CHIEF COMPLAINT: melena

PRESENT ILLNESS: 68 yom with PAF, CAD, Ampullary Adenomas and GAVE w/ recurrent
upper GIB, s/p recent EGD on [**2141-3-27**] w/ resection of ampullary
lesions p/w 1 episode of melena and blood tinged stool in last
24 hours. Patient was travelling in DC when had episode of
melena. Became concerned when the following morning - day of
admission he had a second blood tinged stool. Patient felt light
headed yesterday as well. No syncope. Then got on a flight home
and presented to [**Hospital3 17031**] for evaluation.
.
In the ED, T97, HR 77, BP 107/55, RR 18, 100% RA. Blood tinged
stool - guaiac positive. NG lavage negative. 2 large bore IV's
placed. Given 1L NS. Hgb 8 on presentation from 11.6 previously.
Transfused 2 units PRBC's and started on PPI gtt w/ bolus.
Transferred to [**Hospital1 18**] for further management. Has been NPO since
this AM.
.
Denies any BM's since this AM. No other bloody stools since
procedure before yesterday. No associated belly pain, nausea,
emesis, diarrhea, constipation, fever, chest pain, SOB or other
complaints. Denies recent Aspirin use, and recent coumadin use.

MEDICAL HISTORY: - asymptomatic ampullary adenoma
- h/o duodenal ulcers, with UGIB on coumadin three prior
occasions
- Paroxysmal Atrial Fibrillation/Atrial Flutter s/p ablations -
previously on warfarin and ASA but not on anticoagulation at
this time, rate controlled in sinus.
- CAD, no prior MI
- Lung Ca - partial lobectomy, no recurrence.

MEDICATION ON ADMISSION: Aldactone 25 daily
HCTZ 25
Atenolol 50mg [**Hospital1 **]
Simvastatin 20
Latanoprost 0.05% Solution

ALLERGIES: Cocaine

PHYSICAL EXAM: AF, VSS
General Appearance: Well nourished, No acute distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic
Cardiovascular: regular, no murmur
Respiratory / Chest: (clear
Extremities: no edema,
Skin:  no lesion
Neurologic: normal gait, grossly intact

FAMILY HISTORY: NC

SOCIAL HISTORY: NC
Blood in stool,Atrial flutter,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Personal history of malignant neoplasm of bronchus and lung,Unspecified disorder of kidney and ureter,Tobacco use disorder
Blood in stool,Atrial flutter,Ac posthemorrhag anemia,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Crnry athrscl natve vssl,Angio stm/dudn w/o hmrhg,Hx-bronchogenic malignan,Renal & ureteral dis NOS,Tobacco use disorder
Admission Date:  [**2141-4-7**]              Discharge Date:   [**2141-4-10**]

Date of Birth:  [**2072-7-17**]             Sex:   M

Service: MEDICINE

Allergies:
Cocaine

Attending:[**First Name3 (LF) 358**]
Chief Complaint:
melena

Major Surgical or Invasive Procedure:
endoscopy


History of Present Illness:
68 yom with PAF, CAD, Ampullary Adenomas and GAVE w/ recurrent
upper GIB, s/p recent EGD on [**2141-3-27**] w/ resection of ampullary
lesions p/w 1 episode of melena and blood tinged stool in last
24 hours. Patient was travelling in DC when had episode of
melena. Became concerned when the following morning - day of
admission he had a second blood tinged stool. Patient felt light
headed yesterday as well. No syncope. Then got on a flight home
and presented to [**Hospital3 17031**] for evaluation.
.
In the ED, T97, HR 77, BP 107/55, RR 18, 100% RA. Blood tinged
stool - guaiac positive. NG lavage negative. 2 large bore IV's
placed. Given 1L NS. Hgb 8 on presentation from 11.6 previously.
Transfused 2 units PRBC's and started on PPI gtt w/ bolus.
Transferred to [**Hospital1 18**] for further management. Has been NPO since
this AM.
.
Denies any BM's since this AM. No other bloody stools since
procedure before yesterday. No associated belly pain, nausea,
emesis, diarrhea, constipation, fever, chest pain, SOB or other
complaints. Denies recent Aspirin use, and recent coumadin use.

.
ROS: Negative.


Past Medical History:
- asymptomatic ampullary adenoma
- h/o duodenal ulcers, with UGIB on coumadin three prior
occasions
- Paroxysmal Atrial Fibrillation/Atrial Flutter s/p ablations -
previously on warfarin and ASA but not on anticoagulation at
this time, rate controlled in sinus.
- CAD, no prior MI
- Lung Ca - partial lobectomy, no recurrence.


Social History:
NC

Family History:
NC

Physical Exam:
AF, VSS
General Appearance: Well nourished, No acute distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic
Cardiovascular: regular, no murmur
Respiratory / Chest: (clear
Extremities: no edema,
Skin:  no lesion
Neurologic: normal gait, grossly intact

Pertinent Results:
Admission:
[**2141-4-7**] 10:21PM BLOOD WBC-4.3 RBC-3.04* Hgb-9.4* Hct-27.7*
MCV-91 MCH-30.9 MCHC-34.0 RDW-15.3 Plt Ct-131*
[**2141-4-8**] 05:17AM BLOOD WBC-3.2* RBC-2.79* Hgb-8.8* Hct-27.0*
MCV-97 MCH-31.4 MCHC-32.4 RDW-15.5 Plt Ct-110*
[**2141-4-8**] 08:06AM BLOOD Hct-29.7*
[**2141-4-8**] 02:58PM BLOOD Hct-32.7*
[**2141-4-8**] 10:31PM BLOOD Hct-29.6*
[**2141-4-9**] 05:29AM BLOOD Hct-29.9*
[**2141-4-9**] 05:29AM BLOOD Glucose-156* UreaN-28* Creat-1.3* Na-138
K-4.6 Cl-110* HCO3-22 AnGap-11
[**2141-4-9**] 05:29AM BLOOD Calcium-8.7 Phos-2.6* Mg-2.1
[**2141-4-7**] 10:21PM BLOOD ALT-18 AST-16 LD(LDH)-111 AlkPhos-50
TotBili-1.0
=======================
[**2141-4-10**] 06:15AM BLOOD WBC-3.8* RBC-3.47* Hgb-10.6* Hct-30.6*
MCV-88# MCH-30.7 MCHC-34.7 RDW-14.7 Plt Ct-153
[**2141-4-10**] 06:15AM BLOOD Glucose-125* UreaN-31* Creat-1.5* Na-141
K-4.0 Cl-110* HCO3-22 AnGap-13
[**2141-4-10**] 06:15AM BLOOD Mg-2.1
[**2141-4-7**] 10:21PM BLOOD ALT-18 AST-16 LD(LDH)-111 AlkPhos-50
TotBili-1.0
=======================
SPECIMEN SUBMITTED: DUODENUM LESION...1 JAR.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2141-3-27**] [**2141-3-27**] [**2141-4-4**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **],DR. [**Last Name (STitle) **].
[**Doctor Last Name 7001**]/mb????????????

DIAGNOSIS:



Duodenal lesion (A-D):

Fragments of adenoma, with focal high grade dysplasia.


Brief Hospital Course:
68 y/o M w/ h/o GAVE, recent resection of adenomas a/w melena
and BRBPR.
.

#GIB:  EGD showed erythema and congestion in the antrum
compatible with gastric antral vascular ectasia. Area of
previous polypectomy site distal to the papilla without stigmata
of bleeding. Area of previous polypectomy site proximal to
papilla with flat red spot.
Hematocrit remained stable throughout the remainder of stay.
.
#duodenal adenoma s/p polypectomy -- see "results" section for
pathology.  Patient was informed his tissue had dysplasia, and
he would need close follow up with his primary
gastroenterologist as well as Drs. [**Last Name (STitle) 39930**] and [**Name5 (PTitle) **] for
repeat EGD and possible future resection of the site.

#chronic kidney disease -- near baseline.
.

#PAF: In Sinus. Off ASA and warfarin. Added back atenolol once
stable.
.

#CAD: not taking aspirin currently.  held beta-blocker, pt
resumed at discharge.
.

#HTN: resumed medications at discharge.
.


Medications on Admission:
Aldactone 25 daily
HCTZ 25
Atenolol 50mg [**Hospital1 **]
Simvastatin 20
Latanoprost 0.05% Solution


Discharge Medications:
1. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
2. Atenolol 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
1. upper GI bleeding
2. duodenal adenoma with focal high grade dysplasia, s/p
resection


Discharge Condition:
stable, hct stable


Discharge Instructions:
You were hospitalized with GI bleeding.  The bleeding was
probably from your polypectomy site.  Please return to the
emergency department if you have bloody or dark, tarry stool,
fever, chills, lightheadedness, chest pain.  Stop smoking, as it
contributes to many chronic illnesses and death.  Do not take
aspirin, NSAIDs (ibuprofen, aleve, naprosen) for at least 10
days, as they increase your risk of bleeding.  Because of the
abnormal cells seen in your polyp resected [**2141-3-27**], you should be
seen by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 39930**] to discuss further
interventions.

Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 16827**] Date/Time:[**2141-4-28**] 8:40
Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2141-9-22**]
11:00
Provider: [**Name10 (NameIs) **] [**Apartment Address(1) **] (ST-3) GI ROOMS Date/Time:[**2141-9-22**] 11:00

Please call Dr. [**First Name (STitle) **] [**Name (STitle) 39930**] to make a follow up appointment
within the next two weeks.
{'Blood in stool,Atrial flutter,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Personal history of malignant neoplasm of bronchus and lung,Unspecified disorder of kidney and ureter,Tobacco use 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: melena

PRESENT ILLNESS: 68 yom with PAF, CAD, Ampullary Adenomas and GAVE w/ recurrent
upper GIB, s/p recent EGD on [**2141-3-27**] w/ resection of ampullary
lesions p/w 1 episode of melena and blood tinged stool in last
24 hours. Patient was travelling in DC when had episode of
melena. Became concerned when the following morning - day of
admission he had a second blood tinged stool. Patient felt light
headed yesterday as well. No syncope. Then got on a flight home
and presented to [**Hospital3 17031**] for evaluation.
.
In the ED, T97, HR 77, BP 107/55, RR 18, 100% RA. Blood tinged
stool - guaiac positive. NG lavage negative. 2 large bore IV's
placed. Given 1L NS. Hgb 8 on presentation from 11.6 previously.
Transfused 2 units PRBC's and started on PPI gtt w/ bolus.
Transferred to [**Hospital1 18**] for further management. Has been NPO since
this AM.
.
Denies any BM's since this AM. No other bloody stools since
procedure before yesterday. No associated belly pain, nausea,
emesis, diarrhea, constipation, fever, chest pain, SOB or other
complaints. Denies recent Aspirin use, and recent coumadin use.

MEDICAL HISTORY: - asymptomatic ampullary adenoma
- h/o duodenal ulcers, with UGIB on coumadin three prior
occasions
- Paroxysmal Atrial Fibrillation/Atrial Flutter s/p ablations -
previously on warfarin and ASA but not on anticoagulation at
this time, rate controlled in sinus.
- CAD, no prior MI
- Lung Ca - partial lobectomy, no recurrence.

MEDICATION ON ADMISSION: Aldactone 25 daily
HCTZ 25
Atenolol 50mg [**Hospital1 **]
Simvastatin 20
Latanoprost 0.05% Solution

ALLERGIES: Cocaine

PHYSICAL EXAM: AF, VSS
General Appearance: Well nourished, No acute distress
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic
Cardiovascular: regular, no murmur
Respiratory / Chest: (clear
Extremities: no edema,
Skin:  no lesion
Neurologic: normal gait, grossly intact

FAMILY HISTORY: NC

SOCIAL HISTORY: NC 

### Response:
{'Blood in stool,Atrial flutter,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Personal history of malignant neoplasm of bronchus and lung,Unspecified disorder of kidney and ureter,Tobacco use disorder'}
