CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: HMED ATTG ADMIT NOTE
.
DATE [**2168-7-16**]
TIME 2300
.
PCP [**Name9 (PRE) **]
GI [**Name9 (PRE) **]
.
61 yo M with Crohn's disease on prednisone s/p total colectomy
in [**2147**], complicated by perirectal abscess s/p internal drainage
[**9-22**] and newly diagnosed DVT [**5-24**] on coumadin who presents to
the ED with BRBPR.
.
Patient reports 16 bloody bowel movements yesterday ([**2168-7-15**]).
Went to see PCP ([**Doctor Last Name 2472**]) and INR was 4.7.  Patient instructed
to hold coumadin.  Went home, overnight had multiple bloody
bowel movements.  This am had 3 episodes of syncope where he
awoke on his bathroom floor, denies any head trauma.  Last
bloody BM was around [**1-15**] pm today.  No abdominal pain (has
chronic rectal pain).  No fevers, nausea or vomiting.
Lightheadedness with standing.  Denies any cp or sob.  Endorses
mild dysuria, s/p TURP 4 weeks ago.
.
Went to [**Hospital1 **]-[**Location (un) 620**] ED today and found to have INR 5.4 and Hct of
27 (hct two weeks ago at [**Hospital1 18**] was 36.8).  CT abdomen performed
which showed a 15 mm perirectal abscess connected to right
lateral anal fistula, slightly enlarged from prior MRI in
[**Month (only) 956**] of this year, at which time abscess was less organized.
 Given 4L of NS.  Anoscopic exam performed in ED which showed
moderate maceration of perianal region but no gross bleeding.
Heme positive.  No fistulas or fissures.  Reported that patient
received iv cipro/flagyl however patient states this was never
given.
.
Transferred to [**Hospital1 18**] ED:  97.0  72P  104/76  16  100%RA; 5mg vit
K po; 2 units of FFP; colorectal surgery consulted and reviewed
image with radiology - abscess cavity similar to prior MRI in
[**Month (only) 956**] - no fever or leukocytosis therefore no indication to
urgently drain, needs management of LGIB first.  GI made aware
and will see patient in am.
.
ROS as per HPI, 10 pt ROS otherwise negative

MEDICAL HISTORY: -Crohn's disease (had previously been diagnosed with UC and had
totaly colectomy in [**2147**]) - uncontrolled, s/p internal drainage
perirectal abscess [**9-22**] by [**Doctor Last Name 1120**]
-LLE DVT dx [**2168-6-9**] on coumadin
-Recurrent diarrhea
-ADD
-Anemia
-Arthritis
-Nephrolithiasis
-BPH
-Migraine headaches
-TURP 4 weeks ago

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY

ALLERGIES: Purinethol / Remicade

PHYSICAL EXAM: ADMITTING EXAM

FAMILY HISTORY: Son, mother and sister with [**Name (NI) 4522**] disease

SOCIAL HISTORY: Works as a divorce attorney.  Married, lives with wife.  [**Name (NI) **]
tobacco, 1 beer per week and no illicits.
Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Abscess of anal and rectal regions,Gout, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small)
Gastrointest hemorr NOS,Ac posthemorrhag anemia,Regional enteritis NOS,Ac DVT/emb prox low ext,Anal & rectal abscess,Gout NOS,Migrne unsp wo ntrc mgrn,Hx-ven thrombosis/embols,Long-term use anticoagul,Acquire absnce intestine
Admission Date:  [**2168-7-16**]              Discharge Date:   [**2168-7-20**]

Date of Birth:  [**2106-10-15**]             Sex:   M

Service: MEDICINE

Allergies:
Purinethol / Remicade

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
Upper and lower endoscopy ([**2168-7-17**])


History of Present Illness:
HMED ATTG ADMIT NOTE
.
DATE [**2168-7-16**]
TIME 2300
.
PCP [**Name9 (PRE) **]
GI [**Name9 (PRE) **]
.
61 yo M with Crohn's disease on prednisone s/p total colectomy
in [**2147**], complicated by perirectal abscess s/p internal drainage
[**9-22**] and newly diagnosed DVT [**5-24**] on coumadin who presents to
the ED with BRBPR.
.
Patient reports 16 bloody bowel movements yesterday ([**2168-7-15**]).
Went to see PCP ([**Doctor Last Name 2472**]) and INR was 4.7.  Patient instructed
to hold coumadin.  Went home, overnight had multiple bloody
bowel movements.  This am had 3 episodes of syncope where he
awoke on his bathroom floor, denies any head trauma.  Last
bloody BM was around [**1-15**] pm today.  No abdominal pain (has
chronic rectal pain).  No fevers, nausea or vomiting.
Lightheadedness with standing.  Denies any cp or sob.  Endorses
mild dysuria, s/p TURP 4 weeks ago.
.
Went to [**Hospital1 **]-[**Location (un) 620**] ED today and found to have INR 5.4 and Hct of
27 (hct two weeks ago at [**Hospital1 18**] was 36.8).  CT abdomen performed
which showed a 15 mm perirectal abscess connected to right
lateral anal fistula, slightly enlarged from prior MRI in
[**Month (only) 956**] of this year, at which time abscess was less organized.
 Given 4L of NS.  Anoscopic exam performed in ED which showed
moderate maceration of perianal region but no gross bleeding.
Heme positive.  No fistulas or fissures.  Reported that patient
received iv cipro/flagyl however patient states this was never
given.
.
Transferred to [**Hospital1 18**] ED:  97.0  72P  104/76  16  100%RA; 5mg vit
K po; 2 units of FFP; colorectal surgery consulted and reviewed
image with radiology - abscess cavity similar to prior MRI in
[**Month (only) 956**] - no fever or leukocytosis therefore no indication to
urgently drain, needs management of LGIB first.  GI made aware
and will see patient in am.
.
ROS as per HPI, 10 pt ROS otherwise negative

Past Medical History:
-Crohn's disease (had previously been diagnosed with UC and had
totaly colectomy in [**2147**]) - uncontrolled, s/p internal drainage
perirectal abscess [**9-22**] by [**Doctor Last Name 1120**]
-LLE DVT dx [**2168-6-9**] on coumadin
-Recurrent diarrhea
-ADD
-Anemia
-Arthritis
-Nephrolithiasis
-BPH
-Migraine headaches
-TURP 4 weeks ago

Social History:
Works as a divorce attorney.  Married, lives with wife.  [**Name (NI) **]
tobacco, 1 beer per week and no illicits.

Family History:
Son, mother and sister with [**Name (NI) 4522**] disease

Physical Exam:
ADMITTING EXAM

VS:  98.5  71P  19  98/55  98%RA
Appearance: alert, NAD, pale appearing
Eyes: eomi, perrl, anicteric
ENT: OP clear s lesions, mmd, no JVD, neck supple
Cv: +s1, s2  -m/r/g, no peripheral edema, 2+ dp/pt bilaterally
Pulm: clear bilaterally
Abd: soft, NT, ND, +bs, mild RUQ guarding, no rebound
Msk: 5/5 strength throughout, no joint swelling, no cyanosis or
clubbing
Neuro: cn 2-12 grossly intact, no focal deficits
Skin: no rashes
Psych: appropriate, pleasant
Heme: no cervical [**Doctor First Name **]

DISCHARGE EXAM
VS:  98.9  60P  16  123/56
Appearance: AAOX3, in NAD, asking to leave
Eyes: eomi, perrl, anicteric
ENT: OP clear s lesions, mmd, no JVD, neck supple
Cv: +s1, s2  -m/r/g, no peripheral edema, 2+ dp/pt bilaterally
Pulm: clear bilaterally
Abd: soft, NT, ND, +bs, no rebound, no guarding
Msk: 5/5 strength throughout, no joint swelling, no cyanosis or
clubbing
Neuro: cn 2-12 grossly intact, no focal deficits
Skin: no rashes
Psych: appropriate, pleasant
Heme: no cervical [**Doctor First Name **]


Pertinent Results:
[**2168-7-16**] 07:00PM URINE  MUCOUS-RARE
[**2168-7-16**] 07:00PM URINE  RBC-6* WBC-23* BACTERIA-NONE YEAST-NONE
EPI-<1
[**2168-7-16**] 07:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5
LEUK-SM
[**2168-7-16**] 07:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]->1.050*
[**2168-7-16**] 07:00PM   PLT SMR-NORMAL PLT COUNT-286
[**2168-7-16**] 07:00PM   PT-55.6* PTT-42.3* INR(PT)-5.5*
[**2168-7-16**] 07:00PM   HYPOCHROM-1+ ANISOCYT-OCCASIONAL
POIKILOCY-NORMAL MACROCYT-OCCASIONAL MICROCYT-OCCASIONAL
POLYCHROM-NORMAL
[**2168-7-16**] 07:00PM   NEUTS-73.1* LYMPHS-20.3 MONOS-5.6 EOS-0.8
BASOS-0.3
[**2168-7-16**] 07:00PM   WBC-7.5 RBC-2.52*# HGB-7.8*# HCT-24.2*#
MCV-96 MCH-30.8 MCHC-32.2 RDW-14.3
[**2168-7-16**] 07:00PM   ALBUMIN-2.8*
[**2168-7-16**] 07:00PM   cTropnT-<0.01
[**2168-7-16**] 07:00PM   LIPASE-10
[**2168-7-16**] 07:00PM   ALT(SGPT)-15 AST(SGOT)-16 ALK PHOS-44 TOT
BILI-0.3
[**2168-7-16**] 07:00PM   estGFR-Using this
[**2168-7-16**] 07:00PM   GLUCOSE-97 UREA N-13 CREAT-0.6 SODIUM-141
POTASSIUM-4.5 CHLORIDE-109* TOTAL CO2-25 ANION GAP-12
.
[**2168-7-16**] CT a/p at [**Hospital1 **]-N: no report available in [**Last Name (LF) **], [**First Name3 (LF) **]
colorectal surgery resident review with ED radiologist:
15mm perirectal abscess
connected to right lateral anal fistula, slightly enlarged from
prior MRI in [**Month (only) 956**] of this year (at that time collection
measured 0.9x0.8mm and appeared less organized)
.
[**2168-6-9**] LLE Doppler:
LEFT-SIDED DVT AS DESCRIBED FROM THE POPLITEAL VEIN
     INFERIOR.  NO RIGHT-SIDED DVT.
.
[**2168-7-17**] COLONOSCOPY:
Ulceration and erythema in the ileal pouch and small bowel with
evidence of recent bleeding and clot. These lesions are likely
the cause of GI bleeding in the setting of an elevated INR.
.
[**2168-7-17**] EGD:
Evidence of NG trauma in the stomach, which does not explain
patient's blood loss. Otherwise normal EGD to third part of the
duodenum
.
[**2168-7-16**] URINE CULTURE (Final [**2168-7-20**]):
      ENTEROCOCCUS SP..    10,000-100,000 ORGANISMS/ML..
                              SENSITIVITIES: MIC expressed in
MCG/ML
________________________________________________________
                             ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------  =>16 R
VANCOMYCIN------------     1 S


Brief Hospital Course:
61 yo M with Crohn's disease on prednisone s/p total colectomy
in [**2147**], complicated by perirectal abscess s/p internal drainage
[**9-22**] and newly diagnosed DVT [**5-24**] on coumadin who is admitted
with LGIB in the setting of supratherapeutic INR.
.
#LGIB:  Patient presented with INR of 5.4 and a hematocrit of
24, which dropped to 16 during his stay in the ED.  He received
3 units of FFP and 5 units of pRBCs.  He underwent EGD and
colonoscopy on [**7-17**].  EGD was negative.  Colonoscopy showed
ulcers and evidence of recent bleed/clot in the ileal pouch,
which was likely the cause of his bleeding.  His hematocrit
stabilized in the range of 28-30 and he did not require further
transfusions.  GI bleed was attributed to his underlying Crohn's
disease in the setting of a supratherapeutic INR.

#LLE DVT: Patient underwent repeat LENIs which showed
persistence of his proximal left leg DVT.  Extensive discussion
was had with his colorectal surgeon as well as
gastroenterologist and PCP regarding anticoagulation going
forward.  Heme/onc was also consulted.  It was decided to
continue coumadin at a dose of 2.5 daily and titrate to an INR
goal of 2.0-2.5.  Patient's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 2472**], was contact[**Name (NI) **] and
it was confirmed that he would continue to manage his coumadin.
Patient was also referred to Dr. [**Last Name (STitle) 3060**], of Heme-Onc, to help
manage his anticoagulation.  He has an appointment with Dr.
[**Last Name (STitle) 3060**] on [**2168-8-12**].  Patient was discharged home with services
and instructions for INR to be drawn daily from his PICC line
with results faxed to Dr.[**Name (NI) 5049**] office.

#Perirectal abscess: CT abdomen at [**Hospital1 **] reviewed in ED.
As per radiology abscess better organized and slightly larger
than prior MRI in [**Month (only) 956**]; given lack of fever or leukocytosis,
colorectal surgery decided no need for immediate drainage.  It
was decided to pursue conservative management with antibiotics.
Patient was intially started on Pip/tazo.  ID was consulted re:
longterm antibiotics and recommended 4 week course of ertapenam.
 PICC line was placed and arrangement were made for patient to
go home with services.  He will have 1g ertapenam administered
through PICC daily through [**8-16**] with weekly chem-7s and LFTs
faxed to the [**Hospital **] clinic.  He has an appointment with the [**Hospital **]
clinic to assess progress on [**8-12**].

#Crohn's disease:  This is being managed by Dr. [**Last Name (STitle) 1940**] as an
outpatient.  His prednisone regimen was continued while in the
hospital.  His hydrocortisone enemas were held in the context of
his GI bleed.  Further management will be made as per Dr.
[**Last Name (STitle) 1940**].

#Pyuria:  Patient's U/A on presentation showed 23 wbc's but no
bacteria.  He was complaining of some dysuria which was
initially thought to be [**1-14**] inflammation in setting of recent
TURP.  A urine culture was added to the labs which grew 10-100K
of enterococcus on the last day of hospitalization.  ID was
consulted and determined that his 4 week course of ertapenam
would be appropriate to cover his enterococcus.  Patient has ID
follow-up in 2 weeks.

Chronic Issues

#Gout: allopurinol was held on admission.  remained
asymptomatic.

#Transitional issues: patient was discharged home with services.
 The visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 5050**] daily ertapenam through the
PICC as well as draw daily INR through [**7-28**] and have the
results faxed to Dr.[**Name (NI) 5049**] office.  Weekly chem-7s and LFTs
will also be drawn and faxed to the [**Hospital **] clinic.  All
prescriptions were provided.  Patient has follow-up with [**Hospital **]
clinic in 2 weeks.  Patient instructed to contact Dr. [**Last Name (STitle) 5051**]
for appointment within 3-5 days from discharge, patient
demonstrated understanding.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY


Discharge Medications:
1. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
2. PredniSONE 12 mg PO DAILY
3. Warfarin 2.5 mg PO DAYS ([**Doctor First Name **],MO,TU,WE,TH,FR,SA)
Please titrate to goal INR 2.0-2.5
RX *Coumadin 2.5 mg 1 tablet(s) by mouth once a day Disp #*30
Tablet Refills:*2
4. Allopurinol 300 mg PO DAILY
5. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
6. Ferrous Sulfate 650 mg PO DAILY
7. FoLIC Acid 0.4 mg PO DAILY
8. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
9. ertapenem *NF* 1 gram Intravenous daily Duration: 4 Weeks
last day [**2168-8-16**]
RX *Invanz 1 gram 1 gram Q24h Disp #*30 Vial Refills:*0
10. Outpatient Lab Work
please draw daily INR and hematocrit from [**2168-7-21**] - [**2168-7-28**]
and fax results to Dr.[**Name (NI) 5049**] office at [**Telephone/Fax (1) 445**]


Discharge Disposition:
Home With Service

Facility:
Critical Care Systems

Discharge Diagnosis:
Primary: Lower GI Bleed

Secondary: Crohn's Disease
DVT on Coumadin
Perirectal abscess


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


Discharge Instructions:
Dear Mr. [**Known lastname 5052**],

It was a pleasure to take care of you at [**Hospital1 18**].  You were
admitted for gastrointestinal bleeding in the setting of
elevated INR.  You underwent colononscopy and your bleeding was
controlled.  You are being discharged with a new dose of
coumadin.  You will need to follow-up with Dr. [**Last Name (STitle) 5053**]
regarding your coumadin dosing.  You are also being discharged
on a 4 week course of Ertapenam for treatment of perirectal
abscess.  You have arrangements for a visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 5054**] this and to draw needed labs.

The following changes were made to your medications:
Please STOP ciprofloxacin.
Please START coumadin at 2.5 mg daily.  You will have daily
blood draws for your INR and the results will be faxed to Dr. [**Name (NI) 5055**] office, who will manage this.
Please START ertapenam 1g IV daily.

Please follow with your appointments as illustrated below.
Please continue the rest of your home medications the way you
were taking them at home prior to admission.

Followup Instructions:
Department: INFECTIOUS DISEASE
When: FRIDAY [**2168-8-12**] at 11:30 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Unit Name **] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: HEMATOLOGY/ONCOLOGY
When: FRIDAY [**2168-8-12**] at 9:00 AM
With: [**First Name11 (Name Pattern1) 1730**] [**Last Name (NamePattern4) 5056**], MD [**Telephone/Fax (1) 3062**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: NEUROLOGY
When: MONDAY [**2168-8-8**] at 8:30 AM
With: DR. [**First Name (STitle) 3523**] [**Name (STitle) 3524**] [**Telephone/Fax (1) 44**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please call Dr[**Name (NI) 5049**] office to schedule a follow up
appointment within the next 3-5 days at [**Telephone/Fax (1) 133**].



Completed by:[**2168-7-24**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Abscess of anal and rectal regions,Gout, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small)'}


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: BRBPR

PRESENT ILLNESS: HMED ATTG ADMIT NOTE
.
DATE [**2168-7-16**]
TIME 2300
.
PCP [**Name9 (PRE) **]
GI [**Name9 (PRE) **]
.
61 yo M with Crohn's disease on prednisone s/p total colectomy
in [**2147**], complicated by perirectal abscess s/p internal drainage
[**9-22**] and newly diagnosed DVT [**5-24**] on coumadin who presents to
the ED with BRBPR.
.
Patient reports 16 bloody bowel movements yesterday ([**2168-7-15**]).
Went to see PCP ([**Doctor Last Name 2472**]) and INR was 4.7.  Patient instructed
to hold coumadin.  Went home, overnight had multiple bloody
bowel movements.  This am had 3 episodes of syncope where he
awoke on his bathroom floor, denies any head trauma.  Last
bloody BM was around [**1-15**] pm today.  No abdominal pain (has
chronic rectal pain).  No fevers, nausea or vomiting.
Lightheadedness with standing.  Denies any cp or sob.  Endorses
mild dysuria, s/p TURP 4 weeks ago.
.
Went to [**Hospital1 **]-[**Location (un) 620**] ED today and found to have INR 5.4 and Hct of
27 (hct two weeks ago at [**Hospital1 18**] was 36.8).  CT abdomen performed
which showed a 15 mm perirectal abscess connected to right
lateral anal fistula, slightly enlarged from prior MRI in
[**Month (only) 956**] of this year, at which time abscess was less organized.
 Given 4L of NS.  Anoscopic exam performed in ED which showed
moderate maceration of perianal region but no gross bleeding.
Heme positive.  No fistulas or fissures.  Reported that patient
received iv cipro/flagyl however patient states this was never
given.
.
Transferred to [**Hospital1 18**] ED:  97.0  72P  104/76  16  100%RA; 5mg vit
K po; 2 units of FFP; colorectal surgery consulted and reviewed
image with radiology - abscess cavity similar to prior MRI in
[**Month (only) 956**] - no fever or leukocytosis therefore no indication to
urgently drain, needs management of LGIB first.  GI made aware
and will see patient in am.
.
ROS as per HPI, 10 pt ROS otherwise negative

MEDICAL HISTORY: -Crohn's disease (had previously been diagnosed with UC and had
totaly colectomy in [**2147**]) - uncontrolled, s/p internal drainage
perirectal abscess [**9-22**] by [**Doctor Last Name 1120**]
-LLE DVT dx [**2168-6-9**] on coumadin
-Recurrent diarrhea
-ADD
-Anemia
-Arthritis
-Nephrolithiasis
-BPH
-Migraine headaches
-TURP 4 weeks ago

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Allopurinol 300 mg PO DAILY
2. Ciprofloxacin HCl 500 mg PO Q12H
3. Diphenoxylate-Atropine [**12-14**] TAB PO Q6H:PRN diarrhea
4. Hydrocortisone Enema 100 mg PR DAILY Duration: 21 Days
5. PredniSONE 12 mg PO DAILY
6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
7. Warfarin 5 mg PO DAILY16
8. Zolpidem Tartrate 5 mg PO HS:PRN insomnia
9. Ferrous Sulfate 650 mg PO DAILY
10. FoLIC Acid 0.4 mg PO DAILY

ALLERGIES: Purinethol / Remicade

PHYSICAL EXAM: ADMITTING EXAM

FAMILY HISTORY: Son, mother and sister with [**Name (NI) 4522**] disease

SOCIAL HISTORY: Works as a divorce attorney.  Married, lives with wife.  [**Name (NI) **]
tobacco, 1 beer per week and no illicits. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Regional enteritis of unspecified site,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Abscess of anal and rectal regions,Gout, unspecified,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Acquired absence of intestine (large) (small)'}
