CHIEF COMPLAINT: Hepatitis C with cirrhosis here for liver transplant offer

PRESENT ILLNESS: 58 year old male with history of hepatitis C and cirrhosis and
hepatocellular carcinoma presents for liver transplant offer. Pt
was most recently evaluated for declined liver transplant offer
on [**2140-2-14**].  Since then pt noted no changes in his overall health
status other than continued improvement of his bronchitis
after Z pack treatment 2 weeks ago noted at his last evaluation.
Also of note Earlier in an anterolateral right-sided
hemi-diaphragmatic hernia was reported with herniation of the
hepatic flexure, the middle colonic artery, and mesenteric fat.
He has evidence of splenic and esophageal varices. On ROS he
notes LE edema, nocturnal cough since his bronchitis.  He has
been afebrile, without chills, nausea/ vomiting diarrhea,
constipation, no episodes of encephalopathy He continues on
Methadone 8 years out from heroin relapse, no other drugs used
recently. He walks five miles daily and can ascend 2 flights of
stairs with ease.

MEDICAL HISTORY: PAST MEDICAL HISTORY
metabolic bone disease
hepatic encephalopathy
chronic hepatitis C
resultant cirrhosis
chronic pancreatitis.
Interstitial lung disease
Reflux
Chronic pain
BLE edema
fatigue
psoriasis
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic
diaphragmatic hernia.
[**2140-3-1**] Exploratory laparotomy, repair of
ventral hernia with mesh and liver biopsy.

MEDICATION ON ADMISSION: Creon-10 2 cap with meals
Furosemide 40 mg per day (last [**10-10**])
spironolactone 200 mg per day
Lactulose 10G/15ml [**Hospital1 **] prn (last [**10-10**])
methadone85 mg once a day (took dose today)
omeprazole 20 mg per day
rifaximin 200 mg 3 [**Hospital1 **]
magnesium oxide 400 mg b.i.d.
Creon 10 249 mg 10K-37.5k unit  [**Unit Number **] capsule by mouth with meals
Testosterone 5mg/24hrs
Caltrate 600-plus Vitamin D3 600mg 400Unit Itab [**Hospital1 **]
Boniva 3mg IVevery other month (not currently taking)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.4  70  114/65  18  99 % RA
General: NAD, A & O X3.
HEENT: PERRLA, EOMI, mild scleral icterus, MMM
Card: RRR, II/VI systolic murmur at LSB.
Lungs: CTAB no w/r/r
Abdomen: No scars noted, + BS, no distention or tenderness no
organomegaly.
Extr: 1+ bilateral lower extremity edema, 2+ DPs, warm, well
perfused with significant skin scaling  b/l LE from knee down.
Skin: burn scars on back
scars.
Neuro: No Focal deficits

FAMILY HISTORY: Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness

SOCIAL HISTORY: Patient lives alone in subsidized housing on modest social
security income. He has a supportive brother [**Doctor First Name **]. He
spends time at a motorcycle repair shop helping with repairs.
Mother lives on [**Location (un) **]. History of IVDA and ETOH abuse. He has
abstained from both for over 5 years each. + smoker (1PPD x 48
years). Daily methadone.
Unspecified viral hepatitis C without hepatic coma,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, primary,Unspecified protein-calorie malnutrition,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acquired hypertrophic pyloric stenosis,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Edema of male genital organs,Esophageal reflux,Glossitis,Diaphragmatic hernia without mention of obstruction or gangrene
Hpt C w/o hepat coma NOS,Food/vomit pneumonitis,Mal neo liver, primary,Protein-cal malnutr NOS,Esoph varice oth dis NOS,Acq pyloric stenosis,Alcohol cirrhosis liver,Alcohol abuse-unspec,Edema, male genital orgn,Esophageal reflux,Glossitis,Diaphragmatic hernia
Admission Date:  [**2140-2-27**]              Discharge Date:   [**2140-3-15**]

Date of Birth:  [**2080-10-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
Hepatitis C with cirrhosis here for liver transplant offer


Major Surgical or Invasive Procedure:
[**2140-3-1**] liver transplant


History of Present Illness:
58 year old male with history of hepatitis C and cirrhosis and
hepatocellular carcinoma presents for liver transplant offer. Pt
was most recently evaluated for declined liver transplant offer
on [**2140-2-14**].  Since then pt noted no changes in his overall health
status other than continued improvement of his bronchitis
after Z pack treatment 2 weeks ago noted at his last evaluation.
Also of note Earlier in an anterolateral right-sided
hemi-diaphragmatic hernia was reported with herniation of the
hepatic flexure, the middle colonic artery, and mesenteric fat.
He has evidence of splenic and esophageal varices. On ROS he
notes LE edema, nocturnal cough since his bronchitis.  He has
been afebrile, without chills, nausea/ vomiting diarrhea,
constipation, no episodes of encephalopathy He continues on
Methadone 8 years out from heroin relapse, no other drugs used
recently. He walks five miles daily and can ascend 2 flights of
stairs with ease.


Past Medical History:
PAST MEDICAL HISTORY
metabolic bone disease
hepatic encephalopathy
chronic hepatitis C
resultant cirrhosis
chronic pancreatitis.
Interstitial lung disease
Reflux
Chronic pain
BLE edema
fatigue
psoriasis
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic
diaphragmatic hernia.
[**2140-3-1**] Exploratory laparotomy, repair of
ventral hernia with mesh and liver biopsy.


Social History:
Patient lives alone in subsidized housing on modest social
security income. He has a supportive brother [**Doctor First Name **]. He
spends time at a motorcycle repair shop helping with repairs.
Mother lives on [**Location (un) **]. History of IVDA and ETOH abuse. He has
abstained from both for over 5 years each. + smoker (1PPD x 48
years). Daily methadone.


Family History:
Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness


Physical Exam:
VS: 98.4  70  114/65  18  99 % RA
General: NAD, A & O X3.
HEENT: PERRLA, EOMI, mild scleral icterus, MMM
Card: RRR, II/VI systolic murmur at LSB.
Lungs: CTAB no w/r/r
Abdomen: No scars noted, + BS, no distention or tenderness no
organomegaly.
Extr: 1+ bilateral lower extremity edema, 2+ DPs, warm, well
perfused with significant skin scaling  b/l LE from knee down.
Skin: burn scars on back
scars.
Neuro: No Focal deficits

Labs: Hepatitis from [**2136**]
HBsAg    HBsAb    HBcAb    HAV Ab    HIV
NEGATIVE NEGATIVE POSITIVE POSITIVE  NEGATIVE
HCV VIRAL LOAD (Final [**2136-2-8**]):  441,000 IU/mL.
CMV- Negative, EBV Positive ([**2136**])


Pertinent Results:
On Admission: [**2140-2-27**]
WBC-4.7 RBC-3.04* Hgb-11.5* Hct-32.7* MCV-108* MCH-37.8*
MCHC-35.1* RDW-14.3 Plt Ct-52*
PT-20.7* PTT-149.0* INR(PT)-2.0*
Glucose-221* UreaN-16 Creat-0.7 Na-142 K-4.8 Cl-102 HCO3-25
AnGap-20
ALT-71* AST-112* AlkPhos-125* TotBili-1.8*
Initial post op [**2140-2-28**]
ALT-771* AST-1486* AlkPhos-52 Amylase-27 TotBili-4.5*
DirBili-1.9* IndBili-2.6
Albumin-2.5* Calcium-7.6* Phos-4.0 Mg-2.1
At Discharge:
CXR [**2-27**]
The cardiomediastinal silhouette is stable. There is a
right-sided pleural effusion. There is no focal consolidation or
pneumothorax. Pulmonary vascularity is not increased.
Right pleural effusion with adjacent atelectasis, no
radiographic evidence of pneumonia or CHF

Liver US [**2-28**]
IMPRESSION:
1. Patent portal vein and hepatic veins with no signs of
thrombosis.
2. Normal main hepatic artery with normal systolic upstroke and
no signs of proximal obstruction.

RUE US [**3-3**]
No evidence of deep vein thrombosis in the right arm.

[**2140-3-7**] Swallow
VIDEO OROPHARYNGEAL SWALLOWING EVALUATION: Fluoroscopic video
oropharyngeal swallowing evaluation was performed in conjunction
with speech and swallow pathology. Thin, nectar- thick, thin,
honey, pudding, and barium coated cookie were orally
administered. There was delay in oral transit. There was delayed
initiation in swallowing. There was incomplete epiglottic
deflection during most swallows and marked residual contrast
which could not be cleared after multiple swallows with nectar-
thick contrast, and more significant with pudding- thick and
barium-coated cookie. Attempts to clear the residue with nectar
resulted in silent aspiration which could not be cleared. This
was repeated with thin, nectar, and honey-thick consistencies,
all resulting in aspiration. Aspiration was least during
chin-tuck maneuver.


Brief Hospital Course:
On [**2140-2-27**] he was taken to the OR for cadaveric liver transplant
and repair of chronic diaphragmatic hernia. Surgeon was Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 816**] assisted by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. He received induction
immunosuppression (solumedrol, cellcept). Dissection was
immediately difficult due to abdominal viscera in his right
chest. This is carefully taken down. There was a significant
amount of fat. The diaphragm was then repaired using a running
2-0 Prolene. The case was difficult and it was not possible to
close his abdomen. There was too much in the way of bowels.
Therefore, he was transferred to the SICU where he received
blood products to maintain hemodynamic stability. 36 hours later
he was brought back to the OR ([**3-1**]) for exploratory laparotomy
with repair of ventral hernia with mesh and liver biopsy.
Surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Fascial flaps were mobilized
superiorly and inferiorly and then closed the Chevron incision.
Due to increasing peak airway
pressures further attempts at closing the abdomen would lead to
abdominal compartment syndrome a piece of Vicryl mesh was
incorporated into the abdominal closure. He was then sent to the
SICU intubated.

He was weaned off the vent. He remained hemodynamically stable.
He was extubated on [**3-3**] with some residual hoarseness and ENT
was consulted. Exam showed edema bilat, vocal cord crisp with VC
mobile bilaterally with 2mm central glottic gap. A bedside
swallow eval was done showing aspiration. He was kept NPO, a
feeding tube was placed and tube feedings were started. Chest
tube was to wall suction with stable cxr. Prograf was started on
[**3-1**]. Solumedrol was given per taper and cellcept continued at
1gram [**Hospital1 **]. LFTs increased slightly for a couple days then
trended down. On [**3-3**], an U/S was done to evaluate right arm
swelling. This was negative for DVT.

On [**3-4**], the chest tube and 2 of 3 JP's were removed without
incident. He was transferred out of the SICU to [**Hospital Ward Name 121**] 10. On [**3-6**],
LFTS were up. Duplex U/S was done to evaluate noting patent
hepatic and portal veins with slow flow in portal vein as on
prior study. There were normal arterial and hepatic venous
waveforms. No biliary dilatation was noted. It was difficult to
interrogate the left hepatic artery, as in prior study. Alk phos
continued to stay within a range of 150-164 while other LFTs
decreased. Other labs remained stable.

He continued to cough and raise thick secretions using suction
due to weak cough. A Video swallow was performed on [**3-7**] showing
aspiration of multiple consistencies. On [**3-8**], a videostroboscopy
was done that revealed evidence of significantglottic gap and
lack of vocal fold tension, suspected secondary to fatigue, as
well as glottic hyperfunction and posterior glottic changes
consistent with chronic reflux. No discrete lesions or
restriction in movement of the arytenoids were noted.
Recommendations were for continuation of NPO status per
speech/swallowing team recommendations. Consideration of
muscular strengthening exercises/voice therapy, with repeat
evaluation as indicated.

Methadone was increased to 95mg and MS IR was started as
dilaudid po was ineffective in controlling his abdominal pain.
PT evaluated and found his activity to be limited due to tubings
and edematous state, recommending inpatient rehabilitation. He
was maintained on his immunosuppressants with tacro levels
checked daily. Lasix started to allow for diuresis. Patient
responded appropriately as aimed to diuresis 1-2L daily. Scrotal
and pedal edema decreasing with diuresis.

Physical therapy continued to work with patient and still
recommending inpatient rehab. Voice therapy with voice training,
providing exercises to be worked on while inpatient. Maintained
on tube feeds for nutrition with insulin sliding scale. Foley
was removed [**2140-3-14**]. Continued with rehab screening. Dobhoff
replaced under fluoroscopy. CVL kept due to poor venous access.
Prograf levels increased to 6mg PO BID prior to discharge. JP
drain removed. He will be followed by outpatient clinic closely.
Patient continue on tube feeds with nutren pulm full strength at
his goal of 55ml/hr. He was discharged to [**Hospital **] Rehab at
[**2140-3-15**].


Medications on Admission:
Creon-10 2 cap with meals
Furosemide 40 mg per day (last [**10-10**])
spironolactone 200 mg per day
Lactulose 10G/15ml [**Hospital1 **] prn (last [**10-10**])
methadone85 mg once a day (took dose today)
omeprazole 20 mg per day
rifaximin 200 mg 3 [**Hospital1 **]
magnesium oxide 400 mg b.i.d.
Creon 10 249 mg 10K-37.5k unit  [**Unit Number **] capsule by mouth with meals
Testosterone 5mg/24hrs
Caltrate 600-plus Vitamin D3 600mg 400Unit Itab [**Hospital1 **]
Boniva 3mg IVevery other month (not currently taking)


Discharge Medications:
1. Fluconazole 40 mg/mL Suspension for Reconstitution [**Hospital1 **]: Ten
(10) ml PO Q24H (every 24 hours).
2. Prednisone 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily):
Continue per [**Hospital 55585**] clinic guidelines.
3. Docusate Sodium 100 mg Capsule [**Hospital **]: One (1) Capsule PO BID (2
times a day).
4. Mycophenolate Mofetil 200 mg/mL Suspension for Reconstitution
[**Hospital **]: Five (5) ml PO BID (2 times a day).
5. Valganciclovir 450 mg Tablet [**Hospital **]: Two (2) Tablet PO once a
day: Please give as suspension.
6. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital **]: One (1) ml
Injection TID (3 times a day): Until patient fully mobile.
7. Trimethoprim-Sulfamethoxazole 40-200 mg/5 mL Suspension [**Hospital **]:
Ten (10) ML PO DAILY (Daily).
8. Methadone 10 mg/mL Concentrate [**Hospital **]: 9.5 ml PO DAILY (Daily):
for pain.
9. Morphine 10 mg/5 mL Solution [**Hospital **]: 1.5-3 ml PO Q3H (every 3
hours) as needed for pain.
10. Bisacodyl 10 mg Suppository [**Hospital **]: One (1) Suppository Rectal
HS (at bedtime) as needed: for constipation.
11. Insulin Regular Human 100 unit/mL Solution [**Hospital **]: per sliding
scale  Injection four times a day.
12. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR PO BID (2 times a day).
13. Sodium Chloride 0.9 % 0.9 % Syringe [**Last Name (STitle) **]: Ten (10) ML
Injection PRN (as needed) as needed for line flush.
14. Heparin, Porcine (PF) 10 unit/mL Syringe [**Last Name (STitle) **]: One (1) ML
Intravenous PRN (as needed) as needed for line flush: per
central line care protocol.
15. Tacrolimus 5 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO twice a day:
Please provide suspension.
16. Tacrolimus 1 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO twice a day:
Please provide suspension.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**]/Rehab

Discharge Diagnosis:
HCV cirrhosis now s/p orthotopic liver transplant [**2140-2-28**]
malnutrition
glottic hypofunction
vocal cord changes
reflux


Discharge Condition:
Stable/fair


Discharge Instructions:
Please call the Transplant office [**Telephone/Fax (1) 673**] if fever > 101,
chills, nausea, vomiting, increased abdominal distension or
pain, incision redness/bleeding/drainage, malfunction of tube
feeding tube, jaundice, diarrhea
Labs every Monday and Thursday
Keep binder on when patient OOB to chair or ambulating. [**Month (only) 116**]
cover incision with dry gauze when binder in place
Tube feedings continuous per nutrition recommendations
Patient may shower with assist
All medication changes to be cleared with transplant clinic at
[**Telephone/Fax (1) 673**]. Transplant coordinator is [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 8147**] RN

Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2140-3-24**] 9:40
[**First Name8 (NamePattern2) 156**] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 1046**] Phone [**Telephone/Fax (1) 673**] Date/Time:[**2140-3-24**] 10:00
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2140-3-28**] 9:00
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2140-4-4**] 9:30
{'Unspecified viral hepatitis C without hepatic coma,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, primary,Unspecified protein-calorie malnutrition,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acquired hypertrophic pyloric stenosis,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Edema of male genital organs,Esophageal reflux,Glossitis,Diaphragmatic hernia without mention of obstruction or gangrene'}


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: Hepatitis C with cirrhosis here for liver transplant offer

PRESENT ILLNESS: 58 year old male with history of hepatitis C and cirrhosis and
hepatocellular carcinoma presents for liver transplant offer. Pt
was most recently evaluated for declined liver transplant offer
on [**2140-2-14**].  Since then pt noted no changes in his overall health
status other than continued improvement of his bronchitis
after Z pack treatment 2 weeks ago noted at his last evaluation.
Also of note Earlier in an anterolateral right-sided
hemi-diaphragmatic hernia was reported with herniation of the
hepatic flexure, the middle colonic artery, and mesenteric fat.
He has evidence of splenic and esophageal varices. On ROS he
notes LE edema, nocturnal cough since his bronchitis.  He has
been afebrile, without chills, nausea/ vomiting diarrhea,
constipation, no episodes of encephalopathy He continues on
Methadone 8 years out from heroin relapse, no other drugs used
recently. He walks five miles daily and can ascend 2 flights of
stairs with ease.

MEDICAL HISTORY: PAST MEDICAL HISTORY
metabolic bone disease
hepatic encephalopathy
chronic hepatitis C
resultant cirrhosis
chronic pancreatitis.
Interstitial lung disease
Reflux
Chronic pain
BLE edema
fatigue
psoriasis
.
PAST SURGICAL/PROCEDURAL HISTORY
[**2138**] RFA of liver lesion
[**2132**] lung biopsy
[**2131**] Extensive burns&#[**Numeric Identifier 25684**];skin graft surgeries
[**2140-2-28**] liver transplant with repair of chronic
diaphragmatic hernia.
[**2140-3-1**] Exploratory laparotomy, repair of
ventral hernia with mesh and liver biopsy.

MEDICATION ON ADMISSION: Creon-10 2 cap with meals
Furosemide 40 mg per day (last [**10-10**])
spironolactone 200 mg per day
Lactulose 10G/15ml [**Hospital1 **] prn (last [**10-10**])
methadone85 mg once a day (took dose today)
omeprazole 20 mg per day
rifaximin 200 mg 3 [**Hospital1 **]
magnesium oxide 400 mg b.i.d.
Creon 10 249 mg 10K-37.5k unit  [**Unit Number **] capsule by mouth with meals
Testosterone 5mg/24hrs
Caltrate 600-plus Vitamin D3 600mg 400Unit Itab [**Hospital1 **]
Boniva 3mg IVevery other month (not currently taking)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.4  70  114/65  18  99 % RA
General: NAD, A & O X3.
HEENT: PERRLA, EOMI, mild scleral icterus, MMM
Card: RRR, II/VI systolic murmur at LSB.
Lungs: CTAB no w/r/r
Abdomen: No scars noted, + BS, no distention or tenderness no
organomegaly.
Extr: 1+ bilateral lower extremity edema, 2+ DPs, warm, well
perfused with significant skin scaling  b/l LE from knee down.
Skin: burn scars on back
scars.
Neuro: No Focal deficits

FAMILY HISTORY: Mother, 85: No known illness
Father, dead 76: Liver cancer
Twin brother, dead 18: Murdered
Brother, 35: No known illness
Brother, 46: No known illness

SOCIAL HISTORY: Patient lives alone in subsidized housing on modest social
security income. He has a supportive brother [**Doctor First Name **]. He
spends time at a motorcycle repair shop helping with repairs.
Mother lives on [**Location (un) **]. History of IVDA and ETOH abuse. He has
abstained from both for over 5 years each. + smoker (1PPD x 48
years). Daily methadone. 

### Response:
{'Unspecified viral hepatitis C without hepatic coma,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, primary,Unspecified protein-calorie malnutrition,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acquired hypertrophic pyloric stenosis,Alcoholic cirrhosis of liver,Alcohol abuse, unspecified,Edema of male genital organs,Esophageal reflux,Glossitis,Diaphragmatic hernia without mention of obstruction or gangrene'}
