CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45-year-old
male with cryptogenic cirrhosis and history of recent
hepatitis C encephalopathy, ascites, SBP, hepatorenal
syndrome and grade I esophageal varices. Last admission to
[**Hospital6 256**] was on [**2121-10-22**],
with worsening ascites. He denies any recent fevers or
chills. The patient does complain of a cough but no
expectorant. He denies abdominal tenderness. The patient is
complaining of bloating. The patient has been admitted on
[**2121-12-10**], for potential liver transplant.

MEDICAL HISTORY: Cryptogenic cirrhosis. End-stage liver
disease. Right inguinal hernia, at this point cannot be
repaired secondary to liver disease. Cryptococcal PNA on
[**2120-12-12**]. Right thoracotomy and right upper lobe
lobectomy secondary to cavitary lesions found to be
Cryptococcus, negative LP for Cryptococcus. Also grade I
varices on [**2120-11-16**]. Gastropathy in [**2121-4-16**].
Diverticulitis in [**2121-4-16**]. Internal hemorrhoids.
Spontaneous bacterial peritonitis, [**2121-5-6**]. Hepatorenal
syndrome.

MEDICATION ON ADMISSION: Lactulose 30 ml p.o. t.i.d.,
please titrate to [**1-17**] bowels/day, Ergocalciferol 50,000 units
1 capsule q.week, fluconazole 200 mg q.24, Prevacid 30 mg
daily, ciprofloxacin 750 1 tablet once a week, rifaximin 400
mg t.i.d.

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Denies any history of CAD, hypertension.
There is a history of diabetes mellitus and thyroid in
father, deceased secondary to lung cancer with brain
metastasis.

SOCIAL HISTORY: Lives with mother. [**Name (NI) 4084**] married. No
children. Denied tobacco. Denied alcohol. Denied IV drug use.
No travel outside the United States.
Cirrhosis of liver without mention of alcohol,Hematoma complicating a procedure
Cirrhosis of liver NOS,Hematoma complic proc
Admission Date: [**2121-12-10**]        Discharge Date:

Date of Birth:  [**2075-12-28**]        Sex:  M

Service:  [**Last Name (un) **]


HISTORY OF PRESENT ILLNESS:  The patient is a 45-year-old
male with cryptogenic cirrhosis and history of recent
hepatitis C encephalopathy, ascites, SBP, hepatorenal
syndrome and grade I esophageal varices. Last admission to
[**Hospital6 256**] was on [**2121-10-22**],
with worsening ascites. He denies any recent fevers or
chills. The patient does complain of a cough but no
expectorant. He denies abdominal tenderness. The patient is
complaining of bloating. The patient has been admitted on
[**2121-12-10**], for potential liver transplant.

PAST MEDICAL HISTORY:  Cryptogenic cirrhosis. End-stage liver
disease. Right inguinal hernia, at this point cannot be
repaired secondary to liver disease. Cryptococcal PNA on
[**2120-12-12**]. Right thoracotomy and right upper lobe
lobectomy secondary to cavitary lesions found to be
Cryptococcus, negative LP for Cryptococcus. Also grade I
varices on [**2120-11-16**]. Gastropathy in [**2121-4-16**].
Diverticulitis in [**2121-4-16**]. Internal hemorrhoids.
Spontaneous bacterial peritonitis, [**2121-5-6**]. Hepatorenal
syndrome.

MEDICATIONS ON ADMISSION:  Lactulose 30 ml p.o. t.i.d.,
please titrate to [**1-17**] bowels/day, Ergocalciferol 50,000 units
1 capsule q.week, fluconazole 200 mg q.24, Prevacid 30 mg
daily, ciprofloxacin 750 1 tablet once a week, rifaximin 400
mg t.i.d.

ALLERGIES:  Penicillin.

SOCIAL HISTORY:  Lives with mother. [**Name (NI) 4084**] married. No
children. Denied tobacco. Denied alcohol. Denied IV drug use.
No travel outside the United States.

FAMILY HISTORY:  Denies any history of CAD, hypertension.
There is a history of diabetes mellitus and thyroid in
father, deceased secondary to lung cancer with brain
metastasis.

REVIEW OF SYMPTOMS:  The patient is a poor historian; he
answers "yes/no" answers. Review of systems unremarkable
except for occasional bloody stool. Positive jaundice.

PHYSICAL EXAMINATION:  General: The patient is a lethargic,
ill-appearing male. Vital signs: Temperature 97.8, heart rate
81, blood pressure 105/51, weight 90.5, respirations 20.
Skin: Jaundice. HEENT: Normocephalic. Pupils equal, round and
reactive to light. EOMs full. Tongue midline, no exudates.
Cardiovascular: Regular rate and rhythm. Normal S1 and S2
without murmurs, rubs, or gallops. Lungs: Clear to
auscultation and percussion bilaterally. Abdomen: Positive
bowel sounds. Large, round, soft, nontender. Positive
hepatomegaly. Musculoskeletal: Extremities 2+ AT, dorsalis
pedis bilaterally warm. Extremities x 4. Neurologic: The
patient is confused with rambling speech, one-word answers,
moving all extremities well. Cranial nerves II-XII seem to be
intact.

HOSPITAL COURSE:  The patient went to the OR on [**2121-12-10**], with a preoperative diagnosis of end-stage liver
disease secondary to cryptogenic cirrhosis. The patient had a
piggyback orthotopic liver transplant with a Roux-and-Y
biliary reconstruction performed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**].

Two drains were placed; 1 drain was placed beneath the
biliary anastomosis, and the other drain was placed under the
suprahepatic cava. All bleeding points were ligated, and the
abdomen was closed in a single layer with a running double
looped #1 PDS. Staples were used for the skin. The patient
tolerated the procedure well. Please see the operative note
for details.

Labs were stable. On [**2121-12-10**], after surgery, WBC was
2.4, hematocrit 25.5, platelets 59. LFTs showed an ALT of 47,
AST 1057, alkaline phosphatase 61, total bilirubin 5.4,
direct bilirubin 3.6. BUN and creatinine were 47 and 1.8.
Glucose was 135.

The patient was kept in the ICU over night. The patient was
intubated and received morphine for pain control. The patient
was off pressors. On the following day, the patient did get
an ultrasound of his liver demonstrating that there was
abnormal arterial flow in the main, right and left hepatic
arteries with a high-resistance wave form that suggests
diffuse parenchymal edema such as preservation injury.
Hepatic veins and portal veins were with flow in the
appropriate direction. No thrombus was identified. There was
a 2.3 x 5 cm likely postoperative hematoma adjacent to the
left lobe of the liver. These findings were discussed with
Dr. [**Last Name (STitle) 816**] at the time.

Drain #1 put out 160, drain #2 70. Infectious disease was
consulted postoperative for a history of cryptococcal PNA.
They had suggested that once the patient completes
fluconazole per the liver transplant protocol, that the
fluconazole can be decreased to 200 mg p.o. daily. The
patient does need to remain on fluconazole 200 mg once a day
indefinitely.

On [**2121-12-12**], the patient had another ultrasound of
the liver demonstrating 1) persistent abnormal high-
resistance Doppler arterial wave forms, unchanged compared to
[**2121-12-11**], that may be related to diffuse edema in the
transplanted liver, 2) there is an unchanged small
perihepatic, likely postsurgical hematoma.

Prior to the transplant, the patient did have blood cultures
obtained on [**2121-12-10**], which demonstrated that there
was no growth, and also a swab was obtained on [**2121-12-10**], which demonstrated that the patient had enterococcus
sensitive to linezolid.

Inpatient clinical nutrition consult was obtained, and the
dietician made recommendations.

The patient was extubated and doing well. Platelets were
increasing slowly. On [**2121-12-12**], the patient had been
bolused times 3 with 500 cc of normal saline. CVP was 0-2.
Urine output was 10-15 cc/hr. The patient had a hematoma in
groin. The ultrasound demonstrated a hematoma in the medial
right groin on [**2121-12-12**], and showed no evidence of
pseudoaneurysm.

On [**2121-12-13**], the patient was still in the ICU. Urine
output was slightly improved to 45 cc/hr, platelets to 84.
Hematocrit was stable at 71. The patient was tolerating clear
liquids. The patient received morphine p.r.n. for pain. JPs
were drainage serosanguineous fluid in large amounts.

On [**2121-12-14**], the patient had a right internal jugular
catheter changed demonstrating that there was a persistent
right-sided effusion but no pneumothorax.

On [**2121-12-14**], ALT was 261, AST 77, alkaline
phosphatase 90. Creatinine was up slightly from 2.4 to 2.8.
on [**2121-12-14**], the patient was transferred to the floor
with no over night events. The patient received tacrolimus 1
and 1, prednisone 35. The patient was receiving MMF 1 g
b.i.d. He had good input/output. The patient had a T-tube
with a lateral drain and medial drain.

Cholangiogram was performed on [**2121-12-15**], as a regular
postoperative exam demonstrating that there was biliary
drainage, the catheter was at the tip of the jejunum, patent
hepaticojejunostomy and anastomosis with reflux of contrast
material from the jejunum into the hepatic duct. There was no
significant dilatation of visualized intrahepatic ducts, but
dilated common duct was seen. Again these findings were
discussed with Dr. [**First Name (STitle) **].

PT/OT were consulted for assessment of rehab. The patient's
diet was advanced. The patient continued to be afebrile with
vital signs stable. He had good input/output.

On [**2121-12-18**], the medial JP drain was removed with a
figure-of-eight stitch placed. The patient tolerated the
procedure well. Podiatry met with the patient on [**2121-12-21**], for a left ingrown nail. The patient's medial aspect of
the nail was excised with partial wedge resection and covered
with triple antibiotic ointment.

On [**2121-12-22**], the patient had an ultrasound of the
liver secondary to increased ascites which showed that there
was a patent extrahepatic main hepatic artery with improved
wave forms, but the enterohepatic arteries could not be
found. There was no evidence of portal hepatic venous
problems. There was a small right pleural effusion without
evidence of gross ascites.

On [**2121-12-25**], the patient had intravenous fluids half
normal saline to replete JP output 0.5 cc/cc. The patient,
over 24 hours from JP output, was 1640. On [**2121-12-26**],
labs that morning included a WBC of 6.3, hematocrit 24.0,
platelets 158, sodium 134, 5.5, 112, 17, BUN and creatinine
54 and 1.7, glucose 104, ALT 20, AST 8, alkaline phosphatase
66, total bilirubin 0.4.

The patient continued to eat well with supplements of Nepro
drinks 3 times a day. The patient was out of bed working with
physical therapy. He was urinating on his own. He continued
0.5 cc/cc. He was placed on normal saline for JP output.

[**Last Name (un) **] continued to see the patient and felt that the patient
should be encouraged to drink water in place of coke and be
sure that he is eating a reasonable amount of food.

Currently the patient has no JP drains. His T-tube is capped.
He is tolerating a diet well. He should remain a low
carbohydrate diet with supplement and also should be on a low-
potassium diet. The patient will be leaving today to go to
rehab in [**Doctor Last Name **].

DISCHARGE MEDICATIONS:  Heparin 5000 units subcu q.8 hours,
prednisone 20 mg daily, Protonix 40 mg q.24, Bactrim SS 1
tablet daily, the patient is going to be an insulin NPH 28
units at breakfast and then Humalog sliding scale with
fingersticks checked q.i.d. The patient is also going to be
discharged on MMF 1000 b.i.d., oxycodone 5-10 mg q.6 hours
p.r.n., Valcyte 450 q.o.d., fluconazole 400 q.24, tacrolimus
1 mg b.i.d.

The patient will need outpatient lab work every Monday and
Thursday and have the results faxed to the transplant center.
The patient or the facility needs to call transplant surgery
immediately at [**Telephone/Fax (1) 673**] for any fevers, chills, nausea,
vomiting, inability to take medications, any increased
drainage from the incision site or around the T-tube,
jaundice, redness, bleeding, pus at the incision or with any
questions or concerns.

The patient should have labs every Monday and Thursday which
include CBC, CHEM10, AST, ALT, alkaline phosphatase, total
bilirubin, albumin and Prograf trough level which the results
should be faxed to [**Hospital6 256**]
Transplant Office at [**Telephone/Fax (1) 697**].

FOLLOW UP:  With Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] on [**2122-1-1**], at 10:20
a.m., [**2122-1-8**] at 9 a.m., [**2122-1-15**], at 10 a.m.
Please call [**Telephone/Fax (1) 673**] for any questions about the
appointments.

MAJOR SURGICAL OR INVASIVE PROCEDURES:  Liver transplant on
[**2121-12-10**].

LABORATORY DATA:  On [**2121-12-29**], WBC was 4.5,
hematocrit 28.6, platelets 120; sodium 135, 5.7, 112, 18, BUN
and creatinine 50 and 2.0; ALT 11, AST 10, alkaline
phosphatase 55, total bilirubin 0.4.

The patient is 1 and 1 of Tacrolimus with level today of
10.9.

FINAL DIAGNOSIS:  End-stage liver disease secondary to
cryptogenic cirrhosis.

CONDITION ON DISCHARGE:  The patient is stable for discharge
today.



                        [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**], M.D. [**MD Number(2) 6727**]

Dictated By:[**Last Name (NamePattern1) 4835**]
MEDQUIST36
D:  [**2121-12-29**] 12:36:10
T:  [**2121-12-29**] 13:39:01
Job#:  [**Job Number 62139**]


Name:  [**Known lastname **], [**Known firstname **] V.             Unit No:  [**Numeric Identifier 11193**]

Admission Date: [**2121-12-10**]        Discharge Date:[**2121-12-29**]

Date of Birth:  [**2075-12-28**]        Sex:  M

Service:  [**Last Name (un) **]


ADDENDUM

When the patient came in for this liver transplant on [**2121-12-10**], the patient was slightly confused, answering yes
and no questions. Prior to the liver transplant, the patient
have a CT of the head at 8:14 a.m. demonstrating that there
was no intracranial hemorrhage. Cerebella was atrophic, and
there was a mildly enlarge pituitary gland; however, there
was no evidence of intracranial hemorrhage.

The patient then had the transplant on [**2121-12-10**],
after the CT was reviewed and radiologist thought that there
was no intracranial hemorrhage.



                        [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(2) 7503**]

Dictated By:[**Last Name (NamePattern1) 3068**]
MEDQUIST36
D:  [**2121-12-29**] 12:39:47
T:  [**2121-12-29**] 13:41:52
Job#:  [**Job Number 11194**]
{'Cirrhosis of liver without mention of alcohol,Hematoma complicating a procedure'}


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 45-year-old
male with cryptogenic cirrhosis and history of recent
hepatitis C encephalopathy, ascites, SBP, hepatorenal
syndrome and grade I esophageal varices. Last admission to
[**Hospital6 256**] was on [**2121-10-22**],
with worsening ascites. He denies any recent fevers or
chills. The patient does complain of a cough but no
expectorant. He denies abdominal tenderness. The patient is
complaining of bloating. The patient has been admitted on
[**2121-12-10**], for potential liver transplant.

MEDICAL HISTORY: Cryptogenic cirrhosis. End-stage liver
disease. Right inguinal hernia, at this point cannot be
repaired secondary to liver disease. Cryptococcal PNA on
[**2120-12-12**]. Right thoracotomy and right upper lobe
lobectomy secondary to cavitary lesions found to be
Cryptococcus, negative LP for Cryptococcus. Also grade I
varices on [**2120-11-16**]. Gastropathy in [**2121-4-16**].
Diverticulitis in [**2121-4-16**]. Internal hemorrhoids.
Spontaneous bacterial peritonitis, [**2121-5-6**]. Hepatorenal
syndrome.

MEDICATION ON ADMISSION: Lactulose 30 ml p.o. t.i.d.,
please titrate to [**1-17**] bowels/day, Ergocalciferol 50,000 units
1 capsule q.week, fluconazole 200 mg q.24, Prevacid 30 mg
daily, ciprofloxacin 750 1 tablet once a week, rifaximin 400
mg t.i.d.

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Denies any history of CAD, hypertension.
There is a history of diabetes mellitus and thyroid in
father, deceased secondary to lung cancer with brain
metastasis.

SOCIAL HISTORY: Lives with mother. [**Name (NI) 4084**] married. No
children. Denied tobacco. Denied alcohol. Denied IV drug use.
No travel outside the United States. 

### Response:
{'Cirrhosis of liver without mention of alcohol,Hematoma complicating a procedure'}
