CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, the patient is a
73-year-old female who was transferred from an outside
hospital with fulminate acute hepatitis A infection who had
worsening liver function.  She had been on a recent trip to
[**State 108**] and developed nausea, vomiting, and weight loss.

MEDICAL HISTORY: Past medical history is significant
for bronchiectasis.

MEDICATION ON ADMISSION: She took no medications at home.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Viral hepatitis A with hepatic coma,Other staphylococcal septicemia,Complications of transplanted liver,Portal vein thrombosis,Cocaine abuse, unspecified,Paralytic ileus,Chronic cholecystitis
Hepatitis A with coma,Staphylcocc septicem NEC,Compl liver transplant,Portal vein thrombosis,Cocaine abuse-unspec,Paralytic ileus,Chronic cholecystitis
Admission Date:  [**2192-11-12**]       Discharge Date:  [**2192-12-14**]

Date of Birth:   [**2155-7-2**]       Sex:  F

Service:  Transplant Surgery Service

HISTORY OF PRESENT ILLNESS:  Briefly, the patient is a
73-year-old female who was transferred from an outside
hospital with fulminate acute hepatitis A infection who had
worsening liver function.  She had been on a recent trip to
[**State 108**] and developed nausea, vomiting, and weight loss.

She was seen by her primary care physician and was noted to
have increasing liver function tests and was admitted for
this.  She slowly worsened over time and was transferred to
the Intensive Care Unit here at [**Hospital1 188**].

PAST MEDICAL HISTORY:  Past medical history is significant
for bronchiectasis.

PAST SURGICAL HISTORY:   No past surgical history.

MEDICATIONS ON ADMISSION:  She took no medications at home.

MEDICATIONS ON TRANSFER:  She was on lactulose and
Neutra-Phos upon transfer.

ALLERGIES:  She has no known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
revealed the patient was afebrile, her heart rate was 64, her
blood pressure was 108/60, her respiratory rate was 20, and
her oxygen saturation was 99% on room air.  In general, she
was in no apparent distress.  She was jaundiced and
diaphoretic.  Cardiovascular examination revealed her heart
was regular in rate and rhythm.  There were no murmurs, rubs,
or gallops.   The lungs were clear to auscultation
bilaterally.  The abdomen was soft, nontender, and
nondistended.  She had notable ascites.  She was alert,
awake, and oriented.  She had positive asterixis.  She had no
edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratories on
admission revealed her white blood cell count was 14.4, her
hematocrit was 41.4, and her platelet count was 325.
Chemistries revealed the patient's sodium was 136, potassium
was 5.6, chloride was 100, bicarbonate was 22, blood urea
nitrogen was 3, creatinine was 0.7, and her blood glucose was
107.  Her calcium was 9.6, her magnesium was 1.9, and her
phosphorous was 3.7.  Her alanine-aminotransferase was 1600,
her aspartate aminotransferase was 1060, her alkaline
phosphatase was 129, her total bilirubin was 33.5, and her
albumin was 3.6.  Her hepatitis panels were negative except
for hepatitis A.  Her human immunodeficiency virus was
negative as well.  She had an INR of approximately 4.2.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was admitted
to the Surgical Intensive Care Unit for close monitoring and
was continued on the lactulose.

She slowly deteriorated throughout her hospital course, and
her laboratories continued to elevate.  Her
alanine-aminotransferase and aspartate aminotransferase
slowly improved; however, her synthetic function and INR
continued to elevate.

On [**2192-11-20**] the patient underwent an orthotopic
liver transplantation for her fulminate hepatitis A.  Please
see the Operative Report for further details.  The patient
was transferred to the Intensive Care Unit postoperatively.
She was continued on plasmapheresis due to the fact that she
had a donor mismatched liver, and the patient continued to be
monitored for this.  She underwent daily plasmapheresis for
14 days.  Afterwards, the patient continued to do well.

Her liver function tests and synthetic function slowly
improved after transplantation; however, she continued to
have very high fevers.  Multiple cultures were done.  Her
lines were changed, and her fever slowly defervesced.  She
was given a full course of Zosyn, vancomycin, and Flagyl.
She also requested Unasyn perioperatively as well as a course
of meropenem throughout her hospital course.

The Hematology Service was consulted for her phoresis, and a
Quinton catheter was placed in her right groin.  After her
multiple fevers the catheter was  moved to her left groin.
After completion of her phoresis (14 days), the Quinton
catheter was removed.  The patient's fever slowly defervesced
slowly after that time.  She was slowly weaned from the
ventilator and was able to be successfully extubated.

On postoperative day six, she was noted to have increasing
liver function tests.  An ultrasound was done which showed a
thrombus in her portal vein.  Therefore, she was returned to
the operating room for a portal vein thrombectomy.  Again,
she was in the midst of her phoresis time, and it was decided
that her phoresis would be changed from induction with fresh
frozen plasma to induction with 50% albumin and 50% fresh
frozen plasma.  During her original operation, a splenectomy
was performed.  After multiple fevers a computed tomography
scan revealed fluid in the left upper quadrant.  A pigtail
catheter was placed, and it was found that she had a amylase
from this pigtail of 63,000.  Therefore, there had a
pancreatic leak.  The pigtail catheter was kept in place
throughout her hospital stay.

The patient continued to do well and again was hoped to be
weaned from the ventilator.  On postoperative days 11 and 5,
she was extubated.  She had multiple episodes of distention.
A computed tomography scan showed just large bowel
distention.  Multiple cultures were Clostridium difficile
were negative.  The patient's distention resolved after a
dose of neostigmine and tube decompression.  She was
continued on total parenteral nutrition for nutritional
support during her long Intensive Care Unit stay.

The patient was ultimately stabilized from her
transplantation, and her phoresis was completed.  Her fevers
resolved.  The titers of hepatitis A slowly decreased during
post phoresis, and her last titer was 16 prior to discharge.

The patient was transferred out to the floor.  The Physical
Therapy Service was consulted for ambulation.  Her mental
status slowly improved throughout her hospital stay, and she
was deemed safe to go home by Physical Therapy.

A repeat computed tomography angiogram was performed after
the patient returned to the floor which was negative.  A
liver biopsy was also performed which showed no rejection.
It was decided at this time that the patient was stable.  She
was kept on her immunosuppressives which included prednisone,
cyclosporine, and mycophenolate mofetil with adequate levels.
She was monitored closely for levels throughout her hospital
stay, and her cyclosporine was adjusted daily.  She was
stabilized on approximately 125 mg of cyclosporine at the
time of discharge.

DISCHARGE DISPOSITION:  The patient was to be discharged on
[**2192-12-14**] to home.  A pigtail catheter was in place.

MEDICATIONS ON DISCHARGE:  (Discharge medications included)
 1.  Cyclosporine 125 mg by mouth twice per day.
 2.  Albuterol nebulizers as needed.
 3.  Percocet one to two tablets by mouth q.4h. as needed.
 4.  Lasix was given intermittently for diuresis; however, it
was stopped prior to discharge.
 5.  Mycophenolate mofetil 1000 mg by mouth twice per day.
 6.  Prevacid 30 mg by mouth once per day.
 7.  Prednisone 20 mg by mouth once per day.
 8.  Valcyte 900 mg by mouth once per day.
 9.  Lamivudine 100 mg by mouth once per day.
10.  Bactrim single strength tablets one tablet by mouth once
per day.
11.  Fluconazole 400 mg by mouth once per day.
12.  Colace 100 mg by mouth twice per day (as a stool
softener).

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with the
Transplant Center at the arranged times to have serial blood
draws and monitoring of her liver function as well as her
cyclosporine level.
2.  The patient was instructed to follow up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] as well as with the Liver Service at the Transplant
Center.

DISCHARGE STATUS:  The patient was to be discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE DIAGNOSES:
1.  Fulminate hepatitis A.
2.  Status post orthotopic liver transplantation.
3.  Pancreatic leak; status post pigtail catheter placement.
4.  Bronchiectasis.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,PH.D.[**MD Number(3) 48821**]

Dictated By:[**Last Name (NamePattern4) **]
MEDQUIST36

D:  [**2192-12-13**]  20:47
T:  [**2192-12-13**]  21:00
JOB#:  [**Job Number 53894**]
{'Viral hepatitis A with hepatic coma,Other staphylococcal septicemia,Complications of transplanted liver,Portal vein thrombosis,Cocaine abuse, unspecified,Paralytic ileus,Chronic 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: Briefly, the patient is a
73-year-old female who was transferred from an outside
hospital with fulminate acute hepatitis A infection who had
worsening liver function.  She had been on a recent trip to
[**State 108**] and developed nausea, vomiting, and weight loss.

MEDICAL HISTORY: Past medical history is significant
for bronchiectasis.

MEDICATION ON ADMISSION: She took no medications at home.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Viral hepatitis A with hepatic coma,Other staphylococcal septicemia,Complications of transplanted liver,Portal vein thrombosis,Cocaine abuse, unspecified,Paralytic ileus,Chronic cholecystitis'}
