CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 62 year-old female
with a history of cirrhosis, diverticulitis, colovesicular
fistula who presents with three episodes of melena. The
patient was in her usual state of health until [**2-26**] when a
relative noted her to be jaundice.  She made an appointment
to see her primary care physician [**Last Name (NamePattern4) **] [**3-3**].  On [**3-2**] she had
two episodes of melena. It was not associated with
N-V-C-B-abdominal pain, easy bruising, bleeding with brushing
teeth, bright red blood per rectum, fever, headache, chest
pain, shortness of breath, dysphagia, odynophagia, visual
changes, travel or unusual foods.  She had mild
lightheadedness and had lost four pounds intentionally over
the past two weeks.  She had mild gas and bloating for two
days.  No prior episodes of black stool or bright red blood
per rectum were reported.  She had been taking one aspirin
per day for two weeks for aches and pains as well as one to
two Aleve per day for joint pain.  She denies ingesting
spinach, Pepto-Bismol or iron.  She had an additional episode
of melena on the a.m. of [**3-3**] and her primary care physician
instructed to go directly to the [**Hospital1 190**] Emergency Department where she had a systolic
blood pressure in the 80s and black stool that was guaiac
positive.  In the Emergency Department nasogastric lavage was
performed and was negative.  Access was obtained and the
patient was given 2 units of packed red blood cells and 2
liters of normal saline.  From there she was transferred to
the MICU for further management.

MEDICAL HISTORY: 1.  Cirrhosis (unclear diagnostic criteria).
2.  Hypertension.
3.  Diverticulitis and colovesicular fistula status post
partial colectomy in [**2120**] with Dr. [**Last Name (STitle) 519**].  Colonoscopy with
multiple diverticula in 4/[**2127**].
4.  Cesarean section times three.
5.  Fibroids status post OR.
6.  Right knee arthroscopy in [**2127**].
7.  Obesity.

MEDICATION ON ADMISSION: 1.  Atenolol 50 mg q day.
2.  Accupril 20 mg q day.
3.  Hydrochlorothiazide 25 mg q day.
4.  Lipitor 10 mg every other day.
5.  St. [**Doctor Last Name 11042**] aspirin times two weeks.
6.  Aleve b.i.d.
7.  Vitamin B-12.
8.  Echinacea.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with myocardial infarction at age 67.
Paternal grandmother with diabetes mellitus.

SOCIAL HISTORY: The patient lives with her husband.  She
reports alcohol abuse for 40 years.  She has been sober for
the past two weeks.  When she does drink she drinks six
drinks per day for a week at a time and then will abstain for
a period of weeks.  She smoked in her 20s, but has had no
smoking since then.  She denies intravenous drug use or
occupational exposure.  Her hepatitis status is unknown.
Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, continuous,Alcoholic cirrhosis of liver,Chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction,Orthostatic hypotension,Stricture and stenosis of esophagus,Unspecified essential hypertension
Gastrointest hemorr NOS,Alcoh dep NEC/NOS-contin,Alcohol cirrhosis liver,Chr stomach ulcer NOS,Orthostatic hypotension,Esophageal stricture,Hypertension NOS
Admission Date:  [**2129-3-3**]     Discharge Date:  [**2129-3-5**]

Date of Birth:   [**2066-7-7**]     Sex:  F

Service:  [**Hospital1 **] MEDICINE

HISTORY OF PRESENT ILLNESS:  This is a 62 year-old female
with a history of cirrhosis, diverticulitis, colovesicular
fistula who presents with three episodes of melena. The
patient was in her usual state of health until [**2-26**] when a
relative noted her to be jaundice.  She made an appointment
to see her primary care physician [**Last Name (NamePattern4) **] [**3-3**].  On [**3-2**] she had
two episodes of melena. It was not associated with
N-V-C-B-abdominal pain, easy bruising, bleeding with brushing
teeth, bright red blood per rectum, fever, headache, chest
pain, shortness of breath, dysphagia, odynophagia, visual
changes, travel or unusual foods.  She had mild
lightheadedness and had lost four pounds intentionally over
the past two weeks.  She had mild gas and bloating for two
days.  No prior episodes of black stool or bright red blood
per rectum were reported.  She had been taking one aspirin
per day for two weeks for aches and pains as well as one to
two Aleve per day for joint pain.  She denies ingesting
spinach, Pepto-Bismol or iron.  She had an additional episode
of melena on the a.m. of [**3-3**] and her primary care physician
instructed to go directly to the [**Hospital1 190**] Emergency Department where she had a systolic
blood pressure in the 80s and black stool that was guaiac
positive.  In the Emergency Department nasogastric lavage was
performed and was negative.  Access was obtained and the
patient was given 2 units of packed red blood cells and 2
liters of normal saline.  From there she was transferred to
the MICU for further management.

PAST MEDICAL HISTORY:
1.  Cirrhosis (unclear diagnostic criteria).
2.  Hypertension.
3.  Diverticulitis and colovesicular fistula status post
partial colectomy in [**2120**] with Dr. [**Last Name (STitle) 519**].  Colonoscopy with
multiple diverticula in 4/[**2127**].
4.  Cesarean section times three.
5.  Fibroids status post OR.
6.  Right knee arthroscopy in [**2127**].
7.  Obesity.

SOCIAL HISTORY:  The patient lives with her husband.  She
reports alcohol abuse for 40 years.  She has been sober for
the past two weeks.  When she does drink she drinks six
drinks per day for a week at a time and then will abstain for
a period of weeks.  She smoked in her 20s, but has had no
smoking since then.  She denies intravenous drug use or
occupational exposure.  Her hepatitis status is unknown.

FAMILY HISTORY:  Mother with myocardial infarction at age 67.
Paternal grandmother with diabetes mellitus.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Atenolol 50 mg q day.
2.  Accupril 20 mg q day.
3.  Hydrochlorothiazide 25 mg q day.
4.  Lipitor 10 mg every other day.
5.  St. [**Doctor Last Name 11042**] aspirin times two weeks.
6.  Aleve b.i.d.
7.  Vitamin B-12.
8.  Echinacea.

PHYSICAL EXAMINATION:  Examination on admission revealed
temperature of 97.7.  Blood pressure 85/54.  Heart rate 70.
Respiratory rate 16.  Oxygen saturation of 100% on room air.
General, the patient is pale in no acute distress, alert and
oriented times three.  Appearing stated age and obese.  HEENT
examination revealed no jaundice, pale appearance and
nonicteric sclera.  Neck was supple without masses or
thyromegaly.  There was no lymphadenopathy.  Chest revealed
lungs were clear to auscultation bilaterally.  Cardiovascular
examination revealed a nondisplaced point of maximal impulse.
S1 and S2.  No murmurs, rubs or gallops.  No carotid bruits.
Abdominal examination the patient was soft, nontender,
nondistended.  There was no hepatosplenomegaly, masses or
bruits.  Rectal examination was positive for guaiac positive
stool.  The extremity examination showed no cords, clubbing
or edema.  There was 2+ dorsalis pedis pulses and radial
pulses bilaterally.  There was mild pallor at the nail beds
and Dupuytren's contracture in the right hand.  Skin
examination showed no rashes or bruits.  On neurological
examination motor was 5 out of 5 in all extremities and
sensation was grossly intact to light touch.  Patellar and
brachial radialis reflexes were intact and symmetric.
Cranial nerves II through XII were grossly intact.

LABORATORIES AND STUDIES:  Laboratory results revealed a
white blood cell count of 17.5, hematocrit 33.0 down from 43
in [**2127**] in the computer system.  Platelets 351.  Chem 7
revealed sodium of 137, potassium 4.1, chloride 98, bicarb
25, BUN 68, creatinine 1.3, and an INR was 1.1.  Liver
enzymes testing showed an ALT of 86, AST of 60, amylase of
37, total bilirubin of 1.6.  Troponin was sent and came back
less than ASA.

HOSPITAL COURSE:  After access was established nasogastric
lavage was performed and the patient was given 2 units of
packed red blood cells and 2 liters of normal saline.  She
was transferred to the Medical Intensive Care Unit for
further management.

1.  Gastrointestinal bleed:  Gastrointestinal consult was
obtained.  Hematocrits were check q six hours.  Two
peripheral IVs were maintained at all times.  The patient's
goal hematocrit was greater then 26.  Proton pump inhibitor
was started.  On [**2129-3-4**] the patient had an
esophagogastroduodenoscopy to further investigate the source
of her bleeding.  Findings on that esophagogastroduodenoscopy
were Schatzki's ring, erosions in the antrum and also in the
antrum the erosions and the ulcer were nonbleeding at the
time of the examination, otherwise the
esophagogastroduodenoscopy was normal to the third part of
the duodenum.  Recommendations were to rule out H-pylori,
continue Protonix 40 mg po q day times six weeks and for
repeat esophagogastroduodenoscopy in eight weeks to ensure
healing of ulcers and also for possible esophageal dilation.
H-pylori ASA was sent and came back negative.  Protonix
treatment was continued and the patient was scheduled for a
follow up esophagogastroduodenoscopy in eight weeks.

2.  Cirrhosis:  It was unclear how the diagnosis of cirrhosis
was made in this patient and a cirrhosis workup was
undertaken.  Right upper quadrant ultrasound showed an
echogenic liver.  Hepatitis serologies were sent.  Hepatitis
B surface antigen returned negative.  Surface antibody is
pending at the time of this dictation.  Hepatitis C ASA was
negative.  AMA and [**Doctor First Name **] were also negative.  The patient was
also found to have an elevated ferritin, but was unclear
whether this was due to blood transfusion or the patient's
baseline level.  The patient will follow up in the liver
clinic for further evaluation of her cirrhosis.

3.  Hypertension:  The patient's antihypertension medications
were titrated to her blood pressure given her acute bleed.

4.  Alcohol:  The patient stated she was sober times two
weeks and was without signs of DTs or withdraw.  Thiamine,
folate and MVI were started.  The patient was seen by social
work consult to discuss her alcoholism and provide support
and resources for her.

On the night of [**2129-3-4**] the patient was deemed stable to be
discharged from the Medical Intensive Care Unit to the floor
team.  The patient came out to the floor and maintained good
blood pressure and stable vital signs overnight.  On [**2129-3-5**]
the patient was deemed to be clear for discharge to home.
There was no further evidence of bleeding by physical
examination.

DISCHARGE MEDICATIONS:  Same as admission with exception of
the aspirin and the non-steroidal anti-inflammatory drugs,
which were discontinued and the Protonix 40 mg q day that was
started and will be continued for six weeks.

DISPOSITION:  To home.

DISCHARGE STATUS:  At the time of discharge the patient was
ambulating comfortably without lightheadedness or other
symptoms of hypovolemia.  She was feeling well.  All her
questions had been answered and her follow up appointments
both for workup of her cirrhosis and upper gastrointestinal
bleed and for her repeat esophagogastroduodenoscopy had been
made.

DISCHARGE DIAGNOSES:
1.  Gastrointestinal bleed requiring transfusion of 2 units
of packed red blood cells secondary to erosions and
ulcerations in the antrum.
2.  Cirrhosis of yet undetermined etiology.
3.  Hypertension.
4.  Alcohol abuse.
5.  Obesity.

DISCHARGE FOLLOW UP:  The patient had an appointment for
repeat esophagogastroduodenoscopy six weeks from the time of
discharge.  She will also follow up with her primary care
physician as well as the liver clinic for further workup of
her cirrhosis and upper gastrointestinal bleed.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D.  [**MD Number(1) 1212**]

Dictated By:[**Doctor Last Name 11043**]

MEDQUIST36

D:  [**2129-3-8**]  06:52
T:  [**2129-3-8**]  09:48
JOB#:  [**Job Number 11044**]
{'Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, continuous,Alcoholic cirrhosis of liver,Chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction,Orthostatic hypotension,Stricture and stenosis of esophagus,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: 

PRESENT ILLNESS: This is a 62 year-old female
with a history of cirrhosis, diverticulitis, colovesicular
fistula who presents with three episodes of melena. The
patient was in her usual state of health until [**2-26**] when a
relative noted her to be jaundice.  She made an appointment
to see her primary care physician [**Last Name (NamePattern4) **] [**3-3**].  On [**3-2**] she had
two episodes of melena. It was not associated with
N-V-C-B-abdominal pain, easy bruising, bleeding with brushing
teeth, bright red blood per rectum, fever, headache, chest
pain, shortness of breath, dysphagia, odynophagia, visual
changes, travel or unusual foods.  She had mild
lightheadedness and had lost four pounds intentionally over
the past two weeks.  She had mild gas and bloating for two
days.  No prior episodes of black stool or bright red blood
per rectum were reported.  She had been taking one aspirin
per day for two weeks for aches and pains as well as one to
two Aleve per day for joint pain.  She denies ingesting
spinach, Pepto-Bismol or iron.  She had an additional episode
of melena on the a.m. of [**3-3**] and her primary care physician
instructed to go directly to the [**Hospital1 190**] Emergency Department where she had a systolic
blood pressure in the 80s and black stool that was guaiac
positive.  In the Emergency Department nasogastric lavage was
performed and was negative.  Access was obtained and the
patient was given 2 units of packed red blood cells and 2
liters of normal saline.  From there she was transferred to
the MICU for further management.

MEDICAL HISTORY: 1.  Cirrhosis (unclear diagnostic criteria).
2.  Hypertension.
3.  Diverticulitis and colovesicular fistula status post
partial colectomy in [**2120**] with Dr. [**Last Name (STitle) 519**].  Colonoscopy with
multiple diverticula in 4/[**2127**].
4.  Cesarean section times three.
5.  Fibroids status post OR.
6.  Right knee arthroscopy in [**2127**].
7.  Obesity.

MEDICATION ON ADMISSION: 1.  Atenolol 50 mg q day.
2.  Accupril 20 mg q day.
3.  Hydrochlorothiazide 25 mg q day.
4.  Lipitor 10 mg every other day.
5.  St. [**Doctor Last Name 11042**] aspirin times two weeks.
6.  Aleve b.i.d.
7.  Vitamin B-12.
8.  Echinacea.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with myocardial infarction at age 67.
Paternal grandmother with diabetes mellitus.

SOCIAL HISTORY: The patient lives with her husband.  She
reports alcohol abuse for 40 years.  She has been sober for
the past two weeks.  When she does drink she drinks six
drinks per day for a week at a time and then will abstain for
a period of weeks.  She smoked in her 20s, but has had no
smoking since then.  She denies intravenous drug use or
occupational exposure.  Her hepatitis status is unknown. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, continuous,Alcoholic cirrhosis of liver,Chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction,Orthostatic hypotension,Stricture and stenosis of esophagus,Unspecified essential hypertension'}
