CHIEF COMPLAINT: Upper GI bleed s/p duodenal polypectomy

PRESENT ILLNESS: 46 y/o F with PMhx of MUTYH associated polyposis who underwent
duodenal polypectomy on [**8-17**] and returned home that evening. She
noticed some black stools but was feeling otherwise at baseline.
In the evening, she noticed some mild nausea which progressed to
emesis of BRB. This was followed by episodes of BRB per rectum,
lightheadedness, diaphoresis and chills. She was in the bathroom
with her husband when she had a witnessed syncopal episode
without any head trauma. She was taken to [**Hospital3 **], admitted to the ICU with a hct of 28.6 and SBPs in 100s.
She received a total of 2 units prbcs, IVF and was started on a
PPI and octreotide gtt. She underwent a EGD which revealed
active bleeding, this was treated with local epinephrine prior
to transfer to [**Hospital1 18**].
.
Pt had a transient episode of sbp in the 80s during transfer
which responded to a 250cc bolus of IVF. She remained
asymptomatic and on arrival to the ICU, she was denying
lightheadedness, nausea, palpitations, chest pain, shortness of
breath, weakness or abdominal pain.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. No dysuria. Denied arthralgias or
myalgias.

MEDICAL HISTORY: Appendectomy
MUTYH associated polyposis (followed with yearly colonoscopy and
now regular EGDs)

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.9 BP: 121/66 P: 73 R: 12 O2: 94%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: soft, NT/ND, NABS, no rebound tenderness or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Rectal: guaic + melanotic stool

FAMILY HISTORY: + FAP syndrome

SOCIAL HISTORY: She works as a nurse at an IVF center and lives at home with
four children and her husband. She denies smoking and drink [**1-29**]
alcohol beverages per day. Denies any history of withdrawal.
Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Benign neoplasm of colon,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Hemorrhage complic proc,Ac posthemorrhag anemia,Benign neoplasm lg bowel,Abn react-surg proc NEC
Admission Date:  [**2123-8-18**]              Discharge Date:   [**2123-8-20**]

Date of Birth:  [**2076-11-21**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5893**]
Chief Complaint:
Upper GI bleed s/p duodenal polypectomy

Major Surgical or Invasive Procedure:
None


History of Present Illness:
46 y/o F with PMhx of MUTYH associated polyposis who underwent
duodenal polypectomy on [**8-17**] and returned home that evening. She
noticed some black stools but was feeling otherwise at baseline.
In the evening, she noticed some mild nausea which progressed to
emesis of BRB. This was followed by episodes of BRB per rectum,
lightheadedness, diaphoresis and chills. She was in the bathroom
with her husband when she had a witnessed syncopal episode
without any head trauma. She was taken to [**Hospital3 **], admitted to the ICU with a hct of 28.6 and SBPs in 100s.
She received a total of 2 units prbcs, IVF and was started on a
PPI and octreotide gtt. She underwent a EGD which revealed
active bleeding, this was treated with local epinephrine prior
to transfer to [**Hospital1 18**].
.
Pt had a transient episode of sbp in the 80s during transfer
which responded to a 250cc bolus of IVF. She remained
asymptomatic and on arrival to the ICU, she was denying
lightheadedness, nausea, palpitations, chest pain, shortness of
breath, weakness or abdominal pain.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. No dysuria. Denied arthralgias or
myalgias.


Past Medical History:
Appendectomy
MUTYH associated polyposis (followed with yearly colonoscopy and
now regular EGDs)


Social History:
She works as a nurse at an IVF center and lives at home with
four children and her husband. She denies smoking and drink [**1-29**]
alcohol beverages per day. Denies any history of withdrawal.

Family History:
+ FAP syndrome

Physical Exam:
Vitals: T: 97.9 BP: 121/66 P: 73 R: 12 O2: 94%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: soft, NT/ND, NABS, no rebound tenderness or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Rectal: guaic + melanotic stool


Pertinent Results:
[**2123-8-18**] 09:49PM   GLUCOSE-117* UREA N-6 CREAT-0.6 SODIUM-141
POTASSIUM-3.6 CHLORIDE-113* TOTAL CO2-25 ANION GAP-7*
[**2123-8-18**] 09:49PM   estGFR-Using this
[**2123-8-18**] 09:49PM   ALT(SGPT)-8 AST(SGOT)-10 ALK PHOS-33* TOT
BILI-0.7
[**2123-8-18**] 09:49PM   WBC-8.0 RBC-2.96* HGB-9.1* HCT-27.2* MCV-92
MCH-30.8 MCHC-33.6 RDW-13.7
[**2123-8-18**] 09:49PM   NEUTS-67.4 LYMPHS-26.0 MONOS-5.5 EOS-1.1
BASOS-0.1
[**2123-8-18**] 09:49PM   PLT COUNT-205
[**2123-8-18**] 09:49PM   PT-11.9 PTT-22.2 INR(PT)-1.0

[**2123-8-20**] 04:33AM BLOOD WBC-5.6 RBC-2.75* Hgb-8.7* Hct-25.3*
MCV-92 MCH-31.5 MCHC-34.2 RDW-13.1 Plt Ct-198

Brief Hospital Course:
46 y/o F with PMhx of MAP who presents with upper GI bleed s/p
duodenal polypectomy on [**8-17**].

# Upper GI Bleed: When Mrs. [**Known lastname 2520**] arrived to the [**Hospital Unit Name 153**] all vital
signs were stable. She was s/p EGD with local epi injections and
2u prbcs as well as IVF at an OSH. Initially there was a very
minor amount of melena in the [**Hospital Unit Name 153**] which subsequently resolved
and there were no repeat episodes of melena, emesis, or BRBPR.
Her Hcts were stable in the range of 25-27. No further
transfusions were necessary. The octreodide drip was continued
over night and stopped the next morning. IV PPI was given [**Hospital1 **]
and switched to PO on discharge. Her diet was advanced and on
[**8-20**] she was tolerating a full diet. GI did not feel that repeat
EGD was necessary at this time and will repeat it in 2 months as
an outpatient.
.

# MAP: Pt with known polyposis syndrome with risk for malignant
transformation. Up until this year she has undergone yearly
colonoscopies that result in removal of several polyps each
time. [**2123-6-28**] was her first EGD which revealed the duodenal
polyp that was removed just prior to admission. She will follow
up regularly with GI (Dr. [**Last Name (STitle) **] for colonoscopies/EGDs.

Medications on Admission:
None

Discharge Medications:
Pantoprazole 40mg PO daily
Ferrous Sulfate 325 mg PO daily

Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Upper gastrointestinal bleed
Secondary: MAP


Discharge Condition:
Afebrile, stable vital signs, tolerating normal diet, ambulatory


Discharge Instructions:
You were admitted because of bleeding from your gastroinestinal
tract. You were treated with some fluids, lansoprazole IV, and
octreotide IV.
At home, your medicines will be changed and you can take:
1. Ferrous sulfate 325mg by mouth once/day
2. Pantoprazole 40mg by mouth once/day

Please take all medicines as prescribed. Please follow-up with
all appointments. Please do not hesitate to return to the
hospital for any concerning symptoms such as bleeding,
lightheadedness, fainting, or anything else concerning.

Followup Instructions:
Follow-up with your gastroenterologist, Dr. [**Last Name (STitle) **], for repeat
EGD and colonoscopy as he recommends.
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Benign neoplasm of colon,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Upper GI bleed s/p duodenal polypectomy

PRESENT ILLNESS: 46 y/o F with PMhx of MUTYH associated polyposis who underwent
duodenal polypectomy on [**8-17**] and returned home that evening. She
noticed some black stools but was feeling otherwise at baseline.
In the evening, she noticed some mild nausea which progressed to
emesis of BRB. This was followed by episodes of BRB per rectum,
lightheadedness, diaphoresis and chills. She was in the bathroom
with her husband when she had a witnessed syncopal episode
without any head trauma. She was taken to [**Hospital3 **], admitted to the ICU with a hct of 28.6 and SBPs in 100s.
She received a total of 2 units prbcs, IVF and was started on a
PPI and octreotide gtt. She underwent a EGD which revealed
active bleeding, this was treated with local epinephrine prior
to transfer to [**Hospital1 18**].
.
Pt had a transient episode of sbp in the 80s during transfer
which responded to a 250cc bolus of IVF. She remained
asymptomatic and on arrival to the ICU, she was denying
lightheadedness, nausea, palpitations, chest pain, shortness of
breath, weakness or abdominal pain.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. No dysuria. Denied arthralgias or
myalgias.

MEDICAL HISTORY: Appendectomy
MUTYH associated polyposis (followed with yearly colonoscopy and
now regular EGDs)

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97.9 BP: 121/66 P: 73 R: 12 O2: 94%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no m/r/g
Abdomen: soft, NT/ND, NABS, no rebound tenderness or guarding
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Rectal: guaic + melanotic stool

FAMILY HISTORY: + FAP syndrome

SOCIAL HISTORY: She works as a nurse at an IVF center and lives at home with
four children and her husband. She denies smoking and drink [**1-29**]
alcohol beverages per day. Denies any history of withdrawal. 

### Response:
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Benign neoplasm of colon,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
