CHIEF COMPLAINT: Abdominal wall bleeding s/p pericentesis of abdominal ascites

PRESENT ILLNESS: 50 yo male with history of cirrhosis secondary to Hepatitis C
and ETOH abuse presented for routine paracentesis for diuretic
resistant abdominal ascites. Pt has no history of variceal
bleeds, hepatic encephalopathy, or jaundice. The patient had
never been treated for his Hepatitis.

MEDICAL HISTORY: CAD with stent
Anemia
ETOH abuse
Hepatitis C
Liver cirrhosis/End stage liver disease

MEDICATION ON ADMISSION: Medications on admission
Oxycodone 5 mg po BID
Lasix 20 mg qd
Spironolactone 100 mg qd
nadolol 20 mg qd
Caltrate 600 mg [**Hospital1 **]
Mycelex 1 x 5/day lactulose 30 mg TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.5   BP 108/64  72  14  96% RA
General: awake, somewhat frail, pleasant
HEENT: Dry mucous membranes, mildly icteric sclera, mildly dark
pink mucous,  membranes in the mouth/tongue, OP clear
Lungs: minimal crackles in left base
CVS: RRR
Abdomen: distended, nontender with + BS, flat and tympanic
abdominal sounds (fluid, gas?) 5x5 umbilical hernia,
retractable,
LE: +1 PE wih minimal venous stasis, +2 DP, no lesions,

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Currently unemployed
Lives with wife, a healthcare proxy
Lives in [**Location 21318**]
Has not used drugs x 15 years
No ETOH since [**6-14**]
[**1-12**] pack of cigarrettes/day
Accidental puncture or laceration during a procedure, not elsewhere classified,Alcoholic cirrhosis of liver,Acute hepatitis C without mention of hepatic coma,Hyposmolality and/or hyponatremia,Unspecified chronic bronchitis,Anemia, unspecified,Accidental cut, puncture, perforation or hemorrhage during aspiration of fluid or tissue, puncture, and catheterization
Accidental op laceration,Alcohol cirrhosis liver,Hpt C acute wo hpat coma,Hyposmolality,Chronic bronchitis NOS,Anemia NOS,Acc cut/hem w catheteriz
Admission Date:  [**2187-7-10**]              Discharge Date:   [**2187-7-13**]

Date of Birth:  [**2137-3-14**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Abdominal wall bleeding s/p pericentesis of abdominal ascites

Major Surgical or Invasive Procedure:
Paracentesis [**2187-7-10**]

History of Present Illness:
50 yo male with history of cirrhosis secondary to Hepatitis C
and ETOH abuse presented for routine paracentesis for diuretic
resistant abdominal ascites. Pt has no history of variceal
bleeds, hepatic encephalopathy, or jaundice. The patient had
never been treated for his Hepatitis.

Past Medical History:
CAD with stent
Anemia
ETOH abuse
Hepatitis C
Liver cirrhosis/End stage liver disease


Social History:
Currently unemployed
Lives with wife, a healthcare proxy
Lives in [**Location 21318**]
Has not used drugs x 15 years
No ETOH since [**6-14**]
[**1-12**] pack of cigarrettes/day

Family History:
non-contributory

Physical Exam:
T 99.5   BP 108/64  72  14  96% RA
General: awake, somewhat frail, pleasant
HEENT: Dry mucous membranes, mildly icteric sclera, mildly dark
pink mucous,  membranes in the mouth/tongue, OP clear
Lungs: minimal crackles in left base
CVS: RRR
Abdomen: distended, nontender with + BS, flat and tympanic
abdominal sounds (fluid, gas?) 5x5 umbilical hernia,
retractable,
LE: +1 PE wih minimal venous stasis, +2 DP, no lesions,


Pertinent Results:
[**2187-7-12**] 06:15AM BLOOD WBC-6.6 RBC-3.34* Hgb-10.5* Hct-30.6*
MCV-91 MCH-31.4 MCHC-34.4 RDW-15.8* Plt Ct-82*
[**2187-7-11**] 03:35PM BLOOD WBC-6.2 RBC-3.26* Hgb-10.2* Hct-29.4*
MCV-90 MCH-31.4 MCHC-34.8 RDW-16.4* Plt Ct-72*
[**2187-7-11**] 05:43AM BLOOD WBC-5.9 RBC-3.14* Hgb-9.6* Hct-28.6*
MCV-91 MCH-30.5 MCHC-33.6 RDW-16.3* Plt Ct-94*
[**2187-7-10**] 09:01PM BLOOD Hct-27.9*
[**2187-7-10**] 02:25PM BLOOD Hct-25.8*
[**2187-7-10**] 10:55AM BLOOD WBC-7.8 RBC-2.64* Hgb-8.6* Hct-24.3*
MCV-92 MCH-32.7* MCHC-35.5* RDW-15.9* Plt Ct-94*
[**2187-7-10**] 10:00AM BLOOD WBC-8.1 RBC-2.66* Hgb-8.5* Hct-24.4*
MCV-92 MCH-31.8 MCHC-34.6 RDW-15.9* Plt Ct-106*
[**2187-7-10**] 08:10AM BLOOD WBC-9.1 RBC-3.43* Hgb-11.0* Hct-31.8*
MCV-93 MCH-32.2* MCHC-34.7 RDW-15.9* Plt Ct-114*
[**2187-7-10**] 08:10AM BLOOD Neuts-67.3 Lymphs-16.6* Monos-12.0*
Eos-3.5 Baso-0.6
[**2187-7-12**] 06:15AM BLOOD Plt Ct-82*
[**2187-7-12**] 06:15AM BLOOD PT-16.3* PTT-39.6* INR(PT)-1.8
[**2187-7-11**] 03:35PM BLOOD Plt Ct-72*
[**2187-7-11**] 03:35PM BLOOD PT-15.3* PTT-37.1* INR(PT)-1.5
[**2187-7-11**] 05:43AM BLOOD Plt Ct-94*
[**2187-7-11**] 05:43AM BLOOD PT-14.9* PTT-37.0* INR(PT)-1.5
[**2187-7-10**] 09:39PM BLOOD PT-15.1* PTT-38.9* INR(PT)-1.5
[**2187-7-10**] 02:25PM BLOOD PT-15.7* PTT-42.4* INR(PT)-1.6
[**2187-7-10**] 10:55AM BLOOD Plt Ct-94*
[**2187-7-10**] 10:00AM BLOOD Plt Ct-106*
[**2187-7-10**] 08:10AM BLOOD Plt Ct-114*
[**2187-7-10**] 08:10AM BLOOD PT-16.7* INR(PT)-1.9
[**2187-7-11**] 05:43AM BLOOD Glucose-116* UreaN-23* Creat-1.1 Na-132*
K-4.6 Cl-99 HCO3-24 AnGap-14
[**2187-7-10**] 09:01PM BLOOD Glucose-140* UreaN-27* Creat-1.4* Na-129*
K-5.2* Cl-98 HCO3-23 AnGap-13
[**2187-7-10**] 08:10AM BLOOD Glucose-115* UreaN-34* Creat-2.0*#
Na-127* K-5.5* Cl-95* HCO3-24 AnGap-14
[**2187-7-10**] 08:10AM BLOOD ALT-20 AST-43* AlkPhos-77 TotBili-4.7*
[**2187-7-11**] 05:43AM BLOOD Calcium-8.8
[**2187-7-10**] 09:01PM BLOOD Calcium-8.4 Phos-3.6 Mg-2.1
[**2187-7-10**] 02:25PM BLOOD Calcium-8.7
[**2187-7-10**] 08:10AM BLOOD Albumin-2.8* Calcium-8.9 Phos-4.3

[**2187-7-13**] 09:25AM BLOOD WBC-7.5 RBC-3.56* Hgb-11.0* Hct-32.7*
MCV-92 MCH-31.0 MCHC-33.8 RDW-15.8* Plt Ct-85*

Brief Hospital Course:
Pt is a 50 yo man with cirrhosis secondary to HCV and ETOH abuse
and baseline anemia who had an abdominal bleed after a routine
pericentesis to remove ascitic fluid, s/p transfusions, now
stable.

1.Abdominal bleed: most likely secondary to hitting a vessel
during pericentesis. Pt has been transfused multiple times and
given fluids in an effort to address his falling
hematocrit/bleed. Now that pt is stable, will start to
diurese/remove fluid that has accumulated in his abdomen. Pt
notes that abdominal size is close to, but not as large as his
abdomen prior to getting his pericentesis. Pt seen by Liver and
received another paracentesis for abdominal ascites on [**7-12**]
without complications. Pt is to be dc'd with follow up with Dr.
[**Last Name (STitle) 497**] on [**7-19**].
2.Anemia: pt transfused with FFP, currently 28.6 Hesitant to
transfuse now due to increasing accumulation of fluid in the
abdomen and the sequelae of SOB and discomfort. Will follow and
check crit in AM- Vitals stable, if crit decreased, will
transfuse. Currently stable.
3.FEN: Pt to get meal tonight. DC NPO. Cont bowel regimen. No
protonix due to low platelets.
4.Cirrhosis: continue lactulose.
5.Pain/Headache. Cont. oxycodone for pain until follow up.
6.Cough:  Pt with productive cough, yellowish grey sputum.
Possible etiologies are URI considering slightly elevated
temperature, Chronic bronchitis exacerbation considering pt??????s
smoking history. Pt??????s CXR negative for consolidation. Will
monitor for fevers, worsening cough. Cont. guanefesin-codeine
for cough and cipro 500 mg qd x 7 days and follow up with Dr.
[**Last Name (STitle) 497**] if cough persists.


Medications on Admission:
Medications on admission
Oxycodone 5 mg po BID
Lasix 20 mg qd
Spironolactone 100 mg qd
nadolol 20 mg qd
Caltrate 600 mg [**Hospital1 **]
Mycelex 1 x 5/day lactulose 30 mg TID


Discharge Medications:
1. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
4. Codeine-Guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H
(every 6 hours) as needed.
Disp:*1 ML(s)* Refills:*0*
5. Phytonadione 5 mg Tablet Sig: 1-2 Tablets PO QD (once a day)
for 1 days.
Disp:*1 Tablet(s)* Refills:*0*
6. Oxycodone HCl 5 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for headache.
Disp:*25 Tablet(s)* Refills:*0*
7. Ciprofloxacin HCl 500 mg Tablet Sig: One (1) Tablet PO QD
(once a day) as needed for cough for 7 days.
Disp:*6 Tablet(s)* Refills:*0*
8. Aldactone 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. ESLD
2. Abdominal bleed after therapeutic paracentesis on [**2187-7-7**]
3. Anemia
4. bronchitis


Discharge Condition:
Fever to 100.5 on day of discharge, no localizing symptoms,
tolerating pos, ambulating

Discharge Instructions:
1. Please follow up at the [**Date Range **] unit on [**7-29**] for your next
paracentesis.
2. Take all your medications, including the antibiotics for the
cough
3. If you experience fevers, chills, increasingly severe cough,
nausea, vomiting, or a tender abdomen that causes you pain, come
to the emergency department at once.
4. Take oxycodone for your headaches, 5-10 mg (1-2 tablets) by
mouth every 6 hours.
5. Take the cough syrup, but if you continue to cough by your
appointment with Dr. [**Last Name (STitle) 497**], be sure to be examined and worked up
for something more serious.
6. You need to stay on a strict 1.5 L diet. If you have
questions, talk to Dr. [**Last Name (STitle) 497**] at your appointment.

Followup Instructions:
1 follow up:

Provider: [**Name10 (NameIs) 454**],TEN DAY CARE [**Hospital Ward Name **] 8 Where: DAY CARE [**Hospital Ward Name **] 8
Date/Time:[**2187-7-19**] 11:00


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Accidental puncture or laceration during a procedure, not elsewhere classified,Alcoholic cirrhosis of liver,Acute hepatitis C without mention of hepatic coma,Hyposmolality and/or hyponatremia,Unspecified chronic bronchitis,Anemia, unspecified,Accidental cut, puncture, perforation or hemorrhage during aspiration of fluid or tissue, puncture, and catheterization'}


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: Abdominal wall bleeding s/p pericentesis of abdominal ascites

PRESENT ILLNESS: 50 yo male with history of cirrhosis secondary to Hepatitis C
and ETOH abuse presented for routine paracentesis for diuretic
resistant abdominal ascites. Pt has no history of variceal
bleeds, hepatic encephalopathy, or jaundice. The patient had
never been treated for his Hepatitis.

MEDICAL HISTORY: CAD with stent
Anemia
ETOH abuse
Hepatitis C
Liver cirrhosis/End stage liver disease

MEDICATION ON ADMISSION: Medications on admission
Oxycodone 5 mg po BID
Lasix 20 mg qd
Spironolactone 100 mg qd
nadolol 20 mg qd
Caltrate 600 mg [**Hospital1 **]
Mycelex 1 x 5/day lactulose 30 mg TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.5   BP 108/64  72  14  96% RA
General: awake, somewhat frail, pleasant
HEENT: Dry mucous membranes, mildly icteric sclera, mildly dark
pink mucous,  membranes in the mouth/tongue, OP clear
Lungs: minimal crackles in left base
CVS: RRR
Abdomen: distended, nontender with + BS, flat and tympanic
abdominal sounds (fluid, gas?) 5x5 umbilical hernia,
retractable,
LE: +1 PE wih minimal venous stasis, +2 DP, no lesions,

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Currently unemployed
Lives with wife, a healthcare proxy
Lives in [**Location 21318**]
Has not used drugs x 15 years
No ETOH since [**6-14**]
[**1-12**] pack of cigarrettes/day 

### Response:
{'Accidental puncture or laceration during a procedure, not elsewhere classified,Alcoholic cirrhosis of liver,Acute hepatitis C without mention of hepatic coma,Hyposmolality and/or hyponatremia,Unspecified chronic bronchitis,Anemia, unspecified,Accidental cut, puncture, perforation or hemorrhage during aspiration of fluid or tissue, puncture, and catheterization'}
