CHIEF COMPLAINT: ESLD, to receive liver transplant

PRESENT ILLNESS: 44 y/o male with history of ESLD secondary to HCV and ETOH with
recent admissions for management of the liver disease and
current MELD score of 32 has received offer of liver and will
proceed with transplantation

MEDICAL HISTORY: - transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
- MELD = 37 (INR 5.0, TB 26.7, Cr 1.0, ALB 3.3)

MEDICATION ON ADMISSION: cipro 750 qThur, lasix 40', lactulose 30qid, nadolol 20',
spironolactone 100', thiamine 100', ranitidine 150''

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with mother in [**Name (NI) 86**]. Denies etoh, drugs
Acute and subacute necrosis of liver,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Hepatic encephalopathy,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Other alteration of consciousness,Other and unspecified alcohol dependence, in remission,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use
Acute necrosis of liver,Hpt C w/o hepat coma NOS,Alcohol cirrhosis liver,Hepatic encephalopathy,Hyposmolality,Acq coagul factor defic,Other alter consciousnes,Alcoh dep NEC/NOS-remiss,Pancreatic disorder NEC,Adv eff corticosteroids
Admission Date:  [**2149-1-9**]              Discharge Date:   [**2149-1-23**]

Date of Birth:  [**2104-8-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
ESLD, to receive liver transplant

Major Surgical or Invasive Procedure:
[**2149-1-13**]: Orthotopic Liver transplant

History of Present Illness:
44 y/o male with history of ESLD secondary to HCV and ETOH with
recent admissions for management of the liver disease and
current MELD score of 32 has received offer of liver and will
proceed with transplantation

Past Medical History:
- transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
- MELD = 37 (INR 5.0, TB 26.7, Cr 1.0, ALB 3.3)


Social History:
lives with mother in [**Name (NI) 86**]. Denies etoh, drugs


Family History:
NC

Pertinent Results:
On day of transplant: [**2149-1-13**]
WBC-3.8* RBC-1.96* Hgb-7.2* Hct-20.2* MCV-103*# MCH-36.9*
MCHC-35.8*
RDW-18.4* Plt Ct-83*#
PT-40.9* PTT-100.8* INR(PT)-4.6*
Glucose-240* UreaN-17 Creat-0.9 Na-138 K-4.6 Cl-103 HCO3-25
AnGap-15
ALT-862* AST-1633* AlkPhos-58 Amylase-36 Lipase-43 TotBili-10.0*
DirBili-7.9* IndBili-2.1
Albumin-2.2* Calcium-11.1* Phos-5.7*# Mg-2.9*
[**2149-1-16**] HEPARIN DEPENDENT ANTIBODIES-

Brief Hospital Course:
44 y/o male that was initially admitted on [**2149-1-9**] for an OLT.
The donor liver was not accepted. However, while the patient was
hospitalized awaiting the transplant, he became obtunded. He was
hypoglycemic, which was treated. In addition, his liver function
tests showed decreased function. The patient was admitted to the
SICU for further management.
On [**1-13**] the patient received another offer of a liver
and this organ was accepted for transplant. Please see the op
note for more extensive details. Of note, due to the small
nature of the donor liver, the right hepatic vein was divided
with an endovascular 35 mm stapler and a Derma-weave was placed.
The organ pinked up immediately except for the left lateral
segment which looked somewhat dusky. A branch patch of the right
and left hepatic artery was formed and the organ reperfused. The
patient was left with two [**Doctor Last Name 406**] drains. Initial U/S showed
widely patent hepatic vessels, with no fluid surrounding the
transplanted liver.
Patient received immunosuppression per protocol, and started
Prograf on POD 2.
Patient extubated on POD 1 and transferred from the SICU on POD
3.
Liver function tests improved daily. There was a slight bump in
creatinine, baseline appears to be around 1.5 by end of
hospitalization.
Patient did have lethargy and confusion since the surgery. A
non-contrast head CT was performed on POD 3 which showed no
evidence of acute intracranial hemorrhage.
Patients INR had normalized by POD 3, however he did have Coag
study results prior to transplant with INR as high as 5.
On POD4, patient again noted to have apparent mental status
changes with acute changes, becoming profoundly somnolent which
then resolved almost spontaneously.
Seen by neuro who recommended to rule out infectious etiologies,
although patient never febrile and had normal WBC. They
commented that patient appeared to be at baseline; has had
encephalopathy since [**Month (only) 205**]. They felt that with continued time
after transplant, patients' condition should continue to
improve, however mental status did not improve and in fact
worsened with less ability for recall or identifying persons
known to him and current events.
On [**1-18**], Liver transplant appeared okay, repeat U/S again
showing unchanged appearance of liver transplant with widely
patent hepatic arteries, veins, and portal veins.
A non-contrast MRI of the head was performed on [**1-21**] (POD 8)
showing no acute areas of infarction or parenchymal abnormality.
Signal abnormalities within the basal ganglia bilaterally were
seen, consistent with changes related to underlying chronic
liver disease. Also of note; there is susceptibility effect
within the lateral ventricles and fourth ventricle following
distribution of choroid plexus.
EEG performed on [**1-22**]:
"This is an abnormal EEG due to the bilateral parasagittal sharp
waves seen frequently, the slow and disorganized background and
the bursts of generalized slowing. The first abnormality most
likely suggests a central region of cortical irritability,
although deep subcortical midline dysfunction may also result in
a similar pattern. The slow and disorganized background with the
superimposed delta slowing is seen with an encephalopathy, which
may result from infections, toxic
metabolic abnormalities, ischemia or medication effect. No
electrographic seizures were noted. Of note patient also was
reported to have multiple paranoid thoughts and hallucinations
during the exam.
Liver enzymes continued to improve during the hospitalization
course, but did not totally normalize. Total bilirubin remained
elevated and should be followed closely.
A liver U/S was performed as followup on [**1-23**].
Patient to be discharged to [**Hospital **] Rehab for close monitoring
of mental status, help with rehab and close monitoring of labs.


Medications on Admission:
cipro 750 qThur, lasix 40', lactulose 30qid, nadolol 20',
spironolactone 100', thiamine 100', ranitidine 150''


Discharge Medications:
1. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
2. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
[**Hospital 1326**] clinic will taper.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO every
other day.
5. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
6. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
7. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
8. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
11. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime: Please also follow humalog sliding
scale.
12. Tacrolimus 1 mg Capsule Sig: 2.5 Capsules PO twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
ESLD now s/p orthotopic liver transplant [**2149-1-13**]
Post op mental status changes


Discharge Condition:
Fair


Discharge Instructions:
Please call [**Telephone/Fax (1) 673**] if the patient experiences fever,
chills, nausea, vomiting, diarrhea, inability to take
medications as prescribed.
Monitor incision for redness, drainage. [**Month (only) 116**] leave open to air.
Lab work as ordered: CBC, chem 10, AST, ALT, Alk Phos, T bili,
trough Prograf q Monday and Thursday. Please fax results to
transplant office at [**Telephone/Fax (1) 697**].
Medications as prescribed.
Neuro checks daily

Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2149-2-7**] 12:00
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2149-2-7**] 1:20
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2149-2-13**] 2:20



Completed by:[**2149-1-23**]
{'Acute and subacute necrosis of liver,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Hepatic encephalopathy,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Other alteration of consciousness,Other and unspecified alcohol dependence, in remission,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use'}


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: ESLD, to receive liver transplant

PRESENT ILLNESS: 44 y/o male with history of ESLD secondary to HCV and ETOH with
recent admissions for management of the liver disease and
current MELD score of 32 has received offer of liver and will
proceed with transplantation

MEDICAL HISTORY: - transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
- MELD = 37 (INR 5.0, TB 26.7, Cr 1.0, ALB 3.3)

MEDICATION ON ADMISSION: cipro 750 qThur, lasix 40', lactulose 30qid, nadolol 20',
spironolactone 100', thiamine 100', ranitidine 150''

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with mother in [**Name (NI) 86**]. Denies etoh, drugs 

### Response:
{'Acute and subacute necrosis of liver,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Hepatic encephalopathy,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Other alteration of consciousness,Other and unspecified alcohol dependence, in remission,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use'}
