CHIEF COMPLAINT: HBV cirrhosis and hepatocellular carcinoma

PRESENT ILLNESS: 47-year-old Chinese male with a history of hepatitis B recently
diagnosed in [**7-/2133**] with corresponding liver cirrhosis.  The
patient has been maintained on Baraclude with an overall
undetectable viral load.  In the process of his
workup, the patient underwent ultrasound in addition to a CT,
which confirmed the presence of a liver mass within the right
lobe measuring approximately 5 cm in greatest dimension.  The
patient underwent CT-guided biopsy in addition to radiofrequency
ablation to the right hepatic lobe lesion on [**2133-9-2**].   At
the time of diagnosis of hepatitis B and hepatoma, the patient's
AFP was 788.8.  After radiofrequency ablation, his AFP was
reduced to 119 on [**2133-9-21**].
He had also been started on entecavir and has been successfully
treated so that
his HBV DNA is now undetectable.  He completed a thorough
pretransplant evaluation and was deemed an outstanding
transplant candidate.  He presented for this admission for liver
transplant.

MEDICAL HISTORY: 1.  Hepatitis B diagnosed in [**7-/2133**] in the setting of
asymptomatic elevation in LFTs.  Followup ultrasound and CT
confirmed the diagnosis of hepatoma.  The patient was started on
Baraclude with an undetectable HBV viral load.  The patient's
AFP was 788.8.  Status post radiofrequency ablation, it was 119.

MEDICATION ON ADMISSION: Acyclovir 25', Omeprazole 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: AVSS
Gen: NAD
HEENT: NCAT, PERRL, MMM
Neck: no LAD
CV: RRR, no m/r/g
Resp: CTAB
Abd: soft, NT,ND
Ext: no edema
Skin: no rashes

FAMILY HISTORY: His father is alive at the age of 70, in good
health.   Mother is alive in her 60s, in good health.  He has
two
siblings who appear to be in good health as well.  There is no
family history of inflammatory bowel disease,
cholangiocarcinoma,
gastric cancer, colon cancer, prostate cancer, or hepatocellular
carcinoma.

SOCIAL HISTORY: The patient is married and has two children.  The patient works
fulltime at [**Hospital **] Medical School within a cell biology lab.
He is an immigrant of [**Country 651**]. He came to the United States in
[**2126**].  He has been living in
[**Location (un) 86**] since [**35**]/[**2131**].  The patient adamantly denies any
hepatitis
B exposures in the setting of IV drug abuse, tatoos, recent
unprotected sexual intercourse, or prior blood transfusions.
The
patient reports his family has been tested and they remain
negative.  He reports a heavy history of alcohol use
approximately 10 years ago and he states that now he only drinks
beer occasionally.  He denies any prior history of tobacco use.
Malignant neoplasm of liver, not specified as primary or secondary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Portal hypertension,Lumbago,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use
Malignant neo liver NOS,Hpt B chrn wo cm wo dlta,Cirrhosis of liver NOS,Portal hypertension,Lumbago,Pancreatic disorder NEC,Adv eff corticosteroids
Admission Date:  [**2134-3-15**]              Discharge Date:   [**2134-3-22**]

Date of Birth:  [**2087-1-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
HBV cirrhosis and hepatocellular carcinoma

Major Surgical or Invasive Procedure:
Orthotopic liver transplant [**2134-3-15**]


History of Present Illness:
47-year-old Chinese male with a history of hepatitis B recently
diagnosed in [**7-/2133**] with corresponding liver cirrhosis.  The
patient has been maintained on Baraclude with an overall
undetectable viral load.  In the process of his
workup, the patient underwent ultrasound in addition to a CT,
which confirmed the presence of a liver mass within the right
lobe measuring approximately 5 cm in greatest dimension.  The
patient underwent CT-guided biopsy in addition to radiofrequency
ablation to the right hepatic lobe lesion on [**2133-9-2**].   At
the time of diagnosis of hepatitis B and hepatoma, the patient's
AFP was 788.8.  After radiofrequency ablation, his AFP was
reduced to 119 on [**2133-9-21**].
He had also been started on entecavir and has been successfully
treated so that
his HBV DNA is now undetectable.  He completed a thorough
pretransplant evaluation and was deemed an outstanding
transplant candidate.  He presented for this admission for liver
transplant.


Past Medical History:
1.  Hepatitis B diagnosed in [**7-/2133**] in the setting of
asymptomatic elevation in LFTs.  Followup ultrasound and CT
confirmed the diagnosis of hepatoma.  The patient was started on
Baraclude with an undetectable HBV viral load.  The patient's
AFP was 788.8.  Status post radiofrequency ablation, it was 119.

Core liver biopsy confirmed hepatocellular carcinoma, moderately
differentiated.
2.  History of chronic low back pain.
3.  History of chronic dry cough.  The patient reports a
negative workup in the past and was told that this may be
related to chronic acid reflux.


Social History:
The patient is married and has two children.  The patient works
fulltime at [**Hospital **] Medical School within a cell biology lab.
He is an immigrant of [**Country 651**]. He came to the United States in
[**2126**].  He has been living in
[**Location (un) 86**] since [**35**]/[**2131**].  The patient adamantly denies any
hepatitis
B exposures in the setting of IV drug abuse, tatoos, recent
unprotected sexual intercourse, or prior blood transfusions.
The
patient reports his family has been tested and they remain
negative.  He reports a heavy history of alcohol use
approximately 10 years ago and he states that now he only drinks
beer occasionally.  He denies any prior history of tobacco use.


Family History:
His father is alive at the age of 70, in good
health.   Mother is alive in her 60s, in good health.  He has
two
siblings who appear to be in good health as well.  There is no
family history of inflammatory bowel disease,
cholangiocarcinoma,
gastric cancer, colon cancer, prostate cancer, or hepatocellular
carcinoma.


Physical Exam:
Vitals: AVSS
Gen: NAD
HEENT: NCAT, PERRL, MMM
Neck: no LAD
CV: RRR, no m/r/g
Resp: CTAB
Abd: soft, NT,ND
Ext: no edema
Skin: no rashes

Pertinent Results:
[**2134-3-15**] 04:16AM BLOOD WBC-2.2* RBC-3.58* Hgb-12.1* Hct-34.5*
MCV-96 MCH-33.7* MCHC-35.0 RDW-14.9 Plt Ct-62*
[**2134-3-15**] 03:14PM BLOOD WBC-3.5*# RBC-2.26* Hgb-7.7* Hct-22.1*
MCV-98 MCH-34.3* MCHC-35.1* RDW-14.8 Plt Ct-70*
[**2134-3-15**] 09:27PM BLOOD WBC-5.4# RBC-3.30*# Hgb-10.9*# Hct-30.5*#
MCV-93 MCH-32.9* MCHC-35.6* RDW-15.6* Plt Ct-93*
[**2134-3-15**] 09:27PM BLOOD WBC-5.4# RBC-3.30*# Hgb-10.9*# Hct-30.5*#
MCV-93 MCH-32.9* MCHC-35.6* RDW-15.6* Plt Ct-93*
[**2134-3-22**] 05:10AM BLOOD WBC-5.7 RBC-3.87* Hgb-12.4* Hct-35.4*
MCV-92 MCH-32.2* MCHC-35.1* RDW-15.5 Plt Ct-96*
[**2134-3-15**] 04:16AM BLOOD PT-14.4* PTT-32.9 INR(PT)-1.3*
[**2134-3-19**] 05:46AM BLOOD PT-11.9 PTT-31.8 INR(PT)-1.0
[**2134-3-22**] 05:10AM BLOOD Plt Smr-LOW Plt Ct-96*
[**2134-3-15**] 04:16AM BLOOD Fibrino-130*
[**2134-3-16**] 02:49AM BLOOD Fibrino-259
[**2134-3-15**] 04:16AM BLOOD Glucose-128* UreaN-17 Creat-0.8 Na-141
K-4.3 Cl-108 HCO3-25 AnGap-12
[**2134-3-22**] 05:10AM BLOOD Glucose-88 UreaN-23* Creat-1.0 Na-138
K-4.8 Cl-102 HCO3-29 AnGap-12
[**2134-3-15**] 04:16AM BLOOD ALT-41* AST-51* AlkPhos-138* TotBili-0.7
[**2134-3-22**] 05:10AM BLOOD ALT-339* AST-71* AlkPhos-118* TotBili-0.8
[**2134-3-15**] 04:16AM BLOOD Albumin-3.7 Calcium-9.1 Phos-3.4 Mg-1.9
[**2134-3-15**] 04:16AM BLOOD Albumin-3.7 Calcium-9.1 Phos-3.4 Mg-1.9
[**2134-3-22**] 05:10AM BLOOD Calcium-9.0 Phos-4.3 Mg-1.5*
[**2134-3-21**] 08:00AM BLOOD Albumin-3.4 Calcium-9.1 Phos-3.6 Mg-1.5*
[**2134-3-15**] 04:16AM BLOOD HBsAg-POSITIVE HBsAb-NEGATIVE
HBcAb-POSITIVE HAV Ab-POSITIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE
[**2134-3-16**] 02:49AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE,
[**2134-3-18**] 05:05AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
[**2134-3-19**] 05:46AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE,T
[**2134-3-20**] 05:09AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE,T
[**2134-3-21**] 08:00AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE,T
[**2134-3-17**] 05:12AM BLOOD FK506-3.4*
[**2134-3-18**] 05:05AM BLOOD FK506-9.2
[**2134-3-19**] 05:46AM BLOOD FK506-9.1
[**2134-3-20**] 05:09AM BLOOD FK506-8.4
[**2134-3-21**] 08:00AM BLOOD FK506-7.1
[**2134-3-22**] 05:10AM BLOOD FK506-10.5
[**2134-3-15**] 04:16AM BLOOD HCV Ab-NEGATIVE

Brief Hospital Course:
The patient was admitted [**3-15**] and underwent orthotopic deceased
donor liver transplant, piggyback, portal vein to portal vein
anastomosis, common bile duct to common bile duct anastomosis
without a T tube, donor common hepatic artery to recipient
common hepatic artery end-to-end.  Operative findings were
notable for a cirrhotic liver with a large lesion in the right
lobe of his liver consistent
with prior radiofrequency ablation site. The omentum was stuck
to this lesion. He had mild portal hypertension. He had no other
significant abnormalities.  No T tube was placed. Two 19 [**Doctor Last Name 406**]
drains were placed and brought through separate stab
incisions. Intraoperatively, the patient received 7000 cc of
Plasma-Lyte, 3 units of fresh frozen plasma, 2 units of
platelets, 1 unit of cryo, 500 cc of albumin and made 750 cc of
urine. The patient was transferred to the surgical intensive
care unit in stable condition.  A post-transplant ultrasound
showed patent transplant vasculature except right hepatic artery
not visualized. It also showed higher than normal velocities in
the portal vein.   CXR - NGT coiled in stomach, Swan in PA,
density LLL. HBV DNA non-detectable.  On POD 1, an ultrasound
was repeated which showed patent hepatic vasculature, with
normal waveforms. A 5.5 x 2.7 cm subhepatic collection
consistent with postop changes. On POD 7, an ultrasound was
again performed which showed all hepatic vessels to be patent.

Return of bowel function was noted on POD 2 and the patient's
diet was advanced.
The lateral drain was removed on POD 4 and a 3-0 silk suture was
used to close the site.  The medial drain was removed on POD 7.


The [**Hospital 228**] hospital course has been complicated by high blood
sugars to the 200's.  The patient was changed to a diabetic diet
and [**Last Name (un) **] was consulted.  The patient was placed on a stricter
sliding scale and started on a nighttime dose of Lantus.

The patient is being discharged on POD 7 with minimal pain,
ambulating without difficulty, and tolerating a regular diet.




Medications on Admission:
Acyclovir 25', Omeprazole 20'

Discharge Medications:
1. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
6. Entecavir 0.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed.
Disp:*30 Tablet(s)* Refills:*0*
10. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime: Also follow sliding scale insulin.
Disp:*2 bottles* Refills:*2*
11. Tacrolimus 5 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
12. Hepatitis B Immune Globulin     Injectable Sig: Five (5) ml
Intramuscular ONCE (Once): follow schedule. to be given in
clinic.
13. Insulin Lispro (Human) 100 unit/mL Solution Sig: follow
sliding scale  Subcutaneous four times a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
s/p Orthotopic liver transplant [**2134-3-15**]


Discharge Condition:
Good


Discharge Instructions:
Call the transplant office at [**Telephone/Fax (1) 673**] if you experience any
of the following symptoms: fever, chills, nausea, vomiting,
diarrhea, inability to eat, pain over the incision site or
liver, yellowing of the skin or eyes, an increase in abdominal
girth. Monitor incision for redness, drainage or bleeding.  Do
not drive if you are taking narcotics. Take your medications
exactly as directed.
Have labs drawn every Monday and Thursday and have them faxed to
[**Telephone/Fax (1) 697**]. CBC, Chem 10, AST, ALT, Alk Phos, Albumin, T Bili
and trough Prograf Level


Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2134-3-24**] 1:00
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2134-3-24**]
1:40
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2134-3-31**]
3:20


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]
{'Malignant neoplasm of liver, not specified as primary or secondary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Portal hypertension,Lumbago,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use'}


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: HBV cirrhosis and hepatocellular carcinoma

PRESENT ILLNESS: 47-year-old Chinese male with a history of hepatitis B recently
diagnosed in [**7-/2133**] with corresponding liver cirrhosis.  The
patient has been maintained on Baraclude with an overall
undetectable viral load.  In the process of his
workup, the patient underwent ultrasound in addition to a CT,
which confirmed the presence of a liver mass within the right
lobe measuring approximately 5 cm in greatest dimension.  The
patient underwent CT-guided biopsy in addition to radiofrequency
ablation to the right hepatic lobe lesion on [**2133-9-2**].   At
the time of diagnosis of hepatitis B and hepatoma, the patient's
AFP was 788.8.  After radiofrequency ablation, his AFP was
reduced to 119 on [**2133-9-21**].
He had also been started on entecavir and has been successfully
treated so that
his HBV DNA is now undetectable.  He completed a thorough
pretransplant evaluation and was deemed an outstanding
transplant candidate.  He presented for this admission for liver
transplant.

MEDICAL HISTORY: 1.  Hepatitis B diagnosed in [**7-/2133**] in the setting of
asymptomatic elevation in LFTs.  Followup ultrasound and CT
confirmed the diagnosis of hepatoma.  The patient was started on
Baraclude with an undetectable HBV viral load.  The patient's
AFP was 788.8.  Status post radiofrequency ablation, it was 119.

MEDICATION ON ADMISSION: Acyclovir 25', Omeprazole 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: AVSS
Gen: NAD
HEENT: NCAT, PERRL, MMM
Neck: no LAD
CV: RRR, no m/r/g
Resp: CTAB
Abd: soft, NT,ND
Ext: no edema
Skin: no rashes

FAMILY HISTORY: His father is alive at the age of 70, in good
health.   Mother is alive in her 60s, in good health.  He has
two
siblings who appear to be in good health as well.  There is no
family history of inflammatory bowel disease,
cholangiocarcinoma,
gastric cancer, colon cancer, prostate cancer, or hepatocellular
carcinoma.

SOCIAL HISTORY: The patient is married and has two children.  The patient works
fulltime at [**Hospital **] Medical School within a cell biology lab.
He is an immigrant of [**Country 651**]. He came to the United States in
[**2126**].  He has been living in
[**Location (un) 86**] since [**35**]/[**2131**].  The patient adamantly denies any
hepatitis
B exposures in the setting of IV drug abuse, tatoos, recent
unprotected sexual intercourse, or prior blood transfusions.
The
patient reports his family has been tested and they remain
negative.  He reports a heavy history of alcohol use
approximately 10 years ago and he states that now he only drinks
beer occasionally.  He denies any prior history of tobacco use. 

### Response:
{'Malignant neoplasm of liver, not specified as primary or secondary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Cirrhosis of liver without mention of alcohol,Portal hypertension,Lumbago,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use'}
