CHIEF COMPLAINT: Lower GI bleed.

PRESENT ILLNESS: This is a 72-year-old female
with a past medical history of diabetes type 2, hypertension,
right breast cancer with a history of two prior GI bleeds,
who presents to the Emergency Room with four episodes of dark
bowel movements, one episode of bright red blood per rectum.
Patient's last bloody bowel movement was approximately one
hour before arrival at the Emergency Room.

MEDICAL HISTORY: 1. Diabetes type 2.
2. Hypertension.
3. Breast cancer status post lumpectomy, radiation therapy.
4. History of lower gastrointestinal bleeds with embolization
and colonoscopy.
5. Diverticulitis.
6. Colonic polyp.
7. Syncope.
8. Uterine fibroids.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient had no allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for diabetes and coronary artery
disease.

SOCIAL HISTORY: She is a tobacco user actively.  She drinks
alcohol.  Denies any drug use.
Diverticulosis of colon with hemorrhage,Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast
Dvrtclo colon w hmrhg,Hyperosmolality,DMII wo cmp nt st uncntr,Hypertension NOS,Hx of breast malignancy
Admission Date:  [**2111-12-18**]       Discharge Date:  [**2111-12-25**]

Date of Birth:   [**2039-7-15**]       Sex:  F

Service:  Blue General Surgery

DISCHARGE DIAGNOSES:
1. Status post subtotal colectomy with ileostomy.
2. Hypertension.
3. Diabetes type 2.
4. Lower gastrointestinal bleed.
5. Right breast cancer.
6. Uterine fibroids.
7. Colonic polyps.
8. Tobacco use.

CHIEF COMPLAINT:  Lower GI bleed.

HISTORY OF PRESENT ILLNESS:  This is a 72-year-old female
with a past medical history of diabetes type 2, hypertension,
right breast cancer with a history of two prior GI bleeds,
who presents to the Emergency Room with four episodes of dark
bowel movements, one episode of bright red blood per rectum.
Patient's last bloody bowel movement was approximately one
hour before arrival at the Emergency Room.

The patient denied any abdominal pain, no nausea or vomiting.
No chest pain.  No shortness of breath.  Patient did have
dizziness, but no syncope.  Last meal was at 3 p.m. prior
being admitted.  Patient's hematocrit in the Emergency Room
had dropped from 37 to 26.  Patient had received 2 units of
packed red blood cells.

MEDICATIONS:
1. Glucotrol.
2. Lisinopril.
3. Aspirin.
4. Iron.
5. Glucophage.

PAST MEDICAL HISTORY:
1. Diabetes type 2.
2. Hypertension.
3. Breast cancer status post lumpectomy, radiation therapy.
4. History of lower gastrointestinal bleeds with embolization
and colonoscopy.
5. Diverticulitis.
6. Colonic polyp.
7. Syncope.
8. Uterine fibroids.

FAMILY HISTORY:  Significant for diabetes and coronary artery
disease.

SOCIAL HISTORY:  She is a tobacco user actively.  She drinks
alcohol.  Denies any drug use.

REVIEW OF SYSTEMS:  Patient denied any fevers.  Denied any
changes in weight.  Denied any changes in vision.  The
patient did have a history of hypertension.  Denied any
respiratory problems.  The patient did have a history of
lower GI bleeds with bloody bowel movements.  Patient did not
have any dysuria or frequency.  Patient did not have any
problems with musculoskeletal system.  Patient did have some
anemia.

ALLERGIES:  Patient had no allergies.

PHYSICAL EXAMINATION:  On physical examination, the patient's
temperature was 98.6, heart rate was 117, blood pressure is
144/50, sinus rhythm, patient's oxygen saturation is 96% on
room air.  The patient was a well-nourished and
well-appearing female in no acute distress.  Her eyes were
nonicteric sclerae.  Pupils are equal, round, and reactive to
light.  Patient had moist mucous membranes.  Her neck was
supple with no cervical lymphadenopathy.  Her heart sounds
were regular, rate, and rhythm with a normal S1, S2, no
murmurs, rubs, or gallops.  Lungs are clear to auscultation
bilaterally.  She had some diminished lung sound in the left
and right bases.  Her abdomen was flat, soft, nontender, and
nondistended, was not tympanic.  There was no shifting
dullness, no masses were palpated, and the liver and spleen
were of normal size.  Patient's gynecologic examination was
deferred.  Peripheral vascular examination was intact.
Patient's skin was warm and dry.  Extremities showed no
deformities.  Neurologically, her cranial nerves II through
XII are intact.  She had good sensation and motor response,
and was able to ambulate.

LABORATORY VALUES UPON ADMISSION:  She had a CBC which showed
a white blood cell count of 8.8, hematocrit of 26.1, and
platelet count of 315.  Her chemistries showed a sodium of
146, potassium of 4.4, chloride 110, bicarb of 26, BUN of 29,
creatinine of 1.2, and a glucose of 170.  Patient's bilirubin
is 0.2.  AST was 15, ALT was 6, alkaline phosphatase was 73,
amylase was 121, and lipase was 28.  Urinalysis was negative.

Patient had a transthoracic echocardiogram which showed an
ejection fraction of 70%.

EKG showed normal sinus rhythm, rate of 97, good R-wave
progression with no inverted T's or ST elevations.

ASSESSMENT AND PLAN:  This is a 72-year-old female with a
history of diabetes and hypertension, history of diverticular
disease, and lower GI bleed requiring embolization, who now
presents with recurrent bleed and hematocrit of 36-23.
Patient is hemodynamically stable without cardiac ischemia,
now with a lower hematocrit.  She was transfused 2 units of
blood and was admitted to the Medical service in the MICU for
serial hematocrits and plans for an endoscopic EGD and
colonoscopy.  Patient was also made NPO, IV fluids were
started.  Central lines were placed for IV fluid
resuscitation.

Patient was consulted by the GI service.  GI service
requested two large bore IVs and EGD.

Patient was transferred to the MICU, where she continued to
receive units of packed red blood cells.  On the patient's
fourth unit of packed red blood cells, her hematocrit was 28.
She had three large bowel movements which were red in color.
Her vital signs, however, continued to remain stable with a
heart rate in the 80s and a blood pressure of 135/53 ranging
as high as 160/60 with a mean arterial pressure of 80.

On hospital day two, General Surgery was consulted and
recommended that a bleeding scan and serial hematocrits would
be followed for continued evidence of persistent bleeding of
the lower GI tract.  The patient was sent for attempted
embolization in Angio Suite on [**12-19**], however, nothing was
found to embolize.  It was felt it was too distal.

Patient was then transferred from the [**Hospital Ward Name 516**] to the [**Hospital Ward Name 12053**] for subtotal colectomy in the morning.  The patient
had required at this time 10 units of packed red blood cells
to maintain hematocrits which had trended from 34 down to
29.6 again.  Patient was given 2 units of fresh-frozen
plasma.  Cardiac enzymes were checked which were all
negative.  Patient was preoped for subtotal colectomy.

On hospital day #3, the patient was brought to the operating
room for a subtotal colectomy and ileostomy.  Patient
tolerated the procedure well and was transferred intubated to
the Surgical Intensive Care Unit for IV resuscitation and
stabilization of her vital signs.

The patient, on postoperative day one, continued to be
intubated.  Was on Kefzol and Flagyl perioperatively.  Her
temperature continued to be afebrile.  Blood pressures
continued to be stable.  Patient's CVP was 4.  Immediately
postoperatively, patient's CBC showed that she had a
hematocrit of 30.6.

Patient was planned on postoperative day one, to be
extubated.  Hematocrits will be followed.  Antibiotics will
be continued.

On postoperative day #2, the patient was continued on Flagyl
for antibiotics.  Patient had been extubated and was doing
well.  Patient continued to be febrile with stable vital
signs.  Patient had serial hematocrits which showed that her
hematocrit was stable with a hematocrit of 32 on
postoperative day #2.

On postoperative day #3, patient was doing well.  She
continued to be 2 kg higher than her preoperative weight,
which is attributed to her resuscitation.  However, she was
afebrile.  Vital signs were stable.  Patient was started on a
clear liquid diet.  The ostomy was putting out what appeared
to be stool.  Patient was transferred to the floor on
postoperative day #3.

On postoperative day four, the patient was now out of the
Intensive Care Unit.  Was started on a regular diet.
Physical Therapy was consulted to begin working with the
patient on gait and endurance.  Patient was afebrile.  Vital
signs were stable.  Patient took p.o. well.  Ostomy was now
putting out succus.  Patient was out of bed about with the
help of PT.  Rehab screening was begun.  Medicine consult was
attained for resumption of patient's blood pressure and
diabetes medication, and also to get the patient a primary
care physician at the [**Hospital1 **].

On postoperative day #5, patient was tolerating a regular
diet.  Ostomy was putting out stool.  Patient was ambulating
well with Physical Therapy, however, it was discussed with
the patient and it was felt that she would most benefit from
a short stay in rehabilitation facility.  Patient was
afebrile.  Vital signs were stable.  She was started on all
her home medications and was taken off the PCA.  The Foley
was removed.  Patient was put on oral pain medication, which
did well.  Patient's hematocrit from the day was stable at
28.9.  Patient will be discharged to rehab facility.

DISCHARGE MEDICATIONS:
1. Metoprolol 50 mg one tablet by mouth 2x a day.
2. Lisinopril 10 mg tablets one tablet by mouth once a day.
3. Protonix 40 mg one tablet once a day.
4. Percocet 1-2 tablets p.o. q.4-6h. prn for pain.
5. Glipizide 10 mg tablet one tablet by mouth per day.
6. Metformin 500 mg tablet one tablet by mouth twice a day.
7. Colace 100 mg tablets one tablet by mouth twice a day.

FOLLOW-UP INSTRUCTIONS:  Patient will have follow up with Dr.
[**Last Name (STitle) **] in [**2-12**] weeks in Dr.[**Name (NI) 22019**] clinic.  Patient will
resume a regular diabetic diet, and the patient will continue
working with Physical Therapy in rehab on endurance and gait,
and patient will receive ostomy teaching and care while at
rehab.

DISCHARGE DISPOSITION:  Stable.



                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Last Name (NamePattern1) 10638**]
MEDQUIST36

D:  [**2111-12-25**]  12:43
T:  [**2111-12-25**]  12:50
JOB#:  [**Job Number 45470**]
{'Diverticulosis of colon with hemorrhage,Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}


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: Lower GI bleed.

PRESENT ILLNESS: This is a 72-year-old female
with a past medical history of diabetes type 2, hypertension,
right breast cancer with a history of two prior GI bleeds,
who presents to the Emergency Room with four episodes of dark
bowel movements, one episode of bright red blood per rectum.
Patient's last bloody bowel movement was approximately one
hour before arrival at the Emergency Room.

MEDICAL HISTORY: 1. Diabetes type 2.
2. Hypertension.
3. Breast cancer status post lumpectomy, radiation therapy.
4. History of lower gastrointestinal bleeds with embolization
and colonoscopy.
5. Diverticulitis.
6. Colonic polyp.
7. Syncope.
8. Uterine fibroids.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient had no allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for diabetes and coronary artery
disease.

SOCIAL HISTORY: She is a tobacco user actively.  She drinks
alcohol.  Denies any drug use. 

### Response:
{'Diverticulosis of colon with hemorrhage,Hyperosmolality and/or hypernatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}
