CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: 71F with AIH/cryptogenic cirrhosis and portal hypertension c/b
fluid retention, hyponatremia, hepatic encephalopathy and HCC
s/p RFA [**2158-10-11**] (solitary 2.0 cm segment III liver lesion),
moderate AS, here with increasing abdominal pain for the past 4
days. She denies fevers, chills, sob, cp, diarrhea,
constipation, or pain in other locations beside abdomen. She
denies new weakness or fatigue.  Given h/o prior SBP, she sent
to ED from liver clinic for evalation of SBP and etiology of
worsening abdominal pain.  She denies altered mental status

MEDICAL HISTORY: 1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

MEDICATION ON ADMISSION: The Preadmission Medication list is accurate and complete.
1. Ciprofloxacin HCl 250 mg PO Q24H
2. Acetaminophen 650 mg PO Q8H:PRN pain
3. Aspirin 81 mg PO DAILY
4. Furosemide 40 mg PO DAILY
5. Lactulose 30 mL PO DAILY
6. Lisinopril 5 mg PO DAILY
7. Spironolactone 100 mg PO DAILY

ALLERGIES: Codeine / Percocet / Darvon

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals: 98.1 116/69 86 18 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 [**3-14**] mid to late peaking
systolic murmur with quite S2
Abdomen: obese with somewhat tense, tender, distended, bowel
sounds present, no rebound tenderness or guarding,
Ext: Warm, well perfused, 2+ pulses, 4+ edema throughout lower
extremities, no asterixis
Neuro: non-focal exam except AxOx3, able to perform serial days
of the week accurate, and serial months backward accurately
except for skipping may and [**Month (only) **].

FAMILY HISTORY: No liver disease in family.

SOCIAL HISTORY: She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **].
Cirrhosis of liver without mention of alcohol,Hepatorenal syndrome,Acute respiratory failure,Other shock without mention of trauma,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,End stage renal disease,Thrombocytopenia, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Atrial fibrillation,Hyposmolality and/or hyponatremia,Other ascites,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other acute postoperative pain,Congestive heart failure, unspecified,Aortic valve disorders,Pure hypercholesterolemia,Leukocytosis, unspecified,Do not resuscitate status,Personal history of traumatic fracture,Hip joint replacement,Personal history of pulmonary embolism,Screening examination for pulmonary tuberculosis
Cirrhosis of liver NOS,Hepatorenal syndrome,Acute respiratry failure,Shock w/o trauma NEC,Hyp ht/kd NOS st V w hf,End stage renal disease,Thrombocytopenia NOS,Esoph varice oth dis NOS,Atrial fibrillation,Hyposmolality,Ascites NEC,Mal neo liver, primary,Acute kidney failure NOS,Urin tract infection NOS,Acute postop pain NEC,CHF NOS,Aortic valve disorder,Pure hypercholesterolem,Leukocytosis NOS,Do not resusctate status,Hx traumatic fracture,Joint replaced hip,Hx pulmonary embolism,Screening-pulmonary TB
Admission Date:  [**2158-10-23**]              Discharge Date:   [**2158-11-27**]

Date of Birth:  [**2087-2-2**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Percocet / Darvon

Attending:[**First Name3 (LF) 12174**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
Ultrasound guided paracentesis

History of Present Illness:
71F with AIH/cryptogenic cirrhosis and portal hypertension c/b
fluid retention, hyponatremia, hepatic encephalopathy and HCC
s/p RFA [**2158-10-11**] (solitary 2.0 cm segment III liver lesion),
moderate AS, here with increasing abdominal pain for the past 4
days. She denies fevers, chills, sob, cp, diarrhea,
constipation, or pain in other locations beside abdomen. She
denies new weakness or fatigue.  Given h/o prior SBP, she sent
to ED from liver clinic for evalation of SBP and etiology of
worsening abdominal pain.  She denies altered mental status

Initial VS in the ED: 96.6 122/58 87 18 98% on RA. Exam notable
for tender abdomen, but no nausea/vomiting, fevers, chills. Labs
notable for asymptomatic hyponatremia to 119.  A dx tap was
perform demonstrating only 72 WBC, but 9150 RBC's.  Urine lytes
demonstrates NA <10, OSM 344.  UA was significant for 26 epi's,
mod bacteria, and 33 hyalian cast, but patient was asymptomatic.
Patient was given hydromorphone for pain. VS prior to transfer:
98 84 14 107/60 [**2-17**] pain


Past Medical History:
1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

but she is asymptomatic is not on pharmacologic therapy.
5. Left knee arthroscopy.
6. Left shoulder and elbow fracture with pins (unable to
undergo
MRs.)
7. Left total hip replacement in [**2148**].
8. Total hysterectomy in the [**2116**].
9. Appendectomy at age 30.
10. Tonsillectomy.
11. Cholecystectomy in the [**2126**].
12. Osteoporosis.
13. Systolic heart murmur.
14. Reported history of PE/DVT, on Coumadin in the [**2116**].

Social History:
She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **].


Family History:
No liver disease in family.


Physical Exam:
ADMISSION PHYSICAL EXAM:
Vitals: 98.1 116/69 86 18 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 [**3-14**] mid to late peaking
systolic murmur with quite S2
Abdomen: obese with somewhat tense, tender, distended, bowel
sounds present, no rebound tenderness or guarding,
Ext: Warm, well perfused, 2+ pulses, 4+ edema throughout lower
extremities, no asterixis
Neuro: non-focal exam except AxOx3, able to perform serial days
of the week accurate, and serial months backward accurately
except for skipping may and [**Month (only) **].

DISCHARGE PHYSICAL EXAM:
Vitals: 98.0 104/61 84 18 95%RA, I:740mL O:Inc BMx3
General: Alert, oriented x3, in no acute distress
HEENT: NC/AT, Sclerae icteric, PER, EOMI
Neck: supple
Lungs: normal respiratory effort, no accessory muscle use, clear
to auscultation bilaterally, bibasilar rales, no wheezes or
rhonchi
CV: Regular rate and rhythm, normal S1, [**3-14**] mid to late peaking
systolic murmur with quiet S2, loudest at RUSB
Abdomen: Obese, non-tender, ND, +BS, no rebound or guarding
Ext: Warm, well perfused, 2+ pulses, LE edema
Neuro: no focal neurologic deficits


Pertinent Results:
ADMISSION LABS:
[**2158-10-23**] 01:45PM BLOOD WBC-7.0 RBC-3.62* Hgb-12.5 Hct-36.0
MCV-100* MCH-34.6* MCHC-34.8 RDW-14.6 Plt Ct-UNABLE TO
[**2158-10-23**] 03:47PM BLOOD PT-18.3* PTT-38.6* INR(PT)-1.7*
[**2158-10-23**] 01:45PM BLOOD Glucose-115* UreaN-15 Creat-1.0 Na-119*
K-3.9 Cl-82* HCO3-29 AnGap-12
[**2158-10-23**] 01:45PM BLOOD ALT-24 AST-102* AlkPhos-189* TotBili-5.0*
[**2158-10-23**] 11:35PM BLOOD Osmolal-259*

Studies:

RUQ US ([**2158-10-24**]):
1.  Patent hepatic veins with normal pulsatility and without
evidence for
Budd-Chiari.
2.  Moderate amount of ascites, relatively unchanged from prior
CT.
3.  Cirrhosis without focal lesions.

TTE ([**2158-10-24**]): The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy with normal cavity size.
Regional left ventricular wall motion is normal. Left
ventricular systolic function is hyperdynamic (EF>75%). There is
no ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. The number of aortic valve leaflets
cannot be determined. The aortic valve leaflets are severely
thickened/deformed. There is severe aortic valve stenosis (valve
area 0.8-1.0cm2). Trace aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.
IMPRESSION: Severe calcific aortic stenosis. Symmetric LVH with
hyperdynamic systolic function. Mild mitral regurgitation.

RUQ US ([**2158-10-31**]):
1.  Cirrhotic liver.  Splenomegaly. Moderate amount of ascites.

2.  Doppler assessment of the main portal vein shows patency and
appropriate directionality of flow.

DISCHARGE LABS:

[**2158-11-26**] 07:30AM BLOOD WBC-5.2 RBC-2.82* Hgb-9.4* Hct-28.3*
MCV-100* MCH-33.3* MCHC-33.2 RDW-17.9* Plt Ct-UNABLE TO
[**2158-11-26**] 07:30AM BLOOD Glucose-79 UreaN-27* Creat-2.6* Na-130*
K-4.0 Cl-94* HCO3-27 AnGap-13
[**2158-11-24**] 05:10AM BLOOD ALT-24 AST-69* AlkPhos-192* TotBili-9.8*
[**2158-11-26**] 07:30AM BLOOD Albumin-2.0* Calcium-8.4 Phos-5.1* Mg-1.8

Brief Hospital Course:
Ms. [**Known lastname 25699**] is  a 71 yo female with a PMH of AIH/cryptogenic
cirrhosis and portal hypertension complicated by fluid
retention, hyponatremia, hepatic encephalopathy and HCC s/p RFA
[**2158-10-11**] (solitary 2.0 cm segment III liver lesion), severe AS,
who presented with increasing abdominal pain for 4 days.

# Abdominal Pain: Upon admission the pt reported 4 days of
worsening abdominal pain and distention. This was thought to be
due to post-procedural pain from her recent RFA of an HCC 1.5
weeks prior to admission, as well as distention from ascites
secondary to her cryptogenic cirrhosis. She had a diagnostic
paracentesis performed in the ED which showed no evidence of
SBP. She had a RUQ ultrasound performed which showed patency of
the hepatic vessels, as well as moderate ascites relatively
unchanged from her prior CT scan on [**2158-10-11**]. She was given
oxycodone 5mg Q4H PRN, which adequately controlled her pain. On
[**2158-10-26**] a therapeutic paracentesis was performed with
ultrasound guidance. This markedly improved her pain and
distention. At time of discharge she did not have any abdominal
pain.

# Hypervolemic Hyponatremia: Upon admission the patient's Na was
119, down from a baseline of 125 during her last admission. This
was thought to be due to hypervolemic hyponatremia secondary to
her cirrhosis. She was asymptomatic with regards to the
hyponatremia with no mental status changes. She was initially
maintained on 1L of daily fluid restriction, and her home Lasix
and spironolactone were held in order to preserve sodium.
However, over the course of 2 days this did not result in
appreciable increase in her sodium, which ranged from 116-119
from [**Date range (3) 40847**]. As such she was started on Tolvaptan
15mg on [**2158-10-25**], and her fluid restriction was liberalized. Her
Tolvaptan was increased to 30mg daily on [**2158-10-25**] due to no
increase in her sodium on the 15mg dose. She continued to have
poor response to this so it was stopped and she was ultimately
started on CVVH for removal of fluid with resolution of her
hyponatremia. Due to [**Last Name (un) **] (see below) she was continued on
hemodialysis and her diuretics were stopped.

# Acute Kidney Injury: Patient developed progressive volume
overload that was refractory to diuresis. She was initially
started on octreotide and midodrine out of concern for HRS but
ultimately transitioned to CVVH for removal of approximately
30kg of fluid. Etiology of renal failure was thought to be
predominantly due to cardiorenal syndrome with small component
of HRS. Patient was successfully transitioned to hemodialysis.
She was continued on midodrine and hydrocortisone to support her
blood pressures during dialysis given episodes of hypotension.
Eventually her SBP stabilized in 100-110's and hydrocortisone
was stopped. She was discharged on midodrine 10mg TID.  A
tunneled HD line was placed for outpatient HD which she will
have on a M/W/F basis.

# Hypoxic Respiratory Distress: Patient developed increasing
oxygen requirement in the ICU initially requiring BiPAP and then
mechanical ventilation. The cause of her distress was felt to be
related to volume overload and improved with CVVH. She was
successfully extubated and on nasal cannula at the time of
transfer. She failed speech/swallow evaluation after extubation
but per family wishes, her diet was advanced for comfort with
the understanding that she remains at high risk for aspiration.


# Severe AS: The patient had a history of AS with an estimated
valve area of 1.0-1.2cm from her prior echo in 5/[**2158**]. Upon
admission cardiology was consulted to assess whether or not her
AS might be leading to her fluid overload state. A repeat echo
was obtained which revealed an aortic valve area of 0.9
consistent with severe aortic stenosis. Cardiology was consulted
who felt valvoplasty was not indicated in this patient given her
multiple medical conditions and her high risk of morbidity with
a surgical intervention. Pt has follow up with Dr. [**Last Name (STitle) **].

# AIH/cryptogenic cirrhosis: Pt presented with worsening MELD
scores due to renal failure. Patient is not a transplant
candidate given her severe aortic stenosis. She was maintained
on supportive treatment for her liver disease including
lactulose for her hepatic encephalopathy and tube feeds for her
poor nutrition. Tube feeds were stopped on patient and families
request because they felt she was able to take in adequate
nutrition on her own. She was discharged on lactulose 15 mL PO
TID and neomycin Sulfate 500 mg PO Q8H for prevention of hepatic
encephalopathy. She was also discharged on Ciprofloxacin HCl 250
mg PO Q24H for SBP prophylaxis.

# Goals of Care: Team meeting was held with liver, renal, and
palliative care to discuss goals of care now that patient is
dialysis-dependent. We reviewed her overall poor prognosis given
the extent and incurable nature of her underlying liver disease.
The renal team discussed the importance of continued
hemodialysis and emphasized the fact that no fluid had yet been
taken off during her hemodialysis sessions and that this would
likely be required in the future. The decision of the meeting
was to continue hemodialysis on the floor and see how she
tolerates it. Pt and her family decided that she would do best
going home with hemodialysis. Pt was provided with prescription
for [**Doctor Last Name 2598**] lift, wheel chair, and hospital bed which patient
received and had set up in home prior to discharge.

TRANSITIONAL ISSUES: None

Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Ciprofloxacin HCl 250 mg PO Q24H
2. Acetaminophen 650 mg PO Q8H:PRN pain
3. Aspirin 81 mg PO DAILY
4. Furosemide 40 mg PO DAILY
5. Lactulose 30 mL PO DAILY
6. Lisinopril 5 mg PO DAILY
7. Spironolactone 100 mg PO DAILY

Discharge Medications:
1. Hospital bed
Semi-electric hospital bed. Patient requires this for severe
debility; she is bedbound and requires maximal assistance for
repositioning. Wt 83.1 kg, Ht. 66 in.
2. Wheelchair
Standard wheelchair with elevating leg rests. Patient requires
this for severe debility. Wt 83.1 kg, Ht. 66 in.
3. Alternating pressure pad
Patient requires this as she is completely bedbound, with
multiple pressure ulcers.
4. [**Doctor Last Name 2598**] Lift
Please provide home [**Doctor Last Name 2598**] Lift.
Medically necessary because patient has significantly limited
functional mobility and is dependent for sit to stand transfer.
5. Acetaminophen 650 mg PO Q8H:PRN pain
6. Aspirin 81 mg PO DAILY
7. Lactulose 15 mL PO TID
8. Ascorbic Acid 500 mg PO BID
RX *ascorbic acid 500 mg 1 tablet(s) by mouth twice a day Disp
#*60 Tablet Refills:*0
9. FoLIC Acid 1 mg PO DAILY
RX *folic acid 1 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet
Refills:*0
10. Miconazole Powder 2% 1 Appl TP QID rash
RX *miconazole nitrate [Anti-Fungal] 2 % Apply to fungal rash
four times a day Disp #*1 Bottle Refills:*0
11. Midodrine 10 mg PO TID
RX *midodrine 10 mg 1 tablet(s) by mouth three times a day Disp
#*90 Tablet Refills:*0
12. sevelamer CARBONATE 800 mg PO TID W/MEALS
RX *sevelamer carbonate [Renvela] 800 mg 1 tablet(s) by mouth
TID W/MEALS Disp #*90 Tablet Refills:*0
13. Vitamin B Complex 1 CAP PO DAILY
RX *B complex vitamins [B-Complex]   1 tablet(s) by mouth Daily
Disp #*30 Tablet Refills:*0
14. Ciprofloxacin HCl 250 mg PO Q24H
15. TraMADOL (Ultram) 25 mg PO HS:PRN pain
RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth at bedtime
Disp #*15 Tablet Refills:*0
16. Neomycin Sulfate 500 mg PO Q8H
RX *neomycin 500 mg 1 tablet(s) by mouth every eight (8) hours
Disp #*90 Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Cirrhosis
Hypervolemic hyponatremia
Hypotension
Volume overload
End stage renal failure
Severe Aortic Stenosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear Ms. [**Known lastname 25699**],

You were recently hospitalized for abdominal pain and
distention. These symptoms were thought to be due both pain from
your recent radiofrequency ablation of your hepatocellular
carcinoma, as well as fluid in your belly, known as ascites,
secondary to your cirrhosis. Your ascites was drained under
ultrasound guidance. You also developed hypotension, volume
overload, and failure of your kidneys which requires
hemodialysis. We also found that you have worsening of your
aortic stenosis; you were evaluated by cardiology who determined
that the risks outweighed the benefits of surgery. You will be
discharged home and continue dialysis as an outpatient.

Followup Instructions:
[**Location (un) **] [**Location (un) **] Dialysis Center
[**Location 8262**], [**Numeric Identifier 1415**]
Phone: [**Telephone/Fax (1) 5972**]
Nephrologist: Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 805**]
Scheduled: Monday, Wednesday, Friday-
**Tuesday, [**11-28**] at 6:00pm and Friday, [**12-1**] at
6:00pm- Dr. [**First Name (STitle) 805**] will follow up with you at your next
dialysis for your hospitalization.
 **Special schedule due to the upcoming [**Holiday 1451**] Holiday**

Name: [**Last Name (LF) **],[**First Name3 (LF) 251**] T.
Location: [**Hospital3 **] INTERNAL MEDICINE ASSOCIATES
Address: [**Street Address(2) 4472**], [**Apartment Address(1) 4473**], [**Hospital1 **],[**Numeric Identifier 9331**]
Phone: [**Telephone/Fax (1) 4475**]
Appointment: Tuesday [**2158-12-5**] 1:00pm

Department: CARDIAC SERVICES
When: MONDAY [**2158-12-11**] at 9:00 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: MONDAY [**2158-12-18**] at 9:40 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Cirrhosis of liver without mention of alcohol,Hepatorenal syndrome,Acute respiratory failure,Other shock without mention of trauma,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,End stage renal disease,Thrombocytopenia, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Atrial fibrillation,Hyposmolality and/or hyponatremia,Other ascites,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other acute postoperative pain,Congestive heart failure, unspecified,Aortic valve disorders,Pure hypercholesterolemia,Leukocytosis, unspecified,Do not resuscitate status,Personal history of traumatic fracture,Hip joint replacement,Personal history of pulmonary embolism,Screening examination for pulmonary tuberculosis'}


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: Abdominal pain

PRESENT ILLNESS: 71F with AIH/cryptogenic cirrhosis and portal hypertension c/b
fluid retention, hyponatremia, hepatic encephalopathy and HCC
s/p RFA [**2158-10-11**] (solitary 2.0 cm segment III liver lesion),
moderate AS, here with increasing abdominal pain for the past 4
days. She denies fevers, chills, sob, cp, diarrhea,
constipation, or pain in other locations beside abdomen. She
denies new weakness or fatigue.  Given h/o prior SBP, she sent
to ED from liver clinic for evalation of SBP and etiology of
worsening abdominal pain.  She denies altered mental status

MEDICAL HISTORY: 1. Cirrhosis with portal hypertension
2. Hypertension.
3. Hyperlipidemia (monitored only.)
4. Reported history of UC diagnosed 3 years ago on colonoscopy,

MEDICATION ON ADMISSION: The Preadmission Medication list is accurate and complete.
1. Ciprofloxacin HCl 250 mg PO Q24H
2. Acetaminophen 650 mg PO Q8H:PRN pain
3. Aspirin 81 mg PO DAILY
4. Furosemide 40 mg PO DAILY
5. Lactulose 30 mL PO DAILY
6. Lisinopril 5 mg PO DAILY
7. Spironolactone 100 mg PO DAILY

ALLERGIES: Codeine / Percocet / Darvon

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals: 98.1 116/69 86 18 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 [**3-14**] mid to late peaking
systolic murmur with quite S2
Abdomen: obese with somewhat tense, tender, distended, bowel
sounds present, no rebound tenderness or guarding,
Ext: Warm, well perfused, 2+ pulses, 4+ edema throughout lower
extremities, no asterixis
Neuro: non-focal exam except AxOx3, able to perform serial days
of the week accurate, and serial months backward accurately
except for skipping may and [**Month (only) **].

FAMILY HISTORY: No liver disease in family.

SOCIAL HISTORY: She lives alone. No history of alcohol excess. Lifelong
nonsmoker. Competent of all ADLS IADLS. Previously worked as a
jewelry maker and [**Hospital Ward Name **]. 

### Response:
{'Cirrhosis of liver without mention of alcohol,Hepatorenal syndrome,Acute respiratory failure,Other shock without mention of trauma,Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease,End stage renal disease,Thrombocytopenia, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Atrial fibrillation,Hyposmolality and/or hyponatremia,Other ascites,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Other acute postoperative pain,Congestive heart failure, unspecified,Aortic valve disorders,Pure hypercholesterolemia,Leukocytosis, unspecified,Do not resuscitate status,Personal history of traumatic fracture,Hip joint replacement,Personal history of pulmonary embolism,Screening examination for pulmonary tuberculosis'}
