CHIEF COMPLAINT: 

PRESENT ILLNESS: [**Known firstname 32984**] [**Known lastname **] is a
41-year-old Caucasian female who underwent cadaveric renal
transplant on [**2167-9-21**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1.  Cyclosporin 175 mg b.i.d.
2.  CellCept [**Pager number **] mg b.i.d.
3.  Prednisone 15 mg q.d.
4.  Bactrim q.d.
5.  Synthroid 75 micrograms q.d.
6.  Norvasc 2.5 mg q.d.
7.  Lactulose one to two times per day at 20 cc p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke.  She does not
drink alcohol.  She lives with her husband and two children.
Subdural hemorrhage,Liver replaced by transplant,Compression of brain,Splenomegaly
Subdural hemorrhage,Liver transplant status,Compression of brain,Splenomegaly
Admission Date:  [**2167-12-30**]     Discharge Date:

Date of Birth:   [**2126-4-23**]     Sex:  F

Service:

REASON FOR ADMISSION:  Acute anemia, leukopenia, possible
cytomegalovirus infection.

HISTORY OF PRESENT ILLNESS:  [**Known firstname 32984**] [**Known lastname **] is a
41-year-old Caucasian female who underwent cadaveric renal
transplant on [**2167-9-21**].

Her post transplant course has been complicated by the
development of leukopenia; presumably secondary to Valcyte
which has prompted preliminary discontinuation of the
medication.  At the time of her transplant, the recipient and
donor were both cytomegalovirus positive.

For the past approximately one week, she has noticed
worsening nausea which appears to be a postprandial nature,
as well as watery diarrhea (although not increased in
frequency).  She notes that all of her bowel movements are
brown watery diarrhea.  She denies fevers, chills, and
vomiting.

Her laboratory studies were obtained on [**12-28**] which
demonstrated a hemoglobin of 9.2 and hematocrit of 27.6.
White blood cell count was 2.4 and platelet count was 96,000.
She returned to the office today for a routine visit, and
repeat laboratory studies were obtained which demonstrated a
drop in her hemoglobin of 8.8 and hematocrit of 25.5.  White
blood cell count was 1.7.  The platelets were pending at the
time of this dictation.

PHYSICAL EXAMINATION ON PRESENTATION:  On examination, her
chest was clear to auscultation bilaterally.  Her abdomen was
soft, nontender, and nondistended.  The incision had healed
nicely.   There was no evidence of ventral hernias or wound
breakdown.  She had no tubes or drains in place.  Her abdomen
revealed no hepatosplenomegaly and no tenderness.  There was
no peripheral edema.  She had no asterixis.  Neurologically,
she was alert and oriented times four.  Cranial nerves II
through XII were intact.  No focal abnormalities were
appreciated.

MEDICATIONS ON DISCHARGE:  (Her most recent medications
included)
1.  Bactrim-DS one p.o. q.d.
2.  Prednisone 15 mg p.o. q.d.
3.  Lactulose 20 cc p.o. b.i.d.
4.  Synthroid 0.075 mg p.o. q.d.
5.  CellCept [**Pager number **] mg p.o. b.i.d. (has been changed to 250 mg
p.o. q.6h.).
6.  Norvasc 2.5 mg p.o. q.d.
7.  Neoral 175 mg p.o. b.i.d.

IMPRESSION:  Ms. [**Known lastname **] is a 41-year-old white female who is
approximately three months out from a cadaveric renal
transplant for sclerosing cholangitis who presented with
acute anemia, leukopenia, diarrhea, and nausea.  This
constellation of symptoms was consistent with acute
cytomegalovirus infection.

PLAN:   At this point in time she will be admitted to the
hospital and receive a blood transfusion.  Cytomegalovirus
cultures will be obtained, and she will be started
ganciclovir empirically.  A Gastroenterology consultation
will be obtained for endoscopy to rule out active hemorrhage
from either possibly a cytomegalovirus ulcer disease as well.





                          [**Name6 (MD) 12161**] [**Name8 (MD) **], M.D.  [**MD Number(2) 26099**]

Dictated By:[**Last Name (NamePattern4) 32985**]

MEDQUIST36

D:  [**2167-12-30**]  17:18
T:  [**2168-1-2**]  05:10
JOB#:  [**Job Number 32986**]


Admission Date:  [**2167-12-30**]     Discharge Date:  [**2168-1-8**]

Date of Birth:   [**2126-4-23**]     Sex:  F

Service:Liver Transplant Service
HISTORY OF THE PRESENT ILLNESS:  The patient is a 41-year-old
female status post liver transplant on [**2167-9-20**] for
end-stage liver disease secondary to autoimmune hepatitis and
primary sclerosing cholangitis.  Her postoperative course was
complicated by acute renal failure, pancreatitis, and

The patient was at her usual follow-up in the clinic today
and was found to have a hematocrit of 25.5 and a white blood
cell count of 1.7.  She also had vague complaints of nausea,
watery diarrhea, abnormal frequency.  She denied nausea,
vomiting, fever, chills.  She has had periodic headaches.

1.  End-stage liver disease, status post transplant, primary
sclerosing cholangitis, autoimmune hepatitis.
2.  Hypertension.
3.  Hypertrophic pulmonary osteoarthropathy.
4.  Migraines.
5.  Clostridium difficile infection.
6.  Hypothyroidism.

MEDICATIONS ON ADMISSION:
1.  Cyclosporin 175 mg b.i.d.
2.  CellCept [**Pager number **] mg b.i.d.
3.  Prednisone 15 mg q.d.
4.  Bactrim q.d.
5.  Synthroid 75 micrograms q.d.
6.  Norvasc 2.5 mg q.d.
7.  Lactulose one to two times per day at 20 cc p.r.n.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient does not smoke.  She does not
drink alcohol.  She lives with her husband and two children.

PHYSICAL EXAMINATION ON ADMISSION:  HEENT:  The pupils were
equally round and reactive to light.  The extraocular
movements were intact.  No scleral icterus.  The mucous
membranes were moist.  The neck was supple, midline vertical
surgical scar.  Cardiac:  Regular rate and rhythm, no
murmurs.  The lungs were clear to auscultation bilaterally.
No crackles, wheezes, or rhonchi.  The abdomen revealed
positive bowel sounds, soft, distended, nontympanitic,
Y-shaped surgical scar open at the center.  No erythema or
pus including the open surgical scar.  The rectal examination
showed hemorrhoids, no visible blood.  She was Guaiac
negative.  The extremities revealed positive clubbing, no
cyanosis or edema.  Good pedal pulses.

LABORATORY DATA ON ADMISSION:  White blood cell count 1.7,
hematocrit 25.5.  PT 12.7, PTT 30.7, INR 1.1.  The
electrolytes revealed a sodium of 137, potassium 4.2,
chloride 105, C02 26, BUN 20, creatinine 1.0, glucose 105.
AST 19, ALT 17, alkaline phosphatase 72, total bilirubin 0.5,
albumin 3.5, cyclosporin level 72 on [**2167-12-9**].  Her
absolute granulocyte count was 1,510.

HOSPITAL COURSE:  The patient was admitted to the [**Hospital6 1760**] with a diagnosis of anemia
and leukopenia and possible CMV infection.  She was started
on ganciclovir empirically.  She was given 2 units of packed
red blood cells.  Her CellCept was held for fear it may be
contributing to the pancytopenia, although her Neoral and
prednisone were continued.

Both Infectious Disease and GI were consulted.  GI saw the
patient and performed an upper endoscopy.  The EGD did not
show any evidence of ulceration nor did it show any evidence
of viral illness including CMV and herpes.


TO BE CONTINUED

                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.  02-366

Dictated By:[**Last Name (NamePattern4) 8358**]

MEDQUIST36

D:  [**2168-1-9**]  11:16
T:  [**2168-1-13**]  06:30
JOB#:  [**Job Number 32987**]
{'Subdural hemorrhage,Liver replaced by transplant,Compression of brain,Splenomegaly'}


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: [**Known firstname 32984**] [**Known lastname **] is a
41-year-old Caucasian female who underwent cadaveric renal
transplant on [**2167-9-21**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1.  Cyclosporin 175 mg b.i.d.
2.  CellCept [**Pager number **] mg b.i.d.
3.  Prednisone 15 mg q.d.
4.  Bactrim q.d.
5.  Synthroid 75 micrograms q.d.
6.  Norvasc 2.5 mg q.d.
7.  Lactulose one to two times per day at 20 cc p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke.  She does not
drink alcohol.  She lives with her husband and two children. 

### Response:
{'Subdural hemorrhage,Liver replaced by transplant,Compression of brain,Splenomegaly'}
