CHIEF COMPLAINT: GI bleeding

PRESENT ILLNESS: 45 y/o male with a history of ETOH cirrhosis presents with
nausea, vomiting of blood x 3, and dark stool. the patient was
in his USOH until MN the day prior to admission when he had dark
stool and vomited 3 cups of blood. The patient went back to
sleep and awoke at 7am when he vomitted an additional cup of
blood. His PCP referred him to an OSH where he was found to have
a BP of 160/78 lying to 143/61 sitting and a HR of 115. His HCT
was 37.5 (unknown pbaselnie) Plts 88, Tbili 5.7, ASST 133, ALT
22. He was transferred to the [**Hospital1 18**] ED for further evaluation.
.
In thE [**Hospital1 18**] ED he was found to have a BP of 154/79 and a pulse
of 107. He had hematemsis x 2 of coffee ground stool and
transferred to the ICU for further management.
.
In the ICU he was seen by the GI team and started on PPI [**Hospital1 **] and
octreotide drip. In addition he had a scope performed that per
report demonstrated grade 3 varices with no stigmata of recent
hemorrhage. A banding procedure was performed.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:  98.5 125/68 100 14
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI slight scleral icterus.
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: n/c

SOCIAL HISTORY: works as a bulding manager.  Smokes [**2-12**] pack a day.  Pint of
tequila daily.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Portal hypertension,Other and unspecified alcohol dependence, continuous
Alcohol cirrhosis liver,Bleed esoph var oth dis,Portal hypertension,Alcoh dep NEC/NOS-contin
Admission Date:  [**2172-7-14**]              Discharge Date:   [**2172-7-16**]

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

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 949**]
Chief Complaint:
GI bleeding

Major Surgical or Invasive Procedure:
Esophagoduodenoscopy with banding of esophageal varices.


History of Present Illness:
45 y/o male with a history of ETOH cirrhosis presents with
nausea, vomiting of blood x 3, and dark stool. the patient was
in his USOH until MN the day prior to admission when he had dark
stool and vomited 3 cups of blood. The patient went back to
sleep and awoke at 7am when he vomitted an additional cup of
blood. His PCP referred him to an OSH where he was found to have
a BP of 160/78 lying to 143/61 sitting and a HR of 115. His HCT
was 37.5 (unknown pbaselnie) Plts 88, Tbili 5.7, ASST 133, ALT
22. He was transferred to the [**Hospital1 18**] ED for further evaluation.
.
In thE [**Hospital1 18**] ED he was found to have a BP of 154/79 and a pulse
of 107. He had hematemsis x 2 of coffee ground stool and
transferred to the ICU for further management.
.
In the ICU he was seen by the GI team and started on PPI [**Hospital1 **] and
octreotide drip. In addition he had a scope performed that per
report demonstrated grade 3 varices with no stigmata of recent
hemorrhage. A banding procedure was performed.


Past Medical History:
None

Social History:
works as a bulding manager.  Smokes [**2-12**] pack a day.  Pint of
tequila daily.


Family History:
n/c

Physical Exam:
Physical Exam:  98.5 125/68 100 14
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI slight scleral icterus.
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

Pertinent Results:
[**2172-7-14**] 12:30PM   WBC-10.2 RBC-3.41* HGB-12.1* HCT-35.6*
MCV-104* MCH-35.6* MCHC-34.1 RDW-16.3*
[**2172-7-14**] 12:30PM   NEUTS-85.2* LYMPHS-10.3* MONOS-3.8 EOS-0.3
BASOS-0.3
[**2172-7-14**] 12:30PM   PLT SMR-LOW PLT COUNT-96*
[**2172-7-14**] 12:30PM   PT-20.9* PTT-29.9 INR(PT)-2.0*
[**2172-7-14**] 12:30PM   GLUCOSE-128* UREA N-12 CREAT-0.6 SODIUM-138
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-23 ANION GAP-15
[**2172-7-14**] 12:30PM   ALT(SGPT)-35 AST(SGOT)-111* LD(LDH)-192 ALK
PHOS-83 TOT BILI-6.1*
[**2172-7-14**] 12:30PM   LIPASE-34
[**2172-7-14**] 12:30PM   CALCIUM-8.6 PHOSPHATE-3.2 MAGNESIUM-1.4*

Brief Hospital Course:
45-year-old man with ETOH cirrhosis presented with hematemsis,
found to have grade 3 varives.
.
# GI Bleed: Grade 3 varices. He underwent EGD with banding. He
was given ceftriaxone per GI, octreotide, vitamin K 10 PO x 1,
and [**Hospital1 **] PPI.
.
# ETOH: Initially on CIWA scale. Given banana bag and then
thiamine, folate.
.
# Cirrhosis: RUQ pending, liver following. Meld 21. Discriminant
function 37.

Medications on Admission:
none

Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Upper GI bleed

Secondary:
Alcoholic cirrhosis
Esophageal varices
Alcohol abuse


Discharge Condition:
Vitals stable. Hematocrit stable.


Discharge Instructions:
You were admitted to the hospital after having bloody vomitus.
This is a serious complication from your alcoholic cirrhosis.
You had an endoscopy performed and were found to have esophageal
varices. The varices were banded. It is essential that you stop
drinking to prevent further liver injury. You should also take
all medications as prescribed.

Follow-up as outlined below. You have been given information for
a day program which you can attend to help you stop drinking.

If you have another episode of bleeding, increased abdominal
swelling, confusion, fevers > 101, or other concerning symptoms,
you should return to the emergency room.

Followup Instructions:
You will need to have a repeat EGD in 1.5 weeks. The Liver
Center will arrange the appointment for you with: Dr. [**First Name (STitle) 1382**]
[**Name (STitle) 1383**], Date/Time:[**2172-7-30**] 1:30. Telephone number is ([**Telephone/Fax (1) 16686**].

After that you have an appt with [**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD
Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2172-9-8**] 9:30

You should also follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in the next 2
weeks. Telephone number is [**Telephone/Fax (1) 41966**]. Alternatively, if you
would like a PCP within the [**Hospital1 18**] system, you can call [**Hospital 6308**] at [**Telephone/Fax (1) 250**] and ask for a new patient
appointment with Dr. [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) 23537**].
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Portal hypertension,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: GI bleeding

PRESENT ILLNESS: 45 y/o male with a history of ETOH cirrhosis presents with
nausea, vomiting of blood x 3, and dark stool. the patient was
in his USOH until MN the day prior to admission when he had dark
stool and vomited 3 cups of blood. The patient went back to
sleep and awoke at 7am when he vomitted an additional cup of
blood. His PCP referred him to an OSH where he was found to have
a BP of 160/78 lying to 143/61 sitting and a HR of 115. His HCT
was 37.5 (unknown pbaselnie) Plts 88, Tbili 5.7, ASST 133, ALT
22. He was transferred to the [**Hospital1 18**] ED for further evaluation.
.
In thE [**Hospital1 18**] ED he was found to have a BP of 154/79 and a pulse
of 107. He had hematemsis x 2 of coffee ground stool and
transferred to the ICU for further management.
.
In the ICU he was seen by the GI team and started on PPI [**Hospital1 **] and
octreotide drip. In addition he had a scope performed that per
report demonstrated grade 3 varices with no stigmata of recent
hemorrhage. A banding procedure was performed.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:  98.5 125/68 100 14
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI slight scleral icterus.
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: n/c

SOCIAL HISTORY: works as a bulding manager.  Smokes [**2-12**] pack a day.  Pint of
tequila daily. 

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