CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49 year-old
male with a history of alcoholic cirrhosis with history of
hematuresis, varices, ascites, multiple admissions for
hepatic encephalopathy plus increasing lethargy over two
weeks, increase in severity over the course of last summer.
The patient denies recent hematuresis, melena, bright red
blood per rectum. Also denies any recent fevers, chills,
cough, pain or dysuria. The patient had a prior admission to
[**Hospital1 69**] for hepatic
encephalopathy and was placed on the transplant waiting list.
Prior esophagogastroduodenoscopy demonstrated grade 3
varices. So patient was admitted to [**Hospital1 190**] for a possible liver transplant.

MEDICAL HISTORY: End stage liver disease, alcoholic
cirrhosis, coronary artery disease, status post stent on
aspirin, Imdur, diabetes type 2 with poor glucose control,
pancytopenia, grade 3 esophageal varices, hypertension,
polypectomy for adenomatous polyp.

MEDICATION ON ADMISSION: Aspirin 325 mg q day, nadolol 20
mg q day, NPH 100 units twice a day, isosorbide 60 mg q day,
rifaximin 200 mg b.i.d., spirolactone 100 mg q.d., Lasix 80
mg q.d., trazodone 100 mg p.o. q.h.s., Protonix 40 mg q day,
iron tablets 375 b.i.d., lactulose 10 mg q day, Caltrate,
nitroglycerine sublingual p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died at age 42 of myocardial
infarction. Mother history of coronary artery disease.

SOCIAL HISTORY: Works as a cook. On disability. Smoking [**12-20**]
pack per day. Patient has 6 to 7 beers a day for 20 years,
cocaine in [**2135**].
Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, unspecified,Hepatic encephalopathy,Diastolic heart failure, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of colonic polyps,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of insulin
Alcohol cirrhosis liver,Alcoh dep NEC/NOS-unspec,Hepatic encephalopathy,Diastolc hrt failure NOS,Esoph varice oth dis NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Crnry athrscl natve vssl,Prsnl hst colonic polyps,Status-post ptca,Long-term use of insulin
Admission Date: [**2151-9-3**]        Discharge Date: [**2151-9-15**]

Date of Birth:  [**2101-10-26**]        Sex:  M

Service:  Liver Transplant Service


ADMITTING DIAGNOSES:  Hepatic encephalopathy with increasing
lethargy.

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year-old
male with a history of alcoholic cirrhosis with history of
hematuresis, varices, ascites, multiple admissions for
hepatic encephalopathy plus increasing lethargy over two
weeks, increase in severity over the course of last summer.
The patient denies recent hematuresis, melena, bright red
blood per rectum. Also denies any recent fevers, chills,
cough, pain or dysuria. The patient had a prior admission to
[**Hospital1 69**] for hepatic
encephalopathy and was placed on the transplant waiting list.
Prior esophagogastroduodenoscopy demonstrated grade 3
varices. So patient was admitted to [**Hospital1 190**] for a possible liver transplant.

PAST MEDICAL HISTORY:  End stage liver disease, alcoholic
cirrhosis, coronary artery disease, status post stent on
aspirin, Imdur, diabetes type 2 with poor glucose control,
pancytopenia, grade 3 esophageal varices, hypertension,
polypectomy for adenomatous polyp.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Aspirin 325 mg q day, nadolol 20
mg q day, NPH 100 units twice a day, isosorbide 60 mg q day,
rifaximin 200 mg b.i.d., spirolactone 100 mg q.d., Lasix 80
mg q.d., trazodone 100 mg p.o. q.h.s., Protonix 40 mg q day,
iron tablets 375 b.i.d., lactulose 10 mg q day, Caltrate,
nitroglycerine sublingual p.r.n.

SOCIAL HISTORY:  Works as a cook. On disability. Smoking [**12-20**]
pack per day. Patient has 6 to 7 beers a day for 20 years,
cocaine in [**2135**].

FAMILY HISTORY:  Father died at age 42 of myocardial
infarction. Mother history of coronary artery disease.

PHYSICAL EXAMINATION:  Temperature 97.9, blood pressure
119/70, heart rate 56, 98% on room air. In general in no
acute distress, comfortable. Pupils equal, round, reactive to
light. Mildly icteric sclerae. Neck: No palpable nodes, no
thyromegaly. Lungs clear to auscultation. CV: II/VI systolic
ejection murmur at left upper sternal border and right upper
sternal border. Abdomen: Distended abdomen, nontender. Liver
span 9 to 10 cm percussion and fluid wave noted. No masses.
Extremities: Trace edema to knees bilaterally, dorsalis pedis
pulses intact. Neurologic: Asterixis. Rectal within normal
limits.

Preoperative electrocardiogram demonstrated sinus
bradycardia, fresh T wave changes. Chest x-ray: Clear, mild
pulmonary edema.

LABORATORY ON ADMISSION:  From [**2151-9-3**] when he was
admitted WBC of 4.4, hematocrit of 36.0, platelets 61. Given
platelets prior to operating room. PT 15.4, 38.7, INR 1.6.
Sodium 132, 4.6, 95, bicarb 30, BUN/creatinine 10/0.7,
glucose 230. ALT 30, AST 48, alk phos 171, total bilirubin
10.8.

Patient went to the operating room on [**2151-9-3**] in
which patient had a preoperative diagnosis of Laennec's
cirrhosis, portal hypertension, ascites, hepatic
encephalopathy, splenomegaly. Postoperative patient had an
orthotropic deceased donor liver transplant (piggyback-portal
vein anastomosis-common bile duct. No T tube). Replaced right
hepatic artery from the superior mesenteric artery recipient
(common hepatic artery donor) performed by Drs. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **], [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] and [**First Name8 (NamePattern2) 30564**] [**Last Name (NamePattern1) 30565**]. Please see details of
operative note from [**2151-9-3**]. Postoperatively
patient went to the Intensive Care Unit intubated, sedated.
Patient had an internal jugular Swan-Ganz catheter placed. X-
ray was obtained demonstrating no pneumothorax interval
development of mild congestive heart failure/fluid overload.
Ultrasound was performed on [**2151-9-4**], postoperative
day 1, demonstrating normal color flow and wave forms within
the vasculature of the transplanted liver. No biliary
dilatations. No perihepatic fluid collections. Questionable
slight heterogenicity of the architecture of the liver
posteriorly within the right lobe. Finding may be artificial
and could be re-evaluated. Repeat ultrasonography with
radiologist present.

Postoperative day 2 patient intubated on CPAP. Good ins and
outs. [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains intact. Minimal trace peripheral
edema. Patient was on MMF, Solu-Medrol 150 q day and
tacrolimus 2 and 2. On [**2151-9-6**] patient had a line
change. Chest x-ray was obtained worsening mild congestive
heart failure with new moderate size right sided pleural
effusion. Patient was status post extubation. Central venous
line in appropriate position. No pneumothorax. On [**2151-9-6**] patient continued to be in surgical intensive care
unit, extubated. Vital signs stable. CVP was 14. Ins and
outs. Lungs were mildly coarse. Abdomen distended, hypoactive
bowel sounds. [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains which were both
serosanguineous. Laboratories on [**2151-9-6**]: WBC 5.8,
hematocrit of 32.2, platelets 75. PT 13.2, INR 1.2, PTT 24.9.
Sodium 137, 3.8, 102, 29, 16, 0.8, blood sugar 172, total
bilirubin 4.1, AST 251, ALT 471, alkaline phosphatase 78,
amylase 16. Finger sticks have been in the range of 90s to
150s. [**Last Name (un) **] was consulted and they made appropriate
recommendations.

Physical therapy, occupational therapy were consulted.
Patient transferred from the unit to Far 10 on [**2151-9-9**]. Blood sugars were elevated. Afebrile, vital signs
stable. Liver function tests were slightly elevated.
Ultrasound was performed demonstrating that there was patent
hepatic and portal veins. Patency of the hepatic arteries are
identified and the resistive indices appear slightly
increased in comparison to the previous examination. Because
the ultrasound from [**2151-9-9**] was indefinite in
diagnosis and endoscopic retrograde cholangiopancreatography
was obtained to evaluate for biliary leak and with impression
demonstrated mild narrowing at the biliary anastomosis
without evidence of biliary duct dilatation. No evidence of
biliary leak. Successful placement of plastic stent in the
common bile duct across the anastomosis. On [**2151-9-9**] an ultrasound was done that evening demonstrating stable
Doppler ultrasound examination of the liver with patent
hepatic and portal veins. Hepatic arteries again show
slightly increased resistive indices.

On [**2151-9-12**] it was discussed and decided to have CT
of abdomen and pelvis because of resistive arterial indices
on ultrasound. Findings state that there was patent hepatic
arterial flow without evidence for focal stenosis. The portal
venous and hepatic venous flows unremarkable. 2) Presence of
splenomegaly and extensive collaterals consistent with portal
hypertension. Inflammatory stranding in the right
subcutaneous tissue of uncertain clinical significance which
was related by telephone to Dr. [**Last Name (STitle) 30566**]. On [**2151-9-13**] overnight the patient complained of chest pressure.
Electrocardiogram was obtained. Enzymes were obtained.
Electrocardiogram demonstrated sinus rhythm, prolonged QT
interval. Troponin levels were less than 0.01. Chest pressure
improved. Patient was ruled out for a myocardial infarction.
Patient was discontinued on telemetry.

Patient has been eating well, ambulating well without chest
pain. Patient continued on tacrolimus, MMF and patient was
weaned to prednisone 20 mg q day. On [**2151-9-15**]
patient was doing well, WBC of 4.5, hematocrit 29.4,
platelets 94. PT 13.1, PTT 23.1, INR 1.1. Sodium 136, 3.6,
97, 31, BUN/creatinine 27/1.6, glucose 107, ALT 88, AST 16,
alkaline phosphatase 106, total bilirubin 1.4. Patient's FTA
level on [**2151-9-15**] was 12.4 on 5 and 5. Patient is
being discharged home with [**Hospital6 407**] with no
[**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains. Both [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drains were removed
in the last two days that patient was hospitalized. Patient
will be discharged on the following medications.

DISCHARGE MEDICATIONS:  Aspirin 325 mg q day, trazodone 100
mg q.h.s., Nystatin Swish and Swallow 5 ml p.o. q.i.d.,
isosorbide 60 mg sustained release 1 tablet q day, nicotine
patch transdermal, change q day, prednisone 20 mg q day,
Protonix 40 mg 1 tablet q 12, tacrolimus 5 mg b.i.d.,
Dilaudid 2 mg 1 to 2 tablets q 4 to 6 hours p.r.n., Lasix 20
mg q day, Valcyte 900 mg q day, Lopressor 12.5 b.i.d.,
fluconazole 400 mg q 24 hours, MMF 1,000 b.i.d., Bactrim SS 1
tablet q day and also insulin sliding scale fixed dose NPH 40
units at breakfast and then a sliding scale.

The transplant coordinator has made the follow up appointment
with transplant surgery next week. For an appointment if
patient cannot make it call [**Telephone/Fax (1) 30567**]. Patient was to have
laboratories every Monday and Thursday and wishes to be chem-
10, AST, ALT, alkaline phosphatase, albumin, total bilirubin
and Prograf level to be obtained. Laboratory results should
be faxed to [**Telephone/Fax (1) 697**]. Patient should call transplant
service immediately 24 hours a day at [**Telephone/Fax (1) 673**] if any
fevers, chills, nausea, vomiting, abdominal pain, any
increased swelling in the lower extremities, any change in
skin color, any change in color, size in surgery site, any
discharge from surgery site, any problems with eating,
drinking fluids. If there are any problems with urinating or
with bowel movements please call transplant surgery
immediately.

FINAL DIAGNOSES:  Alcoholic cirrhosis.

SECONDARY DIAGNOSIS:  Coronary artery disease.
Diabetes mellitus type 2.
Major surgical invasive procedure, status post liver surgery
on [**2151-9-3**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD, PhD [**Numeric Identifier 8353**]

Dictated By:[**Last Name (NamePattern1) 4835**]
MEDQUIST36
D:  [**2151-9-16**] 15:51:01
T:  [**2151-9-16**] 17:47:35
Job#:  [**Job Number 30568**]
{'Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, unspecified,Hepatic encephalopathy,Diastolic heart failure, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of colonic polyps,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of insulin'}


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: The patient is a 49 year-old
male with a history of alcoholic cirrhosis with history of
hematuresis, varices, ascites, multiple admissions for
hepatic encephalopathy plus increasing lethargy over two
weeks, increase in severity over the course of last summer.
The patient denies recent hematuresis, melena, bright red
blood per rectum. Also denies any recent fevers, chills,
cough, pain or dysuria. The patient had a prior admission to
[**Hospital1 69**] for hepatic
encephalopathy and was placed on the transplant waiting list.
Prior esophagogastroduodenoscopy demonstrated grade 3
varices. So patient was admitted to [**Hospital1 190**] for a possible liver transplant.

MEDICAL HISTORY: End stage liver disease, alcoholic
cirrhosis, coronary artery disease, status post stent on
aspirin, Imdur, diabetes type 2 with poor glucose control,
pancytopenia, grade 3 esophageal varices, hypertension,
polypectomy for adenomatous polyp.

MEDICATION ON ADMISSION: Aspirin 325 mg q day, nadolol 20
mg q day, NPH 100 units twice a day, isosorbide 60 mg q day,
rifaximin 200 mg b.i.d., spirolactone 100 mg q.d., Lasix 80
mg q.d., trazodone 100 mg p.o. q.h.s., Protonix 40 mg q day,
iron tablets 375 b.i.d., lactulose 10 mg q day, Caltrate,
nitroglycerine sublingual p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died at age 42 of myocardial
infarction. Mother history of coronary artery disease.

SOCIAL HISTORY: Works as a cook. On disability. Smoking [**12-20**]
pack per day. Patient has 6 to 7 beers a day for 20 years,
cocaine in [**2135**]. 

### Response:
{'Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, unspecified,Hepatic encephalopathy,Diastolic heart failure, unspecified,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of colonic polyps,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of insulin'}
