CHIEF COMPLAINT: Hepatocellular carcinoma

PRESENT ILLNESS: Per Dr.[**Name (NI) 1369**] operative note as follows:
65-year-
old male who was noted to have elevated liver function tests.
A CT scan of the chest and abdomen was obtained demonstrating
a large mass in the right lobe of the liver and a CT-guided
biopsy demonstrated hepatocellular carcinoma. A CT of the
chest and abdomen at [**Hospital1 18**] on [**3-8**] demonstrated a 4.9 x
10.6 x 10.4 cm mass involving the right lobe of the liver and
the medial segment of the left lobe (segments 4, 5, and 8)
which demonstrates washout on delayed images and exerts mass
effect on the portal vein branches without any clear
thrombosis or invasion. There was no ascites and the liver
contour appeared smooth. There was no evidence of portal
hypertension. The bone scan was negative. Hepatitis B
serology was negative. AFP was 21. He subsequently underwent
portal vein embolization in preparation for a right hepatic
trisegmentectomy. He subsequently became jaundiced and
underwent ERCP for compression of the biliary tree secondary
to the tumor mass. He has otherwise remained stable. He is
now brought to the operating room after informed consent was
obtained for right hepatic trisegmentectomy, cholecystectomy,
and intraoperative ultrasound.

MEDICAL HISTORY: PMH hypertension, type 2 diabetes mellitus, peripheral
neuropathy, and benign colonic polyps.

MEDICATION ON ADMISSION: lisinopril 20 mg daily
amlodipine 10 mg daily
ciprofloxacin 500 mg daily
ursodiol 600 mg [**Hospital1 **]
glimepiride 2 mg daily prn glucose > 200
sitagliptin-metformin 50-500 mg [**Hospital1 **]
hydromorphone prn
docusate [**Hospital1 **]
diphenhydramine prn itching

ALLERGIES: Oxycodone/Acetaminophen / Hydrocodone / Shellfish Derived

PHYSICAL EXAM: At Admission to OR
Gen: NAD, AxOx3, generalized yellowing of skin
HEENT: + scleral icterus, dry MM, no cervical lymphadenopathy
Card: RRR, no bruits, no MRG
Lungs: CTAB
Abd: + bs, no rebound/guarding, non-tender, distended
extrem: no edema, 2+ DP pulses b/l,
skin: warm, dry with sl jaundice
Neuro: no asterixis, no focal deficit

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: diabetic diet. He has a history of significant alcohol
intake with approximately 21 drinks per week, but he quit in
[**2173-12-17**]. He has a history of smoking but quit 30 years ago.
Malignant neoplasm of liver, primary,Hepatic encephalopathy,Acute vascular insufficiency of intestine,Portal vein thrombosis,Acute kidney failure, unspecified,Acute respiratory failure,Unspecified septicemia,Pneumonia, organism unspecified,Acute and subacute necrosis of liver,Nutritional marasmus,Sepsis,Other ascites,Candidiasis of other urogenital sites,Cachexia,Acidosis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Mechanical complication due to other implant and internal device, not elsewhere classified,Other diseases of spleen,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Pressure ulcer, stage II,Body Mass Index between 19-24, adult,Nontraumatic hematoma of soft tissue,Unspecified essential hypertension,Tobacco use disorder,Personal history of colonic polyps,Fall from other slipping, tripping, or stumbling,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Mal neo liver, primary,Hepatic encephalopathy,Ac vasc insuff intestine,Portal vein thrombosis,Acute kidney failure NOS,Acute respiratry failure,Septicemia NOS,Pneumonia, organism NOS,Acute necrosis of liver,Nutritional marasmus,Sepsis,Ascites NEC,Candidias urogenital NEC,Cachexia,Acidosis,Esoph varice oth dis NOS,Retroperitoneum inj-cl,Malfunc oth device/graft,Spleen disease NEC,DMII oth uncntrld,Neuropathy in diabetes,Pressure ulcer, stage II,BMI between 19-24,adult,Nontrauma hema soft tiss,Hypertension NOS,Tobacco use disorder,Prsnl hst colonic polyps,Fall from slipping NEC,Abn react-artif implant
Admission Date:  [**2174-4-22**]              Discharge Date:   [**2174-8-23**]

Date of Birth:  [**2108-4-21**]             Sex:   M

Service: SURGERY

Allergies:
Oxycodone/Acetaminophen / Hydrocodone / Shellfish Derived

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Hepatocellular carcinoma

Major Surgical or Invasive Procedure:
[**2174-4-22**] right trisegmentectomy
picc line
post pyloric feeding tube
ercp
paracentesis
intubation
Chest pigtail drain



History of Present Illness:
Per Dr.[**Name (NI) 1369**] operative note as follows:
65-year-
old male who was noted to have elevated liver function tests.
A CT scan of the chest and abdomen was obtained demonstrating
a large mass in the right lobe of the liver and a CT-guided
biopsy demonstrated hepatocellular carcinoma. A CT of the
chest and abdomen at [**Hospital1 18**] on [**3-8**] demonstrated a 4.9 x
10.6 x 10.4 cm mass involving the right lobe of the liver and
the medial segment of the left lobe (segments 4, 5, and 8)
which demonstrates washout on delayed images and exerts mass
effect on the portal vein branches without any clear
thrombosis or invasion. There was no ascites and the liver
contour appeared smooth. There was no evidence of portal
hypertension. The bone scan was negative. Hepatitis B
serology was negative. AFP was 21. He subsequently underwent
portal vein embolization in preparation for a right hepatic
trisegmentectomy. He subsequently became jaundiced and
underwent ERCP for compression of the biliary tree secondary
to the tumor mass. He has otherwise remained stable. He is
now brought to the operating room after informed consent was
obtained for right hepatic trisegmentectomy, cholecystectomy,
and intraoperative ultrasound.


Past Medical History:
PMH hypertension, type 2 diabetes mellitus, peripheral
neuropathy, and benign colonic polyps.

PSH: trauma to his left hand requiring repair of his middle and
ring finger in [**2168**], and bilateral wrist carpal tunnel syndrome
in [**2169**] requiring surgical correction
R portal vein embolization [**2174-3-22**]
[**2174-4-22**] Right hepatic trisegmentectomy, cholecystectomy,
intraoperative ultrasound.


Social History:
diabetic diet. He has a history of significant alcohol
intake with approximately 21 drinks per week, but he quit in
[**2173-12-17**]. He has a history of smoking but quit 30 years ago.

He has an occasional social cigarette. He has no history of IV
drug use, marijuana use, blood transfusions, tattoos, hepatitis,

or piercing. married and has two children. He is a retired
program manager for [**Company 22916**]. He has a bachelor's degree


Family History:
Non-contributory

Physical Exam:
At Admission to OR
Gen: NAD, AxOx3, generalized yellowing of skin
HEENT: + scleral icterus, dry MM, no cervical lymphadenopathy
Card: RRR, no bruits, no MRG
Lungs: CTAB
Abd: + bs, no rebound/guarding, non-tender, distended
extrem: no edema, 2+ DP pulses b/l,
skin: warm, dry with sl jaundice
Neuro: no asterixis, no focal deficit


Pertinent Results:
At Admsiion: [**2174-4-22**]
WBC-9.3 RBC-3.26* Hgb-10.3* Hct-29.6* MCV-91# MCH-31.7 MCHC-34.9
RDW-16.4* Plt Ct-148*
PT-13.8* PTT-31.1 INR(PT)-1.2*
Glucose-106* UreaN-15 Creat-1.1 Na-143 K-3.9 Cl-106 HCO3-19*
AnGap-22*
ALT-1333* AST-2410* AlkPhos-95 TotBili-5.0*
Albumin-4.0 Calcium-10.0 Phos-5.0* Mg-1.5*
At Time of discharge
[**2174-8-22**] WBC-11.8* RBC-3.19* Hgb-10.3* Hct-32.0* MCV-100*
MCH-32.2* MCHC-32.1 RDW-25.8* Plt Ct-83*
PT-17.8* PTT-47.3* INR(PT)-1.6*
Glucose-156* UreaN-111* Creat-4.5* Na-145 K-3.1* Cl-104 HCO3-20*
AnGap-24*
Calcium-8.8 Phos-4.8* Mg-3.0*
ALT-43* AST-76* AlkPhos-166* Amylase-42 TotBili-30.1*

Brief Hospital Course:
On [**2174-4-22**], patient underwent right hepatic trisegmentectomy,
cholecystectomy, with intraoperative ultrasound for HCC. Surgeon
was Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]. Please refer to operative note for
details. Postop, he was transferred to the SICU for management.
Postop course was long and complicated with sequelae from liver
that was small for size. He developed recurrent ascites
requiring intermittent paracentesis, jaundice and confusion.
Hospital course was further complicated by acute renal failure
with persistently elevated creatine levels. Patient also
developed several episodes of melena requiring mulitple
transfusions to stabilize his HCT levels. During hospital course
patient required mulitple ICU stays. LFTs remained elevated
during entire hospital course, especially alkaline phosphatase
and bilirubin levels. Worsening renal function was noted with
rising BUN and Cr. Patient ultimately expired on POD123 due to
multiple episodes of bradycardia with decreased O2 saturation
and ultimately respiratory failure.

Significant events during hospital course are as follows:

He was found to have thrombosis of the main portal vein, splenic
vein and superior mesenteric vein on [**5-1**]. IV heparin was
started. Head was negative for bleed or stroke. Rifaximin and
lactulose were started for prevention of encephalopathy. There
was an unsuccessful attempt to recanalize the portal vein due to
inability to advance a guidewire into the main portal vein. The
pleura was traversed upon percutaneous attemt at accessing the
portal vein. CXR within angio suite demonstrated no
pneumothorax.

Bile Leak: Due to rising bilirubin levels, patient underwent
ERCP on [**2174-6-7**], which showed that previously inserted stent had
migrated proximally into the CBD. This stent was removed. [**First Name5 (NamePattern1) **]
[**Last Name (NamePattern1) 97186**] was seen. Injection of contrast showed disruption of
the biliary tree with extravasation of contrast into the liver
parenchyma.

Blood cultures were positive for enterococci on [**5-9**], so patient
was started on vancomycin and continued through [**5-24**]. Subsequent
blood cultures were negative. Urine culture from [**5-10**] grew yeast
and patient received fluconazole from [**Date range (1) 22229**]. Repeat urine
cultures on [**6-9**] were positive for VRE, and patient was started
on linezolid.

Pleural Effusion: CXR on [**8-3**] was significant for R pleural
effusion. Right pigtail catheter was placed and drained 2L of
serosanguinous fluid. Pigtail catheter was left to suction and
removed when drainage had subsided. Fluid was sent for analysis
and did not reveal any signs of infection or active bleeding.
Despite catheter placement, subsequent CXRs demonstrated
persistence of the stable pleural effusion.

Melena: On [**2174-8-3**], patient began to have several episodes of
dark, melanotic stools. Blood pressure became more labile into
the 80-90s systolic, and HCT began to fall. Patient was
transfused pRBCs to maintain HCT, and patient was transferred to
the ICU. Melana continued periodically throughout the remainder
of hospital course, occasionally requiring additional
transfusions. During final week of hospital course, HCT remained
stable in the upper 20s, and melena stopped. EGD was performed
on [**2174-8-3**] that showed high risk esophageal varices, but these
were not felt to be the cause of the bleeding. Colonoscopy on
[**2174-8-3**] showed clot in the rectum, but no signs of active
bleeding.

SBP: Patient required multiple paracenteses during his hospital
course. On [**2174-7-25**], peritoneal fluid tested positive for MRSA.
Patient was started on Vancomycin.

Nutrition/physical therapy: Throughout long hospital course
patient's nutritional status declined. Tube feeds were on/off
throughout his course with attempts at using various formulas to
improve nutritional status. TPN was also used. PO intake was
continually encouraged, but patient was unable to take adequate
po nutrition. As patient remained in bed for such a long time,
he became progressively more deconditioned. Physical therapy was
consulted throughout the hospitalization to work with the
patient. As patient became weaker, he was unable to engage in
significant physical therapy exercises, and consequently became
more deconditioned.

On POD 122, patient began to have episodes of bradycardia, with
heart rates into the high 20s. These episodes were accompanied
by O2 desaturations into the 60s. Patient's mental status
declined as he became minimally responsive. On POD 123, episodes
of bradycardia and desaturation continued. The family was
notified and patient was made DNR/DNI. The patient ultimately
expired at 10:19 am on [**2174-8-23**] with his family at the bedside.



Medications on Admission:
lisinopril 20 mg daily
amlodipine 10 mg daily
ciprofloxacin 500 mg daily
ursodiol 600 mg [**Hospital1 **]
glimepiride 2 mg daily prn glucose > 200
sitagliptin-metformin 50-500 mg [**Hospital1 **]
hydromorphone prn
docusate [**Hospital1 **]
diphenhydramine prn itching


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired; liver failure, cardiopulmonary arrest

Discharge Condition:
Expired

Discharge Instructions:
None

Followup Instructions:
None

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2174-8-25**]
{'Malignant neoplasm of liver, primary,Hepatic encephalopathy,Acute vascular insufficiency of intestine,Portal vein thrombosis,Acute kidney failure, unspecified,Acute respiratory failure,Unspecified septicemia,Pneumonia, organism unspecified,Acute and subacute necrosis of liver,Nutritional marasmus,Sepsis,Other ascites,Candidiasis of other urogenital sites,Cachexia,Acidosis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Mechanical complication due to other implant and internal device, not elsewhere classified,Other diseases of spleen,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Pressure ulcer, stage II,Body Mass Index between 19-24, adult,Nontraumatic hematoma of soft tissue,Unspecified essential hypertension,Tobacco use disorder,Personal history of colonic polyps,Fall from other slipping, tripping, or stumbling,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: Hepatocellular carcinoma

PRESENT ILLNESS: Per Dr.[**Name (NI) 1369**] operative note as follows:
65-year-
old male who was noted to have elevated liver function tests.
A CT scan of the chest and abdomen was obtained demonstrating
a large mass in the right lobe of the liver and a CT-guided
biopsy demonstrated hepatocellular carcinoma. A CT of the
chest and abdomen at [**Hospital1 18**] on [**3-8**] demonstrated a 4.9 x
10.6 x 10.4 cm mass involving the right lobe of the liver and
the medial segment of the left lobe (segments 4, 5, and 8)
which demonstrates washout on delayed images and exerts mass
effect on the portal vein branches without any clear
thrombosis or invasion. There was no ascites and the liver
contour appeared smooth. There was no evidence of portal
hypertension. The bone scan was negative. Hepatitis B
serology was negative. AFP was 21. He subsequently underwent
portal vein embolization in preparation for a right hepatic
trisegmentectomy. He subsequently became jaundiced and
underwent ERCP for compression of the biliary tree secondary
to the tumor mass. He has otherwise remained stable. He is
now brought to the operating room after informed consent was
obtained for right hepatic trisegmentectomy, cholecystectomy,
and intraoperative ultrasound.

MEDICAL HISTORY: PMH hypertension, type 2 diabetes mellitus, peripheral
neuropathy, and benign colonic polyps.

MEDICATION ON ADMISSION: lisinopril 20 mg daily
amlodipine 10 mg daily
ciprofloxacin 500 mg daily
ursodiol 600 mg [**Hospital1 **]
glimepiride 2 mg daily prn glucose > 200
sitagliptin-metformin 50-500 mg [**Hospital1 **]
hydromorphone prn
docusate [**Hospital1 **]
diphenhydramine prn itching

ALLERGIES: Oxycodone/Acetaminophen / Hydrocodone / Shellfish Derived

PHYSICAL EXAM: At Admission to OR
Gen: NAD, AxOx3, generalized yellowing of skin
HEENT: + scleral icterus, dry MM, no cervical lymphadenopathy
Card: RRR, no bruits, no MRG
Lungs: CTAB
Abd: + bs, no rebound/guarding, non-tender, distended
extrem: no edema, 2+ DP pulses b/l,
skin: warm, dry with sl jaundice
Neuro: no asterixis, no focal deficit

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: diabetic diet. He has a history of significant alcohol
intake with approximately 21 drinks per week, but he quit in
[**2173-12-17**]. He has a history of smoking but quit 30 years ago. 

### Response:
{'Malignant neoplasm of liver, primary,Hepatic encephalopathy,Acute vascular insufficiency of intestine,Portal vein thrombosis,Acute kidney failure, unspecified,Acute respiratory failure,Unspecified septicemia,Pneumonia, organism unspecified,Acute and subacute necrosis of liver,Nutritional marasmus,Sepsis,Other ascites,Candidiasis of other urogenital sites,Cachexia,Acidosis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Injury to other intra-abdominal organs without mention of open wound into cavity, retroperitoneum,Mechanical complication due to other implant and internal device, not elsewhere classified,Other diseases of spleen,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Pressure ulcer, stage II,Body Mass Index between 19-24, adult,Nontraumatic hematoma of soft tissue,Unspecified essential hypertension,Tobacco use disorder,Personal history of colonic polyps,Fall from other slipping, tripping, or stumbling,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
