CHIEF COMPLAINT: Liver failure

PRESENT ILLNESS: 57-y.o. male with Child-[**Doctor Last Name 14477**] class C HCV cirrhosis presents for
liver [**Doctor Last Name **].  Pt has cirrhosis with ascites, portal
hypertension, pruritis but no frank decompensation from
encephalopathy or GI hemorrhage.  CT demonstrates partial
thrombosis of the SMV and portal confluence.  On EGD he is known
to have distal esophageal varices and gastropathy.  H/o VRE SBP
8/[**2144**].  Denies recent illness.  Recently admitted
[**0-0-**] for elevated INR on warfarin for portal vein
thrombosis.

MEDICAL HISTORY: HCV cirrhosis - complicated by grade 2 varices s/p banding on
[**6-16**] -> grade I on [**7-15**] EGD, ascites, encephalopathy, has started

MEDICATION ON ADMISSION: albuterol sulfate 90 mcg/actuation 2 puffs [**Hospital1 **] PRN SOB/wheeze
clotrimazole 10 mg 1 troche mucous membrane 5x daily
colesevelam 625 mg TID
doxazosin 2 mg QHS
fluticasone 250 mcg/actuation 2 puffs [**Hospital1 **]
folic acid 1 mg daily
furosemide 40 mg daily
lactulose 10 gram/15 mL x 15 mL TID, titrate to [**3-19**] BMs daily
omeprazole 20 mg [**Hospital1 **]
oxycodone 15 mg Q8H PRN pain
rifaximin 550 mg [**Hospital1 **]
ursodiol 500 mg daily
zolpidem 5 mg QHS
cetirizine 5 mg daily
multivitamin daily
NPH insulin 40 units SC BID
camphor-menthol 0.5-0.5 % lotion topical QID PRN itch
diphenhydramine HCl 12.5 mg TID PRN itch

ALLERGIES: Codeine / Pollen Extracts

PHYSICAL EXAM: At time of [**Name (NI) **] evaluationPhysical Exam:
T: 98.1  P: 113  BP: 136/78  RR: 20  O2sat: 97% on RA
Ht: 67 in  Wt: 89.7 kg
General: awake, alert, NAD
HEENT: NCAT, EOMI, PERRLA, anicteric
Heart: RRR, NMRG
Lungs: CTAB, normal excursion, no respiratory distress
Back: no vertebral tenderness, no CVAT
Abdomen: soft, NT, mildly distended, no mass, no hernia
Pelvis: deferred
Neuro: strength intact/symmetric, sensation intact/symmetric
Extremities: WWP, no CCE, no tenderness, 2+ B radial/DP
Pyschiatric: normal judgment/insight, normal memory, normal
mood/affect

FAMILY HISTORY: Mother with diabetes, but no family history of liver disease

SOCIAL HISTORY: The patient lives alone. On disability for chronic back
problems. [**Name (NI) **] denies tobacco and drug use. He has extensive
alcohol history, but says his last drink was "about one year
ago."
Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Portal hypertension,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Asthma, unspecified type, unspecified
Chrnc hpt C wo hpat coma,Portal vein thrombosis,Portal hypertension,Cirrhosis of liver NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Asthma NOS
Admission Date:  [**2145-2-12**]              Discharge Date:   [**2145-2-20**]

Date of Birth:  [**2087-4-12**]             Sex:   M

Service: SURGERY

Allergies:
Codeine / Pollen Extracts

Attending:[**First Name3 (LF) 5569**]
Chief Complaint:
Liver failure

Major Surgical or Invasive Procedure:
Liver [**First Name3 (LF) 1326**] [**2145-2-12**]


History of Present Illness:
57-y.o. male with Child-[**Doctor Last Name 14477**] class C HCV cirrhosis presents for
liver [**Doctor Last Name **].  Pt has cirrhosis with ascites, portal
hypertension, pruritis but no frank decompensation from
encephalopathy or GI hemorrhage.  CT demonstrates partial
thrombosis of the SMV and portal confluence.  On EGD he is known
to have distal esophageal varices and gastropathy.  H/o VRE SBP
8/[**2144**].  Denies recent illness.  Recently admitted
[**0-0-**] for elevated INR on warfarin for portal vein
thrombosis.


Past Medical History:
HCV cirrhosis - complicated by grade 2 varices s/p banding on
[**6-16**] -> grade I on [**7-15**] EGD, ascites, encephalopathy, has started

liver [**Month/Year (2) **] evaluation, but is not on [**Month/Year (2) **] list
- Insulin Dependent DM - HbA1c 7.1 in [**3-25**], has peripheral
neuropathy
- Chronic neck, low back, and foot pain - on oxycodone
- Asthma/dyspnea


Social History:
The patient lives alone. On disability for chronic back
problems. [**Name (NI) **] denies tobacco and drug use. He has extensive
alcohol history, but says his last drink was "about one year
ago."


Family History:
Mother with diabetes, but no family history of liver disease


Physical Exam:
At time of [**Name (NI) **] evaluationPhysical Exam:
T: 98.1  P: 113  BP: 136/78  RR: 20  O2sat: 97% on RA
Ht: 67 in  Wt: 89.7 kg
General: awake, alert, NAD
HEENT: NCAT, EOMI, PERRLA, anicteric
Heart: RRR, NMRG
Lungs: CTAB, normal excursion, no respiratory distress
Back: no vertebral tenderness, no CVAT
Abdomen: soft, NT, mildly distended, no mass, no hernia
Pelvis: deferred
Neuro: strength intact/symmetric, sensation intact/symmetric
Extremities: WWP, no CCE, no tenderness, 2+ B radial/DP
Pyschiatric: normal judgment/insight, normal memory, normal
mood/affect


Pertinent Results:
[**2-12**] US Liver: Patent [**Month/Year (2) **] hepatic vasculature. No biliary
dilatation or perihepatic collections identified.

Liver pathology P

Brief Hospital Course:
[**2-12**] pt was admitted to the surgical service for
transplantation.  Please see operative note for details of
procedure. Intra-op received 12 RBCs, 12 FFP, 3 platelets, 2
cryo. Postop received 2 units RBCs and 2 platelets.

Post operatively he was admitted to SICU heparin gtt started and
then stopped due to concern for bleeding. HI [**Country **] was
controlled with morphine.  His sedation was weaned as well as
his vent setting for  extubation POD 1.  He was kept NPO, labs
were serially checked.  Tight blood glucose was maintained with
insulin gtt.  Linezolid x1 dose (h/o VRE in peritoneal fluid
[**8-/2144**]), Unasyn x3 doses postop  was given.  HE was started on
immunosuppression with MMF, Solumedrol. Bactrim, Fluc, Valcyte
for prophylaxis.   He was also started on MBL HCV1 Study
protocol.

[**2-12**] POD 1 his aline and PA catheter were removed. tacrolimus
was started and heparin drip was restarted. He was allowed clear
liquids and was transferred to the floor that evening.

[**2-13**] PT was consulted, diet was advanced to a regular diet,
Coumadin was started for his protal vein thrombosis.

[**Date range (1) 15078**] Patient was diuresed, continued on anticoagulation
bridge to Coumadin. He was also continued on his study protocol.
[**Last Name (un) **] services were consulted for management of his blood
sugars. His drains were discontinued [**2-18**] and [**2-20**]. Medication
teaching commenced.

[**2145-2-20**] patient was discharged to home with follow in clinic
scheduled.  HE will have coag studies drawn Monday.  At time of
dc AVSS, ambulating, tolerating a regular diet, with PO pain
meds.


Medications on Admission:
albuterol sulfate 90 mcg/actuation 2 puffs [**Hospital1 **] PRN SOB/wheeze
clotrimazole 10 mg 1 troche mucous membrane 5x daily
colesevelam 625 mg TID
doxazosin 2 mg QHS
fluticasone 250 mcg/actuation 2 puffs [**Hospital1 **]
folic acid 1 mg daily
furosemide 40 mg daily
lactulose 10 gram/15 mL x 15 mL TID, titrate to [**3-19**] BMs daily
omeprazole 20 mg [**Hospital1 **]
oxycodone 15 mg Q8H PRN pain
rifaximin 550 mg [**Hospital1 **]
ursodiol 500 mg daily
zolpidem 5 mg QHS
cetirizine 5 mg daily
multivitamin daily
NPH insulin 40 units SC BID
camphor-menthol 0.5-0.5 % lotion topical QID PRN itch
diphenhydramine HCl 12.5 mg TID PRN itch


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for SOB.
3. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
5. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
6. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
7. doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

8. tacrolimus 1 mg Capsule, twice daily Sig: Five (5) Capsule,
twice daily PO Q12H (every 12 hours) for 2 doses.
Disp:*50 Capsule, twice daily(s)* Refills:*0*
9. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
10. insulin NPH & regular human  Subcutaneou


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Hepatitis C, s/p liver [**Hospital **] (Study patient)


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
CareGroup Visiting Nurse has been arranged to see you at home.
Please call the [**Hospital **] clinic at [**Telephone/Fax (1) 673**] for fever,
chills, nausea, vomiting, diarrhea, constipation, inability to
take or keep down food, fluids or medications.
Monitor the incision for redness, drainage or bleeding.
Drain and record JP drain twice daily and more often as
necessary. Bring copy of record with you to [**Telephone/Fax (1) **] clinic.
all if you notice the output increases greatly, gets more bloody
or green in appearance or develops a foul odor.
No heavy lifting
No driving
Labwork every Monday and Thursday to be drawn at the [**Hospital Unit Name 3269**] Lab, 110 [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2145-2-25**] 8:30
Provider final study infusion at the GCRC on [**Hospital Ward Name 516**]
[**Hospital Ward Name 1826**] Building, Friday, [**2-26**] at 10:30.
[**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] CENTER (NHB) Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2145-3-2**] 10:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2145-3-3**] 1:45



Completed by:[**2145-2-21**]

Name:  [**Known lastname **],[**Known firstname **]                  Unit No:   [**Numeric Identifier 17115**]

Admission Date:  [**2145-2-12**]              Discharge Date:   [**2145-2-20**]

Date of Birth:  [**2087-4-12**]             Sex:   M

Service: SURGERY

Allergies:
Codeine / Pollen Extracts

Attending:[**First Name3 (LF) 3999**]
Addendum:
Please additional medications pt was discharged home on:

Discharge Medications:
Additional meds the patient was disharged on:
11. Tacrolimus 1 mg Capsule, twice daily Sig: Five (5) Capsule,
twice daily PO Q12H (every 12 hours) for 2 doses.
12. Insulin NPH & regular human  Subcutaneous
13. Mycophenolate mofetil  500 mg Tablet 2 Tablet(s) by mouth
twice a day
14. Prednisone 10mg once a day follow taper given to you by
coordinator  [**2145-2-15**]
15. Bactrim  400 mg-80 mg Tablet 1 Tablet(s) by mouth once a day
0.5 mg
16. Valganciclovir [Valcyte] 450 mg Tablet  2 Tablet(s) by mouth
once a day
17. Warfarin 2 mg  by mouth once a day

Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4000**] MD [**MD Number(2) 4001**]

Completed by:[**2145-2-22**]
{'Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Portal hypertension,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Asthma, unspecified type, 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: Liver failure

PRESENT ILLNESS: 57-y.o. male with Child-[**Doctor Last Name 14477**] class C HCV cirrhosis presents for
liver [**Doctor Last Name **].  Pt has cirrhosis with ascites, portal
hypertension, pruritis but no frank decompensation from
encephalopathy or GI hemorrhage.  CT demonstrates partial
thrombosis of the SMV and portal confluence.  On EGD he is known
to have distal esophageal varices and gastropathy.  H/o VRE SBP
8/[**2144**].  Denies recent illness.  Recently admitted
[**0-0-**] for elevated INR on warfarin for portal vein
thrombosis.

MEDICAL HISTORY: HCV cirrhosis - complicated by grade 2 varices s/p banding on
[**6-16**] -> grade I on [**7-15**] EGD, ascites, encephalopathy, has started

MEDICATION ON ADMISSION: albuterol sulfate 90 mcg/actuation 2 puffs [**Hospital1 **] PRN SOB/wheeze
clotrimazole 10 mg 1 troche mucous membrane 5x daily
colesevelam 625 mg TID
doxazosin 2 mg QHS
fluticasone 250 mcg/actuation 2 puffs [**Hospital1 **]
folic acid 1 mg daily
furosemide 40 mg daily
lactulose 10 gram/15 mL x 15 mL TID, titrate to [**3-19**] BMs daily
omeprazole 20 mg [**Hospital1 **]
oxycodone 15 mg Q8H PRN pain
rifaximin 550 mg [**Hospital1 **]
ursodiol 500 mg daily
zolpidem 5 mg QHS
cetirizine 5 mg daily
multivitamin daily
NPH insulin 40 units SC BID
camphor-menthol 0.5-0.5 % lotion topical QID PRN itch
diphenhydramine HCl 12.5 mg TID PRN itch

ALLERGIES: Codeine / Pollen Extracts

PHYSICAL EXAM: At time of [**Name (NI) **] evaluationPhysical Exam:
T: 98.1  P: 113  BP: 136/78  RR: 20  O2sat: 97% on RA
Ht: 67 in  Wt: 89.7 kg
General: awake, alert, NAD
HEENT: NCAT, EOMI, PERRLA, anicteric
Heart: RRR, NMRG
Lungs: CTAB, normal excursion, no respiratory distress
Back: no vertebral tenderness, no CVAT
Abdomen: soft, NT, mildly distended, no mass, no hernia
Pelvis: deferred
Neuro: strength intact/symmetric, sensation intact/symmetric
Extremities: WWP, no CCE, no tenderness, 2+ B radial/DP
Pyschiatric: normal judgment/insight, normal memory, normal
mood/affect

FAMILY HISTORY: Mother with diabetes, but no family history of liver disease

SOCIAL HISTORY: The patient lives alone. On disability for chronic back
problems. [**Name (NI) **] denies tobacco and drug use. He has extensive
alcohol history, but says his last drink was "about one year
ago." 

### Response:
{'Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Portal hypertension,Cirrhosis of liver without mention of alcohol,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Asthma, unspecified type, unspecified'}
