CHIEF COMPLAINT: fever

PRESENT ILLNESS: Pt is a 59 yo man w/ h/o Hep C cirrhosis s/p Liver xplant in
[**11-8**], w/ chronic rejection (demonstrated on biopsy in [**9-9**]),
recurrent Hep C on INF and ribavirin, B cell lymphoma, who p/w
fevers, abdominal pain, SBP. Pt was in USOH until 1 week PTA
when began feeling fatigued, had N/V approximately 1-2 episodes
per day, non-bloody, non-bilious. 3 days PTA, pt began to have
severe abdominal pain. He also noted increased abd girth,
increased LE edema, R > L, denied any calf pain. Over past 3
days, pt also c/o cough with some sputum production, although
difficult to bring up 2/2 abd pain. He also c/o laryngitis
starting 3 days ago. ROS otherwise negative for BRBPR, melena,
SOB, CP/pressure."
.
On [**9-21**], the patient saw Dr. [**Last Name (STitle) 497**] in clinic, the complained of
severe abdomninal pain, was noted to have a fever to 101, and
therefore was sent to the ED for further evaluation.
.
In [**Name (NI) **], pt was noted to be febrile to 102.8, HR 119, BP 104/74,
O2 sat 95% on RA, decreased to low 90's on [**Last Name (LF) **], [**First Name3 (LF) **] placed on 2L
NC and O2 sat increased to mid-90's. Labs notable for WBC 10.7
with 17% bands, T [**First Name3 (LF) **] elevated to 20.5 (last T [**First Name3 (LF) **] 15 on
[**9-19**]), lactate 2.4, INR 1.2 (elevated from 1.0). Paracentesis
was done that demonstrated 8520 WBC w/ 62% polys, c/w SBP. CT
scan report demonstrated no free air, no bowel obstruction,
increased ascites, and ?LLL pna vs clot in lung vs hepatic vein
clot. Pt was given levofloxacin 500mg IV x 1, flagyl 500mg IV x
1, morphine.
.
Due to pt's ill-appearance, and severe SBP, he was admitted to
MICU [**9-21**] for further care and monitering.

MEDICAL HISTORY: 1. hepatitis C (s/p transfusion for bursitis surgery in '[**31**] vs.
EtOH cirrhosis), s/p orthotopic liver transplant on [**2162-11-12**],
followed by Dr. [**Last Name (STitle) 497**].  Post-op complications have been
recurrent hepatitis C viremia and development of cholestatic
jaundice of uncertain etiology, both occurring four months after
liver transplant.
2. B cell lymphoma: nodal marginal zone CD5 positive B-cell
lymphoma noted at the time of transplant; bone marrow biopsy
performed during hospitalization for pancytopenia and PNA in
[**2-7**] revealed approx. 25% involvement. Decision was for no chemo
at that time.
3. h/o PNA in [**2-7**]: Pseudomonas and Staph. cx positive treated
with aztreonam and levofloxacin.
4. Headaches: rxn to Prograf; was taken off for some time then
restarted; HA are throbbing, constant and encompass whole head.
Responds well to cold compress; refractory to pain medications.

MEDICATION ON ADMISSION: 

ALLERGIES: Ceftriaxone

PHYSICAL EXAM: Vitals - T 100.9/100.9, 102 on [**9-22**] at 2PM , HR107 , BP102/58 ,
RR 14, O2 97% room air
General - cachectic, non-toxic, alert, oriented x3
HEENT - scleral icterus
CVS - tachycardic, regular, no noted M/R/G
Lungs - Decreased BS at bases b/l, ?crackles at left base
Abd - distended, incisional and umbilical hernia noted,
reducible, diffuse tenderness, no reboudn or guarding, tap site
without focal tenderness, erythema
Ext - [**12-6**]+ LE edema b/l, R>L--this was noted on admit as well
Skin - jaundiced
Neuro - No noted asterixis, oriented x 3
.
On discharge, Afebrile BP 114/77, HR 85, 97% RA.
similar exam.  Abdomen distended, but soft w/o TTP, rebound, or
guarding.

FAMILY HISTORY: Mother died at 76 from lung cancer.  Father is 85, healthy.
Brother committed suicide ~10 years ago.  Two brothers and two
sisters alive and healthy.

SOCIAL HISTORY: Married >30 years.  Lives with wife and her 10 year old
grandson, whom he takes care of.  Never previously married and
never had children of his own.  [**Country 3992**] veteran and describes
PTSD following 13 months of combat, which he received some
counseling for but no formal treatment.  He used to work as a
custodian in the [**Hospital1 3494**] public schools but is now on
disability following a work injury.
.
Pt drank heavily in the past.  Last drink was >1yr ago, prior to
liver transplant.  Admits to marjuana use and occasional cocaine
use in the past.  Tobacco history, smokes 10 cigarettes daily,
reports only taking 2 puffs and then throwing it away; up to one
pack daily over the last 45 years.  Would like to quit, has
tried in the past with the patch and been successful for up to 2
weeks.
Spontaneous bacterial peritonitis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Complications of transplanted liver,Pulmonary collapse,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Portal hypertension,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Alpha-1-antitrypsin deficiency,Tobacco use disorder,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of other infectious and parasitic diseases
Spontan bact peritonitis,Streptococcus group b,Compl liver transplant,Pulmonary collapse,Oth lymp unsp xtrndl org,Adv eff antibiotics NEC,DMII wo cmp nt st uncntr,Portal hypertension,Unilat inguinal hernia,Alpha-1-antitrypsin def,Tobacco use disorder,Fm hx-trach/bronchog mal,Prsnl hst oth nfct parst
Admission Date:  [**2163-9-21**]              Discharge Date:   [**2163-9-27**]

Date of Birth:  [**2104-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Ceftriaxone

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
fever

Major Surgical or Invasive Procedure:
multiple paracentesis


History of Present Illness:
Pt is a 59 yo man w/ h/o Hep C cirrhosis s/p Liver xplant in
[**11-8**], w/ chronic rejection (demonstrated on biopsy in [**9-9**]),
recurrent Hep C on INF and ribavirin, B cell lymphoma, who p/w
fevers, abdominal pain, SBP. Pt was in USOH until 1 week PTA
when began feeling fatigued, had N/V approximately 1-2 episodes
per day, non-bloody, non-bilious. 3 days PTA, pt began to have
severe abdominal pain. He also noted increased abd girth,
increased LE edema, R > L, denied any calf pain. Over past 3
days, pt also c/o cough with some sputum production, although
difficult to bring up 2/2 abd pain. He also c/o laryngitis
starting 3 days ago. ROS otherwise negative for BRBPR, melena,
SOB, CP/pressure."
.
On [**9-21**], the patient saw Dr. [**Last Name (STitle) 497**] in clinic, the complained of
severe abdomninal pain, was noted to have a fever to 101, and
therefore was sent to the ED for further evaluation.
.
In [**Name (NI) **], pt was noted to be febrile to 102.8, HR 119, BP 104/74,
O2 sat 95% on RA, decreased to low 90's on [**Last Name (LF) **], [**First Name3 (LF) **] placed on 2L
NC and O2 sat increased to mid-90's. Labs notable for WBC 10.7
with 17% bands, T [**First Name3 (LF) **] elevated to 20.5 (last T [**First Name3 (LF) **] 15 on
[**9-19**]), lactate 2.4, INR 1.2 (elevated from 1.0). Paracentesis
was done that demonstrated 8520 WBC w/ 62% polys, c/w SBP. CT
scan report demonstrated no free air, no bowel obstruction,
increased ascites, and ?LLL pna vs clot in lung vs hepatic vein
clot. Pt was given levofloxacin 500mg IV x 1, flagyl 500mg IV x
1, morphine.
.
Due to pt's ill-appearance, and severe SBP, he was admitted to
MICU [**9-21**] for further care and monitering.


Past Medical History:
1. hepatitis C (s/p transfusion for bursitis surgery in '[**31**] vs.
EtOH cirrhosis), s/p orthotopic liver transplant on [**2162-11-12**],
followed by Dr. [**Last Name (STitle) 497**].  Post-op complications have been
recurrent hepatitis C viremia and development of cholestatic
jaundice of uncertain etiology, both occurring four months after
liver transplant.
2. B cell lymphoma: nodal marginal zone CD5 positive B-cell
lymphoma noted at the time of transplant; bone marrow biopsy
performed during hospitalization for pancytopenia and PNA in
[**2-7**] revealed approx. 25% involvement. Decision was for no chemo
at that time.
3. h/o PNA in [**2-7**]: Pseudomonas and Staph. cx positive treated
with aztreonam and levofloxacin.
4. Headaches: rxn to Prograf; was taken off for some time then
restarted; HA are throbbing, constant and encompass whole head.
Responds well to cold compress; refractory to pain medications.

5. IDDM 2: diagnosed in [**2160**], HbA1C 5.4 ([**1-10**]).
6. Arthritis s/p long hospitalization in the 70's.
7. Chronic neck pain s/p cervical procedure [**4-4**].
8. R inguinal hernia; unable to operate given recent liver
transplant.
9. Alpha-1 antitrypsin deficiency - this diagnosis appeared in a
prior discharge summary but was denied by the patient.

Social History:
Married >30 years.  Lives with wife and her 10 year old
grandson, whom he takes care of.  Never previously married and
never had children of his own.  [**Country 3992**] veteran and describes
PTSD following 13 months of combat, which he received some
counseling for but no formal treatment.  He used to work as a
custodian in the [**Hospital1 3494**] public schools but is now on
disability following a work injury.
.
Pt drank heavily in the past.  Last drink was >1yr ago, prior to
liver transplant.  Admits to marjuana use and occasional cocaine
use in the past.  Tobacco history, smokes 10 cigarettes daily,
reports only taking 2 puffs and then throwing it away; up to one
pack daily over the last 45 years.  Would like to quit, has
tried in the past with the patch and been successful for up to 2
weeks.


Family History:
Mother died at 76 from lung cancer.  Father is 85, healthy.
Brother committed suicide ~10 years ago.  Two brothers and two
sisters alive and healthy.

Physical Exam:
Vitals - T 100.9/100.9, 102 on [**9-22**] at 2PM , HR107 , BP102/58 ,
RR 14, O2 97% room air
General - cachectic, non-toxic, alert, oriented x3
HEENT - scleral icterus
CVS - tachycardic, regular, no noted M/R/G
Lungs - Decreased BS at bases b/l, ?crackles at left base
Abd - distended, incisional and umbilical hernia noted,
reducible, diffuse tenderness, no reboudn or guarding, tap site
without focal tenderness, erythema
Ext - [**12-6**]+ LE edema b/l, R>L--this was noted on admit as well
Skin - jaundiced
Neuro - No noted asterixis, oriented x 3
.
On discharge, Afebrile BP 114/77, HR 85, 97% RA.
similar exam.  Abdomen distended, but soft w/o TTP, rebound, or
guarding.


Pertinent Results:
On Admission:
[**2163-9-21**] 04:00PM BLOOD WBC-10.7# RBC-3.62* Hgb-10.8* Hct-30.8*
MCV-85 MCH-29.9 MCHC-35.2* RDW-19.1* Plt Ct-111*
[**2163-9-21**] 04:00PM BLOOD PT-13.8* PTT-31.7 INR(PT)-1.2*
[**2163-9-21**] 04:00PM BLOOD Glucose-211* UreaN-22* Creat-0.6 Na-137
K-3.3 Cl-102 HCO3-21* AnGap-17
[**2163-9-23**] 03:52AM BLOOD calTIBC-144* VitB12-GREATER TH
Folate-18.4 Ferritn-247 TRF-111*
.[**2163-9-21**] 04:00PM   ALT(SGPT)-94* AST(SGOT)-109* ALK PHOS-1529*
AMYLASE-33 TOT [**Month/Day/Year **]-20.5*
[**2163-9-21**] 04:00PM   LIPASE-27
[**2163-9-21**] 04:00PM   ALBUMIN-2.9*
.
On Dishcarge
WBC 2.3, Hct 22.8, Plt 101
Na 134, K 3.4, Cl 101, Bicarb 21, BUN 12, Cr 0.6
Tbili 17.4
AP 960, ALT 51, AST 157
rapamycin 8.3
.
Microbiology:
[**2163-9-21**], [**9-22**], [**9-23**] Blood cx: Pending
[**2163-9-21**] Peritoneal fluid cx: GBS, sensitive to levofloxacin
[**9-22**] sputum: beta strep
.
Imaging:
[**9-22**] CXR: There is consolidation in the left lower lobe with
marked leftward displacement of the mediastinum and elevation of
the left hemidiaphragm suggesting complete or almost complete
atelectasis of the left lower lobe. There are no other
consolidations or masses. There is no sizeable pleural effusion.
The heart size is normal. The mediastinal contours are
unremarkable.

Revision of the recent PET/CT and CT abdomen demonstrates
intermittent obstruction of the left lower lobe segmental
bronchi with subsequent atelectasis. Given this intermittent
nature of the radiological findings and absence of any
endobronchial obstructing lesion on the PET/CT from [**8-31**], [**2162**], recurrent aspirations are the most likely diagnosis.
.
[**2163-9-21**] CT Abdomen and Pelvis:
IMPRESSION:
1. Increase in abundant ascites.
2. Left lower lobe consolidation is likely pneumonia, but
pulmonary infarct
is a consideration given presence of possible left lower lobe
pulmonary embolus.
3. Left lower lobe thrombus that is either within the pulmonary
arteries or veins.


Brief Hospital Course:
This is 59 year-old man with hep C cirrhosis s/p liver
transplant 10 months ago complicated by recurrent Hep C and
chronic rejection who presented with abdmonial pain and was
found to have severe spontaneous bacterial peritonitis.
.
Due to pt's ill-appearance, and severe SBP, he was admitted to
MICU [**9-21**] for further care and monitering.
.
While in the MICU the patient was started on aztreonam,
linezolid, flagyl and levoquin to cover sbp and a possible
pneumonia. His antibiotic regimen was changed to vancomycin,
levofloxacin, and flagyl when he was found to have group B
Streptococci growing from peritoneal culture.  Mr [**Known lastname 13149**]
abdominal pain improved rapidly with antibiotic therapy as well
as a therapeutic paracentesis.  The GBS was found to be
sensitive to levoquin and he was eventually transitioned to
levoquin monotherapy and was discharged to finish a 14 day
course with subsuquent ciprofloxacin SBP prophylaxis.
.
Additionally Mr. [**Known lastname 2379**] was briefly hypoxic in the MICU (wich
resolved).  CT scan revealed a question of LLL pneumonia versus
pulmonary embolus versus atelectasis.  The radiologists
subsuquent discussions with the primary team indicated that the
CT appearance was more consistent with atelectasis and Mr.
[**Name14 (STitle) 13150**] hypoxia resolved without heparin therapy.
.
Mr. [**Known lastname 2379**] is 10 months s/p liver transplant and has both chronic
rejection as well as reactivation of his hepatitis C.  He was on
treatment with interferon and ribavirin for his hepatitis C on
admission in addition to his immunosuppressive regimen.  He was
admitted with an acute rise in his LFTs over baseline most
likely secondary to his rejection and HCV.  His hepatitis C
treatment had to be discontinued due to his acute illness, and
it was difficult to increase his immunosuppressants to treat
rejection due to his reactivation of hepatitis C.  He was
continued on his home regimen of rapamune, prednisone, and
ursidiol.  He was not encephalopathic in house and did not
require lactulose.
.
Mr [**Known lastname 2379**] also suffered from portal hypertension with resultant
chronic ascites and lower extremity edema that were quite
symptomatic.  His diuretics were originally held in house due to
his illness and concern for potentially initiating renal failure
in his infected state.  He was maintainted on a low sodium diet
with one therapeutic paracentesis, which he tolerated.  When he
clinically improved from an infectious standpoint; lasix 40 and
spironolactone 100 were reintroduced without significant renal
dysfunction.
.
Mr [**Known lastname 2379**] also received the standard care of a PPI; insulin to
treat his diabetes, electrolyte repletion, heparin prophylaxis,
nutritional input and physical therapy.
.
Ultimately with regards to his chronic liver failure and
difficult to manage ascites the patient initiated conversations
with Dr. [**Last Name (STitle) 497**] and the hepatology team about his overall
prognosis and therapeutic options.  Because of his ill health
and particularly because he was found to have lymphoma in his
explanted liver he is not a candidate for a second liver
transplant.  Mr. [**Known lastname 2379**] decided he would prefer to therefore
direct the remainder of his medical care to comfort measures.
[**First Name8 (NamePattern2) 2270**] [**Last Name (NamePattern1) 1764**] with the Palliative care service along with the
social workers were very involved in setting up hospice care for
the patient at home and he was discharged with that goal in
mind.
.


Discharge Medications:
1. Oxycodone 5 mg Tablet Sig: Six (6) Tablet PO Q4H (every 4
hours) as needed.
2. Ursodiol 300 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Oxycodone 40 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours).
6. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).

8. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed: please do not take if oversedated.
Disp:*40 Tablet(s)* Refills:*0*
9. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days: Last dose to be on [**10-5**].
Disp:*8 Tablet(s)* Refills:*0*
10. Norfloxacin 400 mg Tablet Sig: One (1) Tablet PO once a day:
to start on [**10-6**], after you complete the levofloxacin.
Disp:*30 Tablet(s)* Refills:*2*
11. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
12. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of [**Location (un) 270**]-East & Visiting Nurse Hospice

Discharge Diagnosis:
1.  Spontaneous bacterial peritonitis
2.  hepatitis C s/p liver transplant
3.  Chronic liver rejection
4.  lymphoma


Discharge Condition:
fair.  Afebrile, VSS


Discharge Instructions:
You were admitted to the hospital with an infection in your
abdomen, you will need to complete a 14-day course of
levofloxacin for this, and afterwards you will need to be on a
medicine called norfloxacin daily to prevent further infections.
 You should seek medical attention if you develop fevers,
chills, or worsening abdominal pain because this may be a sign
that your infection has returned.
.
To treat your ascites and leg swelling we have started you on
lasix 40mg daily and spironolactone 100mg daily.
.
We are also asking that hospice be involved in your care and
they will help you manage things like your pain, encephalopathy,
and other comfort measures.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**].  Thursday [**10-6**];
Dr[**Name (NI) 948**] office should contact you with an appoinment time.
{'Spontaneous bacterial peritonitis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Complications of transplanted liver,Pulmonary collapse,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Portal hypertension,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Alpha-1-antitrypsin deficiency,Tobacco use disorder,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of other infectious and parasitic diseases'}


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: fever

PRESENT ILLNESS: Pt is a 59 yo man w/ h/o Hep C cirrhosis s/p Liver xplant in
[**11-8**], w/ chronic rejection (demonstrated on biopsy in [**9-9**]),
recurrent Hep C on INF and ribavirin, B cell lymphoma, who p/w
fevers, abdominal pain, SBP. Pt was in USOH until 1 week PTA
when began feeling fatigued, had N/V approximately 1-2 episodes
per day, non-bloody, non-bilious. 3 days PTA, pt began to have
severe abdominal pain. He also noted increased abd girth,
increased LE edema, R > L, denied any calf pain. Over past 3
days, pt also c/o cough with some sputum production, although
difficult to bring up 2/2 abd pain. He also c/o laryngitis
starting 3 days ago. ROS otherwise negative for BRBPR, melena,
SOB, CP/pressure."
.
On [**9-21**], the patient saw Dr. [**Last Name (STitle) 497**] in clinic, the complained of
severe abdomninal pain, was noted to have a fever to 101, and
therefore was sent to the ED for further evaluation.
.
In [**Name (NI) **], pt was noted to be febrile to 102.8, HR 119, BP 104/74,
O2 sat 95% on RA, decreased to low 90's on [**Last Name (LF) **], [**First Name3 (LF) **] placed on 2L
NC and O2 sat increased to mid-90's. Labs notable for WBC 10.7
with 17% bands, T [**First Name3 (LF) **] elevated to 20.5 (last T [**First Name3 (LF) **] 15 on
[**9-19**]), lactate 2.4, INR 1.2 (elevated from 1.0). Paracentesis
was done that demonstrated 8520 WBC w/ 62% polys, c/w SBP. CT
scan report demonstrated no free air, no bowel obstruction,
increased ascites, and ?LLL pna vs clot in lung vs hepatic vein
clot. Pt was given levofloxacin 500mg IV x 1, flagyl 500mg IV x
1, morphine.
.
Due to pt's ill-appearance, and severe SBP, he was admitted to
MICU [**9-21**] for further care and monitering.

MEDICAL HISTORY: 1. hepatitis C (s/p transfusion for bursitis surgery in '[**31**] vs.
EtOH cirrhosis), s/p orthotopic liver transplant on [**2162-11-12**],
followed by Dr. [**Last Name (STitle) 497**].  Post-op complications have been
recurrent hepatitis C viremia and development of cholestatic
jaundice of uncertain etiology, both occurring four months after
liver transplant.
2. B cell lymphoma: nodal marginal zone CD5 positive B-cell
lymphoma noted at the time of transplant; bone marrow biopsy
performed during hospitalization for pancytopenia and PNA in
[**2-7**] revealed approx. 25% involvement. Decision was for no chemo
at that time.
3. h/o PNA in [**2-7**]: Pseudomonas and Staph. cx positive treated
with aztreonam and levofloxacin.
4. Headaches: rxn to Prograf; was taken off for some time then
restarted; HA are throbbing, constant and encompass whole head.
Responds well to cold compress; refractory to pain medications.

MEDICATION ON ADMISSION: 

ALLERGIES: Ceftriaxone

PHYSICAL EXAM: Vitals - T 100.9/100.9, 102 on [**9-22**] at 2PM , HR107 , BP102/58 ,
RR 14, O2 97% room air
General - cachectic, non-toxic, alert, oriented x3
HEENT - scleral icterus
CVS - tachycardic, regular, no noted M/R/G
Lungs - Decreased BS at bases b/l, ?crackles at left base
Abd - distended, incisional and umbilical hernia noted,
reducible, diffuse tenderness, no reboudn or guarding, tap site
without focal tenderness, erythema
Ext - [**12-6**]+ LE edema b/l, R>L--this was noted on admit as well
Skin - jaundiced
Neuro - No noted asterixis, oriented x 3
.
On discharge, Afebrile BP 114/77, HR 85, 97% RA.
similar exam.  Abdomen distended, but soft w/o TTP, rebound, or
guarding.

FAMILY HISTORY: Mother died at 76 from lung cancer.  Father is 85, healthy.
Brother committed suicide ~10 years ago.  Two brothers and two
sisters alive and healthy.

SOCIAL HISTORY: Married >30 years.  Lives with wife and her 10 year old
grandson, whom he takes care of.  Never previously married and
never had children of his own.  [**Country 3992**] veteran and describes
PTSD following 13 months of combat, which he received some
counseling for but no formal treatment.  He used to work as a
custodian in the [**Hospital1 3494**] public schools but is now on
disability following a work injury.
.
Pt drank heavily in the past.  Last drink was >1yr ago, prior to
liver transplant.  Admits to marjuana use and occasional cocaine
use in the past.  Tobacco history, smokes 10 cigarettes daily,
reports only taking 2 puffs and then throwing it away; up to one
pack daily over the last 45 years.  Would like to quit, has
tried in the past with the patch and been successful for up to 2
weeks. 

### Response:
{'Spontaneous bacterial peritonitis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Complications of transplanted liver,Pulmonary collapse,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Other specified antibiotics causing adverse effects in therapeutic use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Portal hypertension,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Alpha-1-antitrypsin deficiency,Tobacco use disorder,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of other infectious and parasitic diseases'}
