CHIEF COMPLAINT: altered mental status, distended abdomen, jaundice

PRESENT ILLNESS: 53-year-old man with histoyr of HCC with IVC thrombus receiving
CyberKnife, hep C, presents with worsening ascites and jaundice.
Patient presented to radiation oncology [**2113-8-16**] for another
scheduled CyberKnife treatment but was found to have worsening
abdominal distention, confusion, and was referred to the ED. Of
note, his CT-PET on [**2113-8-9**] showed completely obstructing IVC
thrombus.
.
In the ED, T 97.4, BP 123/74, HR 106, RR 21, 95%2L. He was found
to have AMS with asterixis and jaundice. INR was 12.9, tbili
9.2. He received 2 units of FFP, hydromorphine 4 mg PO x 1, and
was admitted to OMED.
.
On review of systems, patient is unable to answer many questions
due to his altered mental status.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
Hepatocellular carcinoma:
- presented to [**Hospital3 417**] Hospital on [**2113-7-3**] with
fatigue, new-onset ascites and lower extremity edema. During his
hospitalization, CT identified as 7.8 cm mass in the right liver
extending into the IVC.  His AFP was elevated at 49,833.
Thrombus
invading the IVC appeared to be both tumor and bland thrombus.
His portal vein was patent.
- [**2113-8-14**]: CyberKnife started
.
OTHER MEDICAL HISTORY:
1.  Status post left femur fracture, [**2089**].
2.  Hepatitis C.
3.  History of orchitis.
4.  History of nephrolithiasis.
5.  Status post left knee replacement in [**2111**].
6.  Osteoarthritis.
7.  History of L2 vertebral fracture.

MEDICATION ON ADMISSION: fentanyl patch 25 mcg/72hr
furosemide 40 mg PO daily
hydromorphone 4 mg PO q4h prn pain
lorazepam 0.5 mg q8hr prn anxiety
prochlorperazine prn
spironolactone 50 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.4, BP 124/80, HR 107, RR 24, 94%RA
Gen: middle-aged man lying in bed watching TV, responding to
questions but unable to recall much history, oriented to name,
hospital (but "[**Hospital3 2576**]"), US president, not date
Neuro: positive asterixis
HEENT: EOMI, sclerae icteric
Neck: supple
Lungs: CTAB
CV: slightly tachycardic, normal S1/S2, no murmur
Abd: very distended, tense, mildly and diffusely tender, no
rebound tenderness, no guarding, bowel sounds present
Ext: 3+ edema bilaterally to sacrum

FAMILY HISTORY: (from OMR) The patient's maternal aunt died of lung cancer. She
was a smoker.  His mother died at 54 years of a brain aneurysm.
His father is alive at 75 years.  He has four brothers without
health concerns.

SOCIAL HISTORY: (from OMR) The patient is married and lives with his wife. [**Name (NI) **]
does not have children.  He is currently unemployed but
previously worked as a restaurant manager.  Tobacco:  One pack
per day for 30 years.  Alcohol:  History of abuse, now
occasional use.  Illicits:  History of IV drug use, last use 10
years prior.
Acute and subacute necrosis of liver,Other venous embolism and thrombosis of inferior vena cava,Portal vein thrombosis,Malignant neoplasm of liver, primary,Other ascites,Portal hypertension,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Encounter for palliative care,Other ill-defined heart diseases,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Examination of participant in clinical trial,Knee joint replacement
Acute necrosis of liver,Oth inf vena cava thromb,Portal vein thrombosis,Mal neo liver, primary,Ascites NEC,Portal hypertension,Hyposmolality,Cirrhosis of liver NOS,Chrnc hpt C wo hpat coma,Encountr palliative care,Ill-defined hrt dis NEC,Osteoarthros NOS-unspec,Exam-clincal trial,Joint replaced knee
Admission Date:  [**2113-8-16**]              Discharge Date:   [**2113-8-18**]

Date of Birth:  [**2061-5-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
altered mental status, distended abdomen, jaundice

Major Surgical or Invasive Procedure:
None


History of Present Illness:
53-year-old man with histoyr of HCC with IVC thrombus receiving
CyberKnife, hep C, presents with worsening ascites and jaundice.
Patient presented to radiation oncology [**2113-8-16**] for another
scheduled CyberKnife treatment but was found to have worsening
abdominal distention, confusion, and was referred to the ED. Of
note, his CT-PET on [**2113-8-9**] showed completely obstructing IVC
thrombus.
.
In the ED, T 97.4, BP 123/74, HR 106, RR 21, 95%2L. He was found
to have AMS with asterixis and jaundice. INR was 12.9, tbili
9.2. He received 2 units of FFP, hydromorphine 4 mg PO x 1, and
was admitted to OMED.
.
On review of systems, patient is unable to answer many questions
due to his altered mental status.

Past Medical History:
ONCOLOGIC HISTORY:
Hepatocellular carcinoma:
- presented to [**Hospital3 417**] Hospital on [**2113-7-3**] with
fatigue, new-onset ascites and lower extremity edema. During his
hospitalization, CT identified as 7.8 cm mass in the right liver
extending into the IVC.  His AFP was elevated at 49,833.
Thrombus
invading the IVC appeared to be both tumor and bland thrombus.
His portal vein was patent.
- [**2113-8-14**]: CyberKnife started
.
OTHER MEDICAL HISTORY:
1.  Status post left femur fracture, [**2089**].
2.  Hepatitis C.
3.  History of orchitis.
4.  History of nephrolithiasis.
5.  Status post left knee replacement in [**2111**].
6.  Osteoarthritis.
7.  History of L2 vertebral fracture.

Social History:
(from OMR) The patient is married and lives with his wife. [**Name (NI) **]
does not have children.  He is currently unemployed but
previously worked as a restaurant manager.  Tobacco:  One pack
per day for 30 years.  Alcohol:  History of abuse, now
occasional use.  Illicits:  History of IV drug use, last use 10
years prior.


Family History:
(from OMR) The patient's maternal aunt died of lung cancer. She
was a smoker.  His mother died at 54 years of a brain aneurysm.
His father is alive at 75 years.  He has four brothers without
health concerns.

Physical Exam:
T 96.4, BP 124/80, HR 107, RR 24, 94%RA
Gen: middle-aged man lying in bed watching TV, responding to
questions but unable to recall much history, oriented to name,
hospital (but "[**Hospital3 2576**]"), US president, not date
Neuro: positive asterixis
HEENT: EOMI, sclerae icteric
Neck: supple
Lungs: CTAB
CV: slightly tachycardic, normal S1/S2, no murmur
Abd: very distended, tense, mildly and diffusely tender, no
rebound tenderness, no guarding, bowel sounds present
Ext: 3+ edema bilaterally to sacrum

Pertinent Results:
[**2113-8-16**] 01:10PM   WBC-10.4 RBC-5.00 HGB-13.7* HCT-40.9 MCV-82
MCH-27.5 MCHC-33.6 RDW-17.9*
[**2113-8-16**] 01:10PM   PLT COUNT-301
[**2113-8-16**] 01:10PM   PT-102.8* PTT-59.5* INR(PT)-12.9*
[**2113-8-16**] 01:10PM   GLUCOSE-91 UREA N-12 CREAT-0.8 SODIUM-128*
POTASSIUM-4.7 CHLORIDE-98 TOTAL CO2-17* ANION GAP-18
[**2113-8-16**] 01:10PM   ALT(SGPT)-189* AST(SGOT)-292* ALK PHOS-200*
TOT BILI-9.2*
[**2113-8-16**] 01:10PM   CALCIUM-8.4 PHOSPHATE-3.0 MAGNESIUM-2.1

Brief Hospital Course:
53-year-old man with histoyr of HCC with IVC thrombus receiving
CyberKnife, hep C, presents with worsening abdominal distention
and confusion. He was found to have altered mental status.
likely from ascites and known complete IVC occlusion. No fever,
no leukocytosis, no significant abdominal pain. Abdominal
distention is causing dyspnea. Of note, his CT-PET on [**2113-8-9**]
showed completely obstructing IVC thrombus. He was transferred
to ICU due to ongoing shortness of breath and desaturations on
the oncology medical floor to mid-80s. Prior to admission,
patient was supposed to have cyberknife procedure, however given
current clinical status, the procedure was cancelled. According
to radiation oncologists, treatment options had been exhausted.
Family meeting with oncology, ICU team, radiation oncology and
family was conducted and goals of care were discuss. Decision
was made to make patient DNR/DNI and to be sent home with
hospice.


Medications on Admission:
fentanyl patch 25 mcg/72hr
furosemide 40 mg PO daily
hydromorphone 4 mg PO q4h prn pain
lorazepam 0.5 mg q8hr prn anxiety
prochlorperazine prn
spironolactone 50 mg daily

Discharge Medications:
1. Hospice
[**Month (only) 116**] screen and admit to Hospice
2. Morphine Concentrate 20 mg/mL Solution Sig: Five (5) mg PO
every four (4) hours as needed for pain or shortness of breath.
Disp:*30 mL* Refills:*0*
3. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for anxiety.
Disp:*10 Tablet(s)* Refills:*0*
4. Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO every
eight (8) hours as needed for confusion: Titrate to 3 bowel
movements per day.
Disp:*1200 ML(s)* Refills:*0*
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 3005**] Hospice

Discharge Diagnosis:
1. Hepatocellular Carcinoma
2. IVC thrombus


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You were admitted to the hospital from your schedule radiation
oncology appointment due to low blood pressure.  Once you were
admitted, you had some difficulties breathing.  You were
transferred to the Intensive Care Unit for closer monitoring.
You had an ultrasound which showed no change in your tumors.
After discussion with your oncologist, radiation oncology and
your family, you are going home with hospice.

Followup Instructions:
None



Completed by:[**2113-8-21**]
{'Acute and subacute necrosis of liver,Other venous embolism and thrombosis of inferior vena cava,Portal vein thrombosis,Malignant neoplasm of liver, primary,Other ascites,Portal hypertension,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Encounter for palliative care,Other ill-defined heart diseases,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Examination of participant in clinical trial,Knee joint replacement'}


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: altered mental status, distended abdomen, jaundice

PRESENT ILLNESS: 53-year-old man with histoyr of HCC with IVC thrombus receiving
CyberKnife, hep C, presents with worsening ascites and jaundice.
Patient presented to radiation oncology [**2113-8-16**] for another
scheduled CyberKnife treatment but was found to have worsening
abdominal distention, confusion, and was referred to the ED. Of
note, his CT-PET on [**2113-8-9**] showed completely obstructing IVC
thrombus.
.
In the ED, T 97.4, BP 123/74, HR 106, RR 21, 95%2L. He was found
to have AMS with asterixis and jaundice. INR was 12.9, tbili
9.2. He received 2 units of FFP, hydromorphine 4 mg PO x 1, and
was admitted to OMED.
.
On review of systems, patient is unable to answer many questions
due to his altered mental status.

MEDICAL HISTORY: ONCOLOGIC HISTORY:
Hepatocellular carcinoma:
- presented to [**Hospital3 417**] Hospital on [**2113-7-3**] with
fatigue, new-onset ascites and lower extremity edema. During his
hospitalization, CT identified as 7.8 cm mass in the right liver
extending into the IVC.  His AFP was elevated at 49,833.
Thrombus
invading the IVC appeared to be both tumor and bland thrombus.
His portal vein was patent.
- [**2113-8-14**]: CyberKnife started
.
OTHER MEDICAL HISTORY:
1.  Status post left femur fracture, [**2089**].
2.  Hepatitis C.
3.  History of orchitis.
4.  History of nephrolithiasis.
5.  Status post left knee replacement in [**2111**].
6.  Osteoarthritis.
7.  History of L2 vertebral fracture.

MEDICATION ON ADMISSION: fentanyl patch 25 mcg/72hr
furosemide 40 mg PO daily
hydromorphone 4 mg PO q4h prn pain
lorazepam 0.5 mg q8hr prn anxiety
prochlorperazine prn
spironolactone 50 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.4, BP 124/80, HR 107, RR 24, 94%RA
Gen: middle-aged man lying in bed watching TV, responding to
questions but unable to recall much history, oriented to name,
hospital (but "[**Hospital3 2576**]"), US president, not date
Neuro: positive asterixis
HEENT: EOMI, sclerae icteric
Neck: supple
Lungs: CTAB
CV: slightly tachycardic, normal S1/S2, no murmur
Abd: very distended, tense, mildly and diffusely tender, no
rebound tenderness, no guarding, bowel sounds present
Ext: 3+ edema bilaterally to sacrum

FAMILY HISTORY: (from OMR) The patient's maternal aunt died of lung cancer. She
was a smoker.  His mother died at 54 years of a brain aneurysm.
His father is alive at 75 years.  He has four brothers without
health concerns.

SOCIAL HISTORY: (from OMR) The patient is married and lives with his wife. [**Name (NI) **]
does not have children.  He is currently unemployed but
previously worked as a restaurant manager.  Tobacco:  One pack
per day for 30 years.  Alcohol:  History of abuse, now
occasional use.  Illicits:  History of IV drug use, last use 10
years prior. 

### Response:
{'Acute and subacute necrosis of liver,Other venous embolism and thrombosis of inferior vena cava,Portal vein thrombosis,Malignant neoplasm of liver, primary,Other ascites,Portal hypertension,Hyposmolality and/or hyponatremia,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Encounter for palliative care,Other ill-defined heart diseases,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Examination of participant in clinical trial,Knee joint replacement'}
