CHIEF COMPLAINT: hematochezia

PRESENT ILLNESS: 61yo woman with PMH signficant for hemorrhoids s/p
hemorrhoidectomy [**4-30**] admitted with recurrent BRBPR x several
months with dizziness. Pt was initially admitted to [**Hospital1 **] for hemorrhoidal surgery. There were no reported
complications. The next day she noted subjective fevers and left
cervical lymphadenopathy. She began to have more frequent bowel
movements in the next 5 days, up to 4x per day.
Several days prior to admission, she began to have diarrhea. The
day prior to admission, the patient had a large amount of
hematochezia (3 episodes of urgency w/ blood only, per EMS
report, approx 1L), associated with abdominal cramping, worsened
diarrhea, lightheadedness, then presyncope. She denies syncope
except possibly when w/ EMS, and denies any head trauma. Notes
diaphoresis, cold skin. Per report, this blood was a darker red
than her bleeding months ago.

MEDICAL HISTORY: hemorrhoids - since age 20
COPD - on 2.5 L oxygen during exertion
osteoarthritis
obstructive sleep apnea on CPAP
?CHF - EF unknown
h/o colon polyps - [**11-13**] polypectomy
s/p tonsilectomy
s/p appendectomy

MEDICATION ON ADMISSION: (doses unknown)
1. lasix
2. Accolate
3. Celebrex
4. DuoNebs
5. Combivent
6. Advair
7. Tramadol
8. KCl
9. Effexor
10. Catapress
11. Ambien

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 99.2, Tc 97.8, HR 92(89-110), BP 127/54(97-131/41-57), RR
19, SaO2 98%/3L, I/O 4475/940
Genl: NAD, obese, initially very somnolent, but able to wake up
and converse
HEENT: NCAT, anicteric sclera, PERRL, MMM, OP clear
Neck: L cervical LAD - 2 LNs, mobile, rubbery
CV: RRR, nl S1, S2, no m/r/g
Chest: CTA bilaterally with decreased air flow throughout
Abd: soft, NTND, BS+, well-healed scar
Ext: warm & dry, no pitting edema, PP+
Neuro: grossly intact

FAMILY HISTORY: h/o colon CA

SOCIAL HISTORY: h/o tobacco use, occasional EtOH. Divorced.
Hemorrhage complicating a procedure,Iron deficiency anemia secondary to blood loss (chronic),Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Anal fissure,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric)
Hemorrhage complic proc,Chr blood loss anemia,React-indwell urin cath,Urin tract infection NOS,CHF NOS,Chr airway obstruct NEC,Anal fissure,Abn react-urinary cath,Obstructive sleep apnea
Admission Date:  [**2187-5-11**]              Discharge Date:   [**2187-5-14**]

Date of Birth:  [**2126-4-22**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
hematochezia

Major Surgical or Invasive Procedure:
anoscopy

History of Present Illness:
61yo woman with PMH signficant for hemorrhoids s/p
hemorrhoidectomy [**4-30**] admitted with recurrent BRBPR x several
months with dizziness. Pt was initially admitted to [**Hospital1 **] for hemorrhoidal surgery. There were no reported
complications. The next day she noted subjective fevers and left
cervical lymphadenopathy. She began to have more frequent bowel
movements in the next 5 days, up to 4x per day.
Several days prior to admission, she began to have diarrhea. The
day prior to admission, the patient had a large amount of
hematochezia (3 episodes of urgency w/ blood only, per EMS
report, approx 1L), associated with abdominal cramping, worsened
diarrhea, lightheadedness, then presyncope. She denies syncope
except possibly when w/ EMS, and denies any head trauma. Notes
diaphoresis, cold skin. Per report, this blood was a darker red
than her bleeding months ago.

She contined to have BRBPR in the ambulance.

In the ED, her SBP was 90s, HR 120s. She received 2 units PRBCs
with improvement to SBP 105, HR 110. She was admitted to the
MICU.

Past Medical History:
hemorrhoids - since age 20
COPD - on 2.5 L oxygen during exertion
osteoarthritis
obstructive sleep apnea on CPAP
?CHF - EF unknown
h/o colon polyps - [**11-13**] polypectomy
s/p tonsilectomy
s/p appendectomy


Social History:
h/o tobacco use, occasional EtOH. Divorced.

Family History:
h/o colon CA

Physical Exam:
VS: Tm 99.2, Tc 97.8, HR 92(89-110), BP 127/54(97-131/41-57), RR
19, SaO2 98%/3L, I/O 4475/940
Genl: NAD, obese, initially very somnolent, but able to wake up
and converse
HEENT: NCAT, anicteric sclera, PERRL, MMM, OP clear
Neck: L cervical LAD - 2 LNs, mobile, rubbery
CV: RRR, nl S1, S2, no m/r/g
Chest: CTA bilaterally with decreased air flow throughout
Abd: soft, NTND, BS+, well-healed scar
Ext: warm & dry, no pitting edema, PP+
Neuro: grossly intact


Pertinent Results:
Admission labs:
CBC: WBC-13.1* RBC-4.72 Hgb-13.5 Hct-39.6 MCV-84 MCH-28.6
MCHC-34.2 RDW-13.8 Plt Ct-378
Coags: PT-11.6 PTT-21.6* INR(PT)-1.0
Chem10: Glucose-131* UreaN-15 Creat-0.7 Na-141 K-4.0 Cl-106
HCO3-23 Calcium-8.6 Phos-2.8 Mg-2.1
Enzymes: ALT-29 AST-30 LD(LDH)-180 AlkPhos-105 TotBili-0.3
Amylase-36 Albumin-4.1
Serum tox: ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG

Discharge labs:
CBC: WBC-8.9 RBC-3.86* Hgb-11.1* Hct-32.8* MCV-85 MCH-28.8
MCHC-33.9 RDW-14.2 Plt Ct-280
Chem10: Glucose-94 UreaN-8 Creat-0.7 Na-138 K-4.4 Cl-105
HCO3-17*
Calcium-8.1* Phos-2.8 Mg-2.1

[**2187-5-12**] 2:07 pm URINE      Source: Catheter.

   URINE CULTURE (Preliminary):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------    32 R
CEFEPIME--------------       PND
CEFTAZIDIME-----------       PND
CEFTRIAXONE-----------       PND
CEFUROXIME------------       PND
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
IMIPENEM--------------   <=1 S
LEVOFLOXACIN----------<=0.25 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------    64 I
PIPERACILLIN----------       PND
PIPERACILLIN/TAZO-----     8 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S


Brief Hospital Course:
61yo woman with PMH signficant for hemorrhoids s/p
hemorrhoidectomy admitted w/ GIB thought secondary to anal
fissure near site of surgical repair, with stable Hct and
hemodynamics throughout hospitalization.

Hospital course is reviewed below by problem:

1. GIB - GI and surgery were consulted. The patient underwent
anoscopy in the ED, which showed a rectal tear, not actively
bleeding, near the site of her recent surgery. Given these
results, this was the most likely source of the bleed. She was
initially given 2 units PRBCs, then significant IVF while she
was NPO. Her hematocrit remained relatively stable. With stable
hematocrits and hemodynamics, as well as a possible source for
the bleed, no further intervention was indicated. The patient
had several hemoccult positive bowel movements prior to
discharge similar to those she had had in the past several
months, but no further episodes of large volume hematochezia.
Given the patient's celebrex use, she was started on a PPI. She
would likely benefit from EGD as an outpatient.

2. UTI - During the hospitalization, the patient had a foley
catheter in place and was noted to have cloudy urine. A
urinalysis showed pt w/ markedly dirty urinalysis. The foley
catheter was removed. She was treated with ciprofloxacin to
complete a 7 day course given the catheter-associated UTI. Urine
culture results were pending at discharge, but show E coli
sensitive to ciprofloxacin.

3. COPD - She was treated with nebulizers, advair, montelukast,
and supplemental O2 with goal SaO2 93% (this is home SaO2 at
rest). She was initially put on oxygen during the day but this
was weaned off prior to discharge. She was put on her home
regimen on discharge.

4. obstructive sleep apnea - She uses CPAP at home, but this was
held here given her settings were not known. She was instructed
to restart CPAP once home. She was put on supplemental oxygen
while asleep.

5. CHF - She was given IVF for most of the hospital stay. She
was discharged on her home regimen of lasix, dose unknown. She
may benefit from an outpatient ECHO given her history of CHF
without known recent evaluation.

6. psych - She was continued on effexor (a low dose as she did
not know her home dose), as well as ambien. Trazodone was tried
for insomnia, but was ineffective.

Commun - HCP sister [**Name (NI) **] [**Initial (NamePattern1) **] [**Known lastname 1637**] [**Telephone/Fax (1) 97016**], mother is
[**Name (NI) **] [**Initial (NamePattern1) **] [**Known lastname 1637**] [**Telephone/Fax (1) 97017**]
Code status - full


Medications on Admission:
(doses unknown)
1. lasix
2. Accolate
3. Celebrex
4. DuoNebs
5. Combivent
6. Advair
7. Tramadol
8. KCl
9. Effexor
10. Catapress
11. Ambien


Discharge Medications:
1. Furosemide  Oral
2. Celebrex  Oral
3. Albuterol-Ipratropium 2.5-0.5 mg/3 mL Solution Sig: One (1)
nebulizer treatment Inhalation every six (6) hours.
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-11**]
puffs Inhalation every six (6) hours as needed for shortness of
breath or wheezing.
5. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
6. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
7. Effexor XR  Oral
8. Catapres  Oral
9. Accolate 20 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
11. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 4 days.
Disp:*8 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Hematochezia thought secondary to rectal tear
Status post hemorrhoidectomy
Urinary tract infection, catheter-associated
Chronic obstructive pulmonary disease
Obstructive sleep apnea


Discharge Condition:
Stable; hematocrit and hemodynamics are stable and the patient
is asymptomatic.


Discharge Instructions:
Continue all medications as previously prescribed. You should
also take omeprazole, a medication to prevent bleeding in your
stomach while you are on the celebrex. You will need to take the
ciprofloxacin until you have finished all the pills prescribed
(4 more days).

Please call your doctor for a follow up appointment.

Go to the emergency room if you have any more episodes of rectal
bleeding, or if you have lightheadedness, dizziness, nausea,
vomiting up blood, chest pain, difficulty breathing, or any
other concerning symptoms.

Followup Instructions:
Please call Dr. [**Last Name (STitle) 4469**] ([**Telephone/Fax (1) 4475**]) for a follow up
appointment and discuss possible endoscopy. Please call Dr.
[**Last Name (STitle) 43078**] ([**Telephone/Fax (1) 97018**]) to make a follow up appointment within
the next two weeks to discuss the rectal tear.
{'Hemorrhage complicating a procedure,Iron deficiency anemia secondary to blood loss (chronic),Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Anal fissure,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric)'}


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: hematochezia

PRESENT ILLNESS: 61yo woman with PMH signficant for hemorrhoids s/p
hemorrhoidectomy [**4-30**] admitted with recurrent BRBPR x several
months with dizziness. Pt was initially admitted to [**Hospital1 **] for hemorrhoidal surgery. There were no reported
complications. The next day she noted subjective fevers and left
cervical lymphadenopathy. She began to have more frequent bowel
movements in the next 5 days, up to 4x per day.
Several days prior to admission, she began to have diarrhea. The
day prior to admission, the patient had a large amount of
hematochezia (3 episodes of urgency w/ blood only, per EMS
report, approx 1L), associated with abdominal cramping, worsened
diarrhea, lightheadedness, then presyncope. She denies syncope
except possibly when w/ EMS, and denies any head trauma. Notes
diaphoresis, cold skin. Per report, this blood was a darker red
than her bleeding months ago.

MEDICAL HISTORY: hemorrhoids - since age 20
COPD - on 2.5 L oxygen during exertion
osteoarthritis
obstructive sleep apnea on CPAP
?CHF - EF unknown
h/o colon polyps - [**11-13**] polypectomy
s/p tonsilectomy
s/p appendectomy

MEDICATION ON ADMISSION: (doses unknown)
1. lasix
2. Accolate
3. Celebrex
4. DuoNebs
5. Combivent
6. Advair
7. Tramadol
8. KCl
9. Effexor
10. Catapress
11. Ambien

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm 99.2, Tc 97.8, HR 92(89-110), BP 127/54(97-131/41-57), RR
19, SaO2 98%/3L, I/O 4475/940
Genl: NAD, obese, initially very somnolent, but able to wake up
and converse
HEENT: NCAT, anicteric sclera, PERRL, MMM, OP clear
Neck: L cervical LAD - 2 LNs, mobile, rubbery
CV: RRR, nl S1, S2, no m/r/g
Chest: CTA bilaterally with decreased air flow throughout
Abd: soft, NTND, BS+, well-healed scar
Ext: warm & dry, no pitting edema, PP+
Neuro: grossly intact

FAMILY HISTORY: h/o colon CA

SOCIAL HISTORY: h/o tobacco use, occasional EtOH. Divorced. 

### Response:
{'Hemorrhage complicating a procedure,Iron deficiency anemia secondary to blood loss (chronic),Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Anal fissure,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric)'}
