CHIEF COMPLAINT: Thrombosis of distal branch of right portal vein

PRESENT ILLNESS: Mr. [**Known lastname 1140**] is a 61M s/p a simultaneous liver and kidney transplant
in [**2180-2-10**].  He was recently hospitalized and had a portal
vein shunt placed on [**2180-10-10**] for portal vein stenosis.  On
Wednesday [**2180-11-2**] he states that he experienced the acute onset
of sharp, constant, 7 out of 10 left flank pain
that radiates down his left side and to his anterior abdomen.
He denies any recent trauma or strenuous exertion.  Turning his
upper body aggravates the pain and tylenol relieves the pain.
He underwent a CT scan the next day that revealed a thrombosed
distal branch of the right portal vein.  No ascites or focal
hepatic lesions were seen.  No hernias were seen.  He denies
dyspnea and chest pain.  He denies fevers, chills, nausea,
vomiting, and diarrhea.  He is able to tolerate food.  He denies
dysuria and hematuria.

MEDICAL HISTORY: -alcoholic cirrhosis
-diabetes
-hypertension
-mild pulmonary artery hypertension
-CRI (Baseline Cr. 2.0 up to 2.4)
-vitamin B12 deficiency
-rectal adenoma
-herniated lumbar disk
-gastritis
-hyperkalemia

MEDICATION ON ADMISSION: 1. ASA 81mg daily
2. Bactrim SS daily
3. Cellcept 500mg [**Hospital1 **]
4. Florinef 0.1mg daily
5. Gabapentin 300mg TID
6. Humalog SSI
7. Humulin NPH 20units Qam, 14units Qpm
8. Prednisone taper: 10mg ([**Date range (1) 38383**]), 5mg ([**Date range (1) 9649**])
9. Prograf 3mg [**Hospital1 **]
10. Protonix 40mg daily
11. Valcyte 900mg daily

ALLERGIES: Iodine / Heparin Agents

PHYSICAL EXAM: VS: Temp 98.1, HR 86, BP 102/60, RR 20, O2 Sat 100% on room air
Gen: Alert and oriented, no acute distress, comfortable
HEENT: NC/AT, anicteric sclera, mucus membranes moist
Neck: no lymphadenopathy
CV: RRR, no murmurs, gallops, or rubs
Pulm: clear bilaterally
Abd: soft, nontender, nondistended, well healed incisions, no
CVA
tenderness, no palpable masses
Ext: no edema, no calf tenderness, 2+ distal pulses

FAMILY HISTORY: -F: Committed suicide at age 34
-M: Colon CA, doing well

SOCIAL HISTORY: Mr. [**Known lastname 1140**] lives alone in [**Hospital3 **].  He quit smoking 16 years ago.
 He has been sober for 11 years.
Complications of transplanted liver,Closed fracture of lumbar vertebra without mention of spinal cord injury,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified fall,Unspecified disorder of kidney and ureter,Pain in limb,Unspecified essential hypertension,Kidney replaced by transplant,Family history of diabetes mellitus,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of malignant neoplasm of testis,Personal history of alcoholism,Personal history of tobacco use
Compl liver transplant,Fx lumbar vertebra-close,DMII oth nt st uncntrld,Fall NOS,Renal & ureteral dis NOS,Pain in limb,Hypertension NOS,Kidney transplant status,Fam hx-diabetes mellitus,Family hx-gi malignancy,Family hx-breast malig,Fm hx testis malig,Hx of alcoholism,History of tobacco use
Admission Date:  [**2180-11-4**]              Discharge Date:   [**2180-11-24**]

Date of Birth:  [**2119-2-13**]             Sex:   M

Service: SURGERY

Allergies:
Iodine / Heparin Agents

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Thrombosis of distal branch of right portal vein


Major Surgical or Invasive Procedure:
L 3 Kyphoplasty [**2180-11-16**]


History of Present Illness:
Mr. [**Known lastname 1140**] is a 61M s/p a simultaneous liver and kidney transplant
in [**2180-2-10**].  He was recently hospitalized and had a portal
vein shunt placed on [**2180-10-10**] for portal vein stenosis.  On
Wednesday [**2180-11-2**] he states that he experienced the acute onset
of sharp, constant, 7 out of 10 left flank pain
that radiates down his left side and to his anterior abdomen.
He denies any recent trauma or strenuous exertion.  Turning his
upper body aggravates the pain and tylenol relieves the pain.
He underwent a CT scan the next day that revealed a thrombosed
distal branch of the right portal vein.  No ascites or focal
hepatic lesions were seen.  No hernias were seen.  He denies
dyspnea and chest pain.  He denies fevers, chills, nausea,
vomiting, and diarrhea.  He is able to tolerate food.  He denies
dysuria and hematuria.


Past Medical History:
-alcoholic cirrhosis
-diabetes
-hypertension
-mild pulmonary artery hypertension
-CRI (Baseline Cr. 2.0 up to 2.4)
-vitamin B12 deficiency
-rectal adenoma
-herniated lumbar disk
-gastritis
-hyperkalemia


Social History:
Mr. [**Known lastname 1140**] lives alone in [**Hospital3 **].  He quit smoking 16 years ago.
 He has been sober for 11 years.


Family History:
-F: Committed suicide at age 34
-M: Colon CA, doing well

Physical Exam:
VS: Temp 98.1, HR 86, BP 102/60, RR 20, O2 Sat 100% on room air
Gen: Alert and oriented, no acute distress, comfortable
HEENT: NC/AT, anicteric sclera, mucus membranes moist
Neck: no lymphadenopathy
CV: RRR, no murmurs, gallops, or rubs
Pulm: clear bilaterally
Abd: soft, nontender, nondistended, well healed incisions, no
CVA
tenderness, no palpable masses
Ext: no edema, no calf tenderness, 2+ distal pulses


Pertinent Results:
Admission Labs: [**2180-11-4**]
WBC-2.5* RBC-3.64* Hgb-11.9* Hct-34.4* MCV-94 MCH-32.7*
MCHC-34.6 RDW-15.9* Plt Ct-71*
PT-14.6* PTT-35.0 INR(PT)-1.3*
Glucose-143* UreaN-24* Creat-1.3* Na-141 K-4.4 Cl-107 HCO3-27
AnGap-11
ALT-43* AST-25 AlkPhos-74 Amylase-39 Lipase-8  TotBili-0.4
Albumin-3.9 Calcium-9.1 Phos-2.9 Mg-1.3*

[**2180-11-24**] 09:10AM BLOOD WBC-2.2* RBC-3.23* Hgb-10.1* Hct-29.8*
MCV-92 MCH-31.4 MCHC-34.0 RDW-15.6* Plt Ct-105*

[**2180-11-24**] 09:10AM BLOOD Glucose-224* UreaN-25* Creat-1.2 Na-140
K-4.2 Cl-105 HCO3-29 AnGap-10
[**2180-11-24**] 09:10AM BLOOD ALT-45* AST-33 AlkPhos-122* Amylase-25
TotBili-0.6
[**2180-11-23**] 06:00AM BLOOD FK506-13.8

MR L SPINE W/O CONTRAST  [**2180-11-8**] 9:00 PM

FINDINGS: There is a new compression deformity of the L3
vertebral body (approximately 25% decrease in height) with low
signal on T1 and increased signal on STIR imaging, indicating
acute etiology. Other chronic compression deformities and
degenerative changes are noted.

Specifically, at T12-L1, there is a mild posterior disc bulge,
but no central cord stenosis or neural foraminal narrowing.
There is a chronic anterior compression deformity of the L1
vertebral body with approximately 50% loss of height, unchanged
from [**2180-10-10**].

At the L1-L2 level, there is a mild posterior disc bulge, but no
central canal or neural foraminal stenosis. There is a large
Schmorl's node along the superior endplate of the L2 vertebral
body, unchanged.

At L2- L3, there is eccentric left broad-based posterior disc
bulge resulting in mild left neural foramen narrowing, there is
no central canal stenosis. A compression deformity at L3 as
described above.

At L3-L4, there is a moderate posterior disc bulge with
unfolding of the ligamentum flavum that together cause moderate
canal stenosis. There is severe bilateral neural foraminal
stenosis.

At L4-L5, again there is moderate central canal stenosis
secondary to a moderate broad-based posterior disc bulge and
thickening of the ligamentum flavum as well as moderate right
and severe left neural foraminal stenosis.

At L5-S1, there is mild central canal stenosis secondary to mild
posterior disc bulge and thickening of the ligamentum flavum and
severe bilateral neural foraminal stenosis. There is mild facet
hypertrophy from L2- L5.

The left psoas muscle is expanded by an intramuscular hematoma.
The spleen appears enlarged, but visualization is limited.
Please see the CT torso from same day for further details.

IMPRESSION:
1. New acute L3 compression deformity.
2. Multilevel degenerative changes that are most severe from
L3-S1 with mild- to-moderate canal stenosis and
moderate-to-severe neural foraminal narrowing.
3. Chronic L1 compression deformity.
4. Left psoas hematoma.
5. Possible splenomegaly.

Brief Hospital Course:
Mr. [**Known lastname 1140**] was admitted on [**2180-11-4**] after a CT scan of his
abdomen, obtained for a chief complaint of left flank pain
radiating into his abdomen, revealed that a distal branch of his
right portal vein was thrombosed.  He was started on therapeutic
Lovenox, which for him is 80mg SC injection [**Hospital1 **].  On HD2 he
stated that the pain now radiated down into his left testicle.
On CT scan he does have a non-occlusive renal calculus in his
left native kidney.  A urinalysis was obtained, which was
negative.  No blood was seen on microscopic exam.  Pelvic and
hip plain films were also obtained which were negative.  This
pain is likely musculoskeletal in origin. He was started on a
lovenox bridge and coumadin 5mg for the thrombus in his distal
right portal vein.  On [**2180-11-8**] it was noted that his LFT's were
starting to trend upwards and a liver biopsy was planned.
Coumadin and Lovenox were placed on hold. On that same morning,
the patient had an episode of dizziness while shaving and fell
in the patient bathroom. He did hit his head and had a scalp
laceration that required 4 staples. He was found to be
hypotensive so he received a fluid bolus of 3 liters, 1 unit of
RBC's and was transferred to the ICU for further care. He
underwent total body CT to evaluate for bleeding. Head CT showed
no intracranial hemorrhage. In addition, body CT showed a small
left retroperitoneal hematoma, no evidence of pulmonary
embolism, no significant change in thrombosis of one of the
distal right portal vein branches, and a patent portal vein
stent.

He was also evaluated by Ortho trauma due to continued
complaints of back and hip pain. An MRI of his spine was
obtained and revealed that he had a compression fracture of L3,
although it is unclear if this was acute. He was initially
treated conservatively with pain management and was fitted for a
LSO brace.

On [**2180-11-10**] the patient was finally able to undergo the liver
biopsy. This was done as a transjugular biopsy with no
complications. Biopsy results showed features consistent with
mild/partially treated acute cellular rejection. It was decided
per the transplant team to increase Prograf dosing and not use
pulse steroids. In addition he was followed throughout by [**Last Name (un) **]
for his erratic blood sugars.

He continued to have back pain that radiated into his right leg
and was found to be unable to put on his LSO brace by himself.
He was seen again by Ortho on [**11-14**] and requested the kyphoplasty
procedure.  He underwent successful kyphoplasty of L3 on
[**2180-11-16**].  Immediately after the procedure his back pain
improved.  On POD1 he was re-evaluated by physical therapy and
they recommended continuation of physical therapy. He was now
having pain in the right hip that was interfering with
ambulation, as well he was unable to raise his right leg. He was
seen again by the spine service. He underwent a LENI evaluation
negative for DVT, pain most likely due to known history of
spinal stenosis and compression fractures.

Pain management continued to be an issue, patient very reluctant
to take PO pain medication due to his fear of becoming addicted.
He was counseled regarding ths issue by several members of the
transplant team.
He was unable to be placed at a rehab facility due to insurance
issues.
PT cleared him for home after he ambulated 80 feet on [**11-23**].


Medications on Admission:
1. ASA 81mg daily
2. Bactrim SS daily
3. Cellcept 500mg [**Hospital1 **]
4. Florinef 0.1mg daily
5. Gabapentin 300mg TID
6. Humalog SSI
7. Humulin NPH 20units Qam, 14units Qpm
8. Prednisone taper: 10mg ([**Date range (1) 38383**]), 5mg ([**Date range (1) 9649**])
9. Prograf 3mg [**Hospital1 **]
10. Protonix 40mg daily
11. Valcyte 900mg daily


Discharge Medications:
1. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed.
Disp:*10 Suppository(s)* Refills:*0*
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*300 ml* Refills:*0*
9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Fludrocortisone 0.1 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q3H (every
3 hours) as needed.
Disp:*75 Tablet(s)* Refills:*0*
12. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Ten
(10) units Subcutaneous once a day.
Disp:*15 ml* Refills:*2*
13. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Nine
(9) units Subcutaneous at bedtime.
Disp:*15 ml* Refills:*2*
14. Insulin Lispro 100 unit/mL Solution Sig: follow sliding
scale  Subcutaneous four times a day.
Disp:*15 ml* Refills:*2*
15. Mycophenolate Mofetil 250 mg Capsule Sig: Three (3) Capsule
PO BID (2 times a day).
Disp:*180 Capsule(s)* Refills:*2*
16. Tacrolimus 5 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Senior Healthcare - [**Location (un) 38384**]

Discharge Diagnosis:
Thrombosis of distal branch of right portal vein
Compression fracture L3


Discharge Condition:
Fair


Discharge Instructions:
Call the transplant office at [**Telephone/Fax (1) 673**] if:
- you experience a fever > 101.0
- have nausea, vomiting, or diarrhea
- unable to take or keep down medications
- problems with urination
- any infections
- persistent or worsening  back/hip pain not relieved by your
medications

Continue outpatient labwork per the transplant clinic
recommendations.


Followup Instructions:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2180-11-29**]
1:30

ORTHO XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2180-11-29**] 1:10

Please call transplant clinic to make a follow up appointment


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]
{'Complications of transplanted liver,Closed fracture of lumbar vertebra without mention of spinal cord injury,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified fall,Unspecified disorder of kidney and ureter,Pain in limb,Unspecified essential hypertension,Kidney replaced by transplant,Family history of diabetes mellitus,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of malignant neoplasm of testis,Personal history of alcoholism,Personal history of tobacco 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: Thrombosis of distal branch of right portal vein

PRESENT ILLNESS: Mr. [**Known lastname 1140**] is a 61M s/p a simultaneous liver and kidney transplant
in [**2180-2-10**].  He was recently hospitalized and had a portal
vein shunt placed on [**2180-10-10**] for portal vein stenosis.  On
Wednesday [**2180-11-2**] he states that he experienced the acute onset
of sharp, constant, 7 out of 10 left flank pain
that radiates down his left side and to his anterior abdomen.
He denies any recent trauma or strenuous exertion.  Turning his
upper body aggravates the pain and tylenol relieves the pain.
He underwent a CT scan the next day that revealed a thrombosed
distal branch of the right portal vein.  No ascites or focal
hepatic lesions were seen.  No hernias were seen.  He denies
dyspnea and chest pain.  He denies fevers, chills, nausea,
vomiting, and diarrhea.  He is able to tolerate food.  He denies
dysuria and hematuria.

MEDICAL HISTORY: -alcoholic cirrhosis
-diabetes
-hypertension
-mild pulmonary artery hypertension
-CRI (Baseline Cr. 2.0 up to 2.4)
-vitamin B12 deficiency
-rectal adenoma
-herniated lumbar disk
-gastritis
-hyperkalemia

MEDICATION ON ADMISSION: 1. ASA 81mg daily
2. Bactrim SS daily
3. Cellcept 500mg [**Hospital1 **]
4. Florinef 0.1mg daily
5. Gabapentin 300mg TID
6. Humalog SSI
7. Humulin NPH 20units Qam, 14units Qpm
8. Prednisone taper: 10mg ([**Date range (1) 38383**]), 5mg ([**Date range (1) 9649**])
9. Prograf 3mg [**Hospital1 **]
10. Protonix 40mg daily
11. Valcyte 900mg daily

ALLERGIES: Iodine / Heparin Agents

PHYSICAL EXAM: VS: Temp 98.1, HR 86, BP 102/60, RR 20, O2 Sat 100% on room air
Gen: Alert and oriented, no acute distress, comfortable
HEENT: NC/AT, anicteric sclera, mucus membranes moist
Neck: no lymphadenopathy
CV: RRR, no murmurs, gallops, or rubs
Pulm: clear bilaterally
Abd: soft, nontender, nondistended, well healed incisions, no
CVA
tenderness, no palpable masses
Ext: no edema, no calf tenderness, 2+ distal pulses

FAMILY HISTORY: -F: Committed suicide at age 34
-M: Colon CA, doing well

SOCIAL HISTORY: Mr. [**Known lastname 1140**] lives alone in [**Hospital3 **].  He quit smoking 16 years ago.
 He has been sober for 11 years. 

### Response:
{'Complications of transplanted liver,Closed fracture of lumbar vertebra without mention of spinal cord injury,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified fall,Unspecified disorder of kidney and ureter,Pain in limb,Unspecified essential hypertension,Kidney replaced by transplant,Family history of diabetes mellitus,Family history of malignant neoplasm of gastrointestinal tract,Family history of malignant neoplasm of breast,Family history of malignant neoplasm of testis,Personal history of alcoholism,Personal history of tobacco use'}
