CHIEF COMPLAINT: high grade dysplasia of the Barrett's Esophagus

PRESENT ILLNESS: 61-year-old woman, with celiac disease and Barrett's esophagus,
who is on a surveillance program. Her Barrett's has progressed
to high-grade dysplasia
confirmed on pathologic review. We discussed a variety of
interventions for this as well as the risk that this could
represent the presence of invasive cancer somewhere in the
[**Doctor Last Name 15532**] segment. She elected to proceed with resection, and I
recommended a transhiatal approach to which she consented.

MEDICAL HISTORY: Hypothyroidism, celiac disease, s/p resection of thigh melanoma
[**2114**], osteoporosis, high grade dysplasia of the Barrett's
Esophagus

MEDICATION ON ADMISSION: Aciphex, Levoxyl, Calcium, Vitamin D, MVI

ALLERGIES: Gluten

PHYSICAL EXAM: General- healthy appearing older middle age female
HEENT- anicteric, no adenopathy of neck or supraclavicular
Cor-RRR, no m/r/g
Resp-CTAB
Abd-soft, non-tender, + BS, no organomegaly
Ext- 2+ RLE edema, chronic- wears compression stocking

FAMILY HISTORY: mother- died [**Name2 (NI) 24817**] cancer.

SOCIAL HISTORY: non- smoker-lifetime, etoh [**1-5**]/week
lives in [**Location **] w/ husband
[**Name (NI) 67540**] analyst w/ Citizens Bank
Barrett's esophagus,Celiac disease,Other specified anomalies of esophagus,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Other lymphedema,Asthma, unspecified type, unspecified,Personal history of malignant melanoma of skin
Barrett's esophagus,Celiac disease,Esophageal anomaly NEC,Hypothyroidism NOS,Iatrogenc hypotnsion NEC,Diaphragmatic hernia,Osteoporosis NOS,Other lymphedema,Asthma NOS,Hx-malig skin melanoma
Admission Date:  [**2148-7-23**]              Discharge Date:   [**2148-8-2**]

Date of Birth:  [**2086-9-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Gluten

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
high grade dysplasia of the Barrett's Esophagus

Major Surgical or Invasive Procedure:
[**2148-7-23**]-high grade dysplasia of the Barrett's Esophagus s/p
Transhiatal esophagogastrectomy and feeding jejunostomy,
endoscopy


History of Present Illness:
61-year-old woman, with celiac disease and Barrett's esophagus,
who is on a surveillance program. Her Barrett's has progressed
to high-grade dysplasia
confirmed on pathologic review. We discussed a variety of
interventions for this as well as the risk that this could
represent the presence of invasive cancer somewhere in the
[**Doctor Last Name 15532**] segment. She elected to proceed with resection, and I
recommended a transhiatal approach to which she consented.


Past Medical History:
Hypothyroidism, celiac disease, s/p resection of thigh melanoma
[**2114**], osteoporosis, high grade dysplasia of the Barrett's
Esophagus

Social History:
non- smoker-lifetime, etoh [**1-5**]/week
lives in [**Location **] w/ husband
[**Name (NI) 67540**] analyst w/ Citizens Bank

Family History:
mother- died [**Name2 (NI) 24817**] cancer.

Physical Exam:
General- healthy appearing older middle age female
HEENT- anicteric, no adenopathy of neck or supraclavicular
Cor-RRR, no m/r/g
Resp-CTAB
Abd-soft, non-tender, + BS, no organomegaly
Ext- 2+ RLE edema, chronic- wears compression stocking

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2148-7-29**] 09:40AM    9.1 2.95* 9.0* 27.2* 92 30.6 33.2 13.4
399
[**2148-7-29**] 07:35AM          27.5*
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2148-7-29**] 09:40AM        399

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2148-7-31**] 07:05AM    103 7 0.5 137 4.7 103 26 13
  CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron

[**2148-7-31**] 07:05AM          8.8 3.9 2.4

[**2148-7-23**] 01:21PM   GLUCOSE-145* UREA N-12 CREAT-0.5 SODIUM-137
POTASSIUM-3.6 CHLORIDE-108 TOTAL CO2-18* ANION GAP-15
[**2148-7-23**] 01:21PM   CALCIUM-7.2* PHOSPHATE-4.2 MAGNESIUM-1.6
[**2148-7-23**] 01:21PM   WBC-8.9# RBC-3.70* HGB-11.5* HCT-33.4* MCV-90
MCH-31.1 MCHC-34.5 RDW-13.0
[**2148-7-23**] 01:21PM   PLT COUNT-328
[**2148-7-23**] 01:21PM   PT-13.0 PTT-23.2 INR(PT)-1.1
RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2148-8-1**] 8:55 AM
[**Hospital 93**] MEDICAL CONDITION:
61 year old woman s/p esophagectomy now w/ reflux symptoms &
prominent gastric bubble.
REASON FOR THIS EXAMINATION:
eval gastric distension
COMPARISON: [**2148-7-31**].
Patient is status post esophagectomy with a neoesophagus. The
left hemidiaphragm is elevated and remains persistently elevated
with distended gastric bubble. The left lower lobe is collapsed.
Small bilateral pleural effusions, more on the right compared to
the left. Essentially, no change compared to the prior
radiograph.

ABDOMEN (SUPINE & ERECT)  [**2148-7-31**] 11:07 AM
Reason: please eval for interval change
INDICATION: 61-year-old female status post transhiatal
esophagectomy with increased abdominal distention.
COMPARISON: CT torso dated [**2148-7-18**].
ABDOMEN, SUPINE AND ERECT: Surgical skin staples are seen
overlying the midline of the abdomen. The patient is status post
esophagectomy and the neo- esophagus remains mildly dilated.
There is marked elevation of the left hemidiaphragm with
associated left lower lobe compressive atelectasis. The stomach
remains moderately distended. Air is seen throughout the colon
to the level of the rectum. There are no air-fluid levels or
free intraperitoneal air under the hemidiaphragms on the upright
view. There is a moderate right pleural effusion.
IMPRESSION: No evidence of obstruction or free intraperitoneal
air. Persistent gaseous distention of the stomach and elevation
of the left hemidiaphragm. Moderate right pleural effusion.


Brief Hospital Course:
Patient admitted SDA [**2148-7-23**] for above procedure. Pt tolerated
transhiatal esophogogastrectomy  and j- tube placement well. Pt
transferred to ICU directly from OR extubated, instable
condition, epidural for pain control, left CT to sxn, cervical
JP, NGT, foley in place. O2 99% on 2L. IS/ CDB.
POD#1-Epidural cont, IV lopressor, NC, NPO, NGT to LIS, J-tube
to gravity, CT > sxn.IVF.
POD#2- start TF at 10cc/hr; strict NPO, NGT> LISxn; OOB/IS/CDB.
Nutrition consult for tube feeding, IVF. APS following. Transfer
to floor. BS clear, dim bases, CT to w/s.
POD#3-antibiotics d/c; TF ^ 20/hr- probalance; hct 26.3>23.8-
will monitor for anemia. CT d/c w/o complication by CXRY- some
gastric distention. Pain control w/ epid cont.NGT <100cc and
d/c'd.
POD#4 [**2148-7-27**]-Epidural d/c, roxicet via j-tube q4h w/ good
effect; NPO/ J-tube TF 20cc/hr/+ BS, no flatus. NSR. [**Hospital 5065**]
Healthcare initiating tubefeeding teaching.
POD#5-+ BS, + tympany on abd exam- TF held @20/hr> KUB- ^
gastric bubble. NSR, OOB/ambulation
POD#6- reflux during night, resolved, + flatus. No other events
POD#[**2071-6-8**] passed grape juice test; CXR: air-filled distention
of pull-up/neoesophagus, persistent air-filled distention of
stomach. Stable. ambulating independently. Roxicet cont w/ good
control. NSR
POD# [**2073-8-8**]-- TF advanced to 40cc/hr, then goal 55 mL/hr w/o
complication/distention;
POD#10- [**8-2**]-abd staples d/c and steri-strips placed. [**Hospital1 5065**] plans
to start TF cycle [**8-3**] evening.  Pt stable for discharge to home
w/ husband. Discharge instructions given and reviewed w/ pt by
team, NP and RN.
Follow-up plans made for  barium swallow next Thursday AM 10:00,
w/ F/U surgical appt @ 11:30am.
VNA with [**Hospital3 **] VNA [**Telephone/Fax (1) 43399**]; TF [**Hospital 67541**] [**Hospital 5065**]
Healthcare-[**Telephone/Fax (1) 39931**]


Medications on Admission:
Aciphex, Levoxyl, Calcium, Vitamin D, MVI

Discharge Medications:
1. tube feeding
probalance
goal rate 55cc/hr= 6 cans/day
2. tubefeeding supplies
equipment-
kangaroo pump
tube feeding supplies
3. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed.
Disp:*250 ML(s)* Refills:*0*
4. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
5. Lopressor 50 mg Tablet Sig: [**12-6**] Tablet PO twice a day.
Disp:*30 Tablet(s)* Refills:*1*
6. Equipment
[**Hospital 67542**]
Hospital bed
7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
[**Hospital1 **] (2 times a day) as needed.
8. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Docusate Sodium 50 mg/15 mL Syrup Sig: 15-30 cc PO BID (2
times a day).
Disp:*250 cc* Refills:*2*
10. Aciphex 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Reglan 10 mg Tablet Sig: One (1) Tablet PO four times a day.
Disp:*120 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
SouthShore VNA

Discharge Diagnosis:
Hypothyroidism, celiac disease, s/p resection of thigh melanoma
[**2114**], osteoporosis,  high grade dysplasia of the Barrett's
Esophagus


Discharge Condition:
good

Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**]/ Thoracic Surgery office [**Telephone/Fax (1) 170**] for:
fever, shortness of breath, chest pain, excessive or foul
smelling drainage from incision sites, redness, tenderness or
swelling from incision sites,  excessive nausea, any vomitting,
increased abdominal distention or bloating.
Please do not take anything by mouth after midnight the night
before Barium swallow [**2148-8-8**].
Take medications as listed on discharge instructions.
You may take aciphex, lopressor-12.5 mg=one quarter of 50 mg
pill, levoxyl, reglan ( 4 times/day) by mouth.
Take liquid colace, roxicet through J- tube.
Change j- tube dressing and neck dressing every day w/ new
guaze.  Monitor sites for reddness, and drainage as above.

Followup Instructions:
You have appointment for a barium swallow in Radiology [**Hospital Ward Name 23**]
Clinical Center, [**Location (un) **] at 10 am as listed below. Nothing to
eat after midnight [**8-7**]/-[**8-8**] prior to BArium swallow- you may
take tube feeding.
Provider: [**Name10 (NameIs) 326**] UPPER GI (TCC) RADIOLOGY Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2148-8-8**] 10:00
Appointment w/ Dr.[**Initials (NamePattern4) 4738**] [**2148-8-8**]
Provider: [**First Name11 (Name Pattern1) 2389**] [**Last Name (NamePattern1) 2390**], MD Phone:[**0-0-**]
Date/Time:[**2148-8-8**] 11:30  [**Telephone/Fax (1) 170**]



Completed by:[**2148-8-2**]
{"Barrett's esophagus,Celiac disease,Other specified anomalies of esophagus,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Other lymphedema,Asthma, unspecified type, unspecified,Personal history of malignant melanoma of skin"}


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: high grade dysplasia of the Barrett's Esophagus

PRESENT ILLNESS: 61-year-old woman, with celiac disease and Barrett's esophagus,
who is on a surveillance program. Her Barrett's has progressed
to high-grade dysplasia
confirmed on pathologic review. We discussed a variety of
interventions for this as well as the risk that this could
represent the presence of invasive cancer somewhere in the
[**Doctor Last Name 15532**] segment. She elected to proceed with resection, and I
recommended a transhiatal approach to which she consented.

MEDICAL HISTORY: Hypothyroidism, celiac disease, s/p resection of thigh melanoma
[**2114**], osteoporosis, high grade dysplasia of the Barrett's
Esophagus

MEDICATION ON ADMISSION: Aciphex, Levoxyl, Calcium, Vitamin D, MVI

ALLERGIES: Gluten

PHYSICAL EXAM: General- healthy appearing older middle age female
HEENT- anicteric, no adenopathy of neck or supraclavicular
Cor-RRR, no m/r/g
Resp-CTAB
Abd-soft, non-tender, + BS, no organomegaly
Ext- 2+ RLE edema, chronic- wears compression stocking

FAMILY HISTORY: mother- died [**Name2 (NI) 24817**] cancer.

SOCIAL HISTORY: non- smoker-lifetime, etoh [**1-5**]/week
lives in [**Location **] w/ husband
[**Name (NI) 67540**] analyst w/ Citizens Bank 

### Response:
{"Barrett's esophagus,Celiac disease,Other specified anomalies of esophagus,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Osteoporosis, unspecified,Other lymphedema,Asthma, unspecified type, unspecified,Personal history of malignant melanoma of skin"}
