CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: 80 M with hx of R hemicolectomy due to ischemic colitis from
artery embolization for GIB who developed melena colored stool
with some mixed with blood approximately 2d PTA. His stools are
frequently black because of iron supplimentation. Amount of
blood is minimal. He had two bloody BMs this am, last one at 10
am on DOA. One episode of bilious vomiting yesterday. Seen at
[**Hospital 45887**] Hospital and Hct= 35.4.  NGL negative.  Received one
unit PRBC and 2 L enroute. Some subjective abd pain wit
palpation per pt. No SOB/CP. Overall feels well.  Admitted to
the [**Hospital Unit Name 153**] for observation.
  [**Hospital Unit Name 153**] course significant for episode of large BM with
hypotension with MAPs in the 40s.  Repeat NGL negative, HCT drop
from 32-> 23 and received 2u PRBCs.  GI consult was obtained and
EGD unremarkable, colonscopy revealed extensive diverticular
disease throughout the colon, with no active site of bleeding.
However, most of the blood was located in the sigmoid colon.
Tagged RBC scan performed on [**2152-11-20**] which was unremarkable.
Surgical consult suggested that subtotal colectomy would be an
option but last resort.  GI suggested to pursue repeat look at
sigmoid colon to discern possible bleeding source.
  Currently, pt feels well.  His last BM was this afternoon in
the ICU after having clear liquids.  He states he had 2 BM that
were BRBPR with black stool.  He denies any fevers, chills,
abdominal/chest pain, SOB, n/v.

MEDICAL HISTORY: 1. CAD with CABG in [**2141**], no MI since
2. HTN
3. OA
4. Gastrectomy and Billroth II. Revised to a Roux-en-Y in [**2151**].
5. GIB [**2151**] intitally embolized by IR. Developed right ischmeic
colitis requiring right hemicolectomy.

MEDICATION ON ADMISSION: toprol xl 100 mg qd
ASA 81 mg qd
acupril 20 mg qd
pravachol 10 mg qd
vioxx in past but bextra last 3 days
FeSO4 started recently

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical on admission to [**Hospital Unit Name 153**]:
Temp 97 9
BP 132/65
Pulse 59
Resp
O2 sat 98% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-30**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash
Rectal: blood tinged on glove, external non-tender hemmorhoids,
guiac +, good tone

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former smoker, quit in [**2108**]. No etoh
[**2141**].
Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Dvrtclo colon w hmrhg,Chr blood loss anemia,Hypertension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2152-11-19**]              Discharge Date:   [**2152-11-24**]


Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
colonscopy
EGD
sigmoidoscopy


History of Present Illness:
80 M with hx of R hemicolectomy due to ischemic colitis from
artery embolization for GIB who developed melena colored stool
with some mixed with blood approximately 2d PTA. His stools are
frequently black because of iron supplimentation. Amount of
blood is minimal. He had two bloody BMs this am, last one at 10
am on DOA. One episode of bilious vomiting yesterday. Seen at
[**Hospital 45887**] Hospital and Hct= 35.4.  NGL negative.  Received one
unit PRBC and 2 L enroute. Some subjective abd pain wit
palpation per pt. No SOB/CP. Overall feels well.  Admitted to
the [**Hospital Unit Name 153**] for observation.
  [**Hospital Unit Name 153**] course significant for episode of large BM with
hypotension with MAPs in the 40s.  Repeat NGL negative, HCT drop
from 32-> 23 and received 2u PRBCs.  GI consult was obtained and
EGD unremarkable, colonscopy revealed extensive diverticular
disease throughout the colon, with no active site of bleeding.
However, most of the blood was located in the sigmoid colon.
Tagged RBC scan performed on [**2152-11-20**] which was unremarkable.
Surgical consult suggested that subtotal colectomy would be an
option but last resort.  GI suggested to pursue repeat look at
sigmoid colon to discern possible bleeding source.
  Currently, pt feels well.  His last BM was this afternoon in
the ICU after having clear liquids.  He states he had 2 BM that
were BRBPR with black stool.  He denies any fevers, chills,
abdominal/chest pain, SOB, n/v.


Past Medical History:
1. CAD with CABG in [**2141**], no MI since
2. HTN
3. OA
4. Gastrectomy and Billroth II. Revised to a Roux-en-Y in [**2151**].
5. GIB [**2151**] intitally embolized by IR. Developed right ischmeic
colitis requiring right hemicolectomy.

Social History:
Lives with wife in [**Name (NI) **]. Former smoker, quit in [**2108**]. No etoh
[**2141**].

Family History:
Non-contributory.

Physical Exam:
Physical on admission to [**Hospital Unit Name 153**]:
Temp 97 9
BP 132/65
Pulse 59
Resp
O2 sat 98% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-30**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash
Rectal: blood tinged on glove, external non-tender hemmorhoids,
guiac +, good tone

Physical on admission to floor:
T 98.4 BP 130/80 HR 58 RR 18 95%@RA
Unchanged physical exam from [**Hospital Unit Name 153**] admission.


Pertinent Results:
[**2152-11-19**] 02:09PM BLOOD WBC-7.8 RBC-3.70* Hgb-10.6* Hct-31.5*
MCV-85 MCH-28.7 MCHC-33.7 RDW-14.5 Plt Ct-252
[**2152-11-22**] 04:25AM BLOOD WBC-7.5 RBC-3.60* Hgb-10.6* Hct-31.6*
MCV-88 MCH-29.3 MCHC-33.4 RDW-14.2 Plt Ct-202
[**2152-11-19**] 02:09PM BLOOD Glucose-88 UreaN-20 Creat-1.1 Na-140
K-4.1 Cl-107 HCO3-27 AnGap-10
[**2152-11-22**] 04:25AM BLOOD Glucose-115* UreaN-9 Creat-1.0 Na-140
K-4.1 Cl-107 HCO3-28 AnGap-9
[**2152-11-19**] 02:09PM BLOOD Calcium-8.5 Phos-3.4 Mg-1.8

GI BLEEDING STUDY
Reason: 80 Y/O MAN WITH GI BLEED IN PAST WITH BRBPR AND
HEMATOCRIT DROP.
INTERPRETATION: Following intravenous injection of autologous
red blood cells
labeled with Tc-[**Age over 90 **]m, blood flow and delayed images of the
abdomen for 90
minutes were obtained.

Blood flow and delayed blood pool images show no focus of
abnormal uptake to
suggest GI bleed. There is possible aneurysmal dilatation of the
distal aorta
and ectasia of the right iliac artery.

IMPRESSION: No evidence of active GI bleeding on this study.
Possible
aneurysmal dilatation of the distal aorta and ectasia of the
right iliac artery.

EGD Findings:
Esophagus: Normal esophagus

Stomach: Normal stomach

Duodenum: Normal duodenum

Impressions: Normal EGD to mid-jejunum

Colonoscopy Findings:
 Excavated Lesions Extensive diverticular disease was seen
throughout the entire colon. No active site of bleeding was
visualized. However, most of the blood appears to be located in
the sigmoid colon. The color of stool in the transverse colon
appeared brown in color.

Impressions: Diverticulum in the entire colon
Blood in the sigmoid colon

The source of bleeding is likely due to diverticular disease in
the sigmoid colon

Recommendations: Repeat flexible sigmoidoscopy once bleeding has
stopped to reassess for lumenal pathologies.
Serial Hct
Maintain 2 peripheral IV's at all times.
Repeat tagged RBC scan if pt rebleeds acutely.

Sigmoidoscopy Findings:
 Excavated Lesions Multiple non-bleeding diverticula were seen
in the sigmoid colon, descending colon and splenic flexure.

Impression: Extensive diverticulosis of the sigmoid colon,
descending colon and splenic flexure



Brief Hospital Course:
1. GI Bleeding: Pt was emergently admitted to the ICU for
monitoring and observation and the GI service was consulted.
Emergent colonoscopy was performed revealing extensive
diverticuli but no source of bleeding.  An EGD was performed
which was unremarkable.  Surgery was consulted in regrads to
possible surgical colectomy but he was deemed too high a risk
for surgical removal and felt that if possible this should be
medically managed.  He was transfused 2 units of RBCs.  A repeat
sigmoidoscopy was performed to better visualize his sigmoid
colon, since the majority of bleeding was seen in this area.
Sigmoidoscopy revealed extensive diverticuli without source of
bleed.  His diet was advanced to a low-residue diet and
tolerated without complications.

***If he has further episodes of hematochezia, he is instructed
to proceed to the nearest ED for stability and then needs
immediate angiography to investigate bleeding source. ***

2. HTN: Continues on his outpatient medications.  His ASA will
be held in the light of rebleeding.  He needs to follow up with
his cardiologist in regards to restarting his ASA.


Medications on Admission:
toprol xl 100 mg qd
ASA 81 mg qd
acupril 20 mg qd
pravachol 10 mg qd
vioxx in past but bextra last 3 days
FeSO4 started recently

Discharge Medications:
1. Toprol XL 100 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
2. Accupril 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. Pravachol 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Lower gastrointestinal bleed, likely diverticular bleed of
unknown source.
Coronary Artery disease
s/p R hemicolectomy secondary to artery embolization for GIB
Hypertension
Osteoarthritis
s/p Billroth II for GERD


Discharge Condition:
stable

Discharge Instructions:
follow up with your PCP in the next 1-2 weeks.

Please proceed to the CLOSEST emergency room if you are
experiencing further bleeding.  Please make sure you bring a
copy of your discharge summary when you go.

Followup Instructions:
follow up with your PCP in the next 1-2 weeks.
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}


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: BRBPR

PRESENT ILLNESS: 80 M with hx of R hemicolectomy due to ischemic colitis from
artery embolization for GIB who developed melena colored stool
with some mixed with blood approximately 2d PTA. His stools are
frequently black because of iron supplimentation. Amount of
blood is minimal. He had two bloody BMs this am, last one at 10
am on DOA. One episode of bilious vomiting yesterday. Seen at
[**Hospital 45887**] Hospital and Hct= 35.4.  NGL negative.  Received one
unit PRBC and 2 L enroute. Some subjective abd pain wit
palpation per pt. No SOB/CP. Overall feels well.  Admitted to
the [**Hospital Unit Name 153**] for observation.
  [**Hospital Unit Name 153**] course significant for episode of large BM with
hypotension with MAPs in the 40s.  Repeat NGL negative, HCT drop
from 32-> 23 and received 2u PRBCs.  GI consult was obtained and
EGD unremarkable, colonscopy revealed extensive diverticular
disease throughout the colon, with no active site of bleeding.
However, most of the blood was located in the sigmoid colon.
Tagged RBC scan performed on [**2152-11-20**] which was unremarkable.
Surgical consult suggested that subtotal colectomy would be an
option but last resort.  GI suggested to pursue repeat look at
sigmoid colon to discern possible bleeding source.
  Currently, pt feels well.  His last BM was this afternoon in
the ICU after having clear liquids.  He states he had 2 BM that
were BRBPR with black stool.  He denies any fevers, chills,
abdominal/chest pain, SOB, n/v.

MEDICAL HISTORY: 1. CAD with CABG in [**2141**], no MI since
2. HTN
3. OA
4. Gastrectomy and Billroth II. Revised to a Roux-en-Y in [**2151**].
5. GIB [**2151**] intitally embolized by IR. Developed right ischmeic
colitis requiring right hemicolectomy.

MEDICATION ON ADMISSION: toprol xl 100 mg qd
ASA 81 mg qd
acupril 20 mg qd
pravachol 10 mg qd
vioxx in past but bextra last 3 days
FeSO4 started recently

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical on admission to [**Hospital Unit Name 153**]:
Temp 97 9
BP 132/65
Pulse 59
Resp
O2 sat 98% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-30**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash
Rectal: blood tinged on glove, external non-tender hemmorhoids,
guiac +, good tone

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former smoker, quit in [**2108**]. No etoh
[**2141**]. 

### Response:
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
