CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 31-year-old
female status post liver transplant twice in [**2161-3-26**].  The
patient had primary sclerosing cholangitis and cirrhosis of
her native liver and patient underwent a liver transplant on
[**2161-4-13**].  The operation was complicated by
intraoperative thrombosis and the patient had a repeat
transplant on [**2161-4-19**].  That operation was complicated
by portal vein thrombosis and cerebral edema and the patient
had ICP monitor placed and was trached on [**2161-5-6**].
The patient also had a G-tube placed at that time.  The
patient had a prolonged hospital course at that time and was
discharged to rehab.  However, at rehab she was tolerating
tube feeds.  Prior to admission the patient complained of
some indigestion, some nausea and vomiting and on the morning
of admission the patient had bouts of emesis.  A couple hours
prior to admission the patient became cyanotic and
unresponsive and patient was then transported to the
Emergency Room at [**Hospital1 69**].  In
the Emergency Room the patient was emergently intubated and
central line was then placed and patient was started on
intravenous fluids.  The patient required some pressors for
her blood pressure support and patient underwent CT scan
which showed large ventricle size and severe atrophy of her
brain.  CT of the chest showed bilateral large inferior lobe
consolidation, question aspiration pneumonia and abdominal CT
showed dilated stomach along with dilated duodenum.  The
patient was admitted to the Intensive Care Unit and underwent
a somewhat prolonged hospital course.

MEDICAL HISTORY: Includes primary sclerosing
cholangitis, cirrhosis, ulcerative colitis, psoriasis,
cerebral edema and seizure.

MEDICATION ON ADMISSION: She was on Neoral 150 b.i.d.,
CellCept one gram p.o. b.i.d., prednisone 10 mg p.o. q. day,
Diflucan 400 mg p.o. q. day and Valcyte 450 mg p.o.  q. day.
She was on Bactrim, Keppra 1000 mg p.o. b.i.d., amantadine 50
mg p.o. b.i.d., Osmolite 400 mg p.o. q. 6h. and Reglan 10 mg
p.o. b.i.d., Protonix 40 mg p.o. q. day, Lopressor 100 mg
p.o. q. 6h.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Obstructive hydrocephalus,Hyperpotassemia,Intestinal infection due to Clostridium difficile,Other convulsions,Liver replaced by transplant
Food/vomit pneumonitis,Septicemia NOS,Severe sepsis,Acute respiratry failure,Obstructiv hydrocephalus,Hyperpotassemia,Int inf clstrdium dfcile,Convulsions NEC,Liver transplant status
Admission Date: [**2161-6-30**]        Discharge Date: [**2161-7-21**]

Date of Birth:  [**2129-8-16**]        Sex:  F

Service:  LIVER TRANSPLANT SURGERY


HISTORY OF PRESENT ILLNESS:  The patient is a 31-year-old
female status post liver transplant twice in [**2161-3-26**].  The
patient had primary sclerosing cholangitis and cirrhosis of
her native liver and patient underwent a liver transplant on
[**2161-4-13**].  The operation was complicated by
intraoperative thrombosis and the patient had a repeat
transplant on [**2161-4-19**].  That operation was complicated
by portal vein thrombosis and cerebral edema and the patient
had ICP monitor placed and was trached on [**2161-5-6**].
The patient also had a G-tube placed at that time.  The
patient had a prolonged hospital course at that time and was
discharged to rehab.  However, at rehab she was tolerating
tube feeds.  Prior to admission the patient complained of
some indigestion, some nausea and vomiting and on the morning
of admission the patient had bouts of emesis.  A couple hours
prior to admission the patient became cyanotic and
unresponsive and patient was then transported to the
Emergency Room at [**Hospital1 69**].  In
the Emergency Room the patient was emergently intubated and
central line was then placed and patient was started on
intravenous fluids.  The patient required some pressors for
her blood pressure support and patient underwent CT scan
which showed large ventricle size and severe atrophy of her
brain.  CT of the chest showed bilateral large inferior lobe
consolidation, question aspiration pneumonia and abdominal CT
showed dilated stomach along with dilated duodenum.  The
patient was admitted to the Intensive Care Unit and underwent
a somewhat prolonged hospital course.

PAST MEDICAL HISTORY:  Includes primary sclerosing
cholangitis, cirrhosis, ulcerative colitis, psoriasis,
cerebral edema and seizure.

PAST SURGICAL HISTORY:  Two liver transplants
placement, tracheostomy and also G-tube placement and
cerebral edema.

MEDICATIONS ON ADMISSION:  She was on Neoral 150 b.i.d.,
CellCept one gram p.o. b.i.d., prednisone 10 mg p.o. q. day,
Diflucan 400 mg p.o. q. day and Valcyte 450 mg p.o.  q. day.
She was on Bactrim, Keppra 1000 mg p.o. b.i.d., amantadine 50
mg p.o. b.i.d., Osmolite 400 mg p.o. q. 6h. and Reglan 10 mg
p.o. b.i.d., Protonix 40 mg p.o. q. day, Lopressor 100 mg
p.o. q. 6h.

HOSPITAL COURSE BY SYSTEM:  Neurological:  The patient was
initially unresponsive and the Neurology Service and
Neurosurgery Service were then consulted.  There was a
question of whether the patient had increased cerebral edema
and had increased intracranial pressure due to her large
ventricular size.  A CT scan that was done several weeks
prior at [**Hospital6 1129**] was obtained and
showed the ventricular size had not increased so Neurosurgery
held off on drain placement.  Neurology recommended EEG so
EEG was then obtained which showed no seizure activity and
diffuse metabolic encephalopathy.  The patient underwent MRI
which showed question of small new infarct and Neurology
recommended continuing the Keppra.

Cardiovascular:  The patient was initially hypotensive and
throughout the hospital course the patient's pressure has
normalized and patient became increasingly tachycardic.  She
was started back on her Lopressor dose and her heart rate was
then stabilized.  Propofol was weaned off and the patient was
then stable from a cardiovascular standpoint.

Respiratory:  The patient required prolonged intubation and
patient underwent percutaneous tracheostomy by Dr. [**Last Name (STitle) **]
on [**2161-7-16**].  Post-tracheostomy the patient did well and
she tolerated the trach mask.

Gastrointestinal:  The patient had a feeding
tube placed for nutritional support.  G-tube was not used and
on [**7-20**] the patient had an upper GI study which showed
normal gastric emptying and there was no sign of duodenal
dilatation.  Patient was resumed tube feed by her G-tube.

Infectious Disease:  Initially on presentation the patient
had a fever spike and she also had possible Clostridium
difficile.  The patient was placed on vancomycin, Zosyn and
Flagyl for a total of a 21 day course.  Vancomycin, Zosyn and
Flagyl were then discontinued on [**2161-7-20**].

Hematology:  The patient's hematocrit has been stable and did
not require any transfusion or products.

Renal:  The patient's renal function when she first came to
the hospital her creatinine had risen to 3.5 and with
intravenous hydration, creatinine gradually came down to base
level which was 0.9 to 1.0.  Prior to discharge patient's
creatinine was stable at 1.0.

Hepatology:  The patient's liver function enzymes have always
been normal.  She had ultrasound of her liver done which
showed normal flow in the portal vein and also in the hepatic
artery as well as hepatic vein and her alk phos and total
bilirubin have all remained normal.

Prior to discharge, patient was afebrile.  Vital signs were
stable.  Her cultures were persistently negative.
Neurologically, she had improved.  Right now, patient follows
commands and eyes were tracking.  Cardiovascularly, the
patient has been stable on Lopressor.  The patient will be
continued on Lasix 20 mg IV q. day.  Respiratory-wise, the
patient has a trach which she tolerates trach mask.  The
patient will be continued on her trach mask.  Her chest was
clear bilaterally.  Sputum has been negative.
Gastrointestinal-wise, the patient has been tolerating tube
feeds by her G-tube and she will be continued on the tube
feeds via G-tube.  Genitourinary:  The patient's creatinine
prior to discharge was 1.0 and the patient's Foley catheter
can be discontinued.  Infectious Disease-wise, there were no
issues.  All the antibiotics have been discontinued and
patient's cultures have remained negative.  Transplant-wise,
she will remain on the cyclosporin, CellCept and prednisone
for immunosuppressants.

DISCHARGE DIAGNOSES:  Include:  Aspiration pneumonia,
hydrocephalus, sepsis, status post liver transplant times
two, primary sclerosing cholangitis, cirrhosis, ulcerative
colitis, psoriasis, cerebral edema and seizure.

DISCHARGE MEDICATIONS:  Include:
1. Duoneb one to two puffs q. 6h. p.r.n.
2. Neoral 275 p.o. b.i.d.
3. Lasix 20 mg IV q. day.
4. Heparin subcu 5000 units b.i.d.
5. Insulin sliding scale.
6. Lansoprazole 30 mg p.o. q. day.
7. Keppra 1000 mg p.o. b.i.d.
8. Lopressor 125 mg p.o. t.i.d.  Hold for systolic pressure
   less than 100 or heart rate less than 60.
9. CellCept [**Pager number **] mg p.o. b.i.d.
10.      Prednisone 7.5 mg p.o. q. day.
11.      Bactrim one tab p.o. q. day.
12.      ___________ 450 mg p.o. b.i.d.


CONDITION ON DISCHARGE:  Stable.

DISPOSITION:  Discharged to rehab.

DISCHARGE INSTRUCTIONS:  The patient is to follow up at the
[**Hospital 1326**] Clinic once q. week and patient is to get blood
drawn Monday and Thursday.



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

Dictated By:[**Last Name (NamePattern4) 32455**]
MEDQUIST36
D:  [**2161-7-21**] 13:58:25
T:  [**2161-7-21**] 14:30:15
Job#:  [**Job Number 32456**]
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Obstructive hydrocephalus,Hyperpotassemia,Intestinal infection due to Clostridium difficile,Other convulsions,Liver replaced by transplant'}


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: The patient is a 31-year-old
female status post liver transplant twice in [**2161-3-26**].  The
patient had primary sclerosing cholangitis and cirrhosis of
her native liver and patient underwent a liver transplant on
[**2161-4-13**].  The operation was complicated by
intraoperative thrombosis and the patient had a repeat
transplant on [**2161-4-19**].  That operation was complicated
by portal vein thrombosis and cerebral edema and the patient
had ICP monitor placed and was trached on [**2161-5-6**].
The patient also had a G-tube placed at that time.  The
patient had a prolonged hospital course at that time and was
discharged to rehab.  However, at rehab she was tolerating
tube feeds.  Prior to admission the patient complained of
some indigestion, some nausea and vomiting and on the morning
of admission the patient had bouts of emesis.  A couple hours
prior to admission the patient became cyanotic and
unresponsive and patient was then transported to the
Emergency Room at [**Hospital1 69**].  In
the Emergency Room the patient was emergently intubated and
central line was then placed and patient was started on
intravenous fluids.  The patient required some pressors for
her blood pressure support and patient underwent CT scan
which showed large ventricle size and severe atrophy of her
brain.  CT of the chest showed bilateral large inferior lobe
consolidation, question aspiration pneumonia and abdominal CT
showed dilated stomach along with dilated duodenum.  The
patient was admitted to the Intensive Care Unit and underwent
a somewhat prolonged hospital course.

MEDICAL HISTORY: Includes primary sclerosing
cholangitis, cirrhosis, ulcerative colitis, psoriasis,
cerebral edema and seizure.

MEDICATION ON ADMISSION: She was on Neoral 150 b.i.d.,
CellCept one gram p.o. b.i.d., prednisone 10 mg p.o. q. day,
Diflucan 400 mg p.o. q. day and Valcyte 450 mg p.o.  q. day.
She was on Bactrim, Keppra 1000 mg p.o. b.i.d., amantadine 50
mg p.o. b.i.d., Osmolite 400 mg p.o. q. 6h. and Reglan 10 mg
p.o. b.i.d., Protonix 40 mg p.o. q. day, Lopressor 100 mg
p.o. q. 6h.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Obstructive hydrocephalus,Hyperpotassemia,Intestinal infection due to Clostridium difficile,Other convulsions,Liver replaced by transplant'}
