CHIEF COMPLAINT: Tumor thrombus extending into right atrium

PRESENT ILLNESS: Mr. [**Known lastname **] is a very pleasant 60 yo man with a PMH of cirrhosis
[**12-30**] a combination of EtOH and chronic Hepatatis C who was
transferred from an OSH with extensive HCC and tumor/thrombus
extending up his IVC into his RA.
.
He was initially on the surgical service for possible
thrombectomy, but he is not currently a surgical candidate given
the extent of the tumor thrombus.
.
He is being transferred to the medical service for palliative
care.
.
The pt denies any pain or discomfort currently. He denies chest
pain, shortness of breath or abdominal pain or discomfort. He
denies recent hematemesis, melena or hematochezia, although he
did present to the OSH with hematemesis requiring banding of a
variceal bleed.

MEDICAL HISTORY: Cirrhosis [**12-30**] chronic Hepatitis C and EtOH

MEDICATION ON ADMISSION: Vancomycin
Piperacillin-tazobactam
Pantoprazole
Heparin SC tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.8 BP: 92/44 P: 71 R: 19 SaO2: 100% on 2L
General: Awake, drowsy, NAD, pleasant, cooperative
HEENT: EOMI, no scleral icterus, MM dry
Neck: no significant JVD
Pulmonary: Lungs with ronchi anteriorly
Cardiac: RR, soft S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: NT, moderately distended, normoactive bowel sounds
Extremities: trace edema bilaterally
Skin: no rashes or lesions noted.
Neurologic: Alert, oriented x 3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: smoker, denies EtOH for last 2 years
Secondary malignant neoplasm of other specified sites,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Malignant neoplasm of liver, primary
Secondary malig neo NEC,Cirrhosis of liver NOS,Chrnc hpt C wo hpat coma,Mal neo liver, primary
Admission Date:  [**2147-1-27**]              Discharge Date:   [**2147-2-1**]

Date of Birth:  [**2086-2-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
Tumor thrombus extending into right atrium

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname **] is a very pleasant 60 yo man with a PMH of cirrhosis
[**12-30**] a combination of EtOH and chronic Hepatatis C who was
transferred from an OSH with extensive HCC and tumor/thrombus
extending up his IVC into his RA.
.
He was initially on the surgical service for possible
thrombectomy, but he is not currently a surgical candidate given
the extent of the tumor thrombus.
.
He is being transferred to the medical service for palliative
care.
.
The pt denies any pain or discomfort currently. He denies chest
pain, shortness of breath or abdominal pain or discomfort. He
denies recent hematemesis, melena or hematochezia, although he
did present to the OSH with hematemesis requiring banding of a
variceal bleed.

Past Medical History:
Cirrhosis [**12-30**] chronic Hepatitis C and EtOH


Social History:
smoker, denies EtOH for last 2 years


Family History:
Non-contributory

Physical Exam:
Vitals: T: 98.8 BP: 92/44 P: 71 R: 19 SaO2: 100% on 2L
General: Awake, drowsy, NAD, pleasant, cooperative
HEENT: EOMI, no scleral icterus, MM dry
Neck: no significant JVD
Pulmonary: Lungs with ronchi anteriorly
Cardiac: RR, soft S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: NT, moderately distended, normoactive bowel sounds
Extremities: trace edema bilaterally
Skin: no rashes or lesions noted.
Neurologic: Alert, oriented x 3.


Pertinent Results:
Abd/pelvis CT:
1.  Findings consistent with multifocal hepatocellular carcinoma
with large infiltrative lesion in right posterior lobe of the
liver with associated extensive most likely bland thrombus
expanding the entire right portal venous system, and tumor
thrombus infiltrating the middle hepatic and right hepatic vein.

2.  Tumor thrombus from the hepatic veins extends into the
intrahepatic IVC and extends cranially approximately 1.5 cm into
the right atrium.
3.  Likely bland tumor thrombus extends approximately 1 cm into
the main portal vein.  The splenic vein, left portal vein, and
SMV all remain present.
4.  Moderately large amount of ascites surrounding the liver.
No definite peritoneal carcinomatosis.


Brief Hospital Course:
60 yo M with cirrhosis presented from OSH with diffuse HCC and
tumor thrombus extending into the right atrium.

# Tumor thrombus: no intervention possible. Given the prognosis,
palliative care was consulted, and the patient was made CMO. He
should be given pain medicine (hydromorphone PO while still
aware enough, then subl,ingual morphine concentrate) without
concern for respiratory status or somnolence. He should be
treated with lactulose for encephalopathy so that he may have as
much time as possible with his family. He should also be given
lorazepam for agitation and Livsin for secretions.

Medications on Admission:
Vancomycin
Piperacillin-tazobactam
Pantoprazole
Heparin SC tid


Discharge Medications:
1. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
2. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q2H (every 2
hours) as needed for pain, dyspnea, restlessness.
3. Morphine Concentrate 20 mg/mL Solution Sig: 10-30 mg PO q1hr
as needed for pain, restlessness, dyspnea.
4. Lorazepam Intensol 2 mg/mL Concentrate Sig: 1-2 mg PO q2hr as
needed for restlessness, dyspnea.
5. Levsin 0.125 mg/mL Drops Sig: 0.125-0.25 mg PO q4hr as needed
for secretions.
6. Acetaminophen 650 mg Suppository Sig: One (1) suppository
Rectal every 4-6 hours as needed for fever or pain.


Discharge Disposition:
Extended Care

Facility:
[**Last Name (un) 57733**] - [**Location (un) 2203**]

Discharge Diagnosis:
Primary:
Hepatocellular carcinoma
Tumor thrombus involving the inferior vena cava and right atrium
Cirrhosis
Chronic Hepatitis C


Discharge Condition:
Comfortable


Discharge Instructions:
Please take all medications as prescribed. Please do not
withhold pain medication for decreased respiratory rate or
somnolence. If the patient is in pain or agitated, please treat.

Followup Instructions:
None


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]
{'Secondary malignant neoplasm of other specified sites,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Malignant neoplasm of liver, primary'}


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: Tumor thrombus extending into right atrium

PRESENT ILLNESS: Mr. [**Known lastname **] is a very pleasant 60 yo man with a PMH of cirrhosis
[**12-30**] a combination of EtOH and chronic Hepatatis C who was
transferred from an OSH with extensive HCC and tumor/thrombus
extending up his IVC into his RA.
.
He was initially on the surgical service for possible
thrombectomy, but he is not currently a surgical candidate given
the extent of the tumor thrombus.
.
He is being transferred to the medical service for palliative
care.
.
The pt denies any pain or discomfort currently. He denies chest
pain, shortness of breath or abdominal pain or discomfort. He
denies recent hematemesis, melena or hematochezia, although he
did present to the OSH with hematemesis requiring banding of a
variceal bleed.

MEDICAL HISTORY: Cirrhosis [**12-30**] chronic Hepatitis C and EtOH

MEDICATION ON ADMISSION: Vancomycin
Piperacillin-tazobactam
Pantoprazole
Heparin SC tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.8 BP: 92/44 P: 71 R: 19 SaO2: 100% on 2L
General: Awake, drowsy, NAD, pleasant, cooperative
HEENT: EOMI, no scleral icterus, MM dry
Neck: no significant JVD
Pulmonary: Lungs with ronchi anteriorly
Cardiac: RR, soft S1 S2, no murmurs, rubs or gallops appreciated
Abdomen: NT, moderately distended, normoactive bowel sounds
Extremities: trace edema bilaterally
Skin: no rashes or lesions noted.
Neurologic: Alert, oriented x 3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: smoker, denies EtOH for last 2 years 

### Response:
{'Secondary malignant neoplasm of other specified sites,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Malignant neoplasm of liver, primary'}
