CHIEF COMPLAINT: End-stage liver disease.

PRESENT ILLNESS: This is a 50-year-old man
with a prior history of hepatitis C, abnormal transaminases
with probable cirrhosis with ascites, diabetes, increasing
jaundice, who presented to the [**Hospital **] clinic with complaints of
increasing abdominal pain.  The laboratory evaluation showed
a marked increase in albumin and the patient was recommended
to return to the hospital, [**Hospital1 18**], directly from the clinic.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Asthma.
3.  Migraines.
4.  Hepatitis C.
5.  Intravenous drug use in the past, currently on
methadone.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives alone.  He smokes.  He denied
alcohol.  He currently receives methadone daily from the
[**Hospital **] Hospital in [**Location (un) 18293**].
Other sequelae of chronic liver disease,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pulmonary collapse,Iron deficiency anemia secondary to blood loss (chronic)
Oth sequela, chr liv dis,Cirrhosis of liver NOS,Chrnc hpt C wo hpat coma,DMI wo cmp nt st uncntrl,Pulmonary collapse,Chr blood loss anemia
Admission Date:  [**2147-9-29**]     Discharge Date:  [**2147-10-27**]

Date of Birth:   [**2096-10-8**]     Sex:  M

Service:  TRANSPLANT SURGERY

CHIEF COMPLAINT:  End-stage liver disease.

HISTORY OF THE PRESENT ILLNESS:  This is a 50-year-old man
with a prior history of hepatitis C, abnormal transaminases
with probable cirrhosis with ascites, diabetes, increasing
jaundice, who presented to the [**Hospital **] clinic with complaints of
increasing abdominal pain.  The laboratory evaluation showed
a marked increase in albumin and the patient was recommended
to return to the hospital, [**Hospital1 18**], directly from the clinic.

REVIEW OF SYSTEMS:  No fever, no nausea, vomiting, no
diarrhea.  Positive weakness and positive swelling.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus.
2.  Asthma.
3.  Migraines.
4.  Hepatitis C.
5.  Intravenous drug use in the past, currently on
methadone.

SOCIAL HISTORY:  He lives alone.  He smokes.  He denied
alcohol.  He currently receives methadone daily from the
[**Hospital **] Hospital in [**Location (un) 18293**].

ALLERGIES:  The patient has no known drug allergies.

ADMISSION MEDICATIONS:
1.  Aldactone.
2.  Flexeril.
3.  Fluoxetine.
4.  Lasix.
5.  Ibuprofen.
6.  Levofloxacin.
7.  Novolin.
8.  Protonix.
9.  Rhinocort.
10. Methadone.

PHYSICAL EXAMINATION ON ADMISSION:  General:  The patient is
a jaundiced male, awake, alert, and oriented times three.
Head and neck:  Positive for scleral icterus with no cervical
lymphadenopathy.  Chest:  Clear to auscultation bilaterally.
Lungs:  Regular rate and rhythm.  S1, S2.  Abdomen:
Distended with active bowel sounds, tympanitic, positive
fluid wave, nontender.  Extremities:  Marked edema
bilaterally up to the thighs.  Neurologic:  Positive
asterixis, 2+ reflexes, [**5-29**] muscle strength.

LABORATORY/RADIOLOGIC DATA:  CBC:  White blood cell count
8.5, hematocrit 37.9.  His urinalysis showed bilirubin.  His
K was low at 3.1.  His LFTs were as follows:  ALT 80, AST
154, alkaline phosphatase 318, total bilirubin 26.4.  AST
51.4, CEA 9.7.

An ultrasound on admission showed a markedly cirrhotic liver
with a distended and sludge-filled gallbladder.

HOSPITAL COURSE:  It was determined that the patient had
end-stage liver disease and he was admitted to the [**Hospital **]
Medical Service under Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **].  On [**2147-9-30**], the patient underwent paracentesis to drain his
markedly ascitic abdomen.  This was repeated five times over
the next few days.  On one of these paracenteses, there was a
culture that grew out Pneumococcus strep pneumoniae and the
patient did have spontaneous bacterial peritonitis.

On [**2147-10-2**], the patient underwent an endoscopy
examination which failed to reveal any varices.  On [**2147-10-5**], the patient received a Psychiatry consult which
confirmed that the patient had a pre-existing major
depressive disorder.  At about this time, the patient was
evaluated by the Transplant Surgery Team.  After evaluation
by the Transplant Surgery Team, the patient was deemed for a
transplant and added to the liver donor list.

On [**2147-10-10**], a liver was obtained and the patient
was pre-opped.  On [**2147-10-11**], the patient underwent
a transplant operation by Dr. [**Last Name (STitle) **], Dr. [**Last Name (STitle) **], and Dr.
[**First Name (STitle) **].  Please refer to the previously dictated operative
note from [**2147-10-11**] by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for the
specific details of this operation.

Immediately postoperatively, the patient was treated with
intravenous antibiotics, vancomycin, and Zosyn as well as
immunosuppressants, CellCept, Solu-Medrol, and Simulect.  He
was transferred to the unit where he stayed for the next few
days.  He was hemodynamically monitored.  He received several
transfusions for decreasing hematocrit and platelet
transfusions for decreasing platelets.

During this time, he also developed several bouts of
postoperative atelectasis and was eventually diuresed with
Lasix.

By [**2147-10-18**], postoperative day number seven, the
patient was doing much better.  His lungs were clear.  He was
hemodynamically stable.  It was decided that he should be
extubated and he was.  He tolerated this well and on the next
day, postoperative day number eight, the patient was stable
enough to be transferred to the floors.

In addition, it should be noted that during the patient's
SICU stay, his nutritional status was maintained with total
parenteral nutrition and once extubated he was able to be
sustained on an oral diet which was slowly advanced while he
was on the floor to a regular diet which he tolerated without
nausea, vomiting, or abdominal pain.

Once on the floor, the patient was evaluated by Physical
Therapy.  It was determined that he was stable enough and in
good enough condition to be discharged home once he was
cleared medically.

Several radiologic studies were performed over the final few
days of his admission, first on postoperative day number 13,
[**2147-10-24**], a cholangiogram was performed through the
patient's T tube.  This revealed a stricture at the biliary
anastomosis.  On the next day, the patient underwent ERCP and
this previously mentioned stricture was dilated.

Later on [**2147-10-25**], a duplex ultrasound of the liver
was obtained which showed adequate blood flow through the
hepatic arteries and portal veins indicating the transplanted
liver was well perfused.  Therefore, on [**2147-10-27**],
hospital day number 33, postoperative day number 20, the
patient is afebrile with stable vital signs.  He is
tolerating a solid oral diet, making good urine, and having
good bowel movements.  His abdominal examination is benign
and his laboratory work from [**2147-10-26**] is as follows;
white blood cell count 13.1, hematocrit 32.3, platelets
304,000.  Chemistries:  Sodium 137, potassium 4.3, chloride
104, bicarbonate 24, BUN 20, creatinine 1.6, glucose 80.
Liver function tests:  ALT 43, AST 29, alkaline phosphatase
261, total bilirubin 5.5, albumin 2.9, and his latest
cyclosporin level was 351 on a 400 b.i.d. dose.  He is being
discharged home in good condition  with the following
discharge diagnoses.

DISCHARGE DIAGNOSIS:
1.  Major depressive disorder.
2.  Hepatitis C.
3.  End-stage liver disease.
4.  Portal hypertension.
5.  Hepatic encephalopathy.
6.  Cirrhosis.
7.  Ascites.
8.  Spontaneous bacterial peritonitis.
9.  Insulin-dependent diabetes mellitus.
10. Asthma.
11. Migraines.
12. Chronic myofascial pain (fibromyalgia).
13. Outpatient methadone treatment.
14. Orthotopic liver transplant.
15. Hypovolemia requiring fluid resuscitation.
16. Postoperative atelectasis.
17. Hyperalimentation, TPN.
18. Chronic blood loss anemia requiring red blood cell
transfusion.
19. Thrombocytopenia requiring platelet transfusion.
20. Biliary anastomotic stricture.
21. Status post diagnostic paracentesis.
22. Status post endoscopy.
23. Status post intubation and mechanical ventilation.
24. Status post cholangiogram by Interventional Radiology.
25. Status post endoscopic retrograde
cholangiopancreatography.

DISCHARGE MEDICATIONS:
1.  Valcyte 450 mg p.o. q.o.d.
2.  Bactrim one single-strength tablet p.o. q.d.
3.  Celexa 10 mg p.o. q.d.
4.  Fluconazole 400 mg p.o. q.d.
5.  Metoclopramide 10 mg p.o. q.i.d.
6.  CellCept 1,000 mg p.o. b.i.d.
7.  Protonix 40 mg p.o. q.d.
8.  Methadone 45 mg p.o. q.d.
9.  Metoprolol 25 mg p.o. b.i.d.
10. Hydralazine 10 mg p.o. q. six hours.
11. Prednisone 15 mg p.o. q.d.
12. Colace 100 mg p.o. b.i.d.
13. Dilaudid 2-6 mg q. four hours p.r.n. pain.
14. Dulcolax 10 mg p.r. q.d. p.r.n. constipation.
15. Neoral 400 mg p.o. b.i.d.
16. NPH insulin 20 units subcutaneously q.a.m., 14 units
subcutaneously q.p.m. with a regular insulin sliding scale.

FOLLOW-UP:  The patient is to follow-up with Dr. [**Last Name (STitle) **], Dr.
[**First Name (STitle) **], and Dr. [**Last Name (STitle) 497**].  As well, he should continue his
outpatient methadone treatment and he should be receiving
twice weekly laboratory work during which he tests CBC,
Chem-20, including liver function tests, and Neoral
cyclosporin levels.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.  02-366

Dictated By:[**Last Name (NamePattern1) 1179**]

MEDQUIST36

D:  [**2147-10-26**]  02:18
T:  [**2147-10-28**]  19:44
JOB#:  [**Job Number 108602**]
{'Other sequelae of chronic liver disease,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pulmonary collapse,Iron deficiency anemia secondary to blood loss (chronic)'}


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: End-stage liver disease.

PRESENT ILLNESS: This is a 50-year-old man
with a prior history of hepatitis C, abnormal transaminases
with probable cirrhosis with ascites, diabetes, increasing
jaundice, who presented to the [**Hospital **] clinic with complaints of
increasing abdominal pain.  The laboratory evaluation showed
a marked increase in albumin and the patient was recommended
to return to the hospital, [**Hospital1 18**], directly from the clinic.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Asthma.
3.  Migraines.
4.  Hepatitis C.
5.  Intravenous drug use in the past, currently on
methadone.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives alone.  He smokes.  He denied
alcohol.  He currently receives methadone daily from the
[**Hospital **] Hospital in [**Location (un) 18293**]. 

### Response:
{'Other sequelae of chronic liver disease,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pulmonary collapse,Iron deficiency anemia secondary to blood loss (chronic)'}
