CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient was admitted on [**2166-11-14**] with a chief complaint of recurrent right pleural
effusions.  Patient is a 76-year-old female with polycystic
liver disease status post two prior cyst excisions and one
aspiration, who presented on [**10-25**] with a large right pleural
effusion, plus herniation to the liver, and superior cyst
into the right hemithorax with whiteout of the right chest
and mediastinal shift.  An ultrasound guided pigtail catheter
was inserted on [**10-26**] and effectively drained the effusion.
She was discharged home in good condition on [**11-1**].

MEDICAL HISTORY: 1. Polycystic liver disease.
2. Hypertension.
3. Diabetes mellitus, diet controlled.
4. Diverticulosis.

MEDICATION ON ADMISSION: 1. Lisinopril 5 q.d.
2. Aspirin.
3. Colace 100 mg p.o. b.i.d.

ALLERGIES: Sulfa causing nausea and vomiting and codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: No polycystic disease.

SOCIAL HISTORY: Remarkable for no tobacco use and no alcohol
use.  Lives alone.
Congenital cystic disease of liver,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Iatrogenic pneumothorax,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified coagulation defects,Other vascular complications of medical care, not elsewhere classified
Cong cystic liver dis,Ac kidny fail, tubr necr,Acute respiratry failure,Iatrogenic pneumothorax,Atrial fibrillation,CHF NOS,Coagulat defect NEC/NOS,Vasc comp med care NEC
Admission Date:  [**2166-11-14**]       Discharge Date:  [**2166-12-25**]

Date of Birth:   [**2090-9-9**]       Sex:  F

Service:  Blue Surgery

HISTORY OF PRESENT ILLNESS:  Patient was admitted on [**2166-11-14**] with a chief complaint of recurrent right pleural
effusions.  Patient is a 76-year-old female with polycystic
liver disease status post two prior cyst excisions and one
aspiration, who presented on [**10-25**] with a large right pleural
effusion, plus herniation to the liver, and superior cyst
into the right hemithorax with whiteout of the right chest
and mediastinal shift.  An ultrasound guided pigtail catheter
was inserted on [**10-26**] and effectively drained the effusion.
She was discharged home in good condition on [**11-1**].

The day prior to admission she was seen in followup by Dr.
[**Last Name (STitle) **] and repeat chest x-ray was found to have
reaccumulation of her pleural effusion.  She presented on the
date of admission for workup management per her primary care
physician.

PAST MEDICAL HISTORY:
1. Polycystic liver disease.
2. Hypertension.
3. Diabetes mellitus, diet controlled.
4. Diverticulosis.

PAST SURGICAL HISTORY:
1. Status post liver cyst excision about 26 years ago.
2. Status post exploratory lap.
3. Status post cholecystectomy.
4. Status post oophorectomy.

SOCIAL HISTORY:  Remarkable for no tobacco use and no alcohol
use.  Lives alone.

FAMILY HISTORY:  No polycystic disease.

ALLERGIES:  Sulfa causing nausea and vomiting and codeine.

MEDICATIONS ON ADMISSION:
1. Lisinopril 5 q.d.
2. Aspirin.
3. Colace 100 mg p.o. b.i.d.

REVIEW OF SYSTEMS:  Showed mild worsening of the exertional
dyspnea, most prominently some increased dyspnea when she
lies down, but denies orthopnea, paroxysmal nocturnal
dyspnea.  No fever or chills.  No changes in abdominal girth
and no changes in bowel habits.

PHYSICAL EXAMINATION:  She was afebrile at 96.9 with a heart
rate of 100, pressure of 189/84, respirations 15, and satting
96% on room air.  In general, she was a pleasant female in no
acute distress breathing comfortably.  Her HEENT examination
showed no scleral icterus.  Trachea was midline without
stridor.  Chest:  Decreased breath sounds on the right with
dullness to percussion throughout.  Positive egophony and
chest was clear to auscultation on the left.  Heart was
regular rate and rhythm without murmurs, rubs, or gallops.
Abdomen with a firm mass, nontender over the right upper
quadrant just under the right subcostal region.  Extremities
showed no clubbing, cyanosis, or edema.  Palpable DP and PT
pulses were felt.

LABORATORIES:  On admission her laboratory values were a
white count of 6, hematocrit of 43.9, and platelets of 184
with chemistries of sodium 143, potassium 3.4, chloride 101,
bicarb 33, BUN 11, creatinine of 0.6, and a glucose of 187
with an AST of 81, ALT of 88, alkaline phosphatase of 410,
and T bilirubin of 1.4.

A chest x-ray showed a right chest whiteout with positive
shift.

Abdominal MRI on [**11-12**] showed 17 x 16 x 13 cm liver cyst in
the right lobe, right chest, bilateral kidney cysts largest 4
cm.

Patient was immediately followed up by Hepatology for massive
cyst in the liver.  MRI in [**2166-2-8**] showed innumerable
hepatic cysts with preponderance in the left lobe.  There is
a large right hepatic lobe cyst which measured 13 x 15 x 17.5
cm.  The distal common bile duct was normal in contour and
caliber, mild dilatation of the central hepatic ducts.  Some
of the liver cysts demonstrated proteinaceous hemorrhagic
debris.  There was normal hepatofugal flow in the main portal
vein.  No arterial enhancing lesions were identified within
the liver.

Patient had thoracentesis and fluid sent for culture
cytology.  Chest tube placement at that time was also done at
that time.  Chest x-ray still showed elevation of right
hemidiaphragm secondary to compression from the liver.  The
best option was felt to be surgical decompression of the
large cyst in the posterior portion of the right liver lobe
as per recommendations of Hepatobiliary house staff.

Patient was preoped for right thoracoscopy by Thoracics on
[**2166-11-16**], and was taken to the operating room on [**2166-11-17**]
for a diagnosis of polycystic liver disease and for
fenestration of giant liver cyst with repair of the diaphragm
and chest tube placement, pleural biopsy.  Surgeons are Dr.
[**Last Name (STitle) **], Dr. [**Last Name (STitle) 7820**], and Dr. [**Last Name (STitle) 175**].  Under general anesthesia,
the patient was given 4500 units of crystalloid with 600
units of urine output with an estimated blood loss of 200 cc.
Patient was stable postoperatively and was admitted to the
Trauma SICU.

Upon admission to Trauma SICU, the patient was noted to be in
AFib with a heart rate of 103, pressures were 80s/50s, CVP 3,
respiratory rate of 19, and 100% on nasal cannula on 4
liters.  Hematocrit was 36 with a preoperative of 40.  PT was
14.7, PTT was 26, and INR was 1.4.  Albumin 2.1.  Sodium was
140, potassium 4.4, chloride 109, bicarb 25, BUN 9,
creatinine 0.4, glucose 179 with a calcium of 7.9, magnesium
1.4, and phosphorus 3.7, ALT of 186, AST of 253, alkaline
phosphatase 302, T bilirubin 2.6.

Chest x-ray at that time showed elevated right hemidiaphragm.
Right chest tube was in place without effusion.  Heart was
rotated to the left without pneumothorax.  Central line was
in good position and nasogastric tube terminated in the
stomach.

Patient continued to require significant volume to maintain
blood pressures and urine output around 8 liters on [**11-18**], developing a significant metabolic acidosis with a base
access deficit of -8.  Albumin was started at that time in
order to increase intervascular volume load.  Aggressive
resuscitation remained throughout postoperative days two and
three.

Patient was transfused on postoperative day two with volume
resuscitation and was extubated.  By postoperative day three,
the patient was stable and prn Morphine for medications.
Neurologically wise and cardiovascular wise, the patient was
stable.  Respiratory wise, the patient was aggressively
treated with pulmonary toilet and incentive spirometry.

GI:  Patient was on clears.  GU:  Patient was given albumin
to increase urine output.  Heme:  Patient's hematocrit was
stable at 32.9.  Was given vitamin K, and patient was
continued on Unasyn.

Patient's Swan-Ganz catheter was D/C'd on postoperative day
four.  The patient was without complaints, and once again,
aggressive hydration was instilled for decreased urine
output.  Replacement of chest tube losses with IV fluids and
albumin was continued on postoperative day #5.  Small dosed
Lasix was begun, and patient was encouraged p.o. intake of
regular soft diet with continued pulmonary toilet.

Albumin q.i.d. was started on postoperative day #6.  Patient
was seen by Physical Therapy throughout.  Right subclavian
was changed over wire on [**11-26**].  Patient had mild
thrombophlebitis from IV infiltrate on [**11-28**].  Was started on
Kefzol 1 gram IV q.8.  Chest tubes were placed to water-seal
on postoperative day #11.  Chest x-ray was obtained, however,
greater than 500 a day of fluid was still being drained from
the chest tube.  Patient was begun on TPN at that time.

Chest tube was continued to water-seal, and patient was
started on Levaquin on [**2166-12-10**].  Tap pleurodesis was done
on [**2166-12-17**], postoperative day 30.  Patient remained
stable throughout, however, high output continued throughout
the chest tube, and patient began to develop 2+ peripheral
edema on postoperative day 34.

The patient had second tap pleurodesis on [**2166-12-22**].
Chest x-ray showed increased aeration in the right upper
lobe, however, still fluid buildup in the right lobe.  Chest
tubes were D/C'd on [**2166-12-24**].  After chest tube
output decreased from 300 cc/24 hours to 25 cc/24 hours, and
the patient was discharged on [**2166-12-25**] in good
condition to a rehabilitation facility.

DIAGNOSES:
1. Massive liver cyst.
2. Hypertension.
3. Type 2 diabetes mellitus.
3. Polycystic liver disease.
4. Right diaphragmatic dysfunction status post secondary
drainage surgery.
5. History of shortness of breath.
6. Status post oophorectomy and cholecystectomy.
7. Anxiety.
8. Diverticulosis.

Summary of patient's culture data showed blood cultures from
[**2166-12-10**] with no growth as were 2/2 bottles, pleural fluid
sent showed no growth and no PMNs.  On [**2166-12-7**] catheter
tip was sent for culture.  It showed Enterococcus greater
than 15 colonies.  Sensitive to ampicillin, levo, penicillin,
Vancomycin.  Hence, the patient was started on levofloxacin.
Blood cultures on [**2166-12-7**] showed Enterococcus fecalis
sensitive to ampicillin, levo, penicillin, and Vancomycin.
Urine culture was contaminated on [**2166-12-7**]:  No growth on
blood cultures.  On [**2166-11-25**] 2/2 bottles.  Catheter tip on
[**2166-11-25**] showed no growth.  MRSA screen on [**2166-11-19**]
showed no Staphylococcus aureus isolated.  Fluid sent on
[**2166-11-17**] from liver abscess showed no PMNs, no growth.  No
microbacteria, no acid-fast bacilli, no growth on anaerobic
culture, no growth on tissue culture, and Gram stain was
negative for tissue sent from operating room.  Pleural fluid
from operating room also was negative.

Pathology showed diagnosis of cauterized dense fibrovascular
tissue, not iron deficiency, no iron stain, or trichrome
stain showing fibrous tissue.  Cyst draw with multiple cysts
lined on single layer of cuboidal epithelial cells and
focally calcified fibrous wall consistent with polycystic
liver disease.  Focal mild chronic also present in the wall.
No liver parenchyma was seen.

CONDITION ON DISCHARGE:  The patient was discharged home in
good condition.

DISCHARGE STATUS:  To rehabilitation facility.

DISCHARGE MEDICATIONS:
1. Polysaccharide iron complex 150 mg p.o. q.d.
2. Lasix 40 mg p.o. b.i.d.
3. Promethazine 25 mg p.o. q.6h. prn.
4. Protonix 40 mg p.o. q.d.
5. Cepacol prn.
6. Percocet 1-2 tablets p.o. q.4-6h. prn.
7. Ibuprofen 400 mg p.o. q.8h. prn.
8. Acetaminophen 325-650 mg p.o. q.4-6h. prn.
9. Zinc sulfate 220 mg p.o. q.d.
10. Aluminum magnesium hydroxide 15/30 mL p.o. q.i.d. prn.
11. Senna one tablet p.o. b.i.d.
12. Psyllium wafer one wafer p.o. q.d.
13. Colace 100 mg p.o. b.i.d.



                            [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Name8 (MD) 11998**]
MEDQUIST36

D:  [**2166-12-24**]  21:57
T:  [**2166-12-25**]  05:40
JOB#:  [**Job Number 11999**]


Name:  [**Known lastname 1714**], [**Known firstname 1715**]                       Unit No:  [**Numeric Identifier 1716**]

Admission Date:  [**2166-11-14**]     Discharge Date:  [**2167-1-3**]

Date of Birth:   [**2090-9-9**]     Sex:  F

Service:

THIS IS AN ADDENDUM:

HISTORY OF PRESENT ILLNESS:   Please see prior discharge
summary dated [**2166-12-25**], for prior events. Briefly the
patient is a 76 year old female with polycystic liver disease
status post prior liver cyst excisions and one aspiration, a
large right pleural effusion status post pigtail catheter
drainage, status post right thoracoscopy on [**2166-11-16**],
with subsequent demonstration of a giant liver cyst with
repair of diaphragm and chest tube placement and pleural
biopsy on the following day, and one cyst aspiration.

Since the time of the last discharge summary on [**2166-12-25**], the patient was slated to go to rehabilitation
facility, however on [**12-26**], the patient developed
respiratory chest with chest pain and oxygen desaturation. A
cardiology consult was obtained which suggested no acute
coronary syndrome.

On [**2166-12-29**], the patient was transferred to the
Surgical Intensive Care Unit for presumed fluid overload as a
cause of her shortness of breath. In the surgical Intensive
Care Unit the patient was placed on a Lasix strip.  A left
sided subclavian line was placed. A left subclavian central
line for Swan-Ganz catheterization was placed.  A small left
pneumothorax developed. The patient was placed on
levofloxacin empirically for question of pneumonia causing
her shortness of breath. She was continued to be given
intermittent Lasix with albumin.

On approximately [**12-31**], the patient had an episode of
hypoxia. A CT angiogram was obtained to rule out pulmonary
embolism which was negative. The patient developed oliguria
not responsive to Lasix and Zaroxolyn. It was thought that
the patient likely had ATN.  He was transferred to the floor
on [**2167-1-2**].  The next day the patient appeared to
have respiratory distress with increased edema.

The patient was transferred to the medical Intensive Care
Unit on [**2167-1-3**].

A family meeting with the patient's son, and daughter and
daughter in law were held. At this family meeting the family
agreed that the patient would not want aggressive level of
care as would require for hemodialysis.  They said their
mother expressed wishes to spend her last days at home.

Arrangements were made for home hospice and treatment of her
dyspnea for comfort. The patient was transferred later than
day to home with hospice care.

DISCHARGE MEDICATIONS:
1.  Roxanol
2.  Colace.
3.  Senna
4.  Ativan
5.  Heparin flushes for PICC line
6.  Tylenol.

DISCHARGE DISPOSITION:  To home with hospice.





                         DR.[**Last Name (STitle) 72**],[**First Name3 (LF) 73**] 12-761

Dictated By:[**Name8 (MD) 1721**]

MEDQUIST36

D:  [**2167-2-4**]  14:21
T:  [**2167-2-4**]  20:39
JOB#:  [**Job Number 1722**]
{'Congenital cystic disease of liver,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Iatrogenic pneumothorax,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified coagulation defects,Other vascular complications of medical care, not elsewhere classified'}


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: 

PRESENT ILLNESS: Patient was admitted on [**2166-11-14**] with a chief complaint of recurrent right pleural
effusions.  Patient is a 76-year-old female with polycystic
liver disease status post two prior cyst excisions and one
aspiration, who presented on [**10-25**] with a large right pleural
effusion, plus herniation to the liver, and superior cyst
into the right hemithorax with whiteout of the right chest
and mediastinal shift.  An ultrasound guided pigtail catheter
was inserted on [**10-26**] and effectively drained the effusion.
She was discharged home in good condition on [**11-1**].

MEDICAL HISTORY: 1. Polycystic liver disease.
2. Hypertension.
3. Diabetes mellitus, diet controlled.
4. Diverticulosis.

MEDICATION ON ADMISSION: 1. Lisinopril 5 q.d.
2. Aspirin.
3. Colace 100 mg p.o. b.i.d.

ALLERGIES: Sulfa causing nausea and vomiting and codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: No polycystic disease.

SOCIAL HISTORY: Remarkable for no tobacco use and no alcohol
use.  Lives alone. 

### Response:
{'Congenital cystic disease of liver,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Iatrogenic pneumothorax,Atrial fibrillation,Congestive heart failure, unspecified,Other and unspecified coagulation defects,Other vascular complications of medical care, not elsewhere classified'}
