CHIEF COMPLAINT: 

PRESENT ILLNESS: A 62-year-old male with end-
stage liver disease, cirrhosis secondary to alcohol,
encephalopathy, peripheral edema, ascites requiring
paracentesis, upper gastrointestinal bleed from grade 2
varices one time, portal hypertension hepatocellular
carcinoma non-metastatic, status post radiofrequency ablation
in [**2157-11-7**], followed for availability of liver
transplant.  The patient is without new complaints at the
time of admission.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1. Lasix 40 mg once a day.
2. Lactulose one tablespoon once a day.
3. Propranolol 40 mg twice a day.
4. Lithium 900 mg once a day.
5. Protonix 40 mg twice a day.
6. Spironolactone 100 mg twice a day.
7. Mycelex five.
8. Meclizine 25 mg once a day.
9. NPH insulin 100 units q. a.m., 50 units q. p.m.
10.      Doxazosin 1 mg once a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of liver, not specified as primary or secondary,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Chronic hepatitis C with hepatic coma,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Acidosis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Malignant neo liver NOS,Alcohol cirrhosis liver,Alcohol abuse-unspec,Chrnc hpt C w hepat Coma,CHF NOS,Surg compl-heart,Acidosis,Abn react-org transplant
Admission Date: [**2158-5-22**]        Discharge Date: [**2158-6-9**]

Date of Birth:  [**2096-4-23**]        Sex:  M

Service:  TRANSPLANT SURGERY


HISTORY OF PRESENT ILLNESS:  A 62-year-old male with end-
stage liver disease, cirrhosis secondary to alcohol,
encephalopathy, peripheral edema, ascites requiring
paracentesis, upper gastrointestinal bleed from grade 2
varices one time, portal hypertension hepatocellular
carcinoma non-metastatic, status post radiofrequency ablation
in [**2157-11-7**], followed for availability of liver
transplant.  The patient is without new complaints at the
time of admission.

MEDICATIONS ON ADMISSION:
1. Lasix 40 mg once a day.
2. Lactulose one tablespoon once a day.
3. Propranolol 40 mg twice a day.
4. Lithium 900 mg once a day.
5. Protonix 40 mg twice a day.
6. Spironolactone 100 mg twice a day.
7. Mycelex five.
8. Meclizine 25 mg once a day.
9. NPH insulin 100 units q. a.m., 50 units q. p.m.
10.      Doxazosin 1 mg once a day.


PHYSICAL EXAMINATION:  Upon admission this patient was
afebrile with stable vital signs with a weight of 120.0
kilograms.  Head, eyes, ears, nose and throat examination was
normal.  Neck was supple.  Lungs clear to auscultation
bilaterally.  Cardiovascular examination:  Regular rate and
rhythm, no murmurs, rubs or gallops.  Abdominal examination:
Revealed mild ascites, non-tender throughout.  Extremity
examination revealed 1 plus ankle edema.

LABORATORY ON ADMISSION:  Hematocrit 38.5, white blood cell
count 11.2, platelet count 140,000.  Sodium 143, potassium
3.4, chloride 103, carbon dioxide 34, blood urea nitrogen 16,
creatinine 1.0, glucose level 50.  Calcium 10.0, phosphorus
82.6, magnesium 1.6.  AST was 61, ALT was 52 and alk phos was
83.  Total bilirubin was 1.7.  His prothrombin time was 14.3,
his PTT was 26.4.  His fibrinogen was 267 and his INR was
1.4.

HOSPITAL COURSE:  So at this time the patient was admitted
with end-stage liver disease for a liver transplant.  He was
placed nil per os.  Consent was signed.  CellCept, Solu-
Medrol, Unasyn, fluconazole were started.  Labs were drawn.
Urinalysis was performed.  A chest x-ray was performed and an
electrocardiogram was performed.  Anesthesia consent was also
obtained as he was seen by their staff.

On [**2158-5-23**], liver transplant was performed under
general anesthesia.  The patient was brought to the Surgical
Intensive Care Unit after the operation.  The patient was
progressing well at this time and on postoperative day one
the plan was to use morphine sulfate for pain as needed.  A
transesophageal echocardiogram had shown residual clot and
adequate biventricular function.  A chest x-ray was sent and
the patient was weaned off of FiO2.  The patient was also nil
per os at this time and on an nasogastric tube.  The patient
was also on a Foley catheter to follow urine output closely.
Infectious Disease:  The patient was placed on Unasyn times
three days.  The patient was also transfused platelets, fresh
frozen plasma and cryoprecipitate at this time and the
patient began the immunosuppressive regimen with Solu-Medrol
at 140 twice a day, CellCept 1 gram twice a day, ________
times one intraoperatively and, in terms of endocrine,
patient was placed on a regular insulin sliding scale at this
time with a plan to move to an insulin drip if glucose levels
trended upwards.  The patient continued to progress well
during his stay and continued to oxygenate well and was able
to be weaned off of oxygen, FiO2 as he was weaned off of
propofol at this time.  Prophylactic medications, Bactrim and
fluconazole, were continued at this time.

The patient continued to progress well at this time and on
the [**5-25**] propofol was discontinued.  An
electrocardiogram was taken showing no ischemic changes.  The
patient did not need a beta blocker at this time.  Patient
was receiving Nipride which was being held for systolic blood
pressure less than 160.  The patient was given Lasix to
diurese and established an adequate urine output.  The
patient was started on total parenteral nutrition and Unasyn
was discontinued at this time.

On [**2158-5-26**], the patient continued to progress taking
Dilaudid p.r.n. for pain at this time.  Stable vital signs.
Patient receiving CPAP and his total bilirubin and other
liver function tests including ALT and AST continued to trend
downward.  Good bile output out of the drain.  His liver
function tests on this day were 155 for AST, 614 for ALT and
64 for alk phos.  The previous day on [**5-25**] were AST of
252, ALT of 309 and alk phos of 65.  The patient was
continued on Lasix diuresis and continued on prophylactic
Bactrim, fluconazole and ganciclovir.  The patient at this
time was on an insulin drip.

The patient continued to progress on the [**5-27**] and was
being followed at this time by the inpatient clinical
Nutrition team.  They recommended titrating insulin drip as
needed and set up a TPN to regiment with a goal of 2,150
kilocalories per day.

On [**2158-5-28**], the patient continued to progress well.
His wound was noted to be without pus or erythema at this
time.  He was continued on Dilaudid as needed for pain.  He
was still being followed by the SICU team in the Surgical
Intensive Care Unit.  At this time patient was able to change
to largely oral medications.  He had stable respiratory
status and was now off of ventilation.

On postoperative day nine, [**5-30**], the patient continued
to be stable but appeared somewhat confused upon examination.
It was recommended at this time the patient be transferred to
the floor and later in the day he was transferred to [**Hospital Ward Name 121**] 10.
Date of extubation for this patient was [**5-28**].  The
patient began to be evaluated by Physical Therapy on [**2158-5-29**].

On [**2158-5-31**], it was noted they found the patient to be
alert and oriented but mildly inappropriate with tangential
speech.  They noting that he was practicing even coordinated
breathing.  Their general impression was that this man's
mobility would improve.  He was tolerating being out-of-bed
well but that he would require short term rehabilitation upon
discharge to maximize functional status.  They also stated
that his potential to return to baseline was good.  They
recommended one to three more weeks of physical therapy or
until discharge to rehabilitation.

The patient began to be followed by the [**Last Name (un) **] consult team
on the [**6-1**].  The [**Last Name (un) **] attending noted that the
patient was now transitioning to eating meals and suggested
starting Lentes and Humalog regimen.  As per their request
after they reviewed the chart they noted that his prior
regimen was likely suboptimal and that his insulin needs
would be significantly different after this liver
transplantation due to the effects of steroids and his new
liver and they began to discuss outpatient regimens for the
patient.  The patient was also receiving Occupational Therapy
evaluations and it was noted on [**2158-6-1**], by
Occupational Therapy that patient was minimally confused and
that he would likely need rehabilitation prior to returning
home.

On the [**6-2**] the patient continued to progress well,
complained of some mild abdominal pain but noted significant
improvement since the immediate postoperative time.  There
were noted to be multiple ecchymotic areas over his right
upper extremity at this time and four to five skin
ulcerations on his left upper extremity.  Ancef 1 gram every
eight hours was started at this time and a full HUS workup
was commenced and Hematology was consulted.  A blood smear
was sent that was viewed by Hematology not to contain any
schistocytes and that most likely a hemolytic-uremic syndrome
workup was not necessarily warranted but that they would
follow the results.

On postoperative day 12, [**6-3**], the patient continued to
progress well and began to be screened for rehabilitation.
He continued to be followed by [**Last Name (un) **] for glucose levels and
was continued on Ancef at this time.  His vital signs were
stable and the patient was without pain at this time.  He was
passing gas and having bowel movements and was noted an
increased appetite.  The patient continued to be followed by
Nutrition, Respiratory Care and his liver function tests
continued to trend downwards.  Cyclosporin levels were found
to be therapeutic and it was determined again by Transplant
staff that the patient would likely need rehabilitation.
[**Last Name (un) **] continued to follow the patient at this time and
recommended that the patient continue with current Lentes and
Humalog sliding scale regimen.

On the [**6-5**] the patient was doing well with only mild
abdominal pain with lunging or reaching movements.  He was
still passing gas and having bowel movements and taking solid
foods at this time.  The patient still appeared somewhat
distant in conversation and a Psychiatry consult was ordered.
Per Psychiatry's request, the lithium level was sent and
found to be 1.9.  At this time Psychiatry recommended that
lithium be held and Haldol be used as needed for agitation.
At this time it was noted that the patient was not taking
enough food orally and a feeding tube was placed by
Interventional Radiology.

Then on the morning of [**2158-6-7**], the patient went on to
pull the feeding tube from its position and it was determined
that total parenteral nutrition would be delivered through a
PICC line placed on the [**2158-6-6**].  The patient
continued to improve at this time and was followed again by
Psychiatry who suggested 1 mg dose of Haldol for standing
order at night and their formal consultation was noted in the
chart.  The patient's mental status was significant for
confusion and inattention and tangential thought at this
time.  His lithium level and renal function were noted to be
improving at this time.  His lithium level was now down to
1.6.

On [**6-8**] the patient continued to feel better and continued
to note improving appetite.  He was noted by the staff to be
taking all of his meals.  Calorie counts were occurring at
this time.  The patient continued to be screened for
rehabilitation.  The patient was continued on total
parenteral nutrition.  [**Last Name (un) **] was notified of the total
parenteral nutrition and they advised adding 10 units of
insulin to his TPN order which was done.

On [**6-9**], the day of discharge, the patient was doing very
well, not complaining of any pain, with increasing appetite.
Had been out-of-bed three times the previous day.  On
physical examination vital signs were temperature maximum
over the last 24 hours of 98.4 degrees.  Current temperature
97.6 degrees.  59 beats per minute.  Blood pressure 132/71.
Respiratory rate of 20.  Oxygen saturation 94 percent on room
air.  His weight was 123.3 kilograms.  His fingersticks were
in the low 100's.  The patient was in no apparent distress.
His cardiac examination revealed regular rate and rhythm with
no murmurs, rubs or gallops.  His respiratory examination
revealed clear to auscultation bilaterally.  No wheezes,
rales or rhonchi.  On abdominal examination the patient was
noted to be non-distended, normoactive bowel sounds, soft and
non-tender throughout with a well-healing wound.  It was
clean, dry and intact.  Screening for rehabilitation at this
time continued and it was determined that patient would be
discharged on this day.

His laboratory values at this time were the following:  PT
time 12.5, PTT 22.4, INR 1.0, fibrinogen 431.  On [**2158-6-8**], his cyclosporin level was 944.  His liver function
tests revealed an ALT of 14, an AST of 15, alk phos of 127, a
total bilirubin of 1.8 and albumin of 2.8.  White count at
this time was 12.9, hematocrit 27.6 and platelet count
137,000.

DISCHARGE DIAGNOSES:  Status post orthotopic liver transplant
[**2158-5-22**], for hepatitis B/alcoholic cirrhosis.

Cirrhosis with encephalopathy.

Peripheral edema.

Ascites requiring paracentesis.

Upper gastrointestinal bleed with grade 2 varices with one
episode of banding.

Hepatocellular carcinoma status post radiofrequency ablation
[**2157-11-7**].

Diabetes mellitus type 2.

Congestive heart failure with diastolic dysfunction.

Pulmonary hypertension.

Hypertension.

Benign prostatic hypertrophy.

Left lower extremity deep venous thrombosis with pulmonary
embolism in [**2156-12-8**].

Obstructive sleep apnea.

Bipolar disorder.

Post traumatic stress disorder.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE INSTRUCTIONS:  The patient was instructed to call
if fevers, chills, nausea, vomiting or increased redness or
drainage started to occur from the wound site.  The patient
was to be sent to rehabilitation at this time.  Laboratory
levels were to be drawn twice weekly to measure levels of
immunosuppressive drugs and liver function tests.  The
patient's first appointment with the Liver [**Hospital 1326**] Clinic
at the Transplant Center was to occur at the [**Last Name (un) 2577**] Building
[**Hospital 1326**] Clinic on Wednesday, [**2158-6-14**], at 10:50 a.m.

DISCHARGE MEDICATIONS:
1. Pantoprazole 40 mg by mouth once a day.
2. Bactrim one tablet by mouth once a day.
3. Metoprolol 75 mg by mouth twice a day with hold for heart
   rate less than 60 or systolic blood pressure less than
   100.
4. Hydralazine 75 mg by mouth four times a day.  Hold for
   systolic blood pressure less than 110.
5. Bisacodyl 20 mg per rectum once a day as needed.
6. Mycophenolate mofetil 1000 mg by mouth twice a day.
7. Insulin Glargine 60 units subcutaneously once per night.
8. Insulin sliding scale on fixed dose.
9. Fluconazole 200 mg by mouth once a day.
10.      Valganciclovir 450 mg by mouth every other day.
11.      Prednisone 50 mg by mouth once a day.
12.      Doxazosin 1 mg by mouth at night.
13.      Haldol 1 mg by mouth at night one tonight.
14.      Meclizine 25 mg by mouth once a day.
15.      Cyclosporin 150 mg by mouth twice a day, 8:00 p.m.
   and 8:00 a.m.
16.      Furosemide 40 mg by mouth twice a day.
17.      The patient received two more doses of Ancef at this
   time, 1 gram IV q. 8h.
18.      Haldol 2.5 mg IV three times a day as needed for
   agitation.

Again, labs are to be drawn on a twice weekly basis and
levels to be followed by the Transplant team.


DISPOSITION:  To rehabilitation.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD, PhD [**Numeric Identifier 8353**]

Dictated By:[**Last Name (NamePattern1) 48464**]
MEDQUIST36
D:  [**2158-6-9**] 12:44:51
T:  [**2158-6-9**] 15:25:37
Job#:  [**Job Number 48465**]
{'Malignant neoplasm of liver, not specified as primary or secondary,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Chronic hepatitis C with hepatic coma,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Acidosis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: A 62-year-old male with end-
stage liver disease, cirrhosis secondary to alcohol,
encephalopathy, peripheral edema, ascites requiring
paracentesis, upper gastrointestinal bleed from grade 2
varices one time, portal hypertension hepatocellular
carcinoma non-metastatic, status post radiofrequency ablation
in [**2157-11-7**], followed for availability of liver
transplant.  The patient is without new complaints at the
time of admission.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1. Lasix 40 mg once a day.
2. Lactulose one tablespoon once a day.
3. Propranolol 40 mg twice a day.
4. Lithium 900 mg once a day.
5. Protonix 40 mg twice a day.
6. Spironolactone 100 mg twice a day.
7. Mycelex five.
8. Meclizine 25 mg once a day.
9. NPH insulin 100 units q. a.m., 50 units q. p.m.
10.      Doxazosin 1 mg once a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of liver, not specified as primary or secondary,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Chronic hepatitis C with hepatic coma,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Acidosis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
