CHIEF COMPLAINT: potential liver transplant

PRESENT ILLNESS: 69 y.o. h/o M s/p AVR [**6-17**] for calcific aortic valve disease
on [**Month/Year (2) **] with hepatitis C genotype 1 and HCC s/p ethanol ablation
of a 2.5-cm lesion in segment VI [**2149-4-10**] then chemoembolization
[**2149-4-23**]. Surveillance CT scans have been negative for
recurrence.
He was in process of getting chest/abd CT today, but this was
aborted once liver offer was made today. He had already had 1
bottle of po contrast otherwise has been npo. Last CT was [**1-19**].

MEDICAL HISTORY: hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown
[**2150-4-16**] liver transplant

MEDICATION ON ADMISSION: Allergies: wheat/gluten
[**Last Name (un) 1724**]: Flomax 4mg [**Last Name (LF) **], [**First Name3 (LF) **] 81mg qd, trazodone 50mg HS,
clotrimazole
5x/day (doesn't take)

ALLERGIES: Gluten

PHYSICAL EXAM: Temp 97.2 HR 68 reg  BP 143/86 RR 18, WT 60.2kg, Height 5'7"
A&O, no scleral icterus, mildly anxious, talkative/pleasant
No thrush, upper/lower dentures, [**Last Name (un) **]
2+ carotids, no bruits,no TM, no LAD
Lungs clear
Cor s1S2 nl, sys murmur
abd soft, non-tender/non-distended, no HSM
vasc 2 + femoral pulses,
ext no cce, 2+ bilat DPs
skin bronze appearing, no rashes, scattered macules on back

FAMILY HISTORY: nc

SOCIAL HISTORY: Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit)
Unspecified viral hepatitis C without hepatic coma,Malignant neoplasm of liver, primary,Other specified hypersensitivity angiitis,Disruption of internal operation (surgical) wound,Cirrhosis of liver without mention of alcohol,Other abnormal glucose,Personal history of malignant neoplasm of prostate,Heart valve replaced by other means,Celiac disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Contact with or exposure to other viral diseases
Hpt C w/o hepat coma NOS,Mal neo liver, primary,Hypersensit angiitis NEC,Disrup internal op wound,Cirrhosis of liver NOS,Abnormal glucose NEC,Hx-prostatic malignancy,Heart valve replac NEC,Celiac disease,Abn react-anastom/graft,Viral dis contact NEC
Admission Date:  [**2150-4-16**]              Discharge Date:   [**2150-4-24**]

Date of Birth:  [**2080-5-6**]             Sex:   M

Service: SURGERY

Allergies:
Gluten

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
potential liver transplant


Major Surgical or Invasive Procedure:
[**2150-4-16**] liver transplant


History of Present Illness:
69 y.o. h/o M s/p AVR [**6-17**] for calcific aortic valve disease
on [**Month/Year (2) **] with hepatitis C genotype 1 and HCC s/p ethanol ablation
of a 2.5-cm lesion in segment VI [**2149-4-10**] then chemoembolization
[**2149-4-23**]. Surveillance CT scans have been negative for
recurrence.
He was in process of getting chest/abd CT today, but this was
aborted once liver offer was made today. He had already had 1
bottle of po contrast otherwise has been npo. Last CT was [**1-19**].

ROS: + urinary frequency without pain/burning/urgency/hematuria
or cloudy foul smelling urine. Denies HA, dizziness, fever,
chills, recent infections, cp, cough, sob, orthopnea, PND,
indigestion, abd pain, constipation/diarrhea, joint pain.


Past Medical History:
hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown
[**2150-4-16**] liver transplant

Social History:
Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit)


Family History:
nc

Physical Exam:
Temp 97.2 HR 68 reg  BP 143/86 RR 18, WT 60.2kg, Height 5'7"
A&O, no scleral icterus, mildly anxious, talkative/pleasant
No thrush, upper/lower dentures, [**Last Name (un) **]
2+ carotids, no bruits,no TM, no LAD
Lungs clear
Cor s1S2 nl, sys murmur
abd soft, non-tender/non-distended, no HSM
vasc 2 + femoral pulses,
ext no cce, 2+ bilat DPs
skin bronze appearing, no rashes, scattered macules on back


Pertinent Results:
[**2150-4-23**] 05:30AM BLOOD WBC-5.9 RBC-2.76* Hgb-9.3* Hct-26.6*
MCV-96 MCH-33.7* MCHC-35.1* RDW-16.2* Plt Ct-203
[**2150-4-20**] 05:17AM BLOOD PT-14.1* PTT-30.4 INR(PT)-1.2*
[**2150-4-23**] 05:30AM BLOOD Glucose-116* UreaN-12 Creat-0.5 Na-134
K-4.0 Cl-102 HCO3-27 AnGap-9
[**2150-4-23**] 05:30AM BLOOD ALT-161* AST-81* AlkPhos-87 TotBili-0.3

Brief Hospital Course:
On [**2150-4-16**], he underwent liver transplant. Surgeon was Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. Induction immunosuppession was given. HBIG was given
intraop during the anhepatic phase for donor that was HBV+. He
was sent to the SICU postop where he was extubated. He remained
hemodynamicaly stable and was transferred out of the SICU on pod
2.

LFTs improved. JP drains initially had high output. Liver duplex
on postop day 1 was normal. HBAb titers and HBsAg were done
daily. HBsAg remained negative. Antibody titers were >450. Five
days of HBIG were given postop. Lamivudine was also started on
day one. This continued. Per Hepatology, he would only need to
continue on Lamivudine once discharged home.

Diet was advanced and tolerated. He was ambulating and was
cleared by PT for discharge for home. The JPs were removed and
insertion sites sutured.

He required sliding scale insulin for hyperglycemia, but this
improved with steroid taper. He was instructed to monitor his
glucoses and record these results.

Prograf was started on postop day 1. This was titrated per
trough levels. On the day of discharge, his level was 12.3. Dose
was decreased to 3mg [**Hospital1 **], cellcept was 1 gram [**Hospital1 **].

He was discharged to home in stable condition. VNA services were
arranged to assist with glucose monitoring and continuation of
medication teaching.

Medications on Admission:
Allergies: wheat/gluten
[**Last Name (un) 1724**]: Flomax 4mg [**Last Name (LF) **], [**First Name3 (LF) **] 81mg qd, trazodone 50mg HS,
clotrimazole
5x/day (doesn't take)


Discharge Medications:
1. Prednisone 5 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily).

2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Lamivudine 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
5. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
7. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
10. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
11. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
12. Tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO Q12H
(every 12 hours).
13. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
HCV cirrhosis
HCC


Discharge Condition:
good


Discharge Instructions:
Please call the Transplant Office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, inability to take any of your medications,
worsening abdominal pain/distension, jaundice, incision/drain
site redness/bleeding or drainage
Please empty JP drain and record outputs. Bring record of drain
outputs to next appointment in the Transplant office
Check your blood sugars twice daily


Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7167**], RD Phone:[**Telephone/Fax (1) 3681**]
Date/Time:[**2150-4-28**] 1:00

Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2150-4-30**]
10:00
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2150-4-30**]
11:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2150-4-24**]
{'Unspecified viral hepatitis C without hepatic coma,Malignant neoplasm of liver, primary,Other specified hypersensitivity angiitis,Disruption of internal operation (surgical) wound,Cirrhosis of liver without mention of alcohol,Other abnormal glucose,Personal history of malignant neoplasm of prostate,Heart valve replaced by other means,Celiac disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Contact with or exposure to other viral diseases'}


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: potential liver transplant

PRESENT ILLNESS: 69 y.o. h/o M s/p AVR [**6-17**] for calcific aortic valve disease
on [**Month/Year (2) **] with hepatitis C genotype 1 and HCC s/p ethanol ablation
of a 2.5-cm lesion in segment VI [**2149-4-10**] then chemoembolization
[**2149-4-23**]. Surveillance CT scans have been negative for
recurrence.
He was in process of getting chest/abd CT today, but this was
aborted once liver offer was made today. He had already had 1
bottle of po contrast otherwise has been npo. Last CT was [**1-19**].

MEDICAL HISTORY: hepatitis C
hepatocellular cancer
severe aortic stenosis
celiac disease
prostate cancer
-treated with hormone therapy and radiation
R leg skin lesion
-biopsied at [**Hospital1 2177**] last week, results unknown
[**2150-4-16**] liver transplant

MEDICATION ON ADMISSION: Allergies: wheat/gluten
[**Last Name (un) 1724**]: Flomax 4mg [**Last Name (LF) **], [**First Name3 (LF) **] 81mg qd, trazodone 50mg HS,
clotrimazole
5x/day (doesn't take)

ALLERGIES: Gluten

PHYSICAL EXAM: Temp 97.2 HR 68 reg  BP 143/86 RR 18, WT 60.2kg, Height 5'7"
A&O, no scleral icterus, mildly anxious, talkative/pleasant
No thrush, upper/lower dentures, [**Last Name (un) **]
2+ carotids, no bruits,no TM, no LAD
Lungs clear
Cor s1S2 nl, sys murmur
abd soft, non-tender/non-distended, no HSM
vasc 2 + femoral pulses,
ext no cce, 2+ bilat DPs
skin bronze appearing, no rashes, scattered macules on back

FAMILY HISTORY: nc

SOCIAL HISTORY: Lives alone, h/o tobacco (quit) and alcohol use (last alcohol 7
months ago), h/o drug use (quit) 

### Response:
{'Unspecified viral hepatitis C without hepatic coma,Malignant neoplasm of liver, primary,Other specified hypersensitivity angiitis,Disruption of internal operation (surgical) wound,Cirrhosis of liver without mention of alcohol,Other abnormal glucose,Personal history of malignant neoplasm of prostate,Heart valve replaced by other means,Celiac disease,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Contact with or exposure to other viral diseases'}
