CHIEF COMPLAINT: Acute blood loss, GI bleed in setting of known GI stromal tumor,
transfer from [**Hospital1 **] after scope

PRESENT ILLNESS: Pt is a 78yo males w/known non-resectable GI stromal tumor on
Gleevex (dx [**2181**])PMHx significant for prostate cancer w/seed
implant, duodenal ulcer who presented w/weakness, fatigue, SOB
and was found to have HCT of 16. Pt noted symptoms of weakness,
fatigue and SOB on minimal exertion roughly 3-4 days prior to
admission. Denied chest pain or palpiation, no orthopnea, no
diarrhea or constipation, blood in stool or black stool. Did
notice some stool color change several days back after meal high
in iron which he and his wife assumed was related to food they
had eaten. Pt presented to Dr. [**First Name (STitle) 4223**] from Oncology for
regular follow-up and potential change of onco medication and
was found to have HCT of 16. Pt was sent to the [**Hospital1 **] ED
where VS were BP 133/55 71 95% HCT 16, Hgb 5.3 and he was
admitted for GIB. At this time he had maroon color blood stool;
guaiac positive on rectal exam. Of note, CT [**2095-6-10**]* 18 cm
mass, progressed from prior images and pushing on duodenum and
pressing into pancreatic head also w/compression of IVC. Repeat
CT scan yesterday ([**2186-6-27**]) showed minimal necrosis in tumor and
no signs of frank bleeding in abdomen. Pt had EGD on [**2186-6-28**]
prior to transfer to [**Hospital1 18**]; this showed submucosal mass,
invading the wall of the duodenum w/bright blood in duodenum but
no peptic ulcer seen. He was transfused 5 units of pRBC and HCT
improved to 25.3. Last VS prior to transfer 116/64 79 95%
afebrile.
.
On transfer to floor, initial vs were: T 98.6 P 72 BP 124/52 R
13 O2 96% RA. Patient was feeling well, chatting and good
humored. No complaints. No pain no palpitation no abdominal
pain, no chest pain, no fever chills.
.
Review of sytems:
(+) Per HPI, sometimes breaks out in a sweat
(-) Denies fever, chills, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: Stromal Retroperitoneal tumor nonresectable on Glevac diagnosed
in [**2181**]
Mild aortic stenosis
CA Prostate w/seed implanting
Asbestosis
PET neg pulmonary nodule
Cholelithiasis
Cirrhosis

MEDICATION ON ADMISSION: (pt confirmed as best could but couldn't precisely remember all
the names, list is from [**Hospital3 1280**] records)
Leuprolide (Lupron) 1 inj IM q 3 mo
Imatinib (Gleevec) 400mg daily
Terazosin 2mg PO HS
Hydrochlorothiazide 25mg PO daily
Amlodipine 2.5mg daily
Niaspan ER 1000mg PO daily
Simvastatin 20mg PO qpm

ALLERGIES: lisinopril

PHYSICAL EXAM: On admission:
Vitals: T 98.6 P 72 BP 124/52 R 13 O2 96% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, systolic murmur
best appreciated at sternal border (known AS), no rubs or
gallops
Abdomen: soft, non-tender, moderately protuberant abdomen, mass
appreciated on the R side, bowel sounds present, no rebound
tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father - prostate cancer, died of hemorrhage at 88yo.
Mother - died early age after a fall
Brother - prostate cancer

SOCIAL HISTORY: Live w/wife and is independent for all ADLs. Worked in shipyards
in [**Location (un) 86**] and a boiler maker; has asbestosis. Quit smoking 4-5yr
ago but started at ~18yo 1ppd. Occasional EtOH
Secondary malignant neoplasm of small intestine including duodenum,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Compression of vein,Hydronephrosis,Malignant neoplasm of connective and other soft tissue of abdomen,Unspecified essential hypertension,Pure hypercholesterolemia,Mitral valve disorders,Malignant neoplasm of prostate,Asbestosis,Personal history of tobacco use,Stricture or kinking of ureter,Chronic airway obstruction, not elsewhere classified
Sec malig neo sm bowel,Gastrointest hemorr NOS,Ac posthemorrhag anemia,Compression of vein,Hydronephrosis,Mal neo soft tis abdomen,Hypertension NOS,Pure hypercholesterolem,Mitral valve disorder,Malign neopl prostate,Asbestosis,History of tobacco use,Stricture of ureter,Chr airway obstruct NEC
Admission Date:  [**2186-6-28**]              Discharge Date:   [**2186-7-4**]

Date of Birth:  [**2108-4-22**]             Sex:   M

Service: MEDICINE

Allergies:
lisinopril

Attending:[**Doctor First Name 2080**]
Chief Complaint:
Acute blood loss, GI bleed in setting of known GI stromal tumor,
transfer from [**Hospital1 **] after scope


Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is a 78yo males w/known non-resectable GI stromal tumor on
Gleevex (dx [**2181**])PMHx significant for prostate cancer w/seed
implant, duodenal ulcer who presented w/weakness, fatigue, SOB
and was found to have HCT of 16. Pt noted symptoms of weakness,
fatigue and SOB on minimal exertion roughly 3-4 days prior to
admission. Denied chest pain or palpiation, no orthopnea, no
diarrhea or constipation, blood in stool or black stool. Did
notice some stool color change several days back after meal high
in iron which he and his wife assumed was related to food they
had eaten. Pt presented to Dr. [**First Name (STitle) 4223**] from Oncology for
regular follow-up and potential change of onco medication and
was found to have HCT of 16. Pt was sent to the [**Hospital1 **] ED
where VS were BP 133/55 71 95% HCT 16, Hgb 5.3 and he was
admitted for GIB. At this time he had maroon color blood stool;
guaiac positive on rectal exam. Of note, CT [**2095-6-10**]* 18 cm
mass, progressed from prior images and pushing on duodenum and
pressing into pancreatic head also w/compression of IVC. Repeat
CT scan yesterday ([**2186-6-27**]) showed minimal necrosis in tumor and
no signs of frank bleeding in abdomen. Pt had EGD on [**2186-6-28**]
prior to transfer to [**Hospital1 18**]; this showed submucosal mass,
invading the wall of the duodenum w/bright blood in duodenum but
no peptic ulcer seen. He was transfused 5 units of pRBC and HCT
improved to 25.3. Last VS prior to transfer 116/64 79 95%
afebrile.
.
On transfer to floor, initial vs were: T 98.6 P 72 BP 124/52 R
13 O2 96% RA. Patient was feeling well, chatting and good
humored. No complaints. No pain no palpitation no abdominal
pain, no chest pain, no fever chills.
.
Review of sytems:
(+) Per HPI, sometimes breaks out in a sweat
(-) Denies fever, chills, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.


Past Medical History:
Stromal Retroperitoneal tumor nonresectable on Glevac diagnosed
in [**2181**]
Mild aortic stenosis
CA Prostate w/seed implanting
Asbestosis
PET neg pulmonary nodule
Cholelithiasis
Cirrhosis


Social History:
Live w/wife and is independent for all ADLs. Worked in shipyards
in [**Location (un) 86**] and a boiler maker; has asbestosis. Quit smoking 4-5yr
ago but started at ~18yo 1ppd. Occasional EtOH

Family History:
Father - prostate cancer, died of hemorrhage at 88yo.
Mother - died early age after a fall
Brother - prostate cancer


Physical Exam:
On admission:
Vitals: T 98.6 P 72 BP 124/52 R 13 O2 96% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, systolic murmur
best appreciated at sternal border (known AS), no rubs or
gallops
Abdomen: soft, non-tender, moderately protuberant abdomen, mass
appreciated on the R side, bowel sounds present, no rebound
tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

On discharge:
Unchanged- Lungs clear. Cardiac murmur present. Abd mass still
present but no tenderness.

Pertinent Results:
[**2186-6-28**] 09:22PM   LACTATE-0.9
[**2186-6-28**] 09:11PM   GLUCOSE-87 UREA N-23* CREAT-1.3* SODIUM-139
POTASSIUM-3.5 CHLORIDE-105 TOTAL CO2-25 ANION GAP-13
[**2186-6-28**] 09:11PM   CALCIUM-8.9 PHOSPHATE-3.7 MAGNESIUM-2.0
[**2186-6-28**] 09:11PM   WBC-7.1 RBC-2.98* HGB-9.0* HCT-25.9* MCV-87
MCH-30.2 MCHC-34.8 RDW-18.1*
[**2186-6-28**] 09:11PM   PLT COUNT-250
[**2186-6-28**] 03:13PM   GLUCOSE-678* UREA N-22* CREAT-1.2 SODIUM-131*
POTASSIUM-6.4* CHLORIDE-102 TOTAL CO2-24 ANION GAP-11
[**2186-6-28**] 03:13PM   estGFR-Using this
[**2186-6-28**] 03:13PM   ALT(SGPT)-4 AST(SGOT)-19 LD(LDH)-229 ALK
PHOS-53 TOT BILI-0.7
[**2186-6-28**] 03:13PM   CALCIUM-7.4* PHOSPHATE-3.3 MAGNESIUM-1.7
[**2186-6-28**] 03:13PM   WBC-6.7 RBC-2.77* HGB-7.9* HCT-24.6* MCV-89
MCH-28.4 MCHC-32.0 RDW-18.0*
[**2186-6-28**] 03:13PM   PLT COUNT-229
[**2186-6-28**] 03:13PM   PT-14.0* PTT-32.9 INR(PT)-1.2*

.
Images:
CT Abd and Pelvis [**2186-6-10**] [**Hospital3 **]
1. Interim enlargement in the 20x18x18 right retroperitoneal
mass. Greater compression of right kidney, right renal pedicle,
ureter, IVC, and greater displacement of the duodenum and
pancreas as described above. Mild right pelvicalyceal dilation.
No definite invasion of the neighboring structures, which
include liver, gallbladder, IVC. No definite IVC thrombosis,
although extrinsic compression is moderate.
2. Lesion shows central nonenhancement suggesting central
necrosis. Again displacing small bowel aneriorly in the right
lower quadrant. Compressing right gonadal vein, possibly cuasing
right varicocele.
3. Aortoiliac ASVD. Uncomplicated gallstone. Calcified pleural
plaques.
4. Small indeterminate sub cm left paraaortic lymph nodes.
5. Sclerotic appearance of the pubic bones, with small extra
osseous soft tissue structure seen adjacent, which are stable
since last year's exam. Possibly representing metastases and
extra osseaous extension, or anterior pelvic wall lymph node
w/out
.
CT ABD and Pelvis [**2186-6-27**] [**Hospital3 **]
1. Large reight retroperitoneal tumor known from prio exams not
significant changed in size. The high density material
surrounding a low density necrotic center consistent with
hypervascularity and/or samll bleed. However, the amount of
high-density material does not account for a significant drop in
HCT.
2. No other acute interval [**Last Name (un) 38815**] from the prior imagaing
studies.
.
GI scope at [**Hospital1 **] [**2186-6-28**]
showed submucosal mass, invading the wall of the duodenum
w/bright blood in duodenum but no peptic ulcer seen

[**2186-7-4**] 06:32AM BLOOD WBC-4.5 RBC-2.97* Hgb-8.8* Hct-26.4*
MCV-89 MCH-29.7 MCHC-33.5 RDW-16.9* Plt Ct-249
[**2186-7-3**] 06:50AM BLOOD WBC-5.1 RBC-3.02* Hgb-8.7* Hct-27.0*
MCV-89 MCH-28.7 MCHC-32.1 RDW-17.0* Plt Ct-244
[**2186-7-2**] 06:45AM BLOOD WBC-5.2 RBC-3.00* Hgb-8.8* Hct-26.7*
MCV-89 MCH-29.5 MCHC-33.0 RDW-17.2* Plt Ct-272
[**2186-7-1**] 07:00AM BLOOD WBC-5.4 RBC-2.95* Hgb-8.7* Hct-26.2*
MCV-89 MCH-29.4 MCHC-33.1 RDW-17.7* Plt Ct-251
[**2186-6-30**] 12:45PM BLOOD Hct-27.8*

Brief Hospital Course:
Pt is a 78yo male w/known non-resectable GI stromal tumor on
Gleevex (dx [**2181**])PMHx significant for prostate cancer w/seed
implant, duodenal ulcer who presented w/weakness, fatigue, SOB
and was found to have HCT of 16 in [**Hospital **] clinic and ED. Found to
have GI bleeding in setting of GIST and transferred from [**Hospital 3856**] after scope for further management given concern for
progression of cancer and continued GI bleeding with tumor
invasion.
.
# GI bleeding in setting of known GIST: Pt was found to have HCT
drop in onc clinic and ED. Found to have GI bleeding and repeat
CT showed progression of known GIST. Pt was scoped at [**Hospital1 **]
which showed invading mass with bleeding. VS on transfer were
stable. Transferred to [**Hospital1 18**] for further managament of GI
stromal tumor and associated GI bleeding. At [**Hospital1 18**], the
patient's Hct remained stabhle. GI, interventional radiology,
and surgery were consulted. Surgery recommended against
prophylactic embolization. The patient was treated with IV
pantoprazole which was later transitioned to PO.  Imatinib was
increased to 400 mg [**Hospital1 **].  His diet was restarted and his HCT
remained stable during his 7 days in hospital. He was discharged
to have follow up with his oncologist on Friday of the week of
discharge.
.
# Aortic Stenosis, hypertension: Known moderate aortic stenosis,
audible on auscultation. The patient was continued on
simvastatin, niaspan held in-house as not urgent and
non-formulary. His Amlodipine, hydrochlorothiazide and terazosin
were held in setting of recent GI bleed. His BPs remained stable
throughout hospital course.  He will have follow up with his PCP
at which time his BP should be rechecked and medications
titrated accordingly.
.
# Prostate cancer, BPH: Patient has history of prostate cancer
with implanted seeds. Terazosin was held and didn't seem to be
needed so should be restarted as outpt at discretion of PCP.

Medications on Admission:
(pt confirmed as best could but couldn't precisely remember all
the names, list is from [**Hospital3 1280**] records)
Leuprolide (Lupron) 1 inj IM q 3 mo
Imatinib (Gleevec) 400mg daily
Terazosin 2mg PO HS
Hydrochlorothiazide 25mg PO daily
Amlodipine 2.5mg daily
Niaspan ER 1000mg PO daily
Simvastatin 20mg PO qpm


Discharge Medications:
1. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. imatinib 400 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily): Please take this medication 2 hours
after the rest of your morning pills.
Disp:*30 Tablet(s)* Refills:*0*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. Lupron Depot (3 Month) 11.25 mg Kit Sig: One (1) injection
Intramuscular every 3 months.
7. Niaspan Extended-Release 1,000 mg Tablet Extended Release 24
hr Sig: One (1) Tablet Extended Release 24 hr PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
GIST tumor causing GI bleed
Secondary diagnoses:
Blood loss anemia
Hypertension
BPH
Aortic stenosis


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


Discharge Instructions:
You were admitted after your hematocrit dropped after you had a
bleed from a tumor in your GI tract at an outside hospital.
While you were here, we closely monitored your blood counts and
they were stable throughout your time here. You were seen by
interventional radiologists, surgeons and oncologists here who
monitored you but did not do any procedures as your bleeding had
stopped by the time you got here.  You are being discharged with
follow up this week with your oncologist.

The following changes were made to your medications:
INCREASE imatinib to twice daily
START ferrous sulfate (iron) daily- our pharmacists do not see
an interaction of this with your imatinib but to be safe you can
take this 2 hrs after your morning medications.
START docusate (a stool softener) while you are on iron as iron
can make you constipated. You can stop this medications if you
are having loose stools or diarrhea.
STOP Terazosin for your prostate and high blood pressure as it
was not needed while you were here.
STOP Amlodipine and Hydrochlorothiazide for high blood pressure
as they were not needed while you were here. You can talk to
your primary care doctor about possibly restarting these at your
follow up appointment.
START pantoprazole- it decreases the acid in your stomach and
may help decrease your risk of bleeding again. Talk to your
primary doctor when you follow up about whether you need to keep
taking this medication indefinately.

Followup Instructions:
Please follow up with your primary oncologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4223**]
at 1pm on Friday [**7-7**].

Please call your primary care doctor, Dr. [**Last Name (STitle) 94034**] to schedule an
appointment within 2 weeks.



Completed by:[**2186-7-4**]
{'Secondary malignant neoplasm of small intestine including duodenum,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Compression of vein,Hydronephrosis,Malignant neoplasm of connective and other soft tissue of abdomen,Unspecified essential hypertension,Pure hypercholesterolemia,Mitral valve disorders,Malignant neoplasm of prostate,Asbestosis,Personal history of tobacco use,Stricture or kinking of ureter,Chronic airway obstruction, not elsewhere classified'}


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: Acute blood loss, GI bleed in setting of known GI stromal tumor,
transfer from [**Hospital1 **] after scope

PRESENT ILLNESS: Pt is a 78yo males w/known non-resectable GI stromal tumor on
Gleevex (dx [**2181**])PMHx significant for prostate cancer w/seed
implant, duodenal ulcer who presented w/weakness, fatigue, SOB
and was found to have HCT of 16. Pt noted symptoms of weakness,
fatigue and SOB on minimal exertion roughly 3-4 days prior to
admission. Denied chest pain or palpiation, no orthopnea, no
diarrhea or constipation, blood in stool or black stool. Did
notice some stool color change several days back after meal high
in iron which he and his wife assumed was related to food they
had eaten. Pt presented to Dr. [**First Name (STitle) 4223**] from Oncology for
regular follow-up and potential change of onco medication and
was found to have HCT of 16. Pt was sent to the [**Hospital1 **] ED
where VS were BP 133/55 71 95% HCT 16, Hgb 5.3 and he was
admitted for GIB. At this time he had maroon color blood stool;
guaiac positive on rectal exam. Of note, CT [**2095-6-10**]* 18 cm
mass, progressed from prior images and pushing on duodenum and
pressing into pancreatic head also w/compression of IVC. Repeat
CT scan yesterday ([**2186-6-27**]) showed minimal necrosis in tumor and
no signs of frank bleeding in abdomen. Pt had EGD on [**2186-6-28**]
prior to transfer to [**Hospital1 18**]; this showed submucosal mass,
invading the wall of the duodenum w/bright blood in duodenum but
no peptic ulcer seen. He was transfused 5 units of pRBC and HCT
improved to 25.3. Last VS prior to transfer 116/64 79 95%
afebrile.
.
On transfer to floor, initial vs were: T 98.6 P 72 BP 124/52 R
13 O2 96% RA. Patient was feeling well, chatting and good
humored. No complaints. No pain no palpitation no abdominal
pain, no chest pain, no fever chills.
.
Review of sytems:
(+) Per HPI, sometimes breaks out in a sweat
(-) Denies fever, chills, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: Stromal Retroperitoneal tumor nonresectable on Glevac diagnosed
in [**2181**]
Mild aortic stenosis
CA Prostate w/seed implanting
Asbestosis
PET neg pulmonary nodule
Cholelithiasis
Cirrhosis

MEDICATION ON ADMISSION: (pt confirmed as best could but couldn't precisely remember all
the names, list is from [**Hospital3 1280**] records)
Leuprolide (Lupron) 1 inj IM q 3 mo
Imatinib (Gleevec) 400mg daily
Terazosin 2mg PO HS
Hydrochlorothiazide 25mg PO daily
Amlodipine 2.5mg daily
Niaspan ER 1000mg PO daily
Simvastatin 20mg PO qpm

ALLERGIES: lisinopril

PHYSICAL EXAM: On admission:
Vitals: T 98.6 P 72 BP 124/52 R 13 O2 96% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, systolic murmur
best appreciated at sternal border (known AS), no rubs or
gallops
Abdomen: soft, non-tender, moderately protuberant abdomen, mass
appreciated on the R side, bowel sounds present, no rebound
tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father - prostate cancer, died of hemorrhage at 88yo.
Mother - died early age after a fall
Brother - prostate cancer

SOCIAL HISTORY: Live w/wife and is independent for all ADLs. Worked in shipyards
in [**Location (un) 86**] and a boiler maker; has asbestosis. Quit smoking 4-5yr
ago but started at ~18yo 1ppd. Occasional EtOH 

### Response:
{'Secondary malignant neoplasm of small intestine including duodenum,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Compression of vein,Hydronephrosis,Malignant neoplasm of connective and other soft tissue of abdomen,Unspecified essential hypertension,Pure hypercholesterolemia,Mitral valve disorders,Malignant neoplasm of prostate,Asbestosis,Personal history of tobacco use,Stricture or kinking of ureter,Chronic airway obstruction, not elsewhere classified'}
