CHIEF COMPLAINT: 

PRESENT ILLNESS: A 47-year-old male from [**Country 3397**] presented
with pruritus, nausea, diarrhea, ACOG stools and jaundice.
An endoscopy and CT scan performed in [**Country 3397**] approximately
one year ago showed leiomyoma of the stomach.  On [**10-1**], the patient presented at [**Hospital 43512**] Hospital Medical
intrahepatic and extrahepatic bile ducts.  No extrahepatic
disease was seen.  An endoscopy at the outside institution
showed a mass along the duodenum involving the ampulla of
Vater.  Pathology of that mass revealed invasive moderately
well differentiated adenocarcinoma.  An ERCP was done at that
time and a stent was placed.  The patient was transferred to
the [**Hospital6 256**] for surgical

MEDICAL HISTORY: Hepatitis A as a child.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Temperature 99.4??????, heart rate 88, blood
pressure 118/64, respiratory rate 16.
GENERAL:  He was jaundiced.
HEAD, EARS, EYES, NOSE AND THROAT:  Scleral icterus.
COR:  Regular rate and rhythm.
LUNGS:  Clear to auscultation.
ABDOMEN:  Soft, nontender, nondistended, no
hepatosplenomegaly appreciated.  No edema.

FAMILY HISTORY: 

SOCIAL HISTORY: Two glasses of wine per day, smoking a pack
per day since age 15, quit two months ago.
Malignant neoplasm of duodenum,Secondary malignant neoplasm of other digestive organs and spleen,Hematoma complicating a procedure,Acute posthemorrhagic anemia,Acute and chronic cholecystitis
Malignant neopl duodenum,Sec mal neo GI NEC,Hematoma complic proc,Ac posthemorrhag anemia,Acte & chr cholecystitis
Admission Date:  [**2127-10-8**]       Death Date:  [**2127-11-12**]

Date of Birth:   [**2080-6-25**]       Sex:  M

Service:  BLUE SURGERY
PRESENT ILLNESS:  A 47-year-old male from [**Country 3397**] presented
with pruritus, nausea, diarrhea, ACOG stools and jaundice.
An endoscopy and CT scan performed in [**Country 3397**] approximately
one year ago showed leiomyoma of the stomach.  On [**10-1**], the patient presented at [**Hospital 43512**] Hospital Medical
intrahepatic and extrahepatic bile ducts.  No extrahepatic
disease was seen.  An endoscopy at the outside institution
showed a mass along the duodenum involving the ampulla of
Vater.  Pathology of that mass revealed invasive moderately
well differentiated adenocarcinoma.  An ERCP was done at that
time and a stent was placed.  The patient was transferred to
the [**Hospital6 256**] for surgical

PAST MEDICAL HISTORY:  Hepatitis A as a child.

PAST SURGICAL HISTORY:  Tonsillectomy

MEDICATIONS:
1.  Tegretol for facial numbness.
2.  Atarax 25 mg q4h prn itch
3.  Periactin 4 mg po bid
4.  Ciprofloxacin 500 mg po bid with two remaining doses
5.  Vicodin prn

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Two glasses of wine per day, smoking a pack
per day since age 15, quit two months ago.

PHYSICAL EXAM:
VITAL SIGNS:  Temperature 99.4??????, heart rate 88, blood
pressure 118/64, respiratory rate 16.
GENERAL:  He was jaundiced.
HEAD, EARS, EYES, NOSE AND THROAT:  Scleral icterus.
COR:  Regular rate and rhythm.
LUNGS:  Clear to auscultation.
ABDOMEN:  Soft, nontender, nondistended, no
hepatosplenomegaly appreciated.  No edema.

LABORATORY DATA ON ADMISSION:  Hematocrit was 40.3.  Sodium
139, potassium 4.1, chloride 100, bicarbonate 26, BUN 20,
creatinine 0.9, glucose 111, AST 64, ALT 64, alkaline
phosphatase 147, bilirubin 10.4, amylase 46.  CEA is 3.0 and
CA19-9 was 15.

HOSPITAL COURSE:  The patient went to the Operating Room on
[**10-10**] and had a pylorus bearing Whipple performed.
At this time, a cholecystectomy was performed as well.  A
replaced right hepatic artery injured during the procedure
and a gastroduodenal artery interposition graft was placed.
Postoperatively, the patient was transferred to the floor for
surgical care.  There, his hematocrits were stable.  He had a
temperature spike and those original cultures were negative.
He was placed on subcutaneous heparin for prophylaxis, as
well as on Protonix.  His pain was controlled with
intravenous Dilaudid PCA.  The patient continued to do well
until [**10-13**] where he was noted to have some
tachycardia and abdominal pain.  CT scan was done which
revealed a large intraabdominal hematoma.

On [**10-14**], the patient was brought back to the
Operating Room, had an exploratory laparotomy and evacuation
of an intraabdominal clot.  During this procedure, there was
a small bowel enterotomy which was repaired.  After that
surgery, the patient's hematocrit continued to remain stable.
Cultures from the Operating Room revealed [**Female First Name (un) 564**] albicans.
The patient was started on fluconazole at that time.
Multiple ultrasounds were obtained of the liver which
revealed good flow in the right and left hepatic arteries.
The patient's cultures continued to be followed and a repeat
CT scan was obtained on [**10-18**].  There was a moderate
fluid collection.  He started to grow out gram negative rods
and micrococcus.  At that point, he was started on Zosyn and
vancomycin.  Due to increased JP output, JP amylase was sent
and this revealed a value of 29,000.

Repeat ultrasounds were obtained which revealed a small
amount of peritoneal fluid and no loculated fluid
collections.  JP fluid was again sent off on [**10-23**]
which revealed a bilirubin of 12.1 and an amylase of 4,040.
CT scan showed a large amount of fluid in the pelvis.  It was
decided the patient should be started on octreotide on
[**10-23**].  The patient was also started on total
parenteral nutrition.  This was originally started on
[**10-14**] and continued throughout his admission.  It
was decided to bring the patient back to the Operating Room
on [**10-24**] as he continued to have persistent fever
spikes and the above noted findings on CT scan.

Procedure performed was an exploratory laparotomy and the
findings at the time were intraabdominal hematoma with a
breakdown of the pancreaticojejunal anastomosis.  At that
time, the jejunum was oversewed and a portion of the skin
incision was left open and a portion was closed with Marlex
mesh.  The patient remained stable and on his antibiotics of
Zosyn, fluconazole and vancomycin.  The TPN was continued.
The patient was then brought back to the Operating Room on
[**10-31**] to remove the Marlex mesh and perform a wound
debridement.  The wound was then closed with a Marlex mesh.
The patient was transferred to the floor for surgical care
for this.  His repeat cultures revealed no growth.  He was
essentially on the floor for a 10 day period of time where he
was receiving wet to dry dressing changes to the skin
incision.  The Marlex mesh was used to close the fascia.

The patient was doing well until [**11-10**] where he was
found to be in extremis.  A code was called and he was in PEA
for a short period of time where he was given epinephrine and
atropine.  He then regained a pulse and was tachycardic to
140s and his blood pressures were in the 70s.  He was brought
emergently to the Operating Room where an exploratory
laparotomy was performed.  No definitive ...............
bleeding was performed, though a large amount of
intraabdominal clot was evacuated.  His hematocrits continued
to drop and on [**11-11**] he was brought to angiogram where
it was revealed that there was extravasation from the right
hepatic artery.  Three coils were placed.  The patient
received large amounts of packed red blood cells and FFP
transfusion during this time for continued dropped
hematocrits.  After his first angiogram, his [**Location (un) 1661**]-[**Location (un) 1662**]
drain continued to have large amounts of sanguinous output.
He was returned to angiogram where an additional coil was
placed in the right hepatic artery as extravasation was seen.

After this procedure he was stable for a short period of time
until another liter of blood was seen in his [**Location (un) 1661**]-[**Location (un) 1662**]
drains.  He was brought back down to the angiography suite
early on the morning of [**11-12**].  It was very difficult
to cannulate his right hepatic artery and the intervention at
the time was relatively unsuccessful.  He was transferred
back to the Intensive Care Unit where his hematocrits kept
dropping.  His acidosis progressively worsened.  At that
time, a family meeting was held with Dr. [**Last Name (STitle) **] and the
patient's family.  It was decided that the patient should be
made comfort measures only.  All support was removed at
approximately 4 a.m. on [**11-12**].  The patient expired at
approximately 5:15 on the morning of [**11-12**].  A
postmortem will be obtained.

DISCHARGE DIAGNOSES:
1.  Status post Whipple for adenocarcinoma of ampulla of
Vater which was moderately well differentiated and invasive.
2.  Prolonged hospitalization course complicated by four
return trips to the Operating Room and three trips to the
angiography suite.  The patient expired on [**11-12**].




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.  02-366

Dictated By:[**Name8 (MD) 1308**]
MEDQUIST36

D:  [**2127-11-12**]  11:50
T:  [**2127-11-12**]  14:20
JOB#:  [**Job Number 43513**]
{'Malignant neoplasm of duodenum,Secondary malignant neoplasm of other digestive organs and spleen,Hematoma complicating a procedure,Acute posthemorrhagic anemia,Acute and chronic cholecystitis'}


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: 

PRESENT ILLNESS: A 47-year-old male from [**Country 3397**] presented
with pruritus, nausea, diarrhea, ACOG stools and jaundice.
An endoscopy and CT scan performed in [**Country 3397**] approximately
one year ago showed leiomyoma of the stomach.  On [**10-1**], the patient presented at [**Hospital 43512**] Hospital Medical
intrahepatic and extrahepatic bile ducts.  No extrahepatic
disease was seen.  An endoscopy at the outside institution
showed a mass along the duodenum involving the ampulla of
Vater.  Pathology of that mass revealed invasive moderately
well differentiated adenocarcinoma.  An ERCP was done at that
time and a stent was placed.  The patient was transferred to
the [**Hospital6 256**] for surgical

MEDICAL HISTORY: Hepatitis A as a child.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: VITAL SIGNS:  Temperature 99.4??????, heart rate 88, blood
pressure 118/64, respiratory rate 16.
GENERAL:  He was jaundiced.
HEAD, EARS, EYES, NOSE AND THROAT:  Scleral icterus.
COR:  Regular rate and rhythm.
LUNGS:  Clear to auscultation.
ABDOMEN:  Soft, nontender, nondistended, no
hepatosplenomegaly appreciated.  No edema.

FAMILY HISTORY: 

SOCIAL HISTORY: Two glasses of wine per day, smoking a pack
per day since age 15, quit two months ago. 

### Response:
{'Malignant neoplasm of duodenum,Secondary malignant neoplasm of other digestive organs and spleen,Hematoma complicating a procedure,Acute posthemorrhagic anemia,Acute and chronic cholecystitis'}
