CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 47382**] is a 37-year-old
female with a past medical history significant for hepatitis
C cirrhosis (Child class B) with end-stage liver disease who
is listed for transplant.

MEDICAL HISTORY: 1.  Hepatitis C.
2.  Child class B/C cirrhosis.
3.  Non-Hodgkin lymphoma.
4.  History of Clostridium difficile colitis.
5.  History of esophageal varices.
6.  Status post multiple episodes of lower extremity
cellulitis.
7.  Status post splenectomy.
8.  Status post multiple skin grafts.

MEDICATION ON ADMISSION: 1.  Lasix 20 mg by mouth twice per day.
2.  Aldactone 50 mg by mouth once per day.
3.  Ursodiol 300 mg by mouth three times per day.
4.  Nadolol 20 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Doxepin 10 mg by mouth once per day.
7.  Keflex 250 mg.

ALLERGIES: The patient denies any known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient has a family history of
congestive heart failure and hypercholesterolemia.

SOCIAL HISTORY: The patient does computer work for the
[**Company 26765**].  She denies tobacco and alcohol
use.  She lives with her mother and brother.
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Bacteremia,Portal vein thrombosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Chronic hepatitis C with hepatic coma,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency
Intestinal adhes w obstr,Bacteremia,Portal vein thrombosis,Meth sus pneum d/t Staph,Chrnc hpt C w hepat Coma,Cirrhosis of liver NOS,Acq coagul factor defic
Admission Date:  [**2171-12-26**]       Discharge Date:  [**2172-1-21**]

Date of Birth:   [**2134-12-19**]       Sex:  F

Service:  Transplant Surgery

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 47382**] is a 37-year-old
female with a past medical history significant for hepatitis
C cirrhosis (Child class B) with end-stage liver disease who
is listed for transplant.

The patient presented to the Emergency Department with the
acute onset of abdominal pain.  This was associated with
nausea and vomiting, but no fevers or chills.  She states
that she has had a bowel movement and has passed flatus in
the recently.

A workup done in the Emergency Department demonstrated a
small-bowel obstruction with a focal transition point as seen
on computed tomography scan.  She was aggressively
resuscitated in the Emergency Department and was taken to the
operating room for an exploratory laparotomy.

PAST MEDICAL HISTORY:
1.  Hepatitis C.
2.  Child class B/C cirrhosis.
3.  Non-Hodgkin lymphoma.
4.  History of Clostridium difficile colitis.
5.  History of esophageal varices.
6.  Status post multiple episodes of lower extremity
cellulitis.
7.  Status post splenectomy.
8.  Status post multiple skin grafts.

MEDICATIONS ON ADMISSION:
1.  Lasix 20 mg by mouth twice per day.
2.  Aldactone 50 mg by mouth once per day.
3.  Ursodiol 300 mg by mouth three times per day.
4.  Nadolol 20 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Doxepin 10 mg by mouth once per day.
7.  Keflex 250 mg.

ALLERGIES:  The patient denies any known drug allergies.

FAMILY HISTORY:   The patient has a family history of
congestive heart failure and hypercholesterolemia.

SOCIAL HISTORY:  The patient does computer work for the
[**Company 26765**].  She denies tobacco and alcohol
use.  She lives with her mother and brother.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed
her temperature was 98 degrees Fahrenheit, her heart rate was
105, and her blood pressure was 126/60.  In general, the
patient was awake but not responsive.  Her heart was
tachycardic without murmurs.  The lungs were clear to
auscultation.  The abdomen was obese, soft, tender to
palpation in the left lower quadrant but not firm or
distended.  The skin was pale but warm.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Pertinent
laboratory studies revealed her white blood cell count was
17.  Her hematocrit was 26.  Prothrombin time was 16, partial
thromboplastin time was 36, and her INR was 1.7.  Her
creatinine was 1.1.  Her aspartate aminotransferase was 86,
alanine-aminotransferase was 44, total bilirubin was 4.7, and
her amylase was 30.

BRIEF SUMMARY OF HOSPITAL COURSE:  On the day of admission,
the patient was taken to the operating room where an
exploratory laparotomy was performed along with lysis of
adhesions for a small-bowel obstruction.  She tolerated the
procedure well and was discharged to the Surgical Intensive
Care Unit for postoperative monitoring.

The patient's postoperative course was complicated by hepatic
encephalopathy and coagulopathy with resulting prolonged
extubation.  Due to her decompensated liver disease, she had
persistently elevated creatinine levels and INR.  The
encephalopathy resolved slowly with the use of lactulose.
She also received multiple blood products throughout her
hospital stay.  She was initially treated with total
parenteral nutrition for nutritional support; however, this
was transitioned to tube feeds during her hospital stay.

On postoperative day 19, the patient was successfully
extubated.  Throughout her stay, she was treated with
vancomycin, Zosyn, and fluconazole for positive sputum and
urine cultures.

The patient was transferred to the floor on postoperative day
20 with improvement in her encephalopathy.  By this time, her
creatinine had returned to a stable level at 0.5.  Her
aspartate aminotransferase, alanine-aminotransferase, and
total bilirubin levels remained elevated but stable
throughout her hospitalization.

During her hospitalization, she was evaluated for
transplantation and was seen by the Dental Service and the
Ophthalmology Service.  After a video swallow study was done
on [**2172-1-16**], the patient was started on an oral
diet.

On postoperative day 24, the patient's staples were removed
and Steri-Strips were applied.  There was an area
approximately 5 mm X 5 mm that remained open and packed with
wet-to-dry gauze dressing changes.

On postoperative day 26, after completing a 14-day course of
vancomycin, she was discharged to rehabilitation in stable
condition.  She was to remain on lactulose as treatment for
her encephalopathy.  At the time of discharge, her INR
remained stable in the 2.5 range to 2.7 range.   The
remainder of her liver enzymes remained elevated but stable.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  The patient was discharged to a
rehabilitation facility for physical therapy and wound care.

DISCHARGE DIAGNOSES:
1.  Hepatitis C.
2.  Child class B/C cirrhosis.
3.  Non-Hodgkin lymphoma.
4.  History of Clostridium difficile colitis.
5.  History of esophageal varices.
6.  Status post splenectomy.
7.  Status post multiple skin grafts.
8.  Status post exploratory laparotomy with lysis of
adhesions for a small-bowel obstruction.
9.  Hepatic encephalopathy.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with the [**Hospital 9786**]
Clinic for further evaluation.
2.  The patient was instructed to use her eyedrops as needed
with Ophthalmology followup per her discretion.
3.  The patient was instructed to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] in approximately two weeks for assessment.

MEDICATIONS ON DISCHARGE:
1.  Albuterol inhaler as needed.
2.  Artificial Tears 1 to 2 drops to both eyes as needed.
3.  Lactulose 30 mg by mouth three times per day.
4.  Insulin sliding-scale (as written).
5.  Prevacid 30 mg by mouth once per day.
6.  Spironolactone 25 mg by mouth once per day.
7.  Ursodiol 300 mg by mouth three times per day.





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 1331**]

Dictated By:[**Last Name (NamePattern1) 26023**]
MEDQUIST36

D:  [**2172-1-21**]  10:22
T:  [**2172-1-21**]  10:30
JOB#:  [**Job Number 47383**]


Name:  [**Known lastname 8766**], [**Known firstname 3410**]                   Unit No:  [**Numeric Identifier 8767**]

Admission Date:  [**2171-12-26**]     Discharge Date:  [**2172-1-23**]

Date of Birth:   [**2134-12-19**]     Sex:  F

Service:  Transplant Surgery

ADDENDUM:  Mrs. [**Known lastname **] was discharged to rehabilitation on
[**2172-1-23**].  She stayed longer than the anticipated
discharge date of [**2172-1-21**], in order to receive physical
therapy and occupational therapy as needed.  Prior to
discharge, her midline wound was opened with a sterile
hemostat clamp and patched with 1/4 inch Nu-Gauze.  She will
continue to have this wound packed twice daily with wet to
dry dressing changes until it granulates in.  She was again
instructed to follow up if she had any questions or concerns.


                          [**First Name11 (Name Pattern1) 399**] [**Last Name (NamePattern4) 2801**], M.D.  [**MD Number(1) 401**]

Dictated By:[**Last Name (NamePattern1) 7438**]

MEDQUIST36

D:  [**2172-1-22**]  15:41
T:  [**2172-1-22**]  17:50
JOB#:  [**Job Number 8768**]
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Bacteremia,Portal vein thrombosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Chronic hepatitis C with hepatic coma,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency'}


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: Ms. [**Known lastname 47382**] is a 37-year-old
female with a past medical history significant for hepatitis
C cirrhosis (Child class B) with end-stage liver disease who
is listed for transplant.

MEDICAL HISTORY: 1.  Hepatitis C.
2.  Child class B/C cirrhosis.
3.  Non-Hodgkin lymphoma.
4.  History of Clostridium difficile colitis.
5.  History of esophageal varices.
6.  Status post multiple episodes of lower extremity
cellulitis.
7.  Status post splenectomy.
8.  Status post multiple skin grafts.

MEDICATION ON ADMISSION: 1.  Lasix 20 mg by mouth twice per day.
2.  Aldactone 50 mg by mouth once per day.
3.  Ursodiol 300 mg by mouth three times per day.
4.  Nadolol 20 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Doxepin 10 mg by mouth once per day.
7.  Keflex 250 mg.

ALLERGIES: The patient denies any known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient has a family history of
congestive heart failure and hypercholesterolemia.

SOCIAL HISTORY: The patient does computer work for the
[**Company 26765**].  She denies tobacco and alcohol
use.  She lives with her mother and brother. 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Bacteremia,Portal vein thrombosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Chronic hepatitis C with hepatic coma,Cirrhosis of liver without mention of alcohol,Acquired coagulation factor deficiency'}
