CHIEF COMPLAINT: Subcapsular liver hematoma

PRESENT ILLNESS: 77 year old female two week ago started complaining of
abdominal pain, she went to her PCP work up found to have with
liver mass 10 cm in size, she was scheduled to see hepatology
service on [**2113-6-9**]. However, yesterday at 4pm had acute
onset
of RUQ pain, the pain was constant, radiating to the back, she
went to OSH found to have subcapsular hematoma. then the patient
was transferred to  [**Hospital1 18**] for further management.

MEDICAL HISTORY: MI [**2100**]
CVA [**2108**] fully recovered
DT x 2 last one [**2111**] for which was admitted to the ICU
HTN,
High cholesterol
Osteoarthritis
Vit D deficiency
PSH:
Appendectomy
Angioplasty [**2108**] on Plavix no stent per patient son and daughter
[**Name (NI) 86228**] removal R eye
R CEA [**2108**] complicated by stroke

MEDICATION ON ADMISSION: Plavix 75 daily
Metoprolol unknown dose
Simvastatin 40 '
Lidoderm 5 % 700 mg/patch TP'
Alendronate 70mg '
Seroquel 25 "

ALLERGIES: Aspirin

PHYSICAL EXAM: VS: T 97.2   F  P 74  BP 132/64  RR 20  Sat 98  % RA
Gen: NAD, A & O x3
C: RRR
R: CTAB
GI: BS +, Soft, slightly tender RUQ, NR, NG
Rectal exam: Spincter normotonic, no hemorrhoid, no fissure, no
fistula

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Smoke: 2 PKT a day 56pkts year history
Drink: Glass of wine daily last drink 2-3 days ago
Lives with husband
Other specified disorders of liver,Portal vein thrombosis,Malignant neoplasm of liver, primary,Acute posthemorrhagic anemia,Alcohol abuse, continuous,Unspecified vitamin D deficiency,Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction
Liver disorders NEC,Portal vein thrombosis,Mal neo liver, primary,Ac posthemorrhag anemia,Alcohol abuse-continuous,Vitamin D deficiency NOS,Pure hypercholesterolem,Hypertension NOS,Hx TIA/stroke w/o resid,Old myocardial infarct
Admission Date:  [**2113-5-29**]              Discharge Date:   [**2113-6-2**]

Date of Birth:  [**2036-1-4**]             Sex:   F

Service: SURGERY

Allergies:
Aspirin

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Subcapsular liver hematoma

Major Surgical or Invasive Procedure:
None


History of Present Illness:
77 year old female two week ago started complaining of
abdominal pain, she went to her PCP work up found to have with
liver mass 10 cm in size, she was scheduled to see hepatology
service on [**2113-6-9**]. However, yesterday at 4pm had acute
onset
of RUQ pain, the pain was constant, radiating to the back, she
went to OSH found to have subcapsular hematoma. then the patient
was transferred to  [**Hospital1 18**] for further management.

The patient denies trauma, no fever, chills, N/V, no chest pain,
no shortness of breath. no melena, no hematemesis, no jaundice,
the review of system was unremarkable


Past Medical History:
MI [**2100**]
CVA [**2108**] fully recovered
DT x 2 last one [**2111**] for which was admitted to the ICU
HTN,
High cholesterol
Osteoarthritis
Vit D deficiency
PSH:
Appendectomy
Angioplasty [**2108**] on Plavix no stent per patient son and daughter
[**Name (NI) 86228**] removal R eye
R CEA [**2108**] complicated by stroke


Social History:
Smoke: 2 PKT a day 56pkts year history
Drink: Glass of wine daily last drink 2-3 days ago
Lives with husband


Family History:
Noncontributory

Physical Exam:
VS: T 97.2   F  P 74  BP 132/64  RR 20  Sat 98  % RA
Gen: NAD, A & O x3
C: RRR
R: CTAB
GI: BS +, Soft, slightly tender RUQ, NR, NG
Rectal exam: Spincter normotonic, no hemorrhoid, no fissure, no
fistula


Pertinent Results:
On Admission: [**2113-5-28**]
WBC-8.5 RBC-3.67* Hgb-11.4* Hct-34.1* MCV-93 MCH-31.0 MCHC-33.3
RDW-12.2 Plt Ct-379
PT-11.1 PTT-21.5* INR(PT)-0.9
Glucose-116* UreaN-22* Creat-0.9 Na-140 K-4.3 Cl-106 HCO3-24
AnGap-14
ALT-35 AST-35 LD(LDH)-169 AlkPhos-226* TotBili-0.7
Albumin-3.3* Calcium-8.7 Phos-4.2 Mg-2.1
HBsAg-NEGATIVE HBcAb-NEGATIVE HCV Ab-NEGATIVE
CEA-6.8* AFP-3.4 CA125-38*
At Discharge: [**2113-6-2**]
WBC-6.7 RBC-3.48* Hgb-10.9* Hct-32.6* MCV-94 MCH-31.3 MCHC-33.4
RDW-13.1 Plt Ct-284
Glucose-82 UreaN-11 Creat-0.5 Na-143 K-3.1* Cl-109* HCO3-26
AnGap-11
ALT-39 AST-37 AlkPhos-174* TotBili-1.5

Brief Hospital Course:
77 y/o female admitted with abdominal pain.
CT of abdomen on admission showed:
- Large heterogeneously enhancing mass encompassing almost the
entire right
lobe of the liver and extending into the main, right, and left
portal veins
with cavernous transformation. Perihepatic blood could represent
a component
of subcapsular vs free hemorrhage. There was no evidence of
active extravasation.
There was also some fluid in the pelvis consistent with a bleed.
For the first two days the Hct was monitored q 6 hours and there
was no evidence of further bleeding. Her vital signs remained
stable and she was afebrile. It was determined that there were
not surgical issues at this time.
An oncology consult was obtained based upon the CT findings.
Assessment and recommendations include: "large right lobe
hepatic mass.  While this is likely
a primary hepatic cancer, it is also possible that this
represents a metastasis from somewhere else... A colon primary
seems unlikely based on her history and the fact that she has a
normal MCV." Dr [**Last Name (STitle) **] recommended waiting at least two weeks to
obtain a liver biopsy to allow the liver to heal following the
hemorrhage
She will be followed up in the oncology clinic for liver biopsy
and then discussion of further treatment based on the biopsy
results.
She was evaluated by physical therapy while in house and was
deemed to require a skilled nursing facility for monitoring,
(fall risk) and for around the clock care.


Medications on Admission:
Plavix 75 daily
Metoprolol unknown dose
Simvastatin 40 '
Lidoderm 5 % 700 mg/patch TP'
Alendronate 70mg '
Seroquel 25 "

Allergy: ASA


Discharge Medications:
1. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*10 Tablet(s)* Refills:*0*
4. Thiamine 100 mg IV DAILY
5. FoLIC Acid 1 mg IV Q24H


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 5176**]

Discharge Diagnosis:
Liver mass with liver hematoma
ETOH abuse
Confusion


Discharge Condition:
Mental Status: Confused - sometimes.Level of Consciousness:
Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Level of Consciousness: Alert and interactive.


Discharge Instructions:
1) regular diet
2) activity as tolerated
3) you may shower or bathe
4) [**Name8 (MD) **] MD or come to emergency department if you experience
dizziness, bright red or dark red blood per rectum, bloody
vomit, inability to tolerate liquids, diarrhea/vomiting.
Hold Plavix (angioplasty no stent [**2108**])

Followup Instructions:
Oncology: Dr [**Last Name (STitle) **] Phone ([**2108**], Date:Time [**6-14**],
2:30. [**Hospital Ward Name 23**] Building, [**Location (un) 24**].
Evaluate and plan for biopsy which should be 2 weeks out from
hospitalization


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

Completed by:[**2113-6-2**]
{'Other specified disorders of liver,Portal vein thrombosis,Malignant neoplasm of liver, primary,Acute posthemorrhagic anemia,Alcohol abuse, continuous,Unspecified vitamin D deficiency,Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction'}


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: Subcapsular liver hematoma

PRESENT ILLNESS: 77 year old female two week ago started complaining of
abdominal pain, she went to her PCP work up found to have with
liver mass 10 cm in size, she was scheduled to see hepatology
service on [**2113-6-9**]. However, yesterday at 4pm had acute
onset
of RUQ pain, the pain was constant, radiating to the back, she
went to OSH found to have subcapsular hematoma. then the patient
was transferred to  [**Hospital1 18**] for further management.

MEDICAL HISTORY: MI [**2100**]
CVA [**2108**] fully recovered
DT x 2 last one [**2111**] for which was admitted to the ICU
HTN,
High cholesterol
Osteoarthritis
Vit D deficiency
PSH:
Appendectomy
Angioplasty [**2108**] on Plavix no stent per patient son and daughter
[**Name (NI) 86228**] removal R eye
R CEA [**2108**] complicated by stroke

MEDICATION ON ADMISSION: Plavix 75 daily
Metoprolol unknown dose
Simvastatin 40 '
Lidoderm 5 % 700 mg/patch TP'
Alendronate 70mg '
Seroquel 25 "

ALLERGIES: Aspirin

PHYSICAL EXAM: VS: T 97.2   F  P 74  BP 132/64  RR 20  Sat 98  % RA
Gen: NAD, A & O x3
C: RRR
R: CTAB
GI: BS +, Soft, slightly tender RUQ, NR, NG
Rectal exam: Spincter normotonic, no hemorrhoid, no fissure, no
fistula

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Smoke: 2 PKT a day 56pkts year history
Drink: Glass of wine daily last drink 2-3 days ago
Lives with husband 

### Response:
{'Other specified disorders of liver,Portal vein thrombosis,Malignant neoplasm of liver, primary,Acute posthemorrhagic anemia,Alcohol abuse, continuous,Unspecified vitamin D deficiency,Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Old myocardial infarction'}
