CHIEF COMPLAINT: 

PRESENT ILLNESS: A 37-year-old female who
presented on the [**3-3**] with end-stage liver disease
secondary to hepatitis C who presents waking up in bed and
finding a significant amount of blood on her tee shirt from a
bleeding point on a healing midline abdominal incision.  The
patient's bleeding was stopped in the Emergency Room.  The
patient was admitted previously for uncontrolled bleeding
status post an exploratory laparotomy in [**2171-12-22**]
secondary to a small bowel obstruction.  The patient at that
time was without any other complaints and was being followed
as an outpatient with frequent routine labs.  The patient's
base _______had risen from 2 in the last month to 3.4 prior
to admission so the patient was admitted for observation and
management.

MEDICAL HISTORY: Significant for end-stage liver
disease, esophageal cancer, non-Hodgkin's lymphoma, small
bowel obstruction status post exploratory laparotomy and
lysis of adhesions, status post lumpectomy, Clostridium
difficile in [**2171-12-22**], right lower extremity trauma from
motor vehicle accident as a child, chronic lower extremity
cellulitis and poor dentition.

MEDICATION ON ADMISSION: 1. Ursodiol 300 t.i.d.
2. Chloride 300 mEq q. day.
3. Lasix 40 mg q. day.
4. Spironolactone 50 mg q. day.
5. Protonix 40 mg p.o. q. day.
6. Mycelex 10 mg t.i.d.
7. Nadolol 20 mg q. day.
8. Lactulose two teaspoons q. day t.i.d.
9. Ketaconazole cream.
10.      Colace 200 b.i.d.
11.      Multivitamin.

ALLERGIES: The patient reports no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Bacteremia,Chronic hepatitis C without mention of hepatic coma,Iatrogenic pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Acquired coagulation factor deficiency,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Cirrhosis of liver without mention of alcohol
Bacteremia,Chrnc hpt C wo hpat coma,Iatrogen pulm emb/infarc,Chr blood loss anemia,Acq coagul factor defic,Oth lymp unsp xtrndl org,Cirrhosis of liver NOS
Admission Date: [**2172-4-2**]        Discharge Date: [**2172-4-30**]

Date of Birth:  [**2134-12-19**]        Sex:  F

Service:  [**Last Name (un) **]


HISTORY OF PRESENT ILLNESS:  A 37-year-old female who
presented on the [**3-3**] with end-stage liver disease
secondary to hepatitis C who presents waking up in bed and
finding a significant amount of blood on her tee shirt from a
bleeding point on a healing midline abdominal incision.  The
patient's bleeding was stopped in the Emergency Room.  The
patient was admitted previously for uncontrolled bleeding
status post an exploratory laparotomy in [**2171-12-22**]
secondary to a small bowel obstruction.  The patient at that
time was without any other complaints and was being followed
as an outpatient with frequent routine labs.  The patient's
base _______had risen from 2 in the last month to 3.4 prior
to admission so the patient was admitted for observation and
management.

PAST MEDICAL HISTORY:  Significant for end-stage liver
disease, esophageal cancer, non-Hodgkin's lymphoma, small
bowel obstruction status post exploratory laparotomy and
lysis of adhesions, status post lumpectomy, Clostridium
difficile in [**2171-12-22**], right lower extremity trauma from
motor vehicle accident as a child, chronic lower extremity
cellulitis and poor dentition.

ALLERGIES:  The patient reports no known drug allergies.

MEDICATIONS ON ADMISSION:
1. Ursodiol 300 t.i.d.
2. Chloride 300 mEq q. day.
3. Lasix 40 mg q. day.
4. Spironolactone 50 mg q. day.
5. Protonix 40 mg p.o. q. day.
6. Mycelex 10 mg t.i.d.
7. Nadolol 20 mg q. day.
8. Lactulose two teaspoons q. day t.i.d.
9. Ketaconazole cream.
10.      Colace 200 b.i.d.
11.      Multivitamin.


PHYSICAL EXAMINATION ON ADMISSION:  No acute distress.  No
asterixis.  Head and neck examination significant for
icterus.  Cardiovascular:  Regular rate and rhythm.  Lungs
clear to auscultation bilaterally.  Abdomen was soft.  She
had a non-tender healed midline incision with four areas of
ulceration.  No purulence.  Slight staining onto gauze at
second area of ulceration.  No hematoma.  The patient had a
small area of tenderness in the right lower quadrant.
Extremities were without lower extremity edema and no
lesions.  Right below-knee skin graft was patent.

LABORATORY ON ADMISSION:  The patient's laboratories on
admission were a white count 9.1, hematocrit 30.4, hematocrit
57, platelet count 57,000.  Chem-7 with 131/3.3/97/23/16/0.8
and 129.  ALT 14, AST 40, alk phos 112, total bilirubin 6.9,
albumin of 2.6, and amylase of 58.  The patient's INR was
3.4.

HOSPITAL COURSE:  On hospital day five it was discovered the
patient was MRSA bacteremic.  Infectious Disease was
consulted to evaluate patient.  Decided to wait for cultures.
The patient was continued to be worked up by Infectious
Disease, getting a bone scan and _______ to evaluate for
possible sources of infection.  Her vancomycin level was
titrated.  She was transferred to the Medical Intensive Care
Unit on the [**1-12**] for close monitoring, of PA catheter
and for acute renal impairment with a creatinine that went
from 0.8 to 3.4.  The patient's renal function improved over
a period of time returning to a baseline of 1.8.  The patient
was transferred to the floor and prepped for an orthotopic
liver transplant.  On hospital day 17 the patient was being
pre-op'd for orthotopic liver transplant and was given the
appropriate preoperative medications.  On hospital day 17 and
postoperative day one, the patient did not receive her liver
secondary to development of a large clot intraoperatively.
As such, the patient was taken out of the Operating Room and
failed to receive her transplant.  The patient went back to
the unit for close monitoring immediately postoperatively and
was then transferred to the floor.  The patient was finally
transferred to the floor on the [**12-25**] hospital day 23.
On the floor patient had a fairly unremarkable course.  On
hospital day 29 patient was to be discharged to an extended
care facility where she will receive physical therapy and
await a potential new liver for transplant.

DISCHARGE MEDICATIONS:
1. Ketaconazole cream.
2. Acetaminophen 325 mg two tabs p.o. q. 4-6h. p.r.n.
3. Morphine sulfate 2 mg/mL syringe one to two injections q.
   4h.
4. Miconazole powder.
5. Ciprofloxacin 250 mg tabs p.o. b.i.d.
6. Protonix 40 mg one tab p.o. b.i.d.
7. Insulin sliding scale.
8. Fluconazole 200 mg IV q. 24h.
9. Furosemide 60 mg IV q. 12h.
10.      Zofran 2-4 mg IV q. 6h. p.r.n.
11.      Multivitamin.


DISCHARGE DIAGNOSES:  Liver cirrhosis.

Hepatitis C.

Esophageal cancer.

FOLLOW UP:  Patient will follow up in the Liver [**Hospital 1326**]
Clinic with Dr. [**First Name (STitle) **] the week following discharge.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 3432**]

Dictated By:[**Doctor Last Name 13307**]
MEDQUIST36
D:  [**2172-4-30**] 11:35:13
T:  [**2172-4-30**] 12:58:40
Job#:  [**Job Number 47385**]
{'Bacteremia,Chronic hepatitis C without mention of hepatic coma,Iatrogenic pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Acquired coagulation factor deficiency,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Cirrhosis of liver without mention of alcohol'}


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: A 37-year-old female who
presented on the [**3-3**] with end-stage liver disease
secondary to hepatitis C who presents waking up in bed and
finding a significant amount of blood on her tee shirt from a
bleeding point on a healing midline abdominal incision.  The
patient's bleeding was stopped in the Emergency Room.  The
patient was admitted previously for uncontrolled bleeding
status post an exploratory laparotomy in [**2171-12-22**]
secondary to a small bowel obstruction.  The patient at that
time was without any other complaints and was being followed
as an outpatient with frequent routine labs.  The patient's
base _______had risen from 2 in the last month to 3.4 prior
to admission so the patient was admitted for observation and
management.

MEDICAL HISTORY: Significant for end-stage liver
disease, esophageal cancer, non-Hodgkin's lymphoma, small
bowel obstruction status post exploratory laparotomy and
lysis of adhesions, status post lumpectomy, Clostridium
difficile in [**2171-12-22**], right lower extremity trauma from
motor vehicle accident as a child, chronic lower extremity
cellulitis and poor dentition.

MEDICATION ON ADMISSION: 1. Ursodiol 300 t.i.d.
2. Chloride 300 mEq q. day.
3. Lasix 40 mg q. day.
4. Spironolactone 50 mg q. day.
5. Protonix 40 mg p.o. q. day.
6. Mycelex 10 mg t.i.d.
7. Nadolol 20 mg q. day.
8. Lactulose two teaspoons q. day t.i.d.
9. Ketaconazole cream.
10.      Colace 200 b.i.d.
11.      Multivitamin.

ALLERGIES: The patient reports no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Bacteremia,Chronic hepatitis C without mention of hepatic coma,Iatrogenic pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Acquired coagulation factor deficiency,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Cirrhosis of liver without mention of alcohol'}
