CHIEF COMPLAINT: Bilateral lower extremity DVTs

PRESENT ILLNESS: 58 year old man s/p liver transplant on [**2154-1-31**] found to have
DVT on duplex ultrasound. The patient was recently discharged on
[**2154-2-14**] after a liver transplant complicated by bleeding which
required two take-backs to the OR and bilateral occipital stroke
with residual left field visual defect. He has been doing very
well since his discharge, working with PT with minimal pain,
eating well and regaining his strength. His only complaint is
his eyesight which has been stable since his discharge. He was
seen today for scheduled bilateral lower extremity ultrasounds
to evaluate for embolic source for his stroke.  These revealed a
DVT and the patient was directly admitted to the floor for
management. He has no specific complaints at this time.

MEDICAL HISTORY: PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: MMF 1000mg [**Hospital1 **], protonix 40mg daily, fluconazole 400mg daily,
valcyte 900mg daily, plavix 75mg daily, ASA 325mg daily, Bactrim
SS daily, metoprolol 25mg tid, colace 100mg [**Hospital1 **], prednisone
17.5mg daily, prograf 2mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam:
Afebrile, VSS
No distress, alert and oriented x 3
PERLA, EOMI, anicteric
RRR, no murmurs
Lungs clear
Abdomen soft, nontender, nondistended, well healed incision
Ext: no edema, palpable pulses

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs.
Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Intracerebral hemorrhage,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Esophageal reflux,Late effects of cerebrovascular disease, disturbances of vision,Other specified visual disturbances,Anticoagulants causing adverse effects in therapeutic use
Ac DVT/emb prox low ext,Intracerebral hemorrhage,Secundum atrial sept def,Hypertension NOS,Esophageal reflux,Disturbances of vision,Visual disturbances NEC,Adv eff anticoagulants
Admission Date:  [**2154-2-26**]              Discharge Date:   [**2154-3-2**]

Date of Birth:  [**2095-10-7**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5569**]
Chief Complaint:
Bilateral lower extremity DVTs

Major Surgical or Invasive Procedure:
[**2154-2-27**] IVC filter placement


History of Present Illness:
58 year old man s/p liver transplant on [**2154-1-31**] found to have
DVT on duplex ultrasound. The patient was recently discharged on
[**2154-2-14**] after a liver transplant complicated by bleeding which
required two take-backs to the OR and bilateral occipital stroke
with residual left field visual defect. He has been doing very
well since his discharge, working with PT with minimal pain,
eating well and regaining his strength. His only complaint is
his eyesight which has been stable since his discharge. He was
seen today for scheduled bilateral lower extremity ultrasounds
to evaluate for embolic source for his stroke.  These revealed a
DVT and the patient was directly admitted to the floor for
management. He has no specific complaints at this time.

Past Medical History:
PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

PSH: significant for an appendectomy as well as knee and
shoulder
arthroscopies


Social History:
Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs.


Family History:
significant for colon cancer in his father as well as seizures
in his brother


Physical Exam:
Physical exam:
Afebrile, VSS
No distress, alert and oriented x 3
PERLA, EOMI, anicteric
RRR, no murmurs
Lungs clear
Abdomen soft, nontender, nondistended, well healed incision
Ext: no edema, palpable pulses

Pertinent Results:
Discharge labs:
[**2154-3-2**] 04:30AM BLOOD WBC-6.5 RBC-3.98* Hgb-11.8* Hct-36.0*
MCV-91 MCH-29.7 MCHC-32.8 RDW-16.0* Plt Ct-109*
[**2154-3-1**] 05:35AM BLOOD PT-14.8* PTT-25.5 INR(PT)-1.3*
[**2154-3-2**] 04:30AM BLOOD Glucose-103* UreaN-18 Creat-0.8 Na-141
K-4.1 Cl-106 HCO3-28 AnGap-11
[**2154-3-2**] 04:30AM BLOOD ALT-32 AST-24 AlkPhos-70 TotBili-0.4
[**2154-3-2**] 04:30AM BLOOD Albumin-3.0* Calcium-8.4 Phos-4.4 Mg-1.5*
[**2154-3-2**] 04:30AM BLOOD tacroFK-12.4
.
CT head [**2-26**] prior to starting heparin:
- 1. Small gyriform foci of hyperdensity in the right occipital
lobe at the area of prior infarct may represent areas of
hyperperfusion-petechial hemorrhage-laminar necrosis or residual
blood from prior hemorrhage, age-indeterminate. No large
intracranial hemorrhage is seen.
2. Bilateral occipital lobe hypodensity, right larger than left,
unchanged left caudate head hypodensity likely consistent with
chronic ischemic changes.
.
CT head [**2-26**] after the administration of heparin:
- Areas of subacute infarction in the occipital lobes
bilaterally, unchanged since [**2154-2-26**]. Evolving hemorrhage within
the infarctions. Close interval followup is suggested.
.
CT head [**2-27**]:
- Bilateral subacute occipital infarction/hemorrhage. No acute
changes.
.
Duplex:
1. Right superficial femoral and peroneal vein thrombus.
2. Left posterior tibial vein thrombus.


Brief Hospital Course:
Mr. [**Known lastname 71166**] was admitted on [**2154-2-26**] after routine duplex scanning
of his legs revealed right superficial and peroneal vein DVT and
left posterior tibial DVTs.  Due to his recent occipital strokes
a CT scan was obtained prior to the administration of heparin.
The CT scan showed bilateral occipital lobe hypodensities, right
larger than left, unchanged from prior studies.  Neurology was
consulted and a heparin gtt was started at a low rate.  A few
hours after the heparin was started he began to complain of new
visual hallucinations that he did not have before.  Due to
concerns for hemorrhagic conversion of his prior CVA he was
transferred to the ICU for monitoring and a head CT was obtained
that showed areas of subacute infarction in the occipital lobes
bilaterally, unchanged since [**2154-2-26**] with evolving hemorrhage
within the infarctions.  His heparin gtt was immediately stopped
and 2 more follow up head CTs showed no change.  An EEG was
obtained and this show signs of encephalopathy but no seizure
activity.  His hallucinations continued and Keppra [**Hospital1 **] was
started.  A 24hour EEG was obtained, an initial interpretation
showed no seizure activity, but the final read is still pending
as of his discharge.  He was transferred back to the floor.  His
diet was advanced and he is having bowel function.  His
labarotory work is stable.  His visual hallucinations are vastly
improving and his main complaints are blurry vision in his left
visual fields.  He is discharged on Keppra with transplant as
well as neurology follow up.  A Cardiology consult was obtained
to evaluate for closure of his ASD as an appropriate date.  His
tacro dose was decreased to 1.5mg [**Hospital1 **] based on his level.  His
prednisone was decreased to 15mg daily.


Medications on Admission:
MMF 1000mg [**Hospital1 **], protonix 40mg daily, fluconazole 400mg daily,
valcyte 900mg daily, plavix 75mg daily, ASA 325mg daily, Bactrim
SS daily, metoprolol 25mg tid, colace 100mg [**Hospital1 **], prednisone
17.5mg daily, prograf 2mg [**Hospital1 **]

Discharge Medications:
1. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
2. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
3. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Prednisone 5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
8. Tacrolimus 1 mg Capsule Sig: 1 and [**1-12**] Capsule PO Q12H (every
12 hours).
9. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale
per scale Subcutaneous ASDIR (AS DIRECTED).
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Bilateral leg DVTs


Discharge Condition:
Good
Alert and oriented x 3
Ambulating independently


Discharge Instructions:
Please call the [**Hospital 1326**] Clinic at [**Telephone/Fax (1) 673**] if you
experience any of the following: fever, chills, nausea,
vomiting, inability to eat or drink, abdominal pain, diarrhea,
chest pain, shortness of breath, a change in your visual
symptoms, weakness or numbness on one side of your body, or any
other concerns you may have.
.
Resume all of your medications.  Your prednisone dose was
decreased to 15mg daily.  You were started on Keppra due to
concerns for seizures.  Your EEG was tentatively read as
negative.  You should continue the Keppra and follow up with
Neurology.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-3-4**]
9:30
Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-3-11**]
10:00
Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-3-18**]
10:00
.
Follow up with Dr. [**First Name (STitle) **] (Neurology).  His office number is
([**Telephone/Fax (1) 7394**].  You have an appointment on [**2154-3-18**] but he may
want to see you sooner.  Call his office on Monday.
{'Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Intracerebral hemorrhage,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Esophageal reflux,Late effects of cerebrovascular disease, disturbances of vision,Other specified visual disturbances,Anticoagulants 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: Bilateral lower extremity DVTs

PRESENT ILLNESS: 58 year old man s/p liver transplant on [**2154-1-31**] found to have
DVT on duplex ultrasound. The patient was recently discharged on
[**2154-2-14**] after a liver transplant complicated by bleeding which
required two take-backs to the OR and bilateral occipital stroke
with residual left field visual defect. He has been doing very
well since his discharge, working with PT with minimal pain,
eating well and regaining his strength. His only complaint is
his eyesight which has been stable since his discharge. He was
seen today for scheduled bilateral lower extremity ultrasounds
to evaluate for embolic source for his stroke.  These revealed a
DVT and the patient was directly admitted to the floor for
management. He has no specific complaints at this time.

MEDICAL HISTORY: PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: MMF 1000mg [**Hospital1 **], protonix 40mg daily, fluconazole 400mg daily,
valcyte 900mg daily, plavix 75mg daily, ASA 325mg daily, Bactrim
SS daily, metoprolol 25mg tid, colace 100mg [**Hospital1 **], prednisone
17.5mg daily, prograf 2mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam:
Afebrile, VSS
No distress, alert and oriented x 3
PERLA, EOMI, anicteric
RRR, no murmurs
Lungs clear
Abdomen soft, nontender, nondistended, well healed incision
Ext: no edema, palpable pulses

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs. 

### Response:
{'Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Intracerebral hemorrhage,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Esophageal reflux,Late effects of cerebrovascular disease, disturbances of vision,Other specified visual disturbances,Anticoagulants causing adverse effects in therapeutic use'}
