CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: 79 y/oM with PMH HTN, HLD, DM, PVD p/w copious hemetemesis x
45min.   Per wife, patient complained of nausea and vomited 2-3x
this afternoon.  Initially, there were food particles in the
emesis but then wife noticed bright red blood and coffee ground
material.  She collected approx 200cc of bloody emesis.  Patient
complained of chest pain accompanied by SOB beginning after
vomiting episode.  No lightheadedness, syncope, black tarry
stools, etc.  No hx of NSAID use or prior episodes of
hemetemesis.
.
On arrival to ED, initial VS: 72 146/80 18 98% RA.  Initial labs
remarkable for Hct at baseline of 39.4.  Several attempts were
made to perform NG lavage without success. 2 18 guage PIVs were
inserted, volume resuscitated with 2 L NS and protonix gtt
started.  GI saw patient and thought that an emergent scope was
not indicated.
.
ROS:
pertinent +: complains of persistent fatigue, b/l LE pain [**1-8**] DM
pertinent -: denies any significant weight change, fever, cough,
hematuria, dark/ tarry stool

MEDICAL HISTORY: - Type 2 Diabetes mellitus
- Hypertension
- Hyperlipemia
- Legal blindness (can see shapes but blurry)
- History of atypical chest pain
- Dementia
- PVD

MEDICATION ON ADMISSION: - donepezil [Aricept] 10 mg Tablet
- glipizide 10 mg Tablet [**Hospital1 **]
- lisinopril-HCTZ 10 mg-12.5 mg Tablet daily
- memantine 10 mg Tablet [**Hospital1 **]
- metformin 1,000 mg Tablet [**Hospital1 **]
- pioglitazone [Actos] 30 mg Tablet daily
- simvastatin 40 mg Tablet daily
- aspirin 81 mg Tablet daily
- cholecalciferol (vitamin D3)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: afebrile BP: 146/80   HR: 72  RR: 18  O2sat 98%RA
GEN: comfortable, NAD, affect disconjugate with
HEENT: PERRL, EOMI, anicteric, MMM
NECK: no JVP
RESP: CTA anteriorly with good air movement throughout
CV: RRR, S1 and S2 wnl, grade II/VI SEM
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAO x 1 (knows in hospital). Cn II-XII intact. [**4-10**]
strength throughout. No pass-pointing on finger to nose.
RECTAL: deferred

FAMILY HISTORY: unable to obtain

SOCIAL HISTORY: He quit alcohol in [**2112**], but history of heavy alcohol use, quit
tobacco in [**2112**], but a former 2-1/2 pack per day smoker. No
other drug use. He lives with his second wife and has 7
children. His twin brother was killed during the war and he was
therefore discharged from the service.
Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Chest pain, unspecified,Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Legal blindness, as defined in U.S.A.,Dizziness and giddiness,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Other persistent mental disorders due to conditions classified elsewhere
Mallory-weiss syndrome,Ac posthemorrhag anemia,Chest pain NOS,DMII unspf nt st uncntrl,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Legal blindness-usa def,Dizziness and giddiness,Hyperlipidemia NEC/NOS,Periph vascular dis NOS,Mental disor NEC oth dis
Admission Date:  [**2143-9-21**]              Discharge Date:   [**2143-9-24**]

Date of Birth:  [**2064-7-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
hematemesis

Major Surgical or Invasive Procedure:
Upper endoscopy

History of Present Illness:
79 y/oM with PMH HTN, HLD, DM, PVD p/w copious hemetemesis x
45min.   Per wife, patient complained of nausea and vomited 2-3x
this afternoon.  Initially, there were food particles in the
emesis but then wife noticed bright red blood and coffee ground
material.  She collected approx 200cc of bloody emesis.  Patient
complained of chest pain accompanied by SOB beginning after
vomiting episode.  No lightheadedness, syncope, black tarry
stools, etc.  No hx of NSAID use or prior episodes of
hemetemesis.
.
On arrival to ED, initial VS: 72 146/80 18 98% RA.  Initial labs
remarkable for Hct at baseline of 39.4.  Several attempts were
made to perform NG lavage without success. 2 18 guage PIVs were
inserted, volume resuscitated with 2 L NS and protonix gtt
started.  GI saw patient and thought that an emergent scope was
not indicated.
.
ROS:
pertinent +: complains of persistent fatigue, b/l LE pain [**1-8**] DM
pertinent -: denies any significant weight change, fever, cough,
hematuria, dark/ tarry stool


Past Medical History:
- Type 2 Diabetes mellitus
- Hypertension
- Hyperlipemia
- Legal blindness (can see shapes but blurry)
- History of atypical chest pain
- Dementia
- PVD

Social History:
He quit alcohol in [**2112**], but history of heavy alcohol use, quit
tobacco in [**2112**], but a former 2-1/2 pack per day smoker. No
other drug use. He lives with his second wife and has 7
children. His twin brother was killed during the war and he was
therefore discharged from the service.


Family History:
 unable to obtain

Physical Exam:
VS: Temp: afebrile BP: 146/80   HR: 72  RR: 18  O2sat 98%RA
GEN: comfortable, NAD, affect disconjugate with
HEENT: PERRL, EOMI, anicteric, MMM
NECK: no JVP
RESP: CTA anteriorly with good air movement throughout
CV: RRR, S1 and S2 wnl, grade II/VI SEM
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAO x 1 (knows in hospital). Cn II-XII intact. [**4-10**]
strength throughout. No pass-pointing on finger to nose.
RECTAL: deferred

Pertinent Results:
Admission labs:
[**2143-9-21**] 03:45PM BLOOD WBC-4.2 RBC-4.41* Hgb-13.5* Hct-39.4*
MCV-89 MCH-30.6 MCHC-34.2 RDW-13.0 Plt Ct-209
[**2143-9-21**] 03:45PM BLOOD Neuts-80.0* Lymphs-14.3* Monos-4.8
Eos-0.6 Baso-0.3
[**2143-9-21**] 03:45PM BLOOD PT-12.9 PTT-20.9* INR(PT)-1.1
[**2143-9-21**] 03:45PM BLOOD Glucose-172* UreaN-16 Creat-1.3* Na-143
K-3.9 Cl-104 HCO3-27 AnGap-16
[**2143-9-21**] 03:45PM BLOOD ALT-8 AST-14 AlkPhos-58 TotBili-0.5
[**2143-9-21**] 03:45PM BLOOD cTropnT-<0.01
[**2143-9-22**] 12:46AM BLOOD cTropnT-<0.01

Studies:
[**9-21**] CXR: FINDINGS: The lungs are well expanded and clear. The
mediastinum is unremarkable. The cardiac silhouette is within
normal limits for size. No effusion or pneumothorax is noted.
The visualized osseous structures are grossly unremarkable.
  IMPRESSION: No acute pulmonary process.

[**9-22**] Upper endoscopy:
[**Doctor First Name **]-[**Doctor Last Name **] tear. Otherwise normal EGD to third part of the
duodenum.

Brief Hospital Course:
79 y/oM with PMH HTN, HLD, DM, PVD p/w hemetemesis x 45min.
.
1. Acute Blood Loss Anemia due to Hematemesis: Upper GI bleed of
unclear etiology, though upper endoscopy revealed likely
[**Doctor First Name **]-[**Doctor Last Name **] tear at gastroesophageal junction. He was
initially placed on PPI IV, but this was changed to [**Hospital1 **] oral
dosing after the endoscopy. He was allowed to eat soft solids
after his endoscopy, per GI recommendations.

2. Chest pain: Pt presented with episode of chest pain insetting
of GIB concerning for demand ischemia.  He was symptom free upon
arrival to the MICU, with EKG at baseline and no elevation in
CE. His aspirin was held in setting of bleed, but statin was
continued.

3. Dementia/Delirium: The patient was likely delirious in
addition to his baseline dementia, during the first night of his
admission, when he was attacking nursing staff and pulling at
his own IV lines. A code purple was called on the patient and he
received haldol and olanzapine for agitation. He was calm and
not agitated, during the remainder of his stay in the MICU and
medical floor.

4. benign hypertension: His lisinopril- HCTZ was initially held,
in the setting of his acute bleed. restarted prior to discharge

5. type 2 DM uncontrolled without complications: The patient's
oral hypoglycemics (metformin, actos, glipizide) were held
during his stay in the MICU. His blood sugars were monitored
with fingersticks.
.
Code: Full code (confirmed with HCP)

Medications on Admission:
- donepezil [Aricept] 10 mg Tablet
- glipizide 10 mg Tablet [**Hospital1 **]
- lisinopril-HCTZ 10 mg-12.5 mg Tablet daily
- memantine 10 mg Tablet [**Hospital1 **]
- metformin 1,000 mg Tablet [**Hospital1 **]
- pioglitazone [Actos] 30 mg Tablet daily
- simvastatin 40 mg Tablet daily
- aspirin 81 mg Tablet daily
- cholecalciferol (vitamin D3)

Discharge Medications:
1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO BID (2 times a day).
3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. memantine 5 mg Tablet Sig: Two (2) Tablet PO BID  ().
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID prn as needed
for constipation.
7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)  PO
QHS (once a day (at bedtime)).
8. donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

9. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.

10. pioglitazone 30 mg Tablet Sig: One (1) Tablet PO once a day.

11. Aspirin Low Dose 81 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO once a day.
12. glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Tear


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


Discharge Instructions:
Dear Mr. [**Known lastname 48267**]:
It was a pleasure taking care of you at [**Hospital1 18**].  You were
admitted to [**Hospital1 18**] because you had a gastrointestinal bleed
caused by a tear in the space between your esophagus and
stomach, called [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **] tear.  This was caused by your
vomiting.  You were stabilized and given two units of blood in
the medical intensive care unit. You were transferred to the
internal medicine floors, and the gerontologists evaluated you
to adjust your dementia and delerium medications. Your blood
tests stabilized and you were well enough to go home.

Please make the following changes to your home medication
regimen:
1. Stop taking the combination hydrochlorothiazide/lisinopril
pill
2. Start lisinopril 10mg by mouth daily
3. Take memantine to 10mg by mouth twice per day
4. Decrease your donepezil to 5mg by mouth once per day
5. Continue your diabtetes medications, including metformin
100mg twice per day and pioglitazone 30mg daily and glipizide 10
mg [**Hospital1 **]
6. Continue your low dose aspirin 81mg daily
7. Take colace/cocusate 100mg twice per day for constipation
(over the counter)
8. Take senna 1 tab twice per day as needed for constipation
(over the counter)
9. Take Miralax 1 packet every night before bedtime as needed
for constipation (over the counter)

Followup Instructions:
You have the following appointments at [**Hospital1 18**]:

Department: [**Hospital3 249**]
When: TUESDAY [**2143-10-8**] at 9:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**MD Number(3) 4383**]: [**Telephone/Fax (1) 250**]
Address: [**Location (un) 830**], [**Location (un) 86**], MA
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

Department: GASTROENTEROLOGY
When: WEDNESDAY [**2143-10-9**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6970**], MD
Phone:[**Telephone/Fax (1) 463**]
Address: [**Last Name (NamePattern1) 439**], [**Location (un) 86**], MA
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST Best Parking: [**Hospital Ward Name **] Garage

Department: COGNITIVE NEUROLOGY UNIT
When: WEDNESDAY [**2143-11-27**] at 8:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8384**], MD [**Telephone/Fax (1) 1690**]
Building: Ks [**Hospital Ward Name 860**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: [**Hospital3 249**]
When: TUESDAY [**2143-10-8**] at 9:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**MD Number(3) 4383**]: [**Telephone/Fax (1) 250**]
Address: [**Location (un) 830**], [**Location (un) 86**], MA
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: GASTROENTEROLOGY
When: WEDNESDAY [**2143-10-9**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6970**], MD
Phone:[**Telephone/Fax (1) 463**]
Address: [**Last Name (NamePattern1) 439**], [**Location (un) 86**], MA
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage



Completed by:[**2143-9-29**]
{'Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Chest pain, unspecified,Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Legal blindness, as defined in U.S.A.,Dizziness and giddiness,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Other persistent mental disorders due to conditions classified elsewhere'}


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: hematemesis

PRESENT ILLNESS: 79 y/oM with PMH HTN, HLD, DM, PVD p/w copious hemetemesis x
45min.   Per wife, patient complained of nausea and vomited 2-3x
this afternoon.  Initially, there were food particles in the
emesis but then wife noticed bright red blood and coffee ground
material.  She collected approx 200cc of bloody emesis.  Patient
complained of chest pain accompanied by SOB beginning after
vomiting episode.  No lightheadedness, syncope, black tarry
stools, etc.  No hx of NSAID use or prior episodes of
hemetemesis.
.
On arrival to ED, initial VS: 72 146/80 18 98% RA.  Initial labs
remarkable for Hct at baseline of 39.4.  Several attempts were
made to perform NG lavage without success. 2 18 guage PIVs were
inserted, volume resuscitated with 2 L NS and protonix gtt
started.  GI saw patient and thought that an emergent scope was
not indicated.
.
ROS:
pertinent +: complains of persistent fatigue, b/l LE pain [**1-8**] DM
pertinent -: denies any significant weight change, fever, cough,
hematuria, dark/ tarry stool

MEDICAL HISTORY: - Type 2 Diabetes mellitus
- Hypertension
- Hyperlipemia
- Legal blindness (can see shapes but blurry)
- History of atypical chest pain
- Dementia
- PVD

MEDICATION ON ADMISSION: - donepezil [Aricept] 10 mg Tablet
- glipizide 10 mg Tablet [**Hospital1 **]
- lisinopril-HCTZ 10 mg-12.5 mg Tablet daily
- memantine 10 mg Tablet [**Hospital1 **]
- metformin 1,000 mg Tablet [**Hospital1 **]
- pioglitazone [Actos] 30 mg Tablet daily
- simvastatin 40 mg Tablet daily
- aspirin 81 mg Tablet daily
- cholecalciferol (vitamin D3)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: afebrile BP: 146/80   HR: 72  RR: 18  O2sat 98%RA
GEN: comfortable, NAD, affect disconjugate with
HEENT: PERRL, EOMI, anicteric, MMM
NECK: no JVP
RESP: CTA anteriorly with good air movement throughout
CV: RRR, S1 and S2 wnl, grade II/VI SEM
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAO x 1 (knows in hospital). Cn II-XII intact. [**4-10**]
strength throughout. No pass-pointing on finger to nose.
RECTAL: deferred

FAMILY HISTORY: unable to obtain

SOCIAL HISTORY: He quit alcohol in [**2112**], but history of heavy alcohol use, quit
tobacco in [**2112**], but a former 2-1/2 pack per day smoker. No
other drug use. He lives with his second wife and has 7
children. His twin brother was killed during the war and he was
therefore discharged from the service. 

### Response:
{'Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Chest pain, unspecified,Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Legal blindness, as defined in U.S.A.,Dizziness and giddiness,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Other persistent mental disorders due to conditions classified elsewhere'}
