CHIEF COMPLAINT: Shortness of breath, pleuritic chest pain

PRESENT ILLNESS: 46 y/o male who is currently incarcerated who was transferred to
[**Hospital1 18**] for further evaluation and management of PNA, pleural
effusion, and cirrhosis. Pt states that about 2 weeks ago, he
noticed increasing weakness along with chills, SOB, and
pleuritic chest pain. He was sent from jail to the ED for
further evaluation of the above-described symptoms. Pt oxygen
saturation on RA upon arrival to the ED were in the 80s.
Oxygenation improved with NC. Initial CXR revealed a large RLL
PNA and pleural effusion. He was started on levofloxacin for
CAP. He subsequently underwent a CT chest, abdomen, pelvis which
revealed cirrhosis, splenomegaly, and a large right pleural
effusion along with an infiltrate in the left lobe. Pt is s/p
paracentesis x 2. Pt was transferred to [**Hospital1 18**] for further
evaluation and management.
.
ROS: Positive for night sweats, denies wt loss. Positive for
recen fatigue. Positive for pleuritic chest pain and SOB. Denies
N/V/D or abdominal pain.

MEDICAL HISTORY: PMH:
1. Chronic hepatitis C, genotype Ib.
2. Hepatitis B
3. Bipolar disorder
4. Polysubstance abuse
.
PSH:
1. Ankle fracture in [**2162**]
2. Eye surgery as a child

MEDICATION ON ADMISSION: Medications upon transfer:
RISS
Senna
Protonix
Spironolactone 12.5 mg PO daily
Levofloxacin 750 mg IV daily
Atrovent nebs
Albuterol nebs
Clindamycin 600 mg PO Q8H
Zofran PRN
Ativan PRN
Toradol PRN
.
Medications as outpatient:
Promethazine 25 mg PO Q6H PRN
Loperamide 2 mg PRN
Zantac 150 mg PO daily
Klonopin 1 mg PO BID
Lipitor
Lamictal 100 mg PO BID
Oxycodone 50 mg PO BID
Doxepin 100 mg PO QHS

ALLERGIES: Keflex

PHYSICAL EXAM: PE:
Vitals:
T 100.3 BP 108/64 HR 107 RR 39 93% FT with FiO2 50%
General: Comfortable, mild respiratory distress.
HEENT: NC/AT. PERRLA. EOMI. MM dry. OP clear. Nasal passages
with evidence of dried blood. Anicteric sclerae.
Neck: No JVD or LAD.
Chest: No evidence of spider angiomata.
CV: Normal S1, S2 without m/r/g.
Pulm: Significantly decreased BS on right. No wheezes.
Abd: Soft, distended, evidence of ventral hernia, no fluid wave.
Normoactive BS.
Ext: No c/c/e. 2+ DP B/L.
Skin: B/L palmar erythema.
Neuro: A/O x 3. CNsII-XII grossly intact. Good ROM and strength
in all 4 extremities. No asterixis.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Polysubstance abuse including h/o tobacco use, cocaine, and
alcohol abuse. He is currently incarcerated for unarmed robbery.
Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Pneumonia, organism unspecified,Cirrhosis of liver without mention of alcohol,Pulmonary collapse,Other, mixed, or unspecified drug abuse, unspecified,Unspecified pleural effusion,Portal hypertension,Bipolar disorder, unspecified
Hpt B acte wo cm wo dlta,Pneumonia, organism NOS,Cirrhosis of liver NOS,Pulmonary collapse,Drug abuse NEC-unspec,Pleural effusion NOS,Portal hypertension,Bipolar disorder NOS
Admission Date:  [**2166-4-25**]              Discharge Date:   [**2166-5-9**]

Date of Birth:  [**2120-4-13**]             Sex:   M

Service: MEDICINE

Allergies:
Keflex

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
Shortness of breath, pleuritic chest pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
46 y/o male who is currently incarcerated who was transferred to
[**Hospital1 18**] for further evaluation and management of PNA, pleural
effusion, and cirrhosis. Pt states that about 2 weeks ago, he
noticed increasing weakness along with chills, SOB, and
pleuritic chest pain. He was sent from jail to the ED for
further evaluation of the above-described symptoms. Pt oxygen
saturation on RA upon arrival to the ED were in the 80s.
Oxygenation improved with NC. Initial CXR revealed a large RLL
PNA and pleural effusion. He was started on levofloxacin for
CAP. He subsequently underwent a CT chest, abdomen, pelvis which
revealed cirrhosis, splenomegaly, and a large right pleural
effusion along with an infiltrate in the left lobe. Pt is s/p
paracentesis x 2. Pt was transferred to [**Hospital1 18**] for further
evaluation and management.
.
ROS: Positive for night sweats, denies wt loss. Positive for
recen fatigue. Positive for pleuritic chest pain and SOB. Denies
N/V/D or abdominal pain.

Past Medical History:
PMH:
1. Chronic hepatitis C, genotype Ib.
2. Hepatitis B
3. Bipolar disorder
4. Polysubstance abuse
.
PSH:
1. Ankle fracture in [**2162**]
2. Eye surgery as a child


Social History:
Polysubstance abuse including h/o tobacco use, cocaine, and
alcohol abuse. He is currently incarcerated for unarmed robbery.


Family History:
N/C

Physical Exam:
PE:
Vitals:
T 100.3 BP 108/64 HR 107 RR 39 93% FT with FiO2 50%
General: Comfortable, mild respiratory distress.
HEENT: NC/AT. PERRLA. EOMI. MM dry. OP clear. Nasal passages
with evidence of dried blood. Anicteric sclerae.
Neck: No JVD or LAD.
Chest: No evidence of spider angiomata.
CV: Normal S1, S2 without m/r/g.
Pulm: Significantly decreased BS on right. No wheezes.
Abd: Soft, distended, evidence of ventral hernia, no fluid wave.
Normoactive BS.
Ext: No c/c/e. 2+ DP B/L.
Skin: B/L palmar erythema.
Neuro: A/O x 3. CNsII-XII grossly intact. Good ROM and strength
in all 4 extremities. No asterixis.


Pertinent Results:
Imaging Studies:
.
[**2166-4-25**] CXR
Moderate right pleural effusion.
.
[**2166-4-26**] Abdominal U/S
Normal appearing liver. No focal liver lesions. Large right
pleural effusion. Splenomegaly.
.
[**2166-4-26**] CXR
Moderate-to-large right pleural effusion is again demonstrated
and probably unchanged allowing for positional differences from
semi-upright on the prior exam to upright on the current study.
Adjacent atelectasis is present in the right middle and lower
lobes. The left lung is clear except for focal opacity at the
left base peripherally, likely due to atelectasis. Hemidiaphragm
deformity may potentially reflect a small left pleural effusion.
.
[**2166-4-27**] CXR
Accumulating right pleural fluid.
.
Acid Fast Bacilli Stains x3 + BAL specimen, pleural fluid
stains- All negative.
.
CHEST (PA & LAT)  [**2166-5-7**]
Small stable right pleural effusion and right apical
hydropneumothorax. Opacity at the right lung base which may
represent atelectasis versus airspace disease.
.
LIVER CORE BIOPSY- [**2166-5-5**]
Liver, transjugular biopsy:

1.  Fragmented biopsy with wide fibrous septa, bile-duct
proliferation, and vague nodularity consistent with cirrhosis,
trichrome stain evaluated.
2.  Mild septal and lobular mononuclear infiltration with
scattered apoptotic hepatocytes (grade 2 inflammation).
3.  No prominent cholestasis is seen.
4.  No fatty change is seen.
5.  No iron is seen on special stain

Note:  The findings are consistent with chronic viral hepatitis.
.
TRANSJUGULAR HEPATIC WEDGE PRESSURE [**2166-5-5**]-
 24mmhg (normal <12)
.

[**2166-5-9**] 06:30AM BLOOD WBC-8.1 RBC-3.63* Hgb-13.4* Hct-38.9*
MCV-107* MCH-37.0* MCHC-34.5 RDW-15.5 Plt Ct-213
[**2166-5-6**] 05:50AM BLOOD Neuts-64.4 Lymphs-24.3 Monos-6.7 Eos-3.8
Baso-0.9
[**2166-5-9**] 06:30AM BLOOD PT-16.6* PTT-39.4* INR(PT)-1.5*
[**2166-5-9**] 06:30AM BLOOD Glucose-76 UreaN-10 Creat-0.8 Na-135
K-3.9 Cl-105 HCO3-24 AnGap-10
[**2166-5-9**] 06:30AM BLOOD ALT-103* AST-121* LD(LDH)-260*
AlkPhos-133* TotBili-1.6*
[**2166-5-9**] 06:30AM BLOOD Albumin-2.3* Calcium-8.1* Phos-3.9 Mg-2.0
[**2166-5-5**] 06:10AM BLOOD calTIBC-217* Ferritn-418* TRF-167*
[**2166-4-25**] 02:46AM BLOOD Folate-10.5

[**2166-5-2**] 04:00PM BLOOD IgM HBc-POSITIVE
[**2166-4-25**] 10:16AM BLOOD
HBsAg-POSITIVE
HBsAb-NEGATIVE
HBcAb-POSITIVE IgM
Hepatititis A NEGATIVE
[**2166-4-25**] 10:16AM BLOOD HIV Ab-NEGATIVE
[**2166-4-25**] 10:16AM BLOOD HCV Ab-POSITIVE
Hepatitis Be Antigen Positive
Hepatitis Be Antibody negative

Brief Hospital Course:
Mr. [**Known lastname **] is a 46 year old male with history of hepatitis C,
hepatitis B, and bipolar disorder who is currently incarcerated
who was transferred to [**Hospital1 18**] for further evaluation and
management of PNA and pleural effusion.
.
MICU Course:
Pt was transferred from an outside hospital to the [**Hospital1 18**] MICU
for further evaluation and management of a recurrent right
pleural effusion and possible PNA. Pt is s/p thoracentesis x 2
at the OSH which revealed a transudative effusion. Pt was
started on [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 10128**] of ABx for CAP on [**2166-4-20**]. Upon arrival to
the MICU, the pt was hemodynamically stable. Since admission,
the pt was diuresed with Lasix and spironolactone with
significant improvement in his oxygen requirement. He completed
a course of levofloxacin for CAP which was stopped on [**2166-4-27**].
BCx, UCx, and SCx have been NGTD. He is being ruled out for TB
with 2 sputum cultures. PPD placed on [**2166-4-25**] was read as
negative on [**2166-4-27**]. Thoracic surgery was consulted and are
planning to pursue a VATS procedure on Tuesday. Etiology of
pleural effusion is hepatic hydrothorax vs. parapneumonic
effusion. Liver was consulted for Hep C/Hep B/Cirrhosis. Liver
is recommending VATS prior to consideration of TIPS procedure.
Hepatitis serologies and viral load pending. HIV negative.
.
Hospital course on the Floor:
Pt underwent VATS pleuradesis with chest tube placement with
evidence for resolution of the effusion.  Chest tube placement
was complicated by re-expansion pulmonary edema, which resolved
with lasix diuresis and high flow oxygen therapy. The patient
did not require intubation. The chest tube was removed three
days after placement. He developed recurrent pleural effusion
despite pleuradesis.  Pleural effusion was transudative in
nature.  Underwent transjugular biopsy for measurement of his
hepatic wedge pressure shown to be 24 (normal <12), with biopsy
revealing chronic active viral hepatitis (full path results
listed above).  Hepatitis Be antigen positive with IGM viral
load greater than 200,000 copies indicated acute Hep B
infection. The patient was started on Adefovir 10mg daily and
should continue until follow up with Dr. [**Last Name (STitle) **] in Liver Clinic
at [**Hospital1 18**].  It is likely this patient had underlying chronic
liver disease, that was well compensated until acute Hep B
infection.  Pt was started on Spironolactone 100mg daily and
lasix 40mg daily diuresis.  He was on higher doses, but
developed hypotension, and has since been stable on the above
regimen.
- Serial Chest xrays should be performed to assess for interval
change in effusion.
- At time of discharge there was no evidence for recurrence of
effusion, the patient may require TIPS in the future should this
recur given evidence of elevated portal pressures.
- Follow up abdominal ultrasound should be considered in the
setting of possible ascites that may develop.
.
1) Fever/Possible Pneumonia- (AFB negative x3 as above).
Developed fevers [**5-4**] with loculated effusion (However, s/p
pleuradecis last week, s/p chest tube placement) Given recent
instrumentation he was started on broad coverage for HAP with
Vancomycin and Zosyn for HAP [**5-4**]. His cultures of pleural fluid,
sputum, urine and blood all returned negative and his
antibiotics were stopped [**5-8**]. He has been afebrile x48hours and
without leucocytosis at time of discharge.
. ..
2) Bipolar disorder -
Patient was on Doxepin and Lamictal as an outpatient, and had
not been taking it for some time. He was given klonopin 0.5 [**Hospital1 **]
on admission, this was stopped 10 days prior to discharge today,
and the patient has been quite stable from a psychiatric
standpoint.
.
Diet- low sodium

Medications on Admission:
Medications upon transfer:
RISS
Senna
Protonix
Spironolactone 12.5 mg PO daily
Levofloxacin 750 mg IV daily
Atrovent nebs
Albuterol nebs
Clindamycin 600 mg PO Q8H
Zofran PRN
Ativan PRN
Toradol PRN
.
Medications as outpatient:
Promethazine 25 mg PO Q6H PRN
Loperamide 2 mg PRN
Zantac 150 mg PO daily
Klonopin 1 mg PO BID
Lipitor
Lamictal 100 mg PO BID
Oxycodone 50 mg PO BID
Doxepin 100 mg PO QHS


Discharge Medications:
1. Adefovir 10 mg Tablet Sig: One (1) Tablet PO Daily ().
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): hold for loose stools.
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
6. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
10. Spironolactone 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Acute hepatitis B infection
Portal hypertension
.
History of hepatitis C


Discharge Condition:
Fair- stable on room air, repeat chest xray without evidence of
recurrent effusion.


Discharge Instructions:
You were admitted for pleural effusion related to acute
hepatitis B infection.

Please take all of your medications only as prescribed.

Call your doctor or 911 if you experience any worsening
shortness of breath, chest pain, yellowing hands, skin or eyes,
nausea or vomiting, or any other concerning symptoms.

Followup Instructions:
Please keep the following appointment:
Liver Clinic at [**Hospital1 18**], ([**Hospital Unit Name **] on [**Hospital Ward Name **])
[**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2166-5-22**] 9:45
{'Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Pneumonia, organism unspecified,Cirrhosis of liver without mention of alcohol,Pulmonary collapse,Other, mixed, or unspecified drug abuse, unspecified,Unspecified pleural effusion,Portal hypertension,Bipolar disorder, unspecified'}


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: Shortness of breath, pleuritic chest pain

PRESENT ILLNESS: 46 y/o male who is currently incarcerated who was transferred to
[**Hospital1 18**] for further evaluation and management of PNA, pleural
effusion, and cirrhosis. Pt states that about 2 weeks ago, he
noticed increasing weakness along with chills, SOB, and
pleuritic chest pain. He was sent from jail to the ED for
further evaluation of the above-described symptoms. Pt oxygen
saturation on RA upon arrival to the ED were in the 80s.
Oxygenation improved with NC. Initial CXR revealed a large RLL
PNA and pleural effusion. He was started on levofloxacin for
CAP. He subsequently underwent a CT chest, abdomen, pelvis which
revealed cirrhosis, splenomegaly, and a large right pleural
effusion along with an infiltrate in the left lobe. Pt is s/p
paracentesis x 2. Pt was transferred to [**Hospital1 18**] for further
evaluation and management.
.
ROS: Positive for night sweats, denies wt loss. Positive for
recen fatigue. Positive for pleuritic chest pain and SOB. Denies
N/V/D or abdominal pain.

MEDICAL HISTORY: PMH:
1. Chronic hepatitis C, genotype Ib.
2. Hepatitis B
3. Bipolar disorder
4. Polysubstance abuse
.
PSH:
1. Ankle fracture in [**2162**]
2. Eye surgery as a child

MEDICATION ON ADMISSION: Medications upon transfer:
RISS
Senna
Protonix
Spironolactone 12.5 mg PO daily
Levofloxacin 750 mg IV daily
Atrovent nebs
Albuterol nebs
Clindamycin 600 mg PO Q8H
Zofran PRN
Ativan PRN
Toradol PRN
.
Medications as outpatient:
Promethazine 25 mg PO Q6H PRN
Loperamide 2 mg PRN
Zantac 150 mg PO daily
Klonopin 1 mg PO BID
Lipitor
Lamictal 100 mg PO BID
Oxycodone 50 mg PO BID
Doxepin 100 mg PO QHS

ALLERGIES: Keflex

PHYSICAL EXAM: PE:
Vitals:
T 100.3 BP 108/64 HR 107 RR 39 93% FT with FiO2 50%
General: Comfortable, mild respiratory distress.
HEENT: NC/AT. PERRLA. EOMI. MM dry. OP clear. Nasal passages
with evidence of dried blood. Anicteric sclerae.
Neck: No JVD or LAD.
Chest: No evidence of spider angiomata.
CV: Normal S1, S2 without m/r/g.
Pulm: Significantly decreased BS on right. No wheezes.
Abd: Soft, distended, evidence of ventral hernia, no fluid wave.
Normoactive BS.
Ext: No c/c/e. 2+ DP B/L.
Skin: B/L palmar erythema.
Neuro: A/O x 3. CNsII-XII grossly intact. Good ROM and strength
in all 4 extremities. No asterixis.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Polysubstance abuse including h/o tobacco use, cocaine, and
alcohol abuse. He is currently incarcerated for unarmed robbery. 

### Response:
{'Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Pneumonia, organism unspecified,Cirrhosis of liver without mention of alcohol,Pulmonary collapse,Other, mixed, or unspecified drug abuse, unspecified,Unspecified pleural effusion,Portal hypertension,Bipolar disorder, unspecified'}
