CHIEF COMPLAINT: melena, syncope

PRESENT ILLNESS: 52M transferred from [**Hospital **] hospital for managment of difficult
to control UGIB. Pt admitted to [**Location (un) **] after 2 days of
wretching and vomiting in addition to 1 episode of syncope. Pt
states he was in USOH until Mon [**4-15**] AM when he developed nausea
in AM after taking 1 week worth of amox for his sinusitis (he
felt it wasn't working). Vomited his breakfast x 1 no blood. Had
persistent nasal congestion and was having a lot of nausea,
vomiting with wretching numerous times per hour, sometimes with
projectile vomiting. Vomit was dark covered. Through Tuesday, he
continued this, and the vomitus got darker and blood streaked.
He also developed a small amount of diarrhea. Stayed home x 2
days, attempted to keep usp with fluids. Did not report h/o
recent travel. No recent sick contacts. [**Name (NI) **] recent questionable
restaurant food. Only notable risk factor is amox abx course
recently.
.
Tue night, pt continued with nausea/vomiting, also c/o
dizziness, LH, and unsteady gait. 530 wed am, the patient had
+LOC with + loss of bowel and bladder and ? head injury, woke up
on floor--was out for good 3 mins according to wife. Was
confused upon awakening, unaweare of surroundings. Eyes were
rolling onto back of his head. EMS was called, pt was taken to
[**Hospital **] hosp.
.
At [**Location (un) **], his BP was 132/63 and P 102, but pt was orthostatic.
Head CT negative. Admission Hct was 36. Received 2 units of
blood there. Had EGD on [**2148-4-17**] which showed some blood in the
esophagus evidence of bleed with a clot in the GE junction. Was
BiCapped. No Varices were seen. F/U EGD due to ?continued
bleeding on [**2148-4-18**] showed a tear in the posterior aspect of the
GE junction, and a clot in the distal esophagus. It was again
cauterized. Clipping could not be done. He was kept on IV PPI
and sandostatin. Patient continued to have large amounts of
black tarry stool.
.
Hct continued to go down and he was transferred to [**Hospital1 18**] this am
for further management. Per pt, he received 2 units PRBC
overnight and about 2L of IVF.
.
Pt has denied taking any aspirin/motrin/advil/ibuprofen, but
takes indomethacin for his psoriatic arthritis flares. According
to the patient, he has not taken it in months.
.
Current ROS: no CP, no SOB, no dizziness, no LH, no
palpiatations, no headaches, no abdominal pain, no nausea,
vomiting, diaphoresis.
.
MICU course:
[**4-19**]: Admitted. Had EGD showing large ulcer at site of prior
cauterizations. Epi injected per GI. Keep NPO for now.

MEDICAL HISTORY: Psoriasis
Arthritis (psoriatic)
Rosacea
Obstructive sleep apnea (better since he lost wt)

MEDICATION ON ADMISSION: topical steroid cream
recent course of amox

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P 81, BP 134/75, RR 18, O2 97%RA
HEENT: no jaundice, erythematous facial area (rosacea), diffuse
maculopapular rash, psoriatic plaques on scalp
Lungs: mild basilar crackles on the right
CVS: regular rate, no murmurs, rubs or gallobs
Abd: soft, NT, BS+, no HSM appreciated, no rebound
Ext: no edema, maculopapular rash.
Rectal: deferred at this time (pt had large amounts of tarry,
guiaiac + stool in AM at [**Hospital **] hospital.)

FAMILY HISTORY: H/O lung Ca--father died of Lung ca
Mother had [**Name2 (NI) 499**] Ca at age 66 or 67

SOCIAL HISTORY: Married, no smoking, 3-4 beers/wine per night for 30 yrs. Works
as a pharmaceutical researcher for millenium pharmaceuticals
Obstructive sleep apnea (adult)(pediatric),Intestinal infection due to other organism, not elsewhere classified,Acute posthemorrhagic anemia,Gastroesophageal laceration-hemorrhage syndrome,Acute kidney failure, unspecified,Psoriatic arthropathy,Thrombocytopenia, unspecified,Hypovolemia
Obstructive sleep apnea,Viral enteritis NOS,Ac posthemorrhag anemia,Mallory-weiss syndrome,Acute kidney failure NOS,Psoriatic arthropathy,Thrombocytopenia NOS,Hypovolemia
Admission Date:  [**2148-4-19**]              Discharge Date:   [**2148-4-21**]

Date of Birth:  [**2096-2-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9240**]
Chief Complaint:
melena, syncope

Major Surgical or Invasive Procedure:
Upper endoscopy


History of Present Illness:
52M transferred from [**Hospital **] hospital for managment of difficult
to control UGIB. Pt admitted to [**Location (un) **] after 2 days of
wretching and vomiting in addition to 1 episode of syncope. Pt
states he was in USOH until Mon [**4-15**] AM when he developed nausea
in AM after taking 1 week worth of amox for his sinusitis (he
felt it wasn't working). Vomited his breakfast x 1 no blood. Had
persistent nasal congestion and was having a lot of nausea,
vomiting with wretching numerous times per hour, sometimes with
projectile vomiting. Vomit was dark covered. Through Tuesday, he
continued this, and the vomitus got darker and blood streaked.
He also developed a small amount of diarrhea. Stayed home x 2
days, attempted to keep usp with fluids. Did not report h/o
recent travel. No recent sick contacts. [**Name (NI) **] recent questionable
restaurant food. Only notable risk factor is amox abx course
recently.
.
Tue night, pt continued with nausea/vomiting, also c/o
dizziness, LH, and unsteady gait. 530 wed am, the patient had
+LOC with + loss of bowel and bladder and ? head injury, woke up
on floor--was out for good 3 mins according to wife. Was
confused upon awakening, unaweare of surroundings. Eyes were
rolling onto back of his head. EMS was called, pt was taken to
[**Hospital **] hosp.
.
At [**Location (un) **], his BP was 132/63 and P 102, but pt was orthostatic.
Head CT negative. Admission Hct was 36. Received 2 units of
blood there. Had EGD on [**2148-4-17**] which showed some blood in the
esophagus evidence of bleed with a clot in the GE junction. Was
BiCapped. No Varices were seen. F/U EGD due to ?continued
bleeding on [**2148-4-18**] showed a tear in the posterior aspect of the
GE junction, and a clot in the distal esophagus. It was again
cauterized. Clipping could not be done. He was kept on IV PPI
and sandostatin. Patient continued to have large amounts of
black tarry stool.
.
Hct continued to go down and he was transferred to [**Hospital1 18**] this am
for further management. Per pt, he received 2 units PRBC
overnight and about 2L of IVF.
.
Pt has denied taking any aspirin/motrin/advil/ibuprofen, but
takes indomethacin for his psoriatic arthritis flares. According
to the patient, he has not taken it in months.
.
Current ROS: no CP, no SOB, no dizziness, no LH, no
palpiatations, no headaches, no abdominal pain, no nausea,
vomiting, diaphoresis.
.
MICU course:
[**4-19**]: Admitted. Had EGD showing large ulcer at site of prior
cauterizations. Epi injected per GI. Keep NPO for now.

Past Medical History:
Psoriasis
Arthritis (psoriatic)
Rosacea
Obstructive sleep apnea (better since he lost wt)

Social History:
Married, no smoking, 3-4 beers/wine per night for 30 yrs. Works
as a pharmaceutical researcher for millenium pharmaceuticals

Family History:
H/O lung Ca--father died of Lung ca
Mother had [**Name2 (NI) 499**] Ca at age 66 or 67

Physical Exam:
P 81, BP 134/75, RR 18, O2 97%RA
HEENT: no jaundice, erythematous facial area (rosacea), diffuse
maculopapular rash, psoriatic plaques on scalp
Lungs: mild basilar crackles on the right
CVS: regular rate, no murmurs, rubs or gallobs
Abd: soft, NT, BS+, no HSM appreciated, no rebound
Ext: no edema, maculopapular rash.
Rectal: deferred at this time (pt had large amounts of tarry,
guiaiac + stool in AM at [**Hospital **] hospital.)

Pertinent Results:
[**2148-4-19**] 08:50PM   WBC-6.1 RBC-3.02* HGB-10.0* HCT-27.5* MCV-91
MCH-33.1* MCHC-36.5* RDW-17.1*
[**2148-4-19**] 08:50PM   PLT COUNT-128*
[**2148-4-19**] 11:32AM   GLUCOSE-107* UREA N-9 CREAT-0.6 SODIUM-141
POTASSIUM-3.8 CHLORIDE-111* TOTAL CO2-26 ANION GAP-8
[**2148-4-19**] 11:32AM   estGFR-Using this
[**2148-4-19**] 11:32AM   ALT(SGPT)-16 AST(SGOT)-21 LD(LDH)-131 ALK
PHOS-26* AMYLASE-35 TOT BILI-0.6
[**2148-4-19**] 11:32AM   LIPASE-59
[**2148-4-19**] 11:32AM   ALBUMIN-3.0* CALCIUM-7.4* PHOSPHATE-1.4*
MAGNESIUM-2.4
[**2148-4-19**] 11:32AM   VIT B12-311 FOLATE-7.2
[**2148-4-19**] 11:32AM   WBC-5.0 RBC-3.21* HGB-10.4* HCT-30.2* MCV-94
MCH-32.5* MCHC-34.6 RDW-17.1*
[**2148-4-19**] 11:32AM   NEUTS-71.7* LYMPHS-18.1 MONOS-7.1 EOS-3.0
BASOS-0.1
[**2148-4-19**] 11:32AM   ANISOCYT-1+ MACROCYT-1+
[**2148-4-19**] 11:32AM   PLT COUNT-125*
[**2148-4-19**] 11:32AM   PT-11.9 PTT-22.7 INR(PT)-1.0
.
EGD: small distal esophageal ulcer/tear with adherent clot, no
active bleeding, injected with epinephrine, recommend continue
[**Hospital1 **] PPI and f/u EGD in [**4-14**] weeks


Brief Hospital Course:
1. UGIB: M-W tear with clot noted at OSH. Cauterized at OSH,
possibly creating a larger ulcer which was seen on EGD [**4-19**] here
at [**Hospital1 18**]. Re-scoped at [**Hospital1 18**], saw a large ulcer with clot,
injected with epinepherine. Followed with stable hct during his
stay at [**Hospital1 18**]. Tolerating regular diet, melena resolved. Was
given number to call to schedule f/u EGD with Dr. [**First Name (STitle) **] [**Name (STitle) 25355**] in
[**4-14**] weeks. Continued on [**Hospital1 **] PPI. He should also have a follow up
CBC with his PCP [**Last Name (NamePattern4) **] [**2-13**] weeks.
.
2. Gastroenteritis: Suspect a viral gastroenteritis triggered
his nausea/vomiting/diarrhea. Had low grade temp at [**Hospital1 18**] and
mild thrombocytopenia which resolved all supporting viral
gastroenteritis. His nausea/vomiting had resolved, he was having
mild diarrhea on discharge but no further melena.
.
3. Syncope: Most likely due to a combination of acute volume
depletion from UGIB and possible vasovagal episode from
vomiting. On transfer to [**Hospital1 18**], vitals remained stable, no ECG
changes, no events on tele. Was walking without lightheadedness
on discharge.
.
4. anemia: Likely 2/2 blood loss. Was macrocytic at OSH. B12 and
folate levels normal. Hct stable at [**Hospital1 18**]. Should have f/u CBC
with PCP [**Last Name (NamePattern4) **] [**2-13**] weeks, and if still anemic should have iron
studies at that time.
.
5. Thrombocytopenia: Likely due to recent viral infection.
Resolved to normal range at discharge. Follow up CBC with PCP [**Last Name (NamePattern4) **]
[**2-13**] weeks.
.
6. ARF: Resolved after IVF. Likely prerenal due to UGIB and
diarrhea.
.
7. Psoriasis: chronic, treated with topical steroid at home.
Follow up with dermatologist.


Medications on Admission:
topical steroid cream
recent course of amox

Discharge Medications:
1. Outpatient Lab Work
Please have your CBC checked with your PCP in next 1-2 weeks.
2. Fluocinolone 0.01 % Solution Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
3. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Upper Gastrointestinal Bleed due to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Tear
Gastroenteritis


Discharge Condition:
stable


Discharge Instructions:
You had a GI bleed from [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **] tear. Please call your
doctor if you experience black stools, vomiting dark material,
light headedness, or any other concerning symptoms. Continue you
acid suppressing medication twice daily. Please follow up with
your PCP and with Dr. [**Last Name (STitle) 25355**].

Followup Instructions:
1. Please follow up with your PCP in next 2-4 weeks to have your
CBC checked.

2. Please call [**Telephone/Fax (1) 463**] on Monday to schedule an EGD (upper
endoscopy) as follow up with Dr. [**First Name (STitle) **] [**Name (STitle) 25355**] in [**4-14**] weeks.
{'Obstructive sleep apnea (adult)(pediatric),Intestinal infection due to other organism, not elsewhere classified,Acute posthemorrhagic anemia,Gastroesophageal laceration-hemorrhage syndrome,Acute kidney failure, unspecified,Psoriatic arthropathy,Thrombocytopenia, unspecified,Hypovolemia'}


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: melena, syncope

PRESENT ILLNESS: 52M transferred from [**Hospital **] hospital for managment of difficult
to control UGIB. Pt admitted to [**Location (un) **] after 2 days of
wretching and vomiting in addition to 1 episode of syncope. Pt
states he was in USOH until Mon [**4-15**] AM when he developed nausea
in AM after taking 1 week worth of amox for his sinusitis (he
felt it wasn't working). Vomited his breakfast x 1 no blood. Had
persistent nasal congestion and was having a lot of nausea,
vomiting with wretching numerous times per hour, sometimes with
projectile vomiting. Vomit was dark covered. Through Tuesday, he
continued this, and the vomitus got darker and blood streaked.
He also developed a small amount of diarrhea. Stayed home x 2
days, attempted to keep usp with fluids. Did not report h/o
recent travel. No recent sick contacts. [**Name (NI) **] recent questionable
restaurant food. Only notable risk factor is amox abx course
recently.
.
Tue night, pt continued with nausea/vomiting, also c/o
dizziness, LH, and unsteady gait. 530 wed am, the patient had
+LOC with + loss of bowel and bladder and ? head injury, woke up
on floor--was out for good 3 mins according to wife. Was
confused upon awakening, unaweare of surroundings. Eyes were
rolling onto back of his head. EMS was called, pt was taken to
[**Hospital **] hosp.
.
At [**Location (un) **], his BP was 132/63 and P 102, but pt was orthostatic.
Head CT negative. Admission Hct was 36. Received 2 units of
blood there. Had EGD on [**2148-4-17**] which showed some blood in the
esophagus evidence of bleed with a clot in the GE junction. Was
BiCapped. No Varices were seen. F/U EGD due to ?continued
bleeding on [**2148-4-18**] showed a tear in the posterior aspect of the
GE junction, and a clot in the distal esophagus. It was again
cauterized. Clipping could not be done. He was kept on IV PPI
and sandostatin. Patient continued to have large amounts of
black tarry stool.
.
Hct continued to go down and he was transferred to [**Hospital1 18**] this am
for further management. Per pt, he received 2 units PRBC
overnight and about 2L of IVF.
.
Pt has denied taking any aspirin/motrin/advil/ibuprofen, but
takes indomethacin for his psoriatic arthritis flares. According
to the patient, he has not taken it in months.
.
Current ROS: no CP, no SOB, no dizziness, no LH, no
palpiatations, no headaches, no abdominal pain, no nausea,
vomiting, diaphoresis.
.
MICU course:
[**4-19**]: Admitted. Had EGD showing large ulcer at site of prior
cauterizations. Epi injected per GI. Keep NPO for now.

MEDICAL HISTORY: Psoriasis
Arthritis (psoriatic)
Rosacea
Obstructive sleep apnea (better since he lost wt)

MEDICATION ON ADMISSION: topical steroid cream
recent course of amox

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P 81, BP 134/75, RR 18, O2 97%RA
HEENT: no jaundice, erythematous facial area (rosacea), diffuse
maculopapular rash, psoriatic plaques on scalp
Lungs: mild basilar crackles on the right
CVS: regular rate, no murmurs, rubs or gallobs
Abd: soft, NT, BS+, no HSM appreciated, no rebound
Ext: no edema, maculopapular rash.
Rectal: deferred at this time (pt had large amounts of tarry,
guiaiac + stool in AM at [**Hospital **] hospital.)

FAMILY HISTORY: H/O lung Ca--father died of Lung ca
Mother had [**Name2 (NI) 499**] Ca at age 66 or 67

SOCIAL HISTORY: Married, no smoking, 3-4 beers/wine per night for 30 yrs. Works
as a pharmaceutical researcher for millenium pharmaceuticals 

### Response:
{'Obstructive sleep apnea (adult)(pediatric),Intestinal infection due to other organism, not elsewhere classified,Acute posthemorrhagic anemia,Gastroesophageal laceration-hemorrhage syndrome,Acute kidney failure, unspecified,Psoriatic arthropathy,Thrombocytopenia, unspecified,Hypovolemia'}
