CHIEF COMPLAINT: EtOH cirrhosis and HCC admitted for liver transplant

PRESENT ILLNESS: 58M with EtOH cirrhosis and HCC called in for liver transplant.
A donor liver has become available and Mr. [**Known lastname 71166**] is the back-up
recipient.
He is status post CyberKnife treatment on [**2153-7-26**] for HCC.
The patient's last alcohol use was on [**2153-4-16**], and he is
participating in relapse prevention.

MEDICAL HISTORY: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: Clotrimazole 10mg Troche 5x Daily, Nadolol 20 mg Daily,
Pantoprazole 20mg Daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.6 72 108/66 18 100%RA Wt72 kg
Gen: Alert and oriented
CV: RRR, no murmurs/rubs/gallops
Resp: Clear to auscultation
Abd: Soft, non-tender, non-distended, reducible umbilical
hernia,
well-healed appendectomy incision
Ext: Warm and well-perfused, no edema

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good
health.  He is employed as a telecommunications technician.  He
has no children.  He reports that he smoked cigarettes for about
10 years but quit approximately 30 years ago.  He has no history
of use of intravenous or illicit drugs.
Malignant neoplasm of liver, primary,Cerebral artery occlusion, unspecified with cerebral infarction,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Portal hypertension,Ostium secundum type atrial septal defect,Iatrogenic cerebrovascular infarction or hemorrhage,Pulmonary collapse,Alcoholic cirrhosis of liver,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Esophageal reflux,Other and unspecified alcohol dependence, unspecified
Mal neo liver, primary,Crbl art ocl NOS w infrc,Cholelith w cholecys NEC,Hemorrhage complic proc,Portal hypertension,Secundum atrial sept def,Iatrogen CV infarc/hmrhg,Pulmonary collapse,Alcohol cirrhosis liver,Abn react-org transplant,Accid in resident instit,Hypertension NOS,Hx-skin malignancy NEC,Esophageal reflux,Alcoh dep NEC/NOS-unspec
Admission Date:  [**2154-1-31**]              Discharge Date:   [**2154-2-14**]

Date of Birth:  [**2095-10-7**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
EtOH cirrhosis and HCC admitted for liver transplant

Major Surgical or Invasive Procedure:
[**2154-1-31**]: Cadaveric liver transplant with Roux-en-Y biliary
reconstruction.
[**2154-2-1**]: Abdominal washout and control of bleeding
[**2154-2-2**]:  Re-opening of recent laparotomy with control of
hemorrhage.


History of Present Illness:
58M with EtOH cirrhosis and HCC called in for liver transplant.
A donor liver has become available and Mr. [**Known lastname 71166**] is the back-up
recipient.
He is status post CyberKnife treatment on [**2153-7-26**] for HCC.
The patient's last alcohol use was on [**2153-4-16**], and he is
participating in relapse prevention.


Past Medical History:
cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

PSH: significant for an appendectomy as well as knee and
shoulder
arthroscopies


Social History:
Married and lives with his wife, who is in good
health.  He is employed as a telecommunications technician.  He
has no children.  He reports that he smoked cigarettes for about
10 years but quit approximately 30 years ago.  He has no history
of use of intravenous or illicit drugs.


Family History:
significant for colon cancer in his father as well as seizures
in his brother


Physical Exam:
97.6 72 108/66 18 100%RA Wt72 kg
Gen: Alert and oriented
CV: RRR, no murmurs/rubs/gallops
Resp: Clear to auscultation
Abd: Soft, non-tender, non-distended, reducible umbilical
hernia,
well-healed appendectomy incision
Ext: Warm and well-perfused, no edema


Pertinent Results:
On Admission [**2154-1-31**]
WBC-3.9* RBC-3.57* Hgb-11.8* Hct-35.4* MCV-99* MCH-33.2*
MCHC-33.5 RDW-14.7 Plt Ct-54*
PT-17.1* PTT-37.6* INR(PT)-1.5*
Glucose-115* UreaN-8 Creat-0.7 Na-141 K-3.7 Cl-107 HCO3-27
AnGap-11
ALT-19 AST-38 AlkPhos-192* TotBili-3.3*
Albumin-3.4* Calcium-8.7 Phos-3.5 Mg-2.0
At Discharge [**2154-2-14**]
WBC-6.8 RBC-3.62* Hgb-10.8* Hct-33.7* MCV-93 MCH-29.8 MCHC-32.0
RDW-18.0* Plt Ct-101*
PT-14.0* PTT-26.3 INR(PT)-1.2*
Glucose-100 UreaN-11 Creat-0.6 Na-137 K-4.2 Cl-102 HCO3-33*
AnGap-6*
ALT-45* AST-31 AlkPhos-81 TotBili-1.0
Calcium-7.8* Phos-3.0 Mg-1.5* Albumin-2.6*
tacroFK-3.8*

Brief Hospital Course:
58 y/o male who is admitted from home as backup for liver
transplant. The liver was from a 67-year-old woman with normal
liver function but who had a liver with 30%
macrosteatosis and microsteatosis. The patient was taken to the
OR with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] after a careful discussion with the
patient.
The patient received routine immunosuppression induction to
include cellcept, solumedrol intra-op with taper and started
prograf on the evening of POD 1.
Per the operative report during the transplant after the portal
vein was clamped and tied, a few minutes later, the bowels began
to swell and the patient began to bleed significantly , due to
the increased portal hypertension with clamping
the portal vein. despite clamping as much bleeding as possible,
there was
significant oozing everywhere. The donor bile duct was
approximately 2 cm, and per Dr [**Last Name (STitle) 15283**] note did not feel a duct to
duct anastomosis would be done safely, so a Roux-en-Y was
performed. The bleeding remained significant but after
approximately 3 hours of controlling the bleeding the patient
was deemed stable and he was transferred to the SICU.
On [**2154-2-1**] the patient was noted to have falling Hcts despite
multiple transfusions and he was taken back to the OR with DR
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] for intra-abdominal hemorrhage s/p liver transplant.
At the time of surgery, when the old incision was opened there
was a significant amount of blood in the abdomen. This was
washed out, and although there were no areas of overt bleeding,
there was a constant retroperitoneal ooze. The area was argon
beamed and the patient was closed once sites looked
satisfactory.
In thre ensuing 24 hours, he continued to have transfusion
requirement and was also receiving [**Last Name (LF) 9087**], [**First Name3 (LF) **] he was taken back
once again with DR [**Last Name (STitle) 816**]. After opening the old incsision, a
significant amount of clotting was encountered> Again the
abdomen was washed out all anastomoses inspected and it was
again determined the bleeding was  from the retroperitoneum and
diaphragm.
Following this third surgery the hematocrit was more stable and
he required no more intervention. He received 5 days of Unasyn
due to multiple intrabdominal excursions.
In the post operative period, the patient reported visual
changes. He was seen by the neurology/stroke consult team who
recount the patient report that although he was initially "out
of it" while intubated and sedated following the procedures,
he recalled visual difficulty on around [**2-5**] or [**2-6**].  He
noticed that he could only see clearly out of the right visual
fields. Per the neuro note, the patient gave as an example that
he could see his nurse enter from the right before apparently
disappearing and reappearing across the room.  He also recounts
seeing the right
half of other peoples' faces; the left half appears blurry if
not absent. He was unable to identify a clear trigger for the
visual change. A head CT was done showing: Confluent low
attenuation in bilateral occipital lobes as well as left caudate
head.
MRI of the head showed multiple areas of signal abnormality
predominantly in the
bilateral posterior cerebral artery distribution involving the
occipital lobes
bilaterally, with an additional area of involvement in the left
caudate head
and a couple of punctate foci in the left basal ganglia and
internal capsule.
An echo was performed showing mid interatrial septum c/w a small
secundum ASD. No clot was identified.
Head and neck CTa demonstrated that the carotid and vertebral
arteries and their major branches appear patent, with no
evidence of stenoses, aneurysm, dissection, or
thrombus.
The patient was started on aspirin and plavix and will have
outpatient neurology and opthamology follow up.
The liver transplant did very well in the post op period. LFTs
declined daily and T bili settled out at 1.0.
Drains were removed once the majority of old blood and clot
dissipated.
His blood pressure was well maintained on metoprolol and he is
discharged to home on this new med, although the dosing was
dropped to [**Hospital1 **] on discharge.
The patient was followed by OT and PT and he will require home
services with both specialties, but he was deemed safe for home.
Prograf dosing was monitored and adjusted, cellcept and pred
taper were continued.
The patient will go home on short term lasix.




Medications on Admission:
 Clotrimazole 10mg Troche 5x Daily, Nadolol 20 mg Daily,
Pantoprazole 20mg Daily


Discharge Medications:
1. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
2. Prednisone 5 mg Tablet Sig: Four (4) Tablet PO once a day.
3. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for incision pain.
Disp:*40 Tablet(s)* Refills:*0*
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*2 Tablet(s)* Refills:*0*
13. One Touch Ultra System Kit     Kit Sig: One (1) kit
Miscellaneous twice a day: check blood sugars twice daily, bring
record to clinic.
14. Tacrolimus 1 mg Capsule Sig: Four (4) Capsule PO twice a
day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
s/p orthotopic liver transplant
Hematoma evacuation x 2 (OR takebacks)
post transplant subacute infarcts involving both occipital lobes
with visual changes


Discharge Condition:
Stable
A+Ox3: s/p  subacute infarcts involving both occipital lobes
during this admission, resulting in blurred vision
Ambulatory with walker


Discharge Instructions:
Please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever,
chills, nausea, vomiting, diarrhea, constipation, inability to
take or keep down food, fluids or medications or noted increase
in visual changes
You will have labs drawn every Monday and Thursday at the [**Hospital Ward Name **]
Office Building Lab. This will continue until further notice.
Please come to the [**Hospital Ward Name **] lab on Friday [**2-15**] to have labs drawn
for this week only. Come to lab in the morning, do not take
prograf prior to lab draw but bring it with you and take the
prograf once blood is drawn. Take your night time prograf dose
approximately 12 hours before you plan to have labs drawn the
following day.
Take all meds as directed
Monitor the incision for redness, drainage or bleeding
No heavy lifting
No driving if taking narcotic pain medications
You may shower, no tub baths or swimming
Call the transplant clinic at [**Telephone/Fax (1) 673**] for blood sugars over
200 on two consecutive days. Check blood sugars twice daily
(fasting and 4PM, and avoid concentrated sweets in your diet
Please purchase over the counter aspirin and colace (stool
softener)
Monitor for signs of bleeding such as nose bleed, rectal
bleeding or easy bruising since you are now on aspirin and
plavix

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-2-18**] 8:00
[**Last Name (LF) **],[**First Name3 (LF) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2154-2-18**] 9:00
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7304**], MD (Ophthamology) - Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2154-2-22**] 9:15.
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-2-28**] 10:00
[**First Name8 (NamePattern2) 2530**] [**Doctor Last Name **] (Neurology) [**2154-3-18**] at 2pm. Please call
([**Telephone/Fax (1) 2532**] for details regarding that appointment.
 You may also choose to schedule follow up with an
ophthamologist closer to home instead if that is more
convenient.



Completed by:[**2154-2-14**]
{'Malignant neoplasm of liver, primary,Cerebral artery occlusion, unspecified with cerebral infarction,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Portal hypertension,Ostium secundum type atrial septal defect,Iatrogenic cerebrovascular infarction or hemorrhage,Pulmonary collapse,Alcoholic cirrhosis of liver,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Esophageal reflux,Other and unspecified alcohol dependence, unspecified'}


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: EtOH cirrhosis and HCC admitted for liver transplant

PRESENT ILLNESS: 58M with EtOH cirrhosis and HCC called in for liver transplant.
A donor liver has become available and Mr. [**Known lastname 71166**] is the back-up
recipient.
He is status post CyberKnife treatment on [**2153-7-26**] for HCC.
The patient's last alcohol use was on [**2153-4-16**], and he is
participating in relapse prevention.

MEDICAL HISTORY: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: Clotrimazole 10mg Troche 5x Daily, Nadolol 20 mg Daily,
Pantoprazole 20mg Daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.6 72 108/66 18 100%RA Wt72 kg
Gen: Alert and oriented
CV: RRR, no murmurs/rubs/gallops
Resp: Clear to auscultation
Abd: Soft, non-tender, non-distended, reducible umbilical
hernia,
well-healed appendectomy incision
Ext: Warm and well-perfused, no edema

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good
health.  He is employed as a telecommunications technician.  He
has no children.  He reports that he smoked cigarettes for about
10 years but quit approximately 30 years ago.  He has no history
of use of intravenous or illicit drugs. 

### Response:
{'Malignant neoplasm of liver, primary,Cerebral artery occlusion, unspecified with cerebral infarction,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Portal hypertension,Ostium secundum type atrial septal defect,Iatrogenic cerebrovascular infarction or hemorrhage,Pulmonary collapse,Alcoholic cirrhosis of liver,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Esophageal reflux,Other and unspecified alcohol dependence, unspecified'}
