CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: Pt is a 44 yo male history of EtOH (stopped 4 years ago) and
varices diagnosed 5 years ago, who presents to [**Hospital3 3583**]
with hematemesis. Per family, pt felt like he had a cold for the
past few days. He was coughing, felt nauseous, and fatigued.
This am when he awoke, he realized his was spitting up blood and
went to the [**Hospital3 3583**] ED. He was hemodynamically stable
upon arrival with Hct 36, plt 95, INR 1.3. Prior to being
admitted, pt had another episode of hematemesis (~1L per report)
associated with syncope and probable aspiration.
.
He was unresponsive and intubated for airway protected (#8 ETT
26 cm). He was transferred to the ICU at 7 pm. An EGD showed
portal hypertension, [**3-9**] very large variceal chains that fill up
most of the lumen. Per report, a culprit lesion could not be
identified. Initial Hct was 36 in the ED and was given 4 units
of pRBC with later Hct of 39. He was given a dose of Zosyn,
started on protonix gtt, octreotide gtt, and given 10 mg vitamin
K.
.
Initial blood gas on ventilation was 7.34/39/62, and vent
changed to
AC 700/12/8/100% (unclear what was before but PEEP was
increased)
He is continuing to suction bright red blood and per report CXR
shows LLL infiltrate.
.
Pt was medflighted to [**Hospital1 18**] for evaluation of varices. Intubated
and sedated on arrival.

MEDICAL HISTORY: 1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year

MEDICATION ON ADMISSION: Medications on transfer:
Protonix 52cc/hr
Octreotide 50 cc/hr
NS 150 cc/ hr
propofol 18 mcg/kg/min
s/p 10 mg vitamin K
.
Medications at home:
Mucinex
CVS cold

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 98.5' BP: 125/65; HR: 60s; AC 500/16/8/60%. O2: 100
Gen: Intubated, sedated
HEENT: Pupils minimally reactive. ETT in place. No conjunctiva
palor. Sclera anicteric.
CV: Bradycardic S1S2. No M/R/G
Lungs: CTA b/l anteriorly
Abd: NABS. soft, ND. +hepatomegaly 2 fingerbreaths below costal
margin
GU: guaiac positive melena
Ext: No edema. DP 2+ . Right femoral triple lumen C/D/I. No
palmar erythema.
Neuro: Intubated, sedated.

FAMILY HISTORY: M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

SOCIAL HISTORY: Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family.
Alcoholic cirrhosis of liver,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Alkalosis,Thrombocytopenia, unspecified,Portal hypertension,Other and unspecified alcohol dependence, in remission
Alcohol cirrhosis liver,Food/vomit pneumonitis,Bleed esoph var oth dis,Alkalosis,Thrombocytopenia NOS,Portal hypertension,Alcoh dep NEC/NOS-remiss
Admission Date:  [**2137-7-14**]              Discharge Date:   [**2137-7-18**]

Date of Birth:  [**2093-6-29**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
hematemesis

Major Surgical or Invasive Procedure:
upper endoscopy
Intubation/Mechanical ventilation

History of Present Illness:
Pt is a 44 yo male history of EtOH (stopped 4 years ago) and
varices diagnosed 5 years ago, who presents to [**Hospital3 3583**]
with hematemesis. Per family, pt felt like he had a cold for the
past few days. He was coughing, felt nauseous, and fatigued.
This am when he awoke, he realized his was spitting up blood and
went to the [**Hospital3 3583**] ED. He was hemodynamically stable
upon arrival with Hct 36, plt 95, INR 1.3. Prior to being
admitted, pt had another episode of hematemesis (~1L per report)
associated with syncope and probable aspiration.
.
He was unresponsive and intubated for airway protected (#8 ETT
26 cm). He was transferred to the ICU at 7 pm. An EGD showed
portal hypertension, [**3-9**] very large variceal chains that fill up
most of the lumen. Per report, a culprit lesion could not be
identified. Initial Hct was 36 in the ED and was given 4 units
of pRBC with later Hct of 39. He was given a dose of Zosyn,
started on protonix gtt, octreotide gtt, and given 10 mg vitamin
K.
.
Initial blood gas on ventilation was 7.34/39/62, and vent
changed to
AC 700/12/8/100% (unclear what was before but PEEP was
increased)
He is continuing to suction bright red blood and per report CXR
shows LLL infiltrate.
.
Pt was medflighted to [**Hospital1 18**] for evaluation of varices. Intubated
and sedated on arrival.


Past Medical History:
1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year


Social History:
Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family.

Family History:
M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

Physical Exam:
T: 98.5' BP: 125/65; HR: 60s; AC 500/16/8/60%. O2: 100
Gen: Intubated, sedated
HEENT: Pupils minimally reactive. ETT in place. No conjunctiva
palor. Sclera anicteric.
CV: Bradycardic S1S2. No M/R/G
Lungs: CTA b/l anteriorly
Abd: NABS. soft, ND. +hepatomegaly 2 fingerbreaths below costal
margin
GU: guaiac positive melena
Ext: No edema. DP 2+ . Right femoral triple lumen C/D/I. No
palmar erythema.
Neuro: Intubated, sedated.


Pertinent Results:
Labs at OSH:
Na: 139; K: 4.2; Cl: 112; bicarb: 22; BUN/cr 23/0.7; glucose
127; INR 1.4; Hct: as above. Plt: 118.

[**Age over 90 **]|114|24
-----------<122
4.3|23|0.7

[**2137-7-14**] 11:44PM   ALT(SGPT)-22 AST(SGOT)-23 LD(LDH)-171 ALK
PHOS-45 AMYLASE-16 TOT BILI-1.8*
[**2137-7-14**] 11:44PM   LIPASE-26
[**2137-7-14**] 11:44PM   ALBUMIN-3.3* CALCIUM-7.4* PHOSPHATE-3.4
MAGNESIUM-2.4
[**2137-7-14**] 11:44PM   WBC-13.3* RBC-4.40* HGB-14.2 HCT-39.7* MCV-90
MCH-32.2* MCHC-35.7* RDW-15.1
[**2137-7-14**] 11:44PM   PLT COUNT-124*
[**2137-7-14**] 11:44PM   PT-15.6* PTT-32.1 INR(PT)-1.4*
_
_
_
_
_
_
_
_
_
________________________________________________________________
RADIOLOGY   Preliminary Report

LIVER OR GALLBLADDER US (SINGLE ORGAN) PORT  [**2137-7-16**] 7:52 AM

LIVER OR GALLBLADDER US (SINGL

Reason: Please eval liver for cirrhosis/hepatitis/filling
defects

[**Hospital 93**] MEDICAL CONDITION:
44 year old man with variceal bleed
REASON FOR THIS EXAMINATION:
Please eval liver for cirrhosis/hepatitis/filling defects
INDICATION: 44-year-old man with variceal bleed.

COMPARISON: [**2137-7-15**].

RIGHT UPPER QUADRANT ULTRASOUND: Sludge is seen within the
gallbladder. There is mild gallbladder wall edema. Common bile
duct measures 5 mm. The liver is nodular and heterogeneous in
echotexture consistent with cirrhosis. There are no focal
lesions. The portal vein is patent with appropriate hepatopetal
flow. There is a mild-to-moderate amount of perihepatic free
fluid.

IMPRESSION:

1. Nodular heterogeneous-appearing liver consistent with
cirrhosis.

2. Gallbladder sludge. Mild gallbladder wall edema. This may be
secondary to third spacing from the patient's liver disease.

3. Ascites.

_
_
_
_
_
_
_
_
_
________________________________________________________________
Upper endoscopy - [**2137-7-15**] 4 cords of grade III varices seen in
the middle and lower third of the esophagus which were not
bleeding.

Brief Hospital Course:
44 yo male with h/o EtOH abuse, varices, who presents to OSH
with hematemesis. Found to have large variceal bleeding likely
the source of hematemesis. No active bleeding seen.
.
1. Varices- Likely [**2-7**] EtOH liver disease. Hemodynamically
stable with no active bleed s/p banding x5 of grade [**2-8**] varices.

- Started Nadolol 20mg QD per liver recs.
- Started Spironolactone 100mg QD per liver recs.
- Continue protonix 40 mg IV bid.
- Continue levaquin.
.
2. Liver dx- RUQ ultrasound showed nodular liver consistent with
cirrhosis. This is presumed secondary to prior EtOH abuse. Will
need to rule out other causes.
- hepatitis B/C serologies were negative.
- iron studies pending negative for hemachromatosis
- AFP was checked and normal (1.6).
.
3. Question of Aspiration- On CXR AP here, left hemidiaphragm is
not visualized the whole way. Has been afebrile and WBC is
trending down.
- On levaquin.
- No need for additional abx at this time.
.
4. Respiratory- Successfuly extubated
.
5. EGD to follow in 1 week.
- Advance to soft diet (sodium restrict to <80 mmol/day per
liver recs).
.
6. Access: Right femoral triple lumen placed in OSH. We d/cd it.
Has 3 PIVs (2 large bore). Left A-line placed.
.
7. Contact: Primary contact for family is pt's brother: [**Name (NI) **]
[**Name (NI) 780**] cell:[**Telephone/Fax (1) 68026**]. Backup: Sister: [**Name (NI) 1123**] [**Name (NI) 12303**]
[**Telephone/Fax (1) 68027**]
.
8. Prophylaxis: Hold sq heparin given bleed. Pneumoboots. PPI
[**Hospital1 **]
.
9. Code Status: Full Code
.
10. Dispo: Called out to [**Wardname 13487**].


Medications on Admission:
Medications on transfer:
Protonix 52cc/hr
Octreotide 50 cc/hr
NS 150 cc/ hr
propofol 18 mcg/kg/min
s/p 10 mg vitamin K
.
Medications at home:
Mucinex
CVS cold


Discharge Medications:
1. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
Disp:*30 Tablet(s)* Refills:*0*
4. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Spironolactone 50 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Bleeding Esophageal Varicies


Discharge Condition:
Hematocrit 32.2.  Vital signs stable.  Patient able to ambulate.
 Tolerating PO and moving bowels and bladder appropriately.


Discharge Instructions:
Please take the discharge medications as recommended below.
Please follow up for endoscopy at [**Hospital1 18**] in two weeks and with a
liver doctor (Hepatologist) in four weeks.
Please note that you have recently bled.  If you feel
lightheaded, chest pain, short of breath, throw up blood or if
you see blood in your stool, please come back to the hospital.


Followup Instructions:
Please return in two weeks to see Dr. [**Last Name (STitle) 497**] for EGD.  You were
given the contact information from the Gastroenterology fellow.




Completed by:[**2137-7-18**]
{'Alcoholic cirrhosis of liver,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Alkalosis,Thrombocytopenia, unspecified,Portal hypertension,Other and unspecified alcohol dependence, in remission'}


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: Pt is a 44 yo male history of EtOH (stopped 4 years ago) and
varices diagnosed 5 years ago, who presents to [**Hospital3 3583**]
with hematemesis. Per family, pt felt like he had a cold for the
past few days. He was coughing, felt nauseous, and fatigued.
This am when he awoke, he realized his was spitting up blood and
went to the [**Hospital3 3583**] ED. He was hemodynamically stable
upon arrival with Hct 36, plt 95, INR 1.3. Prior to being
admitted, pt had another episode of hematemesis (~1L per report)
associated with syncope and probable aspiration.
.
He was unresponsive and intubated for airway protected (#8 ETT
26 cm). He was transferred to the ICU at 7 pm. An EGD showed
portal hypertension, [**3-9**] very large variceal chains that fill up
most of the lumen. Per report, a culprit lesion could not be
identified. Initial Hct was 36 in the ED and was given 4 units
of pRBC with later Hct of 39. He was given a dose of Zosyn,
started on protonix gtt, octreotide gtt, and given 10 mg vitamin
K.
.
Initial blood gas on ventilation was 7.34/39/62, and vent
changed to
AC 700/12/8/100% (unclear what was before but PEEP was
increased)
He is continuing to suction bright red blood and per report CXR
shows LLL infiltrate.
.
Pt was medflighted to [**Hospital1 18**] for evaluation of varices. Intubated
and sedated on arrival.

MEDICAL HISTORY: 1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year

MEDICATION ON ADMISSION: Medications on transfer:
Protonix 52cc/hr
Octreotide 50 cc/hr
NS 150 cc/ hr
propofol 18 mcg/kg/min
s/p 10 mg vitamin K
.
Medications at home:
Mucinex
CVS cold

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 98.5' BP: 125/65; HR: 60s; AC 500/16/8/60%. O2: 100
Gen: Intubated, sedated
HEENT: Pupils minimally reactive. ETT in place. No conjunctiva
palor. Sclera anicteric.
CV: Bradycardic S1S2. No M/R/G
Lungs: CTA b/l anteriorly
Abd: NABS. soft, ND. +hepatomegaly 2 fingerbreaths below costal
margin
GU: guaiac positive melena
Ext: No edema. DP 2+ . Right femoral triple lumen C/D/I. No
palmar erythema.
Neuro: Intubated, sedated.

FAMILY HISTORY: M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

SOCIAL HISTORY: Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family. 

### Response:
{'Alcoholic cirrhosis of liver,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Alkalosis,Thrombocytopenia, unspecified,Portal hypertension,Other and unspecified alcohol dependence, in remission'}
