CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: 52 y.o. male transferred from [**Hospital3 417**] where he presented
with hematemesis.  He has a history of upper GI bleeding and was
recently discharged from [**Hospital3 417**] 1 day prior to this
admssion for upper GI bleed.  He has a h/o Dieulafoy lesion in
the cardia and peptic ulcer disease.  He underwent EGD ([**2138-3-14**])
which revealed a small Dieulafoy in the cardia of the stomach,
which was injected with epinephrine, resulting in vigorous
bleeding.  He underwent multiple transfusions, and was
stabilized.  Repeat EGD [**3-17**] revealed no active bleeding.  He
was transferred the the medical floor at [**Hospital3 417**] [**3-18**],
but the following day had massive hematemesis again.  He was
transfused 5 units PRBCs, and transferred to [**Hospital1 18**] for further
management.
.
Initially admitted to the MICU, the patient was seen by GI in
consult.  He was hemodynamically stable with no further
hematemesis, and underwent repeat EGD here on [**2138-3-20**], revealing
clips and clots, but no active bleeding.  He is called out to
the floor [**2138-3-21**].

MEDICAL HISTORY: Morbid Obesity
Hypertension
Hypercholesterolemia
Non-insulin dependent diabetes mellitus
Renal insufficiency
- baseline cr 1.7-1.8
Coronary artery disease
- PTCA in [**2135-8-26**] c/b spiral dissection of RCA successfully
stented
- 50% mid LAD
- diffuse 80% mid LCx
- 80% proximal OM2
- 90% ostial rPDA
Congestive heart falure
- EF 30%
s/p pacemaker implant in [**2129**] for sick sinus
previous alcoholic w/ h\o DTs at least twice, last ~ 25 yrs ago

MEDICATION ON ADMISSION: Advair 250/50 [**Hospital1 **]
Rocaltrol 0.25 PO QD
PhosLo 667 PO BID
Prozac 40 PO QD
Trazodone 100 PO QHS prn insomnia
Nephrocaps 1 PO QD
Zocor 40 PO QD
TriCor 145 PO QD
Lasix 80mg QAM, 40mg QPM
Omeprazole 20 PO BID
Toprol XL 150mg daily

ALLERGIES: Codeine

PHYSICAL EXAM: Upon admission to the medical floor:
Vitals: T 98.8  BP 147/85  HR 84  RR 18 99% RA, FS 160
General: morbidly obese, comfortable, NAD
HEENT: PERRL, EOMI, MMM, OP clear
Neck: JVD difficult to assess given body habitus,
Heart: distant HS, but RRR and w/o murs
Lungs: distant lung sounds, but CTAB, no wheezes or rhonchi
Abdomen: obese, NABS, soft, NT/ND; no stigmata of liver disease

FAMILY HISTORY: Mother alive with h/o CVA; [**Name (NI) 50362**] father also alive.
Maternal grandfather died of an MI in his 60s.

SOCIAL HISTORY: Patient is married, lives with his wife in [**Name (NI) 1474**]. Has 2
children. Current 1 PPD smoker x 30 years. Previous alcoholic
with h/o DT's, current EtOH 2-3 beers/day. Now disabled, former
construction worker.
Hematemesis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Morbid obesity,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Hematemesis,Acute kidney failure NOS,CHF NOS,Comp-oth vasc dev/graft,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Morbid obesity,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2138-3-20**]              Discharge Date:   [**2138-3-23**]

Date of Birth:  [**2086-2-22**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
hematemesis

Major Surgical or Invasive Procedure:
EGD


History of Present Illness:
52 y.o. male transferred from [**Hospital3 417**] where he presented
with hematemesis.  He has a history of upper GI bleeding and was
recently discharged from [**Hospital3 417**] 1 day prior to this
admssion for upper GI bleed.  He has a h/o Dieulafoy lesion in
the cardia and peptic ulcer disease.  He underwent EGD ([**2138-3-14**])
which revealed a small Dieulafoy in the cardia of the stomach,
which was injected with epinephrine, resulting in vigorous
bleeding.  He underwent multiple transfusions, and was
stabilized.  Repeat EGD [**3-17**] revealed no active bleeding.  He
was transferred the the medical floor at [**Hospital3 417**] [**3-18**],
but the following day had massive hematemesis again.  He was
transfused 5 units PRBCs, and transferred to [**Hospital1 18**] for further
management.
.
Initially admitted to the MICU, the patient was seen by GI in
consult.  He was hemodynamically stable with no further
hematemesis, and underwent repeat EGD here on [**2138-3-20**], revealing
clips and clots, but no active bleeding.  He is called out to
the floor [**2138-3-21**].

Past Medical History:
Morbid Obesity
Hypertension
Hypercholesterolemia
Non-insulin dependent diabetes mellitus
Renal insufficiency
- baseline cr 1.7-1.8
Coronary artery disease
- PTCA in [**2135-8-26**] c/b spiral dissection of RCA successfully
stented
- 50% mid LAD
- diffuse 80% mid LCx
- 80% proximal OM2
- 90% ostial rPDA
Congestive heart falure
- EF 30%
s/p pacemaker implant in [**2129**] for sick sinus
previous alcoholic w/ h\o DTs at least twice, last ~ 25 yrs ago

COPD
Obesity hypoventilation
Chronic low back pain
Depression
s/p fractured skull in childhood

Social History:
Patient is married, lives with his wife in [**Name (NI) 1474**]. Has 2
children. Current 1 PPD smoker x 30 years. Previous alcoholic
with h/o DT's, current EtOH 2-3 beers/day. Now disabled, former
construction worker.

Family History:
Mother alive with h/o CVA; [**Name (NI) 50362**] father also alive.
Maternal grandfather died of an MI in his 60s.

Physical Exam:
Upon admission to the medical floor:
Vitals: T 98.8  BP 147/85  HR 84  RR 18 99% RA, FS 160
General: morbidly obese, comfortable, NAD
HEENT: PERRL, EOMI, MMM, OP clear
Neck: JVD difficult to assess given body habitus,
Heart: distant HS, but RRR and w/o murs
Lungs: distant lung sounds, but CTAB, no wheezes or rhonchi
Abdomen: obese, NABS, soft, NT/ND; no stigmata of liver disease

Extremities: L arm with 2+ bilat lower extremity pitting edema
Neuro: A&Ox3, strength 5/5, no focal defecits

Pertinent Results:
[**2138-3-20**] 02:11PM   PT-12.6 PTT-25.1 INR(PT)-1.1
[**2138-3-20**] 02:11PM   PLT SMR-LOW PLT COUNT-95*#
[**2138-3-20**] 02:11PM   NEUTS-93.5* BANDS-0 LYMPHS-5.1* MONOS-1.2*
EOS-0.3 BASOS-0
[**2138-3-20**] 02:11PM   WBC-9.4 RBC-3.63* HGB-11.3* HCT-31.7* MCV-87
MCH-31.0 MCHC-35.5* RDW-15.8*
[**2138-3-20**] 02:11PM   HCV Ab-NEGATIVE
[**2138-3-20**] 02:11PM   HBsAg-NEGATIVE HBs Ab-POSITIVE HBc
Ab-NEGATIVE
[**2138-3-20**] 02:11PM   ALBUMIN-2.4* CALCIUM-7.2* PHOSPHATE-4.8*
MAGNESIUM-1.5*
[**2138-3-20**] 02:11PM   LIPASE-161*
[**2138-3-20**] 02:11PM   ALT(SGPT)-57* AST(SGOT)-47* LD(LDH)-317* ALK
PHOS-41 AMYLASE-108* TOT BILI-0.6
[**2138-3-20**] 02:11PM   GLUCOSE-183* UREA N-67* CREAT-1.6* SODIUM-134
POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-21* ANION GAP-13

[**2138-3-20**] 03:18PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2138-3-20**] 03:18PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2138-3-20**] 10:09PM   HCT-29.4*
.
EGD [**2138-3-20**]:
Blood in the fundus
Two clips in the fundus
Ulcer in the duodenal bulb
Otherwise normal EGD to second part of the duodenum
Recommendations: No active bleeding or sites of bleeding seen on
this exam.
.
pCXR [**2138-3-20**]:
Portable AP, without comparison, demonstrates pacemaker leads
within right atrium and right ventricle on single view.  Lungs
are clear.  Costophrenic sulci are sharp.  Heart, mediastinal
contours, and pleural surfaces are unremarkable, given
technique.
IMPRESSION:  No cardiopulmonary process. .
.
Abd u/s [**2138-3-21**]:
1.  Echogenic liver consistent with fatty infiltration, however,
other forms of liver disease including significant hepatic
fibrosis and cirrhosis cannot be excluded on the basis of this
exam.
2.  No ascites.
3.  Cholelithiasis without evidence of cholecystitis.
4.  Normal appearance of the kidneys.
.
L upper extremity u/s [**3-21**]: L cephalic vein DVT

Bilat Leg Venous Ultrasound (OSH [**3-14**]): No evidence of deep
venous thrombosis.
.
ECG ([**2138-3-20**] 18:53)
RRR @ 77, nl axis, intervals, no ST/T changes (no change [**Last Name (un) 834**]
[**2134-8-25**]

Brief Hospital Course:
52 y.o. male with h/o Dieulafoy lesion and PUD p/w hematemesis.

.
# Hematemasis - The patient has a h/o peptic ulcer disease, as
well as Dieulafoy's lesion.   He had EGD at the outside hospital
with hemostatis achieved. He then rebled requiring multiple more
blood transfusions and underwent EGD on [**3-20**] at [**Hospital1 18**] with no
evidence of active bleeding.  He was given protonix [**Hospital1 **]. His Hct
remained stable.  We considered the possibility of bleeding
varices given his ETOH history, but liver U/S w/o evidence of
portal hypertension, showing only fatty liver. No varices were
noted on multiple EGDs.  His diet was advanced to regular and
tolerated well.  He will f/u with his PCP.
.
# L Cephalic Vein clot: The pt had a PICC line placed at [**Hospital 6451**] hospital in his L arm, and was found to have a L
Cephalic vein clot by u/s, which was persued to investigate UE
swelling.  The PICC was removed, but no anticoaggulation given
due to recent GI bleeding.  This is a peripheral vein clot and
was treated with removal of the offending line.
.
# Thrombocytopenia - unclear etiology, likely due to alcohol
use/fatty liver disease, but more likely consumptive in setting
of recent bleeding.  HIT was considered low probability as Plts
remained stable.
.
# Elevated LFTs:  Hepatitis serologies indicate immunity to HBV,
but no active infection.  Abdominal u/s was performed and
revealed fatty liver, but no evidence of portal hypertension or
cirrhosis.  NASH or Alcoholic hepatitis are possible diagnoses.
 In addition, the patient reported he was recently started on a
statin, so this may be the cause.  His Zocor and Tricor were
held.  He was instructed to follow up with his PCP for repeat
LFTs, and referral to Hepatology if they remain elevated.
.
# CAD: The patient has known 3vd, but no evidence of active
ischemia>  His ASA was stopped to due GI bleeding, and should be
restarted by his PCP when appropriate.  After he was stabilized
for >48 hours, his b-blocker was re-started, which he tolerated
well.  He will be discharged on Toprol XL, and his PCP can
titrate the dose as needed.
.
# CHF: EF 30% by report.   His diuretics and b-blocker were held
in the ICU for possiblity of hemodynamic instabiltiy with recent
bleeding.  Upon transfer to the medical floor, the pt was volume
overloaded on exam.  His Lasix and B-blocker were restarted and
doses should be titrated by his primary care physician.
.
# COPD: Advair & nebulizers were continued.
.
# Renal failure: Etiology is unknown, presumed from hypertension
vs diabetes.  According to OSH records, he is near his baseline
(Cr 1.6) His Nephrocaps and Phoslo were restarted.
.
# Chronic back pain: Morphine initially, then Percocet prn.
.
FEN: Regular, monitor lytes
.
Proph: No heparin given GI bleed; Pneumoboots, [**Hospital1 **] PPI
.
FULL CODE

Medications on Admission:
Advair 250/50 [**Hospital1 **]
Rocaltrol 0.25 PO QD
PhosLo 667 PO BID
Prozac 40 PO QD
Trazodone 100 PO QHS prn insomnia
Nephrocaps 1 PO QD
Zocor 40 PO QD
TriCor 145 PO QD
Lasix 80mg QAM, 40mg QPM
Omeprazole 20 PO BID
Toprol XL 150mg daily

Discharge Medications:
1. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Capsule(s)* Refills:*2*
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
4. Lasix 20 mg Tablet Sig: Three (3) Tablet PO twice a day.
5. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain for 7 days.
Disp:*20 Tablet(s)* Refills:*0*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
10. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed.
12. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
prn as needed for shortness of breath or wheezing.


Discharge Disposition:
Home

Discharge Diagnosis:
1. Upper GI bleeding
2. Upper extremity cephalic clot secondary to PICC
3. Transaminitis


Discharge Condition:
Stable, Hct stable, no signs of bleeding


Discharge Instructions:
* Take medications as prescribed.  Several medications were
held, and you should discuss restarting any other medications
with your primary care physician.
* Do not take aspirin until directed by your primary care
physician.
* Call your doctor if you have blood in your vomit or stool,
light-headedness, or any other concerning symptom.
* Please note that you have elevated liver enzymes.  This may be
due to your cholesterol medication, alcohol, or fat infiltration
of your liver.  You must follow up with your primary care
physician and seek referral to a Liver specialist if this does
not resolve.

Followup Instructions:
Please call your doctor, Dr. [**Last Name (STitle) 20426**] ([**Telephone/Fax (1) **]) for an
appointment in the next week.  He needs to monitor your
hematocrit and should check your liver enzymes and if they
remain elevated, refer you to a Liver specialist.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]

Completed by:[**2138-3-23**]
{'Hematemesis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Morbid obesity,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty 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: hematemesis

PRESENT ILLNESS: 52 y.o. male transferred from [**Hospital3 417**] where he presented
with hematemesis.  He has a history of upper GI bleeding and was
recently discharged from [**Hospital3 417**] 1 day prior to this
admssion for upper GI bleed.  He has a h/o Dieulafoy lesion in
the cardia and peptic ulcer disease.  He underwent EGD ([**2138-3-14**])
which revealed a small Dieulafoy in the cardia of the stomach,
which was injected with epinephrine, resulting in vigorous
bleeding.  He underwent multiple transfusions, and was
stabilized.  Repeat EGD [**3-17**] revealed no active bleeding.  He
was transferred the the medical floor at [**Hospital3 417**] [**3-18**],
but the following day had massive hematemesis again.  He was
transfused 5 units PRBCs, and transferred to [**Hospital1 18**] for further
management.
.
Initially admitted to the MICU, the patient was seen by GI in
consult.  He was hemodynamically stable with no further
hematemesis, and underwent repeat EGD here on [**2138-3-20**], revealing
clips and clots, but no active bleeding.  He is called out to
the floor [**2138-3-21**].

MEDICAL HISTORY: Morbid Obesity
Hypertension
Hypercholesterolemia
Non-insulin dependent diabetes mellitus
Renal insufficiency
- baseline cr 1.7-1.8
Coronary artery disease
- PTCA in [**2135-8-26**] c/b spiral dissection of RCA successfully
stented
- 50% mid LAD
- diffuse 80% mid LCx
- 80% proximal OM2
- 90% ostial rPDA
Congestive heart falure
- EF 30%
s/p pacemaker implant in [**2129**] for sick sinus
previous alcoholic w/ h\o DTs at least twice, last ~ 25 yrs ago

MEDICATION ON ADMISSION: Advair 250/50 [**Hospital1 **]
Rocaltrol 0.25 PO QD
PhosLo 667 PO BID
Prozac 40 PO QD
Trazodone 100 PO QHS prn insomnia
Nephrocaps 1 PO QD
Zocor 40 PO QD
TriCor 145 PO QD
Lasix 80mg QAM, 40mg QPM
Omeprazole 20 PO BID
Toprol XL 150mg daily

ALLERGIES: Codeine

PHYSICAL EXAM: Upon admission to the medical floor:
Vitals: T 98.8  BP 147/85  HR 84  RR 18 99% RA, FS 160
General: morbidly obese, comfortable, NAD
HEENT: PERRL, EOMI, MMM, OP clear
Neck: JVD difficult to assess given body habitus,
Heart: distant HS, but RRR and w/o murs
Lungs: distant lung sounds, but CTAB, no wheezes or rhonchi
Abdomen: obese, NABS, soft, NT/ND; no stigmata of liver disease

FAMILY HISTORY: Mother alive with h/o CVA; [**Name (NI) 50362**] father also alive.
Maternal grandfather died of an MI in his 60s.

SOCIAL HISTORY: Patient is married, lives with his wife in [**Name (NI) 1474**]. Has 2
children. Current 1 PPD smoker x 30 years. Previous alcoholic
with h/o DT's, current EtOH 2-3 beers/day. Now disabled, former
construction worker. 

### Response:
{'Hematemesis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Other complications due to other vascular device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Morbid obesity,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
