CHIEF COMPLAINT: 58 yo male with multiple medical problems including [**Name (NI) 2320**], atrial
fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding.

PRESENT ILLNESS: HPI: 58 yo male with multiple medical problems including [**Name (NI) 2320**],
atrial fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding. Pt reports yesterday he awoke feeling "off balance"
and weak. He went to [**Hospital **] hospital where he had a marroon stool
and was found to have Hct of 24. He had CT abd which did not
show an intra-abdominal process. He was given two units of PRBCs
and transferred to [**Hospital1 18**] for further management. Pt denies any
previous episodes of GI bleeding. Last [**Last Name (un) **] was [**1-12**] yrs ago and
demonstrated benign polyps that were removed.
.
In the [**Hospital1 18**] ED initial vitals were T 98 HR 75 BP 105/75 RR 18
O2Sat 100 RA. His hct on arrival was 26, which was then post 2
units. He did have 2 more marroon stools. He received 1L NS and
1 unit PRBCs. Vitals were T96.5 HR:116 BP: 109/63 100RA on
transfer to floor.

MEDICAL HISTORY: 1. Bariatric surgery for morbid obesity [**2139**]
2. Atrial fibrillation / atrial flutter s/p ablation [**2139**]
3. Type 2 diabetes c/b nephropathy and neuropathy
4. Chronic renal insufficiency
5. Hypertriglyceridemia
6. h/o Obstructive sleep apnea prior to gastric sx
7. Hyperoxaluria
8. ? of Non hep a, hep B hepatitis around [**2116**], also ?lft
abnormalities on amiodorone in past
9. CAD: MI [**1-16**]

MEDICATION ON ADMISSION: Trazadone 100mg qHS
Bupropion SR 200mg daily
Potassium citrate 10 mEq 3x/day
Metformin 1000mg [**Hospital1 **]
Lisinopril 5mg daily
Prvastatin 20mg qHS
Metoprolol 25mg [**Hospital1 **]
Clopidogrel 75mg daily
Vitamin D-3 [**2135**] units daily
Acarbose 25mg daily
ASA 81mg daily
Calcium carbonate 2 tabs daily
Cyanobalamin 100 mEq 3x/week

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GA: AOx3, NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no lesions
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.

FAMILY HISTORY: Mother, Father, Brother, Sister all w/ DM2. Father h/o CA Many
of his family members also have problems with obesity

SOCIAL HISTORY: No ETOH, tobacco or illicit drug use
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Persistent postoperative fistula,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery
Chr stomach ulc w hem,Atrial flutter,Hy kid NOS w cr kid I-IV,DMII neuro nt st uncntrl,Neuropathy in diabetes,Old myocardial infarct,Persist postop fistula,Abn react-anastom/graft,Dvrtclo colon w/o hmrhg,Int hemorrhoid w/o compl,Nephritis NOS in oth dis,Chronic kidney dis NOS,Crnry athrscl natve vssl
Admission Date:  [**2146-8-19**]              Discharge Date:   [**2146-8-24**]

Date of Birth:  [**2088-2-1**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
58 yo male with multiple medical problems including [**Name (NI) 2320**], atrial
fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding.

Major Surgical or Invasive Procedure:
-[**2146-8-24**] Colonoscopy
-[**2146-8-24**] Endoscopy


History of Present Illness:
HPI: 58 yo male with multiple medical problems including [**Name (NI) 2320**],
atrial fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding. Pt reports yesterday he awoke feeling "off balance"
and weak. He went to [**Hospital **] hospital where he had a marroon stool
and was found to have Hct of 24. He had CT abd which did not
show an intra-abdominal process. He was given two units of PRBCs
and transferred to [**Hospital1 18**] for further management. Pt denies any
previous episodes of GI bleeding. Last [**Last Name (un) **] was [**1-12**] yrs ago and
demonstrated benign polyps that were removed.
.
In the [**Hospital1 18**] ED initial vitals were T 98 HR 75 BP 105/75 RR 18
O2Sat 100 RA. His hct on arrival was 26, which was then post 2
units. He did have 2 more marroon stools. He received 1L NS and
1 unit PRBCs. Vitals were T96.5 HR:116 BP: 109/63 100RA on
transfer to floor.


Past Medical History:
1. Bariatric surgery for morbid obesity [**2139**]
2. Atrial fibrillation / atrial flutter s/p ablation [**2139**]
3. Type 2 diabetes c/b nephropathy and neuropathy
4. Chronic renal insufficiency
5. Hypertriglyceridemia
6. h/o Obstructive sleep apnea prior to gastric sx
7. Hyperoxaluria
8. ? of Non hep a, hep B hepatitis around [**2116**], also ?lft
abnormalities on amiodorone in past
9. CAD: MI [**1-16**]


Social History:
No ETOH, tobacco or illicit drug use

Family History:
Mother, Father, Brother, Sister all w/ DM2. Father h/o CA Many
of his family members also have problems with obesity

Physical Exam:
GA: AOx3, NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no lesions
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.

.
ECG:atrial fibrillation at 119 bpm. nl axis and intervals. NSTT
changes.


Pertinent Results:
[**2146-8-24**] 12:50PM BLOOD Hct-27.9*
[**2146-8-23**] 08:05AM BLOOD Hct-24.7*
[**2146-8-21**] 07:00PM BLOOD Hct-30.9*
[**2146-8-19**] 06:20PM BLOOD WBC-6.4 RBC-3.12*# Hgb-8.8*# Hct-26.1*#
MCV-84 MCH-28.3 MCHC-33.9 RDW-13.8 Plt Ct-204
[**2146-8-21**] 02:54AM BLOOD PT-13.6* PTT-23.8 INR(PT)-1.2*
[**2146-8-23**] 08:05AM BLOOD Glucose-77 UreaN-8 Creat-0.9 Na-138 K-4.3
Cl-106 HCO3-22 AnGap-14
[**2146-8-23**] 08:05AM BLOOD Calcium-8.1* Phos-2.4* Mg-1.4*

Brief Hospital Course:
Pt was transferred from [**Hospital6 **] for
management of GI bleeding.

He was admitted initially to the Intensive Care Unit where he
had two maroon stools and was transfused 1 unit PRBC. He had a
negative NG lavage there. He was transferred to Dr[**Name (NI) **]
care the following day. Aspirin, plavix and lisinopril were
held. His vitals were monitored regularly and pain was well
controlled. He was NPO for procedure (scope) most of his stay
and was restarted on a regular diet at discharge.

CV: Mr [**Known lastname 7749**] had several short episodes of atrial fibrillation
on tele. He reached ventricular rates up to 120 during these
runs. In sinus rhythym, his HR was 50-70 with SBP 100-110.
Because of these low sinus numbers, his metoprolol was held most
of the stay. Also, his aspirin and plavix were held while the
source of bleeding was worked up.

GI: Pt presented with maroon stools, and had two of these while
in house. He took 5L of bowel prep the night before
EGD/colonoscopy and showed no blood in those stools. Endoscopy
on [**2146-8-24**] showed an ulcer at the anastamosis; the final report
on this and the colonoscopy is pending.


Medications on Admission:
Trazadone 100mg qHS
Bupropion SR 200mg daily
Potassium citrate 10 mEq 3x/day
Metformin 1000mg [**Hospital1 **]
Lisinopril 5mg daily
Prvastatin 20mg qHS
Metoprolol 25mg [**Hospital1 **]
Clopidogrel 75mg daily
Vitamin D-3 [**2135**] units daily
Acarbose 25mg daily
ASA 81mg daily
Calcium carbonate 2 tabs daily
Cyanobalamin 100 mEq 3x/week


Discharge Medications:
1. Pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day for 2 months:
crush tablet.
Disp:*120 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Misoprostol 100 mcg Tablet Sig: One (1) Tablet PO four times
a day: crush tablets.
Disp:*120 Tablet(s)* Refills:*2*
3. Bupropion HCl 100 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO QAM (once a day (in the morning)).
4. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Five (5)
Tablet PO DAILY (Daily).
6. Trazodone 100 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.


Discharge Disposition:
Home

Discharge Diagnosis:
1. Melena
2. Anastamosis ulcer


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


Discharge Instructions:
Please call your surgeon or return to the emergency department
if you develop a fever greater than 101.5, chest pain, shorness
fo breath, severe abdominal pain, pain unrelieved by your pain
medication, severe nausea or vomiting, severe abdominal
bloating, inability to eat or drink, or any other symptoms which
are concerning to you.

Diet:
Regular diet. Avoid spicy foods.

Medications:
Resume your home medications. You will be starting some new
medications:
1. You should take a stool softener, Colace, twice daily for
constipation as needed, or until you resume a normal bowel
pattern.
2. You must not use aspirin or NSAIDS (non-steroidal
anti-inflammatory drugs) Examples are Ibuprofen, Motrin, Aleve,
Nuprin and Naproxen. These agents will cause bleeding and ulcers
in your digestive system.
3. You are prescribed an antacid as well to aid in healing the
ulcer.

Activity:
No heavy lifting of items [**9-23**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.


Followup Instructions:
- Have an endoscopy done in [**5-17**] weeks to monitor your
anastamotic ulcer.
- See your primary care physician [**Name Initial (PRE) 176**] 2 weeks to follow-up
and assist in scheduling the endoscopy.
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Persistent postoperative fistula,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery'}


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: 58 yo male with multiple medical problems including [**Name (NI) 2320**], atrial
fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding.

PRESENT ILLNESS: HPI: 58 yo male with multiple medical problems including [**Name (NI) 2320**],
atrial fibrillation/atrial flutter, s/p gastric bypass who was
transferred from [**Hospital6 **] for management of GI
bleeding. Pt reports yesterday he awoke feeling "off balance"
and weak. He went to [**Hospital **] hospital where he had a marroon stool
and was found to have Hct of 24. He had CT abd which did not
show an intra-abdominal process. He was given two units of PRBCs
and transferred to [**Hospital1 18**] for further management. Pt denies any
previous episodes of GI bleeding. Last [**Last Name (un) **] was [**1-12**] yrs ago and
demonstrated benign polyps that were removed.
.
In the [**Hospital1 18**] ED initial vitals were T 98 HR 75 BP 105/75 RR 18
O2Sat 100 RA. His hct on arrival was 26, which was then post 2
units. He did have 2 more marroon stools. He received 1L NS and
1 unit PRBCs. Vitals were T96.5 HR:116 BP: 109/63 100RA on
transfer to floor.

MEDICAL HISTORY: 1. Bariatric surgery for morbid obesity [**2139**]
2. Atrial fibrillation / atrial flutter s/p ablation [**2139**]
3. Type 2 diabetes c/b nephropathy and neuropathy
4. Chronic renal insufficiency
5. Hypertriglyceridemia
6. h/o Obstructive sleep apnea prior to gastric sx
7. Hyperoxaluria
8. ? of Non hep a, hep B hepatitis around [**2116**], also ?lft
abnormalities on amiodorone in past
9. CAD: MI [**1-16**]

MEDICATION ON ADMISSION: Trazadone 100mg qHS
Bupropion SR 200mg daily
Potassium citrate 10 mEq 3x/day
Metformin 1000mg [**Hospital1 **]
Lisinopril 5mg daily
Prvastatin 20mg qHS
Metoprolol 25mg [**Hospital1 **]
Clopidogrel 75mg daily
Vitamin D-3 [**2135**] units daily
Acarbose 25mg daily
ASA 81mg daily
Calcium carbonate 2 tabs daily
Cyanobalamin 100 mEq 3x/week

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GA: AOx3, NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no lesions
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.

FAMILY HISTORY: Mother, Father, Brother, Sister all w/ DM2. Father h/o CA Many
of his family members also have problems with obesity

SOCIAL HISTORY: No ETOH, tobacco or illicit drug use 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Atrial flutter,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Persistent postoperative fistula,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery'}
