CHIEF COMPLAINT: Melena

PRESENT ILLNESS: Mr. [**Known lastname 449**] is a 77 y.o male with h/o rectal cancer s/p resection
with colostomy and chemotx in [**2164**], afib on coumadin who
presents with black tarry colostomy output x2 days. He states
that for the past 2 weeks he has felt lightheaded, weak, and
fatigued, but otherwise in his USOH. Two days PTA he noticed
black tarry output in his ostomy bag.  He has not had abdominal
pain, nausea/vomiting, or bright red blood.  He notes that this
happened to him once approx 1 year ago but it resolved without
intervention.  Of note, pt has taken naproxen twice daily for
arthritis pain for many years.  Also has taken coumadin for afib
for over 10 years, last INR checked approx 2 weeks ago and was
therapeutic (between [**1-16**]).
.
In the ED, he was noted to be tachycardic with HR 130s, BP
128/60, RR 24, O2 sat 100% on RA.  Labs were notable for Hct 17,
INR 8.7, WBC 21.9, lactate 4.5. He was transfused 2u pRBCs, 2u
FFP, and received 2.5mg IV vit K.  GI was consulted and
performed NG lavage, which was negative. He was started on
pantoprazole gtt and admitted to the MICU for monitoring.
.
On arrival to the MICU, initial vitals were T 98.7, HR 108, BP
130/76, RR 19, O2 sat 99% on 2L NC.  Currently he states that he
feels well overall, improved since receiving transfusions.
Denies CP/SOB, palpitations, N/V, abdominal pain.

MEDICAL HISTORY: -rectal cancer status post resection and end colostomy,
chemotherapy in [**2164**]
-macular degeneration
-remote h/o duodenal ulcer, evaluated at [**Hospital1 112**], resolved without
tx
-osteoarthritis
-atrial fibrillation
-hyperlipidemia
-[**Last Name (un) 23424**] esophagus ([**2171**])

MEDICATION ON ADMISSION: Medications - Prescription
ALPRAZOLAM - 0.5 mg Tablet - 1 Tablet(s) by mouth every night;
half in morning
CLONAZEPAM - 0.5 mg Tablet - 1 po(s) by mouth twice a day as
needed for anxiety
NAPROXEN - 375 mg Tablet - one Tablet(s) by mouth twice a day
PRAVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day in
the evening
SERTRALINE - 100 mg Tablet - 1 Tablet(s) by mouth once a day
TRAMADOL - 50 mg Tablet - [**12-15**] Tablet(s) by mouth every four (4)
-
six (6) hours as needed for pain
VERAPAMIL - 240 mg Cap,Ext Release Pellets 24 hr - 1 Cap,24 hr
Sust Release Pellets(s) by mouth qd for heart rate
WARFARIN - 2 mg Tablet - Take up to 2 (two) tablets by mouth
once
a day or as directed by [**Hospital3 **]

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / NSAIDS

PHYSICAL EXAM: Admission Exam:
General: Pleasant elderly male, breathing comfortably on RA, in
NAD
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Irregularly irregular, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
ostomy bag in LLQ
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII grossly intact, no focal deficits

FAMILY HISTORY: NC

SOCIAL HISTORY: Non-smoker, no EtOH or IVDU.  Lives with wife in [**Name (NI) 5087**].
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Transfusion associated circulatory overload,Atrial fibrillation,Stricture and stenosis of esophagus,Helicobacter pylori [H. pylori],Colostomy status,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anxiety state, unspecified,Abnormal coagulation profile,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other nonspecific abnormal finding of lung field
Chr stomach ulc w hem,Ac posthemorrhag anemia,Transfsn w circ overload,Atrial fibrillation,Esophageal stricture,Helicobacter pylori,Colostomy status,Long-term use anticoagul,Crnry athrscl natve vssl,Osteoarthros NOS-unspec,Anxiety state NOS,Abnrml coagultion prfile,Adv eff analgesic NOS,Hx-rectal & anal malign,Abn react-procedure NEC,Ot nonsp ab fnd lung fld
Admission Date:  [**2177-10-19**]              Discharge Date:   [**2177-10-24**]

Date of Birth:  [**2100-1-9**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / NSAIDS

Attending:[**First Name3 (LF) 9824**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
EGD - [**2177-10-20**] by Drs. [**First Name (STitle) 26390**] and [**Name5 (PTitle) **]

History of Present Illness:
Mr. [**Known lastname 449**] is a 77 y.o male with h/o rectal cancer s/p resection
with colostomy and chemotx in [**2164**], afib on coumadin who
presents with black tarry colostomy output x2 days. He states
that for the past 2 weeks he has felt lightheaded, weak, and
fatigued, but otherwise in his USOH. Two days PTA he noticed
black tarry output in his ostomy bag.  He has not had abdominal
pain, nausea/vomiting, or bright red blood.  He notes that this
happened to him once approx 1 year ago but it resolved without
intervention.  Of note, pt has taken naproxen twice daily for
arthritis pain for many years.  Also has taken coumadin for afib
for over 10 years, last INR checked approx 2 weeks ago and was
therapeutic (between [**1-16**]).
.
In the ED, he was noted to be tachycardic with HR 130s, BP
128/60, RR 24, O2 sat 100% on RA.  Labs were notable for Hct 17,
INR 8.7, WBC 21.9, lactate 4.5. He was transfused 2u pRBCs, 2u
FFP, and received 2.5mg IV vit K.  GI was consulted and
performed NG lavage, which was negative. He was started on
pantoprazole gtt and admitted to the MICU for monitoring.
.
On arrival to the MICU, initial vitals were T 98.7, HR 108, BP
130/76, RR 19, O2 sat 99% on 2L NC.  Currently he states that he
feels well overall, improved since receiving transfusions.
Denies CP/SOB, palpitations, N/V, abdominal pain.

Past Medical History:
-rectal cancer status post resection and end colostomy,
chemotherapy in [**2164**]
-macular degeneration
-remote h/o duodenal ulcer, evaluated at [**Hospital1 112**], resolved without
tx
-osteoarthritis
-atrial fibrillation
-hyperlipidemia
-[**Last Name (un) 23424**] esophagus ([**2171**])

Social History:
Non-smoker, no EtOH or IVDU.  Lives with wife in [**Name (NI) 5087**].


Family History:
NC

Physical Exam:
Admission Exam:
General: Pleasant elderly male, breathing comfortably on RA, in
NAD
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Irregularly irregular, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
ostomy bag in LLQ
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII grossly intact, no focal deficits

Discharge Exam:
Unchanged from admission

Pertinent Results:
Lab Results on Admission:

[**2177-10-19**] 09:15AM BLOOD WBC-21.9*# RBC-1.82*# Hgb-5.5*#
Hct-17.1*# MCV-94 MCH-30.3 MCHC-32.2 RDW-14.9 Plt Ct-294
[**2177-10-19**] 09:15AM BLOOD Neuts-88.6* Lymphs-7.8* Monos-3.4 Eos-0.2
Baso-0.1
[**2177-10-19**] 09:15AM BLOOD PT-75.9* PTT-38.5* INR(PT)-8.7*
[**2177-10-19**] 09:15AM BLOOD Glucose-192* UreaN-30* Creat-0.8 Na-138
K-3.4 Cl-103 HCO3-23 AnGap-15
[**2177-10-19**] 09:15AM BLOOD ALT-10 AST-18 AlkPhos-29* TotBili-0.5
[**2177-10-19**] 09:15AM BLOOD Lipase-9
[**2177-10-20**] 03:02AM BLOOD Calcium-7.3* Phos-2.1* Mg-1.7
[**2177-10-20**] 10:18PM BLOOD Type-ART pH-7.40 Comment-GREEN TOP
[**2177-10-19**] 09:28AM BLOOD Glucose-179* Lactate-4.5* Na-135 K-3.4
Cl-100 calHCO3-24
[**2177-10-19**] 11:43AM BLOOD Lactate-2.2*
[**2177-10-19**] 09:28AM BLOOD Hgb-6.0* calcHCT-18 O2 Sat-91
[**2177-10-20**] 10:18PM BLOOD freeCa-1.06*

STUDIES:

                            **FINAL REPORT [**2177-10-20**]**

   HELICOBACTER PYLORI ANTIBODY TEST (Final [**2177-10-20**]):
      POSITIVE BY EIA.
           (Reference Range-Negative).

IMAGING:

[**2177-10-20**] CXR: IMPRESSION: AP chest reviewed in the absence of
prior chest radiographs, read in conjunction with torso CT
showing images of the lower hemithorax performed [**2170-2-20**]:
Lungs are mildly hyperinflated and the configuration of the
chest suggests
COPD. Heart is moderately enlarged. Asbestos-related pleural
calcification
is extensive and obscures larger areas of the lungs making it
difficult to say whether any significant lung lesions are
present in addition to rounded
atelectasis that was demonstrated on the [**2169**] torso CT.
Conventional
radiographs should be obtained as first step in imaging
evaluation.

Thoracic aorta is generally large, particularly in the aortic
arch but would need a lateral view for more reliable assessment.

[**2177-10-21**] Portable upright radiograph of chest

Comparison was made with prior chest radiograph from [**2177-10-20**].

FINDINGS: Since [**2177-10-20**], there are no relevant changes
in the chest. Hyperinflated lungs suggesting COPD. Bilateral
opacities from calcified and non-calcified pleural plaques which
is appropriate in the clinical setting of asbestos exposure and
right lower lung opacity which corresponds to rounded
atelectasis (on correlation with CT abdomen dated [**2177-2-19**])
are unchanged. Mild-to-moderate heart size and prominent aortic
arch with mild atherosclerotic intimal calcifications is stable.
There are no new lung opacities of concern. No acute
intrathoracic process.

EGD [**2177-10-20**]:
Impression:
Schatzki's ring
Ulcer in the pre-pyloric
Normal mucosa in the duodenum
Otherwise normal EGD to third part of the duodenum

Recommendations: This superficial ulcer is the likely source of
the patient's bleeding. Please check hpylori IgG levels and
treat if positive.
Will need repeat EGD in 8 weeks to confirm healing given risk of
malignancy in gastric uclers.

[**10-19**] ECG: Atrial fibrillation with a moderate ventricular
response. Diffuse non-specific
ST-T wave abnormalities. Compared to the previous tracing of
[**2177-4-9**] one
ventricular premature beat is now seen.

Lab Results on Discharge:

[**2177-10-24**] 06:05AM BLOOD WBC-10.0 RBC-2.76* Hgb-8.6* Hct-25.1*
MCV-91 MCH-31.0 MCHC-34.1 RDW-15.4 Plt Ct-311
[**2177-10-21**] 03:06AM BLOOD Neuts-86.0* Lymphs-8.1* Monos-5.0 Eos-0.7
Baso-0.3
[**2177-10-23**] 06:05AM BLOOD PT-13.5* PTT-30.1 INR(PT)-1.1
[**2177-10-24**] 06:05AM BLOOD Glucose-96 UreaN-14 Creat-0.8 Na-142
K-3.7 Cl-101 HCO3-36* AnGap-9
[**2177-10-24**] 06:05AM BLOOD Calcium-8.2* Phos-3.1 Mg-2.0

Brief Hospital Course:
Primary Reason for Hospitalization:
Patient is a 77yoM with h/o rectal cancer s/p colectomy with
colostomy, afib on coumadin who presented with anemia and
melena. He was found on EGD to have a gastric ulcer and on H.
pylori testing to be infected. His coumadin was held, he was
transfused blood products for anemia, and treated with proton
pump inhibitor and antibiotics for H. pylori. He was discharged
to complete a Prevpac and remained off coumadin to re-start as
an outpatient. His Hct and hemodynamics were stable on discharge
with residual melana per ostomy but no signs of continued
bleeding.

Active Issues:
1. Bleeding Gastric Ulcer: Patient presented with large amounts
of black tarry colostomy output, Hct 17, INR 8.7.  He received a
total of 6u pRBCs, 2u FFP, and 2.5mg IV Vit K.  EGD was
performed and showed a pre-pyloric ulcer, not actively bleeding.
 It was thought that the bleeding had stopped with correction of
his coagulopathy and was likely the source of his melena.  His
Hct gradually stabilized at 26 and he remained hemodynamically
stable.  H pylori Antibody test was positive and he was started
on triple therapy with Amoxicillin, Clarithromycin, and
Pantoprazole.  He was discharged to complete a 14 day course of
the antibiotics and will need to continue a PPI indefinitely.
He should also avoid NSAIDs and is to discuss restarting
warfarin with his primary care physician.

2. Atrial fibrillation: Patient is anticoagulated with coumadin
for Afib and presented with INR 8.7, which likely contributed to
UGIB.  It is unclear why his INR was significantly elevated, as
he has taken coumadin for 10 years and per pt his INR is
typically very stable.  No recent changes in coumadin dosing or
recent medication changes.  His coumadin was held throughout his
hospitalization, and he should follow up with his primary care
physician regarding when to resume anticoagulation.  His rate
was controlled in 70s-90s throughout stay on his home diltiazem.

Chronic Issues:
1. Anxiety: Stable. He was continued on his home regimen of
alprazolam, clonazepam, sertraline.

2. HLD: Stable. He was continued on his home pravastatin and
aspirin 81mg (per GI, safe to continue low dose aspirin).

3. Osteoarthritis: Stable.  His home naproxen was discontinued
due to his UGIB.  He was continued on acetaminophen and tramadol
as needed for pain.

Transitional Issues:
-F/u with primary providers regarding when to restart
anticoagulation for afib
-Outpt f/u of asbestosis plaques seen on CXR
-Repeat EGD in 8 weeks
-Continue PPI indefinitely
-CODE: full

Medications on Admission:
Medications - Prescription
ALPRAZOLAM - 0.5 mg Tablet - 1 Tablet(s) by mouth every night;
half in morning
CLONAZEPAM - 0.5 mg Tablet - 1 po(s) by mouth twice a day as
needed for anxiety
NAPROXEN - 375 mg Tablet - one Tablet(s) by mouth twice a day
PRAVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day in
the evening
SERTRALINE - 100 mg Tablet - 1 Tablet(s) by mouth once a day
TRAMADOL - 50 mg Tablet - [**12-15**] Tablet(s) by mouth every four (4)
-
six (6) hours as needed for pain
VERAPAMIL - 240 mg Cap,Ext Release Pellets 24 hr - 1 Cap,24 hr
Sust Release Pellets(s) by mouth qd for heart rate
WARFARIN - 2 mg Tablet - Take up to 2 (two) tablets by mouth
once
a day or as directed by [**Hospital3 **]

Medications - OTC
ACETAMINOPHEN -  (OTC) - 500 mg Tablet - 2 Tablet(s) by mouth
twice a day ** No more than 6tablets per day **
ASPIRIN -  (OTC) - 81 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s) by mouth daily as per PCP
[**Name Initial (PRE) 26391**] -  (OTC) - Dosage uncertain

Discharge Medications:
1. sertraline 100 mg Tablet Sig: One (1) Tablet PO once a day.
2. pravastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. alprazolam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime.
4. alprazolam 0.5 mg Tablet Sig: 0.5 Tablet PO qam.
5. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for anxiety.
6. tramadol 50 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
7. verapamil 240 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
8. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO twice a
day: ** No more than 6 tablets per day **
.
9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
10. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours):
start taking once you have completed the Prevpac.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
11. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
12. Prevpac 500-500-30 mg Combo Pack Sig: One (1) pill PO twice
a day for 14 days.
Disp:*1 pack* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: gastric ulcer secondary to H pylori infection
Secondary: osteoarthritis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Mr. [**Known lastname 449**],

It was a pleasure taking part in your care. You were admitted to
the hospital because you had black, tarry ostomy output for two
days and two weeks of progressive weakness, lightheadedness, and
fatigue. You were found to have an ulcer in your stomach that is
the presumed source of the bleed. Also, your level of blood
thinner was too high leading to increased likelihood of bleeding
as well. You were admitted to the medical intensive care unit
where you received several units of blood transfusion and blood
products to reverse the blood thinners. The bleeding stopped,
and you were transferred to the medical floor where you were
given diuretics to remove the extra fluid put on in the ICU.
Once the fluid was removed your oxygen levels improved. You were
discharged home with continuting therapy for the ulcer. You may
discuss eventually re-starting the blood thinners with your PCP.

Please make the following changes to your medications:

1. STOP taking coumadin for now. You may re-start this as an
outpatient with your primary care physician.
2. STOP taking ibuprofen, or any other NSAID. You may take your
low-dose aspirin once daily.
3. START Prevpac and complete a 14-day course of two pills daily
4. START Pantoprazole 40mg by mouth twice daily once you have
completed the Prevpac

Please continue the other medications you were taking prior to
this hospitalization.

Please keep all follow-up appointments.

Followup Instructions:
Department: [**Hospital3 249**]
When: THURSDAY [**2177-10-30**] at 10:30 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: DIV. OF GASTROENTEROLOGY
When: WEDNESDAY [**2177-11-26**] at 1:30 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9864**], MD [**Telephone/Fax (1) 463**]
Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: WEST PROCEDURAL CENTER
When: TUESDAY [**2177-12-30**] at 12:30 PM
With: WPC ROOM THREE [**Telephone/Fax (1) 5072**]
Building: [**Hospital Ward Name 121**] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Transfusion associated circulatory overload,Atrial fibrillation,Stricture and stenosis of esophagus,Helicobacter pylori [H. pylori],Colostomy status,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anxiety state, unspecified,Abnormal coagulation profile,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other nonspecific abnormal finding of lung field'}


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: Mr. [**Known lastname 449**] is a 77 y.o male with h/o rectal cancer s/p resection
with colostomy and chemotx in [**2164**], afib on coumadin who
presents with black tarry colostomy output x2 days. He states
that for the past 2 weeks he has felt lightheaded, weak, and
fatigued, but otherwise in his USOH. Two days PTA he noticed
black tarry output in his ostomy bag.  He has not had abdominal
pain, nausea/vomiting, or bright red blood.  He notes that this
happened to him once approx 1 year ago but it resolved without
intervention.  Of note, pt has taken naproxen twice daily for
arthritis pain for many years.  Also has taken coumadin for afib
for over 10 years, last INR checked approx 2 weeks ago and was
therapeutic (between [**1-16**]).
.
In the ED, he was noted to be tachycardic with HR 130s, BP
128/60, RR 24, O2 sat 100% on RA.  Labs were notable for Hct 17,
INR 8.7, WBC 21.9, lactate 4.5. He was transfused 2u pRBCs, 2u
FFP, and received 2.5mg IV vit K.  GI was consulted and
performed NG lavage, which was negative. He was started on
pantoprazole gtt and admitted to the MICU for monitoring.
.
On arrival to the MICU, initial vitals were T 98.7, HR 108, BP
130/76, RR 19, O2 sat 99% on 2L NC.  Currently he states that he
feels well overall, improved since receiving transfusions.
Denies CP/SOB, palpitations, N/V, abdominal pain.

MEDICAL HISTORY: -rectal cancer status post resection and end colostomy,
chemotherapy in [**2164**]
-macular degeneration
-remote h/o duodenal ulcer, evaluated at [**Hospital1 112**], resolved without
tx
-osteoarthritis
-atrial fibrillation
-hyperlipidemia
-[**Last Name (un) 23424**] esophagus ([**2171**])

MEDICATION ON ADMISSION: Medications - Prescription
ALPRAZOLAM - 0.5 mg Tablet - 1 Tablet(s) by mouth every night;
half in morning
CLONAZEPAM - 0.5 mg Tablet - 1 po(s) by mouth twice a day as
needed for anxiety
NAPROXEN - 375 mg Tablet - one Tablet(s) by mouth twice a day
PRAVASTATIN - 20 mg Tablet - 1 Tablet(s) by mouth once a day in
the evening
SERTRALINE - 100 mg Tablet - 1 Tablet(s) by mouth once a day
TRAMADOL - 50 mg Tablet - [**12-15**] Tablet(s) by mouth every four (4)
-
six (6) hours as needed for pain
VERAPAMIL - 240 mg Cap,Ext Release Pellets 24 hr - 1 Cap,24 hr
Sust Release Pellets(s) by mouth qd for heart rate
WARFARIN - 2 mg Tablet - Take up to 2 (two) tablets by mouth
once
a day or as directed by [**Hospital3 **]

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / NSAIDS

PHYSICAL EXAM: Admission Exam:
General: Pleasant elderly male, breathing comfortably on RA, in
NAD
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Irregularly irregular, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
ostomy bag in LLQ
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII grossly intact, no focal deficits

FAMILY HISTORY: NC

SOCIAL HISTORY: Non-smoker, no EtOH or IVDU.  Lives with wife in [**Name (NI) 5087**]. 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Transfusion associated circulatory overload,Atrial fibrillation,Stricture and stenosis of esophagus,Helicobacter pylori [H. pylori],Colostomy status,Long-term (current) use of anticoagulants,Coronary atherosclerosis of native coronary artery,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anxiety state, unspecified,Abnormal coagulation profile,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other nonspecific abnormal finding of lung field'}
