CHIEF COMPLAINT: Colon cancer

PRESENT ILLNESS: Mr. [**Known lastname 74655**] is a 67-year-old gentleman with history of BPH, a
colonoscopy which showed a near circumferential lesion in the
descending colon.  Sent for a
surgical consultation with Dr. [**First Name (STitle) 2819**].  CEA was mildly elevated at
7.3 and CT
scan was performed and it demonstrated a lesion in the mid
descending colon with some adenopathy surrounding the colon in
that region, but no clear evidence of metastatic disease of the
liver.  He had polycystic liver on the imaging.  Mr. [**Known lastname 74655**] was
offered partial colectomy for his colon cancer.
Risks and benefits of that procedure were discussed and he
signed a surgical consent.

MEDICAL HISTORY: PMH:
Lower back pain
BPH currently treated with Flomax and Proscar
Colon polyps
Osteoarthritis
.
PSH:
bilateral hip replacement x2 ([**2153**] & [**2155**])

MEDICATION ON ADMISSION: 1. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins

PHYSICAL EXAM: Weight: 86.18 kg
Height: 69inches
98.0 orally, 67, 128/68, 20 respiratory rate, sat 95% 2L
GEN: no acute distress, alert and oriented to person, place and
time
CV: regular rate and rhythm, S1, S2, no murmurs
Resp: clear to ausculation bilaterally
GI: Abdomen positive bowel sounds, soft, pain pump intact,
minimally tender to palpation, mild distended
GU: foley intact with clear yellow urine
Ext: no edema

FAMILY HISTORY: Mother - Diabetes

SOCIAL HISTORY: Lives in [**Location 686**] with wife and 4 children. Denies tobacco and
recreational drugs, had 2 drinks of alcohol weekly.
Malignant neoplasm of other specified sites of large intestine,Other suppurative peritonitis,Other postoperative infection,Paralytic ileus,Hypopotassemia,Disorders of magnesium metabolism
Malignant neo colon NEC,Suppurat peritonitis NEC,Other postop infection,Paralytic ileus,Hypopotassemia,Dis magnesium metabolism
Admission Date:  [**2167-12-4**]              Discharge Date:   [**2167-12-18**]

Date of Birth:  [**2100-8-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 6346**]
Chief Complaint:
Colon cancer

Major Surgical or Invasive Procedure:
[**2167-12-4**]: Laparoscopic assisted left colectomy with splenic
flexure take down, total colostomy for descending colon cancer
[**2167-12-8**]: Exploratory laparotomy, washout of feculent
peritonitis, partial colectomy, Hartmann's creation and
transverse end colostomy

History of Present Illness:
Mr. [**Known lastname 74655**] is a 67-year-old gentleman with history of BPH, a
colonoscopy which showed a near circumferential lesion in the
descending colon.  Sent for a
surgical consultation with Dr. [**First Name (STitle) 2819**].  CEA was mildly elevated at
7.3 and CT
scan was performed and it demonstrated a lesion in the mid
descending colon with some adenopathy surrounding the colon in
that region, but no clear evidence of metastatic disease of the
liver.  He had polycystic liver on the imaging.  Mr. [**Known lastname 74655**] was
offered partial colectomy for his colon cancer.
Risks and benefits of that procedure were discussed and he
signed a surgical consent.


Past Medical History:
PMH:
Lower back pain
BPH currently treated with Flomax and Proscar
Colon polyps
Osteoarthritis
.
PSH:
bilateral hip replacement x2 ([**2153**] & [**2155**])


Social History:
Lives in [**Location 686**] with wife and 4 children. Denies tobacco and
recreational drugs, had 2 drinks of alcohol weekly.

Family History:
Mother - Diabetes

Physical Exam:
Weight: 86.18 kg
Height: 69inches
98.0 orally, 67, 128/68, 20 respiratory rate, sat 95% 2L
GEN: no acute distress, alert and oriented to person, place and
time
CV: regular rate and rhythm, S1, S2, no murmurs
Resp: clear to ausculation bilaterally
GI: Abdomen positive bowel sounds, soft, pain pump intact,
minimally tender to palpation, mild distended
GU: foley intact with clear yellow urine
Ext: no edema

Pertinent Results:
Admission Labs [**2167-12-4**] 06:12PM
--------------
POTASSIUM-4.3
MAGNESIUM-1.8
HCT-33.1*
WBC-5.0 RBC-4.34* HGB-12.1* HCT-35.7* MCV-82 MCH-27.8 MCHC-33.8
RDW-14.8
PLT COUNT-230
.
Operative Note
--------------


Brief Hospital Course:
The patient was admitted for the aforementioned procedure; for
more details, please see operative note.  Patient tolerated
procedure without intra-operative complications.  Patient was
extubated in the OR and transferred to the PACU in stable
condition. Patient initially recovered in the PACU before being
transferred to [**Hospital Ward Name 121**] 9 in stable condition. Prior to transfer,
patient received Magnesium 2grams intravenously for a Magnesium
of 1.8.
.
The patient initially did well, his diet was slowly advanced and
his pain medication was weaned.  The day prior to anticipated
discharge he had an episode of desaturation.  ABG, EKG, and labs
were all normal.  The episode resolved.  The next day we decided
to keep him one more day due to this.  Overnight he again
desaturated, developed abdominal pain and spiked a temperature.
A CT scan showed evidence of an anastomotic leak and free fluid
in the abdomen.  The patient was taken to the operating room and
explored.  It was found that he had an ischemic anastomosis that
had leaked and lead to fecal peritonitis.  The anastomosis was
resected back to clear margins which had good blood flow.  An
end colostomy was created and the distal colonic segment was
made a Hartmann's pouch.  The patient was transferred to the
SICU in fair condition.
.
The patient was extubated shortly thereafter.  He was
resuscitated with IVFs agressively as his urine output was low
and his CVP was in the 2-4 range.  He responded well to this.
His pain was controlled with fentanyl and then switched to PCA
once he was able to use it.  Due to the length of time without
nutrition and the anticipated ileus, TPN was started.  The
patient remained stable in the ICU and was then transferred to
the floor.
.
His bladder pressures had been running high, and his CVP became
elevated on POD [**1-24**] from his second surgery. We started diuresis
with lasix over the following few days.  He diuresed well
without complications.  Over the next few days his WBC did trend
up somewhat.  Due to his history, we felt it was necessary to
rule out an abscess.  A CT scan was obtained which showed no
evidence of abscess or leak.  The next day his ostomy began
producing stool.  His NGT was removed at this point and he was
started on a clear liquid diet.  He tolerated this well.  His
foley was removed.  His diet was advanced to a regular diet.  On
the day of discharge his JP drain was removed as well.  He was
doing well and was given appropriate follow up with Dr. [**First Name (STitle) 2819**].

Medications on Admission:
1. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 4 days.
Disp:*12 Tablet(s)* Refills:*0*
8. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 4 days.
Disp:*8 Tablet(s)* Refills:*0*
9. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
Disp:*15 Tablet(s)* Refills:*0*
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Descending colon cancer
Anastomotic leak after left total colectomy
Post-operative Fever
Post-operative Tachycardia
Post-operative Electrolyte Imbalance - hypomagnesemia,
hypokalemia
Post-operative Ileus


Discharge Condition:
Stable: Patient was afebrile, hemodynamically stable, tolerate
oral pain medications and diet. He was independent with
colostomy care and scheduled for VNA Services.


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.
* 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.
* Increased abdominal pain that is not improving within [**8-2**]
hours or becoming progressively worse, or inadequately
controlled with the prescribed pain medication.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* If your belly is distended
* The skin around the stoma appears red, swollen or excoriated
* Excessive bleeding (blood in pouch with each emptying of bag)
or continuous bleeding at junction of stoma and skin
* Cramps lasting 2-3 hours
* Severe watery discharge lasting more than 5-6 hours
* Unusual change in stoma size (prolapsed or retraction) and
appearance (color).
* Separation of wound edges, green or yellow drainage from the
wound, or increased redness swelling, warmth or pain of the
incision
* Shortness in breath
* Swelling of your legs
* Any serious change in your symptoms, or any new symptoms that
concern you.

You may resume all home medications.

*Pain: You will be treated with pain medications after discharge
from the hospital, and this should relieve any discomfort that
you may experience. As your discomfort lessens, you may switch
to regular Tylenol (acetaminophen). Do not combine Tylenol with
your prescription pain medication (i.e. Vicoden, Percocet), as
this already contains Tylenol. If you need the prescription pain
medicine, be sure to take it with food to prevent upset stomach.
You should also take Colace, a stool softener, while you are
taking narcotics to prevent constipation. Do not drive while
taking narcotics.
*Incision: Staples will be removed at your hospital follow-up
appointment with Dr. [**First Name (STitle) 2819**].
*Bathing: You may shower, but avoid prolonged water exposure
(i.e baths and/or swimming). When you finish bathing or
showering, be sure to "pat dry" the area of surgery.
Antibiotics: You should continue with Ciprofloxacin and Flagyl
for 1 week after discharge.


Followup Instructions:
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2819**] in [**12-23**] weeks. Please
call ([**Telephone/Fax (1) 6347**] to schedule an appointment.

Please schedule an appointment with a primary care physician.
{'Malignant neoplasm of other specified sites of large intestine,Other suppurative peritonitis,Other postoperative infection,Paralytic ileus,Hypopotassemia,Disorders of magnesium metabolism'}


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: Colon cancer

PRESENT ILLNESS: Mr. [**Known lastname 74655**] is a 67-year-old gentleman with history of BPH, a
colonoscopy which showed a near circumferential lesion in the
descending colon.  Sent for a
surgical consultation with Dr. [**First Name (STitle) 2819**].  CEA was mildly elevated at
7.3 and CT
scan was performed and it demonstrated a lesion in the mid
descending colon with some adenopathy surrounding the colon in
that region, but no clear evidence of metastatic disease of the
liver.  He had polycystic liver on the imaging.  Mr. [**Known lastname 74655**] was
offered partial colectomy for his colon cancer.
Risks and benefits of that procedure were discussed and he
signed a surgical consent.

MEDICAL HISTORY: PMH:
Lower back pain
BPH currently treated with Flomax and Proscar
Colon polyps
Osteoarthritis
.
PSH:
bilateral hip replacement x2 ([**2153**] & [**2155**])

MEDICATION ON ADMISSION: 1. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins

PHYSICAL EXAM: Weight: 86.18 kg
Height: 69inches
98.0 orally, 67, 128/68, 20 respiratory rate, sat 95% 2L
GEN: no acute distress, alert and oriented to person, place and
time
CV: regular rate and rhythm, S1, S2, no murmurs
Resp: clear to ausculation bilaterally
GI: Abdomen positive bowel sounds, soft, pain pump intact,
minimally tender to palpation, mild distended
GU: foley intact with clear yellow urine
Ext: no edema

FAMILY HISTORY: Mother - Diabetes

SOCIAL HISTORY: Lives in [**Location 686**] with wife and 4 children. Denies tobacco and
recreational drugs, had 2 drinks of alcohol weekly. 

### Response:
{'Malignant neoplasm of other specified sites of large intestine,Other suppurative peritonitis,Other postoperative infection,Paralytic ileus,Hypopotassemia,Disorders of magnesium metabolism'}
