CHIEF COMPLAINT: Decreased UOP and increasing LE edema

PRESENT ILLNESS: 73 yo man POD 11 s/p exlap, liver bx, mesenteric bx, portal
exploration ([**10-22**]) for metastatic cholangiocarcinoma, s/p
ERCP/common hepatic stent ([**10-24**]) coming in with decreased UOP
and increasing LE edema.
Pt was discharged from [**Hospital1 18**] on [**10-29**].  Since then family
describes patient with decreased PO intake secondary to poor
appetite, but pt without nausea, vomiting, or diarrhea.  Has had
regular but small BM since discharge; not taking much pain meds.
Also c/o decreased UOP consistently since discharge.
Concurrently family describes pt w/increasing abdominal girth
and increasing serous drainage from medial portion of wound
incision with movement, requiring dressing changes 3x/day,
3x/night.
Also with increasing LE edema b/l.  For this reason pt saw
cardiologist 1 day PTA, who gave him "IV Lasix" in office.
Todaypt returned and saw PCP who put him on "antibiotic".  Today
pt took two doses of nl lasix.  Otherwise no med changes.
ROS: denies
SOB/CP/N/V/D/constipation/dysuria/myalgias/arthralgias/
fever/chills

MEDICAL HISTORY: -cholangiocarcinoma
-Diabetes mellitus II (oral meds)
-Atrial fibrillation (on amiodorone)
-Chronic left ventricular systolic heart failure (last EF 35%
per daughter)
-h/o pneumonia and effusion which was tapped in [**State 108**] recently
-Mass encircling the biliary stent which was biopsied and found
to be cholangiocarcinoma, s/p biliary stent c/b infection s/p
stent removal [**2171-9-11**]
-Depression
-Hyperlipidemia
-Prior MI by EKG
-Hypertension
-Anemia

MEDICATION ON ADMISSION: Amiodarone 100', digoxin 0.125', Lasix 40', Glipizide 7.5",
Metformin 750", Lopressor 25", atorvastastin 80', Aspirin 325',
lisinopril 5', plavix 75'

ALLERGIES: Epinephrine / Keflex

PHYSICAL EXAM: Sleepy but arousable
98.8  100 104/59  18  100%
PERRL, anicteric, moist mucus membranes, no JVD, no sublingual
incteris, CN grossly intact, no LAD
tachycardia + soft systolic murmur no r/g
bibasilar rales no wheezes/rhonchi
soft but distended + diffuse TTP
+ BS no HSM appreciated
incision c/d/i, no gross oozing noted
GU-Foley in place
b/l loss of dermis at buttocks
b/l 2+ edema to mid calf

FAMILY HISTORY: Positive for colon cancer, diagnosed in his 50's. No other
family members with rectal cancer, colon cancer or HNPCC-related
cancers. The patient states he has never had a colonoscopy.

SOCIAL HISTORY: Italian but speaks some English. He is a retired truck driver.
He denies smoking or illicit drug use. He uses [**12-12**] glasses of
wine per day.  He lives with his wife; daughter is nearby.
Acute kidney failure, unspecified,Other suppurative peritonitis,Malignant neoplasm of extrahepatic bile ducts,Chronic systolic heart failure,Hyposmolality and/or hyponatremia,Other specified disorders of biliary tract,Pressure ulcer, buttock,Other specified forms of chronic ischemic heart disease,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Acute kidney failure NOS,Suppurat peritonitis NEC,Mal neo extrahepat ducts,Chr systolic hrt failure,Hyposmolality,Dis of biliary tract NEC,Pressure ulcer, buttock,Chr ischemic hrt dis NEC,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV
Admission Date:  [**2171-11-1**]              Discharge Date:   [**2171-11-12**]

Date of Birth:  [**2098-5-11**]             Sex:   M

Service: SURGERY

Allergies:
Epinephrine / Keflex

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Decreased UOP and increasing LE edema

Major Surgical or Invasive Procedure:
[**11-2**]: Paracentesis
[**11-4**]: ERCP
[**11-4**]: Paracentesis

History of Present Illness:
73 yo man POD 11 s/p exlap, liver bx, mesenteric bx, portal
exploration ([**10-22**]) for metastatic cholangiocarcinoma, s/p
ERCP/common hepatic stent ([**10-24**]) coming in with decreased UOP
and increasing LE edema.
Pt was discharged from [**Hospital1 18**] on [**10-29**].  Since then family
describes patient with decreased PO intake secondary to poor
appetite, but pt without nausea, vomiting, or diarrhea.  Has had
regular but small BM since discharge; not taking much pain meds.
Also c/o decreased UOP consistently since discharge.
Concurrently family describes pt w/increasing abdominal girth
and increasing serous drainage from medial portion of wound
incision with movement, requiring dressing changes 3x/day,
3x/night.
Also with increasing LE edema b/l.  For this reason pt saw
cardiologist 1 day PTA, who gave him "IV Lasix" in office.
Todaypt returned and saw PCP who put him on "antibiotic".  Today
pt took two doses of nl lasix.  Otherwise no med changes.
ROS: denies
SOB/CP/N/V/D/constipation/dysuria/myalgias/arthralgias/
fever/chills


Past Medical History:
-cholangiocarcinoma
-Diabetes mellitus II (oral meds)
-Atrial fibrillation (on amiodorone)
-Chronic left ventricular systolic heart failure (last EF 35%
per daughter)
-h/o pneumonia and effusion which was tapped in [**State 108**] recently
-Mass encircling the biliary stent which was biopsied and found
to be cholangiocarcinoma, s/p biliary stent c/b infection s/p
stent removal [**2171-9-11**]
-Depression
-Hyperlipidemia
-Prior MI by EKG
-Hypertension
-Anemia

PSurgH:
-Status post cholecystectomy
-[**2171-10-22**]: Exploratory laparotomy, liver biopsy and lymph node
biopsy.


Social History:
Italian but speaks some English. He is a retired truck driver.
He denies smoking or illicit drug use. He uses [**12-12**] glasses of
wine per day.  He lives with his wife; daughter is nearby.


Family History:
Positive for colon cancer, diagnosed in his 50's. No other
family members with rectal cancer, colon cancer or HNPCC-related
cancers. The patient states he has never had a colonoscopy.

Physical Exam:
Sleepy but arousable
98.8  100 104/59  18  100%
PERRL, anicteric, moist mucus membranes, no JVD, no sublingual
incteris, CN grossly intact, no LAD
tachycardia + soft systolic murmur no r/g
bibasilar rales no wheezes/rhonchi
soft but distended + diffuse TTP
+ BS no HSM appreciated
incision c/d/i, no gross oozing noted
GU-Foley in place
b/l loss of dermis at buttocks
b/l 2+ edema to mid calf


Pertinent Results:
On Admission: [**2171-11-1**]
WBC-10.2 RBC-3.66* Hgb-11.4* Hct-32.3* MCV-88 MCH-31.0
MCHC-35.2* RDW-15.2 Plt Ct-343#
PT-13.1 PTT-27.7 INR(PT)-1.1
Glucose-171* UreaN-29* Creat-2.3*# Na-127* K-4.9 Cl-91* HCO3-23
AnGap-18
ALT-61* AST-72* LD(LDH)-257* CK(CPK)-67 AlkPhos-941*
TotBili-5.0*
Albumin-3.2* Calcium-8.6 Phos-3.4 Mg-1.8
At Discharge: [**2171-11-12**]
WBC-10.5 RBC-4.04* Hgb-12.1* Hct-35.5* MCV-88 MCH-29.9 MCHC-34.1
RDW-16.6* Plt Ct-109*
Glucose-120* UreaN-52* Creat-4.6* Na-140 K-4.2 Cl-112* HCO3-18*
AnGap-14
ALT-29 AST-42* AlkPhos-884* TotBili-2.7*
Calcium-7.9* Phos-3.5 Mg-1.7

Brief Hospital Course:
73 y/o male with known cholangiocarcinoma who underwent ex-lap
with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]  on [**2171-10-22**] and was unable to be
resected. Since his discharge on the 18th he was noted to have
increased abdominal girth, lower extremity swelling and poor
appetite as reported by family.
Ultrasound of abdomen on admission shows new ascites. He had a
paracentesis on [**11-2**] with the removal of 4 liters of fluid.
Culture done on the fluid revealed E coli. He had empirically
been started on Vanco and Zosyn which was narrowed to Zosyn with
a 14 day recommended course.
Following the paracentsis he was transferred to the SICU for
hypotension to the 80's most likely due to SBP
On [**11-3**] he underwent a gall bladder scan which showed findings
consistent with a bile leak and was sent on [**11-4**] for ERCP. He
had a bare metal stent placed on his previous admission once he
was found to be unresectable.
During ERCP;, the previous uncovered metal stent was visualized
and noted to be patent in the left hepatic system within the
common hepatic duct stricture.  The right hepatic system did not
fill with contrast.
Large bile duct leak in the mid common bile duct, probably at
the site of lymph node biopsy.
Successful placement of a 10mm x 60mm biliary covered Wallstent
in the common bile duct within the previously placed uncovered
metal stent 8mm x 60mm.
On the same day he underwent placemnt of a pigtail drain into
the collection in his abdomen (right flank) which immediately
drained about 800 cc of bilious appearing fluid. Large volumes
were being drained daily of [**2-12**] Liters. He was receiving albumin
and fluid replacements. The drain was removed  on [**11-8**] and
insertion sutured, with no leak.
He was transferred back out of the SICU and was making daily
improvements in appetite, ambulation and bowel function.
He was seen by the Renal team for acute on chronic renal
failure. Management included some medications to be renally dose
and the addition of bicarbonate to his regimen. He did not
require renal replacement therapy. At the current time of
discharge the plan is to keep patient off diuretics with
monitoring of his labs and reinstitution once the kidney
function improves.
In regards to his known CHF, digoxin and amiodarone were renally
dosed and volume status carefully monitored. Diuretics will stay
on hold per renal recommendations until kidney function
improves. Daily weights will be requested. He was also seen by
cardiology during this admission for medication management.
He was seen by the wound care nurse [**First Name (Titles) **] [**Last Name (Titles) 79019**] Stage II
decubitus ulcers.
Stage II pressure ulcer: Duoderm gel/Allevyn foam dressing.
Change q 3 days


Medications on Admission:
Amiodarone 100', digoxin 0.125', Lasix 40', Glipizide 7.5",
Metformin 750", Lopressor 25", atorvastastin 80', Aspirin 325',
lisinopril 5', plavix 75'


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Unresectable cholangiocarcinoma
Chronic heart failure (Systolic, EF 45%)
Acute on Chronic renal failure, currently off diuretics
Stage II decubitus ([**Location (un) 79019**]) ulcer.
Bile leak, E coli recovered from fluid

Unresectable cholangiocarcinoma
Chronic heart failure (Systolic, EF 45%)
Acute on Chronic renal failure, currently off diuretics
Stage II decubitus ([**Location (un) 79019**]) ulcer.
Bile leak, E coli recovered from fluid

Unresectable cholangiocarcinoma
Chronic heart failure (Systolic, EF 45%)
Acute on Chronic renal failure, currently off diuretics
Stage II decubitus ([**Location (un) 79019**]) ulcer.
Bile leak, E coli recovered from fluid


Discharge Condition:
Stable


Discharge Instructions:
Weigh patient daily. Call if greater than 3 pound weight gain in
a day
Call Dr [**Last Name (STitle) 9411**] office at [**Telephone/Fax (1) 673**] for fever > 101, chills,
nausea, vomiting, diarrhea, yellowing of skin or eyes, increased
abdominal pain or other concerning symptoms
Monitor insion for redness, drainage or bleeding. Top portion of
incision has been opened and requires a NS wet to dry dressing
twice daily
Nutritional status important, assure patient receiving
supplements three times daily.
Please note patient has appointment with Dr [**Last Name (STitle) **] [**11-13**]
(Wednesday) in addition to other appointments in next 2 weeks

Followup Instructions:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2502**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2171-11-13**] 4:30
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**Telephone/Fax (1) 673**]  Date/Time [**2171-11-22**]  3:20 PM
DR. [**First Name (STitle) **] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2171-11-28**] 1:30
[**Last Name (LF) **],[**First Name3 (LF) **] L.  [**Telephone/Fax (1) 3183**]  Call to schedule appointment



Completed by:[**2171-11-12**]
{'Acute kidney failure, unspecified,Other suppurative peritonitis,Malignant neoplasm of extrahepatic bile ducts,Chronic systolic heart failure,Hyposmolality and/or hyponatremia,Other specified disorders of biliary tract,Pressure ulcer, buttock,Other specified forms of chronic ischemic heart disease,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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: Decreased UOP and increasing LE edema

PRESENT ILLNESS: 73 yo man POD 11 s/p exlap, liver bx, mesenteric bx, portal
exploration ([**10-22**]) for metastatic cholangiocarcinoma, s/p
ERCP/common hepatic stent ([**10-24**]) coming in with decreased UOP
and increasing LE edema.
Pt was discharged from [**Hospital1 18**] on [**10-29**].  Since then family
describes patient with decreased PO intake secondary to poor
appetite, but pt without nausea, vomiting, or diarrhea.  Has had
regular but small BM since discharge; not taking much pain meds.
Also c/o decreased UOP consistently since discharge.
Concurrently family describes pt w/increasing abdominal girth
and increasing serous drainage from medial portion of wound
incision with movement, requiring dressing changes 3x/day,
3x/night.
Also with increasing LE edema b/l.  For this reason pt saw
cardiologist 1 day PTA, who gave him "IV Lasix" in office.
Todaypt returned and saw PCP who put him on "antibiotic".  Today
pt took two doses of nl lasix.  Otherwise no med changes.
ROS: denies
SOB/CP/N/V/D/constipation/dysuria/myalgias/arthralgias/
fever/chills

MEDICAL HISTORY: -cholangiocarcinoma
-Diabetes mellitus II (oral meds)
-Atrial fibrillation (on amiodorone)
-Chronic left ventricular systolic heart failure (last EF 35%
per daughter)
-h/o pneumonia and effusion which was tapped in [**State 108**] recently
-Mass encircling the biliary stent which was biopsied and found
to be cholangiocarcinoma, s/p biliary stent c/b infection s/p
stent removal [**2171-9-11**]
-Depression
-Hyperlipidemia
-Prior MI by EKG
-Hypertension
-Anemia

MEDICATION ON ADMISSION: Amiodarone 100', digoxin 0.125', Lasix 40', Glipizide 7.5",
Metformin 750", Lopressor 25", atorvastastin 80', Aspirin 325',
lisinopril 5', plavix 75'

ALLERGIES: Epinephrine / Keflex

PHYSICAL EXAM: Sleepy but arousable
98.8  100 104/59  18  100%
PERRL, anicteric, moist mucus membranes, no JVD, no sublingual
incteris, CN grossly intact, no LAD
tachycardia + soft systolic murmur no r/g
bibasilar rales no wheezes/rhonchi
soft but distended + diffuse TTP
+ BS no HSM appreciated
incision c/d/i, no gross oozing noted
GU-Foley in place
b/l loss of dermis at buttocks
b/l 2+ edema to mid calf

FAMILY HISTORY: Positive for colon cancer, diagnosed in his 50's. No other
family members with rectal cancer, colon cancer or HNPCC-related
cancers. The patient states he has never had a colonoscopy.

SOCIAL HISTORY: Italian but speaks some English. He is a retired truck driver.
He denies smoking or illicit drug use. He uses [**12-12**] glasses of
wine per day.  He lives with his wife; daughter is nearby. 

### Response:
{'Acute kidney failure, unspecified,Other suppurative peritonitis,Malignant neoplasm of extrahepatic bile ducts,Chronic systolic heart failure,Hyposmolality and/or hyponatremia,Other specified disorders of biliary tract,Pressure ulcer, buttock,Other specified forms of chronic ischemic heart disease,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
