CHIEF COMPLAINT: adenocarcinoma of the descending colon.

PRESENT ILLNESS: Mr. [**Name14 (STitle) 101858**] is a 69-year-old gentleman with multiple medical
comorbidities who presents for resection of adenocarcinoma of
the
descending colon.

MEDICAL HISTORY: 1. Obesity.
2. Type 2 diabetes mellitus on insulin.
3. Hypertension.
4. Diastolic congestive heart failure with preserved EF.
5. Obstructive sleep apnea and secondary moderate pulmonary
hypertension.  He has been asked to use a CPAP machine, but is
reluctant to do so.
6. Degenerative joint disease.
7. Chronic renal insufficiency with a baseline creatinine in the

MEDICATION ON ADMISSION: Humalog insulin Sliding Scale, NPH 45 AM and 45 PM, Metoprolol
150 AM, Nifedical XL 30', Lisinopril 40', Triamterene/HCTZ
37.5/25', Avapro 150", Simvastatin 80', Lasix 120 AM, 80
afternoon, 80 PM, KDur 30 AM and 20 PM, Colchicine 0.6",
Allopurinol 200', Hectorol 1 AM and 0.5 PM, Omeprazole 40',
Alprazolam PRN

ALLERGIES: Phenergan

PHYSICAL EXAM: At Discharge:
Vitals stable
GEN: A/Ox3, NAD
CV: RRR, no m/r/g
RESP: CTAB, no w/r/r
ABD: soft, obese, appropriately TTP, +flatus, +BM
Incision: midline abdominal OTA with staples, distal erythema
improved.
Extrem: no c/c/e

FAMILY HISTORY: Father had [**Name2 (NI) 101859**] and peripheral vascular disease,
DVTs, and stroke.  Mother is alive.  Sister with CHF.

SOCIAL HISTORY: Married and lives with wife.  [**Name (NI) **] four daughters, ten
grandchildren.  Was laid off from Polaroid around the time the
company went bankrupt, is now retired.  Is of Italian
background, grew up in the [**Hospital3 **].
--Smoked < 5 py, quit 45 y prior
--No current EtOH
Malignant neoplasm of descending colon,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Chronic diastolic heart failure,Other hamartoses, not elsewhere classified,Unspecified erythematous condition,Laparoscopic surgical procedure converted to open procedure,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Aortic valve disorders,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Venous (peripheral) insufficiency, unspecified,Chronic kidney disease, Stage III (moderate),Gout, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Mal neo descend colon,Acute kidney failure NOS,Intestinal obstruct NOS,Chr diastolic hrt fail,Hamartoses NEC,Erythematous cond NOS,Lap surg convert to open,DMII renl nt st uncntrld,Obesity NOS,Aortic valve disorder,Chr pulmon heart dis NEC,Obstructive sleep apnea,Hy kid NOS w cr kid I-IV,Venous insufficiency NOS,Chr kidney dis stage III,Gout NOS,Abn reac-organ rem NEC
Admission Date:  [**2144-4-6**]              Discharge Date:   [**2144-4-14**]

Date of Birth:  [**2074-6-10**]             Sex:   M

Service: SURGERY

Allergies:
Phenergan

Attending:[**First Name3 (LF) 5547**]
Chief Complaint:
adenocarcinoma of the descending colon.


Major Surgical or Invasive Procedure:
1. Laparoscopic converted to open left colectomy.
2. Takedown of splenic flexure of colon.
3. Wedge biopsy of lesion of left lobe of liver.


History of Present Illness:
Mr. [**Name14 (STitle) 101858**] is a 69-year-old gentleman with multiple medical
comorbidities who presents for resection of adenocarcinoma of
the
descending colon.

Due to comorbidities to include obesity, type II diabetes,
diastolic heart failure,hypertension, untreated sleep apnea with
secondary pulmonary hypertension, and chronic renal
insufficiency, the patient was admitted for pre-op evaluation
and
administration of contrast by mouth.

He reports being in his usual state of health. No recent fevers
are reported. Of note, he was hospitalized for a postive stress
test and cardiac cath last month. Results included
identification
of 1. Single vessel coronary artery disease. 2. Mild to moderate
aortic stenosis. 3. Marked biventricular diastolic dysfunction.
4. Severe pulmonary hypertension.


Past Medical History:
1. Obesity.
2. Type 2 diabetes mellitus on insulin.
3. Hypertension.
4. Diastolic congestive heart failure with preserved EF.
5. Obstructive sleep apnea and secondary moderate pulmonary
hypertension.  He has been asked to use a CPAP machine, but is
reluctant to do so.
6. Degenerative joint disease.
7. Chronic renal insufficiency with a baseline creatinine in the

2-2.3 range.
8. Right acoustic neuroma status post gamma knife radiation
therapy with resultant hearing loss.
9. Mild aortic stenosis and mild aortic regurgitation
10. gout.


Social History:
Married and lives with wife.  [**Name (NI) **] four daughters, ten
grandchildren.  Was laid off from Polaroid around the time the
company went bankrupt, is now retired.  Is of Italian
background, grew up in the [**Hospital3 **].
--Smoked < 5 py, quit 45 y prior
--No current EtOH


Family History:
Father had [**Name2 (NI) 101859**] and peripheral vascular disease,
DVTs, and stroke.  Mother is alive.  Sister with CHF.

Physical Exam:
At Discharge:
Vitals stable
GEN: A/Ox3, NAD
CV: RRR, no m/r/g
RESP: CTAB, no w/r/r
ABD: soft, obese, appropriately TTP, +flatus, +BM
Incision: midline abdominal OTA with staples, distal erythema
improved.
Extrem: no c/c/e

Pertinent Results:
[**2144-4-6**] 05:35PM BLOOD WBC-7.5 RBC-5.12 Hgb-11.4* Hct-37.9*
MCV-74* MCH-22.3* MCHC-30.1* RDW-18.4* Plt Ct-251
[**2144-4-8**] 09:08PM BLOOD WBC-10.0 RBC-4.09* Hgb-9.3* Hct-30.4*
MCV-74* MCH-22.8* MCHC-30.7* RDW-18.5* Plt Ct-197
[**2144-4-11**] 08:35AM BLOOD WBC-7.0 RBC-4.05* Hgb-9.0* Hct-29.9*
MCV-74* MCH-22.3* MCHC-30.2* RDW-19.7* Plt Ct-231
[**2144-4-14**] 07:20AM BLOOD WBC-6.4 RBC-4.69 Hgb-10.5* Hct-34.4*
MCV-73* MCH-22.4* MCHC-30.5* RDW-19.0* Plt Ct-290
[**2144-4-6**] 05:35PM BLOOD PT-14.0* PTT-25.1 INR(PT)-1.2*
[**2144-4-6**] 05:35PM BLOOD Glucose-141* UreaN-40* Creat-2.0* Na-144
K-3.2* Cl-103 HCO3-28 AnGap-16
[**2144-4-8**] 09:08PM BLOOD Glucose-142* UreaN-38* Creat-2.8* Na-142
K-3.6 Cl-106 HCO3-26 AnGap-14
[**2144-4-12**] 07:25AM BLOOD Glucose-90 UreaN-63* Creat-2.6* Na-143
K-4.6 Cl-107 HCO3-28 AnGap-13
[**2144-4-14**] 07:20AM BLOOD Glucose-122* UreaN-71* Creat-2.7* Na-141
K-3.9 Cl-101 HCO3-29 AnGap-15
[**2144-4-7**] 08:37PM BLOOD CK(CPK)-262*
[**2144-4-7**] 08:37PM BLOOD CK-MB-5 cTropnT-0.05*
[**2144-4-6**] 05:35PM BLOOD Calcium-10.4* Phos-3.5 Mg-2.2
[**2144-4-7**] 06:50AM BLOOD Calcium-10.0 Phos-2.4* Mg-2.3
[**2144-4-9**] 02:42AM BLOOD Calcium-9.1 Phos-4.7* Mg-2.0
[**2144-4-10**] 07:15AM BLOOD Calcium-9.3 Phos-3.8 Mg-2.4
[**2144-4-13**] 06:20AM BLOOD Calcium-9.3 Phos-3.8 Mg-2.4
[**2144-4-14**] 07:20AM BLOOD Calcium-9.7 Phos-3.9 Mg-2.3
.
Pathology Examination
Procedure date    [**2144-4-7**]
DIAGNOSIS:
I.  Colon, left colectomy (A-Q):
1.  Adenocarcinoma, moderately differentiated, infiltrating
muscularis propria and extending into pericolic fat, See
synoptic report.
2.  Fifteen lymph nodes uninvolved by carcinoma (0/15).
II.  Liver, let lobe, biopsy (R):
1.  Bile duct hamartoma.
2.  Masson trichrome and iron stains performed (negative).
Colon and Rectum: Resection Synopsis
MACROSCOPIC
Specimen Type:  Colonic resection.  Location:  Left.
Specimen Size
    Greatest dimension:  25 cm.  Additional dimensions:  4 cm.
Tumor Site:  Left (descending) colon.
Tumor configuration:  Exophytic (polypoid).
Tumor Size
    Greatest dimension:  4 cm.  Additional dimensions:  3.2 cm x
0.6 cm.
MICROSCOPIC
Histologic Type:  Adenocarcinoma.
Histologic Grade:  Low-grade (well or moderately
differentiated).
EXTENT OF INVASION
Primary Tumor:  pT3:  Tumor invades through the muscularis
propria into the subserosa or the nonperitonealized pericolic or
perirectal soft tissues.
Regional Lymph Nodes:  pN0:  No regional lymph node metastasis.
Lymph Nodes
    Number examined:  15.
    Number involved:  0.
Distant metastasis:  pMX:  Cannot be assessed.
Margins
    Proximal margin:
        Uninvolved by invasive carcinoma:  Distance of tumor
from closest margin:  95 mm.
    Distal margin:
        Uninvolved by invasive carcinoma:  Distance of tumor
from closest margin:  120 mm.
    Circumferential (radial) margin:
        Uninvolved by invasive carcinoma:  Distance of tumor
from closest margin:  40 mm.
Lymphatic Small Vessel Invasion:  Absent.
Venous (large vessel) invasion:  Absent.
Perineural invasion:  Absent.
Tumor border configuration:  Pushing.
Additional Pathologic Findings:  None identified.
Clinical: Left colon cancer.
.


Brief Hospital Course:
Mr. [**Known lastname 101860**] operative course was converted from laparoscopic
to open due to body habitus and intra-abdominal anatomy.
Operative course was otherwise uncomplicated. He was monitored
in the PACU, and transferred to the ICU for closer monitoring
due to medical co-morbidities. ICU issues included low blood
pressure and marginal urine output. Bolused with IV albumin. IV
fluid marginalized due to h/o diastolic CHF. SBP's and urine
output stabilized. Labwork, included creatinine stable.
Transferred to Stone 5 for post-op care.
.
Started on sips on POD [**1-17**]. Pain well controlled with PCA. Foley
placed. Triggered for low SBP to 70's. Bolused with albumin x 1.
Urine output decreased to 5cc/hr, bloody. Bolused w/ albumin. IV
fluid continued at reduced rate. Renal consulted-ACE-I, [**Last Name (un) **],&
nifedipine held; Goal SBP >100 at all times. Daily creatinines
checked. Lasix dose gradually increased to home dose as CR's
returned to baseline. Urine output improved. SBP's returned to
baseline over nect 24-38 hours. Home medications resumed. Foley
removed, able to urinated adequate amounts.
.
Abdominal incision, midline, intact with staples. Distal erythem
progressed beyond markings. IV Kefzol started. Erythema
improved. No exudate/drainage. Diet advanced at bowel function
resumed. Reported flatus and eventual bowel movement prior to
discharge. Physical Therapy consulted due to obesity and
difficulty moving independently with abdominal incision. PT
cleared patient for discharge home with 24 hour supervision, use
of rolling walker at home until stonger/more stable, use of
bedside commode, & continue with home Physical Therapy.
.
Patient discharged home with services, PO Keflex for a few more
day for incisional erythema. Advised to follow-up with
Nephrologist-Dr. [**First Name (STitle) 11916**] within 1 week for creatinine check,
and Dr. [**Last Name (STitle) 1924**] in 1 week for staple removal.

Medications on Admission:
Humalog insulin Sliding Scale, NPH 45 AM and 45 PM, Metoprolol
150 AM, Nifedical XL 30', Lisinopril 40', Triamterene/HCTZ
37.5/25', Avapro 150", Simvastatin 80', Lasix 120 AM, 80
afternoon, 80 PM, KDur 30 AM and 20 PM, Colchicine 0.6",
Allopurinol 200', Hectorol 1 AM and 0.5 PM, Omeprazole 40',
Alprazolam PRN

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO
once a day.
3. Nifedical XL 30 mg Tab,Sust Rel Osmotic Push 24hr Sig: One
(1) Tab,Sust Rel Osmotic Push 24hr PO once a day.
4. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
5. Triamterene-Hydrochlorothiazid 37.5-25 mg Tablet Sig: One (1)
Tablet PO once a day.
6. Avapro 150 mg Tablet Sig: One (1) Tablet PO twice a day.
7. Lasix 40 mg Tablet Sig: Three (3) Tablet PO once a day: In
the AM. Total of 120mg.
8. Furosemide 80 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
9. Furosemide 80 mg Tablet Sig: One (1) Tablet PO AFTERNOON ().

10. Allopurinol 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Three (3) Capsule, Sustained Release PO QAM (once a day (in the
morning)).
12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO once a day: In the PM.
13. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: Three
(3) Capsule, Delayed Release(E.C.) PO once a day.
14. Doxercalciferol 0.5 mcg Capsule Sig: Two (2) Capsule PO QAM
(once a day (in the morning)).
15. Doxercalciferol 0.5 mcg Capsule Sig: One (1) Capsule PO QPM
(once a day (in the evening)).
16. Alprazolam 1 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day) as needed for anxiety.
17. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain: Do not exceed 4 grams of
acetaminophen in one day.
Disp:*45 Tablet(s)* Refills:*0*
18. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation for 2 weeks: Take
with oxycodone. Hold for loose stools.
Disp:*30 Capsule(s)* Refills:*0*
19. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO Q48H (every
48 hours).
20. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 3 days.
Disp:*12 Capsule(s)* Refills:*0*
21. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: 45Units
& 45Units  Subcutaneous QAM & QPM.
22. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation for 2 weeks: Hold for loose
stools. Take with oxucodone.
Disp:*30 Tablet(s)* Refills:*0*
23. Insulin Lispro 100 unit/mL Solution Sig: Per home sliding
scale  Subcutaneous Before meals & at bedtime.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Primary:
Adenocarcinoma of the descending colon
Several small bilobar liver lesions
Diastolic CHF
Post-op renal hypoperfusion injury
Post-op hypotension
.
Secondary:
Obesity., DM2, HTN, ^lipid, Diastolic CHF, OSA with Pulm HTN
(suppose to use CPAP but does not), DJD, CRI (2-2.5),Rt acoustic
neuroma status post gamma knife radiation therapy with resultant
hearing loss, Mild aortic stenosis and mild aortic regurgitation
as
evidenced on a recent echocardiogram last month, Gout.


Discharge Condition:
Stable
Tolerating a regular, low residue diet
Adequate pain control with oral medication

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.
* New or worsening cough or wheezing.
* 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.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.
*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.
.
Incision Care:
-Your staples will be removed at your follow-up appointment with
Dr. [**Last Name (STitle) 1924**].
-Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
.
Diet:
-Please continue with a Low residue regular diet until your
follow-up appointment with Dr. [**Last Name (STitle) 1924**].
-Please refer to hand-out provided to you per hospital staff.
Call Dr. [**Last Name (STitle) 1924**] if you have further questions.
.
Activity:
-Do not get up and walk around without assistance and monitoring
to prevent FALLS. Physical Therapy will work with you at home.
.
Medications:
1. Keflex- This is an antibiotic that you should continue taking
for another 3 days to prevent infection of your surgical
incision. Call Dr. [**Last Name (STitle) 1924**] with any questions or concerns.


Followup Instructions:
1. Please follow-up with your nephrologist Dr. [**First Name (STitle) 10083**] within 1
week to have your creatinine level checked in your blood.Call
his office for an appointment.
.
2. Please follow-up with Dr. [**Last Name (STitle) 1924**] [**Telephone/Fax (1) 7508**] in [**1-17**] weeks
for removal of your incisional staples.
.
Previous appointments:
1.Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 14839**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2144-6-4**] 9:40
2.Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2144-6-4**] 11:15
3.Provider: [**Name10 (NameIs) 1571**] FUNCTION LAB Phone:[**Telephone/Fax (1) 609**]
Date/Time:[**2144-6-17**] 11:10



Completed by:[**2144-4-17**]
{'Malignant neoplasm of descending colon,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Chronic diastolic heart failure,Other hamartoses, not elsewhere classified,Unspecified erythematous condition,Laparoscopic surgical procedure converted to open procedure,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Aortic valve disorders,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Venous (peripheral) insufficiency, unspecified,Chronic kidney disease, Stage III (moderate),Gout, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: adenocarcinoma of the descending colon.

PRESENT ILLNESS: Mr. [**Name14 (STitle) 101858**] is a 69-year-old gentleman with multiple medical
comorbidities who presents for resection of adenocarcinoma of
the
descending colon.

MEDICAL HISTORY: 1. Obesity.
2. Type 2 diabetes mellitus on insulin.
3. Hypertension.
4. Diastolic congestive heart failure with preserved EF.
5. Obstructive sleep apnea and secondary moderate pulmonary
hypertension.  He has been asked to use a CPAP machine, but is
reluctant to do so.
6. Degenerative joint disease.
7. Chronic renal insufficiency with a baseline creatinine in the

MEDICATION ON ADMISSION: Humalog insulin Sliding Scale, NPH 45 AM and 45 PM, Metoprolol
150 AM, Nifedical XL 30', Lisinopril 40', Triamterene/HCTZ
37.5/25', Avapro 150", Simvastatin 80', Lasix 120 AM, 80
afternoon, 80 PM, KDur 30 AM and 20 PM, Colchicine 0.6",
Allopurinol 200', Hectorol 1 AM and 0.5 PM, Omeprazole 40',
Alprazolam PRN

ALLERGIES: Phenergan

PHYSICAL EXAM: At Discharge:
Vitals stable
GEN: A/Ox3, NAD
CV: RRR, no m/r/g
RESP: CTAB, no w/r/r
ABD: soft, obese, appropriately TTP, +flatus, +BM
Incision: midline abdominal OTA with staples, distal erythema
improved.
Extrem: no c/c/e

FAMILY HISTORY: Father had [**Name2 (NI) 101859**] and peripheral vascular disease,
DVTs, and stroke.  Mother is alive.  Sister with CHF.

SOCIAL HISTORY: Married and lives with wife.  [**Name (NI) **] four daughters, ten
grandchildren.  Was laid off from Polaroid around the time the
company went bankrupt, is now retired.  Is of Italian
background, grew up in the [**Hospital3 **].
--Smoked < 5 py, quit 45 y prior
--No current EtOH 

### Response:
{'Malignant neoplasm of descending colon,Acute kidney failure, unspecified,Unspecified intestinal obstruction,Chronic diastolic heart failure,Other hamartoses, not elsewhere classified,Unspecified erythematous condition,Laparoscopic surgical procedure converted to open procedure,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Aortic valve disorders,Other chronic pulmonary heart diseases,Obstructive sleep apnea (adult)(pediatric),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Venous (peripheral) insufficiency, unspecified,Chronic kidney disease, Stage III (moderate),Gout, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
