosis, no admission, no
symptoms, ETT/MIBI [**2159**] showing partially reversible defect in
RCA distribution. No interventions performed.
2) HTN
3) Hyperlipidemia
4) COPD
5) DJD
6) Thoracic artery aneursym, stable
7) Nonsmall cell lung cancer (see below)

MEDICATION ON ADMISSION: 1. Albuterol MDI prn
2. Citalopram 20 daily
3. Fluticasone-Salmeterol 250-50 [**Hospital1 **]
4. Folic Acid 1 mg daily
5. Combivent MDI, every four (4) hours as needed for shortness
of
breath or wheezing.
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
7. Nitroglycerin SL as needed as needed for chest pain.
8. Prochlorperazine 10 mg every eight hours as needed for
nausea.
9. Ambien 5 mg prn insomnia.
10. Calcium Carbonate 500 mg [**Hospital1 **]
11. Multivitamin Daily
12. Omeprazole 20 mg [**Hospital1 **]
13. Diltia XT 120 mg daily
14. Aspirin 325 mg daily
15. Prednisone taper completed on [**2-17**]
16. Insulin Aspart SS qid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.2, BP 122/70, HR 97, RR 24, O2sat 93% on 4LNC, Wt 140
lbs,
Height 62"
GEN: Wearing NC, breathing with pursed lips on expiration.
HEENT: NC/AT.
NECK: Thin, suppple, no lymphadenopathy
PULM: Diffusely decreased breath sounds and air movement. No
crackles or wheezes.
CARD: RR, nl S1, Sl S2, II/VI systolic murmur RUSB
ABD: BS+, soft, NT, ND
EXT: Clubbing of fingernails on hands bilaterally, no LE edema
SKIN: No rashes
NEURO: Oriented x 3, non-focal exam
PSYCH: Patient upbeat with joking manner

FAMILY HISTORY: Father died at age 43 of unknown causes.
Mother died of breast cancer complications at age 53.
Sister had breast cancer and lung cancer and died at age 80

SOCIAL HISTORY: He lives in [**Location 3146**]. He is married and has a daughter and a son.
[**Name (NI) **] has two grandchildren. He is here today with his wife & son.
[**Name (NI) **] smoked for at least 50 years, stopped smoking 3-4 years ago.
He drinks occasional alcohol. He used to work as a carpenter, it
is unclear if he has had asbestos exposure. 

### Response:
{'Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other pulmonary insufficiency, not elsewhere classified,Other ascites,Paralytic ileus,Intermediate coronary syndrome,Intestinal infection due to Clostridium difficile,Acidosis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Other dependence on machines, supplemental oxygen,Personal history of antineoplastic chemotherapy,Long-term (current) use of steroids,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Encounter for palliative care'}
