CHIEF COMPLAINT: transfer from [**Hospital3 4107**] with GI bleeding

PRESENT ILLNESS: 71 yo male with PShx s/p partial colectomy in [**2151**]'s [**1-22**] perfed
bowel. Was in USOH until [**4-30**], presented to [**Hospital1 **] for SBO. Ex
lap revealed incarcerated hernia on [**5-3**] which was reparied with
mesh. Post-op course complicated by renal failure, decreasing
HCT with lower GIB - maroon stool. Underwent EGD on [**5-8**] which
showed gastritis and ulceration that was cauterized. Conoloscopy
showed normal colon up until his partial colectomy, blood in
terminal ilium, and external roids. Thought then that initialy
bleed was from small bowel source. Therefore, transferred here
for ?pill enteroscopy of tagged RBC scan. Of note, the patient
had an INR of 10 and patient is not on coumadin. Recieved 3
units of FFP and Vit K at OSH.

MEDICAL HISTORY: Type II Diabetes Mellitus
Gout
h/o bowel perforation [**2151**]'s.
hypothyroidism

MEDICATION ON ADMISSION: avandia 4', gemfibrozil 600", levothyroxine 125', toprol xl 50',
HCTZ 25', allopurinol 100', glypizide 2.5', colchicine 6',
indomethacin 50"'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.7 72 115/54 17 98%RA
Gen: NAD
HEENT: n/c at
CV: nl s1/s2
pul: cta b/l
abd: midline healing incision, soft,nt,obese.  +rectal tube with
bloody stool
ext: nt

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Worked as welder, 3 drinks/week
Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Mitral valve disorders,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism
Gastrointest hemorr NOS,Ac posthemorrhag anemia,React-oth vasc dev/graft,Bacteremia,Mitral valve disorder,Gout NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS
Admission Date:  [**2177-5-9**]              Discharge Date:   [**2177-5-18**]

Date of Birth:  [**2105-6-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
transfer from [**Hospital3 4107**] with GI bleeding

Major Surgical or Invasive Procedure:
Endoscopy
Colonoscopy


History of Present Illness:
71 yo male with PShx s/p partial colectomy in [**2151**]'s [**1-22**] perfed
bowel. Was in USOH until [**4-30**], presented to [**Hospital1 **] for SBO. Ex
lap revealed incarcerated hernia on [**5-3**] which was reparied with
mesh. Post-op course complicated by renal failure, decreasing
HCT with lower GIB - maroon stool. Underwent EGD on [**5-8**] which
showed gastritis and ulceration that was cauterized. Conoloscopy
showed normal colon up until his partial colectomy, blood in
terminal ilium, and external roids. Thought then that initialy
bleed was from small bowel source. Therefore, transferred here
for ?pill enteroscopy of tagged RBC scan. Of note, the patient
had an INR of 10 and patient is not on coumadin. Recieved 3
units of FFP and Vit K at OSH.

Past Medical History:
Type II Diabetes Mellitus
Gout
h/o bowel perforation [**2151**]'s.
hypothyroidism

Social History:
Worked as welder, 3 drinks/week

Family History:
Noncontributory

Physical Exam:
99.7 72 115/54 17 98%RA
Gen: NAD
HEENT: n/c at
CV: nl s1/s2
pul: cta b/l
abd: midline healing incision, soft,nt,obese.  +rectal tube with
bloody stool
ext: nt


Pertinent Results:
[**2177-5-9**] 09:52PM   GLUCOSE-102 UREA N-55* CREAT-1.5* SODIUM-146*
POTASSIUM-3.9 CHLORIDE-109* TOTAL CO2-26 ANION GAP-15
[**2177-5-9**] 09:52PM   ALT(SGPT)-9 AST(SGOT)-21 LD(LDH)-150 ALK
PHOS-60 AMYLASE-60 TOT BILI-0.6
[**2177-5-9**] 11:55PM   PT-15.5* PTT-33.4 INR(PT)-1.6
[**2177-5-9**] 09:52PM   WBC-8.5 RBC-2.74* HGB-8.5* HCT-24.1* MCV-88
MCH-31.1 MCHC-35.3* RDW-15.2

DISCHARGE LABS:
[**2177-5-18**] 06:00AM BLOOD WBC-9.0 RBC-3.55* Hgb-10.6* Hct-32.3*
MCV-91 MCH-29.9 MCHC-32.9 RDW-14.9 Plt Ct-260
[**2177-5-18**] 06:00AM BLOOD Glucose-121* UreaN-17 Creat-1.3* Na-135
K-4.3 Cl-101 HCO3-24 AnGap-14

CT [**2177-5-15**]:
1) Fluid in the subcutaneous soft tissues overlying the mesh on
the anterior abdominal wall, but no well-defined abscess.
2) Cholelithiasis.
3) Tiny left adrenal nodule, most likely an adenoma, although
not fully characterized.
4) Prominent spleen.
5) Likely renal cysts.
6) Atherosclerosis, including prominent mural plaque in the
superior mesenteric artery. Clinical correlation is suggested
regarding any symptoms of intestinal angina, as the finding may
be incidental, and the clinical significance of this finding is
hard to assess based on the imaging appearance alone.
7) Bilateral iliac aneurysms.

ECHO [**5-16**]:
The left atrium is normal in size. Left ventricular wall
thickness, cavity  size, and systolic function are normal
(LVEF>55%). Right ventricular chamber  size and free wall motion
are normal. There are simple atheroma in the ascending aorta.
The aortic valve leaflets are mildly thickened. No masses or
vegetations are seen on the aortic valve. No aortic valve
abscess is seen.
Trace aortic regurgitation is seen. The mitral valve leaflets
are mildly
thickened. No mass or vegetation is seen on the mitral valve. No
mitral valve  abscess is seen. Mild to moderate ([**12-22**]+) mitral
regurgitation is seen. There  is a trivial/physiologic
pericardial effusion.

No TEE evidence of endocarditis.


Brief Hospital Course:
1) ID: pt spiked on [**5-12**]; urinalysis and chest x-ray were
negative.  The following day, grew 4/4 bottles coag neg staph.
Central line was immediately discontinued and the patient was
started on IV vanco.  When the sensitivities came back showing
sensitivity to levaquin, he was started on PO levaquin [**5-14**] PM.
Cultures from [**5-14**]  were also positive, so he was changed to IV
levaquin on [**5-16**].

While it is possible that the central line caused his
bacteremia, his persisting bacteremia was concerning.
Transthoracic echo was performed to assess for valvular
abnormalities and this was negative.  While his abdominal
incision was non-tender and had no drainage, because of his
habitus, there was concern for occult wound infection or
infected mesh from his hernia repair.  Abdominal CT was
obtained.  Surgery was called to re-evaluate the patient but
they did not feel that the mesh could be infected.   TEE was
performed to rule-out endocarditis, which was negative.   Blood
cultures from [**5-15**] onward were negative so the patient was
discharge on [**5-17**] on levaquin.

2) GIB: Transferred from OSH with GI bleed, felt to be likely
due to small bowel bleeding.  EGD & colonoscopy were repeated
and negative, although he had poor bowel prep.   Hct was checked
serially.  Diet was advanced to full liquids [**5-12**], to full [**5-13**]
per GI.  Should he start bleeding again, he will require a
tagged RBC scan and or a capsule enteroscopy.

3) Gout: We hold colchine and indomethicin, gave his allopurinol
qd.  He will restarted these meds as an outpatient.

4) DM: normally on oral hypoglycemics, now on RISS

5) Access: pt was admitted with central line in R IJ from OSH.
On [**5-13**], once blood cultures came back positive, the central
line was discontinued.

Medications on Admission:
avandia 4', gemfibrozil 600", levothyroxine 125', toprol xl 50',
HCTZ 25', allopurinol 100', glypizide 2.5', colchicine 6',
indomethacin 50"'

Discharge Medications:
1. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
2. Levothyroxine Sodium 125 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
4. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
6. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
Disp:*12 Tablet(s)* Refills:*0*
7. Avandia 4 mg Tablet Sig: One (1) Tablet PO once a day.
8. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
9. Glipizide 2.5 mg Tab, Sust Release Osmotic Push Sig: One (1)
Tab, Sust Release Osmotic Push PO once a day.
10. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
gastrointestinal bleeding
acute blood loss anemia
line sepsis due to coag negative staph
type II diabetes
h/o hypothyroidim


Discharge Condition:
Stable, afebrile.

Discharge Instructions:
Please seek medical attention for fevers>101.4, for chest pain,
for return of bleeding or black stools.

Please take your medications as directed.  You should continue
levofloxacin 250mg daily for a total of 14 days.  You have been
started on Protonix.

Please do not take your toprol xl, cochicine, or indomethacin
until directed by your primary care doctor.

Followup Instructions:
Please see your PCP [**Name Initial (PRE) 176**] 1 week for follow up.  PCP:
[**Name10 (NameIs) **],[**Name11 (NameIs) 6811**] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 63144**]

Please see your surgeon within 1-2 days for removal of your
staples.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Mitral valve disorders,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}


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: transfer from [**Hospital3 4107**] with GI bleeding

PRESENT ILLNESS: 71 yo male with PShx s/p partial colectomy in [**2151**]'s [**1-22**] perfed
bowel. Was in USOH until [**4-30**], presented to [**Hospital1 **] for SBO. Ex
lap revealed incarcerated hernia on [**5-3**] which was reparied with
mesh. Post-op course complicated by renal failure, decreasing
HCT with lower GIB - maroon stool. Underwent EGD on [**5-8**] which
showed gastritis and ulceration that was cauterized. Conoloscopy
showed normal colon up until his partial colectomy, blood in
terminal ilium, and external roids. Thought then that initialy
bleed was from small bowel source. Therefore, transferred here
for ?pill enteroscopy of tagged RBC scan. Of note, the patient
had an INR of 10 and patient is not on coumadin. Recieved 3
units of FFP and Vit K at OSH.

MEDICAL HISTORY: Type II Diabetes Mellitus
Gout
h/o bowel perforation [**2151**]'s.
hypothyroidism

MEDICATION ON ADMISSION: avandia 4', gemfibrozil 600", levothyroxine 125', toprol xl 50',
HCTZ 25', allopurinol 100', glypizide 2.5', colchicine 6',
indomethacin 50"'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.7 72 115/54 17 98%RA
Gen: NAD
HEENT: n/c at
CV: nl s1/s2
pul: cta b/l
abd: midline healing incision, soft,nt,obese.  +rectal tube with
bloody stool
ext: nt

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Worked as welder, 3 drinks/week 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Mitral valve disorders,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}
