CHIEF COMPLAINT: abd pain

PRESENT ILLNESS: 81 yo male with presumed COPD and recently diagnosed metastatic
bladder CA with known left hydronephrosis presents from OSH ED
after complaining of abd pain. The pt reports that he was in his
usual state of health until mid-day on the day PTA. At that
point, he noted the onset of RLQ abd pain that was non-radiating
and intermittently sharp and dull. He presented to the ED at
[**Hospital1 **]-[**Location (un) 620**] where he was afebrile but noted to appear unwell and
have an SBP in the 90s with associcated sinus tachycardia. A CT
scan there demonstrated left hydronephrosis and a question of
gallbladder distention.

MEDICAL HISTORY: multiple papillary bladder tumors
--first dx in [**4-18**]
--s/p BCG therapy
--concern for mets to mid left femur, known extensive liver mets
renal stones many years ago
s/p left inguinal hernia repair
lung nodule concerning for possible malignancy noted on CT scan

MEDICATION ON ADMISSION: oxycontin PRN
colace

ALLERGIES: Codeine

PHYSICAL EXAM: General: Awake and alert though mildly sleepy. NAD, pleasant,
appropriate, cooperative.
HEENT: NCAT, PERRL, EOMI, no scleral icterus, MMM, no lesions
noted in OP.
Neck: Supple, no significant JVD or carotid bruits appreciated.

FAMILY HISTORY: No FH of malignancy or other heritable disease. Both parents
lived to advanced age.

SOCIAL HISTORY: Retired clerical worker. Smoked multiple PPD from age 14 to 61.
Denies EtOH.
Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Hydronephrosis,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Acquired coagulation factor deficiency,Secondary malignant neoplasm of kidney,Mixed acid-base balance disorder,Acute and subacute necrosis of liver,Malignant neoplasm of bladder, part unspecified,Tobacco use disorder,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Encounter for palliative care,Chronic kidney disease, Stage III (moderate),Hypoxemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Severe sepsis
Septicemia NOS,Ac kidny fail, tubr necr,Hydronephrosis,Second malig neo liver,Urin tract infection NOS,Acq coagul factor defic,Second malig neo kidney,Mixed acid-base bal dis,Acute necrosis of liver,Malig neo bladder NOS,Tobacco use disorder,Chr airway obstruct NEC,Hypotension NOS,Hy kid NOS w cr kid I-IV,Encountr palliative care,Chr kidney dis stage III,Hypoxemia,Cholelithiasis NOS,Severe sepsis
Admission Date:  [**2146-8-14**]              Discharge Date:   [**2146-8-17**]

Date of Birth:  [**2064-12-9**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
abd pain

Major Surgical or Invasive Procedure:
percutaneous nephrostomy tube placement, [**2146-8-13**]

History of Present Illness:
81 yo male with presumed COPD and recently diagnosed metastatic
bladder CA with known left hydronephrosis presents from OSH ED
after complaining of abd pain. The pt reports that he was in his
usual state of health until mid-day on the day PTA. At that
point, he noted the onset of RLQ abd pain that was non-radiating
and intermittently sharp and dull. He presented to the ED at
[**Hospital1 **]-[**Location (un) 620**] where he was afebrile but noted to appear unwell and
have an SBP in the 90s with associcated sinus tachycardia. A CT
scan there demonstrated left hydronephrosis and a question of
gallbladder distention.

In the [**Hospital1 18**] ED, initial vitals were 97.2, 103, 24, 98/68 and
90% RA. An abd ultrasound was obtained in the ED. This study did
not show gall bladder abdnormalities but did demonstrate
extensive hepatic mets. He was given emperic doses of Zosyn and
vancomycin as well as 5L NS. A urology consultation was obtained
given the pt's hydronephrosis and a positive UA. There was a
concern for left sided upper urinary tract infection and urgent
percutaneous nephrostomy tube placement was advised; this was
performed by IR immediately after the pt's arrival to the MICU.
A VQ scan was also obtained given the pt's tachycardia and
relative hypoxia; the results of this study are pending.

ROS was otherwise essentially negative. The pt endorsed
intermittent hemature but denied recent unintended weight loss,
fevers, night sweats, chills, headaches, dizziness or vertigo.
No changes in hearing or vision, neck stiffness,
lymphadenopathy, hematemesis, coffee-ground emesis, dysphagia,
odynophagia, heartburn, nausea, vomiting, diarrhea,
constipation, steatorrhea, melena, hematochezia, cough,
hemoptysis, wheezing, shortness of breath, chest pain,
palpitations, dyspnea on exertion, increasing lower extremity
swelling, orthpnea, paroxysmal nocturnal dyspnea, leg pain while
walking, joint pain.

Past Medical History:
multiple papillary bladder tumors
--first dx in [**4-18**]
--s/p BCG therapy
--concern for mets to mid left femur, known extensive liver mets
renal stones many years ago
s/p left inguinal hernia repair
lung nodule concerning for possible malignancy noted on CT scan

Social History:
Retired clerical worker. Smoked multiple PPD from age 14 to 61.
Denies EtOH.


Family History:
No FH of malignancy or other heritable disease. Both parents
lived to advanced age.

Physical Exam:
General: Awake and alert though mildly sleepy. NAD, pleasant,
appropriate, cooperative.
HEENT: NCAT, PERRL, EOMI, no scleral icterus, MMM, no lesions
noted in OP.
Neck: Supple, no significant JVD or carotid bruits appreciated.

Pulmonary: Few crackles at bases bilaterally, no wheezes or
rhochi.
Cardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: Soft, NT, ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: Trace edema, 2+ radial and DP pulses b/l
Skin: No rashes or lesions noted.
Neurologic: Alert, oriented x 3. Able to relate history without
difficulty. Cranial nerves II-XII intact. Normal bulk, strength
and tone throughout. No abnormal movements noted. No deficits to
light touch throughout. No nystagmus, dysarthria, intention or
action tremor. 2+ biceps, triceps, brachioradialis, patellar
reflexes and 2+ ankle jerks bilaterally. Plantar response was
flexor bilaterally.

Pertinent Results:
[**2146-8-14**] 01:05AM   WBC-16.3* RBC-4.49* HGB-14.2 HCT-41.5 MCV-92
MCH-31.6 MCHC-34.2 RDW-14.0
[**2146-8-14**] 01:05AM   NEUTS-91.8* LYMPHS-4.4* MONOS-3.3 EOS-0.3
BASOS-0.1
[**2146-8-14**] 01:05AM   GLUCOSE-100 UREA N-68* CREAT-2.4* SODIUM-140
POTASSIUM-5.6* CHLORIDE-103 TOTAL CO2-18* ANION GAP-25*
.
CXR:
The cardiomediastinal contour is normal. The heart is not
enlarged. There is linear platelike atelectasis at the left lung
base. The lungs are otherwise clear. Osseous structures are
unremarkable.
IMPRESSION: No evidence of focal consolidation on this single
view.
.
Abd US
1. Innumerable hepatic metastases from bladder cancer.
2. Cholelithiasis without evidence of cholecystitis.
3. No evidence of intrahepatic biliary ductal dilatation; normal
size of CBD.

Brief Hospital Course:
81 yo male presenting with bladder cancer, found to have abd
pain, tachycardia and borderline blood pressure, s/p perc
nephrostomy tube drainage of left hydronephrosis, became
persistently hypotensive and subjectively dyspneic with a
refractory metabolic acidosis.  It was decided to place the
patient via care measures and he was placed on a morphine drip
-- the patient subsequently expired.

#UTI: Treating with Cipro. Await culture results. WBC slightly
decreased. Does not meet SIRS criteria.  Pt was agressively
volume repleted.
.
#ARF: Pt's baseline somewhat unclear, however SCr was 1.7 at OSH
approximately one week ago, further elevated on admission, still
further increasing today. Some baseline renal dysfunction
expected given pt's obstruction; suspect that acuity of further
obstruction resulting in additional failure. Pt s/p perc
drainage placement and volume repletion.  Developed a refractory
metabolic acidosis with resultant tachypnea.
.
#SOB/question COPD: Pt with extensive smoking history and a
question of COPD based on prior imaging. No has crackles on exam
after 5L volume resuscitation in MICU.  Patient became
subjectively dyspneic and tachypneic during exams which was
summarily relieved by morphine after CMO status.
.
#Abnormal LFTs/coagulopathy: Likely secondary to extensive
hepatic mets.
.
#Abd pain: Has resolved. Likely secondary to worsening
hydronephrosis/UTI, although numerous other etiologies were
certainly possible.

Medications on Admission:
oxycontin PRN
colace

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
N/A

Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2146-8-21**]
{'Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Hydronephrosis,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Acquired coagulation factor deficiency,Secondary malignant neoplasm of kidney,Mixed acid-base balance disorder,Acute and subacute necrosis of liver,Malignant neoplasm of bladder, part unspecified,Tobacco use disorder,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Encounter for palliative care,Chronic kidney disease, Stage III (moderate),Hypoxemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Severe sepsis'}


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: abd pain

PRESENT ILLNESS: 81 yo male with presumed COPD and recently diagnosed metastatic
bladder CA with known left hydronephrosis presents from OSH ED
after complaining of abd pain. The pt reports that he was in his
usual state of health until mid-day on the day PTA. At that
point, he noted the onset of RLQ abd pain that was non-radiating
and intermittently sharp and dull. He presented to the ED at
[**Hospital1 **]-[**Location (un) 620**] where he was afebrile but noted to appear unwell and
have an SBP in the 90s with associcated sinus tachycardia. A CT
scan there demonstrated left hydronephrosis and a question of
gallbladder distention.

MEDICAL HISTORY: multiple papillary bladder tumors
--first dx in [**4-18**]
--s/p BCG therapy
--concern for mets to mid left femur, known extensive liver mets
renal stones many years ago
s/p left inguinal hernia repair
lung nodule concerning for possible malignancy noted on CT scan

MEDICATION ON ADMISSION: oxycontin PRN
colace

ALLERGIES: Codeine

PHYSICAL EXAM: General: Awake and alert though mildly sleepy. NAD, pleasant,
appropriate, cooperative.
HEENT: NCAT, PERRL, EOMI, no scleral icterus, MMM, no lesions
noted in OP.
Neck: Supple, no significant JVD or carotid bruits appreciated.

FAMILY HISTORY: No FH of malignancy or other heritable disease. Both parents
lived to advanced age.

SOCIAL HISTORY: Retired clerical worker. Smoked multiple PPD from age 14 to 61.
Denies EtOH. 

### Response:
{'Unspecified septicemia,Acute kidney failure with lesion of tubular necrosis,Hydronephrosis,Malignant neoplasm of liver, secondary,Urinary tract infection, site not specified,Acquired coagulation factor deficiency,Secondary malignant neoplasm of kidney,Mixed acid-base balance disorder,Acute and subacute necrosis of liver,Malignant neoplasm of bladder, part unspecified,Tobacco use disorder,Chronic airway obstruction, not elsewhere classified,Hypotension, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Encounter for palliative care,Chronic kidney disease, Stage III (moderate),Hypoxemia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Severe sepsis'}
