CHIEF COMPLAINT: mass in the left lobe of the liver

PRESENT ILLNESS: Per Dr.[**Name (NI) 1369**] operative note: 33-year-old female, with a
history of right upper quadrant abdominal
pain, who was found to have a left lobe liver mass. She was
evaluated in hepatology clinic and on [**4-12**] had an MRI
with gadolinium/BOPTA that demonstrated a mass in the left
lobe of the liver centered in segment III and IVB with a
superior extent which also involves segments II and segment
[**Doctor First Name **]. The mass measured 7.3 x 8.8 x 8.6 cm. The lesion had
imaging characteristics of a benign focal nodular
hyperplasia. After extensive discussions with the patient she
wished to proceed with hepatic resection because of the
abdominal pain and requirement for ongoing follow-up. She
provided informed consent and was brought to the operating
room for left hepatic lobectomy.

MEDICAL HISTORY: Focal liver lesion, Sinusitis with two surgeries, Depression.

MEDICATION ON ADMISSION: Cymbalta 60 mg p.o. daily, ibuprofen 400 mg p.o. twice daily
p.r.n. pain, Singulair 10 mg p.o. daily, tramadol 50 mg p.o.
daily p.r.n., ascorbic acid 500 mg p.o. daily, Tums E-X one
tablet p.o. daily, Mucinex 600 mg daily,
Lactobacillus acidophilus dosage uncertain, loratadine 10 mg
p.o.
daily, multivitamin one p.o. daily, and triprolidine
pseudoephedrine dosage uncertain.

ALLERGIES: Amoxicillin / Sulfa (Sulfonamide Antibiotics) / Melatonin

PHYSICAL EXAM: VS: 99.3, 94, 123/84, 20, 99% 2L
General: epidural reported as not providing adequete pain
relief, switched to IV pain meds in conjunction with APS.
HEENT: moist mucous membranes, NO JVP or LAD
Card: RRR, on telemetry
Lungs; CTA bilaterally
Abd: Soft, obese, appropriately tender, incision C/D/I
Extr: WWP, no edema
Neuro: A+O x3

FAMILY HISTORY: Mother 58 and healthy. father 58 with hypertension.
maternal grandmother is 87 has had CVAs. maternal grandfather
died in his 70s of an MI. paternal grandmother is 81 and has
hypertension. paternal grandfather is 83 and has had an MI and
diabetes mellitus.

SOCIAL HISTORY: She is single, with no children.  She works as a school teacher.
She does not smoke and drinks alcohol on rare occasions.
Other anomalies of gallbladder, bile ducts, and liver,Ventricular fibrillation,Cardiac complications, not elsewhere classified,Asthma, unspecified type, unspecified,Chronic cholecystitis
Biliary & liver anom NEC,Ventricular fibrillation,Surg compl-heart,Asthma NOS,Chronic cholecystitis
Admission Date:  [**2125-6-29**]              Discharge Date:   [**2125-7-6**]

Date of Birth:  [**2091-7-20**]             Sex:   F

Service: SURGERY

Allergies:
Amoxicillin / Sulfa (Sulfonamide Antibiotics) / Melatonin

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
mass in the left lobe of the liver

Major Surgical or Invasive Procedure:
[**2125-7-2**] left hepatic lobectomy, ccy, ious
5/15/09ex lap, liver biopsy and cpr/defibrillation


History of Present Illness:
Per Dr.[**Name (NI) 1369**] operative note: 33-year-old female, with a
history of right upper quadrant abdominal
pain, who was found to have a left lobe liver mass. She was
evaluated in hepatology clinic and on [**4-12**] had an MRI
with gadolinium/BOPTA that demonstrated a mass in the left
lobe of the liver centered in segment III and IVB with a
superior extent which also involves segments II and segment
[**Doctor First Name **]. The mass measured 7.3 x 8.8 x 8.6 cm. The lesion had
imaging characteristics of a benign focal nodular
hyperplasia. After extensive discussions with the patient she
wished to proceed with hepatic resection because of the
abdominal pain and requirement for ongoing follow-up. She
provided informed consent and was brought to the operating
room for left hepatic lobectomy.


Past Medical History:
Focal liver lesion, Sinusitis with two surgeries, Depression.


Social History:
She is single, with no children.  She works as a school teacher.
She does not smoke and drinks alcohol on rare occasions.


Family History:
Mother 58 and healthy. father 58 with hypertension.
maternal grandmother is 87 has had CVAs. maternal grandfather
died in his 70s of an MI. paternal grandmother is 81 and has
hypertension. paternal grandfather is 83 and has had an MI and
diabetes mellitus.

Physical Exam:
VS: 99.3, 94, 123/84, 20, 99% 2L
General: epidural reported as not providing adequete pain
relief, switched to IV pain meds in conjunction with APS.
HEENT: moist mucous membranes, NO JVP or LAD
Card: RRR, on telemetry
Lungs; CTA bilaterally
Abd: Soft, obese, appropriately tender, incision C/D/I
Extr: WWP, no edema
Neuro: A+O x3

Pertinent Results:
Upon Admission: [**2125-6-29**]
WBC-11.8*# RBC-4.00* Hgb-11.8* Hct-35.8* MCV-90 MCH-29.6
MCHC-33.1 RDW-13.8 Plt Ct-237
PT-14.0* PTT-26.2 INR(PT)-1.2*
Glucose-155* UreaN-7 Creat-0.4 Na-138 K-3.7 Cl-107 HCO3-22
AnGap-13
ALT-248* AST-237* AlkPhos-63 TotBili-0.6
Calcium-7.5* Phos-3.8 Mg-1.9
TSH-3.5 Free T4-1.3
At Discharge: [**2125-7-5**]
WBC-6.5 RBC-3.08* Hgb-9.8* Hct-27.3* MCV-89 MCH-31.7 MCHC-35.8*
RDW-13.8 Plt Ct-275
Glucose-92 UreaN-5* Creat-0.4 Na-137 K-3.5 Cl-100 HCO3-29
AnGap-12
ALT-114* AST-66* AlkPhos-57 TotBili-0.4
Albumin-2.9* Calcium-8.1* Phos-3.4 Mg-1.7

Brief Hospital Course:
33 y/o female taken to the OR for symptomatic FNH with Dr
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. The patient was intubated without incident and
the procedure was initiated. The initial dissection was done and
the cut edge along the diaphragm was cauterized with the argon
beam. When the argon beam was turned off, anesthesia noted that
the patient did not return to normal sinus rhythm. Two
pre-cordial thumps were performed and the patient remained in
coarse VFib. Chest compressions were begun and epinephrine was
administered, this did not resolve the coarse VFib and
defibrillation was
accomplished with 360 joules and the patient returned to [**Location 213**]
sinus rhythm. Transthoracic echo was in place immediately and
demonstrated no evidence of pulmonary embolus or air embolus.
The intraoperative ultrasound and a Tru-Cut
biopsy of the mass lesion was done with the patient stable in
normal sinus rhythm. The resection was not completed that day
until the arrhythmia could be evaluated further. The liver was
again cauterized following the biopsy with no arrhythmias. The
abdomen was closed and she was returned to the PACU in stable
condition. She was monitored in the ICU for the next two days
and evaluated by the EPS service who could find no cause for the
VFib arrest. Echo showed No PFO or ASD with normal global and
regional biventricular systolic function.
She remained stable over the weekend and was taken back to the
OR on [**7-2**] for Left hepatic lobectomy and cholecystectomy
following review of the previous events and cardiology
clearance. The mass in the left lobe of the liver was removed
and cholecystectomy performed. Frozen section diagnosis was that
of focal nodular hyperplasia and the final pathology gave the
same diagnosis.
In the post op period, she was kept overnight in the ICU and
then transferred to the regular surgical floor the following
day.
She made excellent post op progress, was tolerating diet,
ambulating and had some return of bowel function and positive
flatus.
The JP drain remains in place. The incision was clean dry and
intact.


Medications on Admission:
Cymbalta 60 mg p.o. daily, ibuprofen 400 mg p.o. twice daily
p.r.n. pain, Singulair 10 mg p.o. daily, tramadol 50 mg p.o.
daily p.r.n., ascorbic acid 500 mg p.o. daily, Tums E-X one
tablet p.o. daily, Mucinex 600 mg daily,
Lactobacillus acidophilus dosage uncertain, loratadine 10 mg
p.o.
daily, multivitamin one p.o. daily, and triprolidine
pseudoephedrine dosage uncertain.


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Loratadine 10 mg Tablet Sig: One (1) Tablet PO qd ().
5. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
8. Cymbalta 60 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
9. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) cc
PO daily PRN constipation as needed for constipation: Do not
take within 2 hours of thyroid medication.
10. Dulcolax 10 mg Suppository Sig: One (1)  Rectal daily as
needed for constipation: Use only as needed for daily BM.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] District Nursing Association

Discharge Diagnosis:
FNH
Vfib arrest


Discharge Condition:
good


Discharge Instructions:
Please call Dr.[**Name (NI) 1369**] office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, abdominal distension, incision redness or
drainage.
Drain and record JP bulb drainage daily and as needed. Bring
record of drain output with you to you clinic visit with Dr
[**Last Name (STitle) **]. Call the office if you note increased drainage, if the
drainage appears bloody or develops a foul odor. Place a drain
sponge around the drain site daily. If you shower make sure the
drain does not hang without support, allow water to run over
incision and drain site, place new dressing once area is patted
dry.
No heavy lifting
No driving while taking pain medication
[**Month (only) 116**] shower

Followup Instructions:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2125-7-11**]
2:00
Cardiology followup through [**Hospital 5700**] Clinic (Dr [**Last Name (STitle) 2357**] has
been recommended)


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

Completed by:[**2125-7-6**]
{'Other anomalies of gallbladder, bile ducts, and liver,Ventricular fibrillation,Cardiac complications, not elsewhere classified,Asthma, unspecified type, unspecified,Chronic cholecystitis'}


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: mass in the left lobe of the liver

PRESENT ILLNESS: Per Dr.[**Name (NI) 1369**] operative note: 33-year-old female, with a
history of right upper quadrant abdominal
pain, who was found to have a left lobe liver mass. She was
evaluated in hepatology clinic and on [**4-12**] had an MRI
with gadolinium/BOPTA that demonstrated a mass in the left
lobe of the liver centered in segment III and IVB with a
superior extent which also involves segments II and segment
[**Doctor First Name **]. The mass measured 7.3 x 8.8 x 8.6 cm. The lesion had
imaging characteristics of a benign focal nodular
hyperplasia. After extensive discussions with the patient she
wished to proceed with hepatic resection because of the
abdominal pain and requirement for ongoing follow-up. She
provided informed consent and was brought to the operating
room for left hepatic lobectomy.

MEDICAL HISTORY: Focal liver lesion, Sinusitis with two surgeries, Depression.

MEDICATION ON ADMISSION: Cymbalta 60 mg p.o. daily, ibuprofen 400 mg p.o. twice daily
p.r.n. pain, Singulair 10 mg p.o. daily, tramadol 50 mg p.o.
daily p.r.n., ascorbic acid 500 mg p.o. daily, Tums E-X one
tablet p.o. daily, Mucinex 600 mg daily,
Lactobacillus acidophilus dosage uncertain, loratadine 10 mg
p.o.
daily, multivitamin one p.o. daily, and triprolidine
pseudoephedrine dosage uncertain.

ALLERGIES: Amoxicillin / Sulfa (Sulfonamide Antibiotics) / Melatonin

PHYSICAL EXAM: VS: 99.3, 94, 123/84, 20, 99% 2L
General: epidural reported as not providing adequete pain
relief, switched to IV pain meds in conjunction with APS.
HEENT: moist mucous membranes, NO JVP or LAD
Card: RRR, on telemetry
Lungs; CTA bilaterally
Abd: Soft, obese, appropriately tender, incision C/D/I
Extr: WWP, no edema
Neuro: A+O x3

FAMILY HISTORY: Mother 58 and healthy. father 58 with hypertension.
maternal grandmother is 87 has had CVAs. maternal grandfather
died in his 70s of an MI. paternal grandmother is 81 and has
hypertension. paternal grandfather is 83 and has had an MI and
diabetes mellitus.

SOCIAL HISTORY: She is single, with no children.  She works as a school teacher.
She does not smoke and drinks alcohol on rare occasions. 

### Response:
{'Other anomalies of gallbladder, bile ducts, and liver,Ventricular fibrillation,Cardiac complications, not elsewhere classified,Asthma, unspecified type, unspecified,Chronic cholecystitis'}
