CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 63-year-old
gentleman with a history of chronic hepatitis B infection who
had previously had hepatocellular carcinoma for which he had
undergone radiofrequency ablation of a 1.3 cm segment 8
lesion in [**2120-6-18**]. In addition, the patient had segmental
Caroli disease. He was evaluated electively in the
hepatobiliary surgery office for possible surgical resection
of a large left lateral segment liver mass which had grown
from 4 x 4 cm to 9.2 x 7.5 cm in segments 2 and 3.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of liver, primary,Unspecified septicemia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other postoperative infection,Severe sepsis,Pneumonia due to Klebsiella pneumoniae,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Portal vein thrombosis,Budd-chiari syndrome,Other anomalies of gallbladder, bile ducts, and liver,Paralytic ileus,Cirrhosis of liver without mention of alcohol,Other and unspecified complications of medical care, not elsewhere classified,Atrial fibrillation
Mal neo liver, primary,Septicemia NOS,Mal neo lymph intra-abd,Hpt B chrn wo cm wo dlta,Other postop infection,Severe sepsis,K. pneumoniae pneumonia,Urin tract infection NOS,Acute kidney failure NOS,Portal vein thrombosis,Budd-chiari syndrome,Biliary & liver anom NEC,Paralytic ileus,Cirrhosis of liver NOS,Complic med care NEC/NOS,Atrial fibrillation
Admission Date: [**2125-1-5**]        Discharge Date: [**2125-1-18**]

Date of Birth:  [**2061-10-28**]        Sex:  M

Service:  [**Last Name (un) **]


ADMISSION DIAGNOSES:
1. Hepatocellular carcinoma.
2. Hepatitis B.
3. Grade 1 esophageal varices.
4. Chronic renal insufficiency.
5. Hypertension.
6. History of thrombocytopenia.
7. Diabetes mellitus type 2.
8. Status post colonic polypectomy.
9. Status post right ankle fixation.

DISCHARGE DIAGNOSES:
1. Death.
2. Multisystem organ failure (respiratory failure, septic
    shock, renal failure, liver failure).
3. Pneumonia (ventilator associated).
4. Urinary tract infection.
5. Portal/middle hepatic venous occlusion.
6. Status post left lateral segmentectomy, segment 6
    resection, intraoperative ultrasound.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 63-year-old
gentleman with a history of chronic hepatitis B infection who
had previously had hepatocellular carcinoma for which he had
undergone radiofrequency ablation of a 1.3 cm segment 8
lesion in [**2120-6-18**]. In addition, the patient had segmental
Caroli disease. He was evaluated electively in the
hepatobiliary surgery office for possible surgical resection
of a large left lateral segment liver mass which had grown
from 4 x 4 cm to 9.2 x 7.5 cm in segments 2 and 3.

LABORATORY DATA:  Preoperatively, his platelet count was 108.
His PT was 13.0. His INR was 1.1. His BUN was 23. His
creatinine was 1.5. His total bilirubin was 0.8. His alkaline
phosphatase was 330. His ALT was 146. His AST was 118. His
albumin was 4.2. His AFT was 54.5. His hepatitis B viral load
was 1890 iu per ml.

HOSPITAL COURSE:  The patient was admitted elective on
[**2125-1-5**], on which day he underwent a left lateral
segmentectomy  and segment 6 resection with intraoperative
ultrasound. At the time of exploration, he was noted to have
an enlarged cirrhotic liver but otherwise no evidence of
portal hypertension. A large mass involving the lateral-most
aspect of the left lateral segment was found in addition to
cystic structures in the liver which contained clear fluid.
The mass was confirmed with intraoperative ultrasound.
Notably the site of the previous RFA was stable without
evidence of recurrent disease but the patient did, by
palpation of the surface, have a 1.5-2 cm nodule in segment 6
laterally and inferiorly which was confirmed with ultrasound.
Please refer to the operative note for additional
intraoperative details. The patient remained intubated
overnight and initially required vasopressors for blood
pressure support and significant fluid resuscitation for a
persistent metabolic acidosis. Early in his postoperative
course, by postop day two, he was found to have partial
thrombosis of his portal vein and middle hepatic vein. He was
started on low dose heparinization for this. Systematically,
the patient's pain was controlled with intravenous narcotics,
generally phentanyl throughout the course of his
hospitalization. Propofol was used intermittently for
sedation. His mental status never really improved during the
course of his hospitalization as his multisystem organ
failure as described below developed.

In terms of the patient's respiratory status, the patient was
ventilated initially postoperative during correction of his
metabolic acidosis. His ventilatory requirements subsequently
continued to increase secondary to the large volume of fluid
required for his resuscitation and subsequently secondary to
the development of bilateral Klebsiella pneumoniae. The
patient developed some degree of ARDS as well and remained
quite difficult to ventilate and oxygenate. Throughout the
course of his hospitalization, his oxygenation and
ventilatory support requirements continued to progressively
increase despite efforts at diuresis and treatment of his
pneumonia with broad spectrum antibiotics. By [**1-18**], the
patient was requiring between 80-100% FIO2 with maximal
positive end respiratory pressure and ventilatory support and
despite this, his oxygenation was marginal with PAO2 of
between 50 and 65.

In terms of the patient's cardiovascular status, he required
moderate doses of phenylephrine initially in the
postoperative period but subsequently as the patient
demonstrated evidence of septic physiology with source
questionable from his pneumonia or possible urinary tract
infection, he continued to require increasing amounts of
vasopressor support including norepinephrine and vasopressin.
His persistent hypotension was not felt to be cardiogenic in
etiology as he had two echocardiograms demonstrating no
significant valvular disease and no significant wall motion
abnormalities with a normal ejection fraction. By [**1-18**],
the patient was requiring increasingly large doses of
norepinephrine as well as vasopressin, maintaining a blood
pressure maximally at 100-105 systolic. Throughout his
hospitalization, multiple sets of cardiac enzymes were sent
and did not demonstrate any evidence of myocardial
infarction. He did notably develop atrial fibrillation which
was felt to be secondary to the amount of fluid resuscitation
and the physiologic stress that the patient was under. This
was managed intermittently with calcium channel blockade.

In terms of the patient's GI status, he was maintained on
prophylaxis with a proton pump inhibitor. He did have
significant ileus which was managed with bowel rest as well
as nasogastric suction. His NG tube put out between 1-1.5
liters per day. The patient's liver function continued to
deteriorate during the postoperative period with his
bilirubin rising to a maximum of 19.2 along with elevations
of his transaminases between 200-300. The hepatic venous and
partial portal venous thromboses were managed with
heparinization as noted previously. The patient's renal
function continued to decline as well in addition to his
baseline chronic renal insufficiency. The patient developed
complete acute renal failure and required the initiation of
continuous venovenous hemodialysis. As noted previously, the
patient did develop a bilateral pneumonia and a urinary tract
infection, both of which were secondary to Klebsiella on
culture. He was treated with the appropriate antibiotics
which included vancomycin for gram positive cocci seen on
gram stain of his sputum as well as ciprofloxacin and Zosyn
for double coverage of pseudomonas and the ciprofloxacin
covered the Klebsiella. The patient's white blood cell count
reached a maximum of 26 and nadir at 13.1 on [**1-16**] but
again began to climb during the final days of his
hospitalization.

Given that the patient was evidencing significant progression
of his multisystem organ failure as well as lack of
responsiveness to maximal medical supportive therapy
including full ventilatory support, full vasopressor support
as well as continuous venovenous hemodialysis and broad
spectrum antibiotic therapy, discussion was held with the
family as to the goals of care. It was decided with the
family that there really was no likelihood of recovery from
his current status and the patient was made comfort measures
only on [**2125-1-18**]. Vasopressor support was withdrawn
and the patient expired one hour thereafter at 3:12 p.m. on
[**2125-1-18**]. The family declined an autopsy. The [**Location (un) **] Organ Bank was contact[**Name (NI) **]. The medical examiner's
office declined an autopsy as well.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 12072**]

Dictated By:[**Doctor Last Name 3763**]
MEDQUIST36
D:  [**2125-1-18**] 15:44:21
T:  [**2125-1-18**] 16:40:36
Job#:  [**Job Number 15330**]
{'Malignant neoplasm of liver, primary,Unspecified septicemia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other postoperative infection,Severe sepsis,Pneumonia due to Klebsiella pneumoniae,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Portal vein thrombosis,Budd-chiari syndrome,Other anomalies of gallbladder, bile ducts, and liver,Paralytic ileus,Cirrhosis of liver without mention of alcohol,Other and unspecified complications of medical care, not elsewhere classified,Atrial fibrillation'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 63-year-old
gentleman with a history of chronic hepatitis B infection who
had previously had hepatocellular carcinoma for which he had
undergone radiofrequency ablation of a 1.3 cm segment 8
lesion in [**2120-6-18**]. In addition, the patient had segmental
Caroli disease. He was evaluated electively in the
hepatobiliary surgery office for possible surgical resection
of a large left lateral segment liver mass which had grown
from 4 x 4 cm to 9.2 x 7.5 cm in segments 2 and 3.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of liver, primary,Unspecified septicemia,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Other postoperative infection,Severe sepsis,Pneumonia due to Klebsiella pneumoniae,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Portal vein thrombosis,Budd-chiari syndrome,Other anomalies of gallbladder, bile ducts, and liver,Paralytic ileus,Cirrhosis of liver without mention of alcohol,Other and unspecified complications of medical care, not elsewhere classified,Atrial fibrillation'}
