CHIEF COMPLAINT: hepatitis, dark stools

PRESENT ILLNESS: 46 yo M hx HTN, cirrhosis and alcohol abuse who presents after a
fall last evening. The patient states he had a mechanical fall
while intoxicated last night, cut his upper lip. The patient was
admitted here [**7-6**] with jaundice and at that time had a liver
biopsy consistent with toxic-metabolic injury. He was also
diagnosed with Zieve syndrome as he had hepatitis, hemolysis,
and hyperlipidemia. He has been followed by Dr. [**Last Name (STitle) **] in
hepatology and has had some recurrences of alcoholic hepatitis
vs Zieve syndrome over the last year. He has had recurrence of
alcohol abuse over the last month, drinking 1-1.5 pints of vodka
daily. Last night, he had a fall with a resulting upper lip
laceration and bleeding. Presented to the ED, where he was noted
to have continuing lip bleeding, INR was 2.7.
On presentation, his HR was 100, BP 110/60, noted to have guaiac
positive rectal exam. Head CT was negative.
He was transfused 2 Units of FFP and transferred to MICU.
Evaluated by hepatology with plan to perform upper endoscopy
once more fluid resuscitated.
On arrival, the patient denies any specific complaints. Notes
some lightheadedness and shakyness which he attributes to
recently started propranolol and possible alcohol withdrawal,
although his EtOH level was noted to be 440 in ED.
.
ROS: + melenic stools x3-4 days, + nausea, no vomiting. No
fever, chills, chest pain, abdominal pain, shortness of breath.

MEDICAL HISTORY: 1. HTN
2. EtOH abuse
3. Zieve syndrome
4. EBV infection

MEDICATION ON ADMISSION: Propranolol
Vitamin K
multivitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS T 99.2, BP 135/67, HR 128, RR 22, O2 sat 94-97% on RA
Gen: elderly male lying in bed, slightly tremulous.
HEENT: very icteric sclerae, EOMI, PERRL, OP clear, upper lip
has stopped bleeding, no LAD, no JVD
CV: reg s1/s2, no m/r/g
Pulm: bilateral wheezes, no crackles
Abd: obese, +BS, soft, NT, ND, no clear ascites.
Ext: warm, 2+ DP B, no edema
Neuro: a/o x 3, CN 2-12 intact, strength 5/5 throughout UE/LE B,
tremor b/l without asterixis.

FAMILY HISTORY: No h/o liver disease.
No GI cancers

SOCIAL HISTORY: lives alone in [**Location (un) 86**] area; works as window washer; smokes 5
pack-years; abuses alcohol 1 quart vodka daily; denies any IV
drugs.
Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Acute kidney failure with lesion of tubular necrosis,Alcohol withdrawal,Iron deficiency anemia secondary to blood loss (chronic),Unspecified septicemia,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Open wound of lip, without mention of complication,Fall from other slipping, tripping, or stumbling,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Nonspecific abnormal findings in stool contents,Chronic ulcer of other specified sites
Acute necrosis of liver,Hepatic encephalopathy,Alcohol cirrhosis liver,Acq coagul factor defic,Food/vomit pneumonitis,Acute respiratry failure,Acidosis,Ac kidny fail, tubr necr,Alcohol withdrawal,Chr blood loss anemia,Septicemia NOS,Severe sepsis,Alcoh dep NEC/NOS-unspec,Open wound of lip,Fall from slipping NEC,Esoph varice oth dis NOS,Abn find-stool contents,Chronic skin ulcer NEC
Admission Date:  [**2157-11-5**]              Discharge Date:   [**2157-11-29**]

Date of Birth:  [**2109-8-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
hepatitis, dark stools

Major Surgical or Invasive Procedure:
paracentesis
intubation
ART line

History of Present Illness:
46 yo M hx HTN, cirrhosis and alcohol abuse who presents after a
fall last evening. The patient states he had a mechanical fall
while intoxicated last night, cut his upper lip. The patient was
admitted here [**7-6**] with jaundice and at that time had a liver
biopsy consistent with toxic-metabolic injury. He was also
diagnosed with Zieve syndrome as he had hepatitis, hemolysis,
and hyperlipidemia. He has been followed by Dr. [**Last Name (STitle) **] in
hepatology and has had some recurrences of alcoholic hepatitis
vs Zieve syndrome over the last year. He has had recurrence of
alcohol abuse over the last month, drinking 1-1.5 pints of vodka
daily. Last night, he had a fall with a resulting upper lip
laceration and bleeding. Presented to the ED, where he was noted
to have continuing lip bleeding, INR was 2.7.
On presentation, his HR was 100, BP 110/60, noted to have guaiac
positive rectal exam. Head CT was negative.
He was transfused 2 Units of FFP and transferred to MICU.
Evaluated by hepatology with plan to perform upper endoscopy
once more fluid resuscitated.
On arrival, the patient denies any specific complaints. Notes
some lightheadedness and shakyness which he attributes to
recently started propranolol and possible alcohol withdrawal,
although his EtOH level was noted to be 440 in ED.
.
ROS: + melenic stools x3-4 days, + nausea, no vomiting. No
fever, chills, chest pain, abdominal pain, shortness of breath.



Past Medical History:
1. HTN
2. EtOH abuse
3. Zieve syndrome
4. EBV infection


Social History:
lives alone in [**Location (un) 86**] area; works as window washer; smokes 5
pack-years; abuses alcohol 1 quart vodka daily; denies any IV
drugs.


Family History:
No h/o liver disease.
No GI cancers


Physical Exam:
VS T 99.2, BP 135/67, HR 128, RR 22, O2 sat 94-97% on RA
Gen: elderly male lying in bed, slightly tremulous.
HEENT: very icteric sclerae, EOMI, PERRL, OP clear, upper lip
has stopped bleeding, no LAD, no JVD
CV: reg s1/s2, no m/r/g
Pulm: bilateral wheezes, no crackles
Abd: obese, +BS, soft, NT, ND, no clear ascites.
Ext: warm, 2+ DP B, no edema
Neuro: a/o x 3, CN 2-12 intact, strength 5/5 throughout UE/LE B,
tremor b/l without asterixis.


Pertinent Results:
[**2157-11-5**] 08:55AM   PT-26.3* PTT-78.7* INR(PT)-2.7*
[**2157-11-5**] 08:55AM   PLT COUNT-99*
[**2157-11-5**] 08:55AM   NEUTS-74.8* LYMPHS-17.4* MONOS-6.9 EOS-0.7
BASOS-0.2
[**2157-11-5**] 08:55AM   WBC-9.7# RBC-2.92*# HGB-10.8*# HCT-29.8*#
MCV-102* MCH-37.0* MCHC-36.3* RDW-18.3*
[**2157-11-5**] 08:55AM   ASA-NEG ETHANOL-433* ACETMNPHN-14.8
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2157-11-5**] 08:55AM   ALBUMIN-3.1* CALCIUM-8.3* MAGNESIUM-1.8
[**2157-11-5**] 08:55AM   ALT(SGPT)-137* AST(SGOT)-708* ALK PHOS-175*
AMYLASE-47 TOT BILI-28.9*
[**2157-11-5**] 08:55AM   GLUCOSE-145* UREA N-19 CREAT-1.1 SODIUM-136
POTASSIUM-3.3 CHLORIDE-96 TOTAL CO2-21* ANION GAP-22
[**2157-11-5**] 10:10AM   AMMONIA-102*
[**2157-11-5**] 12:44PM   PT-22.4* PTT-69.4* INR(PT)-2.2*
[**2157-11-5**] 12:44PM   PLT COUNT-90*
[**2157-11-5**] 12:44PM   HAPTOGLOB-<20*
[**2157-11-5**] 12:44PM   LD(LDH)-404* DIR BILI-22.0*

Brief Hospital Course:
46-yo M hx alcoholic hepatitis, Zieve's syndrome p/w recent
fall, melenic stools x3-4 days and worsened anemia and
tachycardia.
.
While in the MICU the patient was managed for worsening
alcoholic hepatitis.  On admission the patient was evaluated for
GI bleed, but was not found to have one.  However, the patient
did have signs of lip bleeding on admission that was difficult
to control with elevated INR. With persistent lip bleeding and
worsening encephalopathy, the patient appeared to have aspirated
on the first week of admission.  After this the patient
continued to have worsening respiratory status and was intubated
for both respiratory distress and worsening mental status.
# Respiratory distress- Initially intubated for airway
protection and treated with course of antibiotics for
aspiration/hospital acquired pneumonia.  This resulted in
decrease in leukocytosis and fewer fevers, however the patient
still required high ventilator support.  This occurred as the
patient had worsening acidosis and required respiratory
compensation.  Though efforts were made to wean from both
sedation and the ventilator support, the patient was unable to
be weaned secondary to both agitation and tachycardia/tachypnea.
 His respiratory status continued to worsen and on day of death
his family asked that his endotracheal tube be removed.  The
patient passed shortly thereafter.

# Hepatic failure- Patient presented with severe transaminitis
and hyperbiliribunemia.  Per liver recommendations, the patient
was started on numerous medications including rifaximin,
pentoxyphylline, ursodiol and lactulose.  Despited this, the
patient had only mild improvement in LFTs and no obvious
improvement of his mental status.  Additionally about [**11-19**] he
started to have worsening renal function thought likely due to
hepatorenal syndrome. Therefore the patient was started on
albumin, octreotide and midodrine.  With the patinet's
increasing abdominal girth, a paracentesis was performed, but
there were no signs of peritonitis.  Pt's hepatic failure
continued and eventually developed hepatorenal syndrome.
Unfortunately, liver felt this patient was not a candidate for
dialysis given his poor liver function


Medications on Admission:
Propranolol
Vitamin K
multivitamins


Discharge Medications:
.

Discharge Disposition:
Expired

Discharge Diagnosis:
.

Discharge Condition:
.

Discharge Instructions:
.

Followup Instructions:
.
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Acute kidney failure with lesion of tubular necrosis,Alcohol withdrawal,Iron deficiency anemia secondary to blood loss (chronic),Unspecified septicemia,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Open wound of lip, without mention of complication,Fall from other slipping, tripping, or stumbling,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Nonspecific abnormal findings in stool contents,Chronic ulcer of other specified sites'}


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: hepatitis, dark stools

PRESENT ILLNESS: 46 yo M hx HTN, cirrhosis and alcohol abuse who presents after a
fall last evening. The patient states he had a mechanical fall
while intoxicated last night, cut his upper lip. The patient was
admitted here [**7-6**] with jaundice and at that time had a liver
biopsy consistent with toxic-metabolic injury. He was also
diagnosed with Zieve syndrome as he had hepatitis, hemolysis,
and hyperlipidemia. He has been followed by Dr. [**Last Name (STitle) **] in
hepatology and has had some recurrences of alcoholic hepatitis
vs Zieve syndrome over the last year. He has had recurrence of
alcohol abuse over the last month, drinking 1-1.5 pints of vodka
daily. Last night, he had a fall with a resulting upper lip
laceration and bleeding. Presented to the ED, where he was noted
to have continuing lip bleeding, INR was 2.7.
On presentation, his HR was 100, BP 110/60, noted to have guaiac
positive rectal exam. Head CT was negative.
He was transfused 2 Units of FFP and transferred to MICU.
Evaluated by hepatology with plan to perform upper endoscopy
once more fluid resuscitated.
On arrival, the patient denies any specific complaints. Notes
some lightheadedness and shakyness which he attributes to
recently started propranolol and possible alcohol withdrawal,
although his EtOH level was noted to be 440 in ED.
.
ROS: + melenic stools x3-4 days, + nausea, no vomiting. No
fever, chills, chest pain, abdominal pain, shortness of breath.

MEDICAL HISTORY: 1. HTN
2. EtOH abuse
3. Zieve syndrome
4. EBV infection

MEDICATION ON ADMISSION: Propranolol
Vitamin K
multivitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS T 99.2, BP 135/67, HR 128, RR 22, O2 sat 94-97% on RA
Gen: elderly male lying in bed, slightly tremulous.
HEENT: very icteric sclerae, EOMI, PERRL, OP clear, upper lip
has stopped bleeding, no LAD, no JVD
CV: reg s1/s2, no m/r/g
Pulm: bilateral wheezes, no crackles
Abd: obese, +BS, soft, NT, ND, no clear ascites.
Ext: warm, 2+ DP B, no edema
Neuro: a/o x 3, CN 2-12 intact, strength 5/5 throughout UE/LE B,
tremor b/l without asterixis.

FAMILY HISTORY: No h/o liver disease.
No GI cancers

SOCIAL HISTORY: lives alone in [**Location (un) 86**] area; works as window washer; smokes 5
pack-years; abuses alcohol 1 quart vodka daily; denies any IV
drugs. 

### Response:
{'Acute and subacute necrosis of liver,Hepatic encephalopathy,Alcoholic cirrhosis of liver,Acquired coagulation factor deficiency,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Acidosis,Acute kidney failure with lesion of tubular necrosis,Alcohol withdrawal,Iron deficiency anemia secondary to blood loss (chronic),Unspecified septicemia,Severe sepsis,Other and unspecified alcohol dependence, unspecified,Open wound of lip, without mention of complication,Fall from other slipping, tripping, or stumbling,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Nonspecific abnormal findings in stool contents,Chronic ulcer of other specified sites'}
