CHIEF COMPLAINT: etoh cirrhosis

PRESENT ILLNESS: 60 y.o. male with etoh cirrhosis. Last etoh drink 2 years pta.
Denies fevers, or chills, problems or recent illness. Admitted
for liver transplant

MEDICAL HISTORY: 1. DM2: dx 10 years ago, treated w/ glucophage until 1 year ago
when BG normalized, likely [**12-26**] weight loss, now not requiring
medication.
2. HTN: treated w/ Diovan until 1 year ago, when BP normalized,
presumably [**12-26**] weight loss.
3. Lumbar DJD w/ chronic low back pain
4. h/o c.diff
difficulty swallowing s/p esoph dilatation
basal cell ca
htn
failure to thrive
last tap [**Month (only) **]
encephalopathy
oral surgery for dentition

MEDICATION ON ADMISSION: lactulose 30''', lasix 80', protonix 40', spironolactone 100',
zoloft 100', iron, mycelex, propranolol 10'', sertraline 100',
lasix 80', ativan PRN

ALLERGIES: Flagyl

PHYSICAL EXAM: A&O, NAD
CTA bilat
SEM
ABD-NT/ND, minimal ascites, no scars
Ext-wll, LLE ankle deformity

FAMILY HISTORY: 1. CAD: father died of MI
2. Gastric CA: brother died

SOCIAL HISTORY: lives with wife in [**Name (NI) 19407**], [**Name (NI) **]; retired salesman; drank [**5-17**]
beers per day for 40 years but quit 6 months ago; smoked 2
cigars per day for 20 years; no IV or recreational drug use.
Acute and subacute necrosis of liver,Complications of transplanted liver,Alcoholic cirrhosis of liver,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Other and unspecified diseases of the oral soft tissues,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Constipation, unspecified,Long-term (current) use of steroids,Other disorders of plasma protein metabolism,Stricture and stenosis of esophagus,Acute alcoholic intoxication in alcoholism, in remission,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of other malignant neoplasm of skin
Acute necrosis of liver,Compl liver transplant,Alcohol cirrhosis liver,Protein-cal malnutr NOS,CHF NOS,Pulmonary collapse,Pneumonia, organism NOS,Oral soft tissue dis NEC,Cholelithiasis NOS,DMII wo cmp nt st uncntr,Constipation NOS,Long-term use steroids,Dis plas protein met NEC,Esophageal stricture,Ac alcohol intox-remiss,Hypertension NOS,Lumbosacral spondylosis,Hx-skin malignancy NEC
Admission Date:  [**2110-5-13**]              Discharge Date:   [**2110-5-30**]

Date of Birth:  [**2049-10-10**]             Sex:   M

Service: SURGERY

Allergies:
Flagyl

Attending:[**First Name3 (LF) 3127**]
Chief Complaint:
etoh cirrhosis

Major Surgical or Invasive Procedure:
liver transplant [**2110-5-13**]
re-exploration for decreased hepatic flow noted on duplex
[**2110-5-14**]


History of Present Illness:
60 y.o. male with etoh cirrhosis. Last etoh drink 2 years pta.
Denies fevers, or chills, problems or recent illness. Admitted
for liver transplant

Past Medical History:
1. DM2: dx 10 years ago, treated w/ glucophage until 1 year ago
when BG normalized, likely [**12-26**] weight loss, now not requiring
medication.
2. HTN: treated w/ Diovan until 1 year ago, when BP normalized,
presumably [**12-26**] weight loss.
3. Lumbar DJD w/ chronic low back pain
4. h/o c.diff
difficulty swallowing s/p esoph dilatation
basal cell ca
htn
failure to thrive
last tap [**Month (only) **]
encephalopathy
oral surgery for dentition

Social History:
lives with wife in [**Name (NI) 19407**], [**Name (NI) **]; retired salesman; drank [**5-17**]
beers per day for 40 years but quit 6 months ago; smoked 2
cigars per day for 20 years; no IV or recreational drug use.


Family History:
1. CAD: father died of MI
2. Gastric CA: brother died

Physical Exam:
A&O, NAD
CTA bilat
SEM
ABD-NT/ND, minimal ascites, no scars
Ext-wll, LLE ankle deformity

Pertinent Results:
[**2110-5-13**] 01:30AM   FIBRINOGE-402*
[**2110-5-13**] 01:30AM   PT-12.9 PTT-30.3 INR(PT)-1.2*
[**2110-5-13**] 01:30AM   PLT COUNT-226
[**2110-5-13**] 01:30AM   WBC-9.0 RBC-3.08* HGB-10.0* HCT-27.6* MCV-90
MCH-32.4* MCHC-36.2* RDW-13.6
[**2110-5-13**] 01:30AM   ALBUMIN-3.0* CALCIUM-8.6 PHOSPHATE-2.7
MAGNESIUM-1.9
[**2110-5-13**] 01:30AM   ALT(SGPT)-6 AST(SGOT)-12 ALK PHOS-97 TOT
BILI-0.4
[**2110-5-13**] 01:30AM   GLUCOSE-120* UREA N-17 CREAT-1.2 SODIUM-140
POTASSIUM-3.4 CHLORIDE-103 TOTAL CO2-28 ANION GAP-12
[**2110-5-13**] 02:23AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2110-5-13**] 02:23AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010

Brief Hospital Course:
He was taken to the OR on [**5-13**] by Dr. [**First Name (STitle) **] [**Name (STitle) **] for
orthotopic liver transplant, piggyback technique,with portal
vein to portal vein anastomosis, donor celiac artery to
recipient hepatic artery, anastomosis with donor replaced left
hepatic artery and bile duct to bile duct anastomosis. Assisting
surgeon was Dr. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]. Please see operative report for
further details.
Estimated blood loss was about [**2103**] cc.  250 cc were given as
cell [**Doctor Last Name 10105**].  The patient received 8000 units of crystalloid,
6units of FFP, 11 units of packed RBCs, no platelets.  Two [**Doctor Last Name 406**]
drains were place with one below the right lobe of the liver and
the other behind the hilum of the liver. He received induction
immunosuppression consisting of solumedrol and cellcept. Postop,
he was transferred in stable condition to the SICU where he
remained intubated. LFTs increased from preop ast 12, alt 6, apk
phos 97 and t.bili 0.4 to postop ast 3274, alt [**2098**], alk  phos
109, and t.bili 10.1.

On [**5-14**] a liver duplex demonstrated the following: 1)
Non-visualized right hepatic artery, normal arterial waveform
identified within the left hepatic artery.
2) Fatty liver.
3) Blunted hepatic vein waveforms suggesting "stiff" liver or an
element of narrowing at the IVC anastomosis.
4) Small amount of ascites. He was taken back to the OR on [**5-14**]
by Dr. [**First Name (STitle) **] [**Name (STitle) **] for compartment syndrome and exploratory
laparotomy, liver biopsy and closure
of fascia with mesh under general anesthesia. There was good
flow in the hepatic artery, portal vein and hepatic veins. He
was readmitted to the SICU postop where he was weaned off
propofol and extubated on [**5-15**]. LFTs trended down to ast 26, alt
87, alk phos 182 and t.bili 1.2. Prograf was initiated on postop
days 2 and 1. Prograf was adjusted to 2mg [**Hospital1 **] per levels 7.7.
Subsequent levels were 9.9 and 11 by pod 7. Solumedrol was
tapered to prednisone 20mg qd. He will continue slow taper per
transplant clinic over the next 3 months. Cellcept 1gram po bid
continued. Creatinine increased to 1.9 on pod 5 and 4 then
decreased to 1.3 by pod [**6-30**].
Diet was gradually advanced. Nutrition followed making
recommendations for his diet given recent esophageal dilatation.
This included a speech and swallow eval. Findings included no
evidence of aspiration with suggestion to continue on the
current PO diet of thin liquids and regular consistency solids.
He experienced some nausea and vomiting on post op day [**5-29**] after
taking am meds. A kub was done for mild abd distension and
hypoactive bowel sounds. This revealed relatively markedly
distended segment of small bowel over the mid abdomen with air
seen in the distal colon and rectum of uncertain significance.
He was given a dulcolax suppository with passage of bm. N/V
resolved. PO intake was only fair and calorie counts were ~1500
kcal.

On [**5-21**] his wbc increased to 22. A urine culture was negative.
An abdominal CT was done to rule out intra-abd abscess. This
revealed moderate abdominal/pelvic fluid, moderate bilateral
pleural effusions with associated atelectasis and  right adrenal
hematoma. A cxr showed bibasilar atelectasis left greater than
right. He also had some URI symptoms that improved. Levaquin was
started on [**5-25**] for a ten day course. On [**5-29**] he complained of a
sore mouth. Several 4mm punctate ulcerations (aphthous
appearing) were noted on his tongue and gum. This was cultured
for bacterial and viral organisms. Maaolox/benadryl/lidocaine
swish was ordered.

PT followed and recommended rehab.
He experienced serosanguinous leaking via the right side of his
incision. Several staples were removed and a gauze dressing was
loosely packed into the wound. The medial JP was removed on pod
[**5-29**] and the lateral JP remained in place given outputs of 200cc.
His hct trended down slightly each day to 24 on [**5-29**]. He was
ordered for 2 units of prbc. He continued on lasix 80mg [**Hospital1 **] for
edema.
Condition is stable. He is alert and oriented.

He remained in the hospital pending a bed at [**Hospital **] rehab with
labs every Monday and Thursday for cbc, chem 10, lfts, and
trough prograf levels with results fax'd to the [**Hospital1 18**] Transplant
office attn: [**First Name8 (NamePattern2) 1022**] [**Last Name (NamePattern1) **] RN ([**Telephone/Fax (1) 697**]). He is scheduled to
f/u in the clinic.

Patient was discharged home on [**2110-5-30**] after being deemed
capable by team.


Medications on Admission:
lactulose 30''', lasix 80', protonix 40', spironolactone 100',
zoloft 100', iron, mycelex, propranolol 10'', sertraline 100',
lasix 80', ativan PRN

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
2. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
ML PO DAILY (Daily).
3. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
5. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
10. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
12. Insulin Regular Human 100 unit/mL Solution Sig: follow
sliding scale  Injection every six (6) hours.
13. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO HS
(at bedtime).
14. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days.
15. Tacrolimus 1 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
16. Maalox/Benadryl/Lidocaine
5ml po prn qid for sore mouth ulcers


Discharge Disposition:
Home with Service

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

Discharge Diagnosis:
h/o etoh abuse
DM II


Discharge Condition:
stable


Discharge Instructions:
Call [**Telephone/Fax (1) 673**] if fevers, chills, nausea, vomiting, inability
to take medications, jaundice, redness/bleeding/pus from
incisions or increased drainage, abdominal pain or any
questions.
Labs every Monday and Thursday for cbc, chem 10, ast, alt, alk
phos, t.bili,albumin, and trough prograf level. fax results to
[**Hospital1 18**] Transplant office [**Telephone/Fax (1) 697**]

Followup Instructions:
Please call Transplant office [**Telephone/Fax (1) 673**] to schedule follow up
appointment
Provider:  [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2110-5-30**] 1:15
Provider: [**Name10 (NameIs) 1344**] [**Last Name (NamePattern4) 3125**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2110-6-5**] 1:00



Completed by:[**2110-5-30**]
{'Acute and subacute necrosis of liver,Complications of transplanted liver,Alcoholic cirrhosis of liver,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Other and unspecified diseases of the oral soft tissues,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Constipation, unspecified,Long-term (current) use of steroids,Other disorders of plasma protein metabolism,Stricture and stenosis of esophagus,Acute alcoholic intoxication in alcoholism, in remission,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of other malignant neoplasm of skin'}


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: etoh cirrhosis

PRESENT ILLNESS: 60 y.o. male with etoh cirrhosis. Last etoh drink 2 years pta.
Denies fevers, or chills, problems or recent illness. Admitted
for liver transplant

MEDICAL HISTORY: 1. DM2: dx 10 years ago, treated w/ glucophage until 1 year ago
when BG normalized, likely [**12-26**] weight loss, now not requiring
medication.
2. HTN: treated w/ Diovan until 1 year ago, when BP normalized,
presumably [**12-26**] weight loss.
3. Lumbar DJD w/ chronic low back pain
4. h/o c.diff
difficulty swallowing s/p esoph dilatation
basal cell ca
htn
failure to thrive
last tap [**Month (only) **]
encephalopathy
oral surgery for dentition

MEDICATION ON ADMISSION: lactulose 30''', lasix 80', protonix 40', spironolactone 100',
zoloft 100', iron, mycelex, propranolol 10'', sertraline 100',
lasix 80', ativan PRN

ALLERGIES: Flagyl

PHYSICAL EXAM: A&O, NAD
CTA bilat
SEM
ABD-NT/ND, minimal ascites, no scars
Ext-wll, LLE ankle deformity

FAMILY HISTORY: 1. CAD: father died of MI
2. Gastric CA: brother died

SOCIAL HISTORY: lives with wife in [**Name (NI) 19407**], [**Name (NI) **]; retired salesman; drank [**5-17**]
beers per day for 40 years but quit 6 months ago; smoked 2
cigars per day for 20 years; no IV or recreational drug use. 

### Response:
{'Acute and subacute necrosis of liver,Complications of transplanted liver,Alcoholic cirrhosis of liver,Unspecified protein-calorie malnutrition,Congestive heart failure, unspecified,Pulmonary collapse,Pneumonia, organism unspecified,Other and unspecified diseases of the oral soft tissues,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Constipation, unspecified,Long-term (current) use of steroids,Other disorders of plasma protein metabolism,Stricture and stenosis of esophagus,Acute alcoholic intoxication in alcoholism, in remission,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of other malignant neoplasm of skin'}
