CHIEF COMPLAINT: s/p fall, fluid retention

PRESENT ILLNESS: 55 y.o. male with h/o cirrhosis [**3-12**] HCV and EtOH currently
listed for [**Month/Day (2) **] transfered from [**Hospital3 **] Hospital s/p fall
after concern on imaging for splenic laceration. Pt. suffered a
mechanical fall on [**8-28**] while walking up his back concrete step.
States he lost his balance due to 'lower extremity swelling',
tipped over and fell, hitting his face and right flank. There
were no presyncopal symptoms and no LOC. He subsequently
developed abdominal pain. At OSH, CT scan showed ascites and a
small area at the superior portion of the spleen suspicious for
a small laceration. Since he was on the liver [**Month/Year (2) **] list at
[**Hospital1 18**], he was transferred here for further management and
admitted to the SICU where a repeat CT scan showed no laceration
and instead suggested perfusion defects. Patient remained
hemodynamically stable and was then called out to the liver
[**Hospital1 **] floor for further management.

MEDICAL HISTORY: - Cirrhosis, s/p TIPS placement [**8-15**]
- HepC, dx [**2129**]: Nonresponder to interferon and ribavirin after
six months of therapy in [**2149**]. From [**Month (only) 116**] to [**2151-12-10**], the
patient was treated with pegylated interferon and ribavirin for
a period of six months. For unclear reasons, this treatment was
discontinued. The patient was subsequently enrolled in the
colchicine arm of the COPILOT trial in the past. [**10-15**] viral load
is 441,000 IU/mL.
- Chronic Renal Insufficiency (baseline Cr 1.1-1.7 over last
year)
- Depression.
- Osteoarthritis
- Hip osteopenia
- Right knee surgery
- Bilateral hip repair
- s/p Umbilical hernia repair
.

MEDICATION ON ADMISSION: Fluoxetine 20mg daily
Lasix 40mg daily
Vicodin TID prn (currently tapering with PCP)
Lactulose 30ml TID
Mirtazipine 45mg daily
Spironolactone 50mg daily
Ursodiol 300mg [**Hospital1 **]
MVI
Vitamin D
Ca2+
Vitmain E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1 HR 96 BP 124/81 RR 23 SaO2 95% RA
General: Thin male, weathered appearance, NAD, lying flat,
breathing comfortably on RA
HEENT: PERRL, EOMi, scleral icterus, abrasions scattered on face

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives on [**Hospital3 **] in a garage apartment which he rents from a
family with whom he has a good relationship.  Also has
supportive ex-wife and daughter. [**Name (NI) **] works in a recording studio
and plays the guitar in a band. He has a history of alcohol
abuse (last drink [**2136-10-9**], drank heavily for 12 years). Also
h/o IV drug use many years ago. Pt smoked occasionally for 30
years, quit a year ago. Denies any recent ETOH ingestion.
Alcoholic cirrhosis of liver,Other ascites,Headache,Abnormality of gait,Chronic kidney disease, unspecified,Unspecified viral hepatitis C without hepatic coma,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, in remission,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,History of fall
Alcohol cirrhosis liver,Ascites NEC,Headache,Abnormality of gait,Chronic kidney dis NOS,Hpt C w/o hepat coma NOS,Alcoh dep NEC/NOS-unspec,Drug abuse NEC-in remiss,Bone & cartilage dis NOS,Osteoarthros NOS-unspec,Depressive disorder NEC,Personal history of fall
Admission Date:  [**2157-8-29**]              Discharge Date:   [**2157-9-2**]

Date of Birth:  [**2101-9-15**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 949**]
Chief Complaint:
s/p fall, fluid retention

Major Surgical or Invasive Procedure:
Paracentesis x 2

History of Present Illness:
55 y.o. male with h/o cirrhosis [**3-12**] HCV and EtOH currently
listed for [**Month/Day (2) **] transfered from [**Hospital3 **] Hospital s/p fall
after concern on imaging for splenic laceration. Pt. suffered a
mechanical fall on [**8-28**] while walking up his back concrete step.
States he lost his balance due to 'lower extremity swelling',
tipped over and fell, hitting his face and right flank. There
were no presyncopal symptoms and no LOC. He subsequently
developed abdominal pain. At OSH, CT scan showed ascites and a
small area at the superior portion of the spleen suspicious for
a small laceration. Since he was on the liver [**Month/Year (2) **] list at
[**Hospital1 18**], he was transferred here for further management and
admitted to the SICU where a repeat CT scan showed no laceration
and instead suggested perfusion defects. Patient remained
hemodynamically stable and was then called out to the liver
[**Hospital1 **] floor for further management.


Past Medical History:
- Cirrhosis, s/p TIPS placement [**8-15**]
- HepC, dx [**2129**]: Nonresponder to interferon and ribavirin after
six months of therapy in [**2149**]. From [**Month (only) 116**] to [**2151-12-10**], the
patient was treated with pegylated interferon and ribavirin for
a period of six months. For unclear reasons, this treatment was
discontinued. The patient was subsequently enrolled in the
colchicine arm of the COPILOT trial in the past. [**10-15**] viral load
is 441,000 IU/mL.
- Chronic Renal Insufficiency (baseline Cr 1.1-1.7 over last
year)
- Depression.
- Osteoarthritis
- Hip osteopenia
- Right knee surgery
- Bilateral hip repair
- s/p Umbilical hernia repair
.


Social History:
Lives on [**Hospital3 **] in a garage apartment which he rents from a
family with whom he has a good relationship.  Also has
supportive ex-wife and daughter. [**Name (NI) **] works in a recording studio
and plays the guitar in a band. He has a history of alcohol
abuse (last drink [**2136-10-9**], drank heavily for 12 years). Also
h/o IV drug use many years ago. Pt smoked occasionally for 30
years, quit a year ago. Denies any recent ETOH ingestion.


Family History:
non-contributory

Physical Exam:
T 99.1 HR 96 BP 124/81 RR 23 SaO2 95% RA
General: Thin male, weathered appearance, NAD, lying flat,
breathing comfortably on RA
HEENT: PERRL, EOMi, scleral icterus, abrasions scattered on face

Neck: supple, trachea midline
Cardiac: RRR, s1s2 normal, 2/6 sem at LSB, no r/g
Pulmonary: CTAB anterior
Abdomen: +BS, soft, nontender, distended but not tense,
+dullness, periumbilical hernia, well-healed scars
Extremities: warm, 3+ bilateral pitting LE edema, mild erythema
right foot but nontender to palpation
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities, follows commands

Pertinent Results:
Admission Labs:
WBC-9.5# Hgb-9.5* Hct-27.8* MCV-112* MCH-38.2* Plt Ct-84*
PT-20.2* PTT-35.8* INR(PT)-1.9*
Glucose-107* UreaN-22* Creat-1.1 Na-137 K-4.3 Cl-100 HCO3-33*
ALT-38 AST-57* AlkPhos-121* TotBili-6.1*
Albumin-2.5* Calcium-9.6 Phos-2.2*# Mg-2.0
.
Discharge Labs:

WBC-14.2 (N - 86.3, bands - 0, lymphs - 7.9, M - 4.4, E - 1.2,
Bas - 0.3) * Hgb-9.5* Hct-27.0* MCV-113* MCH-39.9* Plt Ct-104*
PT-20.9* PTT-39.7* INR(PT)-2.0*
Glucose-103 UreaN-10 Creat-0.7 Na-134 K-3.5 Cl-95* HCO3-34*
ALT-31 AST-48* AlkPhos-140* TotBili-4.5*
Albumin-2.2* Calcium-8.2* Phos-2.2* Mg-1.8
.
.
Studies:
CT Pelvis ([**8-29**]):
1. Multiple perfusion defects in the spleen without evidence of
splenic
laceration. Findings discussed with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 5700**] in the
evening of
the study.
2. Cirrhotic liver with large-volume ascites. Prior TIPS
procedure, the
shunt is patent.
3. Multiple compression fractures in the thoracic spine of
indeterminate age,
but new from [**2154-6-9**], suggest correlation with clinical
symptoms.
4. Distended gall bladder without CT evidence for stones or
inflammation.


Brief Hospital Course:
55 y.o. male with a history of cirrhosis [**3-12**] HCV and EtOH listed
for [**Month/Day (2) **] who presents s/p fall and was transferred to
[**Hospital1 18**] where he receives his hepatology care, for evaluation of
possible splenic laceration. The following issues were
investigated during this hospitalization:
.
# Fall: Felt to be a mechanical fall as patient was later
evaluated by PT and noted to have a very unsteady gait. Initial
concern was for splenic laceration, but repeat CT showed
perfusion defects, rather than laceration. Both splenic vessels
were patent. Patient was thus transferred from the SICU to the
liver-kidney [**Hospital1 **] service for further management with
stable Hct and hemodynamic stability.
.
# Cirrhosis: S/P TIPS with continued ascites, though TIPS was
found to be patent. Patient underwent two paracenteses for
relief with approximately 2 liters being removed and no evidence
of SBP. Upon discharge, abdomen was soft and comfortable and
patient was maintained on diuretics.
.
# Leukocytosis: Patient was noted to have a leukocytosis to 14
on the day of discharge. Differential did not reveal a bandemia.
Patient additionally did not have any localizing symptoms or
fevers. Paracentesis performed on the day of discharge was
negative for SBP. This information was communicated to the
facility that the patient was discharged to and any positive
cultures will be faxed over.
.
# Chronic renal failure: Previously and likely in the setting of
acute illness. Creatinine was within normal limits with adequate
urinary output during hospitalization.
.
# Depression: Patient was maintained on outpatient Fluoxetine
and Mirtazapine.


Medications on Admission:
Fluoxetine 20mg daily
Lasix 40mg daily
Vicodin TID prn (currently tapering with PCP)
Lactulose 30ml TID
Mirtazipine 45mg daily
Spironolactone 50mg daily
Ursodiol 300mg [**Hospital1 **]
MVI
Vitamin D
Ca2+
Vitmain E


Discharge Medications:
1. Spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
6. Fluoxetine 10 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
9. Mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).


Discharge Disposition:
Extended Care

Facility:
Eagle [**Hospital **] Rehabilitation Center - [**Location 23723**]

Discharge Diagnosis:
Primary
Mechanical Fall
Cirrhosis w/ ascites
.
Secondary
- Chronic Renal Insufficiency (baseline Cr 1.1-1.7 over last
year)
- Depression
- Osteoarthritis
- Hip osteopenia
- Right knee surgery
- Bilateral hip repair
- S/p umbilical hernia repair
- Bilateral inguinal hernia repair


Discharge Condition:
Stable


Discharge Instructions:
You were seen and evaluated after suffering a fall at home.
There was an initial concern for damage to your spleen as a
result of this fall, but repeat imaging of your belly showed
that in fact, your spleen was normal. Since then, you were
managed for your cirrhosis and two attempts were made to remove
fluid from your belly, which was moderately successful,
resulting in approximately 2 liters removal. You are now being
discharged to a rehabilitation facility for further care and
strengthening.

Take all of your medications as directed.

Keep all of your follow-up appointments.

Call your doctor or go to the ER for any of the following:
worsened abdominal distention or ascites, fevers/chills,
confusion, chest pain, shortness of breath,
nausea/vomiting/diarrhea or if you suffer a fall again.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2157-9-7**] 10:20
{'Alcoholic cirrhosis of liver,Other ascites,Headache,Abnormality of gait,Chronic kidney disease, unspecified,Unspecified viral hepatitis C without hepatic coma,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, in remission,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,History of fall'}


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: s/p fall, fluid retention

PRESENT ILLNESS: 55 y.o. male with h/o cirrhosis [**3-12**] HCV and EtOH currently
listed for [**Month/Day (2) **] transfered from [**Hospital3 **] Hospital s/p fall
after concern on imaging for splenic laceration. Pt. suffered a
mechanical fall on [**8-28**] while walking up his back concrete step.
States he lost his balance due to 'lower extremity swelling',
tipped over and fell, hitting his face and right flank. There
were no presyncopal symptoms and no LOC. He subsequently
developed abdominal pain. At OSH, CT scan showed ascites and a
small area at the superior portion of the spleen suspicious for
a small laceration. Since he was on the liver [**Month/Year (2) **] list at
[**Hospital1 18**], he was transferred here for further management and
admitted to the SICU where a repeat CT scan showed no laceration
and instead suggested perfusion defects. Patient remained
hemodynamically stable and was then called out to the liver
[**Hospital1 **] floor for further management.

MEDICAL HISTORY: - Cirrhosis, s/p TIPS placement [**8-15**]
- HepC, dx [**2129**]: Nonresponder to interferon and ribavirin after
six months of therapy in [**2149**]. From [**Month (only) 116**] to [**2151-12-10**], the
patient was treated with pegylated interferon and ribavirin for
a period of six months. For unclear reasons, this treatment was
discontinued. The patient was subsequently enrolled in the
colchicine arm of the COPILOT trial in the past. [**10-15**] viral load
is 441,000 IU/mL.
- Chronic Renal Insufficiency (baseline Cr 1.1-1.7 over last
year)
- Depression.
- Osteoarthritis
- Hip osteopenia
- Right knee surgery
- Bilateral hip repair
- s/p Umbilical hernia repair
.

MEDICATION ON ADMISSION: Fluoxetine 20mg daily
Lasix 40mg daily
Vicodin TID prn (currently tapering with PCP)
Lactulose 30ml TID
Mirtazipine 45mg daily
Spironolactone 50mg daily
Ursodiol 300mg [**Hospital1 **]
MVI
Vitamin D
Ca2+
Vitmain E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1 HR 96 BP 124/81 RR 23 SaO2 95% RA
General: Thin male, weathered appearance, NAD, lying flat,
breathing comfortably on RA
HEENT: PERRL, EOMi, scleral icterus, abrasions scattered on face

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives on [**Hospital3 **] in a garage apartment which he rents from a
family with whom he has a good relationship.  Also has
supportive ex-wife and daughter. [**Name (NI) **] works in a recording studio
and plays the guitar in a band. He has a history of alcohol
abuse (last drink [**2136-10-9**], drank heavily for 12 years). Also
h/o IV drug use many years ago. Pt smoked occasionally for 30
years, quit a year ago. Denies any recent ETOH ingestion. 

### Response:
{'Alcoholic cirrhosis of liver,Other ascites,Headache,Abnormality of gait,Chronic kidney disease, unspecified,Unspecified viral hepatitis C without hepatic coma,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, in remission,Disorder of bone and cartilage, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,History of fall'}
