CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an
82-year-old female with a history of hypertension and
hypercholesterolemia, recent admission for painless jaundice
and cholangitis who was treated with multiple percutaneous
drains by Interventional Radiology and also diagnosed with a
likely cholangiocarcinoma who presents for internalization of
bile duct drains.  The patient was recently discharged on
[**2134-3-16**] from [**Hospital1 18**] on broad spectrum antibiotics for
cholangitis.  She had presented at the time with weight loss,
pruritus, jaundice, right upper quadrant pain, nausea,
vomiting, diarrhea, and [**Male First Name (un) 1658**]-colored stools.  The patient's
imaging was most consistent with cholangiocarcinoma; however,
pathology of the bile duct was nondiagnostic on the first
biopsy and the second biopsy had shown dysplasia and likely
carcinoma.  The patient had percutaneous drains placed at
that time.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia.
3.  Status post hysterectomy.
4.  Status post lumpectomy, benign.
5.  ERCP-induced pancreatitis.
6.  CHF.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is from [**Country 6257**] and moved to
the U.S.  She reports rare alcohol use and denied smoking.
She is widowed.  She lives at home alone.  She has three
daughters in the area.
Malignant neoplasm of intrahepatic bile ducts,Other pulmonary embolism and infarction,Other pulmonary insufficiency, not elsewhere classified,Cardiogenic shock,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Obstruction of bile duct,Unspecified essential hypertension
Mal neo intrahepat ducts,Pulm embol/infarct NEC,Other pulmonary insuff,Cardiogenic shock,Acute kidney failure NOS,Acute necrosis of liver,Acidosis,Obstruction of bile duct,Hypertension NOS
Admission Date:  [**2134-3-28**]     Discharge Date:  [**2134-4-1**]


Service:  CCU

HISTORY OF THE PRESENT ILLNESS:  The patient is an
82-year-old female with a history of hypertension and
hypercholesterolemia, recent admission for painless jaundice
and cholangitis who was treated with multiple percutaneous
drains by Interventional Radiology and also diagnosed with a
likely cholangiocarcinoma who presents for internalization of
bile duct drains.  The patient was recently discharged on
[**2134-3-16**] from [**Hospital1 18**] on broad spectrum antibiotics for
cholangitis.  She had presented at the time with weight loss,
pruritus, jaundice, right upper quadrant pain, nausea,
vomiting, diarrhea, and [**Male First Name (un) 1658**]-colored stools.  The patient's
imaging was most consistent with cholangiocarcinoma; however,
pathology of the bile duct was nondiagnostic on the first
biopsy and the second biopsy had shown dysplasia and likely
carcinoma.  The patient had percutaneous drains placed at
that time.

During this admission, the patient denied fevers, chills,
nausea, vomiting.  She did report some mild right-sided
abdominal pain at the site of her percutaneous drains.  She
denied diarrhea; however, reports continued light bowel
movement and dark urine.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Hypercholesterolemia.
3.  Status post hysterectomy.
4.  Status post lumpectomy, benign.
5.  ERCP-induced pancreatitis.
6.  CHF.

ALLERGIES:  The patient has no known drug allergies.

ADMISSION MEDICATIONS:
1.  Ambien 5 mg q.h.s.
2.  Colace 100 b.i.d.
3.  Oxycodone [**5-3**] q. four hours p.r.n.
4.  Fluconazole 200 q.d.
5.  Flagyl 500 t.i.d.
6.  Vancomycin 1 gram IV q.d.
7.  Levofloxacin 250 q.d.
8.  Senna b.i.d. p.r.n.
9.  Multivitamin q.d.

SOCIAL HISTORY:  The patient is from [**Country 6257**] and moved to
the U.S.  She reports rare alcohol use and denied smoking.
She is widowed.  She lives at home alone.  She has three
daughters in the area.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Temperature
97.6, blood pressure 140/90, heart rate 100, respirations 20,
saturating 94% on room air.  General:  She was alert and
oriented times three, in no acute distress.  HEENT:  The
pupils were equal, round, and reactive to light.  The sclerae
were not icteric.  There was no jaundice.  Cardiovascular:
Regular rate and rhythm.  JVP at 8 cm.  Lungs:  Crackles at
the left base.  Abdomen:  Soft, nontender, nondistended with
good bowel sounds.  Extremities:  There was 1+ pitting edema.
There were two percutaneous drains draining green bile.

LABORATORY/RADIOLOGIC DATA:  On admission, white count 10,
hematocrit 40.4, platelets 369,000.  Her CA-99 was elevated
at 160, AFP 3.8.

HOSPITAL COURSE:  1.  GASTROINTESTINAL:  The patient with
presumed cholangiocarcinoma and history of cholangitis being
treated with antibiotics for coagulase-negative
Staphylococcus and [**Female First Name (un) 564**] in her bile.  The patient reports
no fevers since discharge.  The patient had followed up with
Hematology/Oncology and per the discussion of
Hematology/Oncology and the family there was a decision made
to not prefer any surgical options.  The patient had
represented for elective internalization of the percutaneous
drains.

The patient had finished a full course of the fluconazole,
Flagyl, vancomycin; however, Levofloxacin had been extended
for an additional week.

The patient underwent successful internalization of her
drains; however, the percutaneous drains were left in place
to ensure no further issues.  The plan was to have the drains
removed at a later time.  It was clear that these stents were
fully functional.

2.  RESPIRATORY:  The patient had reported no respiratory
distress on admission; however, on the day of intended
discharge on [**2134-3-31**], the patient developed sudden
onset of acute shortness of breath while showering prior to
discharge.  The patient's oxygen saturations dropped and the
patient was diagnosed with a massive pulmonary embolus.  The
patient was transferred to the Cardiac Catheterization
Laboratory for thrombectomy and required intubation for
severe respiratory distress.  At that time, it was found that
the right pulmonary artery was occluded in the superior
portion as well as the inferior portion. The inferior portion
was successfully Angiojetted with local lytics to restore
flow to that area.  Also, at that time, an IVC filter was
placed.

3.  CARDIAC:  On the morning of [**2134-3-31**], the patient
had a massive pulmonary embolus with resulting cardiogenic
shock.  The patient was intubated and placed on pressors
subsequently.  The patient was maintained on Levophed and
Vasopressin throughout the night.  However, on the morning of
[**2134-4-1**], it became evident that the patient not only
had shock liver but acute renal failure in the setting of
decreased blood pressures on the prior day.  The patient had
also been given Amiodarone for rapid atrial fibrillation post
procedure and had tolerated this well.

The patient's family including her three daughters were aware
of the situation and the significant decline in the patient's
health.  They were aware of the heart failure and subsequent
shock liver and acute renal failure. Given the fact that the
patient had expressed prior wishes to be DNR/DNI and it was
only reversed in the setting of the acute event, the
continued care of the patient was discussed with her three
daughters.  It was decided on the morning of [**2134-4-1**] to
withdrawal pressor support.  After withdrawal of pressor
support, the patient's blood pressure rapidly declined and
she was pronounced at 12:21 p.m. on [**2134-4-1**].  The
patient's family was present and declined postmortem
examination.  The approximate cause of death was cardiac
arrest due to pulmonary embolism in the setting of
cholangiocarcinoma.




                          [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7169**]

Dictated By:[**Name8 (MD) 12502**]

MEDQUIST36

D:  [**2134-4-5**]  02:12
T:  [**2134-4-7**]  14:21
JOB#:  [**Job Number 54964**]
{'Malignant neoplasm of intrahepatic bile ducts,Other pulmonary embolism and infarction,Other pulmonary insufficiency, not elsewhere classified,Cardiogenic shock,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Obstruction of bile duct,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: The patient is an
82-year-old female with a history of hypertension and
hypercholesterolemia, recent admission for painless jaundice
and cholangitis who was treated with multiple percutaneous
drains by Interventional Radiology and also diagnosed with a
likely cholangiocarcinoma who presents for internalization of
bile duct drains.  The patient was recently discharged on
[**2134-3-16**] from [**Hospital1 18**] on broad spectrum antibiotics for
cholangitis.  She had presented at the time with weight loss,
pruritus, jaundice, right upper quadrant pain, nausea,
vomiting, diarrhea, and [**Male First Name (un) 1658**]-colored stools.  The patient's
imaging was most consistent with cholangiocarcinoma; however,
pathology of the bile duct was nondiagnostic on the first
biopsy and the second biopsy had shown dysplasia and likely
carcinoma.  The patient had percutaneous drains placed at
that time.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia.
3.  Status post hysterectomy.
4.  Status post lumpectomy, benign.
5.  ERCP-induced pancreatitis.
6.  CHF.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is from [**Country 6257**] and moved to
the U.S.  She reports rare alcohol use and denied smoking.
She is widowed.  She lives at home alone.  She has three
daughters in the area. 

### Response:
{'Malignant neoplasm of intrahepatic bile ducts,Other pulmonary embolism and infarction,Other pulmonary insufficiency, not elsewhere classified,Cardiogenic shock,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Obstruction of bile duct,Unspecified essential hypertension'}
