CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 40-year-old male
with history of hepatocellular carcinoma type 2 with
hepatitis. Patient underwent an ex-lap on [**2160-3-7**]
with attempts at resection. However, he had evidence of
cirrhosis. Resection was not performed. He underwent
radiofrequency ablation. Current MELD score is 22.

MEDICAL HISTORY: End-stage liver disease secondary to
hepatitis B cirrhosis stage 2, HCC, radiofrequency ablation
[**2160-3-13**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cirrhosis of liver without mention of alcohol,Malignant neoplasm of liver, primary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Iatrogenic pneumothorax
Cirrhosis of liver NOS,Mal neo liver, primary,Hpt B chrn wo cm wo dlta,Iatrogenic pneumothorax
Admission Date: [**2160-7-16**]        Discharge Date: [**2160-7-22**]

Date of Birth:  [**2120-4-18**]        Sex:  M

Service:  LIVER TRANSPLANT SURGERY SERVICE


ADMITTING DIAGNOSES:  End-stage liver disease, admission for
possible liver transplant.

HISTORY OF PRESENT ILLNESS:  Patient is a 40-year-old male
with history of hepatocellular carcinoma type 2 with
hepatitis. Patient underwent an ex-lap on [**2160-3-7**]
with attempts at resection. However, he had evidence of
cirrhosis. Resection was not performed. He underwent
radiofrequency ablation. Current MELD score is 22.

He has not had encephalopathy, [**2160-6-18**] aFP 1.8,
hepatitis A/B nonreactive, ALT 34, AST 34, alkaline
phosphatase 75, total bilirubin 0.7. PT 13.3. Platelets 141.
Albumin 4.5.

Currently taking adefovir 10 mg nightly. Thus, HB viral load
undetectable.

Feeling well. Denies recent illness.

REVIEW OF SYSTEMS:  Denies fever, chills, cough, nausea,
vomiting, shortness of breath, chest pain, dizziness,
indigestion, rashes, constipation, diarrhea, dysuria, or any
mental status changes. On exposure, patient's sister-in-law
had pharyngitis, on antibiotics. Lives with brother and
sister-in-law.

PAST MEDICAL HISTORY:  End-stage liver disease secondary to
hepatitis B cirrhosis stage 2, HCC, radiofrequency ablation
[**2160-3-13**].

PAST SURGICAL HISTORY:  On [**2160-3-7**], ex-lap,
question tonsillectomy, question uvulectomy.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Adefovir 10 mg daily, Protonix 40 mg q.12.,
clotrimazole 5 times a day.

PHYSICAL EXAMINATION:  Patient is alert, awake, and oriented,
pleasant. Pupils are equal, round, and reactive to light.
EOMs are full. Trace scleral icterus. Pharynx: No thrush, no
erythema, no soft tissue swelling. Neck: No JVD. Carotids are
2+, no bruits, no LAD. Lungs: Clear, nonlabored. CV: No S1,
S2 without murmurs, rubs, or gallops. Abdomen: Positive bowel
sounds, soft, nontender, and nondistended, well-healed ex-lap
incision. Vascular: Good femoral pulses, 2+ DPs, no lower
extremity edema, no rashes, no lesions. Neuro exam: Awake,
alert, and oriented x3. Cranial nerves II through XII:
Intact. Strength: Equal. No asterixis. Toes: Down
bilaterally.

Portable chest x-ray: There is no acute cardiopulmonary
process.

EKG: Normal sinus rhythm, no acute ischemia.

HOSPITAL COURSE:  Bloods were obtained. Preop antibiotic was
given on call. Immunosuppressant medications were on call. So
patient went to the OR on [**2160-7-16**], which an orthotopic
liver transplant performed by Drs. [**Last Name (STitle) 816**], [**Name5 (PTitle) **], [**Name5 (PTitle) **].
Patient received 10 liters of plasma, 2 units of FFP, 1 unit
of pack red blood cells. Please see OR note from [**2160-7-16**] for more details.

Postoperatively, the patient went to the unit intubated.
Patient was given HBIG 10,000 units, CellCept [**Pager number **] mg b.i.d.,
and given 2 units of FFP for an INR of 1.5.

Postop day 1, patient was extubated. Patient was on
fluconazole, ganciclovir, Bactrim, and Unasyn. Patient was
given Solu-Medrol, continued on MMF. Patient was weaned off
propofol and morphine sulfate for pain control. Patient was
given another dose of hepatitis B immune globulin postop day
1.

On postop day 1, patient did get a duplex ultrasound of his
liver showing satisfactory ultrasound and Doppler appearance
on the recent liver transplant. There is good upstroke in the
right and left hepatic arteries and full patency of all
portal and hepatic veins. Small right pleural effusion was
noted, but there are no peritransplant fluid collections.

On [**2160-7-17**], line placement was attempted. Chest x-ray
was obtained after right internal jugular placed which
demonstrated a right internal jugular central venous catheter
overlies the right atrium and there was a small pneumothorax
on the right, and it was confirmed on a followup left lateral
decubitus. There was no need for chest tube because of the
small size of the pneumothorax.

On postop day 2, the patient continued with 2nd day of
Unasyn, awake, alert, and oriented x3. Lungs are clear
bilaterally. CV: Regular rate and rhythm. Making good urine
output. Patient had drain in place. Continued MMF, Solu-
Medrol 150 mg IV. Patient received tacrolimus 4 and 4 and
HBIG 5000 units.

On [**2160-7-19**], patient was transferred from the ICU to [**Hospital Ward Name 121**]
10. Patient continued on morphine with good pain management.
Incision was intact with staples. There was a scant amount of
JP drainage.

On postop day 4, patient doing very well. Moved his lateral
JP drain without complications. Continued on Solu-Medrol,
MMF, tacrolimus was tapered to level. [**Hospital Ward Name **] on [**2160-7-20**]
demonstrated WBC of 4.7, hematocrit of 28.7. PT of 12.7,
21.4, platelets 106, INR 1.1. Sodium 140, 3.8, 106, 23, 15,
BUN and creatinine 22 and 0.7, glucose of 149. ALT 1035, AST
1226, and alkaline phosphatase 230.

On hospital day 6, doing remarkably well, ambulating well,
eating well without problems, urinating. [**Name2 (NI) **] on [**7-22**]
demonstrate ALT of 483, AST of 48, alkaline phosphatase 180,
total bilirubin 0.7. Rest of the [**Month (only) **] are pending.

So patient should be able to go home today on the following
medications: Adefovir dipivoxil NF 10 mg oral daily,
fluconazole 400 mg p.o. q.24h., MMF 1000 b.i.d., Percocet [**1-20**]
p.o. q.4-6h. p.r.n. Patient should get HBIG immunoglobulin on
days 7, 14, and 28. Patient should continue with insulin-
sliding scale. Protonix 40 mg q.24, prednisone 20 mg daily,
Bactrim SS 1 tablet daily, and right now tacrolimus 4 mg
b.i.d., ursodiol 300 mg b.i.d., valganciclovir 900 mg daily.

Patient should have [**Month/Day (2) **] every Monday and Thursday starting
this Thursday in which CBC, Chem-10, AST, ALT, alkaline
phosphatase, albumin, total bilirubin, and Prograf should be
obtained and faxed immediately to [**Telephone/Fax (1) 697**]. Patient
should follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**] in [**Hospital Unit Name **] on
[**2160-7-23**] at 3 p.m. Please call [**Telephone/Fax (1) 673**] if you have
any questions about your appointment. Also please follow up
with Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 673**] to make an appointment.

FINAL DIAGNOSES:  End-stage liver disease secondary to
hepatitis B virus, hepatocellular carcinoma, status post
orthotopic liver transplantation on [**2160-7-16**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD, PHD[**Numeric Identifier **]

Dictated By:[**Last Name (NamePattern1) 4835**]
MEDQUIST36
D:  [**2160-7-22**] 08:52:59
T:  [**2160-7-22**] 09:29:19
Job#:  [**Job Number 59503**]
{'Cirrhosis of liver without mention of alcohol,Malignant neoplasm of liver, primary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Iatrogenic pneumothorax'}


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: Patient is a 40-year-old male
with history of hepatocellular carcinoma type 2 with
hepatitis. Patient underwent an ex-lap on [**2160-3-7**]
with attempts at resection. However, he had evidence of
cirrhosis. Resection was not performed. He underwent
radiofrequency ablation. Current MELD score is 22.

MEDICAL HISTORY: End-stage liver disease secondary to
hepatitis B cirrhosis stage 2, HCC, radiofrequency ablation
[**2160-3-13**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cirrhosis of liver without mention of alcohol,Malignant neoplasm of liver, primary,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Iatrogenic pneumothorax'}
