CHIEF COMPLAINT: bleeding from right tonsil

PRESENT ILLNESS: 45yo man with h/o ESLD, cirrhosis, portal HTN [**2-22**] HBV, former
etoh abuse awaiting OLT, recent EGD showing non-bleeding
esophageal varices, who presents with bleeding from his right
tonsil.  The patient awoke this AM to go to the bathroom, and
while going to the bathroom coughed and tasted blood in his
mouth.  He then coughed up about a quarter cup of blood per his
estimation, and subsequently felt relief as if his "throat were
opening up."  According to the patient, this is the first time
that he has coughed up blood although he does report a 10y h/o R
tonsilar problems. These problems are characterized by soreness
and swelling of his right tonsil about once per year, usually in
the winter, that is relieved by him "sucking" on the tonsil
until "pus" comes out.  He says that he sought advice on this
problem once, was told that "no one takes tonsils out anymore,"
and has since dealt with it himself as described.  He feels that
this current bleeding episode is identical to his prior episodes
with the exception that the "pus" is now blood.

MEDICAL HISTORY: Cirrhosis, from HBV and etoh
Hepatitis B, presumably contracted via IVDA
Asthma, several hospitalizations in distant past, no intubations

MEDICATION ON ADMISSION: see previous notes

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals -
Gen - cachectic caucasian middle-aged man looking older than age
with sunken eyes, prominent clavicles and shoulder blades
HEENT - No conjunctival, sublingual or epidermal jaundice; able
to express serosang fluid from R tonsil
Skin - spider angiomata
Neck - +cervical LAD, small rubbery nodes on L>R
CV - RRR, nl S1, split S2
Lungs - decreased BS and fremitus at right base (c/w site of
recurrent pleural
effusions)
Abd - well healed scar above pubic symphasis c/w prior
appendectomy, positive rectus abdominus diasthesis, + prominent
superficial abdominal veins; distended, not tense; liver edge
palp 4cm below CM at midclavicular line; no splenomeg; +shifting
dullness
Extremities - 4+ pitting edema to groin; 1+ DP pulses
Neuro - no asterixis; A+Ox3

FAMILY HISTORY: Mother with DM

SOCIAL HISTORY: Single, but lives with girlfriend. [**Name (NI) **] one daughter. Unemployed.
Pt has a h/o of using heroin (IV and snorting), and former ETOH
abuse (drank a case of beer per day). He has been abstinent for
10 years from both alcohol/heroin. He smokes [**2-24**] cigarettes per
day.
Alcoholic cirrhosis of liver,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatic encephalopathy,Esophageal varices with bleeding,Acute respiratory failure,Cachexia,Hematemesis,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Other and unspecified coagulation defects,Unspecified pleural effusion,Hyperosmolality and/or hypernatremia
Alcohol cirrhosis liver,Hpt B chrn wo cm wo dlta,Hepatic encephalopathy,Esophag varices w bleed,Acute respiratry failure,Cachexia,Hematemesis,Acute kidney failure NOS,Septicemia NOS,Severe sepsis,Septic shock,Coagulat defect NEC/NOS,Pleural effusion NOS,Hyperosmolality
Admission Date:  [**2145-12-29**]              Discharge Date:   [**2146-1-18**]

Date of Birth:  [**2099-12-22**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 3266**]
Chief Complaint:
bleeding from right tonsil

Major Surgical or Invasive Procedure:
CVVH, placement of central lines

History of Present Illness:
45yo man with h/o ESLD, cirrhosis, portal HTN [**2-22**] HBV, former
etoh abuse awaiting OLT, recent EGD showing non-bleeding
esophageal varices, who presents with bleeding from his right
tonsil.  The patient awoke this AM to go to the bathroom, and
while going to the bathroom coughed and tasted blood in his
mouth.  He then coughed up about a quarter cup of blood per his
estimation, and subsequently felt relief as if his "throat were
opening up."  According to the patient, this is the first time
that he has coughed up blood although he does report a 10y h/o R
tonsilar problems. These problems are characterized by soreness
and swelling of his right tonsil about once per year, usually in
the winter, that is relieved by him "sucking" on the tonsil
until "pus" comes out.  He says that he sought advice on this
problem once, was told that "no one takes tonsils out anymore,"
and has since dealt with it himself as described.  He feels that
this current bleeding episode is identical to his prior episodes
with the exception that the "pus" is now blood.

The patient reports that he has had a sore throat and swollen
right tonsil since his EGD a few days ago.  He denies BRBPR,
melena, fever, chills, SOB, chest pain, LH, dizziness, phlegm,
cough, sinus congestion. His sore throat was accompanied by a
change in pitch in his voice, described by his GF as if he
"sounded like a girl," possibly higher pitched. This has
resolved by the presentation today.

ROS: positive for cold intolerance; DOE, "worse since EGD"


Past Medical History:
Cirrhosis, from HBV and etoh
Hepatitis B, presumably contracted via IVDA
Asthma, several hospitalizations in distant past, no intubations


Social History:
Single, but lives with girlfriend. [**Name (NI) **] one daughter. Unemployed.
Pt has a h/o of using heroin (IV and snorting), and former ETOH
abuse (drank a case of beer per day). He has been abstinent for
10 years from both alcohol/heroin. He smokes [**2-24**] cigarettes per
day.

Family History:
Mother with DM

Physical Exam:
Vitals -
Gen - cachectic caucasian middle-aged man looking older than age
with sunken eyes, prominent clavicles and shoulder blades
HEENT - No conjunctival, sublingual or epidermal jaundice; able
to express serosang fluid from R tonsil
Skin - spider angiomata
Neck - +cervical LAD, small rubbery nodes on L>R
CV - RRR, nl S1, split S2
Lungs - decreased BS and fremitus at right base (c/w site of
recurrent pleural
effusions)
Abd - well healed scar above pubic symphasis c/w prior
appendectomy, positive rectus abdominus diasthesis, + prominent
superficial abdominal veins; distended, not tense; liver edge
palp 4cm below CM at midclavicular line; no splenomeg; +shifting
dullness
Extremities - 4+ pitting edema to groin; 1+ DP pulses
Neuro - no asterixis; A+Ox3


Pertinent Results:
[**2145-12-29**] 04:35PM   HCT-26.8*
[**2145-12-29**] 11:30AM   GLUCOSE-90
[**2145-12-29**] 11:30AM   UREA N-49* CREAT-1.5* SODIUM-134
POTASSIUM-4.8 CHLORIDE-98 TOTAL CO2-30* ANION GAP-11
[**2145-12-29**] 11:30AM   ALT(SGPT)-65* AST(SGOT)-68* ALK PHOS-107 TOT
BILI-1.3
[**2145-12-29**] 11:30AM   ALBUMIN-2.2*
[**2145-12-29**] 11:30AM   WBC-9.4 RBC-2.72* HGB-9.4* HCT-27.9* MCV-103*
MCH-34.7* MCHC-33.8 RDW-15.0
[**2145-12-29**] 11:30AM   NEUTS-70 BANDS-4 LYMPHS-9* MONOS-13* EOS-3
BASOS-0 ATYPS-0 METAS-1* MYELOS-0
[**2145-12-29**] 11:30AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-2+ MICROCYT-NORMAL POLYCHROM-NORMAL
[**2145-12-29**] 11:30AM   PLT SMR-VERY LOW PLT COUNT-78*
[**2145-12-29**] 11:30AM   PT-17.0* INR(PT)-1.8

Brief Hospital Course:
Mr. [**Known lastname 1356**] is a 45 yo man with h/o ESLD, cirrhosis, portal HTN
[**2-22**] HBV, former etoh abuse awaiting OLT, recent EGD showing
non-bleeding esophageal varices, who presents after coughing up
blood, possibly from his right tonsil.

He was thought to have coughed blood likely [**2-22**] tonsil with
expressible blood, though possibly [**2-22**] esoph varices. An ENT
eval did not appreciate any abnormalities in OP; will d/w them
the findings of expressible R tonsil. Esophageal varices banding
and TIPS was planned. The patient became hemodynamically
unstable and was intubated. CVVH was initiated for inability to
remove excess fluid. THe patient was made CMO after a series of
family meetings with his girlfriend and mother. [**Name (NI) **] expired after
being extubated on [**2146-1-18**].


Medications on Admission:
see previous notes

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
multiorgan failure
sepsis

Discharge Condition:
expired

Discharge Instructions:
expired
{'Alcoholic cirrhosis of liver,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatic encephalopathy,Esophageal varices with bleeding,Acute respiratory failure,Cachexia,Hematemesis,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Other and unspecified coagulation defects,Unspecified pleural effusion,Hyperosmolality and/or hypernatremia'}


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: bleeding from right tonsil

PRESENT ILLNESS: 45yo man with h/o ESLD, cirrhosis, portal HTN [**2-22**] HBV, former
etoh abuse awaiting OLT, recent EGD showing non-bleeding
esophageal varices, who presents with bleeding from his right
tonsil.  The patient awoke this AM to go to the bathroom, and
while going to the bathroom coughed and tasted blood in his
mouth.  He then coughed up about a quarter cup of blood per his
estimation, and subsequently felt relief as if his "throat were
opening up."  According to the patient, this is the first time
that he has coughed up blood although he does report a 10y h/o R
tonsilar problems. These problems are characterized by soreness
and swelling of his right tonsil about once per year, usually in
the winter, that is relieved by him "sucking" on the tonsil
until "pus" comes out.  He says that he sought advice on this
problem once, was told that "no one takes tonsils out anymore,"
and has since dealt with it himself as described.  He feels that
this current bleeding episode is identical to his prior episodes
with the exception that the "pus" is now blood.

MEDICAL HISTORY: Cirrhosis, from HBV and etoh
Hepatitis B, presumably contracted via IVDA
Asthma, several hospitalizations in distant past, no intubations

MEDICATION ON ADMISSION: see previous notes

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals -
Gen - cachectic caucasian middle-aged man looking older than age
with sunken eyes, prominent clavicles and shoulder blades
HEENT - No conjunctival, sublingual or epidermal jaundice; able
to express serosang fluid from R tonsil
Skin - spider angiomata
Neck - +cervical LAD, small rubbery nodes on L>R
CV - RRR, nl S1, split S2
Lungs - decreased BS and fremitus at right base (c/w site of
recurrent pleural
effusions)
Abd - well healed scar above pubic symphasis c/w prior
appendectomy, positive rectus abdominus diasthesis, + prominent
superficial abdominal veins; distended, not tense; liver edge
palp 4cm below CM at midclavicular line; no splenomeg; +shifting
dullness
Extremities - 4+ pitting edema to groin; 1+ DP pulses
Neuro - no asterixis; A+Ox3

FAMILY HISTORY: Mother with DM

SOCIAL HISTORY: Single, but lives with girlfriend. [**Name (NI) **] one daughter. Unemployed.
Pt has a h/o of using heroin (IV and snorting), and former ETOH
abuse (drank a case of beer per day). He has been abstinent for
10 years from both alcohol/heroin. He smokes [**2-24**] cigarettes per
day. 

### Response:
{'Alcoholic cirrhosis of liver,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatic encephalopathy,Esophageal varices with bleeding,Acute respiratory failure,Cachexia,Hematemesis,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Septic shock,Other and unspecified coagulation defects,Unspecified pleural effusion,Hyperosmolality and/or hypernatremia'}
