CHIEF COMPLAINT: Bloody bowel movements s/p needle biopsy of prostate on [**2176-4-25**]

PRESENT ILLNESS: Pt is 72 yo M with a history of cirrhosis s/p liver
transplnat in [**2174-10-29**] (Dr.[**First Name (STitle) **]) who presents with BRBPR on
[**4-26**], one day after the Pt had a transrectal prostate ultrasound
with bx x 12 by Urology. Pt had an elevated PSA this past
[**Month (only) 404**]. The procedure was painful due to internal hemorrhoids.
Two hours after the procedure, pt had a bowel movement mixed
with
blood. Yesterday morning (PPD #1) pt had 4 more bowel movements
progressively converting to frank blood and clot. During the
last
few of episodes, pt was near-syncopal as he reports being
lightheaded having to sit on the bathroom floor though he [**Month (only) **]
any loss of consciousness. Pt denied any fever, chills, abominal
pain, diarrhea prior to the procedure. He had one episode of n/v
after breakfast yeaterday which was nonbloody and non bilious.
He
denied any CP, SOB, headaches.
.
He presented to [**Hospital3 10310**] Hospital. On arrival to OSH, BS
were BP 79/49, HR 90, RR 18, 100% O2 sat. Pt received 1L NS and
VS improved to BP range of 95/52 to 120/59, HR range of 70s-80s.
HCT was 27, and patient received 1 unit of PRBCs.
.
In [**Hospital1 18**] ED, initial VS were: 98.3 78 114/92 18 100. HCT upon
arrival was 31.8. INR of 1.2 at 2:30pm. Pt continued to pass
clot
and red blood per rectum, repeat HCT at 8pm was 30.5. Pt
admitted
to MICU service, reveived 3 units of PRBC since 8pm. A felxible
sigmoidoscopy was done at the bedside which showed blood in the
rectum, sigmoid, descending and distal transverse colon. There
was profuse bleeding at the beginning of the procedure but no
active bleeding noted at the end of the 1.5 hour scope.
GI/Hepatology recommending RBC Scan if bleeding returns. His
SBPs
have ranged from the 70s to 120s with HR 70s to 103 while in the
MICU. Evaluated by Urology in ED who feels that bleeding source
is likely the internal hemorrhoids and not the biopsy site and
recommends rectal packing if bleeding returns.

MEDICAL HISTORY: 1. ETOH induced ESLD with portal hypertension, refractory
ascites, now s/p orthotopic liver transplant in [**2174-10-10**]
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**], no evidence of ocular involvement on exam,
TTE clean, s/p IV fluconazole
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. L eye retinal repair ~[**2174-11-28**], s/p retinal lasering
recently, s/p L cataract repair

MEDICATION ON ADMISSION: Cellcept [**Pager number **] mg [**Hospital1 **], Sirolimus 3 mg daily, Bactrim 400mg-80mg
daily, Lysine 500 mg [**Hospital1 **]

ALLERGIES: Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape / Neomycin/Polymyxin/Dexameth

PHYSICAL EXAM: Temp 97.1, HR 79, BP 110/75, RR 16, O2 100% on 2lit NC
Gen: Well, NAD, A&O, Conversive
CV: RRR, No R/G/M
RESP: Lungs CTAB
ABD: Well healed chevron insicion, non-tender, non-distended
EXT: No edema

FAMILY HISTORY: His father was an alcoholic. There is no known family history of
liver disease.

SOCIAL HISTORY: Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**].
Diverticulosis of colon with hemorrhage,Liver replaced by transplant,Internal hemorrhoids without mention of complication,Malignant neoplasm of prostate,Chronic kidney disease, unspecified,Other and unspecified alcohol dependence, in remission,Other functional disorders of intestine
Dvrtclo colon w hmrhg,Liver transplant status,Int hemorrhoid w/o compl,Malign neopl prostate,Chronic kidney dis NOS,Alcoh dep NEC/NOS-remiss,Funct dis intestine NEC
Admission Date:  [**2176-4-26**]              Discharge Date:   [**2176-4-29**]

Date of Birth:  [**2103-11-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape / Neomycin/Polymyxin/Dexameth

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Bloody bowel movements s/p needle biopsy of prostate on [**2176-4-25**]

Major Surgical or Invasive Procedure:
[**2176-4-25**]: transrectal prostate biopsy (prior to admission)
[**2176-4-26**]: Flex sigmoidoscopy

History of Present Illness:
Pt is 72 yo M with a history of cirrhosis s/p liver
transplnat in [**2174-10-29**] (Dr.[**First Name (STitle) **]) who presents with BRBPR on
[**4-26**], one day after the Pt had a transrectal prostate ultrasound
with bx x 12 by Urology. Pt had an elevated PSA this past
[**Month (only) 404**]. The procedure was painful due to internal hemorrhoids.
Two hours after the procedure, pt had a bowel movement mixed
with
blood. Yesterday morning (PPD #1) pt had 4 more bowel movements
progressively converting to frank blood and clot. During the
last
few of episodes, pt was near-syncopal as he reports being
lightheaded having to sit on the bathroom floor though he [**Month (only) **]
any loss of consciousness. Pt denied any fever, chills, abominal
pain, diarrhea prior to the procedure. He had one episode of n/v
after breakfast yeaterday which was nonbloody and non bilious.
He
denied any CP, SOB, headaches.
.
He presented to [**Hospital3 10310**] Hospital. On arrival to OSH, BS
were BP 79/49, HR 90, RR 18, 100% O2 sat. Pt received 1L NS and
VS improved to BP range of 95/52 to 120/59, HR range of 70s-80s.
HCT was 27, and patient received 1 unit of PRBCs.
.
In [**Hospital1 18**] ED, initial VS were: 98.3 78 114/92 18 100. HCT upon
arrival was 31.8. INR of 1.2 at 2:30pm. Pt continued to pass
clot
and red blood per rectum, repeat HCT at 8pm was 30.5. Pt
admitted
to MICU service, reveived 3 units of PRBC since 8pm. A felxible
sigmoidoscopy was done at the bedside which showed blood in the
rectum, sigmoid, descending and distal transverse colon. There
was profuse bleeding at the beginning of the procedure but no
active bleeding noted at the end of the 1.5 hour scope.
GI/Hepatology recommending RBC Scan if bleeding returns. His
SBPs
have ranged from the 70s to 120s with HR 70s to 103 while in the
MICU. Evaluated by Urology in ED who feels that bleeding source
is likely the internal hemorrhoids and not the biopsy site and
recommends rectal packing if bleeding returns.


Past Medical History:
1. ETOH induced ESLD with portal hypertension, refractory
ascites, now s/p orthotopic liver transplant in [**2174-10-10**]
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**], no evidence of ocular involvement on exam,
TTE clean, s/p IV fluconazole
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. L eye retinal repair ~[**2174-11-28**], s/p retinal lasering
recently, s/p L cataract repair


Social History:
Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**].


Family History:
His father was an alcoholic. There is no known family history of
liver disease.

Physical Exam:
Temp 97.1, HR 79, BP 110/75, RR 16, O2 100% on 2lit NC
Gen: Well, NAD, A&O, Conversive
CV: RRR, No R/G/M
RESP: Lungs CTAB
ABD: Well healed chevron insicion, non-tender, non-distended
EXT: No edema


Pertinent Results:
On Admission: [**2176-4-26**]
WBC-5.8 RBC-3.84* Hgb-10.5* Hct-31.8* MCV-83 MCH-27.3 MCHC-33.0
RDW-14.4 Plt Ct-246
PT-13.6* PTT-27.2 INR(PT)-1.2*
Glucose-97 UreaN-20 Creat-2.1* Na-137 K-4.7 Cl-108 HCO3-21*
AnGap-13
ALT-19 AST-33 LD(LDH)-189 AlkPhos-101 TotBili-0.3
Albumin-3.9 Calcium-8.5 Phos-3.9 Mg-2.2
On Discharge [**2176-4-29**]
WBC-3.1* RBC-3.45* Hgb-10.1* Hct-28.6* MCV-83 MCH-29.2
MCHC-35.1* RDW-15.2 Plt Ct-140*
Glucose-102 UreaN-19 Creat-1.7* Na-139 K-4.0 Cl-111* HCO3-21*
AnGap-11
ALT-14 AST-26 AlkPhos-58 TotBili-0.3

Brief Hospital Course:
72 y/o male s/p liver transplant about 18 months ago who
underwent transrectal biopsy of the prostate the day prior to
admission and was having rectal bleeding and weakness.
His hematocrit dipped as low as 24% and he received 7 units of
packed RBCs over the 4 day course of his hospitalization.
The patient underwent a flex sigmoidoscopy with the GI service
on the day of admission which showed "Clotted and fresh blood
was seen in the rectum, distal sigmoid colon, distal descending
colon, splenic flexure and distal transverse colon. Protruding
Lesions, Medium non-bleeding grade [**1-12**] internal & external
hemorrhoids with skin tags were noted."
He was also seen by the urology service in followup to the
prostate biopsy and as it was felt the bleeding was due to the
hemorrhoids seen on scope and not bleeding from the biopsy, they
had no further intervention at this time.
His hematocrit was stable [**4-28**] and [**4-29**] and he was discharged to
home, tolerating diet, ambulating and having no evidence of
current/active bleeding.


Medications on Admission:
Cellcept [**Pager number **] mg [**Hospital1 **], Sirolimus 3 mg daily, Bactrim 400mg-80mg
daily, Lysine 500 mg [**Hospital1 **]


Discharge Medications:
1. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
2. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).

3. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. Apraclonidine 0.5 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
5. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic TID (3 times a day).
6. Tobramycin-Dexamethasone 0.3-0.1 % Ointment Sig: One (1) Appl
Ophthalmic DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
s/p prostate biopsy with post procedure bleeding, determined to
be hemorrhoidal bleeding


Discharge Condition:
Stable/Good


Discharge Instructions:
Please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever >
101, chills, nausea, vomiting, blood in stool or urine, dizzy or
light-headed or any other concerning symptoms
Continue labwork per transplant clinic guidelines

Followup Instructions:
[**Name6 (MD) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2176-5-8**]
9:00
[**Name6 (MD) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1669**] Date/Time:[**2176-5-8**]
10:15
EYE IMAGING Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2176-5-29**] 8:30


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2176-4-30**]

Admission Date:  [**2176-4-29**]              Discharge Date:   [**2176-5-5**]

Date of Birth:  [**2103-11-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape / Neomycin/Polymyxin/Dexameth

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
[**2176-5-2**]: Exam under anesthesia

[**2176-5-4**]: EGD

[**2176-5-1**]: Colonoscopy


History of Present Illness:
72M who was discharged earlier this morning after being
admitted for lower GI bleed thought to be the result of bleeding
from a prostate biopsy or hemorrhoid. He reports feeling well
today, however around 3PM he had a bowel movement where he
passed
normal stool with some blood. He subsequently had 4 more bowel
movements where he passed only blood and clot. He report feeling
tired afterwards, however [**Month/Day/Year **] dizziness, lightheadedness,
chest pain, shortness of breath, nausea, vomiting or abdominal
pain. He called an ambulance and was transferred to OSH where he
had a pressure in 60s but was otherwise stable. He was started
on
IVFs and was transferred to [**Hospital1 18**].


Past Medical History:
1. ETOH induced ESLD with portal hypertension, refractory
ascites, now s/p orthotopic liver transplant in [**2174-10-10**]
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**], no evidence of ocular involvement on exam,
TTE clean, s/p IV fluconazole
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. L eye retinal repair ~[**2174-11-28**], s/p retinal lasering
recently, s/p L cataract repair


Social History:
Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**].


Family History:
His father was an alcoholic. There is no known family history of
liver disease.

Physical Exam:
T 97.6 P 73 BP 121/65 RR 18 O2 100% RA
PE:
     Gen - Alert and oriented times 3
     CV - RRR
     Pulm - CTAB
     Abd - Soft, nontender, nondistended, no rebound/guarding
     Rectal - External hemorrhoids, guaiac positive but no gross

     blood, no stool felt in rectal vault, no palpable masses
     Ext - No edema

Labs:

 7.9       141 114  18
>----<     ---|---|---<125
 24.0      4.6  19 1.6


Pertinent Results:
[**2176-4-28**] 02:48AM BLOOD WBC-3.9* RBC-3.42* Hgb-9.7* Hct-27.6*
MCV-81* MCH-28.4 MCHC-35.1* RDW-14.9 Plt Ct-128*
[**2176-4-28**] 02:48AM BLOOD Glucose-82 UreaN-24* Creat-1.9* Na-138
K-4.1 Cl-111* HCO3-20* AnGap-11
[**2176-4-29**] 05:05AM BLOOD ALT-14 AST-26 AlkPhos-58 TotBili-0.3
[**2176-5-5**] 04:56AM BLOOD Glucose-106* UreaN-9 Creat-1.7* Na-139
K-3.8 Cl-109* HCO3-25 AnGap-9
[**2176-5-5**] 04:56AM BLOOD WBC-3.4* RBC-3.54* Hgb-10.4* Hct-29.7*
MCV-84 MCH-29.5 MCHC-35.1* RDW-14.9 Plt Ct-138*
[**2176-5-5**] 04:56AM BLOOD rapmycn-7.1

Brief Hospital Course:
72M with continued bleeding per rectum after prostate biopsy on
[**4-26**]. He was admitted to transplant surgery and given PRBC for a
hct fo 24. GI was consulted and recommended a colonoscopy. He
continued to have bloody output from his rectum. Colonoscopy
showed a large amout of fresh red blood and clots in the whole
colon, but no active bleeding. Blood was larger in quantity in
the left colon. Source of bleeding could not be determined but
was likely in the rectum or sigmoid colon. The examined colonic
mucosa was normal. More than 50% was obscured by blood. He was
then transferred to the SICU where he continued to receive PRBC
and volume for low BP that was responsive to these treatments.
While in the SICU, he received multiple blood transfusions
continued to keep HCT at 30.

On [**5-1**], an angio of the inferior mesenteric artery, superior
mesenteric artery, and bilateral internal iliac arteries
demonstrated hyperemia of the rectal mucosa with irregularity of
small arterial branches feeding the rectum but no evidence of
extravasation or pseudoaneurysm. No intervention was performed.
A CT of the ABD was then done to assess for hematoma or active
extravasation. No source of bleeding was identified. The liver
transplant vasculature was normal. There was no evidence of the
prostate to suggest hemorrhage. There was very mild non-specific
periprostatic fat stranding. No retroperitoneal hemorrhage was
identified.

On [**3-4**], he was taken to the OR for colonoscopy, examination
under anesthesia and rigid sigmoidoscopy. Surgeon was Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. Multiple diverticulae were identified with no finding
of obvious bleeding source. It was presumed that this was a
diverticular bleed. He then underwent inferior mesenteric
arteriogram which demonstrated no active bleeding visualized at
any of its branches, and hyperemia was visualized at the rectum
during arteriogram.

Hematocrit stabilized at 29-30. Urology was consulted. GI bleed
was not felt to have been caused by the transrectal biopsy.
Pathology results of the prostate from [**2176-4-25**] were finalized
significant for K) Left base lateral: Adenocarcinoma, [**Doctor Last Name **]
Score 7 (3+4), involving  80% of the core and L) Left base
medial: [**Doctor Last Name **] Score 7 (3+4 ), involving  40% of the core.
Please refer to complete pathology report. Findings were
discussed with the patient by Urology. Urology was to arrange a
follow up.

He was transferred out of the SICU to the med-[**Doctor First Name **] unit where
diet was advanced and tolerated. He was having nonb-bloody bms.
Vitals remained stable. He was discharged with no source of
hematochezia identified. He was instructed to call the
Transplant Office to schedule follow up appointment.





Medications on Admission:
Cellcept [**Pager number **] mg [**Hospital1 **]
Sirolimus 3 mg daily
Bactrim 400mg-80mg daily
Lysine 500 mg [**Hospital1 **]


Discharge Medications:
1. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).

2. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
3. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Lower GI Bleed

prostate adenoca


Discharge Condition:
Good


Discharge Instructions:
Please [**Name8 (MD) 138**] MD or visit ER if you experience any of the
following: Fevers, chills, mausea/vomiting, bloody bowel
movements, chest pain, shortness of breath, inability to
tolerate food.

Followup Instructions:
Please  call [**Telephone/Fax (1) 63791**], to arrange for a follow up
appointment with Dr. [**First Name (STitle) **].

Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2176-5-8**] 9:00

Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 1669**]
Date/Time:[**2176-5-8**] 10:15

Provider: [**Name10 (NameIs) **] IMAGING Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2176-5-29**] 8:30


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2176-5-9**]
{'Diverticulosis of colon with hemorrhage,Liver replaced by transplant,Internal hemorrhoids without mention of complication,Malignant neoplasm of prostate,Chronic kidney disease, unspecified,Other and unspecified alcohol dependence, in remission,Other functional disorders of intestine'}


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: Bloody bowel movements s/p needle biopsy of prostate on [**2176-4-25**]

PRESENT ILLNESS: Pt is 72 yo M with a history of cirrhosis s/p liver
transplnat in [**2174-10-29**] (Dr.[**First Name (STitle) **]) who presents with BRBPR on
[**4-26**], one day after the Pt had a transrectal prostate ultrasound
with bx x 12 by Urology. Pt had an elevated PSA this past
[**Month (only) 404**]. The procedure was painful due to internal hemorrhoids.
Two hours after the procedure, pt had a bowel movement mixed
with
blood. Yesterday morning (PPD #1) pt had 4 more bowel movements
progressively converting to frank blood and clot. During the
last
few of episodes, pt was near-syncopal as he reports being
lightheaded having to sit on the bathroom floor though he [**Month (only) **]
any loss of consciousness. Pt denied any fever, chills, abominal
pain, diarrhea prior to the procedure. He had one episode of n/v
after breakfast yeaterday which was nonbloody and non bilious.
He
denied any CP, SOB, headaches.
.
He presented to [**Hospital3 10310**] Hospital. On arrival to OSH, BS
were BP 79/49, HR 90, RR 18, 100% O2 sat. Pt received 1L NS and
VS improved to BP range of 95/52 to 120/59, HR range of 70s-80s.
HCT was 27, and patient received 1 unit of PRBCs.
.
In [**Hospital1 18**] ED, initial VS were: 98.3 78 114/92 18 100. HCT upon
arrival was 31.8. INR of 1.2 at 2:30pm. Pt continued to pass
clot
and red blood per rectum, repeat HCT at 8pm was 30.5. Pt
admitted
to MICU service, reveived 3 units of PRBC since 8pm. A felxible
sigmoidoscopy was done at the bedside which showed blood in the
rectum, sigmoid, descending and distal transverse colon. There
was profuse bleeding at the beginning of the procedure but no
active bleeding noted at the end of the 1.5 hour scope.
GI/Hepatology recommending RBC Scan if bleeding returns. His
SBPs
have ranged from the 70s to 120s with HR 70s to 103 while in the
MICU. Evaluated by Urology in ED who feels that bleeding source
is likely the internal hemorrhoids and not the biopsy site and
recommends rectal packing if bleeding returns.

MEDICAL HISTORY: 1. ETOH induced ESLD with portal hypertension, refractory
ascites, now s/p orthotopic liver transplant in [**2174-10-10**]
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**], no evidence of ocular involvement on exam,
TTE clean, s/p IV fluconazole
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. L eye retinal repair ~[**2174-11-28**], s/p retinal lasering
recently, s/p L cataract repair

MEDICATION ON ADMISSION: Cellcept [**Pager number **] mg [**Hospital1 **], Sirolimus 3 mg daily, Bactrim 400mg-80mg
daily, Lysine 500 mg [**Hospital1 **]

ALLERGIES: Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape / Neomycin/Polymyxin/Dexameth

PHYSICAL EXAM: Temp 97.1, HR 79, BP 110/75, RR 16, O2 100% on 2lit NC
Gen: Well, NAD, A&O, Conversive
CV: RRR, No R/G/M
RESP: Lungs CTAB
ABD: Well healed chevron insicion, non-tender, non-distended
EXT: No edema

FAMILY HISTORY: His father was an alcoholic. There is no known family history of
liver disease.

SOCIAL HISTORY: Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**]. 

### Response:
{'Diverticulosis of colon with hemorrhage,Liver replaced by transplant,Internal hemorrhoids without mention of complication,Malignant neoplasm of prostate,Chronic kidney disease, unspecified,Other and unspecified alcohol dependence, in remission,Other functional disorders of intestine'}
