CHIEF COMPLAINT: Metastatic duodenal cancer

PRESENT ILLNESS: Dr. [**Known lastname 107769**] is a 57-year-old patient with a known adenocarcinoma
in the duodenum causing recurrent gastrointestinal bleeding and
recurrent anemia. She has had exhaustive preoperative evaluation
which has demonstrated also the presence of a single metastasis
in the liver. For palliation, if not curative  ntent, I
recommended that she undergo a combined Whipple procedure to try
to get the primary tumor out to eliminate the bleeding and
impending obstruction of the duodenum. I also convened with Dr.
[**Last Name (STitle) **] of our hepatobiliary surgery team to consider resection of
the metastatic disease in the liver, as there is no other
evidence of systemic metastases.

MEDICAL HISTORY: PAST MEDICAL HISTORY: Significant only for known cyst in the
breast.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of duodenum,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Mitral valve disorders
Malignant neopl duodenum,Second malig neo liver,Mal neo lymph intra-abd,Ac posthemorrhag anemia,Mitral valve disorder
Admission Date:  [**2190-1-5**]              Discharge Date:   [**2190-1-16**]

Date of Birth:  [**2132-6-6**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
Metastatic duodenal cancer

Major Surgical or Invasive Procedure:
OPERATIVE PROCEDURE:
1. Pylorus-preserving pancreaticoduodenectomy.
2. Open cholecystectomy.
3. Right hepatic lobectomy


History of Present Illness:
Dr. [**Known lastname 107769**] is a 57-year-old patient with a known adenocarcinoma
in the duodenum causing recurrent gastrointestinal bleeding and
recurrent anemia. She has had exhaustive preoperative evaluation
which has demonstrated also the presence of a single metastasis
in the liver. For palliation, if not curative  ntent, I
recommended that she undergo a combined Whipple procedure to try
to get the primary tumor out to eliminate the bleeding and
impending obstruction of the duodenum. I also convened with Dr.
[**Last Name (STitle) **] of our hepatobiliary surgery team to consider resection of
the metastatic disease in the liver, as there is no other
evidence of systemic metastases.

Past Medical History:
PAST MEDICAL HISTORY: Significant only for known cyst in the
breast.

Brief Hospital Course:
Patient went to the operating room on [**2190-1-5**]. Please see the
OMR note for operative details. There were no unanticipated
intra-operative complications, and the patient lost
approximately one liter of blood and received three units PRBCs
during the procedure. 2 19-French [**Doctor Last Name 406**] drains were placed to
liver bed and pancreatic biliary anastomoses locations.
Post-operatively she went to the surgical ICU. Her pain was
controlled with epidural and PCA. On POD1 INR was 2.0 and the
patient received 2 units of FFP. POD1 liver US also demonstrated
normal spectral analysis and color Doppler evaluation of the
vasculature of the residual left hepatic lobe. On POD2 she
received another 2 units FFP for INR 1.9, and since
transaminases remained elevated another liver ultrasound.
Ultrasound was normal-"Again, seen are widely patent main and
left portal veins with appropriate direction of flow. The left
hepatic vein and hepatic artery are  also patent and  patency
and appropriate direction of flow. Again, the left hepatic
artery demonstrates a resistive index of 0.60. There is no
biliary ductal dilatation.  here is no free fluid. The inferior
vena cava is widely patent." POD3 the G-tube was clamped and
half-strength J-tube feedings were begun. Patient was also
transferred out of the unit to the floor on POD3. TF were slowly
advanced and on POD4 she was advanced to sips as well as
transitioned to oral pain medications. Foley catheter was
removed from the bladder on POD5 and tube feeds were cycled at
night. Lasix was given on POD5 and the patient began to mobilize
significant fluid accumulation, especially in the lower
extremities. By POD5 she was also tolerating full liquids and
was doing well ambulating around the floor and working with
physical therapy. Her central line was removed on POD6 and she
was transitioned to all oral medications per the "Whipple
Protocol". Her electrolytes were aggressively repleted and
intermittent doses of lasix were helpful in gaining euvolemia.
She continued to have some trouble with nausea that was
controlled with antiemetics but was troublesome nonetheless. JP
drains were removed before discharge, and the patient was begun
on a 7 day course of cefazolin for a superficial cellulitis. She
was discharged to home with services on POD10. She was afebrile,
tolerating a full diet and ambulating without difficulty. Her
wounds were healing nicely and she was instructed on proper G
and J tube care. She has follow-up as outlined below.


Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
Disp:*100 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
Disp:*60 Capsule(s)* Refills:*2*
4. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Four (4) Capsule, Sustained Release PO once a day.
Disp:*120 Capsule, Sustained Release(s)* Refills:*2*
5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Cephalexin 500 mg Tablet Sig: One (1) Tablet PO four times a
day for 7 days.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Metastatic duodenal cancer


Discharge Condition:
Stable


Discharge Instructions:
Please call the office or the emergency room if you develop
fever greater than 101.5, your wounds become red, swollen or
begin draining pus or you develop severe nausea or vomiting.

Please take the full 7 day course of antibiotics, as well as all
other medications prescribed.

Do not drive while taking narcotic pain medications, and use a
stool softener such as colace while you are taking the pain
medication.

You may shower when you get home but avoid tub bathing for 3
weeks.

No heavy lifting or activity for at least 6 weeks.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 468**] in the office in [**2-8**] weeks.
Please call ahead of time to make an appointment. ([**Telephone/Fax (1) 27734**].



Completed by:[**2190-3-10**]
{'Malignant neoplasm of duodenum,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Mitral valve disorders'}


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: Metastatic duodenal cancer

PRESENT ILLNESS: Dr. [**Known lastname 107769**] is a 57-year-old patient with a known adenocarcinoma
in the duodenum causing recurrent gastrointestinal bleeding and
recurrent anemia. She has had exhaustive preoperative evaluation
which has demonstrated also the presence of a single metastasis
in the liver. For palliation, if not curative  ntent, I
recommended that she undergo a combined Whipple procedure to try
to get the primary tumor out to eliminate the bleeding and
impending obstruction of the duodenum. I also convened with Dr.
[**Last Name (STitle) **] of our hepatobiliary surgery team to consider resection of
the metastatic disease in the liver, as there is no other
evidence of systemic metastases.

MEDICAL HISTORY: PAST MEDICAL HISTORY: Significant only for known cyst in the
breast.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of duodenum,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Mitral valve disorders'}
