CHIEF COMPLAINT: GI bleeding

PRESENT ILLNESS: 82 y/o female wtih PMH signficant for gastric ulcers s/p partial
gastrectomy who was admitted [**7-14**] with a GI bleed. Pt developed
arthritis only about 6 mo ago, and joint pain had exacerbated
over the last few days before admission.  At 5AM on the morning
of admission, the pt developed nausea and had voluminous bloody
emesis x 2.  After a few hrs, she had voluminous "black"
diarrhea x2 associated with diaphoresis, palpitations, and
lightheadedness. She had taken two Aleve the night prior to
admission for her joint pain.
.
Pt has had 2 prior similar episodes of hematemesis in her life,
one 50 yrs ago, one 9 yrs ago.  The episode 50 yrs ago was due
to ulcers, and pt had gastrectomy performed.  She drank heavily
as an alcoholic for 3 yrs, from the time period of 36 to 33 yrs
ago.  9 yrs ago, she had a similar episode of GI bleeding, and
at that time, etiology was unknown.
.
For the current episode, pt was brought to the ED for further
evaluation.  Pt states that she does not take regular NSAID or
ASA for her joint pain.
.
In th ED, NG lavage was grossly positive and did not clear with
1000cc of NS. Stool was maroon and guaiac positive. Initially,
pt's BP dropped to 60/30 but after 2L of NS it increased to
138/69. Hct returned at 27.6 (no known baseline) and she was
transfused one unit of PRBCs. The pt was admitted to the MICU
for further care, GI consult, EGD, and colonoscopy.
.
In the MICU, the pt underwent an EGD on [**7-14**]. This showed a
normal esophagus; evidence of a Bilroth II in the stomach body;
a single acute cratered non-bleeding 10 mm ulcer in the gastric
side of anastomosis; and a normal duodenum. There was no
stigmata of recent bleeding associated with the ulcer. Over the
first hospital day, the pt required two units of PRBC. Since
that time, the pt has not had any further bleeding and has not
required any more PRBC. She will need a repeat EGD in [**6-9**] weeks
with Dr. [**Last Name (STitle) 21449**]. She will now be transferred to the floor
for further care.

MEDICAL HISTORY: 1. Bleeding gastric ulcer s/p partial gastrectomy in [**2072**].
2. Hematemesis 6-7 years ago. No source was found on EGD.
3. Lap cholecystetomy in [**2124**] complicated by liver laceration
and PE
4. Post-op PE requiring brief intubation and s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**]
filter in [**2124**]
5. S/P appendectomy
6. HTN
7. Hypercholesterolemia
8. Iron deficiency anemia
9. OA of left knee requiring knee replacement

MEDICATION ON ADMISSION: Medications on transfer:
1. Docusate 100 mg [**Hospital1 **]
2. Pantoprazole 40 mg [**Hospital1 **]
3. Pravastatin 40 mg daily
4. Sucralfate 1 gm TID
5. Venlafaxine 75 mg [**Hospital1 **]
PRNs-
Trazadone
Tylenol
Dolasetron mesylate
Senna
.
Allergies:
1. Compazine
2. Ativan--> Causes violence and severe agitation.

ALLERGIES: Ativan / Compazine

PHYSICAL EXAM: Vitals:  99.6 (afebrile in MICU) / HR 70-80 / RR 21 /
106-143/40-60 / 96% RA
Gen:  NAD, appears active, in bed
HEENT:  PERRL, no JVD, no LAD, nl thyroid size
Lungs:  CTA B
Cardiac:  RRR, clear S1/S2, no m/r/g
Abdomen:  Soft, appy scar, gastrectomy scar, small RLQ hernia
surgery scar, +BS, ND, NT
Extr:  Enlarged, prominent MCP joints b/l, Heberden nodes on L
hand at DIP joints, normal appearing toes, no pain on palpation
of joints, no erythema, no edema in joints.  No c/c/e.
Neuro:  [**5-6**] motor throughout, sensation normal b/l,

FAMILY HISTORY: [**Name (NI) 1094**] father died of renal cancer; brother with lung cancer; no
hx of CAD; no hx of colon cancer.

SOCIAL HISTORY: Pt has a history of alcoholism. She has been sober x 33yrs.
Denies tobacco and drug use.
Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Benign neoplasm of colon,Diverticulosis of colon with hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia
Chr marginal ulcer w hem,Ac posthemorrhag anemia,Benign neoplasm lg bowel,Dvrtclo colon w hmrhg,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2128-7-14**]              Discharge Date:   [**2128-7-24**]


Service: MEDICINE

Allergies:
Ativan / Compazine

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
GI bleeding

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
82 y/o female wtih PMH signficant for gastric ulcers s/p partial
gastrectomy who was admitted [**7-14**] with a GI bleed. Pt developed
arthritis only about 6 mo ago, and joint pain had exacerbated
over the last few days before admission.  At 5AM on the morning
of admission, the pt developed nausea and had voluminous bloody
emesis x 2.  After a few hrs, she had voluminous "black"
diarrhea x2 associated with diaphoresis, palpitations, and
lightheadedness. She had taken two Aleve the night prior to
admission for her joint pain.
.
Pt has had 2 prior similar episodes of hematemesis in her life,
one 50 yrs ago, one 9 yrs ago.  The episode 50 yrs ago was due
to ulcers, and pt had gastrectomy performed.  She drank heavily
as an alcoholic for 3 yrs, from the time period of 36 to 33 yrs
ago.  9 yrs ago, she had a similar episode of GI bleeding, and
at that time, etiology was unknown.
.
For the current episode, pt was brought to the ED for further
evaluation.  Pt states that she does not take regular NSAID or
ASA for her joint pain.
.
In th ED, NG lavage was grossly positive and did not clear with
1000cc of NS. Stool was maroon and guaiac positive. Initially,
pt's BP dropped to 60/30 but after 2L of NS it increased to
138/69. Hct returned at 27.6 (no known baseline) and she was
transfused one unit of PRBCs. The pt was admitted to the MICU
for further care, GI consult, EGD, and colonoscopy.
.
In the MICU, the pt underwent an EGD on [**7-14**]. This showed a
normal esophagus; evidence of a Bilroth II in the stomach body;
a single acute cratered non-bleeding 10 mm ulcer in the gastric
side of anastomosis; and a normal duodenum. There was no
stigmata of recent bleeding associated with the ulcer. Over the
first hospital day, the pt required two units of PRBC. Since
that time, the pt has not had any further bleeding and has not
required any more PRBC. She will need a repeat EGD in [**6-9**] weeks
with Dr. [**Last Name (STitle) 21449**]. She will now be transferred to the floor
for further care.

Past Medical History:
1. Bleeding gastric ulcer s/p partial gastrectomy in [**2072**].
2. Hematemesis 6-7 years ago. No source was found on EGD.
3. Lap cholecystetomy in [**2124**] complicated by liver laceration
and PE
4. Post-op PE requiring brief intubation and s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**]
filter in [**2124**]
5. S/P appendectomy
6. HTN
7. Hypercholesterolemia
8. Iron deficiency anemia
9. OA of left knee requiring knee replacement


Social History:
Pt has a history of alcoholism. She has been sober x 33yrs.
Denies tobacco and drug use.

Family History:
[**Name (NI) 1094**] father died of renal cancer; brother with lung cancer; no
hx of CAD; no hx of colon cancer.

Physical Exam:
Vitals:  99.6 (afebrile in MICU) / HR 70-80 / RR 21 /
106-143/40-60 / 96% RA
Gen:  NAD, appears active, in bed
HEENT:  PERRL, no JVD, no LAD, nl thyroid size
Lungs:  CTA B
Cardiac:  RRR, clear S1/S2, no m/r/g
Abdomen:  Soft, appy scar, gastrectomy scar, small RLQ hernia
surgery scar, +BS, ND, NT
Extr:  Enlarged, prominent MCP joints b/l, Heberden nodes on L
hand at DIP joints, normal appearing toes, no pain on palpation
of joints, no erythema, no edema in joints.  No c/c/e.
Neuro:  [**5-6**] motor throughout, sensation normal b/l,

Pertinent Results:
[**2128-7-14**] 10:35AM   PLT COUNT-322
[**2128-7-14**] 10:35AM   NEUTS-87.0* LYMPHS-9.0* MONOS-3.8 EOS-0.1
BASOS-0.1
[**2128-7-14**] 10:35AM   NEUTS-87.0* LYMPHS-9.0* MONOS-3.8 EOS-0.1
BASOS-0.1
[**2128-7-14**] 10:35AM   CK-MB-8 cTropnT-<0.01
[**2128-7-14**] 10:35AM   CK(CPK)-192*
[**2128-7-14**] 10:35AM   GLUCOSE-180* UREA N-54* CREAT-1.1 SODIUM-135
POTASSIUM-5.0 CHLORIDE-98 TOTAL CO2-23 ANION GAP-19
[**2128-7-14**] 12:54PM   PT-12.1 PTT-22.9 INR(PT)-1.0
[**2128-7-14**] 08:34PM   LACTATE-1.0
.
EGD:
Ulcer in the gastric side of anastomosis
Previous Billroth II of the stomach body
Otherwise normal egd to third part of the duodenum
.
ECG ([**7-15**])- Sinus rhythem at 67 beats per minute. Borderline
first degree AV delay. Modest, diffuse nonspecific low amplitude
T waves.
.
CT chest ([**7-14**])- No pulmonary embolism identified. Bibasilar
patchy atelectasis. No focal consolidation or pleural effusions.
Heart is upper limits of normal in size. Great vessels are
unremarkable for aneurysmal dilatation or dissection. No
mediastinal, axillary, or hilar lymph node enlargement. No
pneumothorax. Images through the upper abdomen showed no
abnormalities.
.
CXR ([**7-14**])- Cardiomediastinal silhouette is within normal
limits. Minimal linear atelectasis is present at the left
costophrenic angle. Lungs were other wise clear. Left convexity
scoliosis centered at the upper lumbar spine. Inferior vena cava
filter is present. No free air.


Brief Hospital Course:
82 y/o female wtih PMH signficant for gastric ulcers s/p partial
gastrectomy who was admitted [**7-14**] with a GI bleed.  EGD showed
a single acute cratered non-bleeding 10 mm ulcer in the gastric
side of the pt's anastamosis.  Pt will be maintained on PPI [**Hospital1 **]
until repeat EGD in [**6-9**] weeks with Dr. [**Last Name (STitle) 21449**].  Pt will
also be maintained on carafate 1g PO TID for [**2-6**] more weeks.
.
The GI bleeding was attributed to the ulcer and recent NSAID use
for arthritis.  The pt had black formed stool, and vomiting but
no blood, during her admission.  Her home regimen of
anti-hypertensives was slowly returned, and the pt was
discharged once BP was controlled in the normal range.
.
Pt's arthritis is most likely osteoarthritis, and is associated
with Heberden nodes.  The arthritis is of recent onset (several
months), but not associated with worsening stiffness/pain with
use, or late in the day.  It is not associated with rashes,
pleuritic chest pain, no temporal/scalp/jaw sensitivity/pain.
Arthritis is not associated with fatigue, weakness, back pain.
Thus, questioning bears negative for polymyalgia rheumatica and
temporal arteritis.

Medications on Admission:
Medications on transfer:
1. Docusate 100 mg [**Hospital1 **]
2. Pantoprazole 40 mg [**Hospital1 **]
3. Pravastatin 40 mg daily
4. Sucralfate 1 gm TID
5. Venlafaxine 75 mg [**Hospital1 **]
PRNs-
Trazadone
Tylenol
Dolasetron mesylate
Senna
.
Allergies:
1. Compazine
2. Ativan--> Causes violence and severe agitation.

Discharge Medications:
1. Venlafaxine 75 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Pravastatin Sodium 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Sucralfate 1 g Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Pantoprazole Sodium 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*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
GI bleed

Secondary diagnosis:
Arthritis
Hypertension
Hypercholesterolemia


Discharge Condition:
Stable

Discharge Instructions:
1. Please take all medications as prescribed.

2. Please keep all follow up appointments.

3. Seek medical attention for fevers, chills, chest pain,
shortness of breath, abdominal pain, vomiting blood, flood in
the stool, or any other concerns.

Followup Instructions:
Please follow up with your primary care physician within one
week of discharge.



Completed by:[**2128-8-21**]
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Benign neoplasm of colon,Diverticulosis of colon with hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: GI bleeding

PRESENT ILLNESS: 82 y/o female wtih PMH signficant for gastric ulcers s/p partial
gastrectomy who was admitted [**7-14**] with a GI bleed. Pt developed
arthritis only about 6 mo ago, and joint pain had exacerbated
over the last few days before admission.  At 5AM on the morning
of admission, the pt developed nausea and had voluminous bloody
emesis x 2.  After a few hrs, she had voluminous "black"
diarrhea x2 associated with diaphoresis, palpitations, and
lightheadedness. She had taken two Aleve the night prior to
admission for her joint pain.
.
Pt has had 2 prior similar episodes of hematemesis in her life,
one 50 yrs ago, one 9 yrs ago.  The episode 50 yrs ago was due
to ulcers, and pt had gastrectomy performed.  She drank heavily
as an alcoholic for 3 yrs, from the time period of 36 to 33 yrs
ago.  9 yrs ago, she had a similar episode of GI bleeding, and
at that time, etiology was unknown.
.
For the current episode, pt was brought to the ED for further
evaluation.  Pt states that she does not take regular NSAID or
ASA for her joint pain.
.
In th ED, NG lavage was grossly positive and did not clear with
1000cc of NS. Stool was maroon and guaiac positive. Initially,
pt's BP dropped to 60/30 but after 2L of NS it increased to
138/69. Hct returned at 27.6 (no known baseline) and she was
transfused one unit of PRBCs. The pt was admitted to the MICU
for further care, GI consult, EGD, and colonoscopy.
.
In the MICU, the pt underwent an EGD on [**7-14**]. This showed a
normal esophagus; evidence of a Bilroth II in the stomach body;
a single acute cratered non-bleeding 10 mm ulcer in the gastric
side of anastomosis; and a normal duodenum. There was no
stigmata of recent bleeding associated with the ulcer. Over the
first hospital day, the pt required two units of PRBC. Since
that time, the pt has not had any further bleeding and has not
required any more PRBC. She will need a repeat EGD in [**6-9**] weeks
with Dr. [**Last Name (STitle) 21449**]. She will now be transferred to the floor
for further care.

MEDICAL HISTORY: 1. Bleeding gastric ulcer s/p partial gastrectomy in [**2072**].
2. Hematemesis 6-7 years ago. No source was found on EGD.
3. Lap cholecystetomy in [**2124**] complicated by liver laceration
and PE
4. Post-op PE requiring brief intubation and s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 260**]
filter in [**2124**]
5. S/P appendectomy
6. HTN
7. Hypercholesterolemia
8. Iron deficiency anemia
9. OA of left knee requiring knee replacement

MEDICATION ON ADMISSION: Medications on transfer:
1. Docusate 100 mg [**Hospital1 **]
2. Pantoprazole 40 mg [**Hospital1 **]
3. Pravastatin 40 mg daily
4. Sucralfate 1 gm TID
5. Venlafaxine 75 mg [**Hospital1 **]
PRNs-
Trazadone
Tylenol
Dolasetron mesylate
Senna
.
Allergies:
1. Compazine
2. Ativan--> Causes violence and severe agitation.

ALLERGIES: Ativan / Compazine

PHYSICAL EXAM: Vitals:  99.6 (afebrile in MICU) / HR 70-80 / RR 21 /
106-143/40-60 / 96% RA
Gen:  NAD, appears active, in bed
HEENT:  PERRL, no JVD, no LAD, nl thyroid size
Lungs:  CTA B
Cardiac:  RRR, clear S1/S2, no m/r/g
Abdomen:  Soft, appy scar, gastrectomy scar, small RLQ hernia
surgery scar, +BS, ND, NT
Extr:  Enlarged, prominent MCP joints b/l, Heberden nodes on L
hand at DIP joints, normal appearing toes, no pain on palpation
of joints, no erythema, no edema in joints.  No c/c/e.
Neuro:  [**5-6**] motor throughout, sensation normal b/l,

FAMILY HISTORY: [**Name (NI) 1094**] father died of renal cancer; brother with lung cancer; no
hx of CAD; no hx of colon cancer.

SOCIAL HISTORY: Pt has a history of alcoholism. She has been sober x 33yrs.
Denies tobacco and drug use. 

### Response:
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Benign neoplasm of colon,Diverticulosis of colon with hemorrhage,Unspecified essential hypertension,Pure hypercholesterolemia'}
