CHIEF COMPLAINT: HCV/ETOH cirrhosis

PRESENT ILLNESS: 60M with HCV and alcoholic cirrhosis and HCC s/p RFA x
2([**2118-11-30**]/[**2119-1-31**]) with no evidence of recurrent
disease presents for ABO compatible liver transplantation.  He
denies fevers, chills, nausea, vomiting, abdominal pain and sick
contacts. [**Name (NI) **] reports his appetite has been stable and denies any
weight loss.  His last BM was this morning and was normal in
appearance.  He denies chest pain, shortness of breath, and
dysuria.  He does reports some back pain which he was told was
due to degenerative disk disease or peripheral neuropathy from
his diabetes.

MEDICAL HISTORY: Past Medical History: HCV and alcoholic cirrhosis, mild
hypertension, bipolar depression

MEDICATION ON ADMISSION: Gabapentin 300 mg three times a day, Vistaril 50 mg p.r.n.
anxiety which he takes very rarely, Levemir insulin 30 units
subcutaneously q.a.m., Humalog insulin sliding scale,
lamotrigine
200 mg daily, lisinopril 40 mg daily, Toprol-XL 50 mg daily,
Januvia 100 mg daily, and trazodone 50 mg q.h.s.

ALLERGIES: Penicillins / Codeine / Bactrim

PHYSICAL EXAM: Vitals: 97.5 143/92 72 20 97RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
DRE: normal tone, no gross or occult blood
Ext: No LE edema, LE warm and well perfused, peripheral pulses
intact, [**5-4**] muscle strength bilaterally, normal sensation
bilaterally

FAMILY HISTORY: No family history of colon cancer, liver disease, or pancreatic
cancer.  Both parents lived to their early 90's

SOCIAL HISTORY: No EtOH x 5 months, Non-smoking x 41 days, no drug use x 5
years.
Alcoholic cirrhosis of liver,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Unspecified viral hepatitis C without hepatic coma,Personal history of malignant neoplasm of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Personal history of tobacco use,Obstructive sleep apnea (adult)(pediatric)
Alcohol cirrhosis liver,Bipol I cur depres NOS,Hpt C w/o hepat coma NOS,Hx of liver malignancy,DMII wo cmp nt st uncntr,Alcoh dep NEC/NOS-remiss,History of tobacco use,Obstructive sleep apnea
Admission Date:  [**2119-5-28**]              Discharge Date:   [**2119-6-2**]

Date of Birth:  [**2059-2-24**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Codeine / Bactrim

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
HCV/ETOH cirrhosis

Major Surgical or Invasive Procedure:
[**2119-5-29**] liver transplant


History of Present Illness:
60M with HCV and alcoholic cirrhosis and HCC s/p RFA x
2([**2118-11-30**]/[**2119-1-31**]) with no evidence of recurrent
disease presents for ABO compatible liver transplantation.  He
denies fevers, chills, nausea, vomiting, abdominal pain and sick
contacts. [**Name (NI) **] reports his appetite has been stable and denies any
weight loss.  His last BM was this morning and was normal in
appearance.  He denies chest pain, shortness of breath, and
dysuria.  He does reports some back pain which he was told was
due to degenerative disk disease or peripheral neuropathy from
his diabetes.

ROS:
(+) per HPI
(-) Denies night sweats, fatigue/malaise/lethargy, changes in
appetite, trouble with sleep, pruritis, jaundice, rashes,
bleeding, easy bruising, headache, dizziness, vertigo, syncope,
weakness, paresthesias, hematemesis, bloating, cramping, melena,
BRBPR, dysphagia, chest pain, shortness of breath, cough, edema,
urinary frequency, urgency


Past Medical History:
Past Medical History: HCV and alcoholic cirrhosis, mild
hypertension, bipolar depression

Past Surgical History: ankle surgery [**41**] years ago, right
shoulder
rotator cuff surgery [**2101**], left shoulder surgery [**2087**]'s, removal
of undescended testes [**2087**]'s, prostate surgery


Social History:
No EtOH x 5 months, Non-smoking x 41 days, no drug use x 5
years.


Family History:
No family history of colon cancer, liver disease, or pancreatic
cancer.  Both parents lived to their early 90's

Physical Exam:
Vitals: 97.5 143/92 72 20 97RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
DRE: normal tone, no gross or occult blood
Ext: No LE edema, LE warm and well perfused, peripheral pulses
intact, [**5-4**] muscle strength bilaterally, normal sensation
bilaterally

Pertinent Results:
Labs on admission:
[**2119-5-28**] 02:44PM BLOOD WBC-5.6 RBC-4.66 Hgb-15.1 Hct-41.0 MCV-88
MCH-32.4* MCHC-36.9* RDW-13.9 Plt Ct-115*
[**2119-5-28**] 02:44PM BLOOD PT-12.7 PTT-31.2 INR(PT)-1.1
[**2119-5-28**] 02:44PM BLOOD Glucose-68* UreaN-15 Creat-0.8 Na-144
K-3.8 Cl-109* HCO3-27 AnGap-12
[**2119-5-28**] 02:44PM BLOOD ALT-113* AST-110* AlkPhos-108 TotBili-1.0
[**2119-5-28**] 02:44PM BLOOD Albumin-3.9 Calcium-9.3 Phos-3.7 Mg-1.9
[**2119-5-28**] 02:44PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
HBcAb-NEGATIVE
[**2119-5-28**] 02:44PM BLOOD HIV Ab-NEGATIVE
[**2119-5-30**] 05:00AM BLOOD tacroFK-4.9*
[**2119-5-28**] 09:17PM BLOOD freeCa-1.15
Labs on discharge:
[**2119-6-2**] 06:00AM BLOOD WBC-9.4 RBC-3.76* Hgb-12.4* Hct-33.4*
MCV-89 MCH-32.9* MCHC-37.1* RDW-14.3 Plt Ct-120*
[**2119-6-1**] 06:00AM BLOOD PT-12.9 PTT-22.5 INR(PT)-1.1
[**2119-6-2**] 06:00AM BLOOD Glucose-71 UreaN-20 Creat-0.7 Na-140
K-3.9 Cl-105 HCO3-31 AnGap-8
[**2119-6-2**] 06:00AM BLOOD ALT-242* AST-148* AlkPhos-104 TotBili-0.7
[**2119-6-2**] 06:00AM BLOOD Albumin-2.6* Calcium-7.7* Phos-3.1 Mg-1.9
.
Micro/urine:
[**2119-5-29**] MRSA SCREEN-
[**2119-5-28**] URINE CULTURE-
[**2119-5-28**] SWAB R/O VANCOMYCIN RESISTANT ENTEROCOCCUS-
[**2119-5-28**] IMMUNOLOGY HCV VIRAL LOAD-
[**2119-5-28**] 01:08PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.014
[**2119-5-28**] 01:08PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
.
Imaging:
CXR ([**2119-5-28**]): The cardiomediastinal silhouette is within normal
limits. Pulmonary vasculature is normal. There is no focal
consolidation, pneumothorax, or pleural effusion.
.
EKG: ([**2119-5-28**]): Sinus rhythm. Right bundle-branch block.
Non-diagnostic repolarization abnormalities.
.
Echo ([**2119-1-23**]): The left atrium is mildly dilated. No atrial
septal defect is seen by 2D or color Doppler. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%). There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The diameters of aorta at the sinus, ascending and arch
levels are normal. The aortic valve leaflets (3) appear
structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.
.
[**2119-6-2**]   LIVER OR GALLBLADDER US: pending, pre-lim: patent
vasculature, no biliary duct dilitation.
.
[**2119-5-30**]   ECG:
Sinus rhythm. Compared to tracing #1 the P-R interval is now
shorter.
Rate PR  QRS QT/QTc  P  QRS T
65   182 84  [**Telephone/Fax (2) 111294**]

[**2119-5-29**]   CHEST PORT. LINE PLACEMENT:
A Swan-Ganz catheter and ET tube have been removed. A right
internal jugular central venous line tip lies in the mid SVC.
The nasogastric tube has been advanced. Cardiomediastinal
silhouette is stable. Streaky left mid lung zone atelectasis is
noted. There is no focal consolidation
.
[**2119-5-29**]   LIVER OR GALLBLADDER US:
1. Widely patent portal and hepatic veins with appropriate flow
directions
and waveforms.
2. Widely patent main hepatic artery.
3. Normal liver echotexture with no intrahepatic bile duct
dilation.

Brief Hospital Course:
60M with Hepatitis C and alcoholic cirrhosis with history of HCC
admitted to the Transplant service. On [**2119-5-29**], he underwent
orthotopic deceased donor liver
transplant (from a brain-dead donor), piggyback, portal vein to
portal vein anastomosis, common bile duct to common bile duct
anastomosis with no T tube and common hepatic to common hepatic
arterial anastomosis. Two JP drains were left in placed. Surgeon
was Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] assisted by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Postop, he
was sent to the SICU for management.

He was extubated and remained hemodynamically stable. JP drains
were non-bilious. LFTs increased initially then trended down.
Hepatic duplex demonstrated patent vasculature. Diet was
advanced and tolerated. Glucoses were elevated. Insulin was
adjusted and [**Last Name (un) **] was consulted for management.

Incision remained intact with staples. Lateral JP was removed on
[**6-1**]. Medial JP was removed on [**6-2**].

On [**6-2**], LFTs increased (alt 242 from 198, ast 148 from 102, alk
phos 104 from 64. Tbili remained the same at 0.6/0.7). Repeat
hepatic duplex was done noting patent vasculature and no biliary
ductal dilatation.

Immunosuppression consisted on Solu-Medrol tapered to
prednisone, CellCept [**Hospital1 **] and Prograf adjusted per trough levels.
Medication teaching was done with the coordinator and
pharmacist. Of note, Bactrim was stopped given past h/o allergy
(scrotal rash/redness). Patient addressed this issue and was
concerned about this recurring, therefore Bactrim was stopped
and IH Pentamidine given on [**6-2**].

He was ambulatory and declared safe for home by physical
therapy.


Medications on Admission:
Gabapentin 300 mg three times a day, Vistaril 50 mg p.r.n.
anxiety which he takes very rarely, Levemir insulin 30 units
subcutaneously q.a.m., Humalog insulin sliding scale,
lamotrigine
200 mg daily, lisinopril 40 mg daily, Toprol-XL 50 mg daily,
Januvia 100 mg daily, and trazodone 50 mg q.h.s.

Allergies: Penicillins/Codeine/bactrim


Discharge Medications:
1. fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
2. prednisone 10 mg Tablet Sig: 3.5 Tablets PO ONCE (Once) for 1
doses: on [**6-3**].
3. prednisone 5 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily):
start [**6-4**].
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
6. gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).
7. lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for insomnia.
10. Toprol XL 50 mg Tablet Extended Release 24 hr Sig: One (1)
Tablet Extended Release 24 hr PO once a day.
11. valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
13. tacrolimus 1 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
14. pentamidine 300 mg Recon Soln Sig: One (1) Recon Soln
Inhalation ONCE (Once) as needed for PCP [**Name Initial (PRE) 1102**]: given [**6-2**].
Due around [**7-2**].
15. Levemir 100 unit/mL Solution Sig: Twenty (20) units
Subcutaneous once a day.
16. Humalog 100 unit/mL Solution Sig: follow sliding scale units
Subcutaneous four times a day.
17. tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).


Discharge Disposition:
Home

Discharge Diagnosis:
h/o HCV/ETOH cirrhosis
DM


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Please call the Transplant Office [**Telephone/Fax (1) 673**] if you have any
of the following:
fever (101 or greater), chills, nausea, vomiting, inability to
take any of your medications, jaundice, increased abdominal
pain/distension, incision redness/bleeding/drainage, or
constipation.
You may shower. Do not apply powder/lotion/ointment to incision
No heavy lifting/straining or any concerns.
Follow Transplant Binder instructions
No driving while taking pain medication

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] [**6-8**] at 9:30 (Transplant Surgeon at [**Last Name (NamePattern1) 12939**])
Department: TRANSPLANT
When: MONDAY [**2119-6-12**] at 11:10 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: TRANSPLANT CENTER
When: THURSDAY [**2119-6-15**] at 9:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: TRANSPLANT CENTER
When: WEDNESDAY [**2119-6-21**] at 9:40 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage


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

Completed by:[**2119-6-2**]
{'Alcoholic cirrhosis of liver,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Unspecified viral hepatitis C without hepatic coma,Personal history of malignant neoplasm of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Personal history of tobacco use,Obstructive sleep apnea (adult)(pediatric)'}


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: HCV/ETOH cirrhosis

PRESENT ILLNESS: 60M with HCV and alcoholic cirrhosis and HCC s/p RFA x
2([**2118-11-30**]/[**2119-1-31**]) with no evidence of recurrent
disease presents for ABO compatible liver transplantation.  He
denies fevers, chills, nausea, vomiting, abdominal pain and sick
contacts. [**Name (NI) **] reports his appetite has been stable and denies any
weight loss.  His last BM was this morning and was normal in
appearance.  He denies chest pain, shortness of breath, and
dysuria.  He does reports some back pain which he was told was
due to degenerative disk disease or peripheral neuropathy from
his diabetes.

MEDICAL HISTORY: Past Medical History: HCV and alcoholic cirrhosis, mild
hypertension, bipolar depression

MEDICATION ON ADMISSION: Gabapentin 300 mg three times a day, Vistaril 50 mg p.r.n.
anxiety which he takes very rarely, Levemir insulin 30 units
subcutaneously q.a.m., Humalog insulin sliding scale,
lamotrigine
200 mg daily, lisinopril 40 mg daily, Toprol-XL 50 mg daily,
Januvia 100 mg daily, and trazodone 50 mg q.h.s.

ALLERGIES: Penicillins / Codeine / Bactrim

PHYSICAL EXAM: Vitals: 97.5 143/92 72 20 97RA
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
DRE: normal tone, no gross or occult blood
Ext: No LE edema, LE warm and well perfused, peripheral pulses
intact, [**5-4**] muscle strength bilaterally, normal sensation
bilaterally

FAMILY HISTORY: No family history of colon cancer, liver disease, or pancreatic
cancer.  Both parents lived to their early 90's

SOCIAL HISTORY: No EtOH x 5 months, Non-smoking x 41 days, no drug use x 5
years. 

### Response:
{'Alcoholic cirrhosis of liver,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Unspecified viral hepatitis C without hepatic coma,Personal history of malignant neoplasm of liver,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Personal history of tobacco use,Obstructive sleep apnea (adult)(pediatric)'}
