CHIEF COMPLAINT: Hepatocellular carcinoma, hepatitis C virus-related cirrhosis.

PRESENT ILLNESS: 58-year-old male who presented with a history of hepatitis C
first
diagnosed in [**2139**]. He has a history of esophageal cancer status
post esophagectomy in [**2163**]. He was noted to have a right hepatic
mass on a CT scan in [**2165-4-17**]. At that time it was 0.7 cm.
Initially this was thought to represent metastatic esophageal
carcinoma. However, this was reevaluated on a scan on [**2165-8-9**] and the mass was now 5 cm in diameter. A biopsy was
consistent with hepatocellular carcinoma. His AFP was 30. He has
no evidence of recurrent esophageal cancer.

MEDICAL HISTORY: - Barrett's esophagus
- Esophageal carcinoma
- Asthma
Past Surgical History:
- Bilateral hernia repair
- Cholecystectomy in [**2150**]
- Esophageal CA with resection in [**2163**]
- Elbow surgery in [**2146**].

MEDICATION ON ADMISSION: albuterol, alprazolam 0.25 mg po qd prn, Symbicort inhaler 2
puffs [**Hospital1 **], hyoscyamine sulfate 0.375 mg po bid, Provigil 50 mg
po
qd prn, omeprazole/ sodium bicarbonate combined capsule 40
mg/1.1
gm po qd, oxandrolone 2.5 mg po bid, and Aciphex 20 mg po qd.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.8, 85, 111/50, 14, 96%RA
Gen: NAD, sleep but arousable
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-distended, appropriately tender, JP with
serosanguinous drainage
Extr: No C/C/E

FAMILY HISTORY: N/C

SOCIAL HISTORY: Married, remote history of IVDU and snorted cocaine. More recent
use of marijuana. Multiple tattoos
Malignant neoplasm of liver, primary,Chronic hepatitis C with hepatic coma,Other ascites,Acute and subacute necrosis of liver,Body Mass Index less than 19, adult,Cirrhosis of liver without mention of alcohol,Other acute postoperative pain,Personal history of malignant neoplasm of esophagus,Asthma, unspecified type, unspecified,Postprocedural fever,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Disorders of phosphorus metabolism,Abnormal coagulation profile
Mal neo liver, primary,Chrnc hpt C w hepat Coma,Ascites NEC,Acute necrosis of liver,BMI less than 19,adult,Cirrhosis of liver NOS,Acute postop pain NEC,Hx-esophageal malignancy,Asthma NOS,Postprocedural fever,Abn reac-organ rem NEC,Dis phosphorus metabol,Abnrml coagultion prfile
Admission Date:  [**2165-8-26**]              Discharge Date:   [**2165-9-13**]

Date of Birth:  [**2106-10-17**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Hepatocellular carcinoma, hepatitis C virus-related cirrhosis.


Major Surgical or Invasive Procedure:
[**2165-9-5**]: segment VIII R hepatic lobectomy
[**2165-9-13**]: PICC line placement


History of Present Illness:
58-year-old male who presented with a history of hepatitis C
first
diagnosed in [**2139**]. He has a history of esophageal cancer status
post esophagectomy in [**2163**]. He was noted to have a right hepatic
mass on a CT scan in [**2165-4-17**]. At that time it was 0.7 cm.
Initially this was thought to represent metastatic esophageal
carcinoma. However, this was reevaluated on a scan on [**2165-8-9**] and the mass was now 5 cm in diameter. A biopsy was
consistent with hepatocellular carcinoma. His AFP was 30. He has
no evidence of recurrent esophageal cancer.


Past Medical History:
- Barrett's esophagus
- Esophageal carcinoma
- Asthma
Past Surgical History:
- Bilateral hernia repair
- Cholecystectomy in [**2150**]
- Esophageal CA with resection in [**2163**]
- Elbow surgery in [**2146**].


Social History:
Married, remote history of IVDU and snorted cocaine. More recent
use of marijuana. Multiple tattoos

Family History:
N/C

Physical Exam:
VS: 98.8, 85, 111/50, 14, 96%RA
Gen: NAD, sleep but arousable
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-distended, appropriately tender, JP with
serosanguinous drainage
Extr: No C/C/E

Pertinent Results:
On Admission: [**2165-8-26**]:
WBC-10.2# RBC-4.26* Hgb-12.8* Hct-37.6* MCV-88 MCH-30.1
MCHC-34.1 RDW-13.3 Plt Ct-303
PT-13.3 PTT-30.8 INR(PT)-1.1
Glucose-70 UreaN-22* Creat-0.9 Na-140 K-4.3 Cl-107 HCO3-21*
AnGap-16
ALT-227* AST-277* AlkPhos-86 TotBili-1.5
Albumin-3.6 Calcium-9.1 Phos-4.2 Mg-1.8
[**2165-8-29**] TSH-2.0 T4-5.9 T3-55*
At discharge: [**2165-9-13**]
WBC-8.9 RBC-3.37* Hgb-10.5* Hct-32.4* MCV-96 MCH-31.0 MCHC-32.3
RDW-15.2 Plt Ct-181
Glucose-102 UreaN-24* Creat-1.0 Na-135 K-4.5 Cl-106 HCO3-23
AnGap-11
ALT-132* AST-139* AlkPhos-180* TotBili-2.4*
Calcium-8.5 Phos-2.8 Mg-2.1 Albumin-2.3*

Brief Hospital Course:
58 y/o male with Hep C and HCC taken to the OR with Dr [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] for . Operative findings include patient had a fibrotic
liver but not nodular. This was most likely going to be
consistent with cirrhosis on microscopic examination. He had no
evidence of portal hypertension. He did have dilated perihepatic
lymphatics. He had a relatively small left lobe but this was
felt to be adequate for completion right hepatic lobectomy.
Intraoperative ultrasound demonstrated only the solitary mass in
the right lobe of the liver.
Initially the patient did very well after surgery. Pain was
managed with an epidural.
By POD 3 the petient was noted to be more somnolent and confused
and was noted to have + asterixis. AST and ALT trended up mildly
but the bilirubin continued to elevate and was as high as 6.9 on
POD 8. He was moved to the intensive care unit due to his liver
decompensation, altered mental status and lab derangements.
The patient was listed on the liver transplant list due to his
decompensation. He was started on Rifaxamin and lactulose. He
was never intubated. He spent 4 days in the SICU and after his
mental status started to improve he was able to be moved back to
the regular surgical floor.
Narcotics were discontinued and ibuprofen was used for pain
management.
His JP output was very high, 2-3 Liters daily of straw colored
ascitic fluid. The fluid was replaced cc/cc and then 1/2 cc/cc.
Attempts were made to have patient with enough PO intake to keep
up, but he was unable to do so and it was determined that he
would go home with fluid boluses, and a PICC line was placed.
His mental status, lab values and overall condition improved
greatly and at the liver intake meeting on [**9-10**] it was
determined he could be removed from the transplant list.
He continued to make daily improvements although he had some
complaints of heartburn which are not new for this patient.
Nutritionally he was advised to use supplements TID
Staples were removed prior to discharge.
Lactulose was discontinued and the rifaxamin dose was cut in
half but he will remain on 200 TID at home for now.
He was ambulating without difficulty, had bowel funtion and was
tolerating diet by day of discharge. The PICC line was placed
and arrangements for outpatient fluid management were made. He
was comfortable with the drain care.


Medications on Admission:
 albuterol, alprazolam 0.25 mg po qd prn, Symbicort inhaler 2
puffs [**Hospital1 **], hyoscyamine sulfate 0.375 mg po bid, Provigil 50 mg
po
qd prn, omeprazole/ sodium bicarbonate combined capsule 40
mg/1.1
gm po qd, oxandrolone 2.5 mg po bid, and Aciphex 20 mg po qd.


Discharge Medications:
1. Fluid therapy
500 mL NS Bolus:  500 ml IV Over 60 mins via PICC line [**Hospital1 **]
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day) as needed for heartburn.

5. Rifaximin 200 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*2*
6. Aciphex 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
7. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: qs ML
Intravenous PRN (as needed) as needed for line flush: Per PICC
line protocol.
9. Outpatient Lab Work
Labwork Monday [**2165-9-16**]
CBC, Chem 7, Ca, Phos, Mg, LFTs


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 83301**], RI

Discharge Diagnosis:
HCC
High output ascites post operatively


Discharge Condition:
Stable/good


Discharge Instructions:
Please call Dr [**Last Name (STitle) 4727**] office at [**Telephone/Fax (1) 673**] for fever, chills,
nauesea, vomiting, increased abdominal pain, inability to take
or keep down food, fluids or medications.
Monitor the drain output. Drain and record each time the bulb is
half full and bring copy of drain record with you to your clinic
appointment. Call if the drainage develops a foul odor, changes
in color or becomes bloody. Your output has been between
[**2156**]-3000 cc daily, call if it is more than 3000 cc.
No heavy lifting
You will be giving yourself fluid boluses two times daily via
the PICC live. VNA will help with dressing changes weekly
You may shower, no tub baths, no swimming. Make sure bulb does
no hang freely
Labwork Monday [**9-16**]

Followup Instructions:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2165-9-18**]
10:40


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

Completed by:[**2165-9-13**]
{'Malignant neoplasm of liver, primary,Chronic hepatitis C with hepatic coma,Other ascites,Acute and subacute necrosis of liver,Body Mass Index less than 19, adult,Cirrhosis of liver without mention of alcohol,Other acute postoperative pain,Personal history of malignant neoplasm of esophagus,Asthma, unspecified type, unspecified,Postprocedural fever,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Disorders of phosphorus metabolism,Abnormal coagulation profile'}


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: Hepatocellular carcinoma, hepatitis C virus-related cirrhosis.

PRESENT ILLNESS: 58-year-old male who presented with a history of hepatitis C
first
diagnosed in [**2139**]. He has a history of esophageal cancer status
post esophagectomy in [**2163**]. He was noted to have a right hepatic
mass on a CT scan in [**2165-4-17**]. At that time it was 0.7 cm.
Initially this was thought to represent metastatic esophageal
carcinoma. However, this was reevaluated on a scan on [**2165-8-9**] and the mass was now 5 cm in diameter. A biopsy was
consistent with hepatocellular carcinoma. His AFP was 30. He has
no evidence of recurrent esophageal cancer.

MEDICAL HISTORY: - Barrett's esophagus
- Esophageal carcinoma
- Asthma
Past Surgical History:
- Bilateral hernia repair
- Cholecystectomy in [**2150**]
- Esophageal CA with resection in [**2163**]
- Elbow surgery in [**2146**].

MEDICATION ON ADMISSION: albuterol, alprazolam 0.25 mg po qd prn, Symbicort inhaler 2
puffs [**Hospital1 **], hyoscyamine sulfate 0.375 mg po bid, Provigil 50 mg
po
qd prn, omeprazole/ sodium bicarbonate combined capsule 40
mg/1.1
gm po qd, oxandrolone 2.5 mg po bid, and Aciphex 20 mg po qd.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.8, 85, 111/50, 14, 96%RA
Gen: NAD, sleep but arousable
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-distended, appropriately tender, JP with
serosanguinous drainage
Extr: No C/C/E

FAMILY HISTORY: N/C

SOCIAL HISTORY: Married, remote history of IVDU and snorted cocaine. More recent
use of marijuana. Multiple tattoos 

### Response:
{'Malignant neoplasm of liver, primary,Chronic hepatitis C with hepatic coma,Other ascites,Acute and subacute necrosis of liver,Body Mass Index less than 19, adult,Cirrhosis of liver without mention of alcohol,Other acute postoperative pain,Personal history of malignant neoplasm of esophagus,Asthma, unspecified type, unspecified,Postprocedural fever,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Disorders of phosphorus metabolism,Abnormal coagulation profile'}
