CHIEF COMPLAINT: 63-year-
old female with a history of the hepatitis C virus related
cirrhosis and hepatocellular carcinoma who was evaluated and
found to be a suitable candidate for liver transplantation.

PRESENT ILLNESS: 63-year-old female
who presented to the transplant service with end-stage liver
disease and a hepatoma. She was taken to the operating room
where she underwent a difficult liver transplantation that
was complicated by primary nonfunction. She was then taken
back to the operating room and underwent AB/O incompatible
liver transplantation and underwent temporary abdominal
closure. She was taken back to the operating room for a Vicryl
mesh closure of the abdomen and liverbiopsy that demonstrated
some mild central lobular necrosis.
She underwent followup Doppler ultrasound that demonstrated
patent vessels to the liver and, because she required a
portal vein jump graft to the SMV to re-establish portal
vein inflow, we placed her on heparin after she completed her
abdominal closure. Approximately 24 hours into her
heparinization, she developed an upper GI bleed. She
underwent endoscopy that demonstrated some blood and old
blood in the stomach but no active bleeding or ulcer. There
was what appeared to be a small duodenal diverticulum but no
obvious source of upper GI hemorrhage. Based upon our concern
that the diverticulum may, in fact, have been a small ulcer,
she underwent a CT scan of the abdomen which demonstrated a
contrast extravasation and periduodenal air.

MEDICAL HISTORY: HCC HEP B CVA HYPOTHYROIDISM

MEDICATION ON ADMISSION: fluoxetine, furosemide, lactulose, Synthroid,
Zyprexa, Protonix, Seroquel, spironolactone, [**Last Name (un) **], and Flagyl.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical examination,PRE TRANSPLANT she appeared tired. Skin
warm and
well perfused. Pupils equal, round, and reactive to light
directly and consensually. Extraocular motions intact.
There is no jaundice. She had a plate in her mouth. Oropharynx
is otherwise benign. No carotid bruits. The trachea
is midline. There is no thyromegaly. The lungs clear
bilaterally. Heart rate is regular without rub, murmur, or
gallop.  The abdomen is soft, nontender, and nondistended.
The liver is palpable 1 cm below the costal margin. I was not
able to feel the spleen. She has palpable pedal and groin
pulses. Extremities are normal strength and sensation.
Neurologic is intact.

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH ABUSE:Pt WAS sober from alcohol for three
smoker up to 3 years ago. Denies any IV drug or any other
illicit drug use.
Malignant neoplasm of liver, not specified as primary or secondary,Complications of transplanted liver,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Embolism and thrombosis of other specified artery,Acute pancreatitis,Hemorrhage of gastrointestinal tract, unspecified,Perforation of intestine,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal abscess,Iatrogenic pneumothorax,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, initial episode of care,Portal hypertension,Metabolic encephalopathy
Malignant neo liver NOS,Compl liver transplant,Acute necrosis of liver,Chrnc hpt C wo hpat coma,Portal vein thrombosis,Arterial embolism NEC,Acute pancreatitis,Gastrointest hemorr NOS,Perforation of intestine,Accidental op laceration,Peritoneal abscess,Iatrogenic pneumothorax,Ac kidny fail, tubr necr,Subendo infarct, initial,Portal hypertension,Metabolic encephalopathy
Admission Date:  [**2173-11-5**]              Discharge Date:   [**2173-12-2**]

Date of Birth:  [**2110-5-17**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
63-year-
old female with a history of the hepatitis C virus related
cirrhosis and hepatocellular carcinoma who was evaluated and
found to be a suitable candidate for liver transplantation.


Major Surgical or Invasive Procedure:
[**11-5**]:Orthotopic deceased donor liver
transplant (piggyback, portal vein conduit from the recipient
portal vein to the donor portal vein), common bile duct to
common bile duct anastomosis, donor common hepatic artery to
recipient common hepatic artery end-to-end anastomosis
[**11-7**]:Exploratory laparotomy, evacuation of intra-
abdominal hematoma, portal vein exploration, intraoperative
ultrasound, Tru-Cut biopsy of the liver
[**11-9**] 1. Orthotopic deceased donor liver transplant (piggyback/
ABO incompatible).
2. Superior mesenteric vein to portal vein iliac vein
conduit, donor common hepatic artery to donor #1
branch patch, Roux-en-Y hepaticojejunostomy
[**11-13**] 1. Exploratory laparoscopy.
2. Right and left lobe liver biopsy.
3. Abdominal washout.
4. Thrombectomy.
5. Attempted revision of accessory left hepatic artery
thrombosis.
[**11-16**] 1. Re-opening of recent laparotomy.
2. Exploration of liver.
3. Intraoperative ultrasound.
4. Liver biopsy.
5. Debridement of necrotic muscle and fascia
[**11-26**] 1. Open tracheostomy.
2. Re-exploration of liver transplant with washout liver
biopsy and Vicryl mesh closure of abdominal wall
[**12-2**] 1. Exploratory laparotomy.
2. Portal vein thrombectomy.
3. Hepatic artery thrombectomy.
4. Lysis of adhesions.
5. Peripancreatic and pancreatic debridement, evacuation of
hematoma and temporary abdominal closure.
6. Left liver lobe biopsy

History of Present Illness:
63-year-old female
who presented to the transplant service with end-stage liver
disease and a hepatoma. She was taken to the operating room
where she underwent a difficult liver transplantation that
was complicated by primary nonfunction. She was then taken
back to the operating room and underwent AB/O incompatible
liver transplantation and underwent temporary abdominal
closure. She was taken back to the operating room for a Vicryl
mesh closure of the abdomen and liverbiopsy that demonstrated
some mild central lobular necrosis.
She underwent followup Doppler ultrasound that demonstrated
patent vessels to the liver and, because she required a
portal vein jump graft to the SMV to re-establish portal
vein inflow, we placed her on heparin after she completed her
abdominal closure. Approximately 24 hours into her
heparinization, she developed an upper GI bleed. She
underwent endoscopy that demonstrated some blood and old
blood in the stomach but no active bleeding or ulcer. There
was what appeared to be a small duodenal diverticulum but no
obvious source of upper GI hemorrhage. Based upon our concern
that the diverticulum may, in fact, have been a small ulcer,
she underwent a CT scan of the abdomen which demonstrated a
contrast extravasation and periduodenal air.


Past Medical History:
HCC HEP B CVA HYPOTHYROIDISM

Social History:
ETOH ABUSE:Pt WAS sober from alcohol for three
smoker up to 3 years ago. Denies any IV drug or any other
illicit drug use.


Physical Exam:
On physical examination,PRE TRANSPLANT she appeared tired. Skin
warm and
well perfused. Pupils equal, round, and reactive to light
directly and consensually. Extraocular motions intact.
There is no jaundice. She had a plate in her mouth. Oropharynx
is otherwise benign. No carotid bruits. The trachea
is midline. There is no thyromegaly. The lungs clear
bilaterally. Heart rate is regular without rub, murmur, or
gallop.  The abdomen is soft, nontender, and nondistended.
The liver is palpable 1 cm below the costal margin. I was not
able to feel the spleen. She has palpable pedal and groin
pulses. Extremities are normal strength and sensation.
Neurologic is intact.


Pertinent Results:
Ct Scan 1/5/6
1) Extraluminal hyperdense material in the right upper quadrant
posteriorly
(superior peripancreatic and inferolateral peripancreatic) area
most likely
due to extraluminal oral contrast from proximal small bowel or
duodenum.

2) Small (less than 4.5 cm transverse x 2 cm AP) collection
anterior to the
peripancreatic neck/body region.

3) Small splenic infarct, hypoperfusion or small infarct in the
lower pole
cortex of the right kidney.

4) Moderate bibasilar pleural effusions.



Brief Hospital Course:
63-year-old female
who presented to the transplant service with end-stage liver
disease and a hepatoma. She was taken to the operating room
where she underwent a difficult liver transplantation that
was complicated by primary non function. She was then taken
back to the operating room and underwent AB/O incompatible
liver transplantation and underwent temporary abdominal
closure. She was taken back to the operating room this past
Friday for a Vicryl mesh closure of the abdomen and liver
biopsy that demonstrated some mild central lobular necrosis.
She underwent follow up Doppler ultrasound that demonstrated
patent vessels to the liver and, because she required a
portal vein jump graft to the SMV to re-establish portal
vein inflow, we placed her on heparin after she completed her
abdominal closure. Approximately 24 hours into her
heparinization, she developed an upper GI bleed. She
underwent endoscopy that demonstrated some blood and old
blood in the stomach but no active bleeding or ulcer. There
was what appeared to be a small duodenal diverticulum but no
obvious source of upper GI hemorrhage. Based upon our concern
that the diverticulum may, in fact, have been a small ulcer,
she underwent a CT scan of the abdomen which demonstrated a
contrast extravasation and peri duodenal air. She was taken to
the operating room emergently for exploration.
Exploration showed intestinal contents free in the peritoneal
cavity. Hepatic artery ap reared clotted and she also had a
splenic infarct.At this time, without what
appeared to be a significant insult that we did not believe
was survivable, namely an identified hollow visceral
perforation, portal vein and hepatic artery thrombosis in the
setting of a 2nd liver transplant and infected necrotic
pancreas, pancreatic necrosis, we did not believe that this
was a salvageable situation.Pt was made CMO after discussion
with health proxy abdomen was closed and pt was transferred to
ICU where She expired short after.


Medications on Admission:
fluoxetine, furosemide, lactulose, Synthroid,
Zyprexa, Protonix, Seroquel, spironolactone, [**Last Name (un) **], and Flagyl.



Discharge Medications:
none

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Hepatitis C virus related cirrhosis
and hepatocellular carcinoma. S/P OTL x2 after abo
incompatibility
1. Perforated viscus.
2. Infected pancreatic necrosis.
3. Portal vein thrombus.
4. Hepatic artery thrombosis.
5. Necrotic liver

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2173-12-2**]
{'Malignant neoplasm of liver, not specified as primary or secondary,Complications of transplanted liver,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Embolism and thrombosis of other specified artery,Acute pancreatitis,Hemorrhage of gastrointestinal tract, unspecified,Perforation of intestine,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal abscess,Iatrogenic pneumothorax,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, initial episode of care,Portal hypertension,Metabolic encephalopathy'}


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: 63-year-
old female with a history of the hepatitis C virus related
cirrhosis and hepatocellular carcinoma who was evaluated and
found to be a suitable candidate for liver transplantation.

PRESENT ILLNESS: 63-year-old female
who presented to the transplant service with end-stage liver
disease and a hepatoma. She was taken to the operating room
where she underwent a difficult liver transplantation that
was complicated by primary nonfunction. She was then taken
back to the operating room and underwent AB/O incompatible
liver transplantation and underwent temporary abdominal
closure. She was taken back to the operating room for a Vicryl
mesh closure of the abdomen and liverbiopsy that demonstrated
some mild central lobular necrosis.
She underwent followup Doppler ultrasound that demonstrated
patent vessels to the liver and, because she required a
portal vein jump graft to the SMV to re-establish portal
vein inflow, we placed her on heparin after she completed her
abdominal closure. Approximately 24 hours into her
heparinization, she developed an upper GI bleed. She
underwent endoscopy that demonstrated some blood and old
blood in the stomach but no active bleeding or ulcer. There
was what appeared to be a small duodenal diverticulum but no
obvious source of upper GI hemorrhage. Based upon our concern
that the diverticulum may, in fact, have been a small ulcer,
she underwent a CT scan of the abdomen which demonstrated a
contrast extravasation and periduodenal air.

MEDICAL HISTORY: HCC HEP B CVA HYPOTHYROIDISM

MEDICATION ON ADMISSION: fluoxetine, furosemide, lactulose, Synthroid,
Zyprexa, Protonix, Seroquel, spironolactone, [**Last Name (un) **], and Flagyl.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On physical examination,PRE TRANSPLANT she appeared tired. Skin
warm and
well perfused. Pupils equal, round, and reactive to light
directly and consensually. Extraocular motions intact.
There is no jaundice. She had a plate in her mouth. Oropharynx
is otherwise benign. No carotid bruits. The trachea
is midline. There is no thyromegaly. The lungs clear
bilaterally. Heart rate is regular without rub, murmur, or
gallop.  The abdomen is soft, nontender, and nondistended.
The liver is palpable 1 cm below the costal margin. I was not
able to feel the spleen. She has palpable pedal and groin
pulses. Extremities are normal strength and sensation.
Neurologic is intact.

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH ABUSE:Pt WAS sober from alcohol for three
smoker up to 3 years ago. Denies any IV drug or any other
illicit drug use. 

### Response:
{'Malignant neoplasm of liver, not specified as primary or secondary,Complications of transplanted liver,Acute and subacute necrosis of liver,Chronic hepatitis C without mention of hepatic coma,Portal vein thrombosis,Embolism and thrombosis of other specified artery,Acute pancreatitis,Hemorrhage of gastrointestinal tract, unspecified,Perforation of intestine,Accidental puncture or laceration during a procedure, not elsewhere classified,Peritoneal abscess,Iatrogenic pneumothorax,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, initial episode of care,Portal hypertension,Metabolic encephalopathy'}
