CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: Ms. [**Known lastname **] is a 54 year-old female with a history of Crohn's
disease complicated by strictures and recurrent flares,
currently on steroids, who presents with a 1-week history of
rectal bleeding. She was most recently admitted to [**Hospital1 18**] in
[**5-/2173**] for Crohn's flare and rectal bleeding, treated with
steroids and Pentasa, as well as empiric antibiotics. She
self-discontinued Pentasa after discharge, and tapered her
Prednisone. She was down to 10 mg daily on [**2173-7-12**].
*
She reports a 1-week history of intermittent rectal bleeding,
starting on [**7-14**]. The bleeding was intermittent, painless, and
separate from bowel movements. She notes baseline occasional
abdominal cramping, without a change in the past week. 2 BMs per
day. She restarted Cipro on [**7-14**]. She bled again on [**6-3**], and [**7-21**]. She was seen in Dr.[**Name (NI) 18707**] office on [**2173-7-21**],
at which time a large amount of blood was seen on rectal
examination and around her anus externally. Her blood counts
were stable. She declined an admission. Her Prednisone was
increased to 60 mg daily, decreased to 30 mg on [**7-22**].
*
A flexible sigmoidoscopy was arranged for today. She ended
having a colonoscopy, which revelaed multiple pseudopolyps and
an ulceration with a visible vessel at 20 cm, treated with
epinephrine and clipped with 4 clips. Blood loss estimated at 1
liter. She was admitted to the [**Hospital Unit Name 153**] for close hemodynamic
monitoring.
*
On ROS, she denies chest pain, SOB, lightheadeness or dizziness.
No recent fever or chills.

MEDICAL HISTORY: 1. Crohn's disease diagnosed in [**2147**], c/b strictures status
post sigmoid stricturoplasty [**3-21**], status post anal fistula
surgery. Has been on Remicade, was stopped [**3-18**] paresthesias.
Also with E nodosum and L episcleritis [**2173-7-20**].
2. Status post tubal ligation
3. History of herpes Zoster in left eye [**2164**]

MEDICATION ON ADMISSION: Prednisone, recently increased to 60 mg on [**2173-7-21**], down to 30
mg yesterday.
Cipro 500 mg PO BID (started [**2173-7-14**])

ALLERGIES: Levofloxacin

PHYSICAL EXAM: VITALS: T 96.3, BP 158/95, HR 73, RR 22, Sat 100% on RA.
GEN: In NAD, smiling.
HEENT: Left conjunctival injection.
NECK: JVP flat.
CVS: RRR. Normal S1, S2. No S3, S4.
RESP: CTAB, without adventitious sounds.
ABD: BS NA. Abdomen soft, mild LLQ tenderness to palpation.
EXT: Without edema.
NEURO: A&O X3.

FAMILY HISTORY: Mother had [**Name (NI) 4522**] disease. Mother's sister had
[**Name (NI) 4522**], and maybe mother's father had [**Name (NI) 4522**] disease. She has
an older sister with [**Name (NI) 4522**], and another sister has had
diverticulitis.

SOCIAL HISTORY: Works in billing at waste mgmt facility. Lives with
granddaughter, has [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], dog, and a cat. Quit smoking [**12-19**]
with patch; smoked 1ppd for most of her life prior to that. Has
2 children. Denies EtOH or IVDU.
Regional enteritis of large intestine,Acute posthemorrhagic anemia,Long-term (current) use of steroids
Reg enteritis, lg intest,Ac posthemorrhag anemia,Long-term use steroids
Admission Date:  [**2173-7-23**]              Discharge Date:   [**2173-7-24**]

Date of Birth:  [**2119-7-22**]             Sex:   F

Service: MEDICINE

Allergies:
Levofloxacin

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
colonoscopy


History of Present Illness:
Ms. [**Known lastname **] is a 54 year-old female with a history of Crohn's
disease complicated by strictures and recurrent flares,
currently on steroids, who presents with a 1-week history of
rectal bleeding. She was most recently admitted to [**Hospital1 18**] in
[**5-/2173**] for Crohn's flare and rectal bleeding, treated with
steroids and Pentasa, as well as empiric antibiotics. She
self-discontinued Pentasa after discharge, and tapered her
Prednisone. She was down to 10 mg daily on [**2173-7-12**].
*
She reports a 1-week history of intermittent rectal bleeding,
starting on [**7-14**]. The bleeding was intermittent, painless, and
separate from bowel movements. She notes baseline occasional
abdominal cramping, without a change in the past week. 2 BMs per
day. She restarted Cipro on [**7-14**]. She bled again on [**6-3**], and [**7-21**]. She was seen in Dr.[**Name (NI) 18707**] office on [**2173-7-21**],
at which time a large amount of blood was seen on rectal
examination and around her anus externally. Her blood counts
were stable. She declined an admission. Her Prednisone was
increased to 60 mg daily, decreased to 30 mg on [**7-22**].
*
A flexible sigmoidoscopy was arranged for today. She ended
having a colonoscopy, which revelaed multiple pseudopolyps and
an ulceration with a visible vessel at 20 cm, treated with
epinephrine and clipped with 4 clips. Blood loss estimated at 1
liter. She was admitted to the [**Hospital Unit Name 153**] for close hemodynamic
monitoring.
*
On ROS, she denies chest pain, SOB, lightheadeness or dizziness.
No recent fever or chills.


Past Medical History:
1. Crohn's disease diagnosed in [**2147**], c/b strictures status
post sigmoid stricturoplasty [**3-21**], status post anal fistula
surgery. Has been on Remicade, was stopped [**3-18**] paresthesias.
Also with E nodosum and L episcleritis [**2173-7-20**].
2. Status post tubal ligation
3. History of herpes Zoster in left eye [**2164**]

Social History:
Works in billing at waste mgmt facility. Lives with
granddaughter, has [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], dog, and a cat. Quit smoking [**12-19**]
with patch; smoked 1ppd for most of her life prior to that. Has
2 children. Denies EtOH or IVDU.


Family History:
Mother had [**Name (NI) 4522**] disease. Mother's sister had
[**Name (NI) 4522**], and maybe mother's father had [**Name (NI) 4522**] disease. She has
an older sister with [**Name (NI) 4522**], and another sister has had
diverticulitis.


Physical Exam:
VITALS: T 96.3, BP 158/95, HR 73, RR 22, Sat 100% on RA.
GEN: In NAD, smiling.
HEENT: Left conjunctival injection.
NECK: JVP flat.
CVS: RRR. Normal S1, S2. No S3, S4.
RESP: CTAB, without adventitious sounds.
ABD: BS NA. Abdomen soft, mild LLQ tenderness to palpation.
EXT: Without edema.
NEURO: A&O X3.

Pertinent Results:
Colonoscopy [**2173-7-23**]: Scattered pseudopolyps throughout the
colon. Small amount of dark blood mixed with stool in terminal
ileum. On scope withdrawal, an ulceration with a visible vessel
was found at 20 cm. Epinephrine was injected around the ulcer,
slowing down the bleeding. 4 hemoclips were applited to the
ulcer, and the bleeding appeared to have stopped. 2 of the clips
fell off.

Brief Hospital Course:
1) Hematochezia: On colonoscopy patient was found to have
bleeding from a visible vessel in an ulcer which was secondary
to active Crohn's disease.  The vessel was treated with
epinephrine injection and clipping with good hemostasis.  She
was admitted to the [**Hospital Unit Name 153**] for close observation.  She remained
hemodynamically stable with stable hematocrits overnight.  There
was no further bleeding from her rectum.
*
2) Crohn's disease: Patient was continued on Prednisone 30 mg
and Cipro, and restarted on Pentasa 1250 mg PO TID.  She was
discharged with follow-up with Dr. [**Last Name (STitle) 79**].
*
3) FEN: Regular diet. Lytes repleted as necessary.
*
4) Ppx: Ambulation. No need for PPI. No need for bowel regimen.
*
5) Dispo: Home

Medications on Admission:
Prednisone, recently increased to 60 mg on [**2173-7-21**], down to 30
mg yesterday.
Cipro 500 mg PO BID (started [**2173-7-14**])

Discharge Medications:
1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
Disp:*60 Tablet(s)* Refills:*2*
2. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*0*
3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
4. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
6. Mesalamine 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO three times a day.
Disp:*60 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Crohn's flare
Colonic ulcer s/p hemostatic clipping


Discharge Condition:
stable to be discharged home


Discharge Instructions:
Follow up with appointments as below.
.
Take medications as below.
.
If develop worsening blood from below, dizziness or
lightheadedness, shortness of breath, chest pain, nausea or
vomiting of blood or any other symptom, please call Dr. [**Last Name (STitle) 79**] or
report to the nearest ER.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1954**]
Date/Time:[**2173-8-3**] 2:40


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Regional enteritis of large intestine,Acute posthemorrhagic anemia,Long-term (current) use of steroids'}


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: BRBPR

PRESENT ILLNESS: Ms. [**Known lastname **] is a 54 year-old female with a history of Crohn's
disease complicated by strictures and recurrent flares,
currently on steroids, who presents with a 1-week history of
rectal bleeding. She was most recently admitted to [**Hospital1 18**] in
[**5-/2173**] for Crohn's flare and rectal bleeding, treated with
steroids and Pentasa, as well as empiric antibiotics. She
self-discontinued Pentasa after discharge, and tapered her
Prednisone. She was down to 10 mg daily on [**2173-7-12**].
*
She reports a 1-week history of intermittent rectal bleeding,
starting on [**7-14**]. The bleeding was intermittent, painless, and
separate from bowel movements. She notes baseline occasional
abdominal cramping, without a change in the past week. 2 BMs per
day. She restarted Cipro on [**7-14**]. She bled again on [**6-3**], and [**7-21**]. She was seen in Dr.[**Name (NI) 18707**] office on [**2173-7-21**],
at which time a large amount of blood was seen on rectal
examination and around her anus externally. Her blood counts
were stable. She declined an admission. Her Prednisone was
increased to 60 mg daily, decreased to 30 mg on [**7-22**].
*
A flexible sigmoidoscopy was arranged for today. She ended
having a colonoscopy, which revelaed multiple pseudopolyps and
an ulceration with a visible vessel at 20 cm, treated with
epinephrine and clipped with 4 clips. Blood loss estimated at 1
liter. She was admitted to the [**Hospital Unit Name 153**] for close hemodynamic
monitoring.
*
On ROS, she denies chest pain, SOB, lightheadeness or dizziness.
No recent fever or chills.

MEDICAL HISTORY: 1. Crohn's disease diagnosed in [**2147**], c/b strictures status
post sigmoid stricturoplasty [**3-21**], status post anal fistula
surgery. Has been on Remicade, was stopped [**3-18**] paresthesias.
Also with E nodosum and L episcleritis [**2173-7-20**].
2. Status post tubal ligation
3. History of herpes Zoster in left eye [**2164**]

MEDICATION ON ADMISSION: Prednisone, recently increased to 60 mg on [**2173-7-21**], down to 30
mg yesterday.
Cipro 500 mg PO BID (started [**2173-7-14**])

ALLERGIES: Levofloxacin

PHYSICAL EXAM: VITALS: T 96.3, BP 158/95, HR 73, RR 22, Sat 100% on RA.
GEN: In NAD, smiling.
HEENT: Left conjunctival injection.
NECK: JVP flat.
CVS: RRR. Normal S1, S2. No S3, S4.
RESP: CTAB, without adventitious sounds.
ABD: BS NA. Abdomen soft, mild LLQ tenderness to palpation.
EXT: Without edema.
NEURO: A&O X3.

FAMILY HISTORY: Mother had [**Name (NI) 4522**] disease. Mother's sister had
[**Name (NI) 4522**], and maybe mother's father had [**Name (NI) 4522**] disease. She has
an older sister with [**Name (NI) 4522**], and another sister has had
diverticulitis.

SOCIAL HISTORY: Works in billing at waste mgmt facility. Lives with
granddaughter, has [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], dog, and a cat. Quit smoking [**12-19**]
with patch; smoked 1ppd for most of her life prior to that. Has
2 children. Denies EtOH or IVDU. 

### Response:
{'Regional enteritis of large intestine,Acute posthemorrhagic anemia,Long-term (current) use of steroids'}
