CHIEF COMPLAINT: LGIB

PRESENT ILLNESS: Briefly, patient is a 72 year old female with PMH significant
for CAD s/p MI, Crohn's disease,hypertension, hyperlipidemia,
glucose intolerance and MR who presents with diarrhea and
weakness, orthostatic symptoms, increased bowel movements with
Hct on admission of 28. Patient noted having [**9-13**] bowel
movements per day which were recalled to be loose although
patient unsure if bloody or not. Patient had no associated
vomiting during these episodes. Patient did report fever but no
chills, no night sweats, rare nausea, no vomiting. She was found
to have a HCT of 28 and was referred to the [**Hospital1 18**] ED for
additional evaluation.

MEDICAL HISTORY: 1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

MEDICATION ON ADMISSION: Lipitor 20mg po daily
Lopressor 50 mg po bid
Univasc 15mg PO bid
HCTZ 50mg po daily
glyburide 5mg po bid

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: on admission to ICU:
PE: VS: 113-115 reg. BP 162/97, R25, SpO2 99% RA
Gen: Alert, oriented, pleasant and conversant female in no
distress.
CV: S1 S2 tachycardic. II/VI HSM
Abd: Soft, overweight, NT/ND. Guaiac positive stool per ER
report.
Ext: Varicosities over bilateral LE. No C/C/E x4.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker.
Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Rheumatic heart failure (congestive),Acidosis,Old myocardial infarction,Mitral valve insufficiency and aortic valve insufficiency,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension
Regional enteritis NOS,Ac posthemorrhag anemia,Rheumatic heart failure,Acidosis,Old myocardial infarct,Mitral/aortic val insuff,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2102-5-25**]              Discharge Date:   [**2102-5-31**]

Date of Birth:  [**2029-9-21**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 689**]
Chief Complaint:
LGIB

Major Surgical or Invasive Procedure:
EGD
Colonoscopy
Tagged RBC scan

History of Present Illness:
Briefly, patient is a 72 year old female with PMH significant
for CAD s/p MI, Crohn's disease,hypertension, hyperlipidemia,
glucose intolerance and MR who presents with diarrhea and
weakness, orthostatic symptoms, increased bowel movements with
Hct on admission of 28. Patient noted having [**9-13**] bowel
movements per day which were recalled to be loose although
patient unsure if bloody or not. Patient had no associated
vomiting during these episodes. Patient did report fever but no
chills, no night sweats, rare nausea, no vomiting. She was found
to have a HCT of 28 and was referred to the [**Hospital1 18**] ED for
additional evaluation.


Past Medical History:
1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

Social History:
Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker.


Family History:
non contributory

Physical Exam:
on admission to ICU:
PE: VS: 113-115 reg. BP 162/97, R25, SpO2 99% RA
Gen: Alert, oriented, pleasant and conversant female in no
distress.
CV: S1 S2 tachycardic. II/VI HSM
Abd: Soft, overweight, NT/ND. Guaiac positive stool per ER
report.
Ext: Varicosities over bilateral LE. No C/C/E x4.


Pertinent Results:
[**2102-5-24**] 11:30PM   WBC-11.3* RBC-3.33* HGB-9.3*# HCT-27.4*#
MCV-82# MCH-27.9 MCHC-34.0 RDW-13.6
[**2102-5-24**] 11:30PM   PLT SMR-VERY HIGH PLT COUNT-616*#
[**2102-5-24**] 11:30PM   NEUTS-84.9* BANDS-0 LYMPHS-11.7* MONOS-2.7
EOS-0.4 BASOS-0.3
[**2102-5-25**] 03:26PM   calTIBC-247* FERRITIN-271* TRF-190*

Tagged RBC scan: No abnormal activity or evidence of active
bleeding.

CT abdomen: There is loss of haustral folds involving the cecum
and ascending colon. The transverse colon demonstrates
mesenteric combing, and the descending colon and sigmoid
demonstrate mild colonic wall thickening. Mesenteric combing is
also seen involving the sigmoid colon, more prominent in
appearance than that seen in the transverse colon. Also, there
is mucosal enhancement of the Sigmoid colon suggesting
hyperemia/inflammation. There are multiple small mesenteric
lymph nodes, greater than typically seen, but all less than 1 cm
in size.


Brief Hospital Course:
72 yo female with h/o CAD, MR, Crohn's Disease not on outpatient
medication admitted with diarrhea, hematochezia and anemia.

1. LGIB and blood loss anemia: Patient was thought to have a
LGIB on admission. Given the patient had BRBPR and anemia, she
was admitted to the ICU. She underwent a gastric lavage with no
evidence of active bleeding. She underwent a CT of the abdomen
with changes consistent with chronic Crohn's colitis and a new
area of inflammation in the sigmod colon. She then underwent EGD
which was negative and a colonoscopy which demonstrated
cobblestoning and friable mucosa with blood throughout colon c/w
Crohns as well as small non-bleeding ulcer in ascending colon.
She additionally had a tagged RBC scan which did not reveal a
source of bleeding. She was transfused 4 units pRBCs, given
fluids,IV PPI, and started on Solumedrol therapy. She did well
on the hospital floors. She continued to have small amounts of
melena, but it was felt to be secondary to old blood as her
hematocrit remained stable. She otherwise was without symptoms.
She switched to by mouth steroids and antibiotics. She was also
started on Asacol 800 mg po tid. She is discharged on oral
flagyl and cipro to be continued until she sees Dr. [**First Name (STitle) 679**]. She
will taper her steroids by 5 mg a week until she sees Dr. [**First Name (STitle) 679**].
She will follow up within 2 weeks. She had a ppd placed in case
she needs Enbrel in the future. She will return to the [**Hospital1 18**] in
two days and have this read.

2. Hypertension: her BP was well controlled. Her HCTZ was
decreased to 25 mg a day given good control of her BP and less
risk of hypokalemia.

3. Code: patient expressed wishes to be DNR/DNI for her
admission as well as for future admissions

Medications on Admission:
Lipitor 20mg po daily
Lopressor 50 mg po bid
Univasc 15mg PO bid
HCTZ 50mg po daily
glyburide 5mg po bid


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Moexipril 7.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO TID (3 times a day).
Disp:*180 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
take 40 mg for one week, then 35 mg for one week. Discuss
additional taper with Dr. [**First Name (STitle) 679**].
Disp:*60 Tablet(s)* Refills:*0*
7. Pantoprazole Sodium 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:*2*
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day): Please continue until you see Dr. [**First Name (STitle) 679**].
Disp:*60 Tablet(s)* Refills:*0*
9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for
20 days.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Blood loss anemia
Crohn's Flare
Secondary diagnosis:
hypertension
Diabetes, type 2, controlled


Discharge Condition:
stable with occasional small amounts of melena, but stable vital
signs and hematocrit. PPD planted on right arm and non reactive
x 24 hours.

Discharge Instructions:
Please call Dr. [**First Name (STitle) 679**] if you have any additional blood in your
stool, or if you have lightheadedness, chest pain, shortness of
breath, nausea or vomiting.

You have a few new medications, it is important to take them
regularly. Please see the attached sheets for details.

We have decrease your hydrochlorothiazide to 25 mg by mouth
daily.

You should taper your steroids by 5 mg a week.

You should continue the antibiotics until you see Dr. [**First Name (STitle) 679**].

Followup Instructions:
Please follow up with Dr. [**First Name (STitle) 679**] and Dr. [**Last Name (STitle) 9022**] in one week. They
should check your blood counts at that time.

Please return to the [**Hospital Ward Name **] of the [**Hospital1 18**] on friday after
11:30 and have Dr. [**First Name (STitle) **] [**Name (STitle) 19366**] paged. He will read the PPD on
your right arm.
{'Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Rheumatic heart failure (congestive),Acidosis,Old myocardial infarction,Mitral valve insufficiency and aortic valve insufficiency,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}


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: LGIB

PRESENT ILLNESS: Briefly, patient is a 72 year old female with PMH significant
for CAD s/p MI, Crohn's disease,hypertension, hyperlipidemia,
glucose intolerance and MR who presents with diarrhea and
weakness, orthostatic symptoms, increased bowel movements with
Hct on admission of 28. Patient noted having [**9-13**] bowel
movements per day which were recalled to be loose although
patient unsure if bloody or not. Patient had no associated
vomiting during these episodes. Patient did report fever but no
chills, no night sweats, rare nausea, no vomiting. She was found
to have a HCT of 28 and was referred to the [**Hospital1 18**] ED for
additional evaluation.

MEDICAL HISTORY: 1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

MEDICATION ON ADMISSION: Lipitor 20mg po daily
Lopressor 50 mg po bid
Univasc 15mg PO bid
HCTZ 50mg po daily
glyburide 5mg po bid

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: on admission to ICU:
PE: VS: 113-115 reg. BP 162/97, R25, SpO2 99% RA
Gen: Alert, oriented, pleasant and conversant female in no
distress.
CV: S1 S2 tachycardic. II/VI HSM
Abd: Soft, overweight, NT/ND. Guaiac positive stool per ER
report.
Ext: Varicosities over bilateral LE. No C/C/E x4.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker. 

### Response:
{'Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Rheumatic heart failure (congestive),Acidosis,Old myocardial infarction,Mitral valve insufficiency and aortic valve insufficiency,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}
