CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 71-year-old female
with diabetes who is here for a Holter monitor.  She also
had one episode of bright red blood per rectum in the office
bathroom with diarrhea.  Patient went home and had a large
bright red blood per rectum bowel movement, again, with
diarrhea.  The next thing the patient remembers, she was in
her kitchen with paramedics.  She denies hitting her head.
She was alert and oriented times three in the kitchen.  She
had one previous episode of bright red blood per rectum in
the past with no work-up.  She is getting a Holter monitor
for cataract surgery.  She denies chest pain, shortness of
breath, palpitations, dysuria, nausea and vomiting.  The
patient received 300 cc normal saline in the Emergency
Department.  She could not tolerate an nasogastric lavage.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Breast cancer in [**2104**].
4.  Osteoarthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes, positive for bright
red blood per rectum.

SOCIAL HISTORY: Positive tobacco, half pack per day.
Negative ETOH.
Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of colon,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other seborrheic keratosis,Personal history of malignant neoplasm of breast
Dvrtclo colon w hmrhg,Chr blood loss anemia,Benign neoplasm lg bowel,Hypertension NOS,DMII wo cmp nt st uncntr,Other sborheic keratosis,Hx of breast malignancy
Admission Date:  [**2111-3-9**]       Discharge Date:  [**2111-3-13**]

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

Service:  ACOVE

DISCHARGE STAT ADDENDUM:

PATIENT'S MEDICATIONS AT DISCHARGE:
1.  Pantoprazole 40 mg po q. 24 hours.
2.  Lisinopril 5 mg po q.d.
3.  Iron 325 mg po q.d.
4.  Glipizide XL 10 mg po q.d.
5.  Metformin 500 mg po b.i.d.






                            [**First Name11 (Name Pattern1) 2515**] [**Last Name (NamePattern4) 4517**], M.D. [**MD Number(1) 4518**]

Dictated By:[**First Name3 (LF) 42354**]
MEDQUIST36

D:  [**2111-3-13**]  01:23
T:  [**2111-3-13**]  14:07
JOB#:  [**Job Number 45469**]


Admission Date:  [**2111-3-9**]       Discharge Date:  [**2111-3-13**]

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

Service:  ACOVE

HISTORY OF PRESENT ILLNESS:  Patient is a 71-year-old female
with diabetes who is here for a Holter monitor.  She also
had one episode of bright red blood per rectum in the office
bathroom with diarrhea.  Patient went home and had a large
bright red blood per rectum bowel movement, again, with
diarrhea.  The next thing the patient remembers, she was in
her kitchen with paramedics.  She denies hitting her head.
She was alert and oriented times three in the kitchen.  She
had one previous episode of bright red blood per rectum in
the past with no work-up.  She is getting a Holter monitor
for cataract surgery.  She denies chest pain, shortness of
breath, palpitations, dysuria, nausea and vomiting.  The
patient received 300 cc normal saline in the Emergency
Department.  She could not tolerate an nasogastric lavage.

PAST MEDICAL HISTORY:
1.  Diabetes.
2.  Hypertension.
3.  Breast cancer in [**2104**].
4.  Osteoarthritis.

MEDICATIONS:
1.  Glucotrol 10 once a day
2.  Glucophage 500 twice a day.
3.  Aspirin 81 once a day.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Positive tobacco, half pack per day.
Negative ETOH.

FAMILY HISTORY:  Positive for diabetes, positive for bright
red blood per rectum.

PHYSICAL EXAMINATION:  Patient's vital signs:  Blood pressure
115/50.  Pulse of 90 while lying down, 95/50.  Pulse 112
standing up in no apparent distress.  Patient lightheaded.
Extraocular movements intact without jugular venous
distention.  Lungs:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, normal S1, S2, no
murmurs, rubs or gallops.  Positive bowel sounds.  Abdomen:
Soft, nontender, nondistended.  Extremities:  Negative
cyanosis, clubbing or edema.  Cranial nerves II through XII
are grossly intact and she had bright red blood on her sheet
when she sat up, so guaiac was deferred as it would be
clearly positive.

LABORATORIES ON ADMISSION:  Patient's white blood cell count
was 10.6, hematocrit 31.6, platelet count 219,000.  PT 12.9,
INR 1.1.  PTT 24.7.  Chem-7:  Sodium 145, potassium 3.9,
chloride 105, bicarbonate 32, BUN 23, creatinine 1.4, glucose
189.  CK 127, troponin 0.3.  MB 5.

Electrocardiogram:  Normal sinus rhythm at 90, normal
intervals, normal axis, no ST changes.

HOSPITAL COURSE:  The patient is a 71-year-old female with
bright red blood per rectum times two.  She had no previous
history of gastrointestinal disease.

1.  Gastrointestinal:  The patient was admitted and had two
large bore IVs placed and was immediately started on
intravenous fluids.  This patient was lightheaded and
orthostatic.  The patient was typed and screened and
consented for blood.  Patient had one large 1300 cc of bright
red blood episode.  On the first night of admission, the
patient went for a bleeding scan with nuclear radiology which
was positive for hepatic flexure bleed.  Patient was then
transferred to the Interventional Radiology Suite where she
had an embolization done.  During that time, the patient
received four units of packed red blood.  Patient went
hypotensive in the suite and a code was called.  Patient was
resuscitated with fluids and patient was transferred to the
Intensive Care Unit.  Patient needed seven units of packed
red blood cells throughout the stay.  Patient then had a
colonoscopy done.  Patient's colonoscopy demonstrated a
polyp.  Because patient has seborrheic keratosis, there is
greater concern for other gastrointestinal malignancy.
Patient is to have upper and lower endoscopy to be scheduled
by Dr. [**First Name (STitle) **] [**Name (STitle) **].

2.  Hematocrit:  Patient had falling hematocrit throughout
her stay.  Patient needed a total of seven units packed red
blood cells except for the episode in the Interventional
Radiology Suite, patient was asymptomatic.

3.  Cardiovascular:  The patient was ruled out times three
and had no events on telemetry, but during the hypotensive
episode, patient did have chest pain and was ruled out times
three.  Again, no episodes on telemetry.  Patient will need
an exercise treadmill test MIBI and an echocardiogram as an
outpatient.

4.  Neurological:  Syncope:  Patient's syncope likely
secondary to massive bright red blood per rectum.  Patient
had no other episodes throughout her stay.

5.  Renal:  Patient had increased BUN to creatinine ratio
that immediately came down with hydration and blood, likely
secondary to low volume status.

6.  Endocrine:  Patient was NPO mostly throughout the stay
and was just treated with insulin sliding scale.

DISCHARGE DIAGNOSES:  Diverticular bleed.

DISCHARGE CONDITION:  Stable.

DISCHARGE MEDICATIONS:
1.  Glucotrol 10 once a day.
2.  Glucophage 500 twice a day.
3.  Lisinopril 5 once a day.

DISCHARGE PLAN:  The patient is to see Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on
[**3-27**] at 2:30 p.m.  Gastrointestinal follow-up:
Patient is to call [**Telephone/Fax (1) 1954**] to schedule an upper and
lower endoscopy within the week with Dr. [**First Name (STitle) **] [**Name (STitle) **].  He
will also try to get in touch with her.  Cardiovascular:
Patient needs exercise treadmill test MIBI and
echocardiogram.  At some point, this patient had chest pain
and has a history of diabetes.  Other risk factors include
smoking and age.  Patient has decided to transfer care to the
[**Hospital1 **] system.







                         DR.[**First Name (STitle) 2515**],[**First Name3 (LF) **] 12-927

Dictated By:[**First Name3 (LF) 42354**]
MEDQUIST36

D:  [**2111-3-13**]  01:18
T:  [**2111-3-13**]  13:37
JOB#:  [**Job Number **]
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of colon,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other seborrheic keratosis,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: 

PRESENT ILLNESS: Patient is a 71-year-old female
with diabetes who is here for a Holter monitor.  She also
had one episode of bright red blood per rectum in the office
bathroom with diarrhea.  Patient went home and had a large
bright red blood per rectum bowel movement, again, with
diarrhea.  The next thing the patient remembers, she was in
her kitchen with paramedics.  She denies hitting her head.
She was alert and oriented times three in the kitchen.  She
had one previous episode of bright red blood per rectum in
the past with no work-up.  She is getting a Holter monitor
for cataract surgery.  She denies chest pain, shortness of
breath, palpitations, dysuria, nausea and vomiting.  The
patient received 300 cc normal saline in the Emergency
Department.  She could not tolerate an nasogastric lavage.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Breast cancer in [**2104**].
4.  Osteoarthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for diabetes, positive for bright
red blood per rectum.

SOCIAL HISTORY: Positive tobacco, half pack per day.
Negative ETOH. 

### Response:
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Benign neoplasm of colon,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other seborrheic keratosis,Personal history of malignant neoplasm of breast'}
