CHIEF COMPLAINT: Transfer for exacerbation of chronic cirrhosis

PRESENT ILLNESS: Pt is a 41 y/o man w/ a hx of alcoholic cirrhosis c/b ascites,
portal hypertension, and hepatic encephalopathy who presented w/
an exacerbation of his liver failure over the past 2 months.  He
also had an episode of s. viridans bacteremia in [**9-7**] that was
treated w/ 4wk of vancomycin and 2wk of gentamycin.  He was
admitted to an outside hospital on [**9-5**] w/ bacteremia as above,
[**9-21**] w/ prerenal azotemia, and [**10-20**] w/ complaints of SOB and
fatigue.  He was found during his last admission to have a large
R pleural effusion along with elevated LFTs.  He was treated
empirically with avelox at the outside hospital and was given
diuretics.  A thoracentesis was planned but did not occur [**3-7**]
his elevated INR.  He was transferred to [**Hospital1 18**] for further
management of his acute on chronic liver failure and for w/u of
its etiology.
Upon arrival, the patient was mildly confused taking long time
periods to answer questions and needing some redirection to
focus on the question at hand.  According to the patient, his
liver function has been declining for approximately the past 3
months.  He reports that he has had increasing edema in his LE
despite treatment and that he has been increasingly jaundiced of
late.  He states that he has not been able to think as well as
he used to think.  He denies any CP, SOB, N/V, diarrhea, HA,
palpatations, or pruritis.  He denies any recent viral illness
or sick contacts.  [**Name (NI) **] has not traveled recently and has not has
had any of his medications changed recently.  He denies taking
any herbal supplements.

MEDICAL HISTORY: 1. alcoholic cirrhosis c/b ascites and encephalopathy
2. s viridans bacteremia s/p 4wk vanco 2wk gent
3. ARF [**3-7**] aminoglycoside toxicity

MEDICATION ON ADMISSION: avelox 400mg
aldactone 25 tid
ambien prn
lasix 20
mvi
folate

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen: Jaundiced appearing man lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, O/P clear, + icterus
Skin: + jaundice, - rashes
CV: RRR, S1/S2 intact, -M/R/G
Lungs: dullness to percussion w/out BS on the lower half of the
R lung, otherwise CTA
Abd: S/NT, distended, -HSM, +BS, mild asterixis
Ext: -C/C, 2+ pitting edema to the mid-thigh in the LE
Neuro: AAOx2 (not date), patient not able to do serial 7s past
86

FAMILY HISTORY: Pt w/ diabetes in his mother and father.  Father died of "kidney
and pancreas problems".

SOCIAL HISTORY: Pt is married w/ 2 children.  He lives in [**Location 5450**] and works
as a salesman for Staples.  He has a hx of alcohol abuse w/ his
last drink in [**Month (only) 116**].  He denies smoking, drug use, or tattoos.
Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Subdural hemorrhage,Acute respiratory failure,Portal vein thrombosis,Pneumonia, organism unspecified,Other and unspecified alcohol dependence, unspecified,Hypercalcemia
Acute necrosis of liver,Hepatic encephalopathy,Alcohol cirrhosis liver,Acq coagul factor defic,Subdural hemorrhage,Acute respiratry failure,Portal vein thrombosis,Pneumonia, organism NOS,Alcoh dep NEC/NOS-unspec,Hypercalcemia
Admission Date:  [**2136-10-24**]              Discharge Date:   [**2136-12-28**]

Date of Birth:  [**2095-9-15**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Transfer for exacerbation of chronic cirrhosis

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Pt is a 41 y/o man w/ a hx of alcoholic cirrhosis c/b ascites,
portal hypertension, and hepatic encephalopathy who presented w/
an exacerbation of his liver failure over the past 2 months.  He
also had an episode of s. viridans bacteremia in [**9-7**] that was
treated w/ 4wk of vancomycin and 2wk of gentamycin.  He was
admitted to an outside hospital on [**9-5**] w/ bacteremia as above,
[**9-21**] w/ prerenal azotemia, and [**10-20**] w/ complaints of SOB and
fatigue.  He was found during his last admission to have a large
R pleural effusion along with elevated LFTs.  He was treated
empirically with avelox at the outside hospital and was given
diuretics.  A thoracentesis was planned but did not occur [**3-7**]
his elevated INR.  He was transferred to [**Hospital1 18**] for further
management of his acute on chronic liver failure and for w/u of
its etiology.
Upon arrival, the patient was mildly confused taking long time
periods to answer questions and needing some redirection to
focus on the question at hand.  According to the patient, his
liver function has been declining for approximately the past 3
months.  He reports that he has had increasing edema in his LE
despite treatment and that he has been increasingly jaundiced of
late.  He states that he has not been able to think as well as
he used to think.  He denies any CP, SOB, N/V, diarrhea, HA,
palpatations, or pruritis.  He denies any recent viral illness
or sick contacts.  [**Name (NI) **] has not traveled recently and has not has
had any of his medications changed recently.  He denies taking
any herbal supplements.

Past Medical History:
1. alcoholic cirrhosis c/b ascites and encephalopathy
2. s viridans bacteremia s/p 4wk vanco 2wk gent
3. ARF [**3-7**] aminoglycoside toxicity

Social History:
Pt is married w/ 2 children.  He lives in [**Location 5450**] and works
as a salesman for Staples.  He has a hx of alcohol abuse w/ his
last drink in [**Month (only) 116**].  He denies smoking, drug use, or tattoos.

Family History:
Pt w/ diabetes in his mother and father.  Father died of "kidney
and pancreas problems".

Physical Exam:
Gen: Jaundiced appearing man lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, O/P clear, + icterus
Skin: + jaundice, - rashes
CV: RRR, S1/S2 intact, -M/R/G
Lungs: dullness to percussion w/out BS on the lower half of the
R lung, otherwise CTA
Abd: S/NT, distended, -HSM, +BS, mild asterixis
Ext: -C/C, 2+ pitting edema to the mid-thigh in the LE
Neuro: AAOx2 (not date), patient not able to do serial 7s past
86

Brief Hospital Course:
41 y/o man with h/o alcoholic cirrhosis who presented after
being admitted to an outside hospital with SOB and fatigue.  Was
found to have a R pleural effusion and worsening of his LFTs. No
tap was performed [**3-7**] elevated INR.

He had a long hx of cirrhosis with worsening of his condition
over the past several months. He presented w/ encephalopathy and
severe jaundice with unclear cause of sudden decrease in liver
fxn.  Possible causes included infection, toxin, thrombosis of
veins.  Blood and urine cultures were negative. An US of the
liver w/ doppler revealed a cirrhotic liver without focal
lesions with nearly no flow within the main and left portal
veins, and no detectable flow within the right portal vein.
Massive varices within the abdomen with evidence of splenorenal
shunting. Massive splenomegaly. Small amount of perihepatic
ascites, which was not sufficient
to tap.  Nondistended gallbladder with gallbladder wall edema,
indicative of liver disease and right pleural effusion.

Labs were significant for + [**Last Name (un) 15412**] and IgG. He was followed by the
Hepatology service who initiated transplant workup. The
Transplant service was consulted on [**2137-10-27**] and a transplant
workup was completed. CT of the abdomen demonstrated a cirrhotic
liver with no mass lesion demonstrated. Patent but narrow
caliber portal vessels. Thin linear hypodensity within the main
portal vein likley  representing some nonocclusive thrombus.
Hepatic veins were patent. Features of portal hypertension
including splenomegaly, moderate amount of intra-abdominal
ascites and portosystemic collaterals were described.

He remained in the hospital for management of worsening liver
failure with hepatorenal syndrome. He became coagulopathic
requiring daily transfusions with platelets, FFP, cryo and PRBCs
per Hepatology recommendation to keep plt>20, inr<4, hct>25,
fibrin >150.  Encephalopathy wax and waned. This was managed
with lactulose and rifaximin. He was followed by social work,
psychiatry, nutrition and physical therapy. His MELD score
ranged in the 40s. He did not receive a liver transplant despite
being at the top of the list. He was transferrred to the SICU
with neurology consultation for worsening encephalopathy. He was
intubated.  A CT demonstrated a spontaneous subdural hematoma.
He was coagulopathic and due to his contraindication to
transplant, his family met with the team and decided to make him
CMO. He expired on [**2137-12-28**].


Medications on Admission:
avelox 400mg
aldactone 25 tid
ambien prn
lasix 20
mvi
folate

Discharge Medications:
none

Discharge Disposition:
Home

Discharge Diagnosis:
End Stage Liver Disease secondary to Alcoholic Cirrhosis


Discharge Condition:
expried [**2137-12-31**]

Discharge Instructions:
n/a

Followup Instructions:
n/a

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2137-5-17**]
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Subdural hemorrhage,Acute respiratory failure,Portal vein thrombosis,Pneumonia, organism unspecified,Other and unspecified alcohol dependence, unspecified,Hypercalcemia'}


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: Transfer for exacerbation of chronic cirrhosis

PRESENT ILLNESS: Pt is a 41 y/o man w/ a hx of alcoholic cirrhosis c/b ascites,
portal hypertension, and hepatic encephalopathy who presented w/
an exacerbation of his liver failure over the past 2 months.  He
also had an episode of s. viridans bacteremia in [**9-7**] that was
treated w/ 4wk of vancomycin and 2wk of gentamycin.  He was
admitted to an outside hospital on [**9-5**] w/ bacteremia as above,
[**9-21**] w/ prerenal azotemia, and [**10-20**] w/ complaints of SOB and
fatigue.  He was found during his last admission to have a large
R pleural effusion along with elevated LFTs.  He was treated
empirically with avelox at the outside hospital and was given
diuretics.  A thoracentesis was planned but did not occur [**3-7**]
his elevated INR.  He was transferred to [**Hospital1 18**] for further
management of his acute on chronic liver failure and for w/u of
its etiology.
Upon arrival, the patient was mildly confused taking long time
periods to answer questions and needing some redirection to
focus on the question at hand.  According to the patient, his
liver function has been declining for approximately the past 3
months.  He reports that he has had increasing edema in his LE
despite treatment and that he has been increasingly jaundiced of
late.  He states that he has not been able to think as well as
he used to think.  He denies any CP, SOB, N/V, diarrhea, HA,
palpatations, or pruritis.  He denies any recent viral illness
or sick contacts.  [**Name (NI) **] has not traveled recently and has not has
had any of his medications changed recently.  He denies taking
any herbal supplements.

MEDICAL HISTORY: 1. alcoholic cirrhosis c/b ascites and encephalopathy
2. s viridans bacteremia s/p 4wk vanco 2wk gent
3. ARF [**3-7**] aminoglycoside toxicity

MEDICATION ON ADMISSION: avelox 400mg
aldactone 25 tid
ambien prn
lasix 20
mvi
folate

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen: Jaundiced appearing man lying in bed in NAD
HEENT: EOMI, PERRLA, MMM, O/P clear, + icterus
Skin: + jaundice, - rashes
CV: RRR, S1/S2 intact, -M/R/G
Lungs: dullness to percussion w/out BS on the lower half of the
R lung, otherwise CTA
Abd: S/NT, distended, -HSM, +BS, mild asterixis
Ext: -C/C, 2+ pitting edema to the mid-thigh in the LE
Neuro: AAOx2 (not date), patient not able to do serial 7s past
86

FAMILY HISTORY: Pt w/ diabetes in his mother and father.  Father died of "kidney
and pancreas problems".

SOCIAL HISTORY: Pt is married w/ 2 children.  He lives in [**Location 5450**] and works
as a salesman for Staples.  He has a hx of alcohol abuse w/ his
last drink in [**Month (only) 116**].  He denies smoking, drug use, or tattoos. 

### Response:
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Subdural hemorrhage,Acute respiratory failure,Portal vein thrombosis,Pneumonia, organism unspecified,Other and unspecified alcohol dependence, unspecified,Hypercalcemia'}
