CHIEF COMPLAINT: CC:[**CC Contact Info 92111**]

PRESENT ILLNESS: [**Age over 90 **]-year-old female with past medical history of diverticulitis,
peptic ulcer disease, anemia who presents with "hemoptysis".
.
The patient was in her usual state of health until 1 week prior
to admission. At that time she developed severe epigastric pain
which she attributed to acid-reflux. She also noted nausea which
was intermittent and a sour taste. The day prior to admission
she "coughed up" a half-dollar sized blood clot. She went to bed
without any more symptoms. She awoke with lightheadedness. She
denies any chest pain, palpitations, shortness of breath,
abdominal pain, fevers, chills, cough, changes in bowel habits,
blood in stool (notes dark stool but no different than baseline
given takes oral iron). She presented to [**Hospital1 18**] EW for further
evaluation.
.
Upon presentation to [**Hospital1 18**] EW, initial vitals were: T 98.7, HR
56, BP 200/70, RR 17, SaO2 100% ra. CXR was normal. Hct 20
(unsure of baseline). Coags with INR 1. NGL with coffee ground
emesis. Cleared after 60cc NS. Rectal with brown, heme positive
stool. GI was consulted and the patient was admitted to MICU for
further work up.
.
Currently, she feels well and is without complaints.
.
ROS: Per HPI. Lost weight since [**Month (only) **].
.

MEDICAL HISTORY: - diverticulitis
- peptic ulcer disease
- glaucoma
- cataract
- hyperlipidemia
- hypertension
- anemia - in [**Month (only) 1096**] required 2u PRBC
- anxiety
- GERD

MEDICATION ON ADMISSION: - Atenolol 25mg daily
- Lasix 20mg QOD
- Aspirin 81mg daily
- Lisinopril 40mg [**Hospital1 **]
- Lipitor 10mg daily
- MVI
- omega-3 fatty acid
- Dorzalamide eye drops
- Ativan 0.5mg TID
- Iron pill

ALLERGIES: Cipro Cystitis / Levaquin / Macrobid / Ampicillin

PHYSICAL EXAM: On Admission:
VS: Temp: 98, BP: 233/67, HR: 74, RR: 17, O2sat: 100% RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, dry MM, op without lesions
RESP: CTAB, with good air movement throughout
CV: RR, nl rate, II/VI RUSB
ABD: epigastric tenderness, LLQ tenderness, nondistended +b/s,
soft, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: warm
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: Brother with PUD

SOCIAL HISTORY: Lives at home by self. Denies EtOH, Tobacco, Illicits.
Acute posthemorrhagic anemia,Hemoptysis, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Esophagitis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified hyperlipidemia,Unspecified glaucoma,Anxiety state, unspecified
Ac posthemorrhag anemia,Hemoptysis NOS,Gastrointest hemorr NOS,Acute kidney failure NOS,Esophagitis, unspecified,Diaphragmatic hernia,Hyperpotassemia,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Hyperlipidemia NEC/NOS,Glaucoma NOS,Anxiety state NOS
Admission Date:  [**2128-2-13**]              Discharge Date:   [**2128-2-17**]


Service: MEDICINE

Allergies:
Cipro Cystitis / Levaquin / Macrobid / Ampicillin

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
CC:[**CC Contact Info 92111**]

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy which showed esophagitis and an old
healed ulcer but no sign of bleeding.


History of Present Illness:
[**Age over 90 **]-year-old female with past medical history of diverticulitis,
peptic ulcer disease, anemia who presents with "hemoptysis".
.
The patient was in her usual state of health until 1 week prior
to admission. At that time she developed severe epigastric pain
which she attributed to acid-reflux. She also noted nausea which
was intermittent and a sour taste. The day prior to admission
she "coughed up" a half-dollar sized blood clot. She went to bed
without any more symptoms. She awoke with lightheadedness. She
denies any chest pain, palpitations, shortness of breath,
abdominal pain, fevers, chills, cough, changes in bowel habits,
blood in stool (notes dark stool but no different than baseline
given takes oral iron). She presented to [**Hospital1 18**] EW for further
evaluation.
.
Upon presentation to [**Hospital1 18**] EW, initial vitals were: T 98.7, HR
56, BP 200/70, RR 17, SaO2 100% ra. CXR was normal. Hct 20
(unsure of baseline). Coags with INR 1. NGL with coffee ground
emesis. Cleared after 60cc NS. Rectal with brown, heme positive
stool. GI was consulted and the patient was admitted to MICU for
further work up.
.
Currently, she feels well and is without complaints.
.
ROS: Per HPI. Lost weight since [**Month (only) **].
.


Past Medical History:
- diverticulitis
- peptic ulcer disease
- glaucoma
- cataract
- hyperlipidemia
- hypertension
- anemia - in [**Month (only) 1096**] required 2u PRBC
- anxiety
- GERD


Social History:
Lives at home by self. Denies EtOH, Tobacco, Illicits.


Family History:
Brother with PUD

Physical Exam:
On Admission:
VS: Temp: 98, BP: 233/67, HR: 74, RR: 17, O2sat: 100% RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, dry MM, op without lesions
RESP: CTAB, with good air movement throughout
CV: RR, nl rate, II/VI RUSB
ABD: epigastric tenderness, LLQ tenderness, nondistended +b/s,
soft, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: warm
NEURO: AAOx3. Cn II-XII intact.

On Discharge:
VS: Temp: 98.3, BP: 187/74 (120s-180s/50s-70s), 71 (60s-80s), 18
O2sat: 100% RA
GEN: pleasant, comfortable, NAD, A&Ox3
HEENT: PERRL, EOMI, dry MM, op without lesions
RESP: CTAB, with good air movement throughout
CV: RR, nl rate, 2/6 SEM at RUSB
ABD: soft, non-tender, non-distended, bowel sounds present, no
masses, no hepatosplenomegaly
EXT: no c/c/e
SKIN: warm
NEURO: AAOx3. Cn II-XII intact.

Pertinent Results:
Admission Labs:
[**2128-2-13**] 06:10PM BLOOD WBC-4.9 RBC-2.17* Hgb-7.0* Hct-20.5*
MCV-95 MCH-32.3* MCHC-34.2 RDW-16.2* Plt Ct-278
[**2128-2-13**] 04:15PM BLOOD Glucose-118* UreaN-65* Creat-2.4* Na-134
K-5.4* Cl-106 HCO3-20* AnGap-13
[**2128-2-14**] 04:46AM BLOOD Calcium-9.0 Phos-4.7* Mg-2.3

Discharge Labs:
[**2128-2-17**] 05:30AM BLOOD WBC-6.7 RBC-3.06* Hgb-9.6* Hct-28.0*
MCV-92 MCH-31.5 MCHC-34.3 RDW-17.0* Plt Ct-303
[**2128-2-17**] 01:05PM BLOOD Na-134 K-5.2* Cl-108
[**2128-2-17**] 05:30AM BLOOD Glucose-96 UreaN-52* Creat-2.5* Na-138
K-5.6* Cl-110* HCO3-21* AnGap-13
[**2128-2-17**] 05:30AM BLOOD Calcium-9.0 Phos-4.1 Mg-2.0

Chest X-Ray:
FINDINGS: No consolidation or edema is evident. The mediastinum
is
unremarkable. The cardiac silhouette is borderline enlarged. No
effusion or
pneumothorax is noted. A marked levoconcave scoliosis of the
thoracolumbar
spine is evident.
IMPRESSION: No acute pulmonary process. Borderline cardiomegaly.
Scoliosis.

EGD:
Mild esophagitis in the lower third of the esophagus
Hiatal hernia
Otherwise normal EGD to third part of the duodenum

Brief Hospital Course:
[**Age over 90 **]-year-old female with past medical history of diverticulitis,
peptic ulcer disease who presents with upper GI bleed.

1. Upper GI Bleed: Based on low Hct, +NGL the patient likely has
UGIB. No evidence of varices or liver pathology. Concern was for
[**Doctor First Name 329**] [**Doctor Last Name **] tear or peptic ulcer disease as patient has known
h/o esophagitis and gastritis from prior EGD. Unclear of how
brisk bleed it as unsure of time course but remained
hemodynamically stable in ICU. Transfused 2 units PRBC with
subsequent stable HCts. She did not have any further evidence of
active bleeding.  She was continued on PPI drip in ICU.

Patient remained stable and was called out to medicine floor.
She was continued on IV PPI [**Hospital1 **].  She underwent upper endoscopy
and was found to have mild esophagitis in the lower third of the
esophagus and a hiatal hernia. The EGD was otherwise normal to
the third part of the duodenum.  GI recommended that as part of
the complete anemia work-up the patient should have a virtual
colonoscopy or barium enema done as an outpatient.  This is in
light of the incomplete colonoscopy done at that outside
hospital due to colonic stricture.  Ms. [**Known lastname **] will follow-up
with her GI doctor as an outpatient.  She was discharged home on
a PO PPI. VNA will draw patient's CBC and fax it to her PCP
prior to PCP visit.

2. Hypertension: Ms. [**Known lastname **] had SBP to 200s on admission then
improved on IV hydralazine in the ICU. Lisinopril and atenolol
was held in the setting of GIB and elevated creatinine. Per
prior DC sumamry from [**2127-11-3**], she was supposed to stop
ACE but admission note records her as being on lisinopril 40mg
PO BID. Restarted norvasc as BP med that would not affect HR and
kidneys.

On the floor the patient was continued on norvasc and
hydralazine.  Metoprolol 12.5 mg [**Hospital1 **] was started in place of
atenolol given that patient had an elevated creatinine.
Lisinopril was held at discharge given patient's creatinine of
2.5 (at last admission at [**Hospital1 **] was 2.)

3. Acute on chronic renal failure:  Patient with baseline
creatinine of 1.8 - 2 during recent outside hospital stay, but
during this hospitalization ranged 2.3 - 2.6.  This is possibly
secondary to pre-renal causes given recent GI bleed.  Lisinopril
was held during hospitalization.

4. Hyperkalemia: Patient had elevated potassium in the 5s (5.2
at discharge).  Her ACI inhibitor was held.  EKG did not show
evidence of cardiac conduction abnormalities related to
hyperkalemia.  It is possibly secondary to decreased GFR.
VNA will draw chemistry as an outpatient and fax results to
patient's PCP so hyperkalemia can be followed.

5. GERD: Patient was on PPI drip and then IV PPI during
hospitalization. She was dishcarged on PO PPI.

6. Glaucoma: Continued outpt eye drops

7. Anxiety: Continued home TID ativan for anxiety.

8. Code: DNR/DNI, confirmed with patient.


Medications on Admission:
- Atenolol 25mg daily
- Lasix 20mg QOD
- Aspirin 81mg daily
- Lisinopril 40mg [**Hospital1 **]
- Lipitor 10mg daily
- MVI
- omega-3 fatty acid
- Dorzalamide eye drops
- Ativan 0.5mg TID
- Iron pill

Discharge Medications:
1. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for anxiety.
2. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
4. dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
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:*2*
6. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
7. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
Disp:*120 Tablet(s)* Refills:*2*
8. Omega-3 Fish Oil 1,000 (120-180) mg Capsule Sig: One (1)
Capsule PO twice a day.
9. multivitamin     Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Primary: Acute blood loss anemia from unknown source
Secondary: Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
It was a pleasure to participate in your care Ms. [**Known lastname **].  You
were admitted to the hospital with bleeding that caused a low
blood count and blood in your stomach.  This may have been
caused by bleeding in your upper GI tract, but the
gastroenterologists did not see any bleeding on your upper
endoscopy.  You need to follow-up with your GI doctor as an
outpatient to have a virtual colonoscopy or a barium enema.

Please make the following changes to your medications:
1. STOP Atenolol
2. STOP Lisinopril until your kidneys recover (your primary care
will let you know when it is ok to restart this)
3. STOP Lasix until your kidneys recover (your primary care will
let you know when it is ok to restart this)
4. START Metoprolol 12.5 mg po BID
5. START Amlodipine 10mg po daily
6. START Hydralazine 25 mg by mouth Four times daily ( this will
take the place of lisinopril until your primary care says it is
ok to stop).
7. START Pantoprazole 40mg by mouth daily for stomach protection

Please see below for your follow-up appointments.

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) **] L.
Address: [**Street Address(2) **], STE 2W, [**Location (un) **],[**Numeric Identifier 809**]
Phone: [**Telephone/Fax (1) 2697**]
Appt: [**2-24**] at 11am

Name: [**Last Name (LF) **],[**Name8 (MD) **] MD
Address: 92 [**Last Name (LF) **], [**First Name3 (LF) **],[**Numeric Identifier 21622**]
Phone: [**Telephone/Fax (1) 49449**]
Appt: [**2-27**] at 2:30pm


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]
{'Acute posthemorrhagic anemia,Hemoptysis, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Esophagitis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified hyperlipidemia,Unspecified glaucoma,Anxiety state, unspecified'}


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: CC:[**CC Contact Info 92111**]

PRESENT ILLNESS: [**Age over 90 **]-year-old female with past medical history of diverticulitis,
peptic ulcer disease, anemia who presents with "hemoptysis".
.
The patient was in her usual state of health until 1 week prior
to admission. At that time she developed severe epigastric pain
which she attributed to acid-reflux. She also noted nausea which
was intermittent and a sour taste. The day prior to admission
she "coughed up" a half-dollar sized blood clot. She went to bed
without any more symptoms. She awoke with lightheadedness. She
denies any chest pain, palpitations, shortness of breath,
abdominal pain, fevers, chills, cough, changes in bowel habits,
blood in stool (notes dark stool but no different than baseline
given takes oral iron). She presented to [**Hospital1 18**] EW for further
evaluation.
.
Upon presentation to [**Hospital1 18**] EW, initial vitals were: T 98.7, HR
56, BP 200/70, RR 17, SaO2 100% ra. CXR was normal. Hct 20
(unsure of baseline). Coags with INR 1. NGL with coffee ground
emesis. Cleared after 60cc NS. Rectal with brown, heme positive
stool. GI was consulted and the patient was admitted to MICU for
further work up.
.
Currently, she feels well and is without complaints.
.
ROS: Per HPI. Lost weight since [**Month (only) **].
.

MEDICAL HISTORY: - diverticulitis
- peptic ulcer disease
- glaucoma
- cataract
- hyperlipidemia
- hypertension
- anemia - in [**Month (only) 1096**] required 2u PRBC
- anxiety
- GERD

MEDICATION ON ADMISSION: - Atenolol 25mg daily
- Lasix 20mg QOD
- Aspirin 81mg daily
- Lisinopril 40mg [**Hospital1 **]
- Lipitor 10mg daily
- MVI
- omega-3 fatty acid
- Dorzalamide eye drops
- Ativan 0.5mg TID
- Iron pill

ALLERGIES: Cipro Cystitis / Levaquin / Macrobid / Ampicillin

PHYSICAL EXAM: On Admission:
VS: Temp: 98, BP: 233/67, HR: 74, RR: 17, O2sat: 100% RA
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, dry MM, op without lesions
RESP: CTAB, with good air movement throughout
CV: RR, nl rate, II/VI RUSB
ABD: epigastric tenderness, LLQ tenderness, nondistended +b/s,
soft, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: warm
NEURO: AAOx3. Cn II-XII intact.

FAMILY HISTORY: Brother with PUD

SOCIAL HISTORY: Lives at home by self. Denies EtOH, Tobacco, Illicits. 

### Response:
{'Acute posthemorrhagic anemia,Hemoptysis, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Esophagitis, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Hyperpotassemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Other and unspecified hyperlipidemia,Unspecified glaucoma,Anxiety state, unspecified'}
