CHIEF COMPLAINT: bloody stool

PRESENT ILLNESS: The patient is a 37M with colon cancer s/p resection 8 years ago
and recent PE, who presented with marroon stools and clot. The
patient was found to have a PE approximately 4 months ago when
he presented with severe inspiratory chest pain. He was started
on coumadin and lovenox. A colonoscopy was done at that time and
he was found to have 2 polyps. However, the pt was being
anticoagulated at that point with coumadin, so polypectomy was
deferred. The plan was for continuation of coumadin for 3
months, and then pt would undergo polypectomy. Three days ago,
pt underwent polypectomy off the coumadin. Per the patient, the
gasteroenterologist said his polyps had grown significantly in
size over the three months. He was started on lovenox at that
time. Since Friday night (day after the colonoscopy), he
developed maroon, mucousy stools, 3-4x/day, with clotted blood.
A few stools were black. The patient called his
gastereoenterologist who advised that the patient go to the ED.
The patient states that he usually has [**1-31**] BMs per day since his
colonic resection. He denied BRBPR. Pt denies chest pressure,
lightheadedness, dizziness with standing, or SOB. Denies
abdominal pain, fevers, or hematemesis.
.
In the ED, the pt was given Golytely 4L po. He underwent
colonoscopy this morning which demonstrated clot over the
transverse colon polypectomy site without active bleeding.
Patient underwent surgical ligation.

MEDICAL HISTORY: - Stage III colon Ca - s/p partial colectomy (14-18in of
transverse and descending colon) followed by 5FU/Leucovorin and
localized XRT ([**2158**])
- RLL subsegmental pulmonary embolism [**12-6**]
- GERD

MEDICATION ON ADMISSION: lovenox 80mg SC bid
coumadin 3.75 mg 5 day per wk, 5mg 2 day per wk
prilosec

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.4, 68, 10, 100/54, 5500/2100
Gen: well appearing, conversant, NAD
HEENT: PERRL, EOMI, OP clear, MMM, no conjunctival pallor
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB, no w/r/r
Abd: soft, NT/ND, +BS, no masses
Ext: no c/c/e

FAMILY HISTORY: Father with ureteral, liver, and renal Ca. Mother healthy. [**Name2 (NI) **] FH
of PE or miscarriages in women.

SOCIAL HISTORY: Lives with wife and 2 children (3y/o and 6y/o) in [**Location (un) 56138**].
Works at [**Company 2267**] selling IVC filters and other
vascular products. Smoked about 0.5-1 packs per week, quit in
[**12-6**]. Drinks socially on the weekends, up to 10 beers/week. No
IVDU.
Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of venous thrombosis and embolism
Hemorrhage complic proc,Abn react-surg proc NEC,Esophageal reflux,Hx of colonic malignancy,Hx-ven thrombosis/embols
Admission Date:  [**2168-3-13**]              Discharge Date:   [**2168-3-15**]

Date of Birth:  [**2131-1-20**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
bloody stool

Major Surgical or Invasive Procedure:
Colonscopy with injection and ligation


History of Present Illness:
The patient is a 37M with colon cancer s/p resection 8 years ago
and recent PE, who presented with marroon stools and clot. The
patient was found to have a PE approximately 4 months ago when
he presented with severe inspiratory chest pain. He was started
on coumadin and lovenox. A colonoscopy was done at that time and
he was found to have 2 polyps. However, the pt was being
anticoagulated at that point with coumadin, so polypectomy was
deferred. The plan was for continuation of coumadin for 3
months, and then pt would undergo polypectomy. Three days ago,
pt underwent polypectomy off the coumadin. Per the patient, the
gasteroenterologist said his polyps had grown significantly in
size over the three months. He was started on lovenox at that
time. Since Friday night (day after the colonoscopy), he
developed maroon, mucousy stools, 3-4x/day, with clotted blood.
A few stools were black. The patient called his
gastereoenterologist who advised that the patient go to the ED.
The patient states that he usually has [**1-31**] BMs per day since his
colonic resection. He denied BRBPR. Pt denies chest pressure,
lightheadedness, dizziness with standing, or SOB. Denies
abdominal pain, fevers, or hematemesis.
.
In the ED, the pt was given Golytely 4L po. He underwent
colonoscopy this morning which demonstrated clot over the
transverse colon polypectomy site without active bleeding.
Patient underwent surgical ligation.

Past Medical History:
- Stage III colon Ca - s/p partial colectomy (14-18in of
transverse and descending colon) followed by 5FU/Leucovorin and
localized XRT ([**2158**])
- RLL subsegmental pulmonary embolism [**12-6**]
- GERD

Social History:
Lives with wife and 2 children (3y/o and 6y/o) in [**Location (un) 56138**].
Works at [**Company 2267**] selling IVC filters and other
vascular products. Smoked about 0.5-1 packs per week, quit in
[**12-6**]. Drinks socially on the weekends, up to 10 beers/week. No
IVDU.

Family History:
Father with ureteral, liver, and renal Ca. Mother healthy. [**Name2 (NI) **] FH
of PE or miscarriages in women.

Physical Exam:
VS: 97.4, 68, 10, 100/54, 5500/2100
Gen: well appearing, conversant, NAD
HEENT: PERRL, EOMI, OP clear, MMM, no conjunctival pallor
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB, no w/r/r
Abd: soft, NT/ND, +BS, no masses
Ext: no c/c/e

Pertinent Results:
[**2168-3-13**] 09:00PM   PT-10.9 PTT-25.1 INR(PT)-0.9
[**2168-3-13**] 09:00PM   PLT COUNT-251
[**2168-3-13**] 09:00PM   WBC-10.1 RBC-4.50* HGB-13.4* HCT-37.9* MCV-84
MCH-29.8 MCHC-35.4* RDW-14.2
[**2168-3-13**] 09:00PM   GLUCOSE-85 UREA N-20 CREAT-0.8 SODIUM-135
POTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-23 ANION GAP-17
.
IMAGING:
[**2168-3-2**] PET: negative
.
[**2168-1-5**] COLONOSCOPY: Two sessile 15mm non-bleeding polyps of
benign appearance were found in the transverse colon and cecum.
3 1 cc.[**Country 11150**] ink submucosal injections were applied for
tattooing of area around the polyp in the cecum.
.
[**2168-3-10**] COLONOSCOPY: A single sessile 20 mm polyp of benign
appearance was found in the cecum. A single-piece polypectomy
was performed using a hot snare. The polyp was subsequently cut
in half and completely removed. Two endoclips were deployed
across the base of the polypectomy site to prevent future
bleeding. A single sessile 15 mm polyp of benign appearance was
found in the transverse colon. A piece-meal polypectomy was
performed using a hot snare. The polyp was completely removed.
.
[**2168-3-14**] COLONOSCOPY: The cecal polypectomy site had an endoclip
in place and there was no evidence of bleeding. The transverse
polypectomy site had a clot over the site. The clot could not be
flushed off with lavage. (injection, ligation) Otherwise normal
colonoscopy to cecum.

Brief Hospital Course:
Mr. [**Known lastname **] is a 37 year old male with a history of colon cancer
who underwent resection, chemotherapy and radiation. He recently
presented with bilaterally PEs and it was thought that this may
represent disease recurrence. He was started on Coumadin and
Lovenox for PE and underwent colonoscopy in [**Month (only) 956**] which
demonstrated 2 polyps. Intervention was deferred at that time as
he was being anti-coagulated.
.
His Coumadin was recently held such that he could undergo
colonoscopy and polypectomy in early [**Month (only) 547**]. After his procedure
he was restarted on Coumadin and Lovenox and subsequently
presented with bloody bowel movements. He was admitted to the
MICU and prepped for colonoscopy. Anti-coagulation was held. On
colonoscopy, clot overlying one of the polypectomy sites was
identified. He received injection and ligation of this site.
There was no active bleeding. The patient remained
hemodynamically stable during this admission.
.
He was restarted on anti-coagulation with Lovenox bridge prior
to discharge. He was asked to follow up in the [**Hospital 197**] Clinic
the Friday after discharge.

Medications on Admission:
lovenox 80mg SC bid
coumadin 3.75 mg 5 day per wk, 5mg 2 day per wk
prilosec

Discharge Medications:
1. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) syringe
Subcutaneous [**Hospital1 **] (2 times a day) for 10 days.
Disp:*20 syringes* Refills:*1*
2. 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:*0*
3. Coumadin
Please resume your home regimen of coumadin. 3.75 mg for 5 days
each week and 5mg on the remaining 2 days.
4. Outpatient [**Name (NI) **] Work
PT/INR check twice weekly beginning on Thursday [**2168-3-18**]. Results
should be FAXED to Dr.[**Name (NI) 40905**] office/[**Hospital 18**] [**Hospital 197**] Clinic
(Phone: [**Telephone/Fax (1) 2173**]).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
- lower GI bleed
.
Secondary:
- Stage III colon Ca - s/p partial colectomy (14-18in of
transverse and descending colon) followed by 5FU/Leucovorin and
localized XRT ([**2158**])
- RLL subsegmental pulmonary embolism [**12-6**]
- GERD


Discharge Condition:
Good. Tolerating PO. Hct stable. Afebrile.


Discharge Instructions:
You were admitted to the hospital for a GI bleed. You underwent
colonoscopy and were to have a blood clot overlying the recent
polypectomy site in your colon. You should return to the ER or
call your doctor if you experience any of the following
symptoms: fever > 101.4, weakness/fatigue, chest pain, bright
red blood in your stool, black stool or any other concerning
symptoms.
.
Please take all medications as prescribed. You should restart
your coumadin tonight.
.
Please follow up with all appointments as instructed.

Followup Instructions:
1. Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in 2 weeks.
2. Please have your INR checked at the [**Hospital 18**] [**Hospital 197**] Clinic on
Friday [**2168-3-19**].
3. Please have your INR checked twice weekly when you are
traveling beginning Monday [**2168-3-22**]. A prescription has been
provided for this. Results should be FAXED to Dr.[**Name (NI) 40905**]
office/[**Hospital 197**] Clinic (Phone: [**Telephone/Fax (1) 2173**]).
{'Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of venous thrombosis and embolism'}


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: bloody stool

PRESENT ILLNESS: The patient is a 37M with colon cancer s/p resection 8 years ago
and recent PE, who presented with marroon stools and clot. The
patient was found to have a PE approximately 4 months ago when
he presented with severe inspiratory chest pain. He was started
on coumadin and lovenox. A colonoscopy was done at that time and
he was found to have 2 polyps. However, the pt was being
anticoagulated at that point with coumadin, so polypectomy was
deferred. The plan was for continuation of coumadin for 3
months, and then pt would undergo polypectomy. Three days ago,
pt underwent polypectomy off the coumadin. Per the patient, the
gasteroenterologist said his polyps had grown significantly in
size over the three months. He was started on lovenox at that
time. Since Friday night (day after the colonoscopy), he
developed maroon, mucousy stools, 3-4x/day, with clotted blood.
A few stools were black. The patient called his
gastereoenterologist who advised that the patient go to the ED.
The patient states that he usually has [**1-31**] BMs per day since his
colonic resection. He denied BRBPR. Pt denies chest pressure,
lightheadedness, dizziness with standing, or SOB. Denies
abdominal pain, fevers, or hematemesis.
.
In the ED, the pt was given Golytely 4L po. He underwent
colonoscopy this morning which demonstrated clot over the
transverse colon polypectomy site without active bleeding.
Patient underwent surgical ligation.

MEDICAL HISTORY: - Stage III colon Ca - s/p partial colectomy (14-18in of
transverse and descending colon) followed by 5FU/Leucovorin and
localized XRT ([**2158**])
- RLL subsegmental pulmonary embolism [**12-6**]
- GERD

MEDICATION ON ADMISSION: lovenox 80mg SC bid
coumadin 3.75 mg 5 day per wk, 5mg 2 day per wk
prilosec

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.4, 68, 10, 100/54, 5500/2100
Gen: well appearing, conversant, NAD
HEENT: PERRL, EOMI, OP clear, MMM, no conjunctival pallor
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB, no w/r/r
Abd: soft, NT/ND, +BS, no masses
Ext: no c/c/e

FAMILY HISTORY: Father with ureteral, liver, and renal Ca. Mother healthy. [**Name2 (NI) **] FH
of PE or miscarriages in women.

SOCIAL HISTORY: Lives with wife and 2 children (3y/o and 6y/o) in [**Location (un) 56138**].
Works at [**Company 2267**] selling IVC filters and other
vascular products. Smoked about 0.5-1 packs per week, quit in
[**12-6**]. Drinks socially on the weekends, up to 10 beers/week. No
IVDU. 

### Response:
{'Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Personal history of malignant neoplasm of large intestine,Personal history of venous thrombosis and embolism'}
