CHIEF COMPLAINT: CC:[**CC Contact Info 107528**]

PRESENT ILLNESS: [**Age over 90 **]F with PmHx significant for CAD s/p MI x 2 s/p PCI/stent x2
([**2123**], [**2125**]),DMII, hypertension, diabetes, GERD, asthma,
arthritis, DVT, CRI, and cholangitis/pancreatitis, recently
admitted [**Date range (1) 82134**] with diverticulitis and perforation managed
medically, who now presents with hypoglycemia and rectal
bleeding.
.
Ms. [**Known lastname 74762**] presented [**5-15**] with 1 wk h/o LLQ pain and was found
by CT scan to have sigmoid diverticulitis with associated
perforation. She was managed conservatively without operation,
with a combination of bowel rest and antibiotics (Zosyn ->
augmentin). Course also notable for diarrhea, and although 3 C
dif toxin assays were negative, flagyl was added empirically for
presumed c dif colitis. Patient was also noted to have labile
blood sugars.
.
Ms. [**Known lastname 74762**] was found by her grandson this afternoon to be
somnolent and difficult to arrouse, diaphoretic,and called EMS.
UPon arrival, herFSG was noted to be 34. Ms. [**Known lastname **] has not
been eating much since the recent discharge, stating that she
had a poor appetite. She states that she has not had a similar
episode of hypoglycemia for approximately two years.
.
Ms. [**Known lastname 74762**] also reports an episode of rectal bleeding this am,
with blood on the bowel movement and turning the toilet water
red. She denies having BRBPR prior to this episode, and did not
notice bleeding with a subsequent bowel movement. SHe has
continued to have loose bowel movements since recent discharge,
with approx [**1-15**] bm/day. No fevers, no NS. No abdominal pain.
.
In the ED, she was noted to have guaiac + brown stool. HCT noted
to be 26.4 on ED admission (was 29.8 on recent discharge).

MEDICAL HISTORY: -CAD: s/p MI x 2: anterolateral MI [**2123**] s/p PTCA/stenting of a
large diagonal branch of a "twin" LAD. s/p NSTEMI [**2125**] with cath
demonstrating 30% prox and mid RCA, 70% diag, 100% intermedius,
95% OM1 s/p OM1 Velocity Hepacoat stent. EF 51%.
-Hypertension
-hyperlipidemia
-DMII
-asthma
-gerd
-arthritis
-DVT ([**2118**])
-CRI baseline cr ~1.5
-cholangitis/pancreatitis/cholecystitis ([**2125**]), s/p ERCP with
stent
placement and sphincterotomy for a common bile duct stone.
-s/p cesarean section.

MEDICATION ON ADMISSION: Albuterol 1-2 puffs Q6H
Advair 250/50
plavix
glyburide 2.5
Asa 81
atenolol 100
vicodin PRN
Augmentin 250-125 through [**5-28**] daily
Flagyl 500 [**Hospital1 **] through [**5-28**] [**Hospital1 **]
protonix
HCTZ 3x/wk 25
lisinopril 10

ALLERGIES: Codeine / Darvon / Levofloxacin

PHYSICAL EXAM: 

FAMILY HISTORY: N/C

SOCIAL HISTORY: The patient does not use tobacco or alcohol.
She lives alone, but her gradson lives above her and looks in on
her frequently.
Diverticulosis of colon with hemorrhage,Mitral valve disorders,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Acidosis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Diarrhea,Asthma, unspecified type, unspecified,Esophageal reflux,Unspecified essential hypertension
Dvrtclo colon w hmrhg,Mitral valve disorder,Diastolc hrt failure NOS,Ac posthemorrhag anemia,Acute kidney failure NOS,Acidosis,DMII oth nt st uncntrld,Renal & ureteral dis NOS,Status-post ptca,Old myocardial infarct,Diarrhea,Asthma NOS,Esophageal reflux,Hypertension NOS
Admission Date:  [**2128-5-23**]              Discharge Date:   [**2128-5-31**]


Service: MEDICINE

Allergies:
Codeine / Darvon / Levofloxacin

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
CC:[**CC Contact Info 107528**]

Major Surgical or Invasive Procedure:
None


History of Present Illness:
[**Age over 90 **]F with PmHx significant for CAD s/p MI x 2 s/p PCI/stent x2
([**2123**], [**2125**]),DMII, hypertension, diabetes, GERD, asthma,
arthritis, DVT, CRI, and cholangitis/pancreatitis, recently
admitted [**Date range (1) 82134**] with diverticulitis and perforation managed
medically, who now presents with hypoglycemia and rectal
bleeding.
.
Ms. [**Known lastname 74762**] presented [**5-15**] with 1 wk h/o LLQ pain and was found
by CT scan to have sigmoid diverticulitis with associated
perforation. She was managed conservatively without operation,
with a combination of bowel rest and antibiotics (Zosyn ->
augmentin). Course also notable for diarrhea, and although 3 C
dif toxin assays were negative, flagyl was added empirically for
presumed c dif colitis. Patient was also noted to have labile
blood sugars.
.
Ms. [**Known lastname 74762**] was found by her grandson this afternoon to be
somnolent and difficult to arrouse, diaphoretic,and called EMS.
UPon arrival, herFSG was noted to be 34. Ms. [**Known lastname **] has not
been eating much since the recent discharge, stating that she
had a poor appetite. She states that she has not had a similar
episode of hypoglycemia for approximately two years.
.
Ms. [**Known lastname 74762**] also reports an episode of rectal bleeding this am,
with blood on the bowel movement and turning the toilet water
red. She denies having BRBPR prior to this episode, and did not
notice bleeding with a subsequent bowel movement. SHe has
continued to have loose bowel movements since recent discharge,
with approx [**1-15**] bm/day. No fevers, no NS. No abdominal pain.
.
In the ED, she was noted to have guaiac + brown stool. HCT noted
to be 26.4 on ED admission (was 29.8 on recent discharge).


Past Medical History:
-CAD: s/p MI x 2: anterolateral MI [**2123**] s/p PTCA/stenting of a
large diagonal branch of a "twin" LAD. s/p NSTEMI [**2125**] with cath
demonstrating 30% prox and mid RCA, 70% diag, 100% intermedius,
95% OM1 s/p OM1 Velocity Hepacoat stent. EF 51%.
-Hypertension
-hyperlipidemia
-DMII
-asthma
-gerd
-arthritis
-DVT ([**2118**])
-CRI baseline cr ~1.5
-cholangitis/pancreatitis/cholecystitis ([**2125**]), s/p ERCP with
stent
placement and sphincterotomy for a common bile duct stone.
-s/p cesarean section.


Social History:
The patient does not use tobacco or alcohol.
She lives alone, but her gradson lives above her and looks in on
her frequently.


Family History:
N/C

Physical [**Year (4 digits) **]:
(at admission)
T98.8 P 73 BP 162/50 RR 20 100% RA
Gen: patient appears stated age, found lying flat in bed, in NAD

HEENT: Sclera anicteric, conjunctiva uninjected, PERL, EOMI,
MMM, no sores in OP
Neck: no JVD, no LAD, nl ROM
Cor: RRR nl S1 S2 no M/R/G
Chest: diffuse expiratory wheeze
Abd: soft, dystended with tympany though nontender and with +BS
x 4. No HSM appreciated.
EXT: no calf tenderness. 2+ pitting edema to just below the knee

Neuro: MS [**First Name (Titles) **] [**Last Name (Titles) **], CN II-XII in tact, UE/LE strength 5+
bilaterally, 2+

DTRs (biceps, triceps, patellar), nl cerebellar [**Last Name (Titles) **]

Pertinent Results:
Abd CT:
IMPRESSION:
1. No significant interval change in sigmoid diverticulitis with
associated contained perforation. No drainable collection is
identified.
2. Cholelithiasis without evidence of cholecystitis.
3. No short change in cystic right adnexal lesion, as discussed
on the recent CT.
4. Trace amount of air within the bladder, which could be
consistent with prior instrumentation. Clinical correlation
recommended.
5. New small right pleural effusion.
-----
CXR [**5-23**]:IMPRESSION: No acute cardiopulmonary process.
-----
CXR [**5-25**]:IMPRESSION: Small left effusion without evidence of
overt CHF.
-----
CXR [**5-28**]:IMPRESSION: No definite evidence of congestive heart
failure or pneumonia.
-----
Echo:
1. The left atrium is mildly dilated. The left atrium is
elongated.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity
size is normal. Regional left ventricular wall motion is
probably normal
though the views are limited and the study technically
difficult. Overall left
ventricular systolic function is probably normal (LVEF>55%).
3. Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4. The aortic valve leaflets are mildly thickened. No aortic
regurgitation is
seen.
5.The mitral valve leaflets are mildly thickened. Though
difficult to assess
given the limited views, probably moderate (2+) mitral
regurgitation present.
6.There is moderate pulmonary artery systolic hypertension.
7.There is no pericardial effusion.
-----
CXR PA/Lat:
Subsegmental atelectasis.
Incidental anterior compression fracture of thoracic vertebral
body, as seen on the preoperative film.
-------------
[**2128-5-23**] 05:55PM BLOOD WBC-6.5 RBC-2.83* Hgb-8.7* Hct-26.4*
MCV-94 MCH-30.6 MCHC-32.8 RDW-13.9 Plt Ct-604*
[**2128-5-23**] 05:55PM BLOOD WBC-6.5 RBC-2.83* Hgb-8.7* Hct-26.4*
MCV-94 MCH-30.6 MCHC-32.8 RDW-13.9 Plt Ct-604*
[**2128-5-23**] 05:55PM BLOOD Neuts-71* Bands-5 Lymphs-12* Monos-10
Eos-1 Baso-0 Atyps-0 Metas-0 Myelos-1*
[**2128-5-24**] 04:52AM BLOOD PT-13.5* PTT-29.0 INR(PT)-1.2
[**2128-5-23**] 05:55PM BLOOD Glucose-82 UreaN-21* Creat-1.5* Na-137
K-4.5 Cl-107 HCO3-19* AnGap-16
[**2128-5-24**] 04:52AM BLOOD ALT-12 AST-22 LD(LDH)-158 AlkPhos-74
TotBili-0.6
[**2128-5-26**] 07:05AM BLOOD proBNP-5302*
[**2128-5-24**] 04:52AM BLOOD Albumin-2.1* Calcium-7.3* Phos-2.7 Mg-1.6
[**2128-5-30**] 07:00AM BLOOD Calcium-7.6* Phos-1.8* Mg-1.5* Iron-33
[**2128-5-30**] 07:00AM BLOOD VitB12-729 Folate-10.1 Ferritn-495*
[**2128-5-23**] 08:45PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.020
[**2128-5-23**] 08:45PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-5.0 Leuks-NEG
[**2128-5-28**] 09:35AM URINE RBC-6* WBC-2 Bacteri-NONE Yeast-NONE
Epi-1
------
UCx neg x2
BCx neg x3
C Diff neg

Brief Hospital Course:
1. GI bleed: In the ED, she had guaiac + stool and Hct=26.4(down
from 29.8 on D/C several days earlier).  Went to floor for a
short time, but there was noted to have BRBPR and passed
multiple clots.  Her BP also dropped from systolic of 130s to
100s.  She wasn't symptomatic from this BP.  She was transferred
to the ICU and given IVfs which brought her BP up quickly.  She
was also given 3 units PRBCs.  In ICU, she had no bloody BMs,
and her Hct was stable since transfusions.  Surgery also saw her
in the ED and believed that surgery not indicated at this time.
Her ASA/Plavix was held during admission given bleed, but
restarted on discharge.  She did have traces of blood in her
stools several more times during admission, but her Hct remained
stable.  She had nL BMs for 3-4 days before D/C without blood.
Believe bleed was secondary to her diverticulae.  Does not
appear to be result of her known perforation.  Her diet was
advanced slowly and she did well, without nausea/vomiting or abd
pain.  Discussed with GI, and no possibility of colonoscopy for
at least 6 weeks after her perforation.  She will see her PCP as
[**Name9 (PRE) 3782**] and can have GI colonoscopy set up for 6-8 weeks from now.

.
2. Diverticulitis - She was started on Augmentin and Flagyl with
plans to finish 7 day course on last D/C.  On readmission, she
was switched to flagyl and Unasyn given known perf and
possibility of diverticulitis.  She also had bandemia, but nL
WBC ct. Cxs and CXR were neg, and no other obvious [**Last Name (un) 68421**] of
infection. Abd was benign throughout.   She was febrile for much
of her stay here (low grade), but this had resolved by
discharge.  We stopped her Flagyl several days before D/C, and
sent her out on Augmentin(had switched from Unasyn when she came
to floor) to finish 14 day course of abx.
.
3. Wheezing - She began to have wheezing on [**Last Name (un) **] and has
albuterol at home.  CXRs were clear multiple times, but she did
not respond to nebs very well.  Also continued her Advair.  She
was put on PO prednisone in ICU, but this was stopped when she
reached floor.  We were concerned this may be pulm edema and not
only reactive airways (likely combination of both).  Decided to
try diuresis based on high BNP and LE edema despite clear CXR.
She had a good diuresis for several days and this resulted in
improvement in her O2 sats, LE edema, and comfort.  She was then
sent out on Lasix 10 mg qday.  Had previously been on HCTZ and
this was stopped given new Lasix.
.
4. CAD - Held ASA/Plavix given bleed. Also, her BB and ACE-I was
held due to hypotension initially.  As she stabilized, these
were added back and resulted in excellent BP control.  She was
sent out on these and Lasix as above.
.
5. DM - Held glyburide as she was hypoglycemic on admission.
Continued her on HISS.  Initially with high glucose sec to
steroids.  After D/C of these, she continued to run high in
200s.  Decided to start rosiglitazone as this is not affected in
renal failure and should not cause hypoglycemia.  Started at
dose of 2 mg qday and discharged on dose of 4 mg qday.  She was
also given a glucometer and strips and told to check her BS at
least daily.  She should bring readings to PCP f/u and have
medds adjusted as needed.
.
6. Diarrhea - Continued empiric flagyl when pt admitted.  Repeat
C Diff again neg.  Believe her diarrhea was possibly sec to abx.
 Stopped her Flagyl several days into stay.  Don't believe there
was an infectious source or malabsorption.  By discharge, her
stools had become more formed and less frequent.  Can have this
followed as outpt if it continues.
.
7. CRI: Her baseline recently was Cr=1.5-1.7.  She was actually
better than this for several days and then started to rise with
diuresis.  This then stabilized and her Cr was 1.4 on D/C.
Again, can be followed by PCP. [**Name10 (NameIs) **] [**Name11 (NameIs) **] throughout.
.
8.Seen by PT multiple times and was walking well with her
walker.  They felt she was safe to go home.  She was set up with
very close support, including: home VNA, home PT, bedside
commode, Lifeline, home glucometer.
.
9.She had a compression fracture noted on CXR that was felt to
be old.  SHe was started on Ca and Vit D here.  In addition,
believe she should be started on Alendronate as an outpt,
possibly after a bone scan if PCP feels this is indicated. Also,
a 6 cm adnexal cyst was seen on abd CT.  No obvious sxs from
this.  Will defer this to outpt work-up.

Medications on Admission:
Albuterol 1-2 puffs Q6H
Advair 250/50
plavix
glyburide 2.5
Asa 81
atenolol 100
vicodin PRN
Augmentin 250-125 through [**5-28**] daily
Flagyl 500 [**Hospital1 **] through [**5-28**] [**Hospital1 **]
protonix
HCTZ 3x/wk 25
lisinopril 10


Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Atenolol 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO once a day.
7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
every six (6) hours as needed for shortness of breath or
wheezing.
9. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
10. Rosiglitazone Maleate 4 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
12. Lasix 20 mg Tablet Sig: 0.5 Tablet PO once a day.
Disp:*15 Tablet(s)* Refills:*2*
13. Lancets
Please supply pt with Lancets to use for blood glucose
monitoring.
14. Glucometer Strips
Please supply pt with 1 month supply of glucometer strips for
testing. Refills:3


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Principal:
1. Diverticulitis.
2. Lower GI Bleed.
3. Diastolic Heart Failure.
4. Hypoglycemia.
5. Anemia - Blood Loss, ESRD.
6. Incidental note of L5 and T10 compression fractures.

Secondary:
1. Diabetes Mellitus Type II.
2. Hyperlipidemia.
3. Hypertension.
4. Chronic Renal Failure.
5. COPD.
5. Anterolateral STEMI [**2123**] s/p PTCA-Stent of Diag (Twin LAD).
6. Lateral NSTEMI [**2125**] s/p PTCA-Stent of proximal OM1.


Discharge Condition:
Stable. Ambulating well with walker. No pain. LE edema much
improved. Eating normally. No blood in stools. Afebrile. Vitals
stable.

Discharge Instructions:
Please call Dr [**Last Name (STitle) 24253**] or return to the ED(by ambulance) if you
have any more blood in your stools, dizziness, lightheadedness,
chest pain, shortness of breath, or fevers.
-Take your medications as directed.
-We stopped the following medications:
1.HCTZ
2.Glyburide

-We started the following medications, please take them as
directed:
1.Calcium
2.Vitamin D
3.Rosiglitazone
4.Lasix(furosemide)

Followup Instructions:
1. 6.0 cm right cystic adnexal lesion. Interval follow-up
recommended.
----
Please see Dr [**Last Name (STitle) 24253**] on [**2128-6-8**] at 10:45 am for a follow-up
appointment.
{'Diverticulosis of colon with hemorrhage,Mitral valve disorders,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Acidosis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Diarrhea,Asthma, unspecified type, unspecified,Esophageal reflux,Unspecified essential hypertension'}


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 107528**]

PRESENT ILLNESS: [**Age over 90 **]F with PmHx significant for CAD s/p MI x 2 s/p PCI/stent x2
([**2123**], [**2125**]),DMII, hypertension, diabetes, GERD, asthma,
arthritis, DVT, CRI, and cholangitis/pancreatitis, recently
admitted [**Date range (1) 82134**] with diverticulitis and perforation managed
medically, who now presents with hypoglycemia and rectal
bleeding.
.
Ms. [**Known lastname 74762**] presented [**5-15**] with 1 wk h/o LLQ pain and was found
by CT scan to have sigmoid diverticulitis with associated
perforation. She was managed conservatively without operation,
with a combination of bowel rest and antibiotics (Zosyn ->
augmentin). Course also notable for diarrhea, and although 3 C
dif toxin assays were negative, flagyl was added empirically for
presumed c dif colitis. Patient was also noted to have labile
blood sugars.
.
Ms. [**Known lastname 74762**] was found by her grandson this afternoon to be
somnolent and difficult to arrouse, diaphoretic,and called EMS.
UPon arrival, herFSG was noted to be 34. Ms. [**Known lastname **] has not
been eating much since the recent discharge, stating that she
had a poor appetite. She states that she has not had a similar
episode of hypoglycemia for approximately two years.
.
Ms. [**Known lastname 74762**] also reports an episode of rectal bleeding this am,
with blood on the bowel movement and turning the toilet water
red. She denies having BRBPR prior to this episode, and did not
notice bleeding with a subsequent bowel movement. SHe has
continued to have loose bowel movements since recent discharge,
with approx [**1-15**] bm/day. No fevers, no NS. No abdominal pain.
.
In the ED, she was noted to have guaiac + brown stool. HCT noted
to be 26.4 on ED admission (was 29.8 on recent discharge).

MEDICAL HISTORY: -CAD: s/p MI x 2: anterolateral MI [**2123**] s/p PTCA/stenting of a
large diagonal branch of a "twin" LAD. s/p NSTEMI [**2125**] with cath
demonstrating 30% prox and mid RCA, 70% diag, 100% intermedius,
95% OM1 s/p OM1 Velocity Hepacoat stent. EF 51%.
-Hypertension
-hyperlipidemia
-DMII
-asthma
-gerd
-arthritis
-DVT ([**2118**])
-CRI baseline cr ~1.5
-cholangitis/pancreatitis/cholecystitis ([**2125**]), s/p ERCP with
stent
placement and sphincterotomy for a common bile duct stone.
-s/p cesarean section.

MEDICATION ON ADMISSION: Albuterol 1-2 puffs Q6H
Advair 250/50
plavix
glyburide 2.5
Asa 81
atenolol 100
vicodin PRN
Augmentin 250-125 through [**5-28**] daily
Flagyl 500 [**Hospital1 **] through [**5-28**] [**Hospital1 **]
protonix
HCTZ 3x/wk 25
lisinopril 10

ALLERGIES: Codeine / Darvon / Levofloxacin

PHYSICAL EXAM: 

FAMILY HISTORY: N/C

SOCIAL HISTORY: The patient does not use tobacco or alcohol.
She lives alone, but her gradson lives above her and looks in on
her frequently. 

### Response:
{'Diverticulosis of colon with hemorrhage,Mitral valve disorders,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Acidosis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Diarrhea,Asthma, unspecified type, unspecified,Esophageal reflux,Unspecified essential hypertension'}
