CHIEF COMPLAINT: hypotension, low Hct

PRESENT ILLNESS: This is a 66 yo male with h/o metastatic bladder ca to liver,
lung on chemo who originally presented on [**2104-12-23**] from clinic
with hypotension and Hct of 17.  Pt was having episodes of
syncope at home and some abdominal pain, went to his outpt
oncologist's office for chemotherapy (C1D8
Gemcitabine/Cisplatin) where he was noted to have a BP of 75/56
and Hct was 17 and thus pt was sent to the ED.  In the [**Name (NI) **], pt
was given IVF, started on blood transfusions.  CT abd showed
pneumobilia [**12-17**] cholecystoenteric fistula.  Pt was admitted to
SICU for further management.  Though surgery was initially
considered, it was determined that pt is not a surgical
candidate.  Pt has remained hemodynamically stable, not
requiring pressors.  Pt has been continuously transfused with
goal Hct>30.  GI has been following who performed an EGD which
showed ulcers in stomach and duodenal bulb as well as a larger
ulcerated region at the junction of duodenal bulb and second
part of duodenum on the posterior wall of the duodenum with
adherent clot, suggestive of possible tumor eroding the small
bowel wall. Per GI recs, pt was continued on PPI gtt and blood
transfusions.  Since, pt continued to bleed, pt underwent an IR
procedure today, where no active bleeding was seen and the
gastroduodenal artery was embolized.  Pt continues to get
supportive care with transfusions. Currently, Hct is 21.2 and
getting 2U pRBCs.
.
Upon arrival to the MICU, pt is comfortable in bed.  Endorses
some mild pain in abdomen, but much better from admission.
Denies n/v.  States he continues to have dark red stools.
Denies chest pain.  Denies dysuria.  Admits to occasional
shortness of breath but denies fevers or cough.
.
ROS: per HPI, endorses 20 lb weight loss in last 6 months.
endorses syncopal episodes at home prior to admission.  [**Doctor First Name 1638**]
HAs.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
- [**6-/2104**] pt referred to Dr [**First Name (STitle) **] for microscopic hematuria,
found
to have abnormal digital rectal exam with nodularity adjacent to
the right prostate and the right seminal vesicle
- [**2104-7-22**] cystoscopy showed normal bladder mucosa except for
>2 cm calculus protruding from a diverticulum between the right
urothelial orifice and bladder neck.
- [**2104-9-11**] prostate biopsy showed invasive high-grade
carcinoma
involving the prostatic stroma and extraprostatic adipose
tissue,
one core showed prostatic adenocarcinoma, [**Doctor Last Name **] score 3+3.
- [**2104-10-16**] cystoprostatectomy and ileal conduit.The final
pathology examination showed invasive urothelial (transitional
cell) carcinoma arising from the bladder diverticulum and
extending into the perivesicular adipose tissue, prostate gland
and right seminal vesicle.  The tumor greatest dimension was 5.5
cm, high-grade, pT4a; two of the five regional lymph nodes were
positive for metastasis (pN2), the margins were uninvolved by
carcinoma, but there was extensive lymphovascular invasion and
perineural invasion. A [**Doctor Last Name **] 3+3 adenocarcinoma of the
prostate
was identified, as well.
Other Medical History:
1.  Nephrolithiasis
2.  Peripheral vascular disease
3.  Depression/Anxiety

MEDICATION ON ADMISSION: APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose
Pack - 1 Capsule(s) by mouth daily the day of chemotherapy and
the following 2 days
CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth daily
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth every twelve
(12) hours x 2 days after chemotherapy
LORAZEPAM - 0.5 mg Tablet - [**11-16**] Tablet(s) by mouth daily as
needed for anxiety or nausea
LOVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day
ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by mouth
twice daily x2 days after chemo and as needed afterward
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
every six (6) hours as needed for nausea
ASPIRIN - 81 mg Tablet - 1 Tablet(s) by mouth once a day
DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a
day as needed for constipation take this while taking narcotic
pain medication, stop if you develop diarrhea
POLYETHYLENE GLYCOL 3350 [MIRALAX] -  (Prescribed by Other
Provider) - Dosage uncertain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 96.8  BP: 118/63  HR: 94   RR: 22  O2sat  99% on RA
GEN: pale, weak, NAD
HEENT: PERRL, EOMI, pale conjunctivae, OP clear
RESP: CTAB with good air movement throughout
CV: RRR, no m/r/g
ABD: soft, mild diffuse ttp in abdomen
EXT: no c/c/e
NEURO: AAOx3. CN II-XII intact. 5/5 strength throughout. No
sensory deficits.

FAMILY HISTORY: father died of colon cancer at age 60.  mother with breast
cancer at age [**Age over 90 **] s/p lumpectomy. one sister who died in her late
20s of ovarian cancer.

SOCIAL HISTORY: Smoked 1/2-1 ppd for 50 years, quit recently. Denies EtOH (used
to drink 2 drinks per day prior to bladder ca diagnosis) or
drugs.
Fistula of gallbladder,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Hydronephrosis,Hypotension, unspecified,Dysthymic disorder,Personal history of malignant neoplasm of bladder
Fistula of gallbladder,Chr stomach ulc w hem,Chr duoden ulcer w hem,Acute kidney failure NOS,Ac posthemorrhag anemia,Second malig neo liver,Hydronephrosis,Hypotension NOS,Dysthymic disorder,Hx of bladder malignancy
Admission Date:  [**2104-12-23**]              Discharge Date:   [**2104-12-28**]

Date of Birth:  [**2038-6-16**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
hypotension, low Hct

Major Surgical or Invasive Procedure:
EGD
IR embolization

History of Present Illness:
This is a 66 yo male with h/o metastatic bladder ca to liver,
lung on chemo who originally presented on [**2104-12-23**] from clinic
with hypotension and Hct of 17.  Pt was having episodes of
syncope at home and some abdominal pain, went to his outpt
oncologist's office for chemotherapy (C1D8
Gemcitabine/Cisplatin) where he was noted to have a BP of 75/56
and Hct was 17 and thus pt was sent to the ED.  In the [**Name (NI) **], pt
was given IVF, started on blood transfusions.  CT abd showed
pneumobilia [**12-17**] cholecystoenteric fistula.  Pt was admitted to
SICU for further management.  Though surgery was initially
considered, it was determined that pt is not a surgical
candidate.  Pt has remained hemodynamically stable, not
requiring pressors.  Pt has been continuously transfused with
goal Hct>30.  GI has been following who performed an EGD which
showed ulcers in stomach and duodenal bulb as well as a larger
ulcerated region at the junction of duodenal bulb and second
part of duodenum on the posterior wall of the duodenum with
adherent clot, suggestive of possible tumor eroding the small
bowel wall. Per GI recs, pt was continued on PPI gtt and blood
transfusions.  Since, pt continued to bleed, pt underwent an IR
procedure today, where no active bleeding was seen and the
gastroduodenal artery was embolized.  Pt continues to get
supportive care with transfusions. Currently, Hct is 21.2 and
getting 2U pRBCs.
.
Upon arrival to the MICU, pt is comfortable in bed.  Endorses
some mild pain in abdomen, but much better from admission.
Denies n/v.  States he continues to have dark red stools.
Denies chest pain.  Denies dysuria.  Admits to occasional
shortness of breath but denies fevers or cough.
.
ROS: per HPI, endorses 20 lb weight loss in last 6 months.
endorses syncopal episodes at home prior to admission.  [**Doctor First Name 1638**]
HAs.


Past Medical History:
ONCOLOGIC HISTORY:
- [**6-/2104**] pt referred to Dr [**First Name (STitle) **] for microscopic hematuria,
found
to have abnormal digital rectal exam with nodularity adjacent to
the right prostate and the right seminal vesicle
- [**2104-7-22**] cystoscopy showed normal bladder mucosa except for
>2 cm calculus protruding from a diverticulum between the right
urothelial orifice and bladder neck.
- [**2104-9-11**] prostate biopsy showed invasive high-grade
carcinoma
involving the prostatic stroma and extraprostatic adipose
tissue,
one core showed prostatic adenocarcinoma, [**Doctor Last Name **] score 3+3.
- [**2104-10-16**] cystoprostatectomy and ileal conduit.The final
pathology examination showed invasive urothelial (transitional
cell) carcinoma arising from the bladder diverticulum and
extending into the perivesicular adipose tissue, prostate gland
and right seminal vesicle.  The tumor greatest dimension was 5.5
cm, high-grade, pT4a; two of the five regional lymph nodes were
positive for metastasis (pN2), the margins were uninvolved by
carcinoma, but there was extensive lymphovascular invasion and
perineural invasion. A [**Doctor Last Name **] 3+3 adenocarcinoma of the
prostate
was identified, as well.
Other Medical History:
1.  Nephrolithiasis
2.  Peripheral vascular disease
3.  Depression/Anxiety


Social History:
Smoked 1/2-1 ppd for 50 years, quit recently. Denies EtOH (used
to drink 2 drinks per day prior to bladder ca diagnosis) or
drugs.


Family History:
father died of colon cancer at age 60.  mother with breast
cancer at age [**Age over 90 **] s/p lumpectomy. one sister who died in her late
20s of ovarian cancer.


Physical Exam:
VS: Temp: 96.8  BP: 118/63  HR: 94   RR: 22  O2sat  99% on RA
GEN: pale, weak, NAD
HEENT: PERRL, EOMI, pale conjunctivae, OP clear
RESP: CTAB with good air movement throughout
CV: RRR, no m/r/g
ABD: soft, mild diffuse ttp in abdomen
EXT: no c/c/e
NEURO: AAOx3. CN II-XII intact. 5/5 strength throughout. No
sensory deficits.


Pertinent Results:
[**2104-12-27**] 05:47AM BLOOD Hct-22.5*
[**2104-12-27**] 02:00AM BLOOD WBC-4.3 RBC-2.85*# Hgb-8.9*# Hct-24.4*
MCV-86 MCH-31.1 MCHC-36.3* RDW-14.9 Plt Ct-96*
[**2104-12-26**] 10:14PM BLOOD Hct-26.7*#
[**2104-12-26**] 05:06PM BLOOD Hct-20.9*
[**2104-12-26**] 02:10PM BLOOD Hct-26.3*
[**2104-12-26**] 09:27AM BLOOD WBC-4.8 RBC-4.15*# Hgb-12.2*# Hct-34.0*#
MCV-82 MCH-29.3 MCHC-35.8* RDW-14.7 Plt Ct-109*
[**2104-12-26**] 03:41AM BLOOD WBC-5.1 RBC-2.61* Hgb-7.7*# Hct-21.3*
MCV-82 MCH-29.7 MCHC-36.3* RDW-14.0 Plt Ct-80*
[**2104-12-25**] 08:39PM BLOOD Hct-21.2*
[**2104-12-25**] 03:53PM BLOOD Hct-22.4* Plt Ct-145*#
[**2104-12-25**] 08:26AM BLOOD Hct-22.8* Plt Ct-70*
[**2104-12-25**] 01:45AM BLOOD WBC-10.0 RBC-3.38*# Hgb-10.3*# Hct-28.5*
MCV-84 MCH-30.6 MCHC-36.3* RDW-14.3 Plt Ct-63*
[**2104-12-24**] 11:01PM BLOOD Hct-29.6*#
[**2104-12-24**] 07:15PM BLOOD Hct-22.3*
[**2104-12-24**] 01:44PM BLOOD Hct-21.4*
[**2104-12-24**] 07:23AM BLOOD Hct-28.3*
[**2104-12-24**] 03:59AM BLOOD Hct-28.9*#
[**2104-12-23**] 10:45PM BLOOD WBC-11.5* RBC-2.65* Hgb-7.9* Hct-22.0*
MCV-83 MCH-29.9 MCHC-36.1* RDW-15.2 Plt Ct-108*
[**2104-12-23**] 06:15PM BLOOD WBC-8.8 RBC-2.68*# Hgb-8.0*# Hct-22.5*#
MCV-84 MCH-29.7 MCHC-35.5* RDW-14.7 Plt Ct-105*
[**2104-12-23**] 12:25PM BLOOD WBC-8.9 RBC-1.98* Hgb-5.9* Hct-17.1*
MCV-86 MCH-29.8 MCHC-34.5 RDW-14.4 Plt Ct-124*
[**2104-12-23**] 10:46AM BLOOD WBC-10.4# RBC-2.30*# Hgb-6.6*# Hct-20.6*#
MCV-90 MCH-28.7 MCHC-32.1 RDW-14.1 Plt Ct-154#
[**2104-12-26**] 09:27AM BLOOD PT-15.1* PTT-24.5 INR(PT)-1.3*
[**2104-12-26**] 03:41AM BLOOD PT-19.9* PTT-27.1 INR(PT)-1.8*
[**2104-12-25**] 01:45AM BLOOD PT-15.0* PTT-22.7 INR(PT)-1.3*
[**2104-12-24**] 03:59AM BLOOD PT-13.7* PTT-23.5 INR(PT)-1.2*
[**2104-12-23**] 12:25PM BLOOD PT-13.4 PTT-19.6* INR(PT)-1.1
[**2104-12-24**] 03:59AM BLOOD Fibrino-515*
[**2104-12-27**] 02:00AM BLOOD Glucose-623* UreaN-63* Creat-1.6* Na-134
K-3.9 Cl-110* HCO3-16* AnGap-12
[**2104-12-26**] 03:41AM BLOOD Glucose-212* UreaN-72* Creat-1.7* Na-148*
K-4.5 Cl-120* HCO3-19* AnGap-14
[**2104-12-25**] 01:45AM BLOOD Glucose-114* UreaN-66* Creat-1.3* Na-146*
K-4.2 Cl-116* HCO3-21* AnGap-13
[**2104-12-24**] 03:59AM BLOOD Glucose-112* UreaN-59* Creat-1.3* Na-140
K-3.3 Cl-108 HCO3-22 AnGap-13
[**2104-12-23**] 10:46AM BLOOD UreaN-65* Creat-1.6* Na-130* K-4.1 Cl-91*
HCO3-29 AnGap-14
[**2104-12-26**] 03:41AM BLOOD ALT-14 AST-18 LD(LDH)-153 AlkPhos-28*
TotBili-0.5
[**2104-12-23**] 10:46AM BLOOD ALT-30 AST-26 LD(LDH)-128 AlkPhos-79
TotBili-0.4 DirBili-0.2 IndBili-0.2
[**2104-12-27**] 02:00AM BLOOD Calcium-5.5* Phos-3.8 Mg-1.6
[**2104-12-26**] 03:41AM BLOOD Calcium-6.1* Phos-4.8* Mg-2.0
[**2104-12-25**] 01:45AM BLOOD Calcium-7.0* Phos-4.5 Mg-2.4
[**2104-12-24**] 03:59AM BLOOD Calcium-7.0* Phos-3.6 Mg-1.9
[**2104-12-23**] 10:46AM BLOOD Albumin-2.7* Mg-2.1
[**2104-12-23**] 10:46AM BLOOD Hapto-357*
[**2104-12-23**] 06:27PM BLOOD Lactate-1.0
[**2104-12-23**] 12:44PM BLOOD Lactate-2.4*

Micro:
[**2104-12-24**] MRSA SCREEN MRSA SCREEN-FINAL INPATIENT
[**2104-12-23**] BLOOD CULTURE Blood Culture,
Routine-PENDING

Imaging/Studies:
[**12-23**] CXR: IMPRESSION: Relatively stable examination. The patient
has diffuse nodules presumably from metastatic disease.
Conceivably, there could be early consolidation of the right
lower lung; however, the increased opacity is felt more likely
due to differences in technique, inspiratory effort, and
resultant ronchovascular crowding.

[**12-23**] CT Head: IMPRESSION: No acute intracranial process.

[**12-23**] CT abd/pelvis: IMPRESSION:
1. Likely fistulous communication between the first portion of
the duodenum and the gallbladder which may be from ulceration or
inflammation of previously seen duodenal diverticulum.
High-density material within the gallbladder lumen likely
represents clot/blood.
2. Bilateral moderate-to-severe hydronephrosis, left worse than
right. The right hydronephrosis is new since [**2104-12-8**],
although the cause of the new-onset hydronephrosis not
appreciated on this study.
3. Multiple pulmonary metastases as described on prior studies.

4. Multiple intramuscular metastases as described above.
5. Extensive diverticulosis.

[**12-25**] mesenteric angiogram with embolization of GDA

[**12-26**] GI bleed study: IMPRESSION: Bleeding in the region of
duodenum, presumably in the GDA territory.

[**12-26**] mesenteric angiogram


Brief Hospital Course:
This is a 66 yo male with h/o metastatic bladder ca to liver,
lung on chemo who originally presented on [**2104-12-23**] from clinic
with hypotension and Hct of 17, has been in SICU getting blood
transfusions, then transferred to MICU for further management as
pt is not a surgical candidate.
.
# Goals of care:  On admission, pt was full code.  Pt was deemed
not a surgical candidate by Surgery.  Pt was DNR/DNI at time of
transfer to the MICU.  IR performed IR embolizations with no
success in stabilizing the bleeding.  As the pt continued to
bleed, it was then decided by him and his family that he would
be CMO.  SW and Palliative care teans were involved.  Pt was
started on a Morphine gtt for comfort and the pt passed in early
hours of [**2104-12-28**].
.
# Anemia:  Pt not a surgical candidate.  Continued to require
blood transfusions.  Pt was s/p IR embolization of the
gastroduodenal artery on [**2104-12-25**]. However, continued to require
transfusions and shows active bleeding.  Pt was continued on
PPI gtt.  Per IR recs, pt underwent a tagged RBC scan which
showed active bleeding in GDA territory and pt underwent IR
embolization again on [**2104-12-26**].  However, as pt continud to
bleed, pt and his family decided to change his goals of care to
comfort measures only.  NSAIDs and ASA were held.
.
#  Metastatic bladder cancer/cholecystoenteric fistula: Pt was
maintained on Unasyn to cover any possible GI infections.  Pain
was controlled with Dilaudid PRN. Pt's outpt oncologist Dr.
[**Last Name (STitle) **] was following closely.  SW and palliative care were
consulted to help pt and his family with end of life issues.
.
# PVD: Home ASA and statin were held.
.
# Depression/Anxiety: Home Citalopram was held.  Ativan PRN was
used for anxiety.
.
Pt was initially NPO at MN for possible interventions then
allowed to eat when became CMO.  Pt was on pneumoboots for DVT
ppx.


Medications on Admission:
APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose
Pack - 1 Capsule(s) by mouth daily the day of chemotherapy and
the following 2 days
CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth daily
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth every twelve
(12) hours x 2 days after chemotherapy
LORAZEPAM - 0.5 mg Tablet - [**11-16**] Tablet(s) by mouth daily as
needed for anxiety or nausea
LOVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day
ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by mouth
twice daily x2 days after chemo and as needed afterward
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
every six (6) hours as needed for nausea
ASPIRIN - 81 mg Tablet - 1 Tablet(s) by mouth once a day
DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a
day as needed for constipation take this while taking narcotic
pain medication, stop if you develop diarrhea
POLYETHYLENE GLYCOL 3350 [MIRALAX] -  (Prescribed by Other
Provider) - Dosage uncertain


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Metastatic prostate ca

Discharge Condition:
N/A

Discharge Instructions:
N/A

Followup Instructions:
N/A


Completed by:[**2104-12-28**]
{'Fistula of gallbladder,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Hydronephrosis,Hypotension, unspecified,Dysthymic disorder,Personal history of malignant neoplasm of bladder'}


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: hypotension, low Hct

PRESENT ILLNESS: This is a 66 yo male with h/o metastatic bladder ca to liver,
lung on chemo who originally presented on [**2104-12-23**] from clinic
with hypotension and Hct of 17.  Pt was having episodes of
syncope at home and some abdominal pain, went to his outpt
oncologist's office for chemotherapy (C1D8
Gemcitabine/Cisplatin) where he was noted to have a BP of 75/56
and Hct was 17 and thus pt was sent to the ED.  In the [**Name (NI) **], pt
was given IVF, started on blood transfusions.  CT abd showed
pneumobilia [**12-17**] cholecystoenteric fistula.  Pt was admitted to
SICU for further management.  Though surgery was initially
considered, it was determined that pt is not a surgical
candidate.  Pt has remained hemodynamically stable, not
requiring pressors.  Pt has been continuously transfused with
goal Hct>30.  GI has been following who performed an EGD which
showed ulcers in stomach and duodenal bulb as well as a larger
ulcerated region at the junction of duodenal bulb and second
part of duodenum on the posterior wall of the duodenum with
adherent clot, suggestive of possible tumor eroding the small
bowel wall. Per GI recs, pt was continued on PPI gtt and blood
transfusions.  Since, pt continued to bleed, pt underwent an IR
procedure today, where no active bleeding was seen and the
gastroduodenal artery was embolized.  Pt continues to get
supportive care with transfusions. Currently, Hct is 21.2 and
getting 2U pRBCs.
.
Upon arrival to the MICU, pt is comfortable in bed.  Endorses
some mild pain in abdomen, but much better from admission.
Denies n/v.  States he continues to have dark red stools.
Denies chest pain.  Denies dysuria.  Admits to occasional
shortness of breath but denies fevers or cough.
.
ROS: per HPI, endorses 20 lb weight loss in last 6 months.
endorses syncopal episodes at home prior to admission.  [**Doctor First Name 1638**]
HAs.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
- [**6-/2104**] pt referred to Dr [**First Name (STitle) **] for microscopic hematuria,
found
to have abnormal digital rectal exam with nodularity adjacent to
the right prostate and the right seminal vesicle
- [**2104-7-22**] cystoscopy showed normal bladder mucosa except for
>2 cm calculus protruding from a diverticulum between the right
urothelial orifice and bladder neck.
- [**2104-9-11**] prostate biopsy showed invasive high-grade
carcinoma
involving the prostatic stroma and extraprostatic adipose
tissue,
one core showed prostatic adenocarcinoma, [**Doctor Last Name **] score 3+3.
- [**2104-10-16**] cystoprostatectomy and ileal conduit.The final
pathology examination showed invasive urothelial (transitional
cell) carcinoma arising from the bladder diverticulum and
extending into the perivesicular adipose tissue, prostate gland
and right seminal vesicle.  The tumor greatest dimension was 5.5
cm, high-grade, pT4a; two of the five regional lymph nodes were
positive for metastasis (pN2), the margins were uninvolved by
carcinoma, but there was extensive lymphovascular invasion and
perineural invasion. A [**Doctor Last Name **] 3+3 adenocarcinoma of the
prostate
was identified, as well.
Other Medical History:
1.  Nephrolithiasis
2.  Peripheral vascular disease
3.  Depression/Anxiety

MEDICATION ON ADMISSION: APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose
Pack - 1 Capsule(s) by mouth daily the day of chemotherapy and
the following 2 days
CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth daily
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth every twelve
(12) hours x 2 days after chemotherapy
LORAZEPAM - 0.5 mg Tablet - [**11-16**] Tablet(s) by mouth daily as
needed for anxiety or nausea
LOVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day
ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by mouth
twice daily x2 days after chemo and as needed afterward
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
every six (6) hours as needed for nausea
ASPIRIN - 81 mg Tablet - 1 Tablet(s) by mouth once a day
DOCUSATE SODIUM - 100 mg Capsule - 1 Capsule(s) by mouth twice a
day as needed for constipation take this while taking narcotic
pain medication, stop if you develop diarrhea
POLYETHYLENE GLYCOL 3350 [MIRALAX] -  (Prescribed by Other
Provider) - Dosage uncertain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 96.8  BP: 118/63  HR: 94   RR: 22  O2sat  99% on RA
GEN: pale, weak, NAD
HEENT: PERRL, EOMI, pale conjunctivae, OP clear
RESP: CTAB with good air movement throughout
CV: RRR, no m/r/g
ABD: soft, mild diffuse ttp in abdomen
EXT: no c/c/e
NEURO: AAOx3. CN II-XII intact. 5/5 strength throughout. No
sensory deficits.

FAMILY HISTORY: father died of colon cancer at age 60.  mother with breast
cancer at age [**Age over 90 **] s/p lumpectomy. one sister who died in her late
20s of ovarian cancer.

SOCIAL HISTORY: Smoked 1/2-1 ppd for 50 years, quit recently. Denies EtOH (used
to drink 2 drinks per day prior to bladder ca diagnosis) or
drugs. 

### Response:
{'Fistula of gallbladder,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Malignant neoplasm of liver, secondary,Hydronephrosis,Hypotension, unspecified,Dysthymic disorder,Personal history of malignant neoplasm of bladder'}
