CHIEF COMPLAINT: hypotension, GI bleed

PRESENT ILLNESS: Mr. [**Known firstname 1806**] [**Known lastname 86651**] is a 52 year old man with history of
metastatic esophageal adenocarcinoma to the liver s/p esophageal
stenting ([**2123-6-3**]) who presents from oncology clinic with
upper GI bleed and hypotension SBP 80s, admitted to [**Hospital Unit Name 153**] [**12-13**],
transferred to OMED [**12-14**].
.
Patient reports recurrent pattern of nausea, hematemesis and
dark stools during his chemotherapy cycles.  He reports these
symptoms restarted less than a week after starting his most
recent cycle.  His symptoms and hematocrit are closely monitored
by Dr. [**Last Name (STitle) 3274**] in his outpatient oncology clinic.  On [**2123-12-3**]
he started his seventh cycle of EOX. In clinic he received 2
units of pRBC for Hgb 7.9/Hct 24 in anticipation of blood loss
with repeat Hgb 9.8/Hct 29.4. He returned to Dr.[**Name (NI) 3279**]
office on [**2123-12-10**] for follow up and Hct/Hgb remained low
7.7/22.4. At this time he received 3 units of pRBC with
inappropriate bump to 9.0/26.2. He stopped taking his
chemotherapy on [**2123-12-10**] and had his last episode of hematemesis
on the morning of [**2123-12-12**].  He presented to clinic [**12-13**] for
follow up and though feeling much better he was found to have
Hct 24.7 and systolic blood pressures in the 80s. Given concern
for hemodynamic instability he was sent to the ED for further
evaluation.
.
In the ED, initial vs were: T 98.6 P 71 BP 93/54 R 16 O2 sat
100% RA. Patient received pantoprazole continuous drip, zofran 4
mg IV, 1 u pRBC, and 1 L NS.  He was transferred to [**Hospital Unit Name 153**] for
concern of ongoing upper GI bleed and hypotension with SBP in
the 90s.
.
In the [**Hospital Unit Name 153**], he denied any dizziness, shortness of breath, or
chest pain. He had not had any hematemesis or bowel movements in
over 24 hours.  The patient denied significant concern about
these symptoms as he had similar GI symptoms with his prior
cycle of chemotherapy which resolved with ending the
chemotherapy cycle. He was transfused 2 units blood and 1 unit
plts, and Hct was stable prior to transfer to floor.  CT showed
stent embedded in stomach.
.
He denies use of alcohol, NSAIDS, antiplatelet therapy or
anticoagulation. He reports good compliance to current regimen
of prilosec [**Hospital1 **], Tagamet (cimetidine), and occasional antacid.
.
He currently reports no complaints.  Denies pain and nausea.
Eager to eat "normal" food for dinner. Has not had a BM since
admitted.  currently refusing EGD but willing to discuss further
in AM

MEDICAL HISTORY: - Metastatic esophogeal cancer to the liver, tissue diagnosis
[**6-4**] Poorly-differentiated carcinoma with neuroendocrine
differentiation
  - s/p esophagogastroduodenoscopy with esophageal stent
placement [**2123-6-3**]
  - chemotherapy, s/p cycle 7 of EOX (q21d): epirubicin,
oxaliplatin and xeloda d1-14
- History of torn R ACL- not repaired
- left leg > right leg varicose veins which is chronic since
remote skiing accident
- history of RUE DVT in the setting of PICC line ([**6-/2123**])
- osteoarthritis

MEDICATION ON ADMISSION: - CAPECITABINE [XELODA] -  (Prescribed by Other Provider) - 500
mg
Tablet - Tablet(s) by mouth 2tablets in am and 3 tablets in pm
Take for ONLY 14 days during each chemotherapy cycle
- CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth once a day
- LORAZEPAM - 0.5 mg Tablet - [**2-6**] Tablet(s) by mouth q 6-8 h prn
as
needed for prn anxiety/nausea
- ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by
mouth
q 8-12 h as needed for nausea/vomiting
- OXYCODONE - 5 mg Tablet - 2 Tablet(s) by mouth q4-6
- OXYCODONE [OXYCONTIN] - 10 mg Tablet Sustained Release 12 hr -
3
Tablet(s) by mouth every twelve (12) hours
- PANTOPRAZOLE -  (Prescribed by Other Provider: [**Name Initial (NameIs) **]) - 40
mg
Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
- ZOLPIDEM - 10 mg Tablet - 1 (One) Tablet(s) by mouth at
bedtime prn
- Tagamet almost daily prn
- Mylanta [**Hospital1 **] prn
- dilaudid prn, unclear dosage

ALLERGIES: Prochlorperazine

PHYSICAL EXAM: Vitals: 97.6  602  98/56-102/55  16  98%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-distended, decreased bowel sounds, no rebound
tenderness or guarding, + epigastric pain with deep palpation.
GU: no foley
Ext: warm, well perfused, no cyanosis or edema.
Skin: multiple scattered excoriation throughout the body, dry
skin

FAMILY HISTORY: - "everyone lives to the 90s"
- denies cancer, heart disease, diabetes, clotting or bleeding
diseases

SOCIAL HISTORY: - technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None
Malignant neoplasm of esophagus, unspecified site,Thrombocytopenia, unspecified,Esophageal hemorrhage,Malignant neoplasm of liver, secondary,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Hypotension, unspecified,Fever, unspecified,Dysthymic disorder,Unspecified pruritic disorder
Mal neo esophagus NOS,Thrombocytopenia NOS,Esophageal hemorrhage,Second malig neo liver,Ac posthemorrhag anemia,Hyposmolality,Hypotension NOS,Fever NOS,Dysthymic disorder,Pruritic disorder NOS
Admission Date:  [**2123-12-13**]              Discharge Date:   [**2123-12-15**]

Date of Birth:  [**2071-5-15**]             Sex:   M

Service: MEDICINE

Allergies:
Prochlorperazine

Attending:[**First Name3 (LF) 4282**]
Chief Complaint:
hypotension, GI bleed

Major Surgical or Invasive Procedure:
PRBC transfusion

History of Present Illness:
Mr. [**Known firstname 1806**] [**Known lastname 86651**] is a 52 year old man with history of
metastatic esophageal adenocarcinoma to the liver s/p esophageal
stenting ([**2123-6-3**]) who presents from oncology clinic with
upper GI bleed and hypotension SBP 80s, admitted to [**Hospital Unit Name 153**] [**12-13**],
transferred to OMED [**12-14**].
.
Patient reports recurrent pattern of nausea, hematemesis and
dark stools during his chemotherapy cycles.  He reports these
symptoms restarted less than a week after starting his most
recent cycle.  His symptoms and hematocrit are closely monitored
by Dr. [**Last Name (STitle) 3274**] in his outpatient oncology clinic.  On [**2123-12-3**]
he started his seventh cycle of EOX. In clinic he received 2
units of pRBC for Hgb 7.9/Hct 24 in anticipation of blood loss
with repeat Hgb 9.8/Hct 29.4. He returned to Dr.[**Name (NI) 3279**]
office on [**2123-12-10**] for follow up and Hct/Hgb remained low
7.7/22.4. At this time he received 3 units of pRBC with
inappropriate bump to 9.0/26.2. He stopped taking his
chemotherapy on [**2123-12-10**] and had his last episode of hematemesis
on the morning of [**2123-12-12**].  He presented to clinic [**12-13**] for
follow up and though feeling much better he was found to have
Hct 24.7 and systolic blood pressures in the 80s. Given concern
for hemodynamic instability he was sent to the ED for further
evaluation.
.
In the ED, initial vs were: T 98.6 P 71 BP 93/54 R 16 O2 sat
100% RA. Patient received pantoprazole continuous drip, zofran 4
mg IV, 1 u pRBC, and 1 L NS.  He was transferred to [**Hospital Unit Name 153**] for
concern of ongoing upper GI bleed and hypotension with SBP in
the 90s.
.
In the [**Hospital Unit Name 153**], he denied any dizziness, shortness of breath, or
chest pain. He had not had any hematemesis or bowel movements in
over 24 hours.  The patient denied significant concern about
these symptoms as he had similar GI symptoms with his prior
cycle of chemotherapy which resolved with ending the
chemotherapy cycle. He was transfused 2 units blood and 1 unit
plts, and Hct was stable prior to transfer to floor.  CT showed
stent embedded in stomach.
.
He denies use of alcohol, NSAIDS, antiplatelet therapy or
anticoagulation. He reports good compliance to current regimen
of prilosec [**Hospital1 **], Tagamet (cimetidine), and occasional antacid.
.
He currently reports no complaints.  Denies pain and nausea.
Eager to eat "normal" food for dinner. Has not had a BM since
admitted.  currently refusing EGD but willing to discuss further
in AM


Past Medical History:
- Metastatic esophogeal cancer to the liver, tissue diagnosis
[**6-4**] Poorly-differentiated carcinoma with neuroendocrine
differentiation
  - s/p esophagogastroduodenoscopy with esophageal stent
placement [**2123-6-3**]
  - chemotherapy, s/p cycle 7 of EOX (q21d): epirubicin,
oxaliplatin and xeloda d1-14
- History of torn R ACL- not repaired
- left leg > right leg varicose veins which is chronic since
remote skiing accident
- history of RUE DVT in the setting of PICC line ([**6-/2123**])
- osteoarthritis


Social History:
- technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None


Family History:
- "everyone lives to the 90s"
- denies cancer, heart disease, diabetes, clotting or bleeding
diseases


Physical Exam:
Vitals: 97.6  602  98/56-102/55  16  98%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-distended, decreased bowel sounds, no rebound
tenderness or guarding, + epigastric pain with deep palpation.
GU: no foley
Ext: warm, well perfused, no cyanosis or edema.
Skin: multiple scattered excoriation throughout the body, dry
skin


Pertinent Results:
[**2123-12-13**] 11:20PM   HCT-23.9*
[**2123-12-13**] 11:20PM   PLT COUNT-96*
[**2123-12-13**] 07:49PM   GLUCOSE-88 UREA N-8 CREAT-0.5 SODIUM-130*
POTASSIUM-3.9 CHLORIDE-98 TOTAL CO2-28 ANION GAP-8
[**2123-12-13**] 07:49PM   CALCIUM-7.8* PHOSPHATE-3.8 MAGNESIUM-1.8
[**2123-12-13**] 07:49PM   WBC-3.7* RBC-2.70* HGB-8.5* HCT-25.3* MCV-94
MCH-31.4 MCHC-33.5 RDW-17.0*
[**2123-12-13**] 07:49PM   PLT COUNT-72*
[**2123-12-13**] 10:30AM   UREA N-9 CREAT-0.6 SODIUM-129* POTASSIUM-4.0
CHLORIDE-96 TOTAL CO2-29 ANION GAP-8
[**2123-12-13**] 10:30AM   estGFR-Using this
[**2123-12-13**] 10:30AM   ALT(SGPT)-30 AST(SGOT)-52* ALK PHOS-239* TOT
BILI-0.5
[**2123-12-13**] 10:30AM   CALCIUM-8.4
[**2123-12-13**] 10:30AM   PT-12.5 PTT-29.5 INR(PT)-1.1
[**2123-12-13**] 09:07AM   WBC-4.1 RBC-2.60* HGB-8.3* HCT-24.7* MCV-95
MCH-32.1* MCHC-33.8 RDW-17.5*
[**2123-12-13**] 09:07AM   PLT SMR-LOW PLT COUNT-85*
[**2123-12-13**] 09:07AM   GRAN CT-2930

Brief Hospital Course:
Mr. [**Known firstname 1806**] [**Known lastname 86651**] is a 52 year old man with history of
metastatic esophageal adenocarcinoma to the liver s/p esophageal
stenting ([**2123-6-3**]) who presents from oncology clinic with
upper GI bleed and hypotension SBP 80s, admitted to [**Hospital Unit Name 153**] [**12-13**],
transferred to OMED [**12-14**].
.
# GI Bleeding.  Likely bleeding from esophageal adenocarcinoma
post chemo from sloughing vs bleeding from migrated stent.  CT
abdomen shows local increase in the size of tumour, in
particular at the proximal aspect of the stent in the esophagus
and posterior mediastinum as well as of the large mass centered
in the stomach.  Hcts stable.  No further bleeding.  Tolerating
diet. Thoracic [**Doctor First Name **] input: currently no surgical intervention.
Patient refusing EGD.  F/u with oncology and rad-onc.
.
#Fevers: Spiked to 102 overnight [**Date range (1) 25029**].  [**Month (only) 116**] be related to
underlying malignancy. No leukocytosis.  No evidence for
infection.  CXR shows no evidence of PNA.  Blood and urine cx
pending at discharge.


Medications on Admission:
- CAPECITABINE [XELODA] -  (Prescribed by Other Provider) - 500
mg
Tablet - Tablet(s) by mouth 2tablets in am and 3 tablets in pm
Take for ONLY 14 days during each chemotherapy cycle
- CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth once a day
- LORAZEPAM - 0.5 mg Tablet - [**2-6**] Tablet(s) by mouth q 6-8 h prn
as
needed for prn anxiety/nausea
- ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by
mouth
q 8-12 h as needed for nausea/vomiting
- OXYCODONE - 5 mg Tablet - 2 Tablet(s) by mouth q4-6
- OXYCODONE [OXYCONTIN] - 10 mg Tablet Sustained Release 12 hr -
3
Tablet(s) by mouth every twelve (12) hours
- PANTOPRAZOLE -  (Prescribed by Other Provider: [**Name Initial (NameIs) **]) - 40
mg
Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
- ZOLPIDEM - 10 mg Tablet - 1 (One) Tablet(s) by mouth at
bedtime prn
- Tagamet almost daily prn
- Mylanta [**Hospital1 **] prn
- dilaudid prn, unclear dosage


Discharge Medications:
1. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Tablet(s)
2. lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for anxiety/insomnia.
3. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every 6-8 hours as needed for nausea.
4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
5. OxyContin 10 mg Tablet Sustained Release 12 hr Sig: Three (3)
Tablet Sustained Release 12 hr PO twice a day.
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
7. zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed for insomnia.
8. Mylanta  Oral
9. Dilaudid  Oral
10. capecitabine  Oral


Discharge Disposition:
Home

Discharge Diagnosis:
GI bleed, likely secondary to tumor.

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
You were admitted to [**Hospital1 69**] for GI
bleeding and low blood pressure.  You were given IV fluids and
your blood pressure improved.  You were transfused blood and
your hematocrit remained stable.  You decided against having an
endoscopy.

Please continue your home medications.

Followup Instructions:
The following appointments have been made for you:

Department: RADIOLOGY
When: THURSDAY [**2123-12-23**] at 10:00 AM
With: CAT SCAN [**Telephone/Fax (1) 327**]
Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage

Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2123-12-28**] at 9:30 AM
With: [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2123-12-28**] at 11:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4425**], RN [**Telephone/Fax (1) 22**]
Building: [**Hospital6 29**] [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Malignant neoplasm of esophagus, unspecified site,Thrombocytopenia, unspecified,Esophageal hemorrhage,Malignant neoplasm of liver, secondary,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Hypotension, unspecified,Fever, unspecified,Dysthymic disorder,Unspecified pruritic disorder'}


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: hypotension, GI bleed

PRESENT ILLNESS: Mr. [**Known firstname 1806**] [**Known lastname 86651**] is a 52 year old man with history of
metastatic esophageal adenocarcinoma to the liver s/p esophageal
stenting ([**2123-6-3**]) who presents from oncology clinic with
upper GI bleed and hypotension SBP 80s, admitted to [**Hospital Unit Name 153**] [**12-13**],
transferred to OMED [**12-14**].
.
Patient reports recurrent pattern of nausea, hematemesis and
dark stools during his chemotherapy cycles.  He reports these
symptoms restarted less than a week after starting his most
recent cycle.  His symptoms and hematocrit are closely monitored
by Dr. [**Last Name (STitle) 3274**] in his outpatient oncology clinic.  On [**2123-12-3**]
he started his seventh cycle of EOX. In clinic he received 2
units of pRBC for Hgb 7.9/Hct 24 in anticipation of blood loss
with repeat Hgb 9.8/Hct 29.4. He returned to Dr.[**Name (NI) 3279**]
office on [**2123-12-10**] for follow up and Hct/Hgb remained low
7.7/22.4. At this time he received 3 units of pRBC with
inappropriate bump to 9.0/26.2. He stopped taking his
chemotherapy on [**2123-12-10**] and had his last episode of hematemesis
on the morning of [**2123-12-12**].  He presented to clinic [**12-13**] for
follow up and though feeling much better he was found to have
Hct 24.7 and systolic blood pressures in the 80s. Given concern
for hemodynamic instability he was sent to the ED for further
evaluation.
.
In the ED, initial vs were: T 98.6 P 71 BP 93/54 R 16 O2 sat
100% RA. Patient received pantoprazole continuous drip, zofran 4
mg IV, 1 u pRBC, and 1 L NS.  He was transferred to [**Hospital Unit Name 153**] for
concern of ongoing upper GI bleed and hypotension with SBP in
the 90s.
.
In the [**Hospital Unit Name 153**], he denied any dizziness, shortness of breath, or
chest pain. He had not had any hematemesis or bowel movements in
over 24 hours.  The patient denied significant concern about
these symptoms as he had similar GI symptoms with his prior
cycle of chemotherapy which resolved with ending the
chemotherapy cycle. He was transfused 2 units blood and 1 unit
plts, and Hct was stable prior to transfer to floor.  CT showed
stent embedded in stomach.
.
He denies use of alcohol, NSAIDS, antiplatelet therapy or
anticoagulation. He reports good compliance to current regimen
of prilosec [**Hospital1 **], Tagamet (cimetidine), and occasional antacid.
.
He currently reports no complaints.  Denies pain and nausea.
Eager to eat "normal" food for dinner. Has not had a BM since
admitted.  currently refusing EGD but willing to discuss further
in AM

MEDICAL HISTORY: - Metastatic esophogeal cancer to the liver, tissue diagnosis
[**6-4**] Poorly-differentiated carcinoma with neuroendocrine
differentiation
  - s/p esophagogastroduodenoscopy with esophageal stent
placement [**2123-6-3**]
  - chemotherapy, s/p cycle 7 of EOX (q21d): epirubicin,
oxaliplatin and xeloda d1-14
- History of torn R ACL- not repaired
- left leg > right leg varicose veins which is chronic since
remote skiing accident
- history of RUE DVT in the setting of PICC line ([**6-/2123**])
- osteoarthritis

MEDICATION ON ADMISSION: - CAPECITABINE [XELODA] -  (Prescribed by Other Provider) - 500
mg
Tablet - Tablet(s) by mouth 2tablets in am and 3 tablets in pm
Take for ONLY 14 days during each chemotherapy cycle
- CITALOPRAM - 10 mg Tablet - 1 Tablet(s) by mouth once a day
- LORAZEPAM - 0.5 mg Tablet - [**2-6**] Tablet(s) by mouth q 6-8 h prn
as
needed for prn anxiety/nausea
- ONDANSETRON - 8 mg Tablet, Rapid Dissolve - 1 Tablet(s) by
mouth
q 8-12 h as needed for nausea/vomiting
- OXYCODONE - 5 mg Tablet - 2 Tablet(s) by mouth q4-6
- OXYCODONE [OXYCONTIN] - 10 mg Tablet Sustained Release 12 hr -
3
Tablet(s) by mouth every twelve (12) hours
- PANTOPRAZOLE -  (Prescribed by Other Provider: [**Name Initial (NameIs) **]) - 40
mg
Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth daily
- ZOLPIDEM - 10 mg Tablet - 1 (One) Tablet(s) by mouth at
bedtime prn
- Tagamet almost daily prn
- Mylanta [**Hospital1 **] prn
- dilaudid prn, unclear dosage

ALLERGIES: Prochlorperazine

PHYSICAL EXAM: Vitals: 97.6  602  98/56-102/55  16  98%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-distended, decreased bowel sounds, no rebound
tenderness or guarding, + epigastric pain with deep palpation.
GU: no foley
Ext: warm, well perfused, no cyanosis or edema.
Skin: multiple scattered excoriation throughout the body, dry
skin

FAMILY HISTORY: - "everyone lives to the 90s"
- denies cancer, heart disease, diabetes, clotting or bleeding
diseases

SOCIAL HISTORY: - technology officer to guide engineers, now on long term
disability
- Tobacco:  None
- Alcohol:  None (socially, none since [**5-/2123**])
- Illicits:  None 

### Response:
{'Malignant neoplasm of esophagus, unspecified site,Thrombocytopenia, unspecified,Esophageal hemorrhage,Malignant neoplasm of liver, secondary,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Hypotension, unspecified,Fever, unspecified,Dysthymic disorder,Unspecified pruritic disorder'}
