CHIEF COMPLAINT: Melena

PRESENT ILLNESS: Ms. [**Known lastname 46**] is a 66-year-old woman with history of HTN, DCIS s/p
lumpectomy, XRT, and tamoxifen therapy, remote cervical cancer,
presenting with dizziness and four days of black tarry stool.
Patient had been having ongoing hip pain and difficulty
ambulating for which she had been taking tylenol and naproxen
for the past several weeks. Four days prior to admission patient
had an episode of epigastric pain that lasted for a few hours
and then resolved. She noticed dark bowel movements on Wednesday
and Thursday.  She was seen at her PCP's office yesterday and
was prescribed omeprazole and nabumetone.  The night prior to
admission, patient got up to use the restroom and had a
presyncopal episode, no fall, no LOC.  She has been dizzy since
that time.  Patient also had a black bowel movement the night
prior to admission and the morning of admission.  She has had no
nausea, hematemesis, or vomiting.  Currently no abdominal pain.
No fevers and chills. No chest pain, shortness of breath,
dizziness, lightheadedness.

MEDICAL HISTORY: DCIS status post lumpectomy, XRT, and tamoxifen
Cervical cancer s/p hysterectomy
Left ankle fracture
Hypertension
Former tobacco use

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Amlodipine 10 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]
4. Hydrochlorothiazide 25 mg PO DAILY
5. Nabumetone 500 mg PO BID
6. Omeprazole 20 mg PO DAILY
7. Acetaminophen 325 mg PO Q6H:PRN pain
8. Aspirin 81 mg PO DAILY
9. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral Daily
10. Cetirizine *NF* unknown  Oral Daily
11. Multivitamins 1 TAB PO DAILY
12. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS

ALLERGIES: Percocet

PHYSICAL EXAM: Admission exam:
Vitals: T: 99.9 BP: 149/77 P: 79 R: 17 O2: 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, obese, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation

FAMILY HISTORY: Mother - lung cancer
Father - Bladder cancer

SOCIAL HISTORY: Patient lives with her husband. [**Name (NI) 1403**] at [**Hospital6 13185**].
- Tobacco:  Currently smokes 10 cigarettes per month, previously
smoked 1 PPD
- Alcohol:  3 drinks per day
- Illicits:  None
Acute gastric ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Duodenitis, without mention of hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Tachycardia, unspecified,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Leukocytosis, unspecified,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of cervix uteri,Personal history of irradiation, presenting hazards to health,Family history of malignant neoplasm of trachea, bronchus, and lung
Ac stomach ulcer w hem,Hyposmolality,Ac posthemorrhag anemia,Duodenitis w/o hmrhg,Adv eff analgesic NOS,Tachycardia NOS,Adv eff sympatholytics,Leukocytosis NOS,Hypertension NOS,Osteoarthros NOS-pelvis,Tobacco use disorder,Hx of breast malignancy,Hx-cervical malignancy,Hx of irradiation,Fm hx-trach/bronchog mal
Admission Date:  [**2116-4-25**]              Discharge Date:   [**2116-4-28**]

Date of Birth:  [**2050-3-21**]             Sex:   F

Service: MEDICINE

Allergies:
Percocet

Attending:[**First Name3 (LF) 4095**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
EGD with clipping of pyloric ulcers

History of Present Illness:
Ms. [**Known lastname 46**] is a 66-year-old woman with history of HTN, DCIS s/p
lumpectomy, XRT, and tamoxifen therapy, remote cervical cancer,
presenting with dizziness and four days of black tarry stool.
Patient had been having ongoing hip pain and difficulty
ambulating for which she had been taking tylenol and naproxen
for the past several weeks. Four days prior to admission patient
had an episode of epigastric pain that lasted for a few hours
and then resolved. She noticed dark bowel movements on Wednesday
and Thursday.  She was seen at her PCP's office yesterday and
was prescribed omeprazole and nabumetone.  The night prior to
admission, patient got up to use the restroom and had a
presyncopal episode, no fall, no LOC.  She has been dizzy since
that time.  Patient also had a black bowel movement the night
prior to admission and the morning of admission.  She has had no
nausea, hematemesis, or vomiting.  Currently no abdominal pain.
No fevers and chills. No chest pain, shortness of breath,
dizziness, lightheadedness.

In the ED, initial VS were:  98.2 80 132/69 18 100% RA. Exam was
significant for conjunctival pallor, melena on rectal exam. Labs
significant for WBC 14.4, HCT of 26.1 down from 39.7 in [**8-/2114**],
Na of 130, BUN of 29, Creatinine of 0.6.  Patient had a CXR
showing no infiltrates or effusions.  Patient received protonix
80 mg IV x1 followed by a protonix gtt. Received potassium
chloride 40 mEq IV x1.  IV access with 1 18 gauge and 1 20 gauge
PIV.  Patient was admitted to the MICU.

Past Medical History:
DCIS status post lumpectomy, XRT, and tamoxifen
Cervical cancer s/p hysterectomy
Left ankle fracture
Hypertension
Former tobacco use


Social History:
Patient lives with her husband. [**Name (NI) 1403**] at [**Hospital6 13185**].
- Tobacco:  Currently smokes 10 cigarettes per month, previously
smoked 1 PPD
- Alcohol:  3 drinks per day
- Illicits:  None


Family History:
Mother - lung cancer
Father - Bladder cancer


Physical Exam:
Admission exam:
Vitals: T: 99.9 BP: 149/77 P: 79 R: 17 O2: 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, obese, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation


Pertinent Results:
Admission labs:
[**2116-4-25**] 01:50PM BLOOD WBC-14.4*# RBC-2.55*# Hgb-8.7*#
Hct-26.1*# MCV-102* MCH-34.2* MCHC-33.5 RDW-14.0 Plt Ct-330
[**2116-4-25**] 02:46PM BLOOD PT-11.7 PTT-28.9 INR(PT)-1.1
[**2116-4-25**] 01:50PM BLOOD Glucose-142* UreaN-29* Creat-0.6 Na-130*
K-2.9* Cl-87* HCO3-27 AnGap-19
[**2116-4-25**] 01:50PM BLOOD ALT-17 AST-30 AlkPhos-51 TotBili-0.5
[**2116-4-25**] 01:50PM BLOOD Albumin-4.6 Calcium-10.2 Phos-3.1 Mg-2.1

Chest X-Ray [**2116-4-25**]:  The heart size is normal.  The hilar and
mediastinal contours are within
normal limits.  There is no pneumothorax, focal consolidation,
or pleural effusion.  Clips are noted projecting over the left
axilla.
IMPRESSION:  No acute intrathoracic process.

Brief Hospital Course:
Ms. [**Known lastname 46**] is a 66 year-old with h/o HTN, DCIS s/p
lumpectomy/XRT/Tamoxifen, presenting with four days of black
tarry stool and anemia in setting of NSAID use.
.
#  ACUTE BLOOD LOSS ANEMIA SECONDARY TO GI BLEED: Patient with
four days of tarry stool and drop in HCT from 39 -> 26 in
setting of NSAID use.  [**Location (un) 2611**]-[**Doctor Last Name 80870**] Bleeding Score was 15.
 Patient was hemodynamically stable but admitted to MICU for
closer monitoring and for EGD.  Ms. [**Known lastname 46**] [**Last Name (NamePattern1) 93000**] 2 units
PRBCs for low hct.  On EGD, patient had pyloric ulcers that were
clipped and injected with epi.  She was initially started on a
protonix gtt and then transitioned to protonix IV bid.  Patient
was discharged on omeprazole 40mg [**Hospital1 **] (she already had
omeprazole at home).  Her atenolol was started at 50mg QD, and
amlodipine and hctz were held.  These antihypertensives can be
restarted at the discretion of patient's PCP.  [**Name10 (NameIs) **], patient
will have a hct check on [**2116-5-4**].  Her ASA (taken for stroke
prevention, no history of CAD) was held until primary care
appointment on [**2116-5-4**].  She knows to avoid NSAIDs in the future.
 Ms. [**Known lastname 46**] will have a repeat EGD in 8 weeks.  Her H.Pylori
serum antigen will need to be followed up.
.
# LEUKOCYTOSIS:  Resolved without intervention.
.
# ETOH USE:  Patient has at least 3 drinks/day.  Evidence of
macrocytosis on CBC despite upper GI bleed.  No signs or
symptoms of withdrawal during admission.  Patient was encouraged
to refrain from ETOH use in the setting of GI bleed.

#  MACROCYTIC ANEMIA:  Likely in the setting of ETOH use.
However, if persists, may warrant further investigation.

# TACHYCARDIA:  Patient with tachycardia on the general medicine
floor with negative orthostatics.  However, she was normotensive
despite not being on her 3 home anti-hypertensives.  Tachycardia
likely in the setting of relative volume depletion and
beta-blocker withdrawal.  Ms. [**Known lastname 46**] was restarted on atenolol
50mg QD and her amlodipine and hctz were held.  These
medications can be restarted at follow-up appointment if she is
hypertensive.
.
Transitional issues:
[ ] Repeat hct
[ ] Repeat EGD in 8 weeks
[ ] Follow-up serum H.Pylori
[ ] Restart home antihypertensives if needed
[ ] Follow-up macrocytosis

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Amlodipine 10 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]
4. Hydrochlorothiazide 25 mg PO DAILY
5. Nabumetone 500 mg PO BID
6. Omeprazole 20 mg PO DAILY
7. Acetaminophen 325 mg PO Q6H:PRN pain
8. Aspirin 81 mg PO DAILY
9. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral Daily
10. Cetirizine *NF* unknown  Oral Daily
11. Multivitamins 1 TAB PO DAILY
12. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS

Discharge Medications:
1. Atenolol 50 mg PO DAILY
Please hold for SBP <100 or HR<50.
RX *atenolol 50 mg Once a day Disp #*30 Tablet Refills:*0
2. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS
3. Multivitamins 1 TAB PO DAILY
4. Omeprazole 40 mg PO BID
RX *omeprazole 40 mg Twice a day Disp #*60 Capsule Refills:*3
5. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]
6. Cetirizine *NF* 10 mg ORAL DAILY
7. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral Daily

Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis: Pyloric ulcers [**1-2**] NSAID use

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

Discharge Instructions:
Dear Ms. [**Known lastname 46**],

It was a pleasure taking care of you during your
hospitalization. You were admitted with tarry stools and were
found to have blood loss due to stomach ulcers.  Likely these
ulcers developed from the Naproxen that your were taking for hip
pain.  Alcohol use can also predispose to these types of ulcers.
You were treated with a procedure to stop the bleeding from the
ulcers and with medications to reduce stomach acid.  You were
given blood transfusions to help you recover from the blood
loss.

You will need to have your blood levels checked on Monday [**5-4**] at
your PCP [**Name Initial (PRE) 648**].

You have an appointment for a repeat endoscopy on [**2116-6-23**] at
12:30pm.

The following changes were made to your medications:
--START taking atenolol 50mg once a day instead of 100mg once a
day
--STOP taking HCTZ 25 mg once a day
--STOP taking amlodipine 10 mg once a day
--STOP taking Nabumetone 500 mg [**Hospital1 **]
--START taking Omeprazole 40mg twice a day
--STOP taking Aspirin 81 mg once a day until you see your doctor
--DO not take any NSAIDs
.
Please return to the hospital if you develop lightheadedness,
palpiations, dizziness, continued dark stools, nausea, vomiting,
abdominal pain, fevers, chills, or other concerning signs or
symptoms.

Followup Instructions:
Department: [**Hospital3 249**]
When: MONDAY [**2116-5-4**] at 1:40 PM
With: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

[**2116-6-23**]  12:30p   WPC ROOM,THREE
[**Hospital Ward Name **] BUILDING ([**Hospital Ward Name **] COMPLEX), [**Location (un) **]
WPC ROOMS/BAYS
[**2116-6-23**]  12:30p   [**First Name8 (NamePattern2) **] [**Location (un) **],WPC WEST
[**Hospital Ward Name **] BUILDING ([**Hospital Ward Name **] COMPLEX), [**Location (un) **]
ENDOSCOPY SUITES

Department: [**Hospital3 1935**] CENTER
When: MONDAY [**2116-5-11**] at 9:30 AM
With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital3 249**]
When: FRIDAY [**2116-5-29**] at 8:30 AM
With: [**First Name11 (Name Pattern1) 674**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute gastric ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Duodenitis, without mention of hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Tachycardia, unspecified,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Leukocytosis, unspecified,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of cervix uteri,Personal history of irradiation, presenting hazards to health,Family history of malignant neoplasm of trachea, bronchus, and lung'}


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 46**] is a 66-year-old woman with history of HTN, DCIS s/p
lumpectomy, XRT, and tamoxifen therapy, remote cervical cancer,
presenting with dizziness and four days of black tarry stool.
Patient had been having ongoing hip pain and difficulty
ambulating for which she had been taking tylenol and naproxen
for the past several weeks. Four days prior to admission patient
had an episode of epigastric pain that lasted for a few hours
and then resolved. She noticed dark bowel movements on Wednesday
and Thursday.  She was seen at her PCP's office yesterday and
was prescribed omeprazole and nabumetone.  The night prior to
admission, patient got up to use the restroom and had a
presyncopal episode, no fall, no LOC.  She has been dizzy since
that time.  Patient also had a black bowel movement the night
prior to admission and the morning of admission.  She has had no
nausea, hematemesis, or vomiting.  Currently no abdominal pain.
No fevers and chills. No chest pain, shortness of breath,
dizziness, lightheadedness.

MEDICAL HISTORY: DCIS status post lumpectomy, XRT, and tamoxifen
Cervical cancer s/p hysterectomy
Left ankle fracture
Hypertension
Former tobacco use

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Amlodipine 10 mg PO DAILY
2. Atenolol 100 mg PO DAILY
3. Fluticasone Propionate NASAL 2 SPRY NU [**Hospital1 **]
4. Hydrochlorothiazide 25 mg PO DAILY
5. Nabumetone 500 mg PO BID
6. Omeprazole 20 mg PO DAILY
7. Acetaminophen 325 mg PO Q6H:PRN pain
8. Aspirin 81 mg PO DAILY
9. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral Daily
10. Cetirizine *NF* unknown  Oral Daily
11. Multivitamins 1 TAB PO DAILY
12. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS

ALLERGIES: Percocet

PHYSICAL EXAM: Admission exam:
Vitals: T: 99.9 BP: 149/77 P: 79 R: 17 O2: 98% on RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, obese, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation

FAMILY HISTORY: Mother - lung cancer
Father - Bladder cancer

SOCIAL HISTORY: Patient lives with her husband. [**Name (NI) 1403**] at [**Hospital6 13185**].
- Tobacco:  Currently smokes 10 cigarettes per month, previously
smoked 1 PPD
- Alcohol:  3 drinks per day
- Illicits:  None 

### Response:
{'Acute gastric ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Duodenitis, without mention of hemorrhage,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Tachycardia, unspecified,Sympatholytics [antiadrenergics] causing adverse effects in therapeutic use,Leukocytosis, unspecified,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of cervix uteri,Personal history of irradiation, presenting hazards to health,Family history of malignant neoplasm of trachea, bronchus, and lung'}
