CHIEF COMPLAINT: Abdominal Pain

PRESENT ILLNESS: 49 year old man with a past medical history of HIV (on HAART,
CD4 252 and VL UD [**3-22**]), HCV cirrhosis, Crohn's disease and
gastroporesis who presented with abdominal pain.  Has had 5 days
of worsening abdominal pain.  Started in RUQ and intermittent.
Progressed to diffuse and constant abdominal pain.  Denies
fevers, having some chills.  Some baseline diarrhea due to
lactulose.  New non-productive cough and shortness of breath.
Pain became progressively worse so presented to the ED for
evaluation.  Of note, patient weighed 67.5 Kg on [**4-12**].  On
arrival to ICU patient weighs 72.8 kg.
.
In the ED, initial vs were: T99.2 P153 BP144/93 R22 O2 97% sat.
Well appearing but uncomfortable.  Soft, moderately distended,
tender in RUQ.  Guaiac positive stool in ED.  Mild b/l pitting
edema.  No asterixis.  Lactate 3.1.  Dx paracentesis -> no e/o
SBP.  Similar admission in [**Month (only) 958**] treated with large volume
paracentesis.  RUQ USD with patent portal vein.  Patient was
given 1L NS, now with mtce fluids running.  ECG -> sinus
tachycardia.  Gotten 12mg IV morphine and 4mg zofran, pain is
now well controlled.
.
Most recent VS were, T99.2, 113/74, HR 131, RR 21, 02 95%RA.
Patient has two peripheral IV's.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies dysuria, frequency, or urgency. Denies arthralgias.
Denies rashes or skin changes.

MEDICAL HISTORY: # HIV, CD4 116
- followed by [**First Name8 (NamePattern2) **] [**Doctor Last Name 4020**]
# systolic CHF, EF 55% on TTE [**10-21**]
# hepatitis C
- genotype 1, last VL [**10-21**] 4,000,000 IU/mL.
- elevated AFP
- negative MRI abdomen [**3-18**] and [**12-20**]
# ? Crohn's disease
- diagnosed at [**Hospital1 336**] around [**2149**]
- diarrhea was initial presentation
- treated with unknown medication for 1 month and sx resolved
# htn
# depression
# condylomata, anal, penile, scrotal, L index finger
- s/p Microscopically assisted transanal biopsy and laser
destruction of anal condylomata [**2168-2-5**]
- s/p microscopically assisted laser destruction of penile,
scrotal and left index finger condylomata.
# hemorrhoids
# Verruca vulgaris, prurigo nodularis
- followed by Dr. [**Last Name (STitle) **] of Dermatology
# h/o syphilis
# gastroparesis

MEDICATION ON ADMISSION: -Epzicom (abacavir/lamivudine) 1 tab daily
-citalopram 20 mg daily
-colestipol 4 or 6 grams [**Hospital1 **]
-vitamin D
-furosemide 60 mg a day
-lactulose 30ml TID
-Reglan 5 mg three times a day
-metoprolol 25 mg daily
-Isentress (raltegravir) 400mg [**Hospital1 **]
-spironolactone 100 mg a day
-tenofovir 300 mg a day
-calcium
-vitamin D
-Ensure
-omeprazole 20mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on discharge [**2169-5-12**]:
Vitals: Afebrile BP:90s-100s P: 70s-90s O2: 96RA, 72.4kg
General: Alert, oriented, no acute distress
HEENT: Sclera mildly icteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTA b/l
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: distended but not firm, cellulitis at paracentesis site
resolved
Ext: 2+ pitting edema BLE-mostly in feet, no clubbing or
cyanosis; RUE with 2+ edema
R PICC removed before discharge.

FAMILY HISTORY: A number of relatives have had strokes or MIs in their late 40s

SOCIAL HISTORY: Denies any tobacco, alcohol, or illicit drugs. Specifically,
denies taking methadone.
Streptococcal septicemia,Spontaneous bacterial peritonitis,Human immunodeficiency virus [HIV] disease,Cellulitis and abscess of trunk,Other postoperative infection,Regional enteritis of unspecified site,Chronic systolic heart failure,Portal hypertension,Sepsis,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Edema of male genital organs,Gastroparesis,Thrombocytopenia, unspecified,Herpes simplex without mention of complication
Streptococcal septicemia,Spontan bact peritonitis,Human immuno virus dis,Cellulitis of trunk,Other postop infection,Regional enteritis NOS,Chr systolic hrt failure,Portal hypertension,Sepsis,Cirrhosis of liver NOS,Chrnc hpt C wo hpat coma,Await organ transplnt st,Edema, male genital orgn,Gastroparesis,Thrombocytopenia NOS,Herpes simplex NOS
Admission Date:  [**2169-4-26**]              Discharge Date:   [**2169-5-12**]

Date of Birth:  [**2120-1-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1377**]
Chief Complaint:
Abdominal Pain

Major Surgical or Invasive Procedure:
Diagnostic and Therapeutic Paracentesis


History of Present Illness:
49 year old man with a past medical history of HIV (on HAART,
CD4 252 and VL UD [**3-22**]), HCV cirrhosis, Crohn's disease and
gastroporesis who presented with abdominal pain.  Has had 5 days
of worsening abdominal pain.  Started in RUQ and intermittent.
Progressed to diffuse and constant abdominal pain.  Denies
fevers, having some chills.  Some baseline diarrhea due to
lactulose.  New non-productive cough and shortness of breath.
Pain became progressively worse so presented to the ED for
evaluation.  Of note, patient weighed 67.5 Kg on [**4-12**].  On
arrival to ICU patient weighs 72.8 kg.
.
In the ED, initial vs were: T99.2 P153 BP144/93 R22 O2 97% sat.
Well appearing but uncomfortable.  Soft, moderately distended,
tender in RUQ.  Guaiac positive stool in ED.  Mild b/l pitting
edema.  No asterixis.  Lactate 3.1.  Dx paracentesis -> no e/o
SBP.  Similar admission in [**Month (only) 958**] treated with large volume
paracentesis.  RUQ USD with patent portal vein.  Patient was
given 1L NS, now with mtce fluids running.  ECG -> sinus
tachycardia.  Gotten 12mg IV morphine and 4mg zofran, pain is
now well controlled.
.
Most recent VS were, T99.2, 113/74, HR 131, RR 21, 02 95%RA.
Patient has two peripheral IV's.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies dysuria, frequency, or urgency. Denies arthralgias.
Denies rashes or skin changes.


Past Medical History:
# HIV, CD4 116
- followed by [**First Name8 (NamePattern2) **] [**Doctor Last Name 4020**]
# systolic CHF, EF 55% on TTE [**10-21**]
# hepatitis C
- genotype 1, last VL [**10-21**] 4,000,000 IU/mL.
- elevated AFP
- negative MRI abdomen [**3-18**] and [**12-20**]
# ? Crohn's disease
- diagnosed at [**Hospital1 336**] around [**2149**]
- diarrhea was initial presentation
- treated with unknown medication for 1 month and sx resolved
# htn
# depression
# condylomata, anal, penile, scrotal, L index finger
- s/p Microscopically assisted transanal biopsy and laser
destruction of anal condylomata [**2168-2-5**]
- s/p microscopically assisted laser destruction of penile,
scrotal and left index finger condylomata.
# hemorrhoids
# Verruca vulgaris, prurigo nodularis
- followed by Dr. [**Last Name (STitle) **] of Dermatology
# h/o syphilis
# gastroparesis


Social History:
Denies any tobacco, alcohol, or illicit drugs. Specifically,
denies taking methadone.


Family History:
A number of relatives have had strokes or MIs in their late 40s

or early 50s, including brothers, a sister, and father.


Physical Exam:
Exam on discharge [**2169-5-12**]:
Vitals: Afebrile BP:90s-100s P: 70s-90s O2: 96RA, 72.4kg
General: Alert, oriented, no acute distress
HEENT: Sclera mildly icteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTA b/l
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: distended but not firm, cellulitis at paracentesis site
resolved
Ext: 2+ pitting edema BLE-mostly in feet, no clubbing or
cyanosis; RUE with 2+ edema
R PICC removed before discharge.


Pertinent Results:
Labs on discharge [**2169-5-12**]:

6.9>-------< 35
      27.9

135   100   11
--------------< 113
3.6    28  1.0

INR 3.3
T bili 8.0

Micro:
[**4-25**] BCX:
        BETA STREPTOCOCCUS GROUP B
                             |
CLINDAMYCIN-----------       S
ERYTHROMYCIN----------<=0.25 S
PENICILLIN G----------  0.06 S
VANCOMYCIN------------   <=1 S

[**4-26**] Peritoneal fluid:
B streptoccus group B

[**4-27**] CMV not detected

[**5-4**] DFA for HSV/Zoster uninterpretable due to inadequate
specimen.; culture NGTD

All subsequent Blood, Urine, Stool cultures negative.

[**2169-4-25**]: RUQ Ultrasound
1. Portal vein is patent. Cirrhosis with moderate
intra-abdominal ascites.
2. Cholelithiasis and gallbladder wall thickening. In the
setting of liver
disease, gallbladder wall thickening can be secondary to
underlying liver
disease.

[**2169-4-25**]: CXR (PA & Lateral)
Bibasilar linear compressive atelectasis and low lung volumes
likely secondary to patient's known intra-abdominal ascites. No
definite
pneumonia or congestive heart failure.

[**2169-4-26**]: HIDA Scan
No evidence of cholecystitis.

[**2169-4-26**]: CTA Abdomen/Pelvis
IMPRESSION:
1. Cirrhosis and portal hypertension with moderate-to-large
volume ascites
and mild splenomegaly. No new focal concerning hepatic lesion.
2. No evidence for mesenteric ischemia or obstruction. While
there is
apparent narrowing at the origin of celiac axis, the remainder
of the celiac axis and mesenteric vasculature appears widely
patent.
3. Gallbladder distention has been present on priors with a few
small
gallbladder stones likely.
4. Diffuse colonic wall thickening most likely reflects third
spacing.

[**2169-4-28**]: TTE
No vegetations seen (good-quality study). Normal global and
regional biventricular systolic function. Mild to moderate
regurgitation. Compared with the prior study (images reviewed)
of [**2169-3-8**], the findings are similar. In presence of high
clinical suspicion, absence of vegetations on transthoracic
echocardiogram does not exclude endocarditis.

[**4-30**] US
1. Marked swelling of the scrotal skin with hypoechoic regions
in both the
right and left hemiscrotum. This may represent fluid from
scrotal
edema/third-spacing, but underlying infection cannot be excluded
(though lack of significant associated vascularity argues
against it).
2. No evidence of epididymo-orchitis.

[**4-30**] CT
1. Marked interval increase in diffuse subcutaneous edema and
slight interval decrease in moderate ascites. No organized fluid
collection identified to suggest abscess.
2. Nodular liver and enlarged spleen consistent with cirrhosis
and portal
hypertension.
3. Diffuse colonic wall thickening likely reflecting third
spacing.
4. Bibasilar airspace disease, likely atelectasis, and a tiny
left pleural
effusion.

[**5-3**] US:
1. Unremarkable scrotal ultrasound with normal appearance of the
testes.
2. Extensive subcutaneous edema unchanged

[**5-4**] US
Left lower quadrant abdominal wall edema, but no sign of abscess

TEE [**5-5**]:
No echocardiographic evidence of endocarditis. The catheter tip
present in the right atrium in close proximity to the tricuspid
valve. Recommend withdrawal of the catheter approximately 2 to 3
centimeters to avoid contact/mechanical irritation of the
tricuspid valve. Aortic atheroma as described above.

[**5-11**] CXR:
Near complete resolution of left lower lobe pneumonia.

[**5-12**] RUE US: No DVT

Brief Hospital Course:
Pleasant 49 yo M with HIV and HCV cirrhosis c/b cirrhosis, who
was admitted with abdominal pain. He was found to have SBP and
GBS bacteremia.
.
# SBP with bactermia- Pt completed 2 week course of ceftriaxone
(ended [**2169-5-10**]). He completed albumin [**4-30**]. TTE and TEE without
evidence of endocarditis. He was started on ciprofloxacin 500mg
daily for SBP prophylaxis on [**2169-5-11**]. He remained afebrile for
24 hours after ceftriaxone was stopped.
.
# Cellulits at paracentesis site - No abscess by US. Pt was
treated with 12 days of vancomycin (completed [**2169-5-10**]) and
cellulitis was resolved at time of discharge. He remained
afebrile for 24 hours after vanco was stopped. He was no longer
requiring pain medications and none were given on discharge.
.
# Scrotal swelling/Anasarca - Pt had extremely swollen scrotum,
which was determined to be an extention of his ascites. With
supportive care (sheet under scrotum) and diuresis, it slowly
improved. US and CT were negative for abcess/fourniers. His goal
diuresis of losing 1 kg/day was achieve with lasix 120mg [**Hospital1 **] and
spironolactone 50mg daily. Weight on discharge was 72.4kg.
.
# Oral herpes - Pt had lesions concerning for oral herpes. DFA
with insufficient specimen. He was treated with full course of
acyclovir 400mg 5x/day for 10 days (completed [**2169-5-12**]). DFA
caused lip bleeding that requried stitch. Stitch was removed
after 9 days and there was no further bleeding.
.
# Low grade fevers - Pt had low grade fevers (99.1-99.7) after
transfer out of MICU. They were attributed to cellulitis or HSV.
He also had infiltrate on CXR concerning for pneumonia. Repeat
CXR [**5-11**] (day after antibiotics were stopped) demonstrated
imporovement and antibiotics were stopped as above. Fevers
resolved and he remained afebrile for 24 hours off antibiotics.
.
# Skin care - pt had mild scrotal skin breakdown and complained
of groin fungal infection. Supportive medications and topical
anti-fungals were started during this hospitalization. Pt was
instructed to see his PCP to determine if rashes had improved
and if medications could be stopped.
.
# HCV cirrhosis- lactulose and diuresis as above. On discharge
he was mentating well without signs of encephalopathy. He did
not appear jaundiced but had mild scleral icterus.
.
# HTN: Pt had not taken metoprolol for several weeks prior to
admission. His BP was normal in the hospital. This was held on
discharge and pt was instructed to discuss with PCP regarding
restarting this medication.
.
# HIV: continued HAART without change to regimen.
.
# Thrombocytopenia: Chronic and stable.
.
# Bone health - pt started on vitamin D 50,000 x 6 more weeks
(1st two doses given [**5-3**], [**5-10**]); continued calcium.
.
# Full Code

Medications on Admission:
-Epzicom (abacavir/lamivudine) 1 tab daily
-citalopram 20 mg daily
-colestipol 4 or 6 grams [**Hospital1 **]
-vitamin D
-furosemide 60 mg a day
-lactulose 30ml TID
-Reglan 5 mg three times a day
-metoprolol 25 mg daily
-Isentress (raltegravir) 400mg [**Hospital1 **]
-spironolactone 100 mg a day
-tenofovir 300 mg a day
-calcium
-vitamin D
-Ensure
-omeprazole 20mg daily


Discharge Medications:
1. Spironolactone 100 mg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
Disp:*45 Tablet(s)* Refills:*2*
2. Tenofovir Disoproxil Fumarate 300 mg Tablet Sig: One (1)
Tablet PO QPM (once a day (in the evening)).
3. Epzicom 600-300 mg Tablet Sig: One (1) Tablet PO once a day.

4. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
5. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours).
Disp:*30 Tablet(s)* Refills:*2*
6. Furosemide 40 mg Tablet Sig: Three (3) Tablet PO BID (2 times
a day).
Disp:*180 Tablet(s)* Refills:*2*
7. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed for itching skin.
Disp:*2 bottles* Refills:*0*
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
9. Ammonium Lactate 12 % Lotion Sig: One (1) Appl Topical ASDIR
(AS DIRECTED): Apply once to twice a day for dry skin. Please
stop when dryness resolves.
Disp:*1 bottle* Refills:*2*
10. Ergocalciferol (Vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO 1X/WEEK (WE) for 6 doses: Dose 1 = [**2169-5-3**]
Dose 2 = [**2169-5-10**]
.
Disp:*6 Capsule(s)* Refills:*0*
11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day).
Disp:*1 bottle* Refills:*2*
12. Nystatin 100,000 unit/g Ointment Sig: One (1) Appl Topical
QID (4 times a day) as needed for scrotum cellulitis for 2
weeks.
Disp:*1 tube* Refills:*0*
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. Raltegravir 400 mg Tablet Sig: One (1) Tablet PO twice a
day.
15. Citalopram 20 mg Tablet Sig: One (1) Tablet PO once a day.
16. Outpatient Lab Work
Please check weight (discharge weight 72.4 kg) and chem 7 on
Monday [**2169-5-15**]. Please fax results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4427**] (phone
[**Telephone/Fax (1) 250**]; fax [**Telephone/Fax (1) 6309**]) AND Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**] at
[**Telephone/Fax (1) 673**]; fax [**Telephone/Fax (1) 4400**]).
17. Ensure     Liquid Sig: One (1) can PO twice a day: Iron free
formulation.
18. Colestipol 1 gram Tablet Sig: Four (4) Tablet PO twice a
day.
19. Reglan 5 mg Tablet Sig: One (1) Tablet PO three times a day
as needed for nausea.
20. Calcium 600 600 mg (1,500 mg) Tablet Sig: One (1) Tablet PO
twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary Diagnosis: Spontaneous Bacterial Peritonitis,
Cellulitis, Scrotal Edema

Secondary Diagnosis: HIV, HCV cirrhosis, Crohn's disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
VS: T 98.6 HR 94 (61-94) BP 86/52 (86-115/50-72) 100% RA Wt:72.4
kg


Discharge Instructions:
You were admitted with fevers and abdominal pain. We found that
you had an infection in the fluid (ascites) in your abdomen. You
also had a skin infection on your abdomen. We treated you with
antibiotics. You are awaiting a liver [**Hospital **].

.

Changes to your medications (please see your discharge
medication list for all your medications):

1. Increase Spironolactone to 150mg daily

2. Increase Lasix to 120mg twice a day

3. Increase Omeprazole to 20mg TWICE A DAY.

4. STOP Metoprolol as we are taking fluid off and your blood
pressure was low to normal in the hospital. Discuss with your
doctor if you need to continue this.

5. Start docusate 100mg twice a day to ensure soft stools. You
can buy this over the counter.

6. Start ciprofloxacin 500mg daily to prevent infection.

7. We have started some skin medications (sarna lotion,
lachydrin, miconazole powder, nystatin). As your skin improves,
you may ask your doctor when you can stop these medications.

8. Take your vitamin D 50,000 units every WEEK on Wednesdays for
6 more weeks. Discuss with your doctor what you should take for
vitamin D after this is completed.

9. Take calcium 600mg twice a day.



Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15398**], MD
Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2169-5-16**] 3:00

Provider: [**Name10 (NameIs) **] [**Hospital 1389**] CLINIC
Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2169-5-17**] 8:20

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15398**], MD
Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2169-6-30**] 3:00

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 1379**]
{'Streptococcal septicemia,Spontaneous bacterial peritonitis,Human immunodeficiency virus [HIV] disease,Cellulitis and abscess of trunk,Other postoperative infection,Regional enteritis of unspecified site,Chronic systolic heart failure,Portal hypertension,Sepsis,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Edema of male genital organs,Gastroparesis,Thrombocytopenia, unspecified,Herpes simplex without mention of complication'}


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: Abdominal Pain

PRESENT ILLNESS: 49 year old man with a past medical history of HIV (on HAART,
CD4 252 and VL UD [**3-22**]), HCV cirrhosis, Crohn's disease and
gastroporesis who presented with abdominal pain.  Has had 5 days
of worsening abdominal pain.  Started in RUQ and intermittent.
Progressed to diffuse and constant abdominal pain.  Denies
fevers, having some chills.  Some baseline diarrhea due to
lactulose.  New non-productive cough and shortness of breath.
Pain became progressively worse so presented to the ED for
evaluation.  Of note, patient weighed 67.5 Kg on [**4-12**].  On
arrival to ICU patient weighs 72.8 kg.
.
In the ED, initial vs were: T99.2 P153 BP144/93 R22 O2 97% sat.
Well appearing but uncomfortable.  Soft, moderately distended,
tender in RUQ.  Guaiac positive stool in ED.  Mild b/l pitting
edema.  No asterixis.  Lactate 3.1.  Dx paracentesis -> no e/o
SBP.  Similar admission in [**Month (only) 958**] treated with large volume
paracentesis.  RUQ USD with patent portal vein.  Patient was
given 1L NS, now with mtce fluids running.  ECG -> sinus
tachycardia.  Gotten 12mg IV morphine and 4mg zofran, pain is
now well controlled.
.
Most recent VS were, T99.2, 113/74, HR 131, RR 21, 02 95%RA.
Patient has two peripheral IV's.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies chest pain, chest pressure, palpitations, or weakness.
Denies dysuria, frequency, or urgency. Denies arthralgias.
Denies rashes or skin changes.

MEDICAL HISTORY: # HIV, CD4 116
- followed by [**First Name8 (NamePattern2) **] [**Doctor Last Name 4020**]
# systolic CHF, EF 55% on TTE [**10-21**]
# hepatitis C
- genotype 1, last VL [**10-21**] 4,000,000 IU/mL.
- elevated AFP
- negative MRI abdomen [**3-18**] and [**12-20**]
# ? Crohn's disease
- diagnosed at [**Hospital1 336**] around [**2149**]
- diarrhea was initial presentation
- treated with unknown medication for 1 month and sx resolved
# htn
# depression
# condylomata, anal, penile, scrotal, L index finger
- s/p Microscopically assisted transanal biopsy and laser
destruction of anal condylomata [**2168-2-5**]
- s/p microscopically assisted laser destruction of penile,
scrotal and left index finger condylomata.
# hemorrhoids
# Verruca vulgaris, prurigo nodularis
- followed by Dr. [**Last Name (STitle) **] of Dermatology
# h/o syphilis
# gastroparesis

MEDICATION ON ADMISSION: -Epzicom (abacavir/lamivudine) 1 tab daily
-citalopram 20 mg daily
-colestipol 4 or 6 grams [**Hospital1 **]
-vitamin D
-furosemide 60 mg a day
-lactulose 30ml TID
-Reglan 5 mg three times a day
-metoprolol 25 mg daily
-Isentress (raltegravir) 400mg [**Hospital1 **]
-spironolactone 100 mg a day
-tenofovir 300 mg a day
-calcium
-vitamin D
-Ensure
-omeprazole 20mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on discharge [**2169-5-12**]:
Vitals: Afebrile BP:90s-100s P: 70s-90s O2: 96RA, 72.4kg
General: Alert, oriented, no acute distress
HEENT: Sclera mildly icteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTA b/l
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: distended but not firm, cellulitis at paracentesis site
resolved
Ext: 2+ pitting edema BLE-mostly in feet, no clubbing or
cyanosis; RUE with 2+ edema
R PICC removed before discharge.

FAMILY HISTORY: A number of relatives have had strokes or MIs in their late 40s

SOCIAL HISTORY: Denies any tobacco, alcohol, or illicit drugs. Specifically,
denies taking methadone. 

### Response:
{'Streptococcal septicemia,Spontaneous bacterial peritonitis,Human immunodeficiency virus [HIV] disease,Cellulitis and abscess of trunk,Other postoperative infection,Regional enteritis of unspecified site,Chronic systolic heart failure,Portal hypertension,Sepsis,Cirrhosis of liver without mention of alcohol,Chronic hepatitis C without mention of hepatic coma,Awaiting organ transplant status,Edema of male genital organs,Gastroparesis,Thrombocytopenia, unspecified,Herpes simplex without mention of complication'}
