CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 80-year-old
female with history of congestive heart failure manifested as
diastolic dysfunction with hepatitis C with cirrhosis
admitted [**2151-6-8**] to regular Medicine floor for multiple
problems which included back pain for three days, had an
episode of shortness of breath, no palpitations, some nausea,
but no vomiting.  No abdominal pain, no upper respiratory
infection symptoms, no edema.

MEDICAL HISTORY: 1. Hepatitis C with cirrhosis.
2. Hepatic encephalopathy, ascites.
3. Congestive heart failure.
4. Diastolic dysfunction.
5. Coronary artery disease.
6. Bladder cancer status post bladder resection.
7. Factor XII deficiency.
8. Gallbladder pancreatitis.
9. L4-L5 stenosis.
10. Bilateral total hip replacement.
11. Chronic obstructive pulmonary disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Morphine, manifesting as hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute on chronic diastolic heart failure,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Congenital deficiency of other clotting factors,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pathologic fracture of vertebrae,Acute cholecystitis
Ac on chr diast hrt fail,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Cong def clot factor NEC,Chr airway obstruct NEC,Acute kidney failure NOS,Urin tract infection NOS,Path fx vertebrae,Acute cholecystitis
Admission Date:  [**2151-6-8**]       Discharge Date:  [**2151-6-22**]


Service:  Medical Intensive Care Unit [**Location (un) **] Team

HISTORY OF PRESENT ILLNESS:  The patient is an 80-year-old
female with history of congestive heart failure manifested as
diastolic dysfunction with hepatitis C with cirrhosis
admitted [**2151-6-8**] to regular Medicine floor for multiple
problems which included back pain for three days, had an
episode of shortness of breath, no palpitations, some nausea,
but no vomiting.  No abdominal pain, no upper respiratory
infection symptoms, no edema.

PAST MEDICAL HISTORY:
1. Hepatitis C with cirrhosis.
2. Hepatic encephalopathy, ascites.
3. Congestive heart failure.
4. Diastolic dysfunction.
5. Coronary artery disease.
6. Bladder cancer status post bladder resection.
7. Factor XII deficiency.
8. Gallbladder pancreatitis.
9. L4-L5 stenosis.
10. Bilateral total hip replacement.
11. Chronic obstructive pulmonary disease.

ALLERGIES: Morphine, manifesting as hallucinations.

MEDICATIONS UPON ADMISSION:
1. Aldactone 50 q day.
2. Prozac 20 q day.
3. Combivent two puffs 3x a day.
4. Lasix 60 mg q day.
5. Neomycin 500 q day.
6. Propanolol 20 [**Hospital1 **].
7. Folic acid.
8. Vitamin D 400.
9. Multivitamins.
10. Calcium.
11. Prilosec 20 q day.

Patient's vital signs:  97.6, heart rate of 72, blood
pressure 175/81, 96% on room air.  General exam was in no
acute distress.  HEENT:  Pupils are equal, round, and
reactive to light and accommodation.  Extraocular muscles are
intact.  Icteric sclerae.  Neck showed no jugular venous
distention, supple.  Chest had some dullness at the right
base, no rhonchi.  Cardiac exam was regular rate, rhythmic.
Noted was a 1/6 systolic ejection murmur at the right upper
sternal border, no gallop, S1, S2 noted.  Abdominal
examination is soft, nontender, nondistended, normal
abdominal bowel sounds, urostomy bag was intact.  Extremities
showed +2 left lower extremity edema, pitting; +1 right lower
extremity edema pitting.  The patient is alert and oriented.
Cranial nerves II through XII were grossly intact.

LABORATORIES ON ADMISSION:  White count 8.3, hematocrit 38.4,
platelets 100, MCV 101, differential:  Neutrophils 57,
lymphocytes 21.7, monocytes 6.  Sodium 142, potassium 3.8,
chloride 101, bicarbonate 29, BUN 22, creatinine 0.8, glucose
is 92.  ALT 42, AST 82, total bilirubin 2.6, alkaline
phosphatase 208, amylase 99, lipase 87.

Electrocardiogram done showed normal sinus rhythm at 75 beats
per minute, normal axis, normal intervals, QRS prolongation,
noted was a right bundle branch block.  Q wave and T-wave
inversion in V4 through V6, but noted no ST elevations or
depressions.

Urinalysis showed a specific gravity of 1.020, positive
nitrates, red blood cells [**3-31**], white blood cells [**3-31**], protein
30.

HOSPITAL COURSE:  On [**6-10**], it was noted that the patient's
blood pressure dropped to 64 systolic complaining of fatigue.
Bolus of 250 cc of normal saline which brought blood
pressure up to 78 systolic.

On [**2151-6-11**], the patient was noted to be hypotensive and
during the evening, blood pressure was 54 systolic
subsequently requiring boluses of normal saline.  Blood
pressure responds to 100 systolic, however, with continued
minimum urine output, with no ischemic changes shown per
electrocardiogram, however, peaked T waves were suggestive of
over-diuresis as well as ensuing renal hypoperfusion.  Also
noted was acute renal failure, creatinine of 2.1 from
previous of 0.8 noted on admission likely due to prerenal
cause.

Atypical mixed bacterial flora.  Repeat enzyme workup was not
suggestive of ischemia.  Physical examination: No evidence of
acute congestive heart failure was noted with hypotension.
Even input and output.

CXR done on [**6-11**] was also clear, no
cardiopulmonary infiltrates noted.  On [**6-9**] left base of
duplex showed no evidence of DVT.  On [**6-11**] an abdominal
ultrasound done showed no ascites, but cirrhosis, marginally
distended 7 x 10 cm gallbladder, essentially small
nonobstructing kidney stone.  Echocardiogram showed no
systolic dysfunction with a question of diastolic
dysfunction.

Another differential for patient's hypotension was
hepatorenal syndrome.  On [**6-9**], an echocardiogram showed
left ventricular hypertrophy, with an ejection fraction of
greater than 55% with wall motion, no effusions.  Spine films
on [**6-8**] showed diffuse osteopenia, and a compression
fracture of T10, T11, and T13 of undetermined age.

Given the event of hypotension, the patient was transferred
on [**2151-6-11**] to the Coronary Care Unit.  Patient showed
persistent hypotension.  On [**6-12**], Surgery was consulted for
evaluation of right upper quadrant abdominal pain.
Recommended percutaneous gastrostomy tube placed as well as
antibiotics, proton-pump inhibitors, total parenteral
nutrition.  With troponin peaking at 4.8, with
thrombocytopenia likely due to liver disease.  The patient
was started on TPN on [**2151-6-14**].  He was continued NPO, and
the patient was then transferred to the Medical Intensive
Care Unit.

The patient was continued on the levofloxacin and Flagyl, for
an additional two weeks. Interventional Radiology performed
ultrasound guided placement of the cholecystostomy tube,
pigtail catheter inserted, without any complications.  Five
hundred cc of bile were aspirated and sent for culture.
Sample of bile ultimately grew gram-positive cocci in pairs.

Octreotide was discontinued in response to the patient's
fever.  Chest x-ray was done with congestive heart failure.
Therefore, IV Lasix was given, following serial electrolytes.
Physical Therapy was consulted on ambulation.  Saturation was
82% on 3 liters oxygen.  The patient was diuresed for about 2
liters without any improvement.  Hydralazine, as well as
isosorbide was added to decrease afterload.

Congestive heart failure attending specialist suggested
treatment with Natrecor.  Resultant diuresis more than 1
liter with prn Lasix. Bile culture done on [**6-14**] showed
Enterococcus species with a bedside swallowing evaluation
suggesting possible aspiration, with thick nectar fluids, but
no signs of aspiration of puree fluid.

The patient is to keep NPO until a video swallowing study
could be done.  On [**2151-6-19**] a chest CT scan was undertaken
for possibility of pulmonary embolus versus ARDS, which
showed signs of heart failure.  The patient was short of
breath.  Microbiologic cultures, Clostridium difficile
cultures turned to be negative.  The patient is noted to have
increasing white blood cell count of 19.1 from previous of
17.6 and also increasing liver function tests as well as
elevated AST as well as alkaline phosphatase of 112.  P.o.
diuresis with Lasix, with a goal of -500 cc/day.  Noninvasive
ventilation was tried as needed.

Antibiotic triple coverage of ampicillin, Flagyl, and
levofloxacin was continued.  Abdominal ultrasound was
repeated on [**2151-6-20**] showing no signs of obstructions, and
normal common bile duct.  Lasix drip was started 5 mg to 8
mg.  Patient had an episode of agitation overnight and was
given Ativan and Fentanyl with impending continued
respiratory requirement with a very high FIO2, 100% on
nonrebreather.  In spite of aggressive care to cover
cardiogenic versus noncardiogenic pulmonary condition, the
patient has been gradually deteriorating.

His prognosis was discussed with primary care doctor, Dr.
[**First Name (STitle) 679**], and the patient's family, who decided that patient
would be DNR/DNI, that patient would be designated to have
comfort measures only.

Therefore on [**2151-6-21**] all medications were discontinued
except drip for pain control, continued to have respiratory
failure and deterioration of cardiac status.

The patient expired at 1:15 pm, pronounced at 1:15 pm after
noting aystolle, no response to physical stimuli, no
respirations, pulse, nor heart beat was noted by physical exam.

The patient's family was made aware of the events, and have
declined postmortem.



                            [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7585**]

Dictated By:[**Last Name (NamePattern1) 17322**]
MEDQUIST36

D:  [**2151-6-22**]  14:56
T:  [**2151-6-22**]  15:55
JOB#:  [**Job Number **]
{'Acute on chronic diastolic heart failure,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Congenital deficiency of other clotting factors,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pathologic fracture of vertebrae,Acute cholecystitis'}


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: The patient is an 80-year-old
female with history of congestive heart failure manifested as
diastolic dysfunction with hepatitis C with cirrhosis
admitted [**2151-6-8**] to regular Medicine floor for multiple
problems which included back pain for three days, had an
episode of shortness of breath, no palpitations, some nausea,
but no vomiting.  No abdominal pain, no upper respiratory
infection symptoms, no edema.

MEDICAL HISTORY: 1. Hepatitis C with cirrhosis.
2. Hepatic encephalopathy, ascites.
3. Congestive heart failure.
4. Diastolic dysfunction.
5. Coronary artery disease.
6. Bladder cancer status post bladder resection.
7. Factor XII deficiency.
8. Gallbladder pancreatitis.
9. L4-L5 stenosis.
10. Bilateral total hip replacement.
11. Chronic obstructive pulmonary disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Morphine, manifesting as hallucinations.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute on chronic diastolic heart failure,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Congenital deficiency of other clotting factors,Chronic airway obstruction, not elsewhere classified,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pathologic fracture of vertebrae,Acute cholecystitis'}
