CHIEF COMPLAINT: Melena

PRESENT ILLNESS: Ms. [**Known lastname 32130**] is a 46 yo woman with history of asthma and
occasional GERD now admitted to the ICU with 5 day history of
black tarry stool, lightheadedness, fatigue, pallor and HCT 19
with guaiac positive stool in ED and negative NG lavage. Mrs.
[**Known lastname 32130**] reports initial complaint of nausea on [**1-4**] associated
with lightheadedness after teaching 2 yoga classes. Symptoms
improved with rest and she then had noted decreased appetite and
had episode of diaphoresis with presyncope at dinner which
resolved with cold packs. She noted ongoing fatigue and weakness
on [**1-5**] and had first black tarry stool x [**1-14**] in am. Stools
prior to this had always been normal and regular. She attributed
this to stress and possible viral infection. On [**1-6**] she had
[**2-15**] black tarry stools but subsequently had normal BMs on [**1-7**]
and [**1-8**] so she did not seek medical evaluation.
.
This am, she had black stool x 1 and overall fatigue with DOE
climbing one flight of stairs so saw PCP who sent her to ED for
further eval given pallor and concern for GIB. Orthostatics
prior to transfer: supine: 118/58 88 upright 112/62 104. She
denies any history of similar symptoms, denies abdominal pain,
chest pain, vomiting, and BRBPR but does have feeling of
"hunger/cramping". She takes aleve prn menstrual cramping most
recently took 2-3 tabs total [**1-1**] and [**1-2**]. LMP [**12-29**]. She
denies any other nsaid use but does not increased stress related
to financial situation trying to support her family and run a
business. Also reports occasional GERD, most recently 1-1.5
weeks ago after eating Indian food for which she took Tums with
good effect.
.
In the emergency department, initial VS:98.2 151/79 107 16
100%RA. She was mentating well but appeared pale with HCT 19.6
and rectal exam was positive for guaiac positive black tarry
stool. NG lavage was negative. She received 1L NS and was typed
and crossed for 4 units and received 1 unit PRBCs. PIV x 2 18g
were placed. GI was consulted who recommended bolusing and
starting Pantoprazole drip with plan to scope tomorrow. Reason
for MICU admission was PPI drip.
.
Upon arrival to [**Hospital Unit Name 153**], she reports she is feeling much better
after 1 unit PRBCs.
.
REVIEW OF SYSTEMS:
(+)ve:Recent sore throat x 1 day and, nasal congestion, cough
and worsening of asthma over last 4-5 days. Also reports HA,
strain left leg related to yoga.
(-)ve: fever, chills, night sweats, chest pain, sputum
production, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea,
vomiting, diarrhea, constipation, hematochezia, dysuria, urinary
frequency, urinary urgency, focal numbness, focal weakness,
myalgias, arthralgias

MEDICAL HISTORY: Asthma
Seasonal allergies
Occasional GERD with spicy foods

MEDICATION ON ADMISSION: Advair 250 [**Hospital1 **]
Atrovent QID
Tylenol prn
Aleve prn last dose 12/21

ALLERGIES: Sudafed

PHYSICAL EXAM: GENERAL: Pleasant, well appearing woman in NAD
HEENT: Normocephalic, atraumatic. + conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally, no wheezes with
forced exhalation.
ABDOMEN: NABS. Soft, NT, ND. No HSM. Reports "cramping right
side of abdomen" but no TTP
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately although
occasionally tearful

FAMILY HISTORY: No FH of bleeding disorder, colon or GI malignancy or IBD.
Mother - died young of [**Name (NI) 4278**]. Father primary
hyperparathyroidism per OMR, DM, HTN, high chol, arrhythmia,
pacemaker. Grandparents lived to 90's.
.

SOCIAL HISTORY: Married with two children (8 and 11 yo daughters). She owns her
own business teaching yoga to children. Denies tobacco. Drinks
0.5-1 glass red wine per night. No drug use. Exercises
4x/wk - walking, biking and yoga. Increased stress related to
financial concerns (unable to afford skating classes for 11 yo
daughter)
Blood in stool,Acute posthemorrhagic anemia,Syncope and collapse,Esophageal reflux,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Asthma, unspecified type, unspecified,Other allergy, other than to medicinal agents,Anxiety state, unspecified
Blood in stool,Ac posthemorrhag anemia,Syncope and collapse,Esophageal reflux,Adv eff analgesic NOS,Dvrtclo colon w/o hmrhg,Int hemorrhoid w/o compl,Asthma NOS,Hx-allergy NEC,Anxiety state NOS
Admission Date:  [**2119-1-9**]              Discharge Date:   [**2119-1-12**]

Date of Birth:  [**2072-11-9**]             Sex:   F

Service: MEDICINE

Allergies:
Sudafed

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
EGD [**1-10**]

History of Present Illness:
Ms. [**Known lastname 32130**] is a 46 yo woman with history of asthma and
occasional GERD now admitted to the ICU with 5 day history of
black tarry stool, lightheadedness, fatigue, pallor and HCT 19
with guaiac positive stool in ED and negative NG lavage. Mrs.
[**Known lastname 32130**] reports initial complaint of nausea on [**1-4**] associated
with lightheadedness after teaching 2 yoga classes. Symptoms
improved with rest and she then had noted decreased appetite and
had episode of diaphoresis with presyncope at dinner which
resolved with cold packs. She noted ongoing fatigue and weakness
on [**1-5**] and had first black tarry stool x [**1-14**] in am. Stools
prior to this had always been normal and regular. She attributed
this to stress and possible viral infection. On [**1-6**] she had
[**2-15**] black tarry stools but subsequently had normal BMs on [**1-7**]
and [**1-8**] so she did not seek medical evaluation.
.
This am, she had black stool x 1 and overall fatigue with DOE
climbing one flight of stairs so saw PCP who sent her to ED for
further eval given pallor and concern for GIB. Orthostatics
prior to transfer: supine: 118/58 88 upright 112/62 104. She
denies any history of similar symptoms, denies abdominal pain,
chest pain, vomiting, and BRBPR but does have feeling of
"hunger/cramping". She takes aleve prn menstrual cramping most
recently took 2-3 tabs total [**1-1**] and [**1-2**]. LMP [**12-29**]. She
denies any other nsaid use but does not increased stress related
to financial situation trying to support her family and run a
business. Also reports occasional GERD, most recently 1-1.5
weeks ago after eating Indian food for which she took Tums with
good effect.
.
In the emergency department, initial VS:98.2 151/79 107 16
100%RA. She was mentating well but appeared pale with HCT 19.6
and rectal exam was positive for guaiac positive black tarry
stool. NG lavage was negative. She received 1L NS and was typed
and crossed for 4 units and received 1 unit PRBCs. PIV x 2 18g
were placed. GI was consulted who recommended bolusing and
starting Pantoprazole drip with plan to scope tomorrow. Reason
for MICU admission was PPI drip.
.
Upon arrival to [**Hospital Unit Name 153**], she reports she is feeling much better
after 1 unit PRBCs.
.
REVIEW OF SYSTEMS:
(+)ve:Recent sore throat x 1 day and, nasal congestion, cough
and worsening of asthma over last 4-5 days. Also reports HA,
strain left leg related to yoga.
(-)ve: fever, chills, night sweats, chest pain, sputum
production, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea,
vomiting, diarrhea, constipation, hematochezia, dysuria, urinary
frequency, urinary urgency, focal numbness, focal weakness,
myalgias, arthralgias


Past Medical History:
Asthma
Seasonal allergies
Occasional GERD with spicy foods


Social History:
Married with two children (8 and 11 yo daughters). She owns her
own business teaching yoga to children. Denies tobacco. Drinks
0.5-1 glass red wine per night. No drug use. Exercises
4x/wk - walking, biking and yoga. Increased stress related to
financial concerns (unable to afford skating classes for 11 yo
daughter)


Family History:
No FH of bleeding disorder, colon or GI malignancy or IBD.
Mother - died young of [**Name (NI) 4278**]. Father primary
hyperparathyroidism per OMR, DM, HTN, high chol, arrhythmia,
pacemaker. Grandparents lived to 90's.
.


Physical Exam:
GENERAL: Pleasant, well appearing woman in NAD
HEENT: Normocephalic, atraumatic. + conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally, no wheezes with
forced exhalation.
ABDOMEN: NABS. Soft, NT, ND. No HSM. Reports "cramping right
side of abdomen" but no TTP
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately although
occasionally tearful


Pertinent Results:
EGD [**1-9**]:
Schatzki's Ring at distal Esophagus.
No stigmata of bleeding noted
Otherwise normal EGD to third part of the duodenum


Brief Hospital Course:
46 year old woman with asthma who was admitted with GI bleed.
She used NSAID for menstrual pain. She had an acute onset of
melena consistent with upper GI bleed (although NG lavage
reportedly negative in ED). However, upper endoscopy revealed no
source of bleeding. The colonoscopy showed dry blood in the
cecum which confirmed the suspicion of a higher bleed. At
admission, the patient's HCT was 19 but she remained
hemodynamically stable with HR 90s-100s, normal BP, and normal
mental status. She was initially treated with PPI drip but
changed to PO PPI after negative upper endoscopy. She was
transfused 3 units PRBCs and HCT rose appropriately. She was
monitored for additional 24 hours after her colonoscopy and 30
hours after her last transfusion with stable HCT. Her last bowel
movement on the day of discharge was completely normal. She
therefore requested discharge. Of note she had leukocytosis
related to stress reaction for GI bleed and had no other
localizing symptoms/signs of infection. The patient was
discharged on Iron. She may need repeat EGD or capsule endoscopy
if she gets recurrent GI bleed. No NSAIDS. She will have a close
follow up with PCP/GI to discuss the indications for Capsule
endoscopy. She was informed about symptoms/signs of bleeding.

Medications on Admission:
Advair 250 [**Hospital1 **]
Atrovent QID
Tylenol prn
Aleve prn last dose 12/21


Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Combivent 18-103 mcg/Actuation Aerosol Sig: One (1)
Inhalation four times a day.
3. 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*
4. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*3*


Discharge Disposition:
Home

Discharge Diagnosis:
gastrointestinal bleeding

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

Discharge Instructions:
You had gastrointestinal bleeding. Avoid NSAIDs: Ibuprofen,
Advil, Indocin, Indomethacin, Diclofenac, Meloxicam, Naproxen,
etc. If you have a recurrent bleeding you may need repeat EGD or
Capsule endoscopy. You are going to discuss these options with
your GI doctor during your close follow up appointment. You need
to take Iron with Vit C/[**Location (un) 2452**] juice and laxatives. Iron
treatment is for at least 3 months.

Followup Instructions:
Appointment #1

MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]

Specialty: Internal Medicine/ PCP

Date/ Time: Tuesday, [**1-24**], 3pm

Location: [**Location (un) **], [**Location (un) **]

Phone number: [**Telephone/Fax (1) 4775**]

Appointment #2

MD: [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 679**]

Specialty: Gastroenterology

Date/ Time: Wednesday, [**1-25**], 9:15

Location: [**Last Name (NamePattern1) **], [**Hospital Unit Name **], [**Hospital Unit Name **]

Phone number: [**Telephone/Fax (1) 682**]

Provider: [**Name10 (NameIs) 2352**] MAMMOGRAPHY Phone:[**Telephone/Fax (1) 4832**]
Date/Time:[**2119-1-18**] 10:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8988**], MD Phone:[**Telephone/Fax (1) 4775**]
Date/Time:[**2119-3-20**] 11:30
{'Blood in stool,Acute posthemorrhagic anemia,Syncope and collapse,Esophageal reflux,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Asthma, unspecified type, unspecified,Other allergy, other than to medicinal agents,Anxiety state, unspecified'}


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

PRESENT ILLNESS: Ms. [**Known lastname 32130**] is a 46 yo woman with history of asthma and
occasional GERD now admitted to the ICU with 5 day history of
black tarry stool, lightheadedness, fatigue, pallor and HCT 19
with guaiac positive stool in ED and negative NG lavage. Mrs.
[**Known lastname 32130**] reports initial complaint of nausea on [**1-4**] associated
with lightheadedness after teaching 2 yoga classes. Symptoms
improved with rest and she then had noted decreased appetite and
had episode of diaphoresis with presyncope at dinner which
resolved with cold packs. She noted ongoing fatigue and weakness
on [**1-5**] and had first black tarry stool x [**1-14**] in am. Stools
prior to this had always been normal and regular. She attributed
this to stress and possible viral infection. On [**1-6**] she had
[**2-15**] black tarry stools but subsequently had normal BMs on [**1-7**]
and [**1-8**] so she did not seek medical evaluation.
.
This am, she had black stool x 1 and overall fatigue with DOE
climbing one flight of stairs so saw PCP who sent her to ED for
further eval given pallor and concern for GIB. Orthostatics
prior to transfer: supine: 118/58 88 upright 112/62 104. She
denies any history of similar symptoms, denies abdominal pain,
chest pain, vomiting, and BRBPR but does have feeling of
"hunger/cramping". She takes aleve prn menstrual cramping most
recently took 2-3 tabs total [**1-1**] and [**1-2**]. LMP [**12-29**]. She
denies any other nsaid use but does not increased stress related
to financial situation trying to support her family and run a
business. Also reports occasional GERD, most recently 1-1.5
weeks ago after eating Indian food for which she took Tums with
good effect.
.
In the emergency department, initial VS:98.2 151/79 107 16
100%RA. She was mentating well but appeared pale with HCT 19.6
and rectal exam was positive for guaiac positive black tarry
stool. NG lavage was negative. She received 1L NS and was typed
and crossed for 4 units and received 1 unit PRBCs. PIV x 2 18g
were placed. GI was consulted who recommended bolusing and
starting Pantoprazole drip with plan to scope tomorrow. Reason
for MICU admission was PPI drip.
.
Upon arrival to [**Hospital Unit Name 153**], she reports she is feeling much better
after 1 unit PRBCs.
.
REVIEW OF SYSTEMS:
(+)ve:Recent sore throat x 1 day and, nasal congestion, cough
and worsening of asthma over last 4-5 days. Also reports HA,
strain left leg related to yoga.
(-)ve: fever, chills, night sweats, chest pain, sputum
production, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea,
vomiting, diarrhea, constipation, hematochezia, dysuria, urinary
frequency, urinary urgency, focal numbness, focal weakness,
myalgias, arthralgias

MEDICAL HISTORY: Asthma
Seasonal allergies
Occasional GERD with spicy foods

MEDICATION ON ADMISSION: Advair 250 [**Hospital1 **]
Atrovent QID
Tylenol prn
Aleve prn last dose 12/21

ALLERGIES: Sudafed

PHYSICAL EXAM: GENERAL: Pleasant, well appearing woman in NAD
HEENT: Normocephalic, atraumatic. + conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally, no wheezes with
forced exhalation.
ABDOMEN: NABS. Soft, NT, ND. No HSM. Reports "cramping right
side of abdomen" but no TTP
EXTREMITIES: No edema, 2+ dorsalis pedis/ posterior tibial
pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. Gait assessment deferred
PSYCH: Listens and responds to questions appropriately although
occasionally tearful

FAMILY HISTORY: No FH of bleeding disorder, colon or GI malignancy or IBD.
Mother - died young of [**Name (NI) 4278**]. Father primary
hyperparathyroidism per OMR, DM, HTN, high chol, arrhythmia,
pacemaker. Grandparents lived to 90's.
.

SOCIAL HISTORY: Married with two children (8 and 11 yo daughters). She owns her
own business teaching yoga to children. Denies tobacco. Drinks
0.5-1 glass red wine per night. No drug use. Exercises
4x/wk - walking, biking and yoga. Increased stress related to
financial concerns (unable to afford skating classes for 11 yo
daughter) 

### Response:
{'Blood in stool,Acute posthemorrhagic anemia,Syncope and collapse,Esophageal reflux,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Asthma, unspecified type, unspecified,Other allergy, other than to medicinal agents,Anxiety state, unspecified'}
