CHIEF COMPLAINT: Vomiting blood

PRESENT ILLNESS: This is a 31 y.o male w/ past medical history of GERD and
alcohol abuse who reports being in his normal state of health
until last night when he developed nausea and went to the
bathroom where he vomited [**11-26**] tablespoons of red blood mixed w/
emesis. He had previously had symptoms similar to this so he
wasn't particularly concerned and then went back to bed. He went
on to have two further episodes of bloody emesis during which he
filled up the sink and then the toilet with what appeared to be
pure blood by his report. This led him to seek care at [**Hospital 1562**]
Hospital. There, he was hemodynamically stable by report but
nevertheless received two units of blood and was started on
octreotide and PPI drips and was trensferred here. Over the
course of these symptoms he reports that he developed mild to
moderate epigastric pain. No chest pain or shortness of breath.
He reports he did develop some dizziness as he was riding to
[**Hospital1 1562**] but has had none since. No syncope.
.
In the ED, initial VS were T 97.2, P 83, BP 139/80, RR 16, O2
Sat 97 % on RA. He was placed on PPI drip and an NG lavage was
done that yielded red blood which then failed to clear. His PPI
and octreotide drips were continued and he was admited to the
ICU.
.
Currently, he reports mild abdominal discomfort and nausea but
no other symptoms at this time.
.
Review of systems: No fevers, chills, weight loss, night sweats.
Reports
.

MEDICAL HISTORY: Past Medical History:
-MVA in [**2173**] with multiple fractures, now takes chronic
narcotics for chronic pain
-History of GSW to right leg
-GERD

MEDICATION ON ADMISSION: Oxycodone/APAP PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile 142/75 p80 96%RA
Large M sitting in unit bed without shirt on, wife in chair next
to bed, watching Pats game on TV. Nice, alert, oriented, no
distress.
CTAB no w/c/r/r
S1 S2 are clear, light 1-2/6 systolic murmur noted, with heart
sounds and murmur decreasing in intensity moving towards the
apex. Radial pulses are 2+ bilaterally.
Abd with prominent midline scar from ex lap, per pt. No TTP in
any quadrant. BS+.
RUE has 2 PIV's well placed. No c/c/e.
RLE with scar tissue on anterior aspect of shin, LLE with
prominent scar tissue and deformity near ankle. DP's are 2+.
There is no LE edema.

FAMILY HISTORY: Mother reportedly died of "untreated ulcer"

SOCIAL HISTORY: EtOH abuse in the past, currently 1ppd, has wife and 2 children
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Esophageal reflux,Alcohol abuse, unspecified,Unspecified essential hypertension,Other chronic pain
Chr stomach ulc w hem,Ac posthemorrhag anemia,Helicobacter pylori,Esophageal reflux,Alcohol abuse-unspec,Hypertension NOS,Chronic pain NEC
Admission Date:  [**2185-9-3**]              Discharge Date:   [**2185-9-5**]

Date of Birth:  [**2153-12-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9454**]
Chief Complaint:
Vomiting blood

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy (EGD)


History of Present Illness:
This is a 31 y.o male w/ past medical history of GERD and
alcohol abuse who reports being in his normal state of health
until last night when he developed nausea and went to the
bathroom where he vomited [**11-26**] tablespoons of red blood mixed w/
emesis. He had previously had symptoms similar to this so he
wasn't particularly concerned and then went back to bed. He went
on to have two further episodes of bloody emesis during which he
filled up the sink and then the toilet with what appeared to be
pure blood by his report. This led him to seek care at [**Hospital 1562**]
Hospital. There, he was hemodynamically stable by report but
nevertheless received two units of blood and was started on
octreotide and PPI drips and was trensferred here. Over the
course of these symptoms he reports that he developed mild to
moderate epigastric pain. No chest pain or shortness of breath.
He reports he did develop some dizziness as he was riding to
[**Hospital1 1562**] but has had none since. No syncope.
.
In the ED, initial VS were T 97.2, P 83, BP 139/80, RR 16, O2
Sat 97 % on RA. He was placed on PPI drip and an NG lavage was
done that yielded red blood which then failed to clear. His PPI
and octreotide drips were continued and he was admited to the
ICU.
.
Currently, he reports mild abdominal discomfort and nausea but
no other symptoms at this time.
.
Review of systems: No fevers, chills, weight loss, night sweats.
Reports
.


Past Medical History:
Past Medical History:
-MVA in [**2173**] with multiple fractures, now takes chronic
narcotics for chronic pain
-History of GSW to right leg
-GERD


Social History:
EtOH abuse in the past, currently 1ppd, has wife and 2 children

Family History:
Mother reportedly died of "untreated ulcer"

Physical Exam:
Afebrile 142/75 p80 96%RA
Large M sitting in unit bed without shirt on, wife in chair next
to bed, watching Pats game on TV. Nice, alert, oriented, no
distress.
CTAB no w/c/r/r
S1 S2 are clear, light 1-2/6 systolic murmur noted, with heart
sounds and murmur decreasing in intensity moving towards the
apex. Radial pulses are 2+ bilaterally.
Abd with prominent midline scar from ex lap, per pt. No TTP in
any quadrant. BS+.
RUE has 2 PIV's well placed. No c/c/e.
RLE with scar tissue on anterior aspect of shin, LLE with
prominent scar tissue and deformity near ankle. DP's are 2+.
There is no LE edema.


Pertinent Results:
WBC 11.4 --> 4.5 on discharge
Hct 38.1 --> 32.0
Plts 289
Chems  BUN/Cr  21/0.8 on admission but otherwise all normal
through admission
LFT's normal
Lipase 37
H. pylori serology positive

[**2185-9-3**] EKG
Sinus rhythm. Normal tracing. No previous tracing available for
comparison.

EGD [**2185-9-3**]
Findings: Esophagus:
Mucosa: Several areas of ulceration with erythema and evidence
of prior bleeding were noted in the gastroesophageal junction
and cardia. There was no active bleeding or visible vessel, and
due to patient intolerance after repeated procedure attempts, no
intervention was performed.
Stomach: Normal stomach.
Duodenum: Normal duodenum.
Impression: Erythema and ulceration in the gastroesophageal
junction and cardia
Otherwise normal EGD to second part of the duodenum
Recommendations: Routine post procedure orders
Serial HCTs.
IV PPI gtt.
NPO with sips.
If stable overnight can advance to clears tomorrow.
Will need 6-8 weeks of [**Hospital1 **] PPI therapy and repeat endoscopy to
assess for healing.

Brief Hospital Course:
31yo healthy M with sujective h/o severe GERD admit for
hematemesis, found to have multiple GE junction ulcerations not
actively intervened upon, to be treated with medical therapy.

1. GI bleed--Admitted to MICU hemodynamically stable and was
stable through admission. Had received 2U PRBC's at OSH but did
not require any blood products at [**Hospital1 18**]. Had EGD without any
active bleeding or varices and only old blood and multiple
ulcers with clot. Had difficult tolerating procedure so no
electrocautery employed or clipping done, GI recommended [**5-2**] wks
of PPI therapy and reassessment with repeat EGD in future.
Serial Hct's post procedure was stable and rest of hospital
course uncomplicated. Pt was hemodynamically stable through
admission and on discharge.

2. History of alcohol abuse--Pt with h/o considerable alcohol
consumption in the past, but less so currently by history. Had
h/o mild withdrawal symptoms (tremulous and anxious) but no
seizures or complicated withdrawal. Kept on CIWA scale, no
complications this admission.

3. PUD, H. pylori positive--Given prescription for triple
therapy with Clarithromycin, Amoxicillin, and Omeprazole. N.b.
Discharge worksheet showing Rx for 2wks Omeprazole, with GI recs
for 6-8wks PPI Tx --> Called both pt's PCP and pt to make them
aware and give 6-8wks of Tx. Stressed importance of ABx
compliance. Will need repeat EGD in future after medical therapy
complete.


Medications on Admission:
Oxycodone/APAP PRN

Discharge Medications:
1. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day for 2 weeks.
Disp:*28 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Amoxicillin 500 mg Capsule Sig: Two (2) Capsule PO twice a
day for 2 weeks.
Disp:*56 Capsule(s)* Refills:*0*
3. Clarithromycin 500 mg Tablet Sig: One (1) Tablet PO twice a
day for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Upper GI tract bleed
2. Ulcers at gastoesophageal junction, H. Pylori positive


Discharge Condition:
By the time of discharge, the pt's hematocrit was stable, vital
signs were stable, the pt was taking good PO food and liquids,
and was medically clear for discharge.


Discharge Instructions:
You were admitted to [**Hospital1 18**] after you vomited a large amount of
blood. You were given 2 units of blood at an outside hospital
and transferred to [**Hospital1 18**], where you were admitted to the
intensive care unit. You had a procedure to visualize your
esophagus and stomach and were found to have bleeding ulcers at
the junction of your stomach and esophagus. It was not actively
bleeding and no interventions were taken because you were not
tolerating the procedure well. You will need to treat these
ulcers with medical therapy for several weeks.

You will need to be treated for a bacterial infection of your
stomach that contributes to ulcers. You will need to take this
medicine regimen for two weeks:

1. Omeprazole 20mg twice daily
2. Amoxicillin 1g twice daily
3. Clarithromycin 500mg twice daily

Please note that if you do not complete the course of
antibiotics for two weeks, you risk recurrence of the ulcers.

Please seek immediate medical attention if you experience
further vomiting of blood, blood in your stool, dizziness or
lightheadedness, signs of bleeding from anywhere in your body,
abdominal pain that does not spontaneously resolve, or any other
concerns.

Followup Instructions:
Please follow up with your primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 84672**], at [**Street Address(2) 84673**], [**Location (un) **],MA, sometime THIS WEEK
to have your hematocrit checked. The clinic has already been
called, at [**Telephone/Fax (1) 14916**], and they will contact you sometime this
week to set up this appointment. This is VERY important and it
is important that you keep this appointment.

You will also need a repeat EGD (a procedure to visualize your
esophagus and stomach) in [**5-2**] weeks to assess your ulcers. You
can arrange this by calling the Department of Gastroenterology
at [**Hospital1 18**] at([**Telephone/Fax (1) 2233**] and telling them that you were seen
while an inpatient and need to set up a follow up appointment.
Or, you can ask your primary care doctor to arrange this for
you.



Completed by:[**2185-9-11**]
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Esophageal reflux,Alcohol abuse, unspecified,Unspecified essential hypertension,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: Vomiting blood

PRESENT ILLNESS: This is a 31 y.o male w/ past medical history of GERD and
alcohol abuse who reports being in his normal state of health
until last night when he developed nausea and went to the
bathroom where he vomited [**11-26**] tablespoons of red blood mixed w/
emesis. He had previously had symptoms similar to this so he
wasn't particularly concerned and then went back to bed. He went
on to have two further episodes of bloody emesis during which he
filled up the sink and then the toilet with what appeared to be
pure blood by his report. This led him to seek care at [**Hospital 1562**]
Hospital. There, he was hemodynamically stable by report but
nevertheless received two units of blood and was started on
octreotide and PPI drips and was trensferred here. Over the
course of these symptoms he reports that he developed mild to
moderate epigastric pain. No chest pain or shortness of breath.
He reports he did develop some dizziness as he was riding to
[**Hospital1 1562**] but has had none since. No syncope.
.
In the ED, initial VS were T 97.2, P 83, BP 139/80, RR 16, O2
Sat 97 % on RA. He was placed on PPI drip and an NG lavage was
done that yielded red blood which then failed to clear. His PPI
and octreotide drips were continued and he was admited to the
ICU.
.
Currently, he reports mild abdominal discomfort and nausea but
no other symptoms at this time.
.
Review of systems: No fevers, chills, weight loss, night sweats.
Reports
.

MEDICAL HISTORY: Past Medical History:
-MVA in [**2173**] with multiple fractures, now takes chronic
narcotics for chronic pain
-History of GSW to right leg
-GERD

MEDICATION ON ADMISSION: Oxycodone/APAP PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile 142/75 p80 96%RA
Large M sitting in unit bed without shirt on, wife in chair next
to bed, watching Pats game on TV. Nice, alert, oriented, no
distress.
CTAB no w/c/r/r
S1 S2 are clear, light 1-2/6 systolic murmur noted, with heart
sounds and murmur decreasing in intensity moving towards the
apex. Radial pulses are 2+ bilaterally.
Abd with prominent midline scar from ex lap, per pt. No TTP in
any quadrant. BS+.
RUE has 2 PIV's well placed. No c/c/e.
RLE with scar tissue on anterior aspect of shin, LLE with
prominent scar tissue and deformity near ankle. DP's are 2+.
There is no LE edema.

FAMILY HISTORY: Mother reportedly died of "untreated ulcer"

SOCIAL HISTORY: EtOH abuse in the past, currently 1ppd, has wife and 2 children 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Esophageal reflux,Alcohol abuse, unspecified,Unspecified essential hypertension,Other chronic pain'}
