CHIEF COMPLAINT: Bright red blood per rectum

PRESENT ILLNESS: The patient is a 64 year old male with history of GERD who
recently discontinued omeprazole presented to the [**Hospital1 18**] ED with
complaints of bright red by rectum at 1pm one the afternoon of
admission. According to the patient, he had been in his usual
state of good health until the the day of admission when he had
six episodes of bright red blood per rectum. He states that the
first episode was a "gush" of blood which "filled the toilet
bowl", following that he had five more bowel movements which he
initially described as diarrhea but acknowledged that is was
mostly blood. He had never had similar episodes. He took two
tablets of Alieve two days before admission for hip pain but
stated that he did not regularly take NSAIDS. His last
colonoscopy was in [**2127**] at [**Hospital1 112**] and he reported that it was
normal.

MEDICAL HISTORY: Gastroesophageal Reflux
Erectile Dysfunction

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Sildenafil 150 mg PO DAILY:PRN Sexual activity
2. Fish Oil (Omega 3) 1000 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VS: T 98.2 P:84 116/54 O2 Sat 100%, Vent settings assist control
Vt 500x16 [**9-19**] Fio2 100%
General: Sedated intubated male not responsive to commands or
painful stiumuls
HEENT: Sclera anicteric, MMM, ET tube in place, pupils 1mm and
non-reactive
Neck: Right CVL in place C/D/I
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds
normoactive, no organomegaly
GU: foley in place
RECTAL: Frank blood oozing from rectum
Ext: warm, well perfused, right groin access site c/d/i. Pulses
2+ in PT and DP

FAMILY HISTORY: Denies family history of gastrointestinal malignancy,
cardiovascular disease, diabetes or malignancy.

SOCIAL HISTORY: Born in [**Country 4812**]. He is seperated from his wife and has 5
daughters. His brother lives in [**Hospital1 **] and is involved in his
care. He is a never smoker and drinks 1-2 beers 1-2x/week.
Denies illicit substances.
Diverticulosis of colon with hemorrhage,Other shock without mention of trauma,Acute posthemorrhagic anemia,Benign neoplasm of adrenal gland,Esophageal reflux
Dvrtclo colon w hmrhg,Shock w/o trauma NEC,Ac posthemorrhag anemia,Benign neoplasm adrenal,Esophageal reflux
Admission Date:  [**2131-9-1**]              Discharge Date:   [**2131-9-5**]

Date of Birth:  [**2067-8-1**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2145**]
Chief Complaint:
Bright red blood per rectum

Major Surgical or Invasive Procedure:
Central venous line placement [**2131-9-1**]
Right radial arterial catheter placement [**2131-9-1**]
Endotracheal intubation [**2131-9-1**]
Colonic arteriography via right femoral artery [**2131-9-1**]
Colonoscopy


History of Present Illness:
The patient is a 64 year old male with history of GERD who
recently discontinued omeprazole presented to the [**Hospital1 18**] ED with
complaints of bright red by rectum at 1pm one the afternoon of
admission. According to the patient, he had been in his usual
state of good health until the the day of admission when he had
six episodes of bright red blood per rectum. He states that the
first episode was a "gush" of blood which "filled the toilet
bowl", following that he had five more bowel movements which he
initially described as diarrhea but acknowledged that is was
mostly blood. He had never had similar episodes. He took two
tablets of Alieve two days before admission for hip pain but
stated that he did not regularly take NSAIDS. His last
colonoscopy was in [**2127**] at [**Hospital1 112**] and he reported that it was
normal.

Past Medical History:
Gastroesophageal Reflux
Erectile Dysfunction

Social History:
Born in [**Country 4812**]. He is seperated from his wife and has 5
daughters. His brother lives in [**Hospital1 **] and is involved in his
care. He is a never smoker and drinks 1-2 beers 1-2x/week.
Denies illicit substances.

Family History:
Denies family history of gastrointestinal malignancy,
cardiovascular disease, diabetes or malignancy.

Physical Exam:
ADMISSION EXAM
VS: T 98.2 P:84 116/54 O2 Sat 100%, Vent settings assist control
Vt 500x16 [**9-19**] Fio2 100%
General: Sedated intubated male not responsive to commands or
painful stiumuls
HEENT: Sclera anicteric, MMM, ET tube in place, pupils 1mm and
non-reactive
Neck: Right CVL in place C/D/I
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds
normoactive, no organomegaly
GU: foley in place
RECTAL: Frank blood oozing from rectum
Ext: warm, well perfused, right groin access site c/d/i. Pulses
2+ in PT and DP

VS: 98.1  136/72  68  20  100%
Gen: Well-appearing male of stated age, NAD
HEENT: NCAT MMM EOMI
Pulm: CTA b/l without noted wheeze or rhonchi
Cor: RRR (+)S1/S2
Abd: Soft, mild distention, non-tender to palpation, active BS
LE: No LE edema, distal pulses 2+
Neuro: CNII-XII grossly intact, moving all extremities

Pertinent Results:
ADMISSION LABS
==============
[**2131-9-1**] 05:22PM BLOOD WBC-9.0 RBC-4.23* Hgb-13.1* Hct-38.3*
MCV-91 MCH-31.0 MCHC-34.2 RDW-13.2 Plt Ct-237
[**2131-9-1**] 05:22PM BLOOD Neuts-65.3 Lymphs-28.2 Monos-3.9 Eos-2.1
Baso-0.5
[**2131-9-1**] 05:22PM BLOOD Glucose-141* UreaN-20 Creat-1.1 Na-138
K-3.8 Cl-104 HCO3-25 AnGap-13
[**2131-9-2**] 03:40AM BLOOD Calcium-7.2* Phos-3.0 Mg-1.9
.
Hematocrit trend
================
.
[**2131-9-1**] 05:22PM BLOOD WBC-9.0 RBC-4.23* Hgb-13.1* Hct-38.3*
MCV-91 MCH-31.0 MCHC-34.2 RDW-13.2 Plt Ct-237
[**2131-9-1**] 11:33PM BLOOD Hgb-8.5* calcHCT-26
[**2131-9-2**] 03:40AM BLOOD WBC-8.7 RBC-3.36* Hgb-10.4* Hct-29.8*
MCV-89 MCH-31.1 MCHC-35.0 RDW-13.7 Plt Ct-149*
[**2131-9-2**] 08:12AM BLOOD Hct-30.8*
[**2131-9-2**] 01:43PM BLOOD WBC-14.4*# RBC-3.61* Hgb-11.0* Hct-32.1*
MCV-89 MCH-30.6 MCHC-34.3 RDW-13.9 Plt Ct-150
[**2131-9-2**] 08:41PM BLOOD WBC-UNABLE TO  RBC-UNABLE TO  Hgb-UNABLE
TO  Hct-UNABLE TO  MCV-UNABLE TO  MCH-UNABLE TO  MCHC-UNABLE TO
RDW-UNABLE TO  Plt Ct-UNABLE TO
[**2131-9-2**] 09:29PM BLOOD WBC-14.9* RBC-3.52* Hgb-10.8* Hct-31.3*
MCV-89 MCH-30.6 MCHC-34.4 RDW-13.8 Plt Ct-159
[**2131-9-3**] 03:10AM BLOOD WBC-9.9 RBC-3.23* Hgb-9.9* Hct-28.8*
MCV-89 MCH-30.7 MCHC-34.4 RDW-13.9 Plt Ct-152
[**2131-9-3**] 07:37AM BLOOD Hct-30.2*
[**2131-9-3**] 04:44PM BLOOD WBC-8.5 RBC-3.29* Hgb-10.0* Hct-29.1*
MCV-89 MCH-30.5 MCHC-34.5 RDW-13.7 Plt Ct-162
[**2131-9-3**] 11:23PM BLOOD Hct-27.8*
[**2131-9-4**] 03:30AM BLOOD WBC-8.1 RBC-3.27* Hgb-10.1* Hct-29.1*
MCV-89 MCH-31.1 MCHC-34.8 RDW-13.8 Plt Ct-155
[**2131-9-4**] 03:30PM BLOOD Hct-30.4*
[**2131-9-5**] 05:50AM BLOOD WBC-7.0 RBC-3.27* Hgb-10.2* Hct-29.6*
MCV-91 MCH-31.2 MCHC-34.5 RDW-13.7 Plt Ct-202
.
DISCHARGE LABS
===============
.
[**2131-9-5**] 05:50AM BLOOD WBC-7.0 RBC-3.27* Hgb-10.2* Hct-29.6*
MCV-91 MCH-31.2 MCHC-34.5 RDW-13.7 Plt Ct-202
[**2131-9-5**] 05:50AM BLOOD Glucose-117* UreaN-8 Creat-0.7 Na-145
K-3.9 Cl-111* HCO3-25 AnGap-13
[**2131-9-4**] 03:30AM BLOOD Calcium-8.5 Phos-2.8 Mg-2.1
.
CTA Abdomen ([**9-1**]): Arterial extravasation in the ascending
colon, just proximal to the hepatic flexure, compatible with
active GI bleeding. Small hiatal hernia with fluid in the distal
esophagus. Left adrenal adenoma.
.
Colonoscopy ([**9-5**]): Diverticulosis of the whole colon. Otherwise
normal colonoscopy to terminal ileum. Due to only fair prep,
which was inadequate, would recommend repeat colonoscopy within
the next 1 year.

Brief Hospital Course:
A 64 year old male with PMH GERD presents with bright red blood
per rectum and found to have active extravasation of blood into
the colon.
.
ACUTE ISSUES
#Lower GI Bleed
In the ED, initial vital signs were stable, and by report,
patient was well-appearing and asymptomatic. A CTA abdomen
revealed active extravasation in the ascending colon. Prior to
being transported from the ER, the patient was noted to have
systolic pressures in the 60-70s, and was fluid resuscitated and
transfused with packed red blood cells. In Interventional
Radiology, the source of the bleeding could not be identified
despite the CTA, but due to deteriorating vital signs, the
patient was electively intubated and transported to the MICU for
further volume resuscitation. In the MICU, the patient required
pressors for a brief time to support his pressure, but was
easily weaned soon after arrival. Over the course of his ER and
MICU stay, the patient required a total of 4 units of PRBCs. By
morning, the patient was stable, thus extubated without
additional signs of bleeding. His hematocrit was trended, and
stabilized around 30%. The patient had a colonoscopy performed
at OSH 5 years before this admission, which revealed extensive
diverticular disease throughout the colon. No polyps were
identified at the time. Because of the nature of the bleed, it
was thought that this was most likely lower GI in origin, and
most likely from a diverticular source. GI had been consulted in
the ER and agreed that the pattern of bleeding was consistent
with [**Month/Year (2) **]. They deferred on performing a colonscopy
during the acute bleeding phase for concern of poor
visualization in the setting of bleeding. The patient was
transferred to the general medicine floor and his hematocrits
continued to be trended, and remained stable around 30%. He had
multiple small brown stools that had some red tinge, but there
were no signs of active bleeding. On the day of discharge, the
patient was taken for colonoscopy by GI who again noted
extensive diverticular disease in the setting of only a fair
prep, but did not identify a source of bleeding. GI recommended
a repeat colonoscopy in one year's time. The patient was
discharged with a follow-up appointment scheduled with his PCP
in one week and explicit instructions to return to the ER if
additional bleeding occurred or the patient experienced
lightheadedness or CV symptoms.
.
#Suspected Adrenal Adenoma: The CTA abdomen on [**2131-9-1**]
demonstrated a 2.2 x 1.9 cm left adrenal nodule has Hounsfield
attenuation of -7.2, compatible with an adrenal adenoma.
.
TRANSITIONAL ISSUES
#Patient was scheduled to follow-up in one week with his PCP
#[**Name10 (NameIs) **] will require a repeat colonoscopy in one year per GI
#Patient will require follow-up of an adrenal incidentaloma

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Sildenafil 150 mg PO DAILY:PRN Sexual activity
2. Fish Oil (Omega 3) 1000 mg PO DAILY


Discharge Medications:
1. Fish Oil (Omega 3) 1000 mg PO DAILY
2. Sildenafil 150 mg PO DAILY:PRN Sexual activity


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnoses:
Lower GI bleed
Diverticulosis


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


Discharge Instructions:
Mr. [**Known lastname 100672**],

You were admitted because you experienced bleeding from your
gastrointestinal tract. The Interventional Radiology team was
unable to locate where the bleeding was coming from. You were
transferred to the ICU because your blood pressure became
unstable. Your were stabilized and your bleeding was stopped,
and you were then transferred to the floor. You underwent
colonoscopy by the GI doctors who [**Name5 (PTitle) **] [**Name5 (PTitle) **] (outpuchings
of the bowel wall), but no specific source of the bleeding. They
recommended a follow-up colonoscopy in one year.

Please CONTINUE your home medications
Please use TYLENOL for pain relief, NOT ibuprofen/motrin or
naproxen/aleve.

Please FOLLOW-UP with your primary care doctor, an appointment
has been made on your behalf. Please find the details below.

If you have additional episodes of BLEEDING or feel LIGHTHEADED
or DIZZY, please proceed to the ER or contact your PCP for
further evaluation.

It's been a pleasure taking care of you, thank you for choosing
[**Hospital1 18**]!

Followup Instructions:
Adrenal Adenoma: The CT scan we did of your abdomen on [**2131-9-1**]
showed a mass in your adrenal gland that is likely an adrenal
adenoma, which is a benign mass that are commonly found on these
types of CT scans. This needs to be followed up as an outpatient
however to make sure it is nothing worrisome. You should discuss
this with your doctor at your outpatient follow up visit.

Name: [**Last Name (LF) **],[**First Name3 (LF) **] N.
Location: [**Hospital1 641**]
Address: [**Street Address(2) 642**], [**Location (un) **],[**Numeric Identifier 643**]
Phone: [**Telephone/Fax (1) 644**]
Appointment: Tuesday [**2131-9-11**] 10:50am


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**]
{'Diverticulosis of colon with hemorrhage,Other shock without mention of trauma,Acute posthemorrhagic anemia,Benign neoplasm of adrenal gland,Esophageal reflux'}


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: Bright red blood per rectum

PRESENT ILLNESS: The patient is a 64 year old male with history of GERD who
recently discontinued omeprazole presented to the [**Hospital1 18**] ED with
complaints of bright red by rectum at 1pm one the afternoon of
admission. According to the patient, he had been in his usual
state of good health until the the day of admission when he had
six episodes of bright red blood per rectum. He states that the
first episode was a "gush" of blood which "filled the toilet
bowl", following that he had five more bowel movements which he
initially described as diarrhea but acknowledged that is was
mostly blood. He had never had similar episodes. He took two
tablets of Alieve two days before admission for hip pain but
stated that he did not regularly take NSAIDS. His last
colonoscopy was in [**2127**] at [**Hospital1 112**] and he reported that it was
normal.

MEDICAL HISTORY: Gastroesophageal Reflux
Erectile Dysfunction

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Sildenafil 150 mg PO DAILY:PRN Sexual activity
2. Fish Oil (Omega 3) 1000 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
VS: T 98.2 P:84 116/54 O2 Sat 100%, Vent settings assist control
Vt 500x16 [**9-19**] Fio2 100%
General: Sedated intubated male not responsive to commands or
painful stiumuls
HEENT: Sclera anicteric, MMM, ET tube in place, pupils 1mm and
non-reactive
Neck: Right CVL in place C/D/I
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds
normoactive, no organomegaly
GU: foley in place
RECTAL: Frank blood oozing from rectum
Ext: warm, well perfused, right groin access site c/d/i. Pulses
2+ in PT and DP

FAMILY HISTORY: Denies family history of gastrointestinal malignancy,
cardiovascular disease, diabetes or malignancy.

SOCIAL HISTORY: Born in [**Country 4812**]. He is seperated from his wife and has 5
daughters. His brother lives in [**Hospital1 **] and is involved in his
care. He is a never smoker and drinks 1-2 beers 1-2x/week.
Denies illicit substances. 

### Response:
{'Diverticulosis of colon with hemorrhage,Other shock without mention of trauma,Acute posthemorrhagic anemia,Benign neoplasm of adrenal gland,Esophageal reflux'}
