CHIEF COMPLAINT: End stage liver disease

PRESENT ILLNESS: ESLD status post hepatitis C infection and cirrhosis with a 3x 4
lesion in segment II treated with ablation on final path was 1.2
cm hepatocellular carcinoma in pathology specimen, recovery was
prolonged by persistent ascites

MEDICAL HISTORY: ESLD, Hep C, HCC, Psoriasis, Grade I varices, Left sciatic pain,
arthritis, H/O lyme disease, diverticulosis, B/L inguinal hernia
repair, r cataract surgery, discectomy L-[**4-5**]

MEDICATION ON ADMISSION: Protonix 40, clotrimozole cream, oxycodone 5, potasium, Eye
drops

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AXO X3, CN 2-12 intact, MAE no defecits [**5-5**], reflexes symmetric
[**Last Name (un) **], PERRL, NC, At, no LAD, anicteric, EOM-I, no JVD, no
bruit, no thyroidmegaly
CTA-B/L
S1, S2, trace SEM LLSB no R/G
S-Nt-ND, no masses no RT no guarding
+ fem B/L, + DP b/L

FAMILY HISTORY: NC

SOCIAL HISTORY: PPD for 25 years quit [**8-4**], H/O cocaine, denied IVDA, H/O heavy
drinking, disabled carpenter, married one son
Malignant neoplasm of liver, primary,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Portal hypertension,Other psoriasis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Mal neo liver, primary,Cirrhosis of liver NOS,Hpt C w/o hepat coma NOS,Hyposmolality,Portal hypertension,Other psoriasis,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2185-4-29**]              Discharge Date:   [**2185-5-29**]

Date of Birth:  [**2128-6-7**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
End stage liver disease

Major Surgical or Invasive Procedure:
liver transplant

History of Present Illness:
ESLD status post hepatitis C infection and cirrhosis with a 3x 4
lesion in segment II treated with ablation on final path was 1.2
cm hepatocellular carcinoma in pathology specimen, recovery was
prolonged by persistent ascites

Past Medical History:
ESLD, Hep C, HCC, Psoriasis, Grade I varices, Left sciatic pain,
arthritis, H/O lyme disease, diverticulosis, B/L inguinal hernia
repair, r cataract surgery, discectomy L-[**4-5**]

Social History:
PPD for 25 years quit [**8-4**], H/O cocaine, denied IVDA, H/O heavy
drinking, disabled carpenter, married one son

Family History:
NC

Physical Exam:
AXO X3, CN 2-12 intact, MAE no defecits [**5-5**], reflexes symmetric
[**Last Name (un) **], PERRL, NC, At, no LAD, anicteric, EOM-I, no JVD, no
bruit, no thyroidmegaly
CTA-B/L
S1, S2, trace SEM LLSB no R/G
S-Nt-ND, no masses no RT no guarding
+ fem B/L, + DP b/L

Pertinent Results:
[**2185-4-29**] 11:46PM   TYPE-ART PO2-179* PCO2-40 PH-7.39 TOTAL
CO2-25 BASE XS-0

[**2185-4-29**] 11:25PM   GLUCOSE-216* UREA N-12 CREAT-0.7 SODIUM-142
POTASSIUM-4.2 CHLORIDE-110* TOTAL CO2-23 ANION GAP-13
[**2185-4-29**] 11:25PM   ALT(SGPT)-652* AST(SGOT)-1840* ALK PHOS-72
TOT BILI-1.7*
[**2185-4-29**] 11:25PM   ALBUMIN-2.0* CALCIUM-8.0* PHOSPHATE-4.1
MAGNESIUM-1.9
[**2185-4-29**] 11:25PM   PT-17.7* PTT-56.1* INR(PT)-2.1   RADIOLOGY
Final Report

CHEST (PORTABLE AP)  [**2185-4-29**] 11:20 PM

CHEST (PORTABLE AP); -59 DISTINCT PROCEDURAL SERVIC

Reason: LINE PLACEMENT

[**Hospital 93**] MEDICAL CONDITION:
56 year old man with S/P LIVER trasnplant
REASON FOR THIS EXAMINATION:
LINE PLACEMENT
INDICATION: Status post liver transplant with line placement.

CHEST X-RAY, PORTABLE AP: Comparison made to prior study of 10
hours earlier. There is an endotracheal tube with tip at the
thoracic inlet. A right internal jugular Cordis catheter and
right internal jugular Swan-Ganz catheter are present. The tip
of the Swan-Ganz catheter is in the pulmonary trunk. The
cardiomediastinal silhouette is within normal limits. The lungs
are clear. There are two JP drains overlying the right upper
quadrant.

IMPRESSION:
Tubes and lines as described above.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
DR. [**First Name (STitle) 7204**] [**Name (STitle) 7205**]
Approved: SUN [**2185-5-1**] 8:39 PM
PROCEDURE: Written informed consent was obtained from the
patient after the patient's questions were answered. A
pre-procedure time checklist confirming patient identity and the
procedure to be done was performed. Under sterile technique and
ultrasound guidance, the right internal jugular vein was
accessed with a micropuncture needle and a wire was passed into
the superior vena cava (SVC) under fluoroscopic guidance. The
needle was exchanged for a micropuncture sheath. Through this, a
[**Last Name (un) 7648**] wire was advanced into the inferior vena cava (IVC). The
catheter was upsized to a 5 French sheath.
Through the sheath and over the wire, a catheter was advanced
into the right hepatic vein. Venograms were obtained in two
projections (AP and LAO caudo- cranial) with the catheter tip in
the right hepatic vein. Then, transcatheter pressure
measurements were obtained at multiple levels in this vein and
in the IVC.

The catheter was then exchanged over the wire for a 5 French
pigtail catheter, which was advanced under fluoroscopy in the
IVC up to the level of the renal veins, and a cavogram was
obtained. Transcatheter pressure measurements were obtained
along the infra and retrohepatic IVC up to the right atrium.

The findings were then discussed in person with the transplant
team and no intervention was performed. The sheath was removed
and hemostasis obtained.
IMPRESSION:
1. Smoothly tapered, long narrowing of the retrohepatic segment
of the IVC, associated with a 7 mm Hg gradient (mean pressure).
This is located caudally to the IVC anastomosis (which appears
well patent) and could possibly be related to extrinsic
compression from the overlying liver and surrounding structure
in supine position.
2. No focal areas of stricture suggesting significant venous
anastomotic stenosis.

Findings reviewed with Dr. [**Last Name (STitle) **] prior to termination of the
procedure.

ADIOLOGY   Preliminary Report

[**Numeric Identifier **] TUBE CHOLANGIOGRAM  [**2185-5-24**] 10:04 AM

Reason: to gravity to check biliary leak
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
56 year old man with elevated alk phos s/p liver tx [**4-29**]
REASON FOR THIS EXAMINATION:
to gravity to check biliary leak
INDICATION: Status post liver transplant [**2185-4-29**], with leak on
prior T-tube cholangiogram.

TECHNIQUE/FINDINGS: This procedure was performed by Dr. [**First Name (STitle) **] and
Dr. [**Last Name (STitle) 19420**] with Dr. [**Last Name (STitle) 19420**] present and supervising. Through the
T-tube, Conray nonionic contrast was connected to the patient's
T-tube via three way stopcock and placed to gravity. There was
free filling of the intrahepatic bile ducts proximal to the tip
of the T-tube as well as free flow of contrast into the
jejunostomy. There is no evidence of extraluminal extravasation.

Findings were discussed with Dr. [**Last Name (STitle) **] at the time of the
examination.

IMPRESSION: Tube cholangiogram demonstrates no evidence of leak.
There is free filling of intrahepatic bile ducts as well as free
flow of contrast into the jejunostomy.
T-TUBE CHOLANGIO (POST-OP)  [**2185-5-18**] 2:31 PM

T-TUBE CHOLANGIO (POST-OP)

Reason: ?patency of vessels ? collection

[**Hospital 93**] MEDICAL CONDITION:
56 year old man s/p liver transplant on [**2185-4-29**] with elevated
lft'ss
REASON FOR THIS EXAMINATION:
?patency of vessels ? collection
HISTORY: 56-year-old man status post liver transplant with
rising LFTs.

COMPARISON: [**2185-5-13**].

PROCEDURE AND FINDINGS: The procedure was performed by Dr. [**Last Name (STitle) **]
and Dr. [**Last Name (STitle) **], who was present and supervising. Gravity
cholangiogram was performed with Optiray nonionic contrast. This
revealed a nondilated common duct above and below the level of
the T-tube. Contrast was seen passing into the small bowel.
However, there was brisk extravasation of contrast observed at
the level of the common duct anastomosis. Examination with the
patient in lateral decubitus position revealed the contrast to
be collecting anteriorly. The exam was subsequently
discontinued. These findings were discussed with Dr. [**Last Name (STitle) **] at
the time of the exam. The T-tube was subsequently recapped.

IMPRESSION: Gravity cholangiogram demonstrating extravasation of
contrast at the common duct anastomosis.
[**2185-5-14**] 4:00 pm PERITONEAL FLUID

                            **FINAL REPORT [**2185-5-20**]**

   GRAM STAIN (Final [**2185-5-14**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.

   FLUID CULTURE (Final [**2185-5-17**]):    NO GROWTH.

   ANAEROBIC CULTURE (Final [**2185-5-20**]):    NO GROWTH.

   HCV VIRAL LOAD (Final [**2185-5-8**]):
      6,620,000 IU/mL.
      HCV viral load end-point determination.
      Performed by RT-PCR.
      Detection range: 60,000 - 70,000,000 IU/ml.
      FOR RESEARCH USE ONLY..
      NOT FOR USE IN DIAGNOSTIC PROCEDURES.
      This test has been validated by the Microbiology
laboratory at [**Hospital1 18**].
      If HCV genotype on patient's sample is desired, please
contact
      laboratory at ext. [**7-/3198**] within two weeks.

                            **FINAL REPORT [**2185-5-8**]**

   HBV Viral Load (Final [**2185-5-8**]):
      HBV DNA not detected.
      Performed by PCR.
      Detection Range: 300 - 200,000 copies/ml.
      FOR RESEARCH USE ONLY..
      NOT FOR USE IN DIAGNOSTIC PROCEDURES.
      This test has been validated by the Microbiology
laboratory at [**Hospital1 18**].


Brief Hospital Course:
Admitted S/P OLT [**2185-02-28**], Post Op uneventful, please see
operative report,given crystalloind and product support,
extubated and transferred to floor POD # 2 was aggressively
rehabilitated. He continued to show improvement and his LFTS
were followed closely as well as his immunosuporession levels
Below :is order of diagnostic examinations performed please
evaluate individual reports
[**2185-5-27**] Pathology Tissue: LIVER CORE BX. [**2185-5-27**] [**Last Name (LF) **],[**First Name3 (LF) **]
W. Not Finalized
[**2185-5-27**] Radiology BX-NEEDLE LIVER BY RADIOLOGIST
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-27**] Radiology GUIDANCE/LOCALIZATION FOR NEEDLE BIOPSY US
(S&I)   [**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-25**] Radiology US ABD LIMIT, SINGLE ORGAN   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-25**] Radiology CHEST (PA & LAT)   [**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-24**] Radiology [**Numeric Identifier 23564**] CHALNAGIOGRAPHY VIA EXISTING CATHETER
[**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 45133**]
[**2185-5-24**] Radiology [**Numeric Identifier **] TUBE CHOLANGIOGRAM   [**Last Name (LF) **],[**First Name3 (LF) **] W.
[**First Name3 (LF) 45133**]
[**2185-5-23**] Radiology PARACENTESIS DIAG. OR THERAPEUTIC
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-23**] Radiology US ABD LIMIT, SINGLE ORGAN   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-20**] Radiology PARACENTESIS DIAG. OR THERAPEUTIC
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology GUIDANCE FOR [**Female First Name (un) **]/ABD/PARA CENTESIS US
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology IVC GRAM   [**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 45134**]
[**2185-5-20**] Radiology [**Numeric Identifier 45135**] 1SR ORDER BRANCH VENOUS SYSTEM
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology [**Numeric Identifier 45136**] HEPATIC VENOGRAM WITH PRESSURES
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology [**Numeric Identifier 45137**] IVC GRAM   [**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology C1769 GUID WIRES INCL INF   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-20**] Radiology C1769 GUID WIRES INCL INF   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-20**] Radiology C1894 INT.SHTH NOT/GUID,EP,NONLASER
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology C1894 INT.SHTH NOT/GUID,EP,NONLASER
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-20**] Radiology NON-IONIC 50 CC   [**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-19**] Radiology CT ABDOMEN W/O CONTRAST   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-19**] Radiology CT PELVIS W/O CONTRAST   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-18**] Radiology T-TUBE CHOLANGIO (POST-OP)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-18**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-17**] Radiology US ABD LIMIT, SINGLE ORGAN   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-17**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-15**] Radiology UNILAT LOWER EXT VEINS RIGHT   [**Last Name (LF) **],[**First Name3 (LF) **]
W. APPROVED
[**2185-5-14**] Radiology CT ABD W&W/O C   [**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-14**] Radiology CT PELVIS W/CONTRAST   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-14**] Radiology CT 150CC NONIONIC CONTRAST   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-14**] Radiology PARACENTESIS DIAG. OR THERAPEUTIC
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-13**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-13**] Radiology T-TUBE CHOLANGIO (POST-OP)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-12**] Radiology MRI ABDOMEN W/O & W/CONTRAST   [**Last Name (LF) **],[**First Name3 (LF) **]
W. APPROVED
[**2185-5-12**] Radiology MR CONTRAST GADOLIN   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-12**] Radiology US ABD LIMIT, SINGLE ORGAN PORT
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-12**] Radiology -59 DISTINCT PROCEDURAL SERVICE
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-12**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-6**] Radiology LIVER OR GALLBLADDER US (SINGLE ORGAN)
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-6**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-4**] Radiology [**Numeric Identifier 23564**] CHALNAGIOGRAPHY VIA EXISTING CATHETER
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-4**] Radiology [**Numeric Identifier **] TUBE CHOLANGIOGRAM   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-1**] Radiology LIVER OR GALLBLADDER US (SINGLE ORGAN)
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-5-1**] Radiology DUPLEX DOPP ABD/PEL   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-5-1**] Radiology CHEST (PORTABLE AP)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-4-30**] Radiology US ABD LIMIT, SINGLE ORGAN PORT
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED
[**2185-4-30**] Radiology DUPLEX DOPP ABD/PEL PORT   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-4-30**] Radiology CHEST (PORTABLE AP)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-4-29**] Cardiology ECG [**2185-5-3**] [**Last Name (LF) **],[**First Name3 (LF) **] W.
[**2185-4-29**] Pathology Tissue: LIVER AND GALLBLADDER. [**2185-4-30**]
[**Last Name (LF) **],[**First Name3 (LF) **] W.
[**2185-4-29**] Radiology CHEST (PRE-OP PA & LAT)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-4-29**] Radiology CHEST (PORTABLE AP)   [**Last Name (LF) **],[**First Name3 (LF) **] W.
APPROVED
[**2185-4-29**] Radiology -59 DISTINCT PROCEDURAL SERVICE
[**Last Name (LF) **],[**First Name3 (LF) **] W. APPROVED

Pt was down to pre-operative weight and was without pedal edema
or with minimal ascites, feeling well ambulating/ mentating
normally prior to D/C


Medications on Admission:
Protonix 40, clotrimozole cream, oxycodone 5, potasium, Eye
drops

Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
Disp:*60 Tablet(s)* Refills:*2*
4. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q
3-6PRN ().
Disp:*45 Tablet(s)* Refills:*2*
8. Valganciclovir HCl 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Sirolimus 1 mg Tablet Sig: Seven (7) Tablet PO ONCE (once)
for 1 weeks.
Disp:*49 Tablet(s)* Refills:*0*
10. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day) for 1 weeks.
Disp:*28 Capsule(s)* Refills:*0*
11. Ciprofloxacin 0.3 % Drops Sig: One (1) Drop Ophthalmic  Q24H
(every 24 hours).
Disp:*QS ML(s)* Refills:*2*
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic  once a day: until [**6-2**].
Disp:*QS ML(s)* Refills:*2*
14. Tobramycin-Dexamethasone 0.3-0.1 % Ointment Sig: One (1)
Appl Ophthalmic  once a day: until [**6-2**].
Disp:*QS ML(s)* Refills:*2*
15. Chlorhexidine Gluconate 0.12 % Liquid Sig: Fifteen (15) ML
Mucous membrane  [**Hospital1 **] (2 times a day).
Disp:*900 ML(s)* Refills:*2*
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day): While taking Percocets, do not take if stools
are loose.
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA of [**Hospital3 **]

Discharge Diagnosis:
S/P liver transplant


Discharge Condition:
stable

Discharge Instructions:
Please if any symptoms of malaise, fevers, chills, redness or
drainage at wound site return for immediate evaluation, you will
need to take all medications prescribed and please make certain
to arrange and attend all f/u appointments and the medication
levels will need to be followed closely as instructed, for you
laboratory schedule will be as follows.
Call transplant office if you have any fevers/chills,
nausea/vomiting, inability to take your medications,
redness/oozing from your incision site, decreased urine output
or no urine output.
Labs every Monday & Thursday for cbc, chem 7, calcium,
phosphorous, ast, t.bili, urinalysis and trough prograf level.
Results to be fax'd to [**Hospital1 18**] Transplant office [**Telephone/Fax (1) 697**]
No heavy lifting, no driving while on pain medication
[**Month (only) 116**] shower with soap/water. Pat incision dry. apply gauze to old
right drain site
Chem &, CBC Ca, Po4, AST, T bili, UA, Prograf level, Must be
done [**Hospital1 **]- Weekly (Monday and Thursday) Lab results must be faxed
to [**Telephone/Fax (1) 697**] transplant coordinator levels

Followup Instructions:
F/U appointment with [**Last Name (un) **] and with transplant office: Call to
transplant office [**Telephone/Fax (1) 673**] to set up F/U appointment with
both the [**Last Name (un) **] Biabetes center and the transplant office


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2185-7-1**]
{'Malignant neoplasm of liver, primary,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Portal hypertension,Other psoriasis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: End stage liver disease

PRESENT ILLNESS: ESLD status post hepatitis C infection and cirrhosis with a 3x 4
lesion in segment II treated with ablation on final path was 1.2
cm hepatocellular carcinoma in pathology specimen, recovery was
prolonged by persistent ascites

MEDICAL HISTORY: ESLD, Hep C, HCC, Psoriasis, Grade I varices, Left sciatic pain,
arthritis, H/O lyme disease, diverticulosis, B/L inguinal hernia
repair, r cataract surgery, discectomy L-[**4-5**]

MEDICATION ON ADMISSION: Protonix 40, clotrimozole cream, oxycodone 5, potasium, Eye
drops

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AXO X3, CN 2-12 intact, MAE no defecits [**5-5**], reflexes symmetric
[**Last Name (un) **], PERRL, NC, At, no LAD, anicteric, EOM-I, no JVD, no
bruit, no thyroidmegaly
CTA-B/L
S1, S2, trace SEM LLSB no R/G
S-Nt-ND, no masses no RT no guarding
+ fem B/L, + DP b/L

FAMILY HISTORY: NC

SOCIAL HISTORY: PPD for 25 years quit [**8-4**], H/O cocaine, denied IVDA, H/O heavy
drinking, disabled carpenter, married one son 

### Response:
{'Malignant neoplasm of liver, primary,Cirrhosis of liver without mention of alcohol,Unspecified viral hepatitis C without hepatic coma,Hyposmolality and/or hyponatremia,Portal hypertension,Other psoriasis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
