CHIEF COMPLAINT: CC:[**CC Contact Info 78798**]

PRESENT ILLNESS: This is a 45 yo M with EtOH cirrhosis and grade II esophageal
varices s/p banding in [**7-19**]. Notes that yesterday and today he
had dark stools. Then notes that ~3pm today he ate some lunch
and then felt nauseous and subsequently had ~ 1 cup of
hematemesis- bright red. Denies having had any since. Denies
lightheadedness/chest pain associated.  Notes that he has been
drinking 6 pack of Mikes Hard Lemonade daily plus occassional
tumbler of cognac, last drink was yesterday.

MEDICAL HISTORY: grade II varices s/p banding [**2172-12-17**]
Etoh cirrhosis

MEDICATION ON ADMISSION: Nadolol 20mg daily
Omeprazole 20mg daily
Folic acid
Multivitamin
Thiamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On presentation:
Vitals: T: 99.2 BP: 156/75 HR: 69 RR: 21 O2Sat:98%RA
GEN: Thin, Well-appearing, no acute distress
HEENT: EOMI, PERRL, sclera icteric BL, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, + flow murmur, G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No asterixis noted
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: He denies any liver disease in his family.  He has 9 sisters and
3 brothers.  His mom died of pancreatic cancer at a young age.
He denies any liver cancer in the family or GI cancer.

SOCIAL HISTORY: He had a history of 10 years of heavy drinking up to [**Month (only) **] of
[**2172**], drinking [**2-12**] to 1 pint a day.  He has been drinking 2
beers a day since [**2172-7-12**].  He has never gone through
detox.  He smokes [**2-12**] a pack per day for the past 20
years.  He denies using IV drugs or smoking drugs.  He lives in
his apartment with his fiance and his 17-year-old son.  [**Name (NI) **] works
as an apartment building manager.  He has had recent travel to
[**Male First Name (un) 1056**].
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Other and unspecified alcohol dependence, continuous
Alcohol cirrhosis liver,Bleed esoph var oth dis,Ac posthemorrhag anemia,Thrombocytopenia NOS,Alcoh dep NEC/NOS-contin
Admission Date:  [**2173-1-2**]              Discharge Date:   [**2173-1-5**]

Date of Birth:  [**2127-1-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9853**]
Chief Complaint:
CC:[**CC Contact Info 78798**]

Major Surgical or Invasive Procedure:
EGD with variceal banding


History of Present Illness:
This is a 45 yo M with EtOH cirrhosis and grade II esophageal
varices s/p banding in [**7-19**]. Notes that yesterday and today he
had dark stools. Then notes that ~3pm today he ate some lunch
and then felt nauseous and subsequently had ~ 1 cup of
hematemesis- bright red. Denies having had any since. Denies
lightheadedness/chest pain associated.  Notes that he has been
drinking 6 pack of Mikes Hard Lemonade daily plus occassional
tumbler of cognac, last drink was yesterday.

.
In the ED, T 98.2 HR 68 BP 142/72 sat100% on RA. GI was
consulted and he was started on Protonix IV and octreotide drip.
HCT was 37 and INR 1.8.

.
ROS: The patient denies any fevers, chills,  abdominal pain,
diarrhea, constipation, shortness of breath, orthopnea, PND,
lower extremity edema, cough, weight change,urinary frequency,
urgency, dysuria, gait unsteadiness, focal weakness, vision
changes, headache, rash or skin changes.
.


Past Medical History:
grade II varices s/p banding [**2172-12-17**]
Etoh cirrhosis


Social History:
He had a history of 10 years of heavy drinking up to [**Month (only) **] of
[**2172**], drinking [**2-12**] to 1 pint a day.  He has been drinking 2
beers a day since [**2172-7-12**].  He has never gone through
detox.  He smokes [**2-12**] a pack per day for the past 20
years.  He denies using IV drugs or smoking drugs.  He lives in
his apartment with his fiance and his 17-year-old son.  [**Name (NI) **] works
as an apartment building manager.  He has had recent travel to
[**Male First Name (un) 1056**].


Family History:
He denies any liver disease in his family.  He has 9 sisters and
3 brothers.  His mom died of pancreatic cancer at a young age.
He denies any liver cancer in the family or GI cancer.


Physical Exam:
On presentation:
Vitals: T: 99.2 BP: 156/75 HR: 69 RR: 21 O2Sat:98%RA
GEN: Thin, Well-appearing, no acute distress
HEENT: EOMI, PERRL, sclera icteric BL, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, + flow murmur, G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No asterixis noted
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

.


Pertinent Results:
[**2173-1-2**] 05:14PM   WBC-5.8 RBC-4.00* HGB-12.4* HCT-37.0* MCV-93
MCH-31.0 MCHC-33.5 RDW-17.2*
[**2173-1-2**] 05:14PM   NEUTS-75.6* LYMPHS-17.6* MONOS-4.2 EOS-1.8
BASOS-0.8
[**2173-1-2**] 05:14PM   PLT COUNT-104*
.
[**2173-1-2**] 05:14PM   PT-19.3* PTT-32.4 INR(PT)-1.8*
.
[**2173-1-2**] 05:14PM   GLUCOSE-110* UREA N-8 CREAT-0.6 SODIUM-139
POTASSIUM-4.0 CHLORIDE-108 TOTAL CO2-22 ANION GAP-13
[**2173-1-2**] 05:14PM   ALT(SGPT)-31 AST(SGOT)-74* ALK PHOS-75 TOT
BILI-2.6*
[**2173-1-2**] 05:14PM   ALBUMIN-3.2*
.
[**2173-1-2**] 05:40PM   HGB-13.4* calcHCT-40
[**2173-1-2**] 10:11PM   HCT-34.5*
[**2173-1-3**] 03:31AM   Hct-32.9*
[**2173-1-3**] 07:25AM   Hct-29.9*
[**2173-1-3**] 11:51AM   Hct-29.9*
[**2173-1-3**] 05:29PM   Hct-29.0*
.
[**2173-1-2**] CXR - CONCLUSION: No acute cardiopulmonary process.
.
[**2173-1-2**] EGD - Impression: Ulcer in the 36 cm on varix
Varices at the gastroesophageal junction, middle third of the
esophagus and lower third of the esophagus
No gastric varices, portal hypertensive gastropathy.
Blood in the fundus and stomach body
Blood in the gastroesophageal junction and lower third of the
esophagus
(ligation)
Otherwise normal EGD to second part of the duodenum

Brief Hospital Course:
# UGI Bleed: EGD showed esophageal varices, one with ulcer on
top, in the setting of cirrhosis, and he underwent banding.
Patient was not transfused and Hct stablized over the course of
24 hrs. In AM of day 2 of ICU stay, patient had repeat
hematemesis, but Hct was unchanged. He was continued on
octreotide gtt and transitioned to IV PPI [**Hospital1 **]. After being
called out to the floor, he was switched to oral PPI and Cipro.
Octreotide was stopped after ~24 hours. His diet was advanced
without incident, and his Hct remained stable with no further
signs of significant bleeding. Nadolol was continued and
carafate was started per hepatology.

# Etoh Cirrhosis: Child B, complicated by esophageal varices. He
is followed outpt by Dr. [**Last Name (STitle) **] and has followup appointment in
1 week.

# ETOH: last drink was the day before admission, no h/o
withdrawal sx/seizures. Placed on CIWA but never above 10 and
never required benzos. Thiamine and folate were continued.

# Acute blood loss anemia: baseline HCT around 27-29, and his
Hct stabilized in this range after banding. He did not require
transfusion.

# Thrombocytopenia: from underlying liver disease; baseline plt
count at 90-100, remained at baseline.


Medications on Admission:
Nadolol 20mg daily
Omeprazole 20mg daily
Folic acid
Multivitamin
Thiamine

Discharge Medications:
1. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
4. Multivitamin     Capsule Sig: One (1) Capsule PO once a day.

5. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.

6. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times
a day) for 1 weeks.
Disp:*28 Tablet(s)* Refills:*0*
7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 3 days.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: esophageal varices
Secondary: alcoholic cirrhosis, acute blood loss anemia,
thrombocytopenia


Discharge Condition:
good, stable, tolerating regular diet, no abdominal pain, no
hematemesis or hematochezia


Discharge Instructions:
You were evaluated for blood in your emesis and stool and were
found to have bleeding esophageal varices that were banded. Your
blood levels remained stable.

If you have further blood in your emesis or stool, abdominal
pain, lightheadedness, chest pain, shortness of breath, or any
other concerning symptoms, call your doctor or seek medical
attention immediately.

Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) **] on [**2173-1-12**] at 8:45am.
Call his office at [**Telephone/Fax (1) 2422**] with any questions. His office
will contact you regarding scheduling a repeat EGD.
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Other and unspecified alcohol dependence, continuous'}


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: CC:[**CC Contact Info 78798**]

PRESENT ILLNESS: This is a 45 yo M with EtOH cirrhosis and grade II esophageal
varices s/p banding in [**7-19**]. Notes that yesterday and today he
had dark stools. Then notes that ~3pm today he ate some lunch
and then felt nauseous and subsequently had ~ 1 cup of
hematemesis- bright red. Denies having had any since. Denies
lightheadedness/chest pain associated.  Notes that he has been
drinking 6 pack of Mikes Hard Lemonade daily plus occassional
tumbler of cognac, last drink was yesterday.

MEDICAL HISTORY: grade II varices s/p banding [**2172-12-17**]
Etoh cirrhosis

MEDICATION ON ADMISSION: Nadolol 20mg daily
Omeprazole 20mg daily
Folic acid
Multivitamin
Thiamine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On presentation:
Vitals: T: 99.2 BP: 156/75 HR: 69 RR: 21 O2Sat:98%RA
GEN: Thin, Well-appearing, no acute distress
HEENT: EOMI, PERRL, sclera icteric BL, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, + flow murmur, G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No asterixis noted
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: He denies any liver disease in his family.  He has 9 sisters and
3 brothers.  His mom died of pancreatic cancer at a young age.
He denies any liver cancer in the family or GI cancer.

SOCIAL HISTORY: He had a history of 10 years of heavy drinking up to [**Month (only) **] of
[**2172**], drinking [**2-12**] to 1 pint a day.  He has been drinking 2
beers a day since [**2172-7-12**].  He has never gone through
detox.  He smokes [**2-12**] a pack per day for the past 20
years.  He denies using IV drugs or smoking drugs.  He lives in
his apartment with his fiance and his 17-year-old son.  [**Name (NI) **] works
as an apartment building manager.  He has had recent travel to
[**Male First Name (un) 1056**]. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Other and unspecified alcohol dependence, continuous'}
