CHIEF COMPLAINT: Fulminant liver failure

PRESENT ILLNESS: 46 y.o. W with hx of acute hepatitis in [**2134**], which was
attributed at that time to ditropan vs unclear etiology, and
multiple schlerosis, presents from an urgent care visit with her
PCP where she presented with lower extremity edema, nausea,
decreased PO intake for the past 2-3 days, and jaundice.
.
In [**2134**], patient had a complete work-up for hepatic failure
including: hepatitis A, B, C serologies, leptospira,
ceruloplasmin, copper, herpes type I and type II antibodies,
HIV, ascites fluid for culture, blood cultures, and ophtho
consult for Kayser-Fleischer rings, which were all negative. A
CT of the liver as part of a liver transplant work-up showed a
shrunken cirrhotic liver with regenerating nodules with
hyperintense lesions susicious for hepatomas. There was evidence
of ascites and portal hypertension as indicated by dilated
portal vein and recanalization of the periumbilical vein. A
transjugular liver biopsy showed
(1) Confluent a bridging necrosis, submassive necrosis with
collapse in bile ductular proliferation. (2) Lobular chronic
inflammation with necrosis and hepatocellular cholelithiasis.
(3) No fatty changes or viral cytopathic changes seen. (4) Focal
increase in stainable iron seen. (5) Trichrome reticulin in
ursine stains performed. The patient was put on the liver
transplant list and followed by hepatology, but her hepatic
failure slowly resolved over the course of about four months.
.
The patient says she has been in her usual state of health. She
is on disability for her MS but otherwise has no other
significant medical problems. She estimates drinking less than 1
alcoholic beverage per month, and denies any changes in her
routine. No recent changes in medications, travel, sick contacts
except for her six-year-old son who has a cough.
.
In the ED, Hepatology and Transplant Surgery were both
consulted. A RUQ US was performed which showed possible
cirrhosis, no ascites, and a CTA was ordered and is still
pending. Head CT was negative. Hepatitis serologies and many
other labs as detailed below in the A & P were sent. Serum tox
screen was negative. Patient was admitted to MICU for close
monitoring. Of note, when patient was admitted to the unit she
was discovered to have an old tampon in place which had been
there for at least several days.

MEDICAL HISTORY: 1. Multiple sclerosis diagnosed in [**2133**]. The patient complains
of numbness and weakness in bilateral lower extremities.
2. Episode of fulminant liver failure in [**2134**] with negative
work-up as above.
3. Status post C-section.

MEDICATION ON ADMISSION: Baclofen
Promethazine
Naproxen
Copaxone
Tizanadine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: P: 120 BP: 134/75 RR: 18 O2 sat: 98%
GEN: NAD, jaundiced
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, +
icterus, OP clear, MM dry, neck supple, no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: firm, NT, ND, + BS,
EXT: warm, dry, +2 distal pulses BL, + 3 pitting edema in feet
to ankles BL
NEURO: alert & oriented, CN II-XII grossly intact, 5/5 strength
throughout. No sensory deficits to light touch appreciated. +
mild asterixis
PSYCH: appropriate affect

FAMILY HISTORY: No contact with father since young age. Mother died at 62, exact
cause unknown.

SOCIAL HISTORY: Tobacco - quit [**9-/2136**]
EtOH less than 1 glass of wine per month
Drugs: remote hx of marijuana use
No IVDU
Married, has two children ages 7 and 9. On disability.
Acute and subacute necrosis of liver,Hepatic encephalopathy,Acute respiratory failure,Other ascites,Other and unspecified coagulation defects,Pulmonary congestion and hypostasis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Hyperosmolality and/or hypernatremia,Cirrhosis of liver without mention of alcohol,Multiple sclerosis,Other specified cardiac dysrhythmias,Anemia, unspecified,Unilateral paralysis of vocal cords or larynx, partial,Other specified disorders of pancreatic internal secretion,Thrombocytopenia, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Nontoxic uninodular goiter,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of tobacco use
Acute necrosis of liver,Hepatic encephalopathy,Acute respiratry failure,Ascites NEC,Coagulat defect NEC/NOS,Pulm congest/hypostasis,Cholelith w ac cholecyst,Hyperosmolality,Cirrhosis of liver NOS,Multiple sclerosis,Cardiac dysrhythmias NEC,Anemia NOS,Vocal paral unilat part,Pancreatic disorder NEC,Thrombocytopenia NOS,Adv eff corticosteroids,Nontox uninodular goiter,Epilep NOS w/o intr epil,History of tobacco use
Admission Date:  [**2142-5-11**]              Discharge Date:   [**2142-6-1**]

Date of Birth:  [**2095-6-24**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
Fulminant liver failure

Major Surgical or Invasive Procedure:
[**2142-5-15**] orthotopic liver transplant


History of Present Illness:
46 y.o. W with hx of acute hepatitis in [**2134**], which was
attributed at that time to ditropan vs unclear etiology, and
multiple schlerosis, presents from an urgent care visit with her
PCP where she presented with lower extremity edema, nausea,
decreased PO intake for the past 2-3 days, and jaundice.
.
In [**2134**], patient had a complete work-up for hepatic failure
including: hepatitis A, B, C serologies, leptospira,
ceruloplasmin, copper, herpes type I and type II antibodies,
HIV, ascites fluid for culture, blood cultures, and ophtho
consult for Kayser-Fleischer rings, which were all negative. A
CT of the liver as part of a liver transplant work-up showed a
shrunken cirrhotic liver with regenerating nodules with
hyperintense lesions susicious for hepatomas. There was evidence
of ascites and portal hypertension as indicated by dilated
portal vein and recanalization of the periumbilical vein. A
transjugular liver biopsy showed
(1) Confluent a bridging necrosis, submassive necrosis with
collapse in bile ductular proliferation. (2) Lobular chronic
inflammation with necrosis and hepatocellular cholelithiasis.
(3) No fatty changes or viral cytopathic changes seen. (4) Focal
increase in stainable iron seen. (5) Trichrome reticulin in
ursine stains performed. The patient was put on the liver
transplant list and followed by hepatology, but her hepatic
failure slowly resolved over the course of about four months.
.
The patient says she has been in her usual state of health. She
is on disability for her MS but otherwise has no other
significant medical problems. She estimates drinking less than 1
alcoholic beverage per month, and denies any changes in her
routine. No recent changes in medications, travel, sick contacts
except for her six-year-old son who has a cough.
.
In the ED, Hepatology and Transplant Surgery were both
consulted. A RUQ US was performed which showed possible
cirrhosis, no ascites, and a CTA was ordered and is still
pending. Head CT was negative. Hepatitis serologies and many
other labs as detailed below in the A & P were sent. Serum tox
screen was negative. Patient was admitted to MICU for close
monitoring. Of note, when patient was admitted to the unit she
was discovered to have an old tampon in place which had been
there for at least several days.


Past Medical History:
1. Multiple sclerosis diagnosed in [**2133**]. The patient complains
of numbness and weakness in bilateral lower extremities.
2. Episode of fulminant liver failure in [**2134**] with negative
work-up as above.
3. Status post C-section.

Social History:
Tobacco - quit [**9-/2136**]
EtOH less than 1 glass of wine per month
Drugs: remote hx of marijuana use
No IVDU
Married, has two children ages 7 and 9. On disability.


Family History:
No contact with father since young age. Mother died at 62, exact
cause unknown.

Physical Exam:
VS: T: P: 120 BP: 134/75 RR: 18 O2 sat: 98%
GEN: NAD, jaundiced
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, +
icterus, OP clear, MM dry, neck supple, no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: firm, NT, ND, + BS,
EXT: warm, dry, +2 distal pulses BL, + 3 pitting edema in feet
to ankles BL
NEURO: alert & oriented, CN II-XII grossly intact, 5/5 strength
throughout. No sensory deficits to light touch appreciated. +
mild asterixis
PSYCH: appropriate affect


Brief Hospital Course:
She was admitted to the MICU with acute liver failure and
moderate encephalopathy with MELD score of 32 on admission.
Patient now with  but laboratories stable. Unclear etiology.
Patient recently given solumedrol, which has been shown in case
reports to be associated with acute liver failure. CTA showed
cirrhosis, patent vasculature. Lactulose was given for
encephalopathy and w/u for liver failure was done. She was
intubated for respiratory failure from fluid overload and from
inability to manage secretions from encephalopathy.

On [**2142-5-15**] a liver donor was available and she underwent
piggyback liver transplant. Surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] assisted
by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Induction immunosuppression was given
(solumedrol and cellcept). Per operative note, The GDA was
taken. The common hepatic artery was dissected down to an
appropriate spot where it could be clamped. A graybulldog was
placed on the artery. The donor artery was cut to
the appropriate length using a branch patch from the GDA and a
running 6-0 Prolene anastomosis was accomplished.  Please see
operative report for further details. She tolerated the surgery
without complications and was transferred immediately afterward
to the SICU intubated.
On POD 3 she was febrile to 101.5 and Pan-cultured.  Her NGT was
removed on POD 3 and she was extubated.  She tolerated the
extubation well, and was placed on cool Neb's only.  On POD 5
and Insulin drip was started for Blood Sugars of 390.  She was
also started on clears and advanced to a regular diet.  She was
transferred to the floor and her foley was removed on POD 6 and
neurology was consulted regarding management of her MS while she
was in house.  She was A+Ox2 and had persistent RUE weakness.
Her mental status improved and she was A+Ox 3 on discharge.  She
continues to have RUE weakness, but she states this is her
baseline during a "[**Last Name (NamePattern1) **]".  Neurology recommended an MRI head
+/- spine with contrast (which was done on [**5-27**]), Continue with
PT/OT, and to continue steroids the immunosuppression should
help her new MS [**Last Name (Titles) **].  Her husband to brought in the OSH MRI
for comparison to the MRI on [**5-27**] and the MS lesions were
stable.  She will follow up with her Neurologist Dr [**Last Name (STitle) 32186**] in
[**Location (un) **], MA.  On POD 8 her Lasix was stopped.  Another
post-operative issue was hoarseness.  She was evaluated by
speech and swallow and aspiration was ruled out. After a video
swallow she was placed on a diet of thin liquids and regular
solids, and Tube Feeds were started to ensure adequate
nutrition.  She was encouraged to take in PO's.  ENT was also
consulted to assess [**Location (un) **] cords.  She was scheduled for a video
Stroboscopy on [**5-29**] which demonstrated Right [**Month/Year (2) **] [**Month/Year (2) **]
paralysis.  She will follow up with Dr [**First Name (STitle) **] as an outpatients
regarding treatment of her [**First Name (STitle) **] cords.
On POD 11 her JP drain was removed.  Physical Therapy continued
to work with her and she was placed in Rehab facility per
physical therapy recommensations.  She is being discharged
afebrile, vital signs stable, tolerating her tube feeds, A+Ox3
and at her baseline physical ability.  She will follow up with
Dr [**Last Name (STitle) 816**], Dr [**First Name (STitle) **] from ENT, and her neurologist Dr [**Last Name (STitle) 32186**].



Medications on Admission:
Baclofen
Promethazine
Naproxen
Copaxone
Tizanadine


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Cirrhosis etiology unknown
MS
[**First Name (Titles) **] [**Last Name (Titles) **] paralysis


Discharge Condition:
good


Discharge Instructions:
please call the Transplant Office [**Telephone/Fax (1) 673**] if you have
fever, chills, nausea, vomiting, inability to take any of your
medications, increased abdominal pain, incision
redness/bleeding/drainage, jaundice or dark urine
Labs every Monday and Thursday with results fax'd to
[**Telephone/Fax (1) 697**]




Name:  [**Known lastname **],[**Known firstname 5592**]                     Unit No:   [**Numeric Identifier 5593**]

Admission Date:  [**2142-5-11**]              Discharge Date:   [**2142-6-1**]

Date of Birth:  [**2095-6-24**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2648**]
Addendum:
prograf adjusted to 3.5mg [**Hospital1 **] starting pm [**5-22**] for trough level
6.4

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2649**] MD [**MD Number(2) 2650**]

Completed by:[**2142-6-1**]
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Acute respiratory failure,Other ascites,Other and unspecified coagulation defects,Pulmonary congestion and hypostasis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Hyperosmolality and/or hypernatremia,Cirrhosis of liver without mention of alcohol,Multiple sclerosis,Other specified cardiac dysrhythmias,Anemia, unspecified,Unilateral paralysis of vocal cords or larynx, partial,Other specified disorders of pancreatic internal secretion,Thrombocytopenia, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Nontoxic uninodular goiter,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of tobacco use'}


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: Fulminant liver failure

PRESENT ILLNESS: 46 y.o. W with hx of acute hepatitis in [**2134**], which was
attributed at that time to ditropan vs unclear etiology, and
multiple schlerosis, presents from an urgent care visit with her
PCP where she presented with lower extremity edema, nausea,
decreased PO intake for the past 2-3 days, and jaundice.
.
In [**2134**], patient had a complete work-up for hepatic failure
including: hepatitis A, B, C serologies, leptospira,
ceruloplasmin, copper, herpes type I and type II antibodies,
HIV, ascites fluid for culture, blood cultures, and ophtho
consult for Kayser-Fleischer rings, which were all negative. A
CT of the liver as part of a liver transplant work-up showed a
shrunken cirrhotic liver with regenerating nodules with
hyperintense lesions susicious for hepatomas. There was evidence
of ascites and portal hypertension as indicated by dilated
portal vein and recanalization of the periumbilical vein. A
transjugular liver biopsy showed
(1) Confluent a bridging necrosis, submassive necrosis with
collapse in bile ductular proliferation. (2) Lobular chronic
inflammation with necrosis and hepatocellular cholelithiasis.
(3) No fatty changes or viral cytopathic changes seen. (4) Focal
increase in stainable iron seen. (5) Trichrome reticulin in
ursine stains performed. The patient was put on the liver
transplant list and followed by hepatology, but her hepatic
failure slowly resolved over the course of about four months.
.
The patient says she has been in her usual state of health. She
is on disability for her MS but otherwise has no other
significant medical problems. She estimates drinking less than 1
alcoholic beverage per month, and denies any changes in her
routine. No recent changes in medications, travel, sick contacts
except for her six-year-old son who has a cough.
.
In the ED, Hepatology and Transplant Surgery were both
consulted. A RUQ US was performed which showed possible
cirrhosis, no ascites, and a CTA was ordered and is still
pending. Head CT was negative. Hepatitis serologies and many
other labs as detailed below in the A & P were sent. Serum tox
screen was negative. Patient was admitted to MICU for close
monitoring. Of note, when patient was admitted to the unit she
was discovered to have an old tampon in place which had been
there for at least several days.

MEDICAL HISTORY: 1. Multiple sclerosis diagnosed in [**2133**]. The patient complains
of numbness and weakness in bilateral lower extremities.
2. Episode of fulminant liver failure in [**2134**] with negative
work-up as above.
3. Status post C-section.

MEDICATION ON ADMISSION: Baclofen
Promethazine
Naproxen
Copaxone
Tizanadine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: P: 120 BP: 134/75 RR: 18 O2 sat: 98%
GEN: NAD, jaundiced
HEENT: AT, NC, PERRLA, EOMI, no conjuctival injection, +
icterus, OP clear, MM dry, neck supple, no carotid bruits
CV: RRR, nl s1, s2, no m/r/g
PULM: CTAB, no w/r/r with good air movement throughout
ABD: firm, NT, ND, + BS,
EXT: warm, dry, +2 distal pulses BL, + 3 pitting edema in feet
to ankles BL
NEURO: alert & oriented, CN II-XII grossly intact, 5/5 strength
throughout. No sensory deficits to light touch appreciated. +
mild asterixis
PSYCH: appropriate affect

FAMILY HISTORY: No contact with father since young age. Mother died at 62, exact
cause unknown.

SOCIAL HISTORY: Tobacco - quit [**9-/2136**]
EtOH less than 1 glass of wine per month
Drugs: remote hx of marijuana use
No IVDU
Married, has two children ages 7 and 9. On disability. 

### Response:
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Acute respiratory failure,Other ascites,Other and unspecified coagulation defects,Pulmonary congestion and hypostasis,Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Hyperosmolality and/or hypernatremia,Cirrhosis of liver without mention of alcohol,Multiple sclerosis,Other specified cardiac dysrhythmias,Anemia, unspecified,Unilateral paralysis of vocal cords or larynx, partial,Other specified disorders of pancreatic internal secretion,Thrombocytopenia, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Nontoxic uninodular goiter,Epilepsy, unspecified, without mention of intractable epilepsy,Personal history of tobacco use'}
