CHIEF COMPLAINT: Upper GI bleed, C. Diff Colitis

PRESENT ILLNESS: Pt was admitted to [**Hospital3 **] on [**2157-4-9**] for septic shock
[**1-28**] C.Diff colitis. Pt received pressors and hydrocortisone
initially for BP mgmt. He was treated with po vancomycin and IV
flagyl, and also got vancomycin enemas when he developed an
ileus. Abdominal CT [**4-13**] showed diffuse colonic submucosal edema
and pericolonic fat stranding, ascites, and bilateral lower lobe
consolidations w/ effusions. Repeat abd CT [**4-17**] showed no
improvement. Surgery was following closely and considering
sub-total colectomy w/ end-ileostomy given severity of disease
despite maximal medical tx.
.
On [**2157-4-17**], routine labs showed a Hct of 20.2 from 35.1 2 days
prior. On questioning pt admitted to noticing black tarry stools
x several days. Upper endoscopy showed a 1.5x1.5cm lower
esophageal ulcer at the GE jxn. Cautery of the lesion was
ineffective [**1-28**] bleeding, and so was injected with epinephrine.
Pt received 5U PRBCs--> Hct 29.8. He was transferred to [**Hospital1 18**]
for upper endoscopy and management of bleeding esophageal ulcer.

MEDICAL HISTORY: Recent hospitalization for pneumonia ([**Date range (1) 72694**])
Zoster, c/b post-herpetic neuralgia
Sick Sinus Syndrome, s/p pacemaker [**2150**]
Gout
HTN
Hypercholesterolemia
Hiatal hernia
c.diff colitis
Cholecystectomy

MEDICATION ON ADMISSION: Home meds:
HCTZ 12.5mg daily, ASA 81mg daily, Quinapril 20mg daily, Avacor
500mg daily, Probenecid 500mg daily
.
MEDS on transfer:
Protonix 80mg IV q8h
Lyrica 75mg po bid
Flagyl 500mg IV q8h
Vancomycin 500mg po qid
Vancomycin 500mg pr q6h
Combivent 2 puffs tid standing and q4h prn
Flovent 4 puffs inh [**Hospital1 **]
Albuterol 2.5mg/3ml neb q4h prn
TPN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.1, 111/64, 77, 18, 97
HEENT: PERRL, EOMI. Dry MM.
Neck: Supple, no lymphadenopathy
Lungs: mild expiratory wheezes bilaterally. No rales or rhonchi.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife [**Name (NI) **] in [**Name (NI) **]. Smoked 1ppd x 15-20 years, quit
in [**2115**]. Drinks 1.5 ounces hard alcohol daily. Denies other drug
use. Until [**2-/2157**] hospitalization for pneumonia, was working
full time in an equipment store.
Ulcer of esophagus with bleeding,Intestinal infection due to Clostridium difficile,Chronic airway obstruction, not elsewhere classified,Other specified gastritis, without mention of hemorrhage,Edema,Pure hypercholesterolemia,Gout, unspecified,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ
Ulcer esophagus w bleed,Int inf clstrdium dfcile,Chr airway obstruct NEC,Oth spf gstrt w/o hmrhg,Edema,Pure hypercholesterolem,Gout NOS,Hypertension NOS,Diaphragmatic hernia,Status cardiac pacemaker
Admission Date:  [**2157-4-18**]              Discharge Date:   [**2157-4-25**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
Upper GI bleed, C. Diff Colitis

Major Surgical or Invasive Procedure:
EGD
PICC

History of Present Illness:
Pt was admitted to [**Hospital3 **] on [**2157-4-9**] for septic shock
[**1-28**] C.Diff colitis. Pt received pressors and hydrocortisone
initially for BP mgmt. He was treated with po vancomycin and IV
flagyl, and also got vancomycin enemas when he developed an
ileus. Abdominal CT [**4-13**] showed diffuse colonic submucosal edema
and pericolonic fat stranding, ascites, and bilateral lower lobe
consolidations w/ effusions. Repeat abd CT [**4-17**] showed no
improvement. Surgery was following closely and considering
sub-total colectomy w/ end-ileostomy given severity of disease
despite maximal medical tx.
.
On [**2157-4-17**], routine labs showed a Hct of 20.2 from 35.1 2 days
prior. On questioning pt admitted to noticing black tarry stools
x several days. Upper endoscopy showed a 1.5x1.5cm lower
esophageal ulcer at the GE jxn. Cautery of the lesion was
ineffective [**1-28**] bleeding, and so was injected with epinephrine.
Pt received 5U PRBCs--> Hct 29.8. He was transferred to [**Hospital1 18**]
for upper endoscopy and management of bleeding esophageal ulcer.

.
On arrival to [**Name (NI) 153**], pt was hemodynamically stable. He reports
having recent dark, tarry stools and complains of abdominal pain
[**1-28**] healing zoster but none otherwise. He denies nausea,
vomiting, chest pain, SOB, dysphagia, dizziness, or fatigue.


Past Medical History:
Recent hospitalization for pneumonia ([**Date range (1) 72694**])
Zoster, c/b post-herpetic neuralgia
Sick Sinus Syndrome, s/p pacemaker [**2150**]
Gout
HTN
Hypercholesterolemia
Hiatal hernia
c.diff colitis
Cholecystectomy

Social History:
Lives with wife [**Name (NI) **] in [**Name (NI) **]. Smoked 1ppd x 15-20 years, quit
in [**2115**]. Drinks 1.5 ounces hard alcohol daily. Denies other drug
use. Until [**2-/2157**] hospitalization for pneumonia, was working
full time in an equipment store.

Family History:
Non-contributory

Physical Exam:
T 98.1, 111/64, 77, 18, 97
HEENT: PERRL, EOMI. Dry MM.
Neck: Supple, no lymphadenopathy
Lungs: mild expiratory wheezes bilaterally. No rales or rhonchi.

Chest: RRR, nl S1/S2, no m/r/g
Abd: Soft, non tender, +distension, +BS
Healing R low thoracic zoster. Midline scar from prior appy. No
HSM appreciated.
Extrem: 2+ pulses, WWP.
Neuro: AOx3, moving all 4 extremities


Pertinent Results:
[**2157-4-18**] 05:20PM   WBC-19.9* RBC-3.80* HGB-11.8* HCT-33.8*
MCV-89 MCH-31.0 MCHC-34.9 RDW-16.2*
[**2157-4-18**] 05:20PM   NEUTS-75.0* BANDS-3.0 LYMPHS-11.0* MONOS-9.0
EOS-1.0 BASOS-0 ATYPS-1.0*
[**2157-4-18**] 05:20PM   PLT SMR-NORMAL PLT COUNT-220
[**2157-4-18**] 05:20PM   PT-12.9 PTT-31.5 INR(PT)-1.1
[**2157-4-18**] 05:20PM   GLUCOSE-86 UREA N-21* CREAT-0.6 SODIUM-132*
POTASSIUM-4.9 CHLORIDE-104 TOTAL CO2-23 ANION GAP-10
[**2157-4-18**] 05:20PM   ALT(SGPT)-15 AST(SGOT)-28 LD(LDH)-238 ALK
PHOS-44 AMYLASE-135* TOT BILI-0.6
[**2157-4-18**] 05:20PM   LIPASE-79*
.
[**2157-4-18**] CXR: Small right-sided pleural effusion.
.
[**2157-4-19**] CT CHEST: No evidence of extravasation of contrast.
Moderate bilateral pleural effusions with underlying compressive
atelectasis. Ectasia of the ascending aorta. Ascites.
.
[**2157-4-20**] UNILAT UP EXT VEINS US: No evidence of deep venous
thrombosis involving the left upper extremity.
.
[**2157-4-20**] UNILAT LOWER EXT VEINS LEFT: No evidence of deep venous
thrombosis in the left lower extremity.
.
[**2157-4-18**] EGD: Esophagus:
Excavated Lesions A single 20mm ulcer with overlyign organizing
clot was found in the lower third of the esophagus extending
from 29cms to 34cms from the incisors. The GE junction was noted
at 38cms. No evidence of active bleeding was noted. Three
punctate small ulcers were noted on the opposite wall. The
distal esophagus was tortous.
Mucosa: Localized linear erythema of the mucosa was noted in the
antrum. These findings are compatible with gastritis.
Duodenum: Normal duodenum.
Other findings: No fresh blood or coffee ground material was
noted in the stomach.
Impression: Ulcer in the lower third of the esophagus
Erythema in the antrum compatible with gastritis
No fresh blood or coffee ground material was noted in the
stomach.
Otherwise normal EGD to second part of the duodenum
.

[**2157-4-19**] 10:41 am SEROLOGY/BLOOD      Source: Line-rsc tlcl.
   HELICOBACTER PYLORI ANTIBODY TEST (Final [**2157-4-20**]):
      NEGATIVE BY EIA.
.
[**2157-4-22**] 11:46 am URINE      Source: Catheter.
   URINE CULTURE (Final [**2157-4-23**]):
      YEAST.    10,000-100,000 ORGANISMS/ML..
.
[**2157-4-23**] 6:14 pm URINE     Site: CATHETER      Source: Catheter.

   URINE CULTURE (Final [**2157-4-25**]):
      YEAST.    10,000-100,000 ORGANISMS/ML.
.

[**2157-4-22**] 11:46AM URINE Color-Amber Appear-SlCloudy Sp [**Last Name (un) **]-1.025
[**2157-4-22**] 11:46AM URINE Blood-LGE Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-SM  Urobiln-NEG pH-6.5 Leuks-MOD
[**2157-4-22**] 11:46AM URINE RBC-583* WBC-120* Bacteri-MOD Yeast-MANY
Epi-0
[**2157-4-23**] 06:14PM URINE Color-Amber Appear-Clear Sp [**Last Name (un) **]-1.020
[**2157-4-23**] 06:14PM URINE Blood-LGE Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-SM  Urobiln-NEG pH-5.0 Leuks-SM
[**2157-4-23**] 06:14PM URINE RBC-3* WBC-3 Bacteri-NONE Yeast-NONE
Epi-0
.

[**2157-4-24**] 06:41AM BLOOD WBC-10.3 RBC-3.36* Hgb-10.9* Hct-32.5*
MCV-97 MCH-32.4* MCHC-33.4 RDW-16.2* Plt Ct-190
[**2157-4-24**] 06:41AM BLOOD Plt Ct-190
[**2157-4-24**] 06:41AM BLOOD Glucose-85 UreaN-12 Creat-0.7 Na-135
K-3.8 Cl-102 HCO3-28 AnGap-9
.

[**2157-4-25**] 07:03AM BLOOD WBC-9.2 RBC-3.63* Hgb-11.7* Hct-34.9*
MCV-96 MCH-32.2* MCHC-33.5 RDW-16.4* Plt Ct-207
[**2157-4-25**] 07:03AM BLOOD Plt Ct-207
.


Brief Hospital Course:
1) C. DIFF COLITIS:
Pt had been on flagyl and vanco at OSH with improvement.  His
symptoms had mostly resolved by arrival here.  He was continued
on PO flagyl and PO vanco here.  Abd pain and diarrhea resolved.
 Both were continued for 2 weeks.
.
2) Esophageal Ulcer:
The esophageal ulcer was cauterized and injected.  EGD was
repeated here and did not show any active bleeding.  Pt was kept
on high dose PPI and Hct was stable.  Received call from OSH
that there was concern there could have been esophageal
perforation during EGD.  A chestCT was done here which did not
show any evidence of this.
.
3) ANASARCA:
Pt had peripheral edema, ascites, and pleural effusions.  It was
likely due to fluids received during sepsis and hypoalbunemia.
He was started on lasix for diuresis

4) COPD
Pt improved with inhaled steroids and bronchodilators.


Medications on Admission:
Home meds:
HCTZ 12.5mg daily, ASA 81mg daily, Quinapril 20mg daily, Avacor
500mg daily, Probenecid 500mg daily
.
MEDS on transfer:
Protonix 80mg IV q8h
Lyrica 75mg po bid
Flagyl 500mg IV q8h
Vancomycin 500mg po qid
Vancomycin 500mg pr q6h
Combivent 2 puffs tid standing and q4h prn
Flovent 4 puffs inh [**Hospital1 **]
Albuterol 2.5mg/3ml neb q4h prn
TPN


Discharge Medications:
1. Pregabalin 75 mg Capsule Sig: One (1) Capsule PO bid ().
2. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
3. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 2 days.
Disp:*8 Capsule(s)* Refills:*0*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 10 days.
Disp:*20 Capsule(s)* Refills:*0*
6. Flovent HFA 220 mcg/Actuation Aerosol Sig: One (1) Puff
Inhalation twice a day.
Disp:*1 MDI* Refills:*2*
7. FOLEY
Foley Care with Leg Bag per protocol

Voiding Trial in 1 week


Discharge Disposition:
Home With Service

Facility:
 SouthShore VNA

Discharge Diagnosis:
C diff colitis
Upper GI bleed from esophageal ulcer
Anasarca
Chronic Obstructive Pulmonary Disease

Discharge Condition:
Good

Discharge Instructions:
1.  Take medication as prescribed.
2.  Follow up as below.
3.  Please seek medical attention for fevers, increasing
shortness of breath, chest pain, diarrhea, abdominal pain, blood
in your stool.

Followup Instructions:
1. You have an appointment scheduled with Dr. [**Last Name (STitle) **] on Monday
[**2157-5-2**] at 4:30. [**Telephone/Fax (1) 53156**]

2.  You have an appointment scheduled with a urologist to
discuss your urinary retention.  Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4653**],
MD Phone:[**Telephone/Fax (1) 274**] Date/Time:[**2157-5-30**] 2:30
{'Ulcer of esophagus with bleeding,Intestinal infection due to Clostridium difficile,Chronic airway obstruction, not elsewhere classified,Other specified gastritis, without mention of hemorrhage,Edema,Pure hypercholesterolemia,Gout, unspecified,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ'}


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: Upper GI bleed, C. Diff Colitis

PRESENT ILLNESS: Pt was admitted to [**Hospital3 **] on [**2157-4-9**] for septic shock
[**1-28**] C.Diff colitis. Pt received pressors and hydrocortisone
initially for BP mgmt. He was treated with po vancomycin and IV
flagyl, and also got vancomycin enemas when he developed an
ileus. Abdominal CT [**4-13**] showed diffuse colonic submucosal edema
and pericolonic fat stranding, ascites, and bilateral lower lobe
consolidations w/ effusions. Repeat abd CT [**4-17**] showed no
improvement. Surgery was following closely and considering
sub-total colectomy w/ end-ileostomy given severity of disease
despite maximal medical tx.
.
On [**2157-4-17**], routine labs showed a Hct of 20.2 from 35.1 2 days
prior. On questioning pt admitted to noticing black tarry stools
x several days. Upper endoscopy showed a 1.5x1.5cm lower
esophageal ulcer at the GE jxn. Cautery of the lesion was
ineffective [**1-28**] bleeding, and so was injected with epinephrine.
Pt received 5U PRBCs--> Hct 29.8. He was transferred to [**Hospital1 18**]
for upper endoscopy and management of bleeding esophageal ulcer.

MEDICAL HISTORY: Recent hospitalization for pneumonia ([**Date range (1) 72694**])
Zoster, c/b post-herpetic neuralgia
Sick Sinus Syndrome, s/p pacemaker [**2150**]
Gout
HTN
Hypercholesterolemia
Hiatal hernia
c.diff colitis
Cholecystectomy

MEDICATION ON ADMISSION: Home meds:
HCTZ 12.5mg daily, ASA 81mg daily, Quinapril 20mg daily, Avacor
500mg daily, Probenecid 500mg daily
.
MEDS on transfer:
Protonix 80mg IV q8h
Lyrica 75mg po bid
Flagyl 500mg IV q8h
Vancomycin 500mg po qid
Vancomycin 500mg pr q6h
Combivent 2 puffs tid standing and q4h prn
Flovent 4 puffs inh [**Hospital1 **]
Albuterol 2.5mg/3ml neb q4h prn
TPN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.1, 111/64, 77, 18, 97
HEENT: PERRL, EOMI. Dry MM.
Neck: Supple, no lymphadenopathy
Lungs: mild expiratory wheezes bilaterally. No rales or rhonchi.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with wife [**Name (NI) **] in [**Name (NI) **]. Smoked 1ppd x 15-20 years, quit
in [**2115**]. Drinks 1.5 ounces hard alcohol daily. Denies other drug
use. Until [**2-/2157**] hospitalization for pneumonia, was working
full time in an equipment store. 

### Response:
{'Ulcer of esophagus with bleeding,Intestinal infection due to Clostridium difficile,Chronic airway obstruction, not elsewhere classified,Other specified gastritis, without mention of hemorrhage,Edema,Pure hypercholesterolemia,Gout, unspecified,Unspecified essential hypertension,Diaphragmatic hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ'}
