CHIEF COMPLAINT: chest pain, decrease in hematocrit

PRESENT ILLNESS: Pt is a 72 yo female with history of chronic GI bleeding, CAD
s/p CABG, CHF w/EF 35%, diabetes, chronic renal failure, and
cryptogenic cirrhosis admitted to the medical servce after
presenting to the ED with chest pain and a low hematocrit.
.
She states that she began having episodes of chest pain
frequently today. Usually she gets chest pains with a low
hematocrit. She has chronic blood loss anemia as well as anemia
of chronic disease, and has her Hct monitored closely. Her HCt
on the day of admission was 26. She was also having
marroon-colored stools. All this, along with her ongoing chest
pains brought her to the ED.
.
In the ED her VS were 96.9 58 121/69 18 97%RA. She was noted to
have guaiac positive marroon stool. GI was consulted and
recommended NPO> MNm, IV protonix and transfusion. She received
2 Units PRBCS and 40mg IV protonix. She had multiple episodes of
chest pains which were relieved with NTG. She had EKGs that were
unchanged from baseline studies.

MEDICAL HISTORY: # CAD s/p CABG in [**2138**] - Followed by Dr. [**Last Name (STitle) **]
- MI in [**2122**]
- CABG [**2138**] = LIMA-->LAD, VG-->OM, VG--->RCA
- Echo with 35% EF
# AAA - [**3-2**] Abd MRI showed infrarenal AAA 5 x 6 cm with diffuse
atherosclerotic change
- [**2142-7-6**] - underwent endovascular repair of abdominal aortic
aneurysm
- complicated by left external iliac artery avulsion (? apparent
intra-op rupture of iliac) s/p left iliac stent graft to left
CFA, bilateral femoral endartectomies and rt CFA patch
angioplasty [**2142-7-7**] with right groin washout [**2142-7-8**] (for ?
lymphatic leak)
# DM type II: for 20 years typically under good control unless
she is sick
# Cryptogenic cirrhosis (?NASH) with grade II esophageal
varices, portal gastropathy, gastric angioectasias
- chronic GI bleed; has required 64 transfusion over the past 6
years
- last colonoscopy [**7-2**], last EGD [**6-1**]
# Pancytopenia
# Anemia
- due to CRF and chronic GI bleed
- Angina when hct <30
# CRF (1.9-2.5)
# h/o PUD
# h/o lower GI bleeding due to AVM: Colonocsopy in [**2143**] found
diverticulosis, internal hemorrhoids, normal TI; EGD in [**2143**]
with non-bleeding varices, portal gastropathy, two angioectasias
in the second part of the duodenum
# + HIT [**7-31**]
# Ecoli UTI resistant to Bactrim and cipro
Cardiac Risk Factors: + Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: CARVEDILOL - 12.5 [**Hospital1 **]
EPOETIN ALFA [EPOGEN] - 4,000 2x/week
FUROSEMIDE - 160mg [**Hospital1 **]
INSULIN ASPART sliding scale
INSULIN GLARGINE [LANTUS] 23u qHS
ISOSORBIDE MONONITRATE [IMDUR, SR] - 120 [**Hospital1 **]
LISINOPRIL - 5 mg qday
NITROGLYCERIN - 0.4 mg SL prn
PANTOPRAZOLE [PROTONIX] - 40 mg [**Hospital1 **]
PRAMIPEXOLE [MIRAPEX] - 0.125 mg qHS
CALCIUM CARBONATE [TUMS] - 500 mg Tablet 4x/day
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] - 400 unit qday
FERROUS SULFATE - 325(65)MG [**Hospital1 **]

ALLERGIES: Cardizem / Codeine / Optiray 300 / Heparin Agents / Atorvastatin
/ Spironolactone

PHYSICAL EXAM: VS: 97.8 120/54 61 95%RA
GEN: Chronically ill-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD
CV: regular with occasional premature beats. 2/6 SEM at USBs, no
G/R
PULM: crackles @ lungs bialterally
ABD: Soft, NT, ND, +BS
EXT: No C/C/E. 2+ distal pulses

FAMILY HISTORY: Her mother had non-alcoholic liver cirrhosis and diabetes type
2. Her father had diabetes and died of lung cancer. One of her
daughters and her son have both required
pacemakers/defibrillators for hypertrophic cardiomyopathy. She
had a brother who died of a brain tumor and has an older sister
who is generally in good health. No family history of blood
clots.

SOCIAL HISTORY: [**Month/Year (2) **] worked as a hairdresser. She quit tobacco 20 yrs ago
(started smoking at 17 yo, 1-2pks/day, unfiltered), no EtOH. She
lives w/her son who is home from [**Country 22390**] but will be leaving in
1wk. Has 2 daughters who work at [**Hospital1 18**] in [**Name (NI) 13042**]. Has another
daughter. [**Name (NI) **] her children and her 7 grandchildren live in the
[**Location (un) 86**] area.
.
Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Chronic systolic heart failure,Acute kidney failure, unspecified,Portal hypertension,Iron deficiency anemia secondary to blood loss (chronic),Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Other specified disorders of stomach and duodenum,Internal hemorrhoids with other complication,Other specified forms of chronic ischemic heart disease,Abdominal aneurysm without mention of rupture
Cirrhosis of liver NOS,Bleed esoph var oth dis,Chr systolic hrt failure,Acute kidney failure NOS,Portal hypertension,Chr blood loss anemia,Chronic kidney dis NOS,DMII wo cmp nt st uncntr,Aortocoronary bypass,Gastroduodenal dis NEC,Int hemrrhoid w comp NEC,Chr ischemic hrt dis NEC,Abdom aortic aneurysm
Admission Date:  [**2145-9-23**]              Discharge Date:   [**2145-10-1**]

Date of Birth:  [**2072-12-5**]             Sex:   F

Service: MEDICINE

Allergies:
Cardizem / Codeine / Optiray 300 / Heparin Agents / Atorvastatin
/ Spironolactone

Attending:[**First Name3 (LF) 19836**]
Chief Complaint:
chest pain, decrease in hematocrit

Major Surgical or Invasive Procedure:
endoscopy with variceal banding x4
colonoscopy

History of Present Illness:
Pt is a 72 yo female with history of chronic GI bleeding, CAD
s/p CABG, CHF w/EF 35%, diabetes, chronic renal failure, and
cryptogenic cirrhosis admitted to the medical servce after
presenting to the ED with chest pain and a low hematocrit.
.
She states that she began having episodes of chest pain
frequently today. Usually she gets chest pains with a low
hematocrit. She has chronic blood loss anemia as well as anemia
of chronic disease, and has her Hct monitored closely. Her HCt
on the day of admission was 26. She was also having
marroon-colored stools. All this, along with her ongoing chest
pains brought her to the ED.
.
In the ED her VS were 96.9 58 121/69 18 97%RA. She was noted to
have guaiac positive marroon stool. GI was consulted and
recommended NPO> MNm, IV protonix and transfusion. She received
2 Units PRBCS and 40mg IV protonix. She had multiple episodes of
chest pains which were relieved with NTG. She had EKGs that were
unchanged from baseline studies.




Past Medical History:
# CAD s/p CABG in [**2138**] - Followed by Dr. [**Last Name (STitle) **]
- MI in [**2122**]
- CABG [**2138**] = LIMA-->LAD, VG-->OM, VG--->RCA
- Echo with 35% EF
# AAA - [**3-2**] Abd MRI showed infrarenal AAA 5 x 6 cm with diffuse
atherosclerotic change
- [**2142-7-6**] - underwent endovascular repair of abdominal aortic
aneurysm
- complicated by left external iliac artery avulsion (? apparent
intra-op rupture of iliac) s/p left iliac stent graft to left
CFA, bilateral femoral endartectomies and rt CFA patch
angioplasty [**2142-7-7**] with right groin washout [**2142-7-8**] (for ?
lymphatic leak)
# DM type II: for 20 years typically under good control unless
she is sick
# Cryptogenic cirrhosis (?NASH) with grade II esophageal
varices, portal gastropathy, gastric angioectasias
- chronic GI bleed; has required 64 transfusion over the past 6
years
- last colonoscopy [**7-2**], last EGD [**6-1**]
# Pancytopenia
# Anemia
- due to CRF and chronic GI bleed
- Angina when hct <30
# CRF (1.9-2.5)
# h/o PUD
# h/o lower GI bleeding due to AVM: Colonocsopy in [**2143**] found
diverticulosis, internal hemorrhoids, normal TI; EGD in [**2143**]
with non-bleeding varices, portal gastropathy, two angioectasias
in the second part of the duodenum
# + HIT [**7-31**]
# Ecoli UTI resistant to Bactrim and cipro
Cardiac Risk Factors: + Diabetes, +Dyslipidemia, +Hypertension


Social History:
[**Month/Year (2) **] worked as a hairdresser. She quit tobacco 20 yrs ago
(started smoking at 17 yo, 1-2pks/day, unfiltered), no EtOH. She
lives w/her son who is home from [**Country 22390**] but will be leaving in
1wk. Has 2 daughters who work at [**Hospital1 18**] in [**Name (NI) 13042**]. Has another
daughter. [**Name (NI) **] her children and her 7 grandchildren live in the
[**Location (un) 86**] area.
.


Family History:
Her mother had non-alcoholic liver cirrhosis and diabetes type
2. Her father had diabetes and died of lung cancer. One of her
daughters and her son have both required
pacemakers/defibrillators for hypertrophic cardiomyopathy. She
had a brother who died of a brain tumor and has an older sister
who is generally in good health. No family history of blood
clots.


Physical Exam:
VS: 97.8 120/54 61 95%RA
GEN: Chronically ill-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD
CV: regular with occasional premature beats. 2/6 SEM at USBs, no
G/R
PULM: crackles @ lungs bialterally
ABD: Soft, NT, ND, +BS
EXT: No C/C/E. 2+ distal pulses


Pertinent Results:
Imaging:
CXR ([**9-25**])
There is no significant interval change. The lungs remain clear.
There is no effusion, pneumothorax or pneumomediastinum.
Cardiomediastinal silhouette is unchanged, again noted mild
cardiomegaly. Post-sternotomy changes are noted.  IMPRESSION: No
significant interval change. No acute cardiopulmonary process.

Abdominal U/S with Doppler ([**9-24**])
The liver demonstrates normal echogenicity and texture without
focal hepatic lesions or masses. The CBD measures up to 5.5 mm.
There is cholelithiasis without evidence of acute cholecystitis.
There is no free fluid; however, the spleen is enlarged
measuring 18 cm. The portal vein is patent with hepatopetal
flow, however, the splenic venous and superior mesenteric vein
confluence is dilated measuring up to 2.2 cm. Findings
suggestive of portal hypertension.  Doppler evaluation
demonstrates normal hepatopetal flow in main, right and left
portal veins. The systemic vasculature including middle hepatic,
right and left hepatic veins is patent with normal venous
waveform. The main hepatic artery commensurate normal systolic
and diastolic flow.  IMPRESSION: 1.Normal hepatic portal venous
and arterial vasculature.  2.Cholelithiasis with cholecystitis.
3.Prominent portal confluence and splenomegaly suggestive of
portal hypertension. No ascites.

EGD ([**9-24**]):
Impression: Varices at the lower third of the esophagus
(ligation)
Granularity and mosaic appearance in the whole stomach
compatible with portal hypertensive gastropathy
Polyps in the antrum
Otherwise normal EGD to second part of the duodenum

Sigmoidoscopy ([**9-24**]):
Impression: Grade 2 internal & external hemorrhoids
There was solid black stool in the rectum which precluded
advancement of the scope. Otherwise normal sigmoidoscopy to
rectum

ECG ([**9-24**])
Sinus rhythm. Left axis deviation. Non-specific intraventricular
conduction delay. There is an abnormal precordial transition
with anterior Q waves consistent with possible prior myocardial
infarction. There are tiny R waves in the inferior leads
consistent with possible prior inferior myocardial infarction.
Non-specific ST-T wave changes. Compared to the previous tracing
of [**2145-9-23**] there is no significant change.

Colonoscopy ([**9-30**])
Impression: Grade 3 internal & external hemorrhoids.
At least 2 cords of moderate size and branching rectal varices
without signs of active bleeding. Otherwise normal colon up to
the cecum.


[**2145-9-23**] 07:50PM   PT-16.5* PTT-39.0* INR(PT)-1.5*
[**2145-9-23**] 07:50PM   PLT COUNT-48*
[**2145-9-23**] 07:50PM   WBC-2.9* RBC-2.98*# HGB-8.5*# HCT-24.6*#
MCV-83 MCH-28.6 MCHC-34.7 RDW-14.6
[**2145-9-23**] 07:50PM   NEUTS-79.4* LYMPHS-15.8* MONOS-4.0 EOS-0.6
BASOS-0.2
[**2145-9-23**] 07:50PM   ALT(SGPT)-9 AST(SGOT)-31 CK(CPK)-90 ALK
PHOS-60 TOT BILI-0.5
[**2145-9-23**] 07:50PM   GLUCOSE-210* UREA N-83* CREAT-2.9*
SODIUM-129* POTASSIUM-5.4* CHLORIDE-95* TOTAL CO2-27 ANION
GAP-12

[**2145-10-1**] 05:25AM BLOOD WBC-3.4* RBC-3.92* Hgb-11.5* Hct-32.9*
MCV-84 MCH-29.3 MCHC-34.8 RDW-15.1 Plt Ct-47*

Brief Hospital Course:
72yo female with CAD s/p CABG, CHF (EF 35%), AAA s/p repair, PVD
s/p multiple bypasses, cryptogenic cirrhosis (likely [**2-27**] NASH)
w/ grade II esophageal varices, portal gastropathy, and gastric
angioectasias, peptic ulcer disease, and h/o lower GI bleeding
[**2-27**] AVMs and diverticulosis, who presented to the hospital w/
chest pain and anemia. Seen by hepatology w/ EGD showing
esophageal varices s/p banding x4, on Octeotride gtt, IV PPI
[**Hospital1 **], and CTX IV daily. Transferred to the ICU with continued
melanotic stools and orthostatic hypotension for closer
monitoring in preparation for scope. Returned to medical floor
on [**9-29**], kept NPO for colonoscopy. Colonoscopy showed colonic and
rectal varices, internal and external hemorrhoids. Stable
hemodynamically, stable hematocrit at discharge.
.
1.  Anemia: Hct lower than baseline on admission, found to be
low by VNA services.  After transfusion of 2 units patient's Hct
went up to 27.7. Etiology most likely secondary to patient's
chronic GI bleeds and anemia of chronic disease. Continued to
transfuse to keep Hct >25. Hct stable [**Date range (1) 22391**].
.
2.  GI Bleed:  Patient had melena prior to admission. Consulted
GI medicine specifically liver team. Recommended IV protonix for
possible upper GI component, octreotide drip, ceftriaxone 1gm IV
QD for SBP prophylaxis. Patient was transferred to the ICU for
emergent EGD and colonoscopy and then transferred out of the
unit back to the floor in the same day. On [**9-30**], colonoscopy was
performed, found grade III rectal varices.  No acute
interventions at this time, to be followed up in liver clinic in
2 weeks.
.
3.  Chest Pain: likely cardiac ischemia in the setting of low
Hct. Patient had no EKG changes during hospital stay and pain
resolved with nitroglycerin. Pain became less severe and less
frequent following blood transfusion. Ruled out MI with serial
cardiac enzymes (troponin 0.03-0.05). Monitored on telemetry.
Continued nitroglycerin and morphine PRN pain.
.
4.  Congestive Heart Failure:  Patient has history of likely
ischemic cardiomyopathy, EF 30-35%. As patient received fluid in
the form of PRBCs, monitored fluid status closely with daily
weights and I/Os. Lasix 160 mg [**Hospital1 **], carvedilol 12.5 mg [**Hospital1 **],
lisinopril 2.5 mg QHS held and restarted on [**9-29**] pm. Carvedilol
switched to nadolol 40mg qd in view of varices.
.
5.  DM:  Gave [**1-27**] PM lantus while NPO and continued sliding
scale.
.
6.  Acute on Chronic Renal Failure: Crn 2.9 on admission with
elevation of BUN most likely secondary to UGIB.  Improved
slightly with IV fluids to 2.6.  Monitored and replaced fluid as
necessary.  Improved by transition to floor back to baseline, Cr
1.7 on day of discharge.

Medications on Admission:
CARVEDILOL - 12.5 [**Hospital1 **]
EPOETIN ALFA [EPOGEN] - 4,000 2x/week
FUROSEMIDE - 160mg [**Hospital1 **]
INSULIN ASPART sliding scale
INSULIN GLARGINE [LANTUS] 23u qHS
ISOSORBIDE MONONITRATE [IMDUR, SR] - 120 [**Hospital1 **]
LISINOPRIL - 5 mg qday
NITROGLYCERIN - 0.4 mg SL prn
PANTOPRAZOLE [PROTONIX] - 40 mg [**Hospital1 **]
PRAMIPEXOLE [MIRAPEX] - 0.125 mg qHS
CALCIUM CARBONATE [TUMS] - 500 mg Tablet 4x/day
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] - 400 unit qday
FERROUS SULFATE - 325(65)MG [**Hospital1 **]


Discharge Medications:
1. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed).
2. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
3. Furosemide 80 mg Tablet Sig: one (1) Tablet PO BID (2 times a
day).
4. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Epoetin Alfa 3,000 unit/mL Solution Sig: One (1)  Injection
QMOWEFR (Monday -Wednesday-Friday): Please hold administration
until Hct < 30.
9. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
11. Insulin Glargine 100 unit/mL Solution Sig: Twenty Three (23)
units Subcutaneous at bedtime.
12. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
13. Lactulose 10 gram Packet Sig: [**1-27**]  PO once a day.
14. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
15. VNA Services Order
Please resume telemetry monitoring


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Primary Diagnosis:
Gastrointestinal bleed
.
Secondary Diagnosis:
Coronary artery disease, chronic systolic congestive heart
failure, anemia of chronic disease, chronic kidney disease,
cirrhosis, type 2 diabetes mellitus


Discharge Condition:
Stable, ambulating, knitting, eating, drinking, voiding without
complaints. Most recent Hct at 32.


Discharge Instructions:
You were admitted to [**Hospital1 18**] with a drop in your Hct and chest
pain.  You were found to be anemic and the cause of your anemia
most likely was a GI bleed.  You had an endoscopy and
colonoscopy to determine the etiology of the bleed.  You were
treated with IV therapy, given blood transfusions and monitored
closely.  Prior to discharge your Hct was stable, you were no
longer having blood in your stool and no longer having chest
pain.
.
If you experience chest pain, shortness of breath, nausea,
vomiting, abdominal pain, blood in your stool, dark tarry stool
or any other worrisome symptom please seek medical attention.
.
Please follow up with your primary doctor, Dr. [**Last Name (STitle) 9006**], at your
scheduled appointment on [**2145-11-29**] at 11:20.
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet

Followup Instructions:
Liver Center Appointment - Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD
Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2145-10-13**] 2:50

Primary Care Phyisican - Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], [**Name Initial (NameIs) **].D.
Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2145-11-29**] 11:20


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD, [**MD Number(3) 19838**]

Completed by:[**2145-10-1**]
{'Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Chronic systolic heart failure,Acute kidney failure, unspecified,Portal hypertension,Iron deficiency anemia secondary to blood loss (chronic),Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Other specified disorders of stomach and duodenum,Internal hemorrhoids with other complication,Other specified forms of chronic ischemic heart disease,Abdominal aneurysm without mention of rupture'}


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: chest pain, decrease in hematocrit

PRESENT ILLNESS: Pt is a 72 yo female with history of chronic GI bleeding, CAD
s/p CABG, CHF w/EF 35%, diabetes, chronic renal failure, and
cryptogenic cirrhosis admitted to the medical servce after
presenting to the ED with chest pain and a low hematocrit.
.
She states that she began having episodes of chest pain
frequently today. Usually she gets chest pains with a low
hematocrit. She has chronic blood loss anemia as well as anemia
of chronic disease, and has her Hct monitored closely. Her HCt
on the day of admission was 26. She was also having
marroon-colored stools. All this, along with her ongoing chest
pains brought her to the ED.
.
In the ED her VS were 96.9 58 121/69 18 97%RA. She was noted to
have guaiac positive marroon stool. GI was consulted and
recommended NPO> MNm, IV protonix and transfusion. She received
2 Units PRBCS and 40mg IV protonix. She had multiple episodes of
chest pains which were relieved with NTG. She had EKGs that were
unchanged from baseline studies.

MEDICAL HISTORY: # CAD s/p CABG in [**2138**] - Followed by Dr. [**Last Name (STitle) **]
- MI in [**2122**]
- CABG [**2138**] = LIMA-->LAD, VG-->OM, VG--->RCA
- Echo with 35% EF
# AAA - [**3-2**] Abd MRI showed infrarenal AAA 5 x 6 cm with diffuse
atherosclerotic change
- [**2142-7-6**] - underwent endovascular repair of abdominal aortic
aneurysm
- complicated by left external iliac artery avulsion (? apparent
intra-op rupture of iliac) s/p left iliac stent graft to left
CFA, bilateral femoral endartectomies and rt CFA patch
angioplasty [**2142-7-7**] with right groin washout [**2142-7-8**] (for ?
lymphatic leak)
# DM type II: for 20 years typically under good control unless
she is sick
# Cryptogenic cirrhosis (?NASH) with grade II esophageal
varices, portal gastropathy, gastric angioectasias
- chronic GI bleed; has required 64 transfusion over the past 6
years
- last colonoscopy [**7-2**], last EGD [**6-1**]
# Pancytopenia
# Anemia
- due to CRF and chronic GI bleed
- Angina when hct <30
# CRF (1.9-2.5)
# h/o PUD
# h/o lower GI bleeding due to AVM: Colonocsopy in [**2143**] found
diverticulosis, internal hemorrhoids, normal TI; EGD in [**2143**]
with non-bleeding varices, portal gastropathy, two angioectasias
in the second part of the duodenum
# + HIT [**7-31**]
# Ecoli UTI resistant to Bactrim and cipro
Cardiac Risk Factors: + Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: CARVEDILOL - 12.5 [**Hospital1 **]
EPOETIN ALFA [EPOGEN] - 4,000 2x/week
FUROSEMIDE - 160mg [**Hospital1 **]
INSULIN ASPART sliding scale
INSULIN GLARGINE [LANTUS] 23u qHS
ISOSORBIDE MONONITRATE [IMDUR, SR] - 120 [**Hospital1 **]
LISINOPRIL - 5 mg qday
NITROGLYCERIN - 0.4 mg SL prn
PANTOPRAZOLE [PROTONIX] - 40 mg [**Hospital1 **]
PRAMIPEXOLE [MIRAPEX] - 0.125 mg qHS
CALCIUM CARBONATE [TUMS] - 500 mg Tablet 4x/day
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] - 400 unit qday
FERROUS SULFATE - 325(65)MG [**Hospital1 **]

ALLERGIES: Cardizem / Codeine / Optiray 300 / Heparin Agents / Atorvastatin
/ Spironolactone

PHYSICAL EXAM: VS: 97.8 120/54 61 95%RA
GEN: Chronically ill-appearing, NAD
HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM
NECK: Supple, no LAD
CV: regular with occasional premature beats. 2/6 SEM at USBs, no
G/R
PULM: crackles @ lungs bialterally
ABD: Soft, NT, ND, +BS
EXT: No C/C/E. 2+ distal pulses

FAMILY HISTORY: Her mother had non-alcoholic liver cirrhosis and diabetes type
2. Her father had diabetes and died of lung cancer. One of her
daughters and her son have both required
pacemakers/defibrillators for hypertrophic cardiomyopathy. She
had a brother who died of a brain tumor and has an older sister
who is generally in good health. No family history of blood
clots.

SOCIAL HISTORY: [**Month/Year (2) **] worked as a hairdresser. She quit tobacco 20 yrs ago
(started smoking at 17 yo, 1-2pks/day, unfiltered), no EtOH. She
lives w/her son who is home from [**Country 22390**] but will be leaving in
1wk. Has 2 daughters who work at [**Hospital1 18**] in [**Name (NI) 13042**]. Has another
daughter. [**Name (NI) **] her children and her 7 grandchildren live in the
[**Location (un) 86**] area.
. 

### Response:
{'Cirrhosis of liver without mention of alcohol,Esophageal varices in diseases classified elsewhere, with bleeding,Chronic systolic heart failure,Acute kidney failure, unspecified,Portal hypertension,Iron deficiency anemia secondary to blood loss (chronic),Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Other specified disorders of stomach and duodenum,Internal hemorrhoids with other complication,Other specified forms of chronic ischemic heart disease,Abdominal aneurysm without mention of rupture'}
