CHIEF COMPLAINT: Endstage liver disease. Here for DCD liver
transplant.

PRESENT ILLNESS: The patient is a 53-year-old
male with a history of hepatitis C virus cirrhosis, endstage
liver disease, first diagnosed approximately 2 years prior to
admission. He also has a history of alcohol abuse. Recently
the patient was admitted to [**Hospital1 18**] approximately 2 weeks prior
to admission with right upper quadrant pain and headache and
was found to have a distended gallbladder with stones. He
underwent an ERCP with sphincterotomy at that time and was
discharged home on [**2107-2-22**] with a 7-day course of
Flagyl and Levaquin. He has felt well over the past week
prior to his admission.

MEDICAL HISTORY: Significant for endstage liver
disease, hepatitis C virus cirrhosis, post traumatic stress
disorder, depression, history of long QT, hypertension, grade
1 esophageal varices, endocarditis and poly substance abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Posttraumatic stress disorder, polysubstance
abuse, IV drug abuse in the past and was using heroin,
cocaine and alcohol; now on methadone. The patient is married
with 4 children, worked as a truck driver x25 years on
disability currently.
Combinations of opioid type drug with any other drug dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Portal hypertension,Esophageal varices without mention of bleeding,Unspecified essential hypertension,Other abnormal glucose,Other hamartoses, not elsewhere classified,Ostium secundum type atrial septal defect,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Alcohol abuse, unspecified,Malignant neoplasm of liver, not specified as primary or secondary
Opioid/other dep-contin,Peritoneal adhesions,Portal hypertension,Esoph varices w/o bleed,Hypertension NOS,Abnormal glucose NEC,Hamartoses NEC,Secundum atrial sept def,Posttraumatic stress dis,Depressive disorder NEC,Cirrhosis of liver NOS,Hpt C w/o hepat coma NOS,Alcohol abuse-unspec,Malignant neo liver NOS
Admission Date: [**2107-2-28**]        Discharge Date: [**2107-3-10**]

Date of Birth:  [**2053-3-13**]        Sex:  M

Service:  Liver Transplant Surgery Service


This is a 53-year-old patient who was admitted to the
transplant service on [**2107-2-28**]. He was admitted
under Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **].

CHIEF COMPLAINT:  Endstage liver disease. Here for DCD liver
transplant.

HISTORY OF PRESENT ILLNESS:  The patient is a 53-year-old
male with a history of hepatitis C virus cirrhosis, endstage
liver disease, first diagnosed approximately 2 years prior to
admission. He also has a history of alcohol abuse. Recently
the patient was admitted to [**Hospital1 18**] approximately 2 weeks prior
to admission with right upper quadrant pain and headache and
was found to have a distended gallbladder with stones. He
underwent an ERCP with sphincterotomy at that time and was
discharged home on [**2107-2-22**] with a 7-day course of
Flagyl and Levaquin. He has felt well over the past week
prior to his admission.

REVIEW OF SYMPTOMS:  He denied any fevers, chills, rigors,
upper respiratory infection symptoms, GI symptoms including
diarrhea, melena, hematochezia, UTI symptoms or recent
changes in headache or hematemesis.

PAST MEDICAL HISTORY:  Significant for endstage liver
disease, hepatitis C virus cirrhosis, post traumatic stress
disorder, depression, history of long QT, hypertension, grade
1 esophageal varices, endocarditis and poly substance abuse.

ALLERGIES:  No known drug allergies.

MEDICATIONS:
1.  Percocet, not seeking now.
2.  Protonix 40 mg PO once daily.
3.  Citalopram 20 mg PO once daily.
4.  Folic acid 1 mg PO once daily.
5.  Thiamine 100 mg PO once daily.
6.  Lasix 40 mg PO once daily.
7.  Rifaximin 200 mg PO t.i.d.
8.  Nadolol 20 mg PO once daily.
9.  Lisinopril 10 mg PO once daily.
10. Lactulose 15 ml t.i.d.
11. Spironolactone 50 mg PO once daily.
12. Levofloxacin 500 mg 1 a day with 1 day left to complete 7-
    day treatment.
13. Flagyl 500 mg t.i.d. The patient complaining last day of
    treatment.
14. Multivitamin 1 tab PO once daily.
15. Methadone 5 mg PO once daily.

SOCIAL HISTORY:  Posttraumatic stress disorder, polysubstance
abuse, IV drug abuse in the past and was using heroin,
cocaine and alcohol; now on methadone. The patient is married
with 4 children, worked as a truck driver x25 years on
disability currently.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Temperature 98, heart rate 48, BP
102/62, respiratory rate 16, 95% on room air. Weight was
107.6 kg. He is in no acute distress. He is comfortable.
Regular rate and rhythm. Lungs are clear bilaterally. Abdomen
appeared soft and nontender, and appeared distended. Positive
ascites. Normal rectal tone, guaiac negative. No gross heme.
EXTREMITIES: No clubbing, cyanosis. 1+ pedal edema with
sitting. NEUROLOGIC: Alert and oriented x3. Cranial nerves II
through XII grossly intact. Cranial nerve X not tested. 5 out
of 5 strength throughout. 2+ lower extremity reflexes at
knees.

The patient was preop'd. An EKG was done as well as a chest x-
ray. Chest x-ray demonstrated no acute cardiopulmonary
abnormality. Urinalysis was sent off. Urine was negative. The
patient was started on preoperative heparin and Unasyn. Of
note an echo on [**2106-12-30**] demonstrated an EF of
greater that 55% with a patent foramen ovale. A
catheterization on [**2106-9-14**] demonstrated mild
pulmonary hypertension. PST's on [**2106-7-23**] demonstrated
decreased diffusion capacity (isolated), ? perfusion
limitation.

The patient was taken to the OR on [**3-1**] for orthotopic
DCD liver transplant. Surgeon was Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **],
assisted by Dr. [**First Name (STitle) **] [**Name (STitle) **], and assisted by resident Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Please see operative report for further details.
No complications occurred. EBL was 2 liters. He received 6
liters of Plasmalyte, 2 units of fresh frozen plasma, 5 units
of packed red blood cells, 3 units of platelets, and 1500 cc
of cell [**Doctor Last Name 10105**]. Urine output was 3370 cc. He also received 1
unit of cryoglobulin. Assessment of the liver was sent to
pathology. Two JP drains were placed. He was stable. He was
intubated and transferred to the surgical intensive care unit
where he remained for a total of 5 days during which time his
liver function tests initially increased. AST was 2471 up
from 115. ALT was 1161, up from 55. Alkaline phosphatase 164,
up from 135 and total bilirubin 13.9 up from 2.9. His
hematocrit was relatively stable at 32.3.

On postoperative day 1, he did receive 2 units of packed red
blood cells and one bag of platelets. His hematocrit dropped
down to 22 as well as platelet count decreased into 40s. He
received 4 units of packed red blood cells as well as 3 bags
of platelets and repeat hematocrit was 30 and platelet count
of 86. He was extubated on postoperative day 1. Pressures
were off as of day 1. He was maintained on an insulin drop
for hyperglycemia with blood sugars ranging to 143. A liver
duplex was done. This demonstrated normal arterial, venous,
and portal venous wave forms. A tiny amount of ascites was
noted on [**2107-3-1**]. Repeat chest x-ray was done that
demonstrated satisfactory positioning of all lines and tubes
without any pneumothorax and bibasilar atelectasis was noted
with the left side greater than the right side.

On [**3-1**] he had pathology assessment of the native
liver that demonstrated well differentiated hepatocellular
carcinoma 1 cm present in the right lobe. No vascular
invasion was seen. A nodule of small cell dysplasia measuring
0.6 cm in diameter was present in the left lobe. Serosa with
grade 2 inflammation was noted.  Multiple bile duct
hamartomas were noted. Iron stain demonstrated moderate iron
deposition in hepatic sites and bile ducts. It was
recommended that the patient be evaluated to rule out iron
overload disease. The gallbladder appeared with mild
autolytic changes and there was negative vascular and biliary
margin. Trichome and reticulin stains were evaluated. A
biopsy of the liver donor demonstrated predominantly
macrovascular steatosis involving 20% of the liver
parenchyma. Bile duct hamartoma was noted with no significant
inflammation. Liver function tests trended down daily. By
postoperative day 5 his AST was 62, ALT 188, alkaline
phosphatase 176 with a bilirubin of 3.1. Creatinine
diminished to 1.0 and ranged between 1.1 to 1.3. His
hematocrit remained stable throughout the remainder of the
hospital course. His medial JP was removed on postoperative
day 5 and the lateral JP was removed on postoperative day 8.
His incision appeared clean, dry and intact.

He received pamidronate 30 mg IV x1 on postoperative 5. For
immunosuppression he remained on CellCept 1 gram PO b.i.d..
Solu-Medrol was tapered per protocol over the course of the
hospital stay down to 20 mg PO once daily and he was
discharged home on 20 mg of prednisone PO once daily.

Prograf was initiated on postoperative day 1 at 1 mg PO
b.i.d. This was up titrated to 5 mg over the course of 4
days. Prograf level was achieved of 15.4. The Prograf dosing
was decreased to 3 mg b.i.d. and repeat Prograf level
demonstrated a level of 15.4. He was decreased to 3 mg PO
b.i.d of Prograf. Hepatology followed throughout his hospital
course concurring with the plan. Given the low platelet
count, the HIT antibody was checked; this was subsequently
found to be negative. Platelets increased to 112 by the day
of discharge.

In the surgical intensive care unit he received IV diuresis
using Diamox. A chest x-ray demonstrated no overt evidence of
CHF. A repeat chest x-ray on [**2107-3-3**] demonstrated
bilateral pleural effusions and associated bibasilar
atelectasis as well as discoid atelectasis in the right
apical region.

Of note on [**2107-3-1**] the patient received intraop
cardiac echo for evaluation of ASD/patent foramen ovale.
Ejection fraction was 50 to 60%. Conclusion demonstrated tiny
atrial septal defect seen by color Doppler with minimal left
to right flow. They were unable to obtain adequate
transgastric views. The left ventricle was not well seen from
the transgastric. It was noted that the left ventricle was
grossly normal in function without significant wall motion
abnormalities. The right ventricle appeared normal. Aortic
leaflet appeared structurally normal with leaflet excursion
and no aortic regurgitation. The mitral valve leaflets
appeared structurally normal. There was mild 1+ mitral
regurgitation seen as well as 2+ moderate tricuspid
regurgitation.

[**Last Name (un) **] was consulted for management of hyperglycemia. He was
placed on 70/30 insulin q a.m. and pre supper as well as the
Humalog sliding scale. Blood sugars were decreased. Nutrition
consult was obtained. Diet was progressed. By the time of
discharge he was tolerating a regular diet without problems.

He was started on 10 mg of methadone and was maintained on
this. Towards the end of hospital stay it was discovered that
the patient had actually been weaned off his methadone
maintenance program on [**2-15**], and had been restarted on
methadone on admission to the hospital. After consultation
with the methadone clinic it was decided to taper and wean
the patient from methadone. He dose was decreased and he was
sent him with 2.5 mg of methadone one a day for 2 days and
then off; the methadone was to be stopped. He tolerated this
taper well without incident. He also took oral pain
medication in the form of Percocet for discomfort.

Psychiatry was called to discuss management of his history of
depression and PTSD. Recommendations included resuming
Risperdal and Celexa. This was restarted on hospital day 5.
He appeared clear. He did comment that his mood was somewhat
depressed but he was given reassurance that the prednisone
taper would help to alleviate some of this depressed mood.

Physical therapy followed the patient and discharged him home
without home PT.

He continued to receive IV Lasix 20 mg b.i.d. for generalized
edema. His preoperative weight was 107.6; this had increased
to 122.9 kg on postoperative day 2. This continued diuresis.
His weight decreased to 115.4 on postoperative day 8.

He was sent home on Lasix 20 mg PO once daily. He was
discharged home on postoperative day 9 in stable condition.
He was alert and oriented. His lungs were clear. Heart rate
was regular. His abdomen appeared rounded. He had positive
bowel sounds and was passing flatus. He was tolerating a
regular diet, voiding independently without any problems. His
incision was open to air with staples.

LABORATORY DATA ON DISCHARGE:  White blood cell count 10.2,
hematocrit 31.5, platelet count 111. His creatinine was 1.3,
and his BUN 29. AST was 41,  ALT 99, alkaline phosphatase 208
and total bilirubin was 2.4. He and his wife received
instructions on administration of insulin. The visiting nurse
services were set up. VNA was set up.

DISCHARGE MEDICATIONS:
1.  Prednisone 20 mg PO once daily.
2.  Protonix 40 mg PO once daily.
3.  Percocet 1 to 2 tablets PO p.r.n. q 4 to 6 hours.
4.  Fluconazole 400 mg PO once daily.
5.  CellCept 1 gram PO b.i.d.
6.  Lisinopril 10 mg PO once daily.
7.  Celexa 20 mg PO once daily.
8.  Multivitamin 1 tablet PO once daily.
9.  Bactrim single strength 1 tab PO once daily.
10. Methadone 2.5 mg PO once daily x2 days and then stop.
11. Risperdal 1 mg PO qhs.
12. Prograf 3 mg PO b.i.d.
13. Valcyte 900 mg PO once daily.
14. Lasix 20 m PO once daily.
15. Insulin 70/30. Insulin 10 units s.c. q a.m. and 3 units
    of s.c pre supper.
16. Insulin Humalog sliding scale.

The patient was scheduled to follow up with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) **] on [**2107-3-16**] at 10:30 a.m.

CONDITION ON DISCHARGE:  Stable.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD,PHD[**Numeric Identifier **]

Dictated By:[**Name8 (MD) 4664**]
MEDQUIST36
D:  [**2107-3-11**] 16:34:39
T:  [**2107-3-12**] 06:11:57
Job#:  [**Job Number 109453**]
{'Combinations of opioid type drug with any other drug dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Portal hypertension,Esophageal varices without mention of bleeding,Unspecified essential hypertension,Other abnormal glucose,Other hamartoses, not elsewhere classified,Ostium secundum type atrial septal defect,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Alcohol abuse, unspecified,Malignant neoplasm of liver, not specified as primary or secondary'}


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: Endstage liver disease. Here for DCD liver
transplant.

PRESENT ILLNESS: The patient is a 53-year-old
male with a history of hepatitis C virus cirrhosis, endstage
liver disease, first diagnosed approximately 2 years prior to
admission. He also has a history of alcohol abuse. Recently
the patient was admitted to [**Hospital1 18**] approximately 2 weeks prior
to admission with right upper quadrant pain and headache and
was found to have a distended gallbladder with stones. He
underwent an ERCP with sphincterotomy at that time and was
discharged home on [**2107-2-22**] with a 7-day course of
Flagyl and Levaquin. He has felt well over the past week
prior to his admission.

MEDICAL HISTORY: Significant for endstage liver
disease, hepatitis C virus cirrhosis, post traumatic stress
disorder, depression, history of long QT, hypertension, grade
1 esophageal varices, endocarditis and poly substance abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Posttraumatic stress disorder, polysubstance
abuse, IV drug abuse in the past and was using heroin,
cocaine and alcohol; now on methadone. The patient is married
with 4 children, worked as a truck driver x25 years on
disability currently. 

### Response:
{'Combinations of opioid type drug with any other drug dependence, continuous,Peritoneal adhesions (postoperative) (postinfection),Portal hypertension,Esophageal varices without mention of bleeding,Unspecified essential hypertension,Other abnormal glucose,Other hamartoses, not elsewhere classified,Ostium secundum type atrial septal defect,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Alcohol abuse, unspecified,Malignant neoplasm of liver, not specified as primary or secondary'}
