CHIEF COMPLAINT: coffee ground hematemesis and melena

PRESENT ILLNESS: Patient is a 55 year old male with pmh sig for CRI, cirrhosis(on
liver-kidney transplant list) complicated by grade I esophageal
varicies presenting with one day of coffee ground hematemesis
and melena. He awoke with slight nausea, then proceded to have
coffee ground emesis x 2 episodes, no BRB. He initially
presented to OSH, and was transfered to [**Hospital1 18**] for further care.
He reports chest tightness since this AM, similar to pain he has
with exertion (walking >4 blocks). No SOB, or diaphoresis. He
had a stress MIBI in [**10-29**] which was normal. He denies abdominal
pain or palpitations.
.
On review of the [**Name (NI) **], pt complained of BRBPR in early [**2101**], a
colonoscopy was performed which showed grade 1 external
hemorrhoids. Additionally, he has had an EGD performed in
[**2101-10-19**] that revealed only grade 1 varices.
.
He was transferred to the floor where he was stable and he did
not get any transfusions. He had paracentesis 3 times during
this hospitalization and had almot [**11-5**] lts taken out. He got
albumin during all these taps.

MEDICAL HISTORY: Hepatitis C/ETOH induced cirrhosis
(SBP [**2100-1-7**], no variceal bleeds, EGD [**2101-10-19**] Grade 1 varices)
Mitral valve prolapse
Hypertension
Gout
Osteopenia
CKD - baseline creatinine 2.0
Anemia

MEDICATION ON ADMISSION: Lactulose 30ml po tid-qid for BM 3-4x per day
Allopurinol - 100 mg po qd
Colchicine - 0.6 mg p qd
Atenolol - 50mg po qhs
Omeprazole - 20mg po qd
Levofloxacin 500mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.2 BP: 104/82 HR: 82 RR: 14 O2: 100%RA
.
Gen: Comfortable, pleasant, A+Ox3, no acute distress
HEENT: NCAT, PERRL, EOMI, slt scleral icterus, no LAD, flat JVP

FAMILY HISTORY: Father-HTN, MI in his 80s
Mother- "spine cancer"

SOCIAL HISTORY: The pt denies current cigarette use, but reports smoking 10
cig/day for 20 years.  He also quit drinking 1 [**12-26**] yr ago but
prior had drank for 23 years with 1 pint of gin or brandy a day.
Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Alcoholic cirrhosis of liver,Unspecified viral hepatitis C without hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Awaiting organ transplant status,Mitral valve disorders,Esophageal varices without mention of bleeding,Esophagitis, unspecified,Unspecified disorder of stomach and duodenum,Benign neoplasm of duodenum, jejunum, and ileum,Gout, unspecified
Gastrointest hemorr NOS,Acute kidney failure NOS,Alcohol cirrhosis liver,Hpt C w/o hepat coma NOS,Hyp kid NOS w cr kid V,Await organ transplnt st,Mitral valve disorder,Esoph varices w/o bleed,Esophagitis, unspecified,Gastroduodenal dis NOS,Benign neoplasm sm bowel,Gout NOS
Admission Date:  [**2102-5-26**]              Discharge Date:   [**2102-5-31**]

Date of Birth:  [**2047-3-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1493**]
Chief Complaint:
coffee ground hematemesis and melena

Major Surgical or Invasive Procedure:
Paracentesis


History of Present Illness:
Patient is a 55 year old male with pmh sig for CRI, cirrhosis(on
liver-kidney transplant list) complicated by grade I esophageal
varicies presenting with one day of coffee ground hematemesis
and melena. He awoke with slight nausea, then proceded to have
coffee ground emesis x 2 episodes, no BRB. He initially
presented to OSH, and was transfered to [**Hospital1 18**] for further care.
He reports chest tightness since this AM, similar to pain he has
with exertion (walking >4 blocks). No SOB, or diaphoresis. He
had a stress MIBI in [**10-29**] which was normal. He denies abdominal
pain or palpitations.
.
On review of the [**Name (NI) **], pt complained of BRBPR in early [**2101**], a
colonoscopy was performed which showed grade 1 external
hemorrhoids. Additionally, he has had an EGD performed in
[**2101-10-19**] that revealed only grade 1 varices.
.
He was transferred to the floor where he was stable and he did
not get any transfusions. He had paracentesis 3 times during
this hospitalization and had almot [**11-5**] lts taken out. He got
albumin during all these taps.

Past Medical History:
Hepatitis C/ETOH induced cirrhosis
(SBP [**2100-1-7**], no variceal bleeds, EGD [**2101-10-19**] Grade 1 varices)
Mitral valve prolapse
Hypertension
Gout
Osteopenia
CKD - baseline creatinine 2.0
Anemia

Social History:
The pt denies current cigarette use, but reports smoking 10
cig/day for 20 years.  He also quit drinking 1 [**12-26**] yr ago but
prior had drank for 23 years with 1 pint of gin or brandy a day.

He denies IVDU, but has snorted cocaine in the past.  He works
at the JP VA currently and lives in the [**Location (un) 4398**] alone.  His
sister is his HCP and is very supportive


Family History:
Father-HTN, MI in his 80s
Mother- "spine cancer"

Physical Exam:
Vitals: T 98.2 BP: 104/82 HR: 82 RR: 14 O2: 100%RA
.
Gen: Comfortable, pleasant, A+Ox3, no acute distress
HEENT: NCAT, PERRL, EOMI, slt scleral icterus, no LAD, flat JVP

OP: Clear, no lesions, no dried blood
Chest: CTA Bilateral, no wheeze or rhonchi
Cor: RRR no murmurs rubs or gallops
Abd: massively distended, + bulging flanks, + fluid wave, NT
Ext: warm, well perfused, 2+DP/PT bilaterally


Pertinent Results:
[**2102-5-31**] 05:05AM BLOOD WBC-4.9 RBC-3.40* Hgb-10.6* Hct-31.5*
MCV-93 MCH-31.0 MCHC-33.5 RDW-18.1* Plt Ct-57*
[**2102-5-28**] 09:40AM BLOOD Neuts-53.6 Lymphs-36.3 Monos-6.0 Eos-3.3
Baso-0.9
[**2102-5-31**] 05:05AM BLOOD Plt Ct-57*
[**2102-5-31**] 05:05AM BLOOD PT-19.5* PTT-41.1* INR(PT)-1.9*
[**2102-5-31**] 05:05AM BLOOD Glucose-93 UreaN-33* Creat-2.3* Na-143
K-3.6 Cl-116* HCO3-16* AnGap-15
[**2102-5-29**] 05:35AM BLOOD ALT-25 AST-79* LD(LDH)-198 AlkPhos-119*
TotBili-3.2*
[**2102-5-31**] 05:05AM BLOOD Calcium-8.5 Phos-2.3* Mg-1.7
[**2102-5-28**] 04:00PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2102-5-28**] 09:40AM BLOOD CK-MB-9 cTropnT-0.07*
[**2102-5-26**] 02:10PM BLOOD CK-MB-8 cTropnT-<0.01
[**2102-5-27**] 08:14AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
[**2102-5-26**] 02:26PM BLOOD Hgb-9.1* calcHCT-27
***
LIVER OR GALLBLADDER US (SINGLE ORGAN)  [**2102-5-30**]
1. Patent hepatic and portal vessels.
2. Cholelithiasis.
3. There are no focal liver lesions.
***


Brief Hospital Course:
#GI Bleed: Likely upper GI bleed given hematemesis, EGD showeds
Gr. I varices, esophagitis, portal gastropathy but no actively
bleeding lesion. Hemodynamically stable. Got transfused in ICU
and was stable. Did not require transfusion on floor. Octreotide
gtt dc'd. NO melanotic stools/hematemesis in ICU. Continued
levofloxacin prophylaxis (at request of liver team) .
.
# Chest pain: c/o chest discomfort w/ dizziness. EKG shows new
T-wave in III, aVF. Could have been demand ischemia from low
HCT. CE's cycled --> ruled out for MI.
.
# Hep C/ETOH cirrhosis - MELD score 27 (was 21 on [**5-9**]). Had
total of around [**11-5**] lts of peritoneal fluid taken out. Was
given albumin during these procedures. There was no evidence of
SBP from the analysis of the peritoneal fluid. Lactulose dose
increased (given pt hx sleep-wake reversal). Had liver usg which
did not show portal vein thrombosis or focal liver lesions.
.
#Acute on Chronic renal failure: etiology unclear,
?hypertensive. FeNa 0.33%, c/w prerenal failure. U na+ 22.  Was
on octreotide, midodrine for hepatorenal failure. Cont IV volume
support with 5% albumin
.
#HTN: held Atenolol for SBPs were marginal. Patient was not sent
home on Atenolol as he had an appointment with Dr. [**Last Name (STitle) 497**] in 1
week at which time he could discuss with Dr.[**Last Name (STitle) 497**] about starting
back on Atenolol.
.
#Gout: stable, asymptomatic. Continued on allopurinol,
colchicine.
.
#FEN - Na+ restricted diet, Fluid restrict <1500cc/d,
follow/replete lytes

Medications on Admission:
Lactulose 30ml po tid-qid for BM 3-4x per day
Allopurinol - 100 mg po qd
Colchicine - 0.6 mg p qd
Atenolol - 50mg po qhs
Omeprazole - 20mg po qd
Levofloxacin 500mg po qd


Discharge Medications:
1. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
2. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed.
4. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
5. Lactulose 10 g/15 mL Syrup Sig: Forty Five (45) ML PO TID (3
times a day).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).


Discharge Disposition:
Home

Discharge Diagnosis:
Gastrointestinal bleed
Cirrhosis
Ascites


Discharge Condition:
all vitals are stable


Discharge Instructions:
Please take all your medications and follow up with all your
appointments. Please report to the ED or to your physician if
you have shortness of breath, cough, blood in vomit or stools,
dark stools, dizziness, chest pain or any other concerns.
.
Your blood pressure medication (Atenolol) is being held as your
blood pressure has been low during this hospitalization and you
had bleeding from your GI tract. Please discuss about restarting
this medication with Dr. [**Last Name (STitle) 497**] when you see him on the 14th of
this month. If you have any headache, chest pain, blurriness of
visiion or other concerns regarding high blood pressure, please
call Dr. [**Last Name (STitle) 497**] or come to the ED.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2102-6-7**] 3:20



Completed by:[**2102-5-31**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Alcoholic cirrhosis of liver,Unspecified viral hepatitis C without hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Awaiting organ transplant status,Mitral valve disorders,Esophageal varices without mention of bleeding,Esophagitis, unspecified,Unspecified disorder of stomach and duodenum,Benign neoplasm of duodenum, jejunum, and ileum,Gout, unspecified'}


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: coffee ground hematemesis and melena

PRESENT ILLNESS: Patient is a 55 year old male with pmh sig for CRI, cirrhosis(on
liver-kidney transplant list) complicated by grade I esophageal
varicies presenting with one day of coffee ground hematemesis
and melena. He awoke with slight nausea, then proceded to have
coffee ground emesis x 2 episodes, no BRB. He initially
presented to OSH, and was transfered to [**Hospital1 18**] for further care.
He reports chest tightness since this AM, similar to pain he has
with exertion (walking >4 blocks). No SOB, or diaphoresis. He
had a stress MIBI in [**10-29**] which was normal. He denies abdominal
pain or palpitations.
.
On review of the [**Name (NI) **], pt complained of BRBPR in early [**2101**], a
colonoscopy was performed which showed grade 1 external
hemorrhoids. Additionally, he has had an EGD performed in
[**2101-10-19**] that revealed only grade 1 varices.
.
He was transferred to the floor where he was stable and he did
not get any transfusions. He had paracentesis 3 times during
this hospitalization and had almot [**11-5**] lts taken out. He got
albumin during all these taps.

MEDICAL HISTORY: Hepatitis C/ETOH induced cirrhosis
(SBP [**2100-1-7**], no variceal bleeds, EGD [**2101-10-19**] Grade 1 varices)
Mitral valve prolapse
Hypertension
Gout
Osteopenia
CKD - baseline creatinine 2.0
Anemia

MEDICATION ON ADMISSION: Lactulose 30ml po tid-qid for BM 3-4x per day
Allopurinol - 100 mg po qd
Colchicine - 0.6 mg p qd
Atenolol - 50mg po qhs
Omeprazole - 20mg po qd
Levofloxacin 500mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.2 BP: 104/82 HR: 82 RR: 14 O2: 100%RA
.
Gen: Comfortable, pleasant, A+Ox3, no acute distress
HEENT: NCAT, PERRL, EOMI, slt scleral icterus, no LAD, flat JVP

FAMILY HISTORY: Father-HTN, MI in his 80s
Mother- "spine cancer"

SOCIAL HISTORY: The pt denies current cigarette use, but reports smoking 10
cig/day for 20 years.  He also quit drinking 1 [**12-26**] yr ago but
prior had drank for 23 years with 1 pint of gin or brandy a day. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Alcoholic cirrhosis of liver,Unspecified viral hepatitis C without hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Awaiting organ transplant status,Mitral valve disorders,Esophageal varices without mention of bleeding,Esophagitis, unspecified,Unspecified disorder of stomach and duodenum,Benign neoplasm of duodenum, jejunum, and ileum,Gout, unspecified'}
