CHIEF COMPLAINT: Cirhhosis; Observation s/p TIPS

PRESENT ILLNESS: 49 y/o m with EtOH induced cirrhosis, h/o SBP, H63D homozygosity
who was recently admitted to [**Location (un) **] [**2033-7-17**] for hyponatremia
and worsening ascites. He was given IVF per his report and his
Na improved and he recieved a paracentesis as well, and per his
report was not infected. Although he takes daily cipro for
prophylaxis. He went to [**Location (un) **] today for follow up blood work
and was found to have Na of 123, and he was transferred here to
[**Hospital1 **] as his hepatologist, Dr. [**Last Name (STitle) **], is here.
He otherwise denies fever/chills/diarrhea/black or bloody
stool/confusion/fatigue. He has not had EtOH for the past month,
and is currently abstaining as he is waiting for a transplant.

MEDICAL HISTORY: sbp
cirrhosis
caogulapathy
hypoalbuminemia

MEDICATION ON ADMISSION: 1. Lasix 80 mg q day
2. Aldactone 200 mg q day
3. Lactulose tid
4. Potassium prn
5. Folic acid, thiamine, and MVI
6. Cipro 500 mg daily

ALLERGIES: Morphine

PHYSICAL EXAM: T 97.5 HR 91 BP 114/57 R 18 sat 98% RA
gen alert, NAD,
HEENT mmm, mild scleral icterus, no OP lesions , RIJ CDI
CV RRR no m/r/g
pulm ctab
abd s/nt/distended, + fluid wave +BS
ext no edema, 2+ pulses

FAMILY HISTORY: family hx: alcoholism in father, h/o emphysema and lung cancer

SOCIAL HISTORY: Social hx: continues to drink- 6 beers a day and sometimes wine
had stopped in 198 then restrated 5 years ago, smokes 1 pack per
day had stopped smoking in [**2095**], restarted 3 years ago, lives
alone, divorced and has been on temp. disability for 2 years and
has been working as a floor refinisher.
Alcoholic cirrhosis of liver,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Awaiting organ transplant status,Portal hypertension
Alcohol cirrhosis liver,Hyposmolality,Chr airway obstruct NEC,CHF NOS,Await organ transplnt st,Portal hypertension
Admission Date:  [**2113-7-21**]              Discharge Date:   [**2113-7-25**]

Date of Birth:  [**2063-8-28**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
Cirhhosis; Observation s/p TIPS

Major Surgical or Invasive Procedure:
Trans-intrahepatic portosystemic shunt procedure (TIPS)


History of Present Illness:
49 y/o m with EtOH induced cirrhosis, h/o SBP, H63D homozygosity
who was recently admitted to [**Location (un) **] [**2033-7-17**] for hyponatremia
and worsening ascites. He was given IVF per his report and his
Na improved and he recieved a paracentesis as well, and per his
report was not infected. Although he takes daily cipro for
prophylaxis. He went to [**Location (un) **] today for follow up blood work
and was found to have Na of 123, and he was transferred here to
[**Hospital1 **] as his hepatologist, Dr. [**Last Name (STitle) **], is here.
He otherwise denies fever/chills/diarrhea/black or bloody
stool/confusion/fatigue. He has not had EtOH for the past month,
and is currently abstaining as he is waiting for a transplant.


Past Medical History:
sbp
cirrhosis
caogulapathy
hypoalbuminemia

Social History:
Social hx: continues to drink- 6 beers a day and sometimes wine
had stopped in 198 then restrated 5 years ago, smokes 1 pack per
day had stopped smoking in [**2095**], restarted 3 years ago, lives
alone, divorced and has been on temp. disability for 2 years and
has been working as a floor refinisher.


Family History:
family hx: alcoholism in father, h/o emphysema and lung cancer


Physical Exam:
T 97.5 HR 91 BP 114/57 R 18 sat 98% RA
gen alert, NAD,
HEENT mmm, mild scleral icterus, no OP lesions , RIJ CDI
CV RRR no m/r/g
pulm ctab
abd s/nt/distended, + fluid wave +BS
ext no edema, 2+ pulses


Pertinent Results:
[**2113-7-21**] 05:37PM   GLUCOSE-95 UREA N-7 CREAT-0.5 SODIUM-123*
POTASSIUM-4.6 CHLORIDE-89* TOTAL CO2-30 ANION GAP-9
[**2113-7-21**] 05:37PM   ALT(SGPT)-42* AST(SGOT)-74* ALK PHOS-189*
AMYLASE-79 TOT BILI-1.6*
[**2113-7-21**] 05:37PM   LIPASE-45
[**2113-7-21**] 05:37PM   ALBUMIN-2.7*
[**2113-7-21**] 05:37PM   OSMOLAL-260*
[**2113-7-21**] 05:37PM   WBC-10.2 RBC-4.02* HGB-13.7* HCT-39.4* MCV-98
MCH-34.1* MCHC-34.8 RDW-14.2
[**2113-7-21**] 05:37PM   NEUTS-76.4* LYMPHS-15.1* MONOS-7.0 EOS-1.3
BASOS-0.3
[**2113-7-21**] 05:37PM   PT-15.2* PTT-33.8 INR(PT)-1.5

Abdominal u/s: There is marked ascites seen. The liver itself
appears with relatively normal echogenicity and no evidence of
mass. Hepatofugal flow is noted within the right, left, and main
portal veins. Vasculature appears patent, but with reversed
flow. The right kidney measures 11.6 cm. The left kidney
measures 10.9 cm. There is no hydronephrosis or stones. The
gallbladder appears normal without evidence of stones. The
common duct is not dilated. There is splenomegaly. Pancreas is
not well visualized secondary to abdominal gas.

IMPRESSION:
1. Marked ascites consistent with cirrhosis.
2. Hepatofugal flow within the portal veins consistent with
portal hypertension.
3. Splenomegaly.

TIPS: 1. Paracentesis with a total of 4.4 liters of ascitic
fluid removed.
2. Successful placement of a transjugular intrahepatic
portosystemic shunt between the right hepatic vein and main
portal vein by way of the right portal vein. A total of 2 10 x
68 mm Wallstents were used in overlap.
3. A 9-French triple-lumen central venous catheter was placed
through the right internal jugular venous access with tip at the
superior vena cava-right atrial junction. The catheter may be
used immediately.
A single 3-0 nylon suture was placed at the paracentesis site in
the right lower quadrant of the abdomen. This can be removed in
7 days' time. Please note that another suture was in place in
the right lower quadrant of the abdomen that was present prior
to the beginning of today's procedure.


Brief Hospital Course:
Mr [**Known lastname 19419**] was admitted to the MICU for one day for monitoring
after his TIPS procedure.  He remained hemodynamically stable
and afebrile throughot his stay. He was to be transferred to the
floor the morning following his procedure, but was doing well
without acute issue and for this reason was discharged directly
from the MICU one day following admission.

Medications on Admission:
1. Lasix 80 mg q day
2. Aldactone 200 mg q day
3. Lactulose tid
4. Potassium prn
5. Folic acid, thiamine, and MVI
6. Cipro 500 mg daily


Discharge Medications:
1. Ciprofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a
week.
Disp:*2 Tablet(s)* Refills:*2*
2. Nadolol 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Aldactone 50 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain for 2 weeks.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary
1. Alcoholic Cirrhosis
2. Coagulopathy
3. Hypoalbuminemia


Discharge Condition:
Good


Discharge Instructions:
Please continue your home medications. Please call the liver
center [**Telephone/Fax (1) 2422**] or go to the ER for increased confusion,
fevers, chills, or any other problems.  [**Name (NI) **] should not drink
more than 6 cups of fluid a day.  (1500 cc)

Followup Instructions:
Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Where: LM [**Hospital Unit Name 7129**]
CENTER Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2113-8-11**] 10:40

Do not drink more than 6 cups of fluid (1500 cc) a day
{'Alcoholic cirrhosis of liver,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Awaiting organ transplant status,Portal hypertension'}


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: Cirhhosis; Observation s/p TIPS

PRESENT ILLNESS: 49 y/o m with EtOH induced cirrhosis, h/o SBP, H63D homozygosity
who was recently admitted to [**Location (un) **] [**2033-7-17**] for hyponatremia
and worsening ascites. He was given IVF per his report and his
Na improved and he recieved a paracentesis as well, and per his
report was not infected. Although he takes daily cipro for
prophylaxis. He went to [**Location (un) **] today for follow up blood work
and was found to have Na of 123, and he was transferred here to
[**Hospital1 **] as his hepatologist, Dr. [**Last Name (STitle) **], is here.
He otherwise denies fever/chills/diarrhea/black or bloody
stool/confusion/fatigue. He has not had EtOH for the past month,
and is currently abstaining as he is waiting for a transplant.

MEDICAL HISTORY: sbp
cirrhosis
caogulapathy
hypoalbuminemia

MEDICATION ON ADMISSION: 1. Lasix 80 mg q day
2. Aldactone 200 mg q day
3. Lactulose tid
4. Potassium prn
5. Folic acid, thiamine, and MVI
6. Cipro 500 mg daily

ALLERGIES: Morphine

PHYSICAL EXAM: T 97.5 HR 91 BP 114/57 R 18 sat 98% RA
gen alert, NAD,
HEENT mmm, mild scleral icterus, no OP lesions , RIJ CDI
CV RRR no m/r/g
pulm ctab
abd s/nt/distended, + fluid wave +BS
ext no edema, 2+ pulses

FAMILY HISTORY: family hx: alcoholism in father, h/o emphysema and lung cancer

SOCIAL HISTORY: Social hx: continues to drink- 6 beers a day and sometimes wine
had stopped in 198 then restrated 5 years ago, smokes 1 pack per
day had stopped smoking in [**2095**], restarted 3 years ago, lives
alone, divorced and has been on temp. disability for 2 years and
has been working as a floor refinisher. 

### Response:
{'Alcoholic cirrhosis of liver,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified,Awaiting organ transplant status,Portal hypertension'}
