CHIEF COMPLAINT: increasing abdominal pain, nausea and vomiting

PRESENT ILLNESS: 49M s/p ECD renal transplant [**7-27**] presents with hct of 16.7 24
hours post liver bx and peritoneal tap by IR. These were
performed because of pt's idiopathic jaundice and recent LFT
elevation. Pt reports diarrhea since the procedure and
increasing abdominal discomfort, nausea and dizziness.
Diagnostic paracentesis was attempted in the ED with return of
frank blood.

MEDICAL HISTORY: -End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

MEDICATION ON ADMISSION: Norvasc 10', Procrit 10,000 qwk, Lasix 120'', Gabapentin  100',
insulin lantus 6 qam, ISS, Ativan 2mg hs, Lopressor 100'',
Cellcept [**Pager number **]'', Omeprazole 20 prn, Kayexalate prn, Tacro 1'',
Bactrim ss', Valcyte [**Age over 90 **] M/[**Last Name (LF) **], [**First Name3 (LF) **] 325', Benadryl 50 HS

ALLERGIES: Motrin / Lisinopril / Rapamune

PHYSICAL EXAM: On admission:
97.5 76 117/46 14 96
Gen: Uncomfortable appearing
HEENT: +scleral icterus
Skin: visible jaundice
CV: RRR
Resp: Clear to auscultation
Abd: Distended, +fluid wave, diffuse moderate tenderness, no
rebound or guarding

FAMILY HISTORY: Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.

SOCIAL HISTORY: The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**].
Hemorrhage complicating a procedure,End stage renal disease,Hemoperitoneum (nontraumatic),Cytomegaloviral disease,Acute posthemorrhagic anemia,Hepatitis in viral diseases classified elsewhere,Complications of transplanted kidney,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other ascites,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Other acquired deformities of ankle and foot,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Congestive heart failure, unspecified,Other chronic pulmonary heart diseases
Hemorrhage complic proc,End stage renal disease,Hemoperitoneum,Cytomegaloviral disease,Ac posthemorrhag anemia,Hepatitis in viral dis,Compl kidney transplant,DMII renl nt st uncntrld,Ascites NEC,Hyp kid NOS w cr kid V,Urin tract infection NOS,Abn react-surg proc NEC,Neuropathy in diabetes,Acq ankle-foot def NEC,Status-post ptca,Old myocardial infarct,Depressive disorder NEC,Hyperlipidemia NEC/NOS,CHF NOS,Chr pulmon heart dis NEC
Admission Date:  [**2166-12-4**]              Discharge Date:   [**2166-12-10**]

Date of Birth:  [**2117-4-21**]             Sex:   M

Service: SURGERY

Allergies:
Motrin / Lisinopril / Rapamune

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
increasing abdominal pain, nausea and vomiting

Major Surgical or Invasive Procedure:
Interventional radiology - right lateral sacral artery
successfully embolized using Gelfoam, R IJ line placed
hemodialysis
picc placement

History of Present Illness:
49M s/p ECD renal transplant [**7-27**] presents with hct of 16.7 24
hours post liver bx and peritoneal tap by IR. These were
performed because of pt's idiopathic jaundice and recent LFT
elevation. Pt reports diarrhea since the procedure and
increasing abdominal discomfort, nausea and dizziness.
Diagnostic paracentesis was attempted in the ED with return of
frank blood.

Past Medical History:
-End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

-hypertension
-depression
-hyperlipidemia

PSH:
[**2166-8-1**] ECD renal transplant with delayed graft function

Social History:
The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**].


Family History:
Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.

Physical Exam:
On admission:
97.5 76 117/46 14 96
Gen: Uncomfortable appearing
HEENT: +scleral icterus
Skin: visible jaundice
CV: RRR
Resp: Clear to auscultation
Abd: Distended, +fluid wave, diffuse moderate tenderness, no
rebound or guarding


Pertinent Results:
[**2166-12-10**] 05:27AM BLOOD WBC-6.1 RBC-3.19* Hgb-9.2* Hct-29.3*
MCV-92 MCH-28.9 MCHC-31.5 RDW-16.6* Plt Ct-190
[**2166-12-10**] 05:27AM BLOOD Glucose-99 UreaN-25* Creat-3.5* Na-135
K-3.7 Cl-91* HCO3-33* AnGap-15
[**2166-12-7**] 06:00AM BLOOD ALT-19 AST-31 LD(LDH)-223 AlkPhos-453*
TotBili-1.9*
[**2166-12-10**] 05:27AM BLOOD tacroFK-4.2*

CMV Viral Load (Final [**2166-12-9**]): 17,100 copies/ml

Brief Hospital Course:
The patient was seen in the emergency room and transferred
directly to the interventional radiology suite for embolization.
 He was given DDAVP, 6u RBC, and 3 FFP.  Following the above
procedure he was transferred to the SICU for continued
monitoring.  He resumes his tacrolimus, valcyte, MMF, diet was
NPO, q 6 hour hct, foley catheter in place, 120mg IV lasix x 1.

[**12-5**] transfused two units RBC for drifting hct, RUQ ultrasound
performed demonstrating patent hepatic vasculature with normal
waveforms and flow, no evidence of cholecystitis.  Remained NPO.

[**12-6**] Hct stable, diet advanced to a regular diet, continued
tacrolimus, switched to gancicolvir due to CMV viral load, foley
catheter removed, transferred to the floor.

[**12-7**] - albuterol nebs started, continued home medications

[**12-8**] - ECHO performed - left ventricular wall thickness,
systolic function normal. LVEF = 63%, increased left ventricular
filling pressure, aortic valve leaflets are mildly thickened but
aortic stenosis is not present, mitral valve leaflets are mildly
thickened.

[**12-9**] PICC line obtained for gancicolvir, HD performed for 4.5
L, metolazone started, temp to 101.1 overnight, pan cultured

[**12-10**] - UA positive, started on levofloxavin, pulmonary consult
for continued O2 requirement.  Their recommendations included
continue to optimize his fluid status and albuterol nebs.  He
will follow up in pulm [**Hospital 3782**] clinic.  CT chest demonstrated no
airspace opacity or interstitial abnl to suggest pneumonitis.
Discharged home

Medications on Admission:
Norvasc 10', Procrit 10,000 qwk, Lasix 120'', Gabapentin  100',
insulin lantus 6 qam, ISS, Ativan 2mg hs, Lopressor 100'',
Cellcept [**Pager number **]'', Omeprazole 20 prn, Kayexalate prn, Tacro 1'',
Bactrim ss', Valcyte [**Age over 90 **] M/[**Last Name (LF) **], [**First Name3 (LF) **] 325', Benadryl 50 HS

Discharge Medications:
1. Ganciclovir Sodium 500 mg Recon Soln Sig: Ninety (90) mg
Intravenous 3X/WEEK ([**Doctor First Name **],TU,TH): 3x/wk  on dialysis days after
dialysis.
Disp:*12 doses* Refills:*1*
2. Outpatient Lab Work
Weekly CMV viral load, ast, alt, alk phos, tbili
fax results to ID [**Telephone/Fax (1) 1419**] attention Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 724**]
3. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
4. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML
Intravenous PRN (as needed) as needed for line flush: PICC line
care.
5. Insulin Glargine 100 unit/mL Solution Sig: Six (6) units
Subcutaneous once a day.
6. Insulin Regular Human 100 unit/mL Solution Sig: per sliding
scale  Injection four times a day.
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO Q24H (every
24 hours).
10. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day.

11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO QOD ().
13. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
14. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours) as
needed for wheeze.
15. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours).
Disp:*13 Tablet(s)* Refills:*0*
16. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO once a day:
PM dose.
17. Tacrolimus 1 mg Capsule Sig: One (1) Capsule PO once a day:
AM dose.
18. Lasix 80 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
19. Metolazone 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
cmv hepatitis
esrd s/p kidney transplant now back on hemodialysis
chronic allograft nephropathy


Discharge Condition:
alert/oriented
ambulating independently, desats to 81% room air
tolerating a regular diet


Discharge Instructions:
Dialysis Schedule:
Thursday [**12-11**]   7:00 AM
[**Month (only) 1017**]   [**12-14**]   3:30 PM
Tuesday  [**12-16**]   3:30 PM
Thursday [**12-18**]   3:30 PM
[**First Name8 (NamePattern2) 1017**]   [**12-21**]    3:30 PM
Wednesday [**12-24**]   3:30 PM
Then Monday, Wednesday Friday at 3:30 PM
.
Please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever,
chills, increased shortness of breath, increased abdominal pain,
yellowing of skin or eyes, inability to take food, fluids or
medications
You will be getting the gancyclovir IV medication through the
PICC line following hemodialysis (three times a week)


Followup Instructions:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4861**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2166-12-15**] 3:30
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2167-1-19**] 1:20
***Please call transplant clinic for appointment on [**12-15**]
- Outpt PFTs and Pulmonary clinic follow up.
{'Hemorrhage complicating a procedure,End stage renal disease,Hemoperitoneum (nontraumatic),Cytomegaloviral disease,Acute posthemorrhagic anemia,Hepatitis in viral diseases classified elsewhere,Complications of transplanted kidney,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other ascites,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Other acquired deformities of ankle and foot,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Congestive heart failure, unspecified,Other chronic pulmonary heart 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: increasing abdominal pain, nausea and vomiting

PRESENT ILLNESS: 49M s/p ECD renal transplant [**7-27**] presents with hct of 16.7 24
hours post liver bx and peritoneal tap by IR. These were
performed because of pt's idiopathic jaundice and recent LFT
elevation. Pt reports diarrhea since the procedure and
increasing abdominal discomfort, nausea and dizziness.
Diagnostic paracentesis was attempted in the ED with return of
frank blood.

MEDICAL HISTORY: -End-stage renal disease on HD T/T/S secondary to diabetic
nephropathy-started on dialysis [**2163-7-19**]
-diabetes for at least 20 years with retinopathy and neuropathy
with
footdrop
-coronary artery disease with history of ST elevation MI [**7-24**]
c/b pericardial tamponade requiring pericardiocentesis
-three-vessel disease with stents in the RCA and left circumflex

MEDICATION ON ADMISSION: Norvasc 10', Procrit 10,000 qwk, Lasix 120'', Gabapentin  100',
insulin lantus 6 qam, ISS, Ativan 2mg hs, Lopressor 100'',
Cellcept [**Pager number **]'', Omeprazole 20 prn, Kayexalate prn, Tacro 1'',
Bactrim ss', Valcyte [**Age over 90 **] M/[**Last Name (LF) **], [**First Name3 (LF) **] 325', Benadryl 50 HS

ALLERGIES: Motrin / Lisinopril / Rapamune

PHYSICAL EXAM: On admission:
97.5 76 117/46 14 96
Gen: Uncomfortable appearing
HEENT: +scleral icterus
Skin: visible jaundice
CV: RRR
Resp: Clear to auscultation
Abd: Distended, +fluid wave, diffuse moderate tenderness, no
rebound or guarding

FAMILY HISTORY: Significant for myocardial infarction in his father at the age
of 49. Multiple family members with diabetes.

SOCIAL HISTORY: The patient does not smoke and he does not drink alcohol. He
lives with his wife, [**Name (NI) **].  From [**Male First Name (un) 1056**] originally. Has
multiple family members in the area including 4 children, one of
which works in BMT on the [**Hospital Ward Name 516**]. 

### Response:
{'Hemorrhage complicating a procedure,End stage renal disease,Hemoperitoneum (nontraumatic),Cytomegaloviral disease,Acute posthemorrhagic anemia,Hepatitis in viral diseases classified elsewhere,Complications of transplanted kidney,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Other ascites,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Other acquired deformities of ankle and foot,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Congestive heart failure, unspecified,Other chronic pulmonary heart diseases'}
