CHIEF COMPLAINT: Hepatopulmonary Syndrome, admitted for liver transplant

PRESENT ILLNESS: 39F admitted [**2120-7-2**] when she was called for ABO incompatibile
liver transplant. Has been followed extensively for autoimmune
hepatitis and following complications (see PMhedhx) and reports
over the last few weeks that she has beens table with no medical
issues. She denies any fever or pain, but does  have some mild
nausea and one episode of emesis before arrival to hospital
which she attributes to anxiousness/nervousness for her upcoming
surgery.

MEDICAL HISTORY: - autoimmune hepatitis dx [**2095**], [**Doctor First Name **] -, SMA +, liver biopsy
[**1-17**]: mild to moderate periportal inflammation including plasma

MEDICATION ON ADMISSION: Alendronate 70 weekly, Aripiprazole 2.5 mg QOD, Azathioprine
50', clotrimazole 10''''', Fluoxetine 60', folate', Furosemide
80', Gabapentin 200''', humalog, Lactulose 30', omeprazole 20'',
oxycodone 5''', prednisone 10', Rifaximin 550'', Spironolactone
200', Bactrim 400mg-80mg 1 tab MWF, Trazadone 150mg QHS, NPH
Insulin (patient says she rarely uses with sliding scale)

ALLERGIES: Dilaudid / Shellfish Derived

PHYSICAL EXAM: VS: T 99.6 BP 146/66 P 81 RR 20 99% on non-rebreather
Gen: A&Ox3, Appears stated age, laying comforably in bed with
NAD, obese caucasian female
HEENT: EOMI, non-rebreather mask in place
CV: RRR, no m/r/g
Pulm: CTAB
Abd: obese, non-distended, no organomegaly, tender to deep
palpation in epigastrum, LUQ, RLQ
Ext: Warm, well perfused, Distal pulses intact

FAMILY HISTORY: No h/o autoimmune illnesses  or liver disease. Father with CAD,
mother had a CVA. Her children are healthy although two of them
have asthma. Maternal uncle with esophageal cancer.

SOCIAL HISTORY: She curretly lives at rehab. She does not smoke, use alcohol, or
illicit drugs. She is currently unemployed but worked as a bus
driver previously.
Autoimmune hepatitis,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Other specified disorders of biliary tract,Splenomegaly,Other diseases of lung, not elsewhere classified,Portal hypertension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Varices of other sites
Autoimmune hepatitis,Chr pulmon heart dis NEC,Depend-supplement oxygen,Dis of biliary tract NEC,Splenomegaly,Other lung disease NEC,Portal hypertension,Abn react-anastom/graft,Sec DM wo cmp nt st uncn,Long-term use of insulin,Adv eff corticosteroids,Varices of other sites
Admission Date:  [**2120-7-2**]              Discharge Date:   [**2120-7-24**]

Date of Birth:  [**2081-2-11**]             Sex:   F

Service: SURGERY

Allergies:
Dilaudid / Shellfish Derived

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Hepatopulmonary Syndrome, admitted for liver transplant

Major Surgical or Invasive Procedure:
[**2120-7-2**] ABO Incompatible Liver transplant
[**2120-7-3**] Ex-Lap, choledochocholedochostomy
[**2120-7-4**] - [**2120-7-15**] Plasmapheresis (12 times total)
[**2120-7-22**] U/S guided Liver Biopsy


History of Present Illness:
39F admitted [**2120-7-2**] when she was called for ABO incompatibile
liver transplant. Has been followed extensively for autoimmune
hepatitis and following complications (see PMhedhx) and reports
over the last few weeks that she has beens table with no medical
issues. She denies any fever or pain, but does  have some mild
nausea and one episode of emesis before arrival to hospital
which she attributes to anxiousness/nervousness for her upcoming
surgery.


Past Medical History:
- autoimmune hepatitis dx [**2095**], [**Doctor First Name **] -, SMA +, liver biopsy
[**1-17**]: mild to moderate periportal inflammation including plasma

cells, portal fibrosis and possible stage 3 fibrosis
- DM 2
- portal hypertension
- splenomegaly
- hepatopulmonary syndrome (dx [**1-/2119**] based on platypnea,
orthodeoxya and Aa gradient; she had a ? PFO vs. AVM on TEE w/
some echos showing incr. PAP vs. not)
- hx of hepatic encephalopathy
- migraine headaches
- depression
- Cholecystectomy in [**2112**]
- Endometrial ablation [**2114**] (but pt unsure)
- Cesarian sections

Social History:
She curretly lives at rehab. She does not smoke, use alcohol, or
illicit drugs. She is currently unemployed but worked as a bus
driver previously.


Family History:
No h/o autoimmune illnesses  or liver disease. Father with CAD,
mother had a CVA. Her children are healthy although two of them
have asthma. Maternal uncle with esophageal cancer.

Physical Exam:
VS: T 99.6 BP 146/66 P 81 RR 20 99% on non-rebreather
Gen: A&Ox3, Appears stated age, laying comforably in bed with
NAD, obese caucasian female
HEENT: EOMI, non-rebreather mask in place
CV: RRR, no m/r/g
Pulm: CTAB
Abd: obese, non-distended, no organomegaly, tender to deep
palpation in epigastrum, LUQ, RLQ
Ext: Warm, well perfused, Distal pulses intact


Pertinent Results:
On Admission: [**2120-7-2**]
WBC-2.7* RBC-3.99* Hgb-11.7* Hct-33.1* MCV-83 MCH-29.2
MCHC-35.2* RDW-15.7* Plt Ct-120*
PT-14.5* PTT-26.4 INR(PT)-1.3*
Glucose-190* UreaN-14 Creat-0.7 Na-136 K-3.4 Cl-103 HCO3-27
AnGap-9
ALT-20 AST-29 AlkPhos-124* TotBili-0.7
Albumin-3.4* Calcium-9.1 Phos-3.8# Mg-1.6
[**2120-7-24**] calTIBC-195* Ferritn-653* TRF-150* Iron-19*
[**2120-7-2**] TSH-5.0*
On Discharge: [**2120-7-24**]
[**2120-7-24**] 04:50AM BLOOD WBC-16.7* RBC-2.97* Hgb-8.4* Hct-25.6*
MCV-86 MCH-28.4 MCHC-33.0 RDW-15.6* Plt Ct-807*
PT-14.2* PTT-22.5 INR(PT)-1.2*
Glucose-53* UreaN-30* Creat-1.1 Na-137 K-5.1 Cl-97 HCO3-27
AnGap-18
ALT-44* AST-24 AlkPhos-171* TotBili-0.3
Albumin-3.9 Calcium-9.9 Phos-5.4* Mg-1.9
tacroFK-10.9

Brief Hospital Course:
Ms. [**Known firstname **] [**Known lastname **] is a 39F with past medical history significant
for Auto Immune Hepatitis, portal hypertension,  splenomegaly,
and hepatopulmonary syndrome requiring home O2. She was admitted
[**2120-7-2**] for a liver transplant, and subsequently underwent
surgery where she received an ABO incompatible liver, and had a
splenectomy. On POD#1 it was noted that she had biliary drainage
from [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] drain and there was concern for bile duct [**Last Name (LF) 3564**], [**First Name3 (LF) **]
the patient was taken back to the OR for an ex-lap,
choledochocholedochostomy. She tolerated the procedure well and
was monitored in the SICU until she was stable for transfer on
[**2120-7-11**].  In regards to her immunosuppression, the patient
received MMF, methylprednisolone to prednisone taper,
Tacrolimus, and ATG per ABO incompatible liver transplant
protocol. Tacrolimus levels were monitored daily and adequate
suppression was achieved (most recent tacro levels ranging
[**9-21**]). Initially the patient was checked for Anti-A and Anti-B
titers. Throughout her hospital course patient was pheresed a
total of 12 times for elevated titers, which was continued when
the patient was transferred to the floor. Due to the history of
hepatopulmonary syndrome, the patient has continued to require
oxygen by face mask. Throughout her course she has been able to
maintain good sats on face mask, but decompensates into the 80's
upon ambulation. This was consistent with her initial baseline,
and she will require supplemental oxygen upon discharge. While
on the floor, her blood sugars were monitored and patient was
managed on an ISS with the help of [**Hospital **] [**Hospital 982**] Clinic.
Through her course serial liver enzymes were monitored, and
AST/ALT levels remained stable. Recently on [**2120-7-20**] there was a
bump in the Alk Phos 121 up to 171 on [**2120-7-24**]. A Liver US was
performed which demonstrated a patent portal vein and branches,
and good flow on the Hepatic artery. An U/S guided liver biopsy
was also performed on [**2120-7-22**] to check for signs of rejection,
the pathology report was negative for signs of acute rejection
or ductal proliferation. Patient remained stable and was set up
for discharge to a rehab facility ([**Hospital1 **] [**Location (un) 701**]).

Medications on Admission:
Alendronate 70 weekly, Aripiprazole 2.5 mg QOD, Azathioprine
50', clotrimazole 10''''', Fluoxetine 60', folate', Furosemide
80', Gabapentin 200''', humalog, Lactulose 30', omeprazole 20'',
oxycodone 5''', prednisone 10', Rifaximin 550'', Spironolactone
200', Bactrim 400mg-80mg 1 tab MWF, Trazadone 150mg QHS, NPH
Insulin (patient says she rarely uses with sliding scale)


Discharge Medications:
1. fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
2. valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO Q24H
(every 24 hours).
3. fluoxetine 20 mg Capsule Sig: Three (3) Capsule PO DAILY
(Daily).
4. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours).
5. docusate sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
7. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
8. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
10. NPH insulin human recomb 100 unit/mL Suspension Sig: Forty
Two (42) units in AM Subcutaneous once a day: 8 units PM, please
follow insulin scale provided.
11. insulin lispro 100 unit/mL Solution Sig: Per Sliding Scale
Subcutaneous four times a day: Please follow sliding scale
provided.
12. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
13. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO DAILY (Daily).
14. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
15. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for Anxiety.
16. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain: Not to exceed 2 grams total
daily.
17. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
18. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheezes.
19. diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO HS
(at bedtime) as needed for insomnia.
20. prednisone 5 mg Tablet Sig: 3.5 Tablets PO DAILY (Daily):
Please follow transplant clinic taper.
21. Ondansetron 4 mg IV Q8H:PRN nausea/vomiting


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
ABO Incompatible Liver Transplant with Splenectomy
Autoimmune Hepatitis
Hepatopulmonary Syndrome
Diabetes Mellitus (Type II)

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (pt has
desaturation upon ambulation).


Discharge Instructions:
Please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever,
chills, nausea, vomiting, diarrhea, constipation, worsening
respiratory status (patient has desaturations with
movement/ambulation), inability to tolerate food, fluids or
medications, increased abdominal pain, yellowing of skin or
eyes, increased lower extremity edema, or any other concerning
symptoms
Monitor incision for redness, drainage or bleeding
Patient may shower, pat incision dry and leave open to air,
staples will be removed in clinic
No heavy lifting

Followup Instructions:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 673**] Date/Time:[**2120-7-31**]
2:00, [**Last Name (NamePattern1) **], [**Hospital Unit Name **] [**Location (un) **], [**Location (un) 86**], MA
TRANSPLANT SOCIAL WORKER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2120-7-31**]
2:40 [**Last Name (NamePattern1) **], [**Hospital Unit Name **] [**Location (un) **], [**Location (un) 86**], MA



Completed by:[**2120-7-24**]
{'Autoimmune hepatitis,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Other specified disorders of biliary tract,Splenomegaly,Other diseases of lung, not elsewhere classified,Portal hypertension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Varices of other sites'}


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: Hepatopulmonary Syndrome, admitted for liver transplant

PRESENT ILLNESS: 39F admitted [**2120-7-2**] when she was called for ABO incompatibile
liver transplant. Has been followed extensively for autoimmune
hepatitis and following complications (see PMhedhx) and reports
over the last few weeks that she has beens table with no medical
issues. She denies any fever or pain, but does  have some mild
nausea and one episode of emesis before arrival to hospital
which she attributes to anxiousness/nervousness for her upcoming
surgery.

MEDICAL HISTORY: - autoimmune hepatitis dx [**2095**], [**Doctor First Name **] -, SMA +, liver biopsy
[**1-17**]: mild to moderate periportal inflammation including plasma

MEDICATION ON ADMISSION: Alendronate 70 weekly, Aripiprazole 2.5 mg QOD, Azathioprine
50', clotrimazole 10''''', Fluoxetine 60', folate', Furosemide
80', Gabapentin 200''', humalog, Lactulose 30', omeprazole 20'',
oxycodone 5''', prednisone 10', Rifaximin 550'', Spironolactone
200', Bactrim 400mg-80mg 1 tab MWF, Trazadone 150mg QHS, NPH
Insulin (patient says she rarely uses with sliding scale)

ALLERGIES: Dilaudid / Shellfish Derived

PHYSICAL EXAM: VS: T 99.6 BP 146/66 P 81 RR 20 99% on non-rebreather
Gen: A&Ox3, Appears stated age, laying comforably in bed with
NAD, obese caucasian female
HEENT: EOMI, non-rebreather mask in place
CV: RRR, no m/r/g
Pulm: CTAB
Abd: obese, non-distended, no organomegaly, tender to deep
palpation in epigastrum, LUQ, RLQ
Ext: Warm, well perfused, Distal pulses intact

FAMILY HISTORY: No h/o autoimmune illnesses  or liver disease. Father with CAD,
mother had a CVA. Her children are healthy although two of them
have asthma. Maternal uncle with esophageal cancer.

SOCIAL HISTORY: She curretly lives at rehab. She does not smoke, use alcohol, or
illicit drugs. She is currently unemployed but worked as a bus
driver previously. 

### Response:
{'Autoimmune hepatitis,Other chronic pulmonary heart diseases,Other dependence on machines, supplemental oxygen,Other specified disorders of biliary tract,Splenomegaly,Other diseases of lung, not elsewhere classified,Portal hypertension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Long-term (current) use of insulin,Adrenal cortical steroids causing adverse effects in therapeutic use,Varices of other sites'}
