CHIEF COMPLAINT: hematemsis

PRESENT ILLNESS: 58F w. h/o HCV and etoh cirrhosis hx of varices/[**Doctor First Name 329**] [**Doctor Last Name **]
tear, p/w 2 episdoes of bright red hematemeis, first 11am
reported as 1 quart with blood clots. Second episode 1:30pm.
Also with coughing with pain in chest and lightheaded since day
prior to admission.  Similar episode 2-3 months prior when small
esophageal varices on endoscopy. Denies any recent nausea, or
retching prior to episode of hematemesis. ED notes that her last
drink was [**Doctor Last Name 1017**].
.
Regarding risk factors for bleeding, she drinks a bottle of
vodka/brandy daily. She reports taking aspirin 81 mg daily
(unknown indication, not on prescribed by [**Hospital1 18**] provider). In
addition, has been taking at least 2 advil tablets daily for
past month for chronic lower back pain. Her most recent
admission was for low back pain, fall, weakness following
steroid injection for back pain.
.
Initial Vitals in ED, 97.4, 69, 115/55, 16, 98/RA. She was
transiently hyptotensive to 90s in ED. Exam notable for no
tenderness to palpation.
.
Labs significant for lactate 2.2, creatinine 1.1.  AST 65.
Lipase 99 (baseline 50).  Tox negative including alcohol. WBC
6.9, Hct 27.2 (36.1 in [**6-/2150**]), Platelet 97. INR 1.5.
.
NG lavage with 800cc coffee ground, NGT in place which she
vomited around once in the ED.  Vomited coffee grounds X 1 in
ED. Has 2 18G.  Got 1L NS and 1 U of PRBC was hung.
.
She was started on PPI drip, Ceftriaxone, octreotide. Given
Zofran, Morphine
.
VS on transfer:  119/71, 92, 17, 95/RA. Code not addressed. She
was cross matched for 3 U more.
.
On the floor, she reports no chest pain or shortness of breath.
She denies abdominal pain.
.
ROS: Other ROS unable to obtain given rapid intubation

MEDICAL HISTORY: - Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension
- Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension

MEDICATION ON ADMISSION: 1. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Multi-Vitamins W/Iron Tablet, Chewable Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. ferrous s
ulfate 300 mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
==============
Vitals: 98.2, 114/50 93, 16, 98/RA
General: Alert, tearful and agitated prior to intubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachycardic rate and reg rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in placed
Ext: warm, well perfused, trace b/l LE edema.
Neuro: tongue midline, face symmetric, EOMI, strength 5/5 upper
extremities, negative pronator drift, 4+/5 IP right strength,
[**6-11**] on left, gait normal

FAMILY HISTORY: Mother had MI
Sister with diabetes.
Many family members with alcohol abuse

SOCIAL HISTORY: Lives in [**Location 686**] with her 16yo son. [**Name (NI) **] history of alcohol
abuse, over 10 years. Current smoker. Denies other drug use. Has
been in alcohol detox once - relaped shortly thereafter. Drinks
[**2-8**] to 1 pint brandy per day though is actively trying to quit.
Had set the [**Month/Day (2) 1017**] prior to this episode as her quit date.
Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Encephalopathy, unspecified,Acute posthemorrhagic anemia,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Unspecified viral hepatitis C without hepatic coma,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Backache, unspecified,Other chronic pain
Dieulafoy les,stom&duod,Encephalopathy NOS,Ac posthemorrhag anemia,Alcohol cirrhosis liver,Alcoh dep NEC/NOS-contin,Hpt C w/o hepat coma NOS,Thrombocytopenia NOS,Complic med care NEC/NOS,Backache NOS,Chronic pain NEC
Admission Date:  [**2150-7-29**]              Discharge Date:   [**2150-8-4**]

Date of Birth:  [**2091-12-3**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1115**]
Chief Complaint:
hematemsis


Major Surgical or Invasive Procedure:
Femoral CVC
EGD with clipping

History of Present Illness:
58F w. h/o HCV and etoh cirrhosis hx of varices/[**Doctor First Name 329**] [**Doctor Last Name **]
tear, p/w 2 episdoes of bright red hematemeis, first 11am
reported as 1 quart with blood clots. Second episode 1:30pm.
Also with coughing with pain in chest and lightheaded since day
prior to admission.  Similar episode 2-3 months prior when small
esophageal varices on endoscopy. Denies any recent nausea, or
retching prior to episode of hematemesis. ED notes that her last
drink was [**Doctor Last Name 1017**].
.
Regarding risk factors for bleeding, she drinks a bottle of
vodka/brandy daily. She reports taking aspirin 81 mg daily
(unknown indication, not on prescribed by [**Hospital1 18**] provider). In
addition, has been taking at least 2 advil tablets daily for
past month for chronic lower back pain. Her most recent
admission was for low back pain, fall, weakness following
steroid injection for back pain.
.
Initial Vitals in ED, 97.4, 69, 115/55, 16, 98/RA. She was
transiently hyptotensive to 90s in ED. Exam notable for no
tenderness to palpation.
.
Labs significant for lactate 2.2, creatinine 1.1.  AST 65.
Lipase 99 (baseline 50).  Tox negative including alcohol. WBC
6.9, Hct 27.2 (36.1 in [**6-/2150**]), Platelet 97. INR 1.5.
.
NG lavage with 800cc coffee ground, NGT in place which she
vomited around once in the ED.  Vomited coffee grounds X 1 in
ED. Has 2 18G.  Got 1L NS and 1 U of PRBC was hung.
.
She was started on PPI drip, Ceftriaxone, octreotide. Given
Zofran, Morphine
.
VS on transfer:  119/71, 92, 17, 95/RA. Code not addressed. She
was cross matched for 3 U more.
.
On the floor, she reports no chest pain or shortness of breath.
She denies abdominal pain.
.
ROS: Other ROS unable to obtain given rapid intubation


Past Medical History:
- Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension
- Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension


Social History:
Lives in [**Location 686**] with her 16yo son. [**Name (NI) **] history of alcohol
abuse, over 10 years. Current smoker. Denies other drug use. Has
been in alcohol detox once - relaped shortly thereafter. Drinks
[**2-8**] to 1 pint brandy per day though is actively trying to quit.
Had set the [**Month/Day (2) 1017**] prior to this episode as her quit date.


Family History:
Mother had MI
Sister with diabetes.
Many family members with alcohol abuse

Physical Exam:
ADMISSION EXAM
==============
Vitals: 98.2, 114/50 93, 16, 98/RA
General: Alert, tearful and agitated prior to intubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachycardic rate and reg rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in placed
Ext: warm, well perfused, trace b/l LE edema.
Neuro: tongue midline, face symmetric, EOMI, strength 5/5 upper
extremities, negative pronator drift, 4+/5 IP right strength,
[**6-11**] on left, gait normal

DISCHARGE EXAM
==============
GI: +BS, obese, soft, non-tender, non-distended without rebound
tenderness or guarding
EXT: Warm and well perfused, no edema. RUE with large ecchymosis
in antecubital fossa in region of previous PIV. Radial pulses
palpable bilaterally.
NEURO: Strength and sensation normal in both upper extremities.
4+/5 right IP, [**6-11**] on left. Normal gait.


Pertinent Results:
[**2150-7-29**] 12:30PM BLOOD WBC-6.9 RBC-2.60*# Hgb-9.4*# Hct-27.2*
MCV-105* MCH-36.0* MCHC-34.4 RDW-16.6* Plt Ct-97*
[**2150-7-29**] 07:33PM BLOOD WBC-6.7 RBC-2.89* Hgb-10.3* Hct-28.8*
MCV-100* MCH-35.8* MCHC-35.9* RDW-18.9* Plt Ct-102*
[**2150-8-4**] 05:24AM BLOOD WBC-7.6 RBC-2.92* Hgb-10.1* Hct-29.5*
MCV-101* MCH-34.6* MCHC-34.2 RDW-19.2* Plt Ct-118*
[**2150-7-29**] 12:30PM BLOOD PT-17.1* PTT-29.0 INR(PT)-1.5*
[**2150-8-4**] 05:24AM BLOOD Plt Ct-118*
[**2150-8-4**] 05:24AM BLOOD PT-16.7* PTT-30.7 INR(PT)-1.5*
[**2150-7-29**] 12:30PM BLOOD Glucose-103* UreaN-35* Creat-1.1 Na-138
K-4.5 Cl-106 HCO3-25 AnGap-12
[**2150-7-30**] 02:22AM BLOOD Glucose-145* UreaN-37* Creat-1.1 Na-138
K-4.4 Cl-108 HCO3-22 AnGap-12
[**2150-8-3**] 05:27AM BLOOD Glucose-102* UreaN-8 Creat-0.7 Na-133
K-3.9 Cl-103 HCO3-24 AnGap-10
[**2150-8-4**] 05:24AM BLOOD Glucose-108* UreaN-8 Creat-0.7 Na-135
K-4.0 Cl-106 HCO3-23 AnGap-10
[**2150-7-29**] 12:30PM BLOOD ALT-32 AST-65* AlkPhos-64 TotBili-1.4
[**2150-7-30**] 02:22AM BLOOD ALT-32 AST-63* AlkPhos-64 TotBili-2.8*
[**2150-8-3**] 05:27AM BLOOD ALT-34 AST-66* LD(LDH)-245 AlkPhos-77
TotBili-1.6*
[**2150-8-4**] 05:24AM BLOOD ALT-37 AST-71* AlkPhos-83 TotBili-1.5
[**2150-7-29**] 12:30PM BLOOD Albumin-2.8*
[**2150-7-30**] 02:22AM BLOOD Calcium-8.8 Phos-5.1* Mg-1.7
[**2150-8-3**] 05:27AM BLOOD Calcium-8.7 Phos-3.8 Mg-1.8
[**2150-8-4**] 05:24AM BLOOD Calcium-8.9 Phos-3.4 Mg-1.7
[**2150-7-29**] 12:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**7-29**] blood culture NGTD
[**7-31**] urine culture NGTD
.
CXR [**7-29**]:
AP chest compared to [**6-21**]:
Tip of the endotracheal tube is in standard placement, between 4
and 5 cm
above the carina. Lung volumes are low exaggerating pulmonary
vascular and
cardiac caliber, which are probably normal. No pneumothorax or
pleural
effusions.
.
Upper Endoscopy ([**2150-7-29**])
Findings: Esophagus:
 Protruding Lesions 3 cords of grade I varices were seen in the
esophagus. The varices were not bleeding.
Stomach:
 Contents: Coffee ground heme was seen in the fundus and stomach
body.
 Mucosa: Localized 3 heme spots. Nonbleeding. of the mucosa with
stigmata of recent bleeding was noted in the stomach body at
lesser curvature.
Duodenum: Normal duodenum.
Other
procedures: One triclip was successfully applied to the heme
spot on lesser curvature for the purpose of hemostasis.
Impression: Esophageal varices
3 heme spots. Nonbleeding. in the stomach body at lesser
curvature
Blood in the fundus and stomach body
(endoclip)
Otherwise normal EGD to third part of the duodenum
Additional notes: The attending was present for the entire
procedure. FINAL DIAGNOSIS are listed in the impression section
above. Estimated blood loss = zero. No specimens were taken for
pathology.


Brief Hospital Course:
58 y/o female with HCV/Etoh cirrhosis, low-grade varices,
presented to the ED with upper GI bleeding.
.
# Upper GI Bleed: She was admitted to the ICU and intubated for
airway protection.  She underwent an EGD that revealed heme
spots without significant bleeding in stomach with one area was
clipped for ?duleofoy. There was coffee ground material in the
stomach. There were grade I esophageal varices. No explanation
for the amount of bleeding was seen.  She was started on a
protonix and octreotide drip. She received a total of 4u of
PRBC. She was given a 5 day course of ceftriaxone.  She was
extubated the after twenty four hours. The octreotide and
protonix drip were stopped and she was transferred to the floor.
She continued to be hemodynamically stable without evidence of
ongoing bleeding and stable hematocrit of 28-29.   Her stool
returned to [**Location 213**] color the day prior to discharge and she
denied any melena or hematochezia.
.
# Cirrhosis: Thought to be secondary to etoh and HCV. LFTs at
baseline with mild elevation of lipase likely secondary to
vomiting. Home nadolol, lasix, spironolactone initially held and
then restarted. Hepatology following and will arrange for
outpatient follow up with Dr. [**Last Name (STitle) **].
.
# ETOH abuse: per daughter and [**Name (NI) **], last drink on [**Name (NI) 1017**] prior to
admission. Monitored for signs/symptoms of withdrawal once
extubated. She was seen by SW as an inpatient and plans to quit
drinking with support from family following discharge, but
declined additional services.

# Infiltrated line: Patient complained of pain in right arm
prior to intubation. Her arm was tense and likely received 400
cc of propofol and blood from infiltrated IV. Her radial pulse
was serially monitored and remained intact.  She was evaluated
by plastic surgery but there was no evidence of compartment
syndrome.  Arm still with large ecchymosis in the antecubital
region, but pulses are strong and there are no changes in exam.
.
# Code: DNR but ok to intubate (confirmed with patient), patient
confirmed daughter [**Name (NI) **] as HCP [**Telephone/Fax (1) 69301**]


Medications on Admission:
1. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Multi-Vitamins W/Iron Tablet, Chewable Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. ferrous s
ulfate 300 mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

Disp:*30 Tablet(s)* Refills:*2*
8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

Disp:*30 Tablet(s)* Refills:*2*


Discharge Medications:
1. spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Upper GI bleed


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
It was a pleasure to participate in your care [**Known firstname **] [**Known lastname **].
You were admitted to [**Hospital1 18**] with bleeding from your upper GI
tract. You underwent endoscopy where you were found to have
several lesions that were likely the source of the bleeding, one
of which was clipped. Following the procedure there was no
evidence of continued bleeding and your blood counts remained
stable. You were followed by the liver specialists and will
continue to see them after you leave the hospital. You were
tolerating a regular diet at discharge.

Please continue your home medications with the following
changes:
1. START taking omeprazole to reduce stomach acid

Followup Instructions:
Department: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**]
When: THURSDAY [**2150-8-6**] at 2:00 PM
With: Dr [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 1520**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] South [**Hospital **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
This appointment is with a hospital-based doctor as part of your
transition from the hospital back to your primary care provider.
 [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor
(Dr [**Last Name (STitle) 953**]in follow up.

Department: [**Name (NI) 69302**] pt pcp appt
When: TUESDAY [**2150-8-11**] at 1:45 PM
With: [**Name6 (MD) 69303**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
NOTE: Dr [**First Name8 (NamePattern2) **] [**Name (STitle) 953**] is your new physician in [**Name9 (PRE) 191**] and Dr
[**Last Name (STitle) 953**] works closely with Dr [**First Name8 (NamePattern2) 61904**] [**Last Name (NamePattern1) 5263**] so both will be
involved in your care.  You MUST call your insurance and change
your primary care doctor to Dr [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) 5263**] in [**Hospital **] BEFORE YOUR APPT.
Also, please ask Dr [**Last Name (STitle) 953**] for help in booking a sooner Liver
appt--see below.

Department: LIVER CENTER
When: TUESDAY [**2150-11-10**] at 2:00 PM
With: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
NOTE:  You need to follow up in our Liver Center much sooner
than [**Month (only) 359**].  Please discuss with Dr [**Last Name (STitle) 953**] that you need her
help in obtaining a sooner appt with Dr [**Doctor Last Name 69304**] within
the next two weeks. If you have not heard from the liver center
by your primary care appointment please call [**Telephone/Fax (1) **] to
schedule.
{'Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Encephalopathy, unspecified,Acute posthemorrhagic anemia,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Unspecified viral hepatitis C without hepatic coma,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Backache, unspecified,Other chronic pain'}


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: hematemsis

PRESENT ILLNESS: 58F w. h/o HCV and etoh cirrhosis hx of varices/[**Doctor First Name 329**] [**Doctor Last Name **]
tear, p/w 2 episdoes of bright red hematemeis, first 11am
reported as 1 quart with blood clots. Second episode 1:30pm.
Also with coughing with pain in chest and lightheaded since day
prior to admission.  Similar episode 2-3 months prior when small
esophageal varices on endoscopy. Denies any recent nausea, or
retching prior to episode of hematemesis. ED notes that her last
drink was [**Doctor Last Name 1017**].
.
Regarding risk factors for bleeding, she drinks a bottle of
vodka/brandy daily. She reports taking aspirin 81 mg daily
(unknown indication, not on prescribed by [**Hospital1 18**] provider). In
addition, has been taking at least 2 advil tablets daily for
past month for chronic lower back pain. Her most recent
admission was for low back pain, fall, weakness following
steroid injection for back pain.
.
Initial Vitals in ED, 97.4, 69, 115/55, 16, 98/RA. She was
transiently hyptotensive to 90s in ED. Exam notable for no
tenderness to palpation.
.
Labs significant for lactate 2.2, creatinine 1.1.  AST 65.
Lipase 99 (baseline 50).  Tox negative including alcohol. WBC
6.9, Hct 27.2 (36.1 in [**6-/2150**]), Platelet 97. INR 1.5.
.
NG lavage with 800cc coffee ground, NGT in place which she
vomited around once in the ED.  Vomited coffee grounds X 1 in
ED. Has 2 18G.  Got 1L NS and 1 U of PRBC was hung.
.
She was started on PPI drip, Ceftriaxone, octreotide. Given
Zofran, Morphine
.
VS on transfer:  119/71, 92, 17, 95/RA. Code not addressed. She
was cross matched for 3 U more.
.
On the floor, she reports no chest pain or shortness of breath.
She denies abdominal pain.
.
ROS: Other ROS unable to obtain given rapid intubation

MEDICAL HISTORY: - Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension
- Alcoholic cirrhosis- low grade varices- not banded, not
bleeding in past. Peripheral edema (on lasix 20mg daily). 1 pint
brandy per day for more than a year. She had tried detox once.
Denies withdrawal
seizures.
- Chronic Back pain
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Hypertension

MEDICATION ON ADMISSION: 1. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Multi-Vitamins W/Iron Tablet, Chewable Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. ferrous s
ulfate 300 mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
==============
Vitals: 98.2, 114/50 93, 16, 98/RA
General: Alert, tearful and agitated prior to intubation
HEENT: Sclera anicteric, MMM, oropharynx clear
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachycardic rate and reg rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding, no organomegaly
GU: foley in placed
Ext: warm, well perfused, trace b/l LE edema.
Neuro: tongue midline, face symmetric, EOMI, strength 5/5 upper
extremities, negative pronator drift, 4+/5 IP right strength,
[**6-11**] on left, gait normal

FAMILY HISTORY: Mother had MI
Sister with diabetes.
Many family members with alcohol abuse

SOCIAL HISTORY: Lives in [**Location 686**] with her 16yo son. [**Name (NI) **] history of alcohol
abuse, over 10 years. Current smoker. Denies other drug use. Has
been in alcohol detox once - relaped shortly thereafter. Drinks
[**2-8**] to 1 pint brandy per day though is actively trying to quit.
Had set the [**Month/Day (2) 1017**] prior to this episode as her quit date. 

### Response:
{'Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Encephalopathy, unspecified,Acute posthemorrhagic anemia,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, continuous,Unspecified viral hepatitis C without hepatic coma,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Backache, unspecified,Other chronic pain'}
