CHIEF COMPLAINT: weakness, dyspnea

PRESENT ILLNESS: 62-year-old M with history of cholangiocarcinoma (C2D15
gemcitabine and oxaliplatin on [**2142-4-9**]), CAD, remote renal
transplant, who presents with diffuse weakness, rigors, dyspnea,
emesis x 1.

MEDICAL HISTORY: - Renal transplant (LRRT) [**2105**] [**1-1**] to post-strep GN on imuran
- CAD with MI in [**12/2135**] s/p stent. MI in [**10/2136**] and area of
stent was found to be occluded but no other interventions done.
First stent was BMS; found to have total occlusion; at
subsequent cath had attempt at correcting with placement of [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) **]/b dissection and resulting no flow at end of procedure.
- TIA/stroke in left eye causing decreased vision
- Hyperlipidemia
- Depression
- Hypertension
- Avascular necrosis of his left patella
- Recent diagnosis of adenocarcinoma at liver, s/p liver biopsy
[**1-17**].
- Mild chronic cardiomyopathy with LVEF of 50-55%
- Small secundum ASD
- Hiatal hernia

MEDICATION ON ADMISSION: APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose Pack - 1 Capsule(s) by mouth once a day Take 125mg 1 hr
prior to chemotherapy on day 1 and 80mg tablet in am first and
second day after chemo
AZATHIOPRINE [IMURAN] - 50 mg Tablet - 2 Tablet(s) by mouth
daily
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - (Prescribed by Other
Provider) - 50,000 unit Capsule - one Capsule(s) by mouth one
tablet per week times 4 weeks Last dose taken on [**2142-1-16**]
LORAZEPAM - 0.5 mg Tablet - [**12-1**] Tablet(s) by mouth q6-8hrs as
needed for nausea, anxiety, insomnia avoid if ovrsedated
MEGESTROL - 400 mg/10 mL Suspension - [**9-18**] mL by mouth once a
day Start at 10mL, can increase to 20mL
METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth prior to
meals (three times a day)
METOPROLOL SUCCINATE [TOPROL XL] - 50 mg Tablet Sustained
Release 24 hr - one Tablet(s) by mouth once a day
MORPHINE - 30 mg Tablet Sustained Release - One Tablet(s) by
mouth Twice daily, every 12 hours
MORPHINE - 15 mg Tablet - one Tablet(s) by mouth every six horus
as needed for as needed for pain
PANTOPRAZOLE [PROTONIX] - 40 mg Tablet, Delayed Release (E.C.) -
1 Tablet(s) by mouth daily. brand name only
PREDNISONE - 5 mg Tablet - 1 Tablet(s) by mouth daily
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
three times a day as needed for nausea
SERTRALINE [ZOLOFT] - 100 mg Tablet - 1 Tablet(s) by mouth daily

ALLERGIES: Horse Blood Extract / Lipitor

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: distended and tympanic but soft, non-tender, bowel
sounds present, no rebound tenderness or guarding, unable to
appreciate hsm on palpation, percussion consistent with
hepatomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact, intact sensation to touch and 5/5 strength
throughout.

FAMILY HISTORY: Mother had [**Name2 (NI) 499**] cancer; maternal uncle and paternal aunt had
liver cancer. Maternal aunt had pancreatic cancer. The patient
does not know if they had cirrhosis or not.

SOCIAL HISTORY: Married. No smoking, he drinks alcohol almost on a daily basis,
2 to 3 drinks daily. This has been ongoing for 15 to 20 years.
He also smokes marijuana a few times per week due to nausea. He
denies any cocaine or heroin. He works in school food services.
Dehydration,Acute kidney failure, unspecified,Other ascites,Other primary cardiomyopathies,Malignant neoplasm of intrahepatic bile ducts,Ostium secundum type atrial septal defect,Kidney replaced by transplant,Hypotension, unspecified,Anemia in neoplastic disease,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery
Dehydration,Acute kidney failure NOS,Ascites NEC,Prim cardiomyopathy NEC,Mal neo intrahepat ducts,Secundum atrial sept def,Kidney transplant status,Hypotension NOS,Anemia in neoplastic dis,Depressive disorder NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl
Admission Date:  [**2142-4-16**]              Discharge Date:   [**2142-4-19**]

Date of Birth:  [**2080-1-12**]             Sex:   M

Service: MEDICINE

Allergies:
Horse Blood Extract / Lipitor

Attending:[**First Name3 (LF) 3016**]
Chief Complaint:
weakness, dyspnea

Major Surgical or Invasive Procedure:
Paracentesis
Blood transfusion with 6 units of packed red blood cells


History of Present Illness:
62-year-old M with history of cholangiocarcinoma (C2D15
gemcitabine and oxaliplatin on [**2142-4-9**]), CAD, remote renal
transplant, who presents with diffuse weakness, rigors, dyspnea,
emesis x 1.

This morning, the patient's wife found him in the showers,
crouching over, rigoring, with dyspnea, complaining of
generalized weakness. At home, T was 98.1. His symptoms are
associated with worsening abdominal distention over the last few
days. He also complains of watery diarrhea over the last few
months. He denies headache, visual changes, weakness or
paresthesias. No changes in smell. No CP. No sore throat, cough
rhinorrhea. No weight loss. Had similar symptoms on thursday but
did not make much of them. Over last few weeks had decreased
appetite and has been taking appetite stimulant. His anginal
equivalent is chest pain.

Patient received C2D15 of his gemcitabine and oxaliplatin on
[**2142-4-9**]. His first cycle was uncomplicated.

Of note, his clopidogrel and ASA were discontinued in [**Month (only) **] for
liver biopsy.

In ED, T 95.5, BP 80-100s/50-70s (baseline SBP 100s), HR 120s,
RR 24, 100%RA. Exam revealed distended abdomen with significant
hepatomegaly. ECG showed no ischemic changes. Labs were notable
for Hct 21, AG of 16 with lactate 4.5. He received 3L NS, and HR
decreased to 90s. With hypothermia, tachycardia, lactic
acidosis, and ongoing chemo, he received empiric vancomycin and
pip-tazo and was admitted to the MICU.

In the floor he complains of abdominal pain and worsened
abdominal distention. He doesnt have any other complaints but
expresses being sad regarding his cancer burden.

Review of sytems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denied coughs. Denied chest pain or tightness, palpitations. No
dysuria. Denied arthralgias or myalgias. Denies hematochezia,
melena, arthralgias.


Past Medical History:
- Renal transplant (LRRT) [**2105**] [**1-1**] to post-strep GN on imuran
- CAD with MI in [**12/2135**] s/p stent. MI in [**10/2136**] and area of
stent was found to be occluded but no other interventions done.
First stent was BMS; found to have total occlusion; at
subsequent cath had attempt at correcting with placement of [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) **]/b dissection and resulting no flow at end of procedure.
- TIA/stroke in left eye causing decreased vision
- Hyperlipidemia
- Depression
- Hypertension
- Avascular necrosis of his left patella
- Recent diagnosis of adenocarcinoma at liver, s/p liver biopsy
[**1-17**].
- Mild chronic cardiomyopathy with LVEF of 50-55%
- Small secundum ASD
- Hiatal hernia


Social History:
Married. No smoking, he drinks alcohol almost on a daily basis,
2 to 3 drinks daily. This has been ongoing for 15 to 20 years.
He also smokes marijuana a few times per week due to nausea. He
denies any cocaine or heroin. He works in school food services.


Family History:
Mother had [**Name2 (NI) 499**] cancer; maternal uncle and paternal aunt had
liver cancer. Maternal aunt had pancreatic cancer. The patient
does not know if they had cirrhosis or not.


Physical Exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: distended and tympanic but soft, non-tender, bowel
sounds present, no rebound tenderness or guarding, unable to
appreciate hsm on palpation, percussion consistent with
hepatomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact, intact sensation to touch and 5/5 strength
throughout.


Pertinent Results:
[**2142-4-16**] 11:42AM   LACTATE-4.5*
[**2142-4-16**] 11:35AM   GLUCOSE-136* UREA N-23* CREAT-1.5* SODIUM-136
POTASSIUM-3.5 CHLORIDE-100 TOTAL CO2-20* ANION GAP-20
[**2142-4-16**] 11:35AM   estGFR-Using this
[**2142-4-16**] 11:35AM   ALT(SGPT)-14 AST(SGOT)-28 CK(CPK)-49 ALK
PHOS-151* TOT BILI-1.0
[**2142-4-16**] 11:35AM   LIPASE-62*
[**2142-4-16**] 11:35AM   CK-MB-NotDone cTropnT-0.02*
[**2142-4-16**] 11:35AM   ALBUMIN-3.1* IRON-27*
[**2142-4-16**] 11:35AM   calTIBC-152* VIT B12-1013* FOLATE-6.2
FERRITIN-1455* TRF-117*
[**2142-4-16**] 11:35AM   TSH-4.7*
[**2142-4-16**] 11:35AM   WBC-9.0# RBC-2.26* HGB-6.8* HCT-21.0* MCV-93
MCH-30.2 MCHC-32.4 RDW-20.6*
[**2142-4-16**] 11:35AM   PT-18.4* PTT-29.5 INR(PT)-1.7*
[**2142-4-16**] 11:35AM   PT-18.4* PTT-29.5 INR(PT)-1.7*

CXR [**2142-4-16**]: FINDINGS: In comparison with the study of [**2142-2-26**],
the central catheter remains in position. Low lung volumes, but
no evidence of acute focal pneumonia, vascular congestion, or
pleural effusion.

Peritoneal cytology [**2142-4-18**]: pending


Brief Hospital Course:
62 yo male with hx of cholangiocarcinoma (C2D15 gemcitabine and
oxaliplatin on [**2142-4-9**]), CAD, remote renal transplant, who was
admitted due to hypotension, N/V, and abdominal pain, now
resolving

# Hypotension: With hypothermia initially, tachycardia, lactic
acidosis, and ongoing chemo, he received empiric vancomycin and
pip-tazo and was admitted to the MICU.  His SBPs remained stable
after initial volume resuscitation and his Vanc/zosyn was
stopped on [**4-18**].   He underwent a paracentesis on [**4-18**] which
showed no evidence of SBP.  He remained afebrile and clinically
stable after the antibiotics were stopped.  His initial
hypotension was thought to be due to dehydration likely from
decreased po intake and vomiting.

# N/V: Patient had multiple days of N/V during his
hospitalization which resolved after he underwent a paracentesis
during which 6 L were removed from his abdomen. His nausea was
controled with Dronabinol 5 mg PO BID prn, Prochlorperazine 10
mg PO/IV Q6H prn, Ondansetron 8 mg IV Q8H prn, Metoclopramide 10
mg PO TID, and Lorazepam 0.5 mg PO Q4H prn.  He was given IVF
until he was able to tolerate adequate po intake.

# Lactic acidosis: Lactate of 4.5 on admission likely related to
hypovolemia.  Normalized after receiving IVF.

# Normocytic anemia: Likely secondary to recent chemotherapy. He
received a total of 6 units of PRBC during this hospitalization
over many days.  Anemia of chronic disease by recent iron
studies. Folate and Vit B12 normal/high.  He had no clinical
evidence of bleeding.

# Thrombocytopenia: Related to chemotherapy and perhaps
intrahepatic obstruction of portal circulation leading to
hypersplenism.  This remained stable in the mid 100's during
this admission.

# Acute renal failure:   Patient had a Cr of 1.5 on admission
thought to be due to hypovolemia as his UNa < 10.  He received
IVF with improvement of his Cr to baseline.

# Cholangiocarcinoma: Patient was dianoged in [**2141-12-31**], on s/p
two cycles of gemcitabine and oxaliplatin (#C2D15 on [**2142-4-9**]).
His pain was controlled with his home regimen: MS Contin 30 mg
PO Q12H with Morphine 15 mg PO Q6H:PRN. He will follow up with
his outpatient oncologist on [**4-25**].

# History of CAD: Patient had a MI in [**2135**] s/p BMS complicated
by in stent thrombosis and DES without flow improvement. Plavix
stopped in [**Month (only) **].  He was ruled out for MI on admission given his
hypotension.  He remained asymptomatic during this
hospitalization and was continued on his aspirin and statin.
His B-blocker was initially held due to hypotension, but
restarted after he had been clinically stable for a few days.

# h/o CAD with MI [**2135**] s/p BMS c/b in stent thrombosis and DES
without flow improvement. Anginal equivalent is chest pain. LVEF
of 50-55%.  R/O MI in MICU.  Note ASx currently.
- re-start asa, cont statin, off plavix since [**Month (only) **].

# S/p renal transplant: Patient on azathioprine and prednisone
as an outpatient. Cr improved to his baseline with IVF as above.
 Renal followed him during his admission and recommended
decreasing azathioprine from 100 mg daily to 50 mg daily.  He
was discharged on this lower dose.  He was continued on 5 mg
prednisone daily.

# Code: DNR/DNI


Medications on Admission:
APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose Pack - 1 Capsule(s) by mouth once a day Take 125mg 1 hr
prior to chemotherapy on day 1 and 80mg tablet in am first and
second day after chemo
AZATHIOPRINE [IMURAN] - 50 mg Tablet - 2 Tablet(s) by mouth
daily
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - (Prescribed by Other
Provider) - 50,000 unit Capsule - one Capsule(s) by mouth one
tablet per week times 4 weeks Last dose taken on [**2142-1-16**]
LORAZEPAM - 0.5 mg Tablet - [**12-1**] Tablet(s) by mouth q6-8hrs as
needed for nausea, anxiety, insomnia avoid if ovrsedated
MEGESTROL - 400 mg/10 mL Suspension - [**9-18**] mL by mouth once a
day Start at 10mL, can increase to 20mL
METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth prior to
meals (three times a day)
METOPROLOL SUCCINATE [TOPROL XL] - 50 mg Tablet Sustained
Release 24 hr - one Tablet(s) by mouth once a day
MORPHINE - 30 mg Tablet Sustained Release - One Tablet(s) by
mouth Twice daily, every 12 hours
MORPHINE - 15 mg Tablet - one Tablet(s) by mouth every six horus
as needed for as needed for pain
PANTOPRAZOLE [PROTONIX] - 40 mg Tablet, Delayed Release (E.C.) -
1 Tablet(s) by mouth daily. brand name only
PREDNISONE - 5 mg Tablet - 1 Tablet(s) by mouth daily
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
three times a day as needed for nausea
SERTRALINE [ZOLOFT] - 100 mg Tablet - 1 Tablet(s) by mouth daily

SIMVASTATIN - 80 mg Tablet - 1 Tablet(s) by mouth daily

Medications - OTC
ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet, Delayed
Release (E.C.) - 1 Tablet(s) by mouth daily Stopped [**2142-1-9**]
until [**2142-1-24**]- pre & post liver biopsy


Discharge Medications:
1. Azathioprine 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours
as needed for nausea, anxiety, insomnia.
3. Megestrol 400 mg/10 mL Suspension Sig: Ten (10) mL PO DAILY
(Daily).
4. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO at bedtime.
9. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for nausea.
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
11. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
12. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for break through pain. Tablet(s)
13. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): prior to meals.
14. Zofran 8 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for nausea.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Primary -
Hypotension
Nausea and vomiting
Anemia

Secondary -
History of renal transplantation


Discharge Condition:
Stable, afebrile, tolerating an a regular diet.


Discharge Instructions:
You were admitted to the hospital due to low blood pressure and
nausea and vomiting.  You were initially treated with
antibiotics due to concern for infection, however there was no
evidence of infection so these were stopped and you remained
stable.

Your abdomen is elarged due to fluid and some of this was
drained which improved your nausea and vomiting.  You were also
anemic likely secondary to recent chemotherapy you received.
You were transfused with a total of 6 units of packed red blood
cells over your hospitalization.

Medication changes:
1.  Your azathioprine (imuran) was decreased from 100 mg daily
to 50 mg daily.  You should only take 1 tablet daily of your
previous prescription.

Call your primary doctor, or go to the emergency room if you
experience fevers, chills, dizziness, shortness of breath, chest
pain, inability to tolerate oral intake, blood in your stool, or
black stool.

Followup Instructions:
Please keep your previously scheduled appointments:

Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2142-4-25**] 2:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2502**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2142-4-25**] 2:00
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 14688**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2142-4-25**] 3:30


                             [**Name6 (MD) **] [**Name8 (MD) 831**] MD, [**Doctor First Name 3018**]

Completed by:[**2142-4-20**]
{'Dehydration,Acute kidney failure, unspecified,Other ascites,Other primary cardiomyopathies,Malignant neoplasm of intrahepatic bile ducts,Ostium secundum type atrial septal defect,Kidney replaced by transplant,Hypotension, unspecified,Anemia in neoplastic disease,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery'}


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: weakness, dyspnea

PRESENT ILLNESS: 62-year-old M with history of cholangiocarcinoma (C2D15
gemcitabine and oxaliplatin on [**2142-4-9**]), CAD, remote renal
transplant, who presents with diffuse weakness, rigors, dyspnea,
emesis x 1.

MEDICAL HISTORY: - Renal transplant (LRRT) [**2105**] [**1-1**] to post-strep GN on imuran
- CAD with MI in [**12/2135**] s/p stent. MI in [**10/2136**] and area of
stent was found to be occluded but no other interventions done.
First stent was BMS; found to have total occlusion; at
subsequent cath had attempt at correcting with placement of [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) **]/b dissection and resulting no flow at end of procedure.
- TIA/stroke in left eye causing decreased vision
- Hyperlipidemia
- Depression
- Hypertension
- Avascular necrosis of his left patella
- Recent diagnosis of adenocarcinoma at liver, s/p liver biopsy
[**1-17**].
- Mild chronic cardiomyopathy with LVEF of 50-55%
- Small secundum ASD
- Hiatal hernia

MEDICATION ON ADMISSION: APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose Pack - 1 Capsule(s) by mouth once a day Take 125mg 1 hr
prior to chemotherapy on day 1 and 80mg tablet in am first and
second day after chemo
AZATHIOPRINE [IMURAN] - 50 mg Tablet - 2 Tablet(s) by mouth
daily
ERGOCALCIFEROL (VITAMIN D2) [VITAMIN D] - (Prescribed by Other
Provider) - 50,000 unit Capsule - one Capsule(s) by mouth one
tablet per week times 4 weeks Last dose taken on [**2142-1-16**]
LORAZEPAM - 0.5 mg Tablet - [**12-1**] Tablet(s) by mouth q6-8hrs as
needed for nausea, anxiety, insomnia avoid if ovrsedated
MEGESTROL - 400 mg/10 mL Suspension - [**9-18**] mL by mouth once a
day Start at 10mL, can increase to 20mL
METOCLOPRAMIDE - 10 mg Tablet - 1 Tablet(s) by mouth prior to
meals (three times a day)
METOPROLOL SUCCINATE [TOPROL XL] - 50 mg Tablet Sustained
Release 24 hr - one Tablet(s) by mouth once a day
MORPHINE - 30 mg Tablet Sustained Release - One Tablet(s) by
mouth Twice daily, every 12 hours
MORPHINE - 15 mg Tablet - one Tablet(s) by mouth every six horus
as needed for as needed for pain
PANTOPRAZOLE [PROTONIX] - 40 mg Tablet, Delayed Release (E.C.) -
1 Tablet(s) by mouth daily. brand name only
PREDNISONE - 5 mg Tablet - 1 Tablet(s) by mouth daily
PROCHLORPERAZINE MALEATE - 10 mg Tablet - 1 Tablet(s) by mouth
three times a day as needed for nausea
SERTRALINE [ZOLOFT] - 100 mg Tablet - 1 Tablet(s) by mouth daily

ALLERGIES: Horse Blood Extract / Lipitor

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: distended and tympanic but soft, non-tender, bowel
sounds present, no rebound tenderness or guarding, unable to
appreciate hsm on palpation, percussion consistent with
hepatomegaly.
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN2-12 intact, intact sensation to touch and 5/5 strength
throughout.

FAMILY HISTORY: Mother had [**Name2 (NI) 499**] cancer; maternal uncle and paternal aunt had
liver cancer. Maternal aunt had pancreatic cancer. The patient
does not know if they had cirrhosis or not.

SOCIAL HISTORY: Married. No smoking, he drinks alcohol almost on a daily basis,
2 to 3 drinks daily. This has been ongoing for 15 to 20 years.
He also smokes marijuana a few times per week due to nausea. He
denies any cocaine or heroin. He works in school food services. 

### Response:
{'Dehydration,Acute kidney failure, unspecified,Other ascites,Other primary cardiomyopathies,Malignant neoplasm of intrahepatic bile ducts,Ostium secundum type atrial septal defect,Kidney replaced by transplant,Hypotension, unspecified,Anemia in neoplastic disease,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery'}
