CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 40-year-old
male status post [**Last Name (un) 59506**] on [**2160-7-17**] complicated by bile
leak/biliary necrosis, status post ex-lap [**8-16**] with
findings of complete biliary necrosis. The patient was
relisted and presents for potential liver transplant surgery
on [**2160-9-21**]. The patient states that he feels well.
Denies fevers, chills, nausea, vomiting, urinary tract
infection symptoms. Normal bowel movements. No diarrhea.
Patient tolerating p.o.'s well. Good appetite and ambulatory.

MEDICAL HISTORY: HBV, hepatoma, biliary
necrosis/biliary leak, status post [**First Name9 (NamePattern2) 59506**] [**2160-7-17**], status
post ex-lap [**2160-8-16**], status post ex-lap liver biopsy
hepatoma segment IV and V.

MEDICATION ON ADMISSION: Bactrim SS 1 tab once daily,
fluconazole 400 once daily, Protonix 48 once daily, ursodiol
300 mg b.i.d., Valcyte 450 once daily, prednisone 10 mg once
daily, tacrolimus, adefovir 10 mg once daily, levofloxacin,
Colace 100 mg b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Temperature 100.2, heart rate 92, BP 120/78,
respirations 20. Patient appears in no acute distress, awake,
alert, oriented x3. Pupils equal, round, reactive to light.
EOMI's are full. MOUTH: Moist buccal mucosa, no exudates.
Lungs clear to auscultation bilaterally. CV regular rate and
rhythm. ABDOMEN: Well-healed incision, soft. The patient has
JP and PTC sites which are clean, dry and intact.
EXTREMITIES: No C/C/E, 2+ dorsalis pedis and anterior
tibialis. No cellulitis. No rash. RECTAL EXAM: Normal tone,
no masses.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: No alcohol. No tobacco.
Complications of transplanted liver,Iatrogenic pneumothorax,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of other diseases of digestive system
Compl liver transplant,Iatrogenic pneumothorax,Pancreatic disorder NEC,Adv eff corticosteroids,Prsnl hst ot spf dgst ds
Admission Date: [**2160-9-21**]        Discharge Date: [**2160-10-2**]

Date of Birth:  [**2120-4-18**]        Sex:  M

Service:  [**Last Name (un) **]


ADMITTING DIAGNOSIS:  Preoperative for liver transplant.

HISTORY OF PRESENT ILLNESS:  The patient is a 40-year-old
male status post [**Last Name (un) 59506**] on [**2160-7-17**] complicated by bile
leak/biliary necrosis, status post ex-lap [**8-16**] with
findings of complete biliary necrosis. The patient was
relisted and presents for potential liver transplant surgery
on [**2160-9-21**]. The patient states that he feels well.
Denies fevers, chills, nausea, vomiting, urinary tract
infection symptoms. Normal bowel movements. No diarrhea.
Patient tolerating p.o.'s well. Good appetite and ambulatory.

PAST MEDICAL HISTORY:  HBV, hepatoma, biliary
necrosis/biliary leak, status post [**First Name9 (NamePattern2) 59506**] [**2160-7-17**], status
post ex-lap [**2160-8-16**], status post ex-lap liver biopsy
hepatoma segment IV and V.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Bactrim SS 1 tab once daily,
fluconazole 400 once daily, Protonix 48 once daily, ursodiol
300 mg b.i.d., Valcyte 450 once daily, prednisone 10 mg once
daily, tacrolimus, adefovir 10 mg once daily, levofloxacin,
Colace 100 mg b.i.d.

SOCIAL HISTORY:  No alcohol. No tobacco.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAM:  Temperature 100.2, heart rate 92, BP 120/78,
respirations 20. Patient appears in no acute distress, awake,
alert, oriented x3. Pupils equal, round, reactive to light.
EOMI's are full. MOUTH: Moist buccal mucosa, no exudates.
Lungs clear to auscultation bilaterally. CV regular rate and
rhythm. ABDOMEN: Well-healed incision, soft. The patient has
JP and PTC sites which are clean, dry and intact.
EXTREMITIES: No C/C/E, 2+ dorsalis pedis and anterior
tibialis. No cellulitis. No rash. RECTAL EXAM: Normal tone,
no masses.

[**Year (4 digits) **] ON ADMISSION:  WBC 5.4, hematocrit of 33.5, platelets
345, coags 13.2, PTT 22.7, INR 1.1, sodium 139, 4.7, 105, 21,
BUN and creatinine 14 and 1.2, glucose of 90, ALT 318, AST
137, alkaline phosphatase 666, total bilirubin 3.2. UA is
negative. EKG: Normal sinus rhythm at 97 beats per minute, no
S-wave changes. Chest x-ray: No acute cardiopulmonary
process. Patient was typed and crossed for 10 units of packed
red blood cells, FFP, platelets and cryogen. H-BIG 10,000
units were given, Solu-Medrol 500, CellCept.

Patient went to the OR on [**2160-9-22**] for preop
diagnosis of biliary ischemia. Patient had a redo orthotopic
liver transplant performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**], Dr. [**First Name (STitle) **]
[**Name (STitle) **]. Please see operative note for more details. The
patient went to the SICU postoperatively. The patient was
intubated. Postop day 1, patient afebrile, vital signs
stable, intubated, but awake, alert to commands. Lungs -
coarse breath sounds. Abdomen - dressings clean, dry, intact.
Patient had 2 drains and 1 T-tube. Patient was continued
tacrolimus, Bactrim, MMF, and also was started on
ganciclovir. On [**2160-9-23**], the patient had a duplex
ultrasound demonstrating normal postoperative liver Doppler
transplant ultrasound. Resistive indices ranged from 0.55-
0.65 with appropriate waveforms. Perioperatively, a right IJ
was placed. On [**2160-9-24**], the LFTs were markedly
decreasing. ALT was 434, AST 112, alkaline phosphatase 220
and total bilirubin 0.7. On [**2160-9-23**], going back, a
chest x-ray was obtained to evaluate the right IJ which
demonstrated a small lateral right pneumothorax. On [**2160-9-24**], repeat chest x-ray was obtained demonstrating a tiny
right apical pneumothorax about 5%.

On [**2160-9-24**], Mr. [**Known lastname 59509**] was transferred to the floor,
awake, alert. Incision clean, dry and intact. The patient had
2 JP's still in place with scant and serosanguineous fluid,
had a T-tube with scant bile. The patient transferred to the
floor with a Foley catheter in place, with a right IJ in
place. On [**2160-9-25**], lateral JP drain was removed.
Patient continued to get routine postop liver transplant
medications. Received Solu-Medrol 100 mg IV x1 on [**2160-9-25**]. Patient's FK level from [**2160-9-24**] was 8.3
once he received 1 in 1. Physical therapy was consulted and
felt that patient would not need rehab.

Postop day 4, hospital day 6, the patient had positive
flatus, no bowel movement, tolerating clears. Foley was
removed on [**2160-9-26**]. Diet was advanced. On [**2160-9-29**], cholangiogram was performed through the T-tube,
demonstrating opacification of the intra and extrahepatic
biliary system with no evidence of biliary leak. [**Last Name (un) **] was
consulted because the patient was on high doses of steroids
and recommended continuing the sliding scale, and that they
would follow patient while he was in-house. On [**2160-9-27**], right IJ was removed. Tolerating a regular diet. On
[**2160-9-29**], postop day 7, hospital day 9, the patient
had a T-max of 101.3. A fever work-up was performed. Those
cultures are pending from [**9-28**], [**9-29**]. Chest x-
ray was performed demonstrating no radiographic evidence for
pneumonia, bibasilar atelectasis and small bilateral pleural
effusions right greater than left. Also, CT abdomen and
pelvis was performed because of the fever and acute elevated
LFTs, which demonstrated new right pleural effusion with
atelectasis, postsurgical changes in the abdomen, patent
portal vein with focal relative narrowing and questionable
web, and small free fluid in the pelvis. ALT was 169. The
other JP drain was removed. T-tube was capped. So, the
patient is doing very well. The patient is afebrile. Vital
signs stable, tolerating a good diet, ambulating well,
urinating without difficulty.

Patient's [**Month (only) **] on [**2160-10-2**]: WBC 6.0, hematocrit of
25.9, platelets 285, sodium 141, 4.7, 106, 25, BUN and
creatinine 14/0.9, ALT 156 that decreased from 186 on the
14th, AST 39 from 56, alkaline phosphatase 186 on [**10-2**], and total bilirubin 0.6. The patient's level from
[**2160-10-1**] was 11.9.

Final recommendations were discussed with [**Last Name (un) **]. So, the
patient is leaving today, which is [**2160-10-2**]. Still
pending, which we have spoken with the pathologist, is the
path result from [**2160-9-22**] not finalized. Dr. [**Last Name (STitle) 10165**]
was notified, and the pathology is still pending.

DISCHARGE MEDICATIONS:  Adefovir dipivoxil 10 mg, Colace 100
mg b.i.d., fluconazole 400 once daily, valganciclovir 900 mg
once daily, insulin sliding scale with a fixed dose in the
evening with Humalog pre-supper coverage, MMF 1000 b.i.d.,
Percocet 1-2 tabs q. [**4-23**] h p.r.n., Protonix 40 mg q. 24,
prednisone 20 mg once daily, Bactrim SS 1 tab once daily and
tacrolimus 2.5 b.i.d.

Patient will need [**Month/Day (3) **] q. Monday and Thursday starting
[**10-6**], in which CBC, Chem-10, AST, ALT, alkaline
phosphatase, total bilirubin, albumin and a Prograf trough
level. The patient will also need weekly hepatitis antigen
and antibody titer, and please fax all the results to [**Telephone/Fax (1) 24749**]. Patient will need to follow-up with transplant surgeon
in 1 week at [**Telephone/Fax (1) 673**], and at that time the patient needs
a duplex ultrasound of the liver. Spoke with [**Doctor First Name **] from
transplant who is the transplant coordinator to arrange both
appointments. The patient will also need to have a scheduled
hepatitis B immune globulin dose on [**2160-10-7**], in
which 5 mL IM injection to be performed. The patient needs to
call [**Telephone/Fax (1) 673**] if any fevers, chills, nausea, vomiting,
inability to take medications, redness/bleeding or pus from
incision, any diarrhea, jaundice, leaking.



                        [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 4841**]

Dictated By:[**Last Name (NamePattern1) 4835**]
MEDQUIST36
D:  [**2160-10-2**] 11:02:20
T:  [**2160-10-2**] 12:14:09
Job#:  [**Job Number 59510**]
{'Complications of transplanted liver,Iatrogenic pneumothorax,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of other diseases of digestive system'}


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: The patient is a 40-year-old
male status post [**Last Name (un) 59506**] on [**2160-7-17**] complicated by bile
leak/biliary necrosis, status post ex-lap [**8-16**] with
findings of complete biliary necrosis. The patient was
relisted and presents for potential liver transplant surgery
on [**2160-9-21**]. The patient states that he feels well.
Denies fevers, chills, nausea, vomiting, urinary tract
infection symptoms. Normal bowel movements. No diarrhea.
Patient tolerating p.o.'s well. Good appetite and ambulatory.

MEDICAL HISTORY: HBV, hepatoma, biliary
necrosis/biliary leak, status post [**First Name9 (NamePattern2) 59506**] [**2160-7-17**], status
post ex-lap [**2160-8-16**], status post ex-lap liver biopsy
hepatoma segment IV and V.

MEDICATION ON ADMISSION: Bactrim SS 1 tab once daily,
fluconazole 400 once daily, Protonix 48 once daily, ursodiol
300 mg b.i.d., Valcyte 450 once daily, prednisone 10 mg once
daily, tacrolimus, adefovir 10 mg once daily, levofloxacin,
Colace 100 mg b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Temperature 100.2, heart rate 92, BP 120/78,
respirations 20. Patient appears in no acute distress, awake,
alert, oriented x3. Pupils equal, round, reactive to light.
EOMI's are full. MOUTH: Moist buccal mucosa, no exudates.
Lungs clear to auscultation bilaterally. CV regular rate and
rhythm. ABDOMEN: Well-healed incision, soft. The patient has
JP and PTC sites which are clean, dry and intact.
EXTREMITIES: No C/C/E, 2+ dorsalis pedis and anterior
tibialis. No cellulitis. No rash. RECTAL EXAM: Normal tone,
no masses.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: No alcohol. No tobacco. 

### Response:
{'Complications of transplanted liver,Iatrogenic pneumothorax,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of other diseases of digestive system'}
