CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, the patient is a
79-year-old gentleman who presented with bright red blood per
rectum.  He has had multiple episodes of this prior to
admission and presented slightly tachycardic.

MEDICAL HISTORY: 1.  Peptic ulcer disease.
2.  Coronary artery disease.
3.  Hypertension.
4.  Arthritis.

MEDICATION ON ADMISSION: (His medications on admission
included)
1.  Toprol-XL 100 mg by mouth once per day.
2.  Aspirin 81 mg by mouth once per day.
3.  Accupril 20 mg by mouth once per day.
4.  Imdur 60 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Pravachol 10 mg by mouth once per day.
7.  Hydrochlorothiazide 25 mg by mouth three times per day.
8.  Vioxx by mouth as needed.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hemorrhage of gastrointestinal tract, unspecified,Acute vascular insufficiency of intestine,Peripheral vascular complications, not elsewhere classified,Embolism and thrombosis of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified peritonitis,Anemia, unspecified,Esophageal reflux,Unspecified essential hypertension
Gastrointest hemorr NOS,Ac vasc insuff intestine,Surg comp-peri vasc syst,Iliac artery embolism,Accidental op laceration,Peritonitis NOS,Anemia NOS,Esophageal reflux,Hypertension NOS
Admission Date:  [**2152-1-9**]     Discharge Date:  [**2152-1-16**]


Service:  Surgery, Green Team

HISTORY OF PRESENT ILLNESS:  Briefly, the patient is a
79-year-old gentleman who presented with bright red blood per
rectum.  He has had multiple episodes of this prior to
admission and presented slightly tachycardic.

The patient was admitted to the Medical Intensive Care Unit
and large bore IV access was obtained and resuscitation was
begun.

PAST MEDICAL HISTORY:
1.  Peptic ulcer disease.
2.  Coronary artery disease.
3.  Hypertension.
4.  Arthritis.

PAST SURGICAL HISTORY:
1.  He is status post a total gastrectomy and Billroth II
reconstruction.
2.  He is also status post revision of his Billroth II to a
Roux-en-Y in [**2151-10-18**] for biliary reflux.
3.  He is also status post coronary artery bypass graft in
[**2141**].

MEDICATIONS ON ADMISSION:  (His medications on admission
included)
1.  Toprol-XL 100 mg by mouth once per day.
2.  Aspirin 81 mg by mouth once per day.
3.  Accupril 20 mg by mouth once per day.
4.  Imdur 60 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Pravachol 10 mg by mouth once per day.
7.  Hydrochlorothiazide 25 mg by mouth three times per day.
8.  Vioxx by mouth as needed.

PHYSICAL EXAMINATION ON PRESENTATION:  The patient's physical
examination revealed he was afebrile.  He was tachycardic and
mildly hypotensive.  The patient was in mild distress.  His
lungs were clear.  His heart was regular.  His abdomen was
soft, nontender, and nondistended.  Bowel sounds were
present.  His rectal examination was guaiac-positive.

BRIEF SUMMARY OF HOSPITAL COURSE:  The patient was admitted
to the Medicine Service.  He was transfused multiple units
and sent to tagged red cell scan.  The tagged red cell scan
was positive for a bleed in a question of the duodenum.  He
was taken to angio at that time.  After a 3-vessel angio it
was found that he had bleeding of the hepatic flexure, and
this was coiled successfully.  The patient was then taken
back to the Intensive Care Unit, and hematocrit levels were
cycled, and he was stable from this standpoint.

The patient was examined on hospital day two and was found to
have peritoneal signs.  He was taken emergently to the
operating room for an exploratory laparotomy and right
colectomy.  Please see the Operative Report for further
details.

Postoperatively, the patient was transferred to the Intensive
Care Unit and slowly improved.  His hematocrit was
stabilized.  He was making good urine, and the patient was
able to do well.

He was transferred to the floor, and after return of bowel
function his diet was slowly advanced.  He was able to
tolerate a regular diet before the time of discharge.
Physical Therapy was also consulted, and the patient began
ambulating and did well from a Physical Therapy standpoint.
It was felt that he could go home and follow up with for a
home safety evaluation.

The patient continued to improve.  His intravenous fluids
were Heplocked.  His diet was advanced, and the patient was
tolerating regular food.  He was slowly restarted on all of
his medications including his antihypertensive medications.

The patient was doing well on postoperative day five.  The
patient was discharged to home.  His staples were removed,
and Steri-Strips were placed prior to discharge.  The patient
was tolerating a regular diet at this time.

DISCHARGE STATUS:  The patient was discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

PRIMARY DISCHARGE DIAGNOSES:
1.  Lower gastrointestinal bleed.
2.  Status post tagged red cell scan.
3.  Status post angio coiling of the left colon complicated
by right colonic ischemia.
4.  Status post exploratory laparotomy and right colectomy.

SECONDARY DISCHARGE DIAGNOSES:
1.  Peptic ulcer disease.
2.  Coronary artery disease.
3.  Hypertension.
4.  Arthritis.
5.  Status post subtotal gastrectomy and Billroth II
reconstruction.
6.  Status post revision of his Billroth II to a Roux-en-Y
for biliary reflux.
7.  Status post coronary artery bypass graft.

MEDICATIONS ON DISCHARGE:  He was given prescriptions for
Percocet and Colace as well as to continue all of his home
medications.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was instructed
to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in one to two weeks for a
wound check.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3799**], M.D.  [**MD Number(1) 3800**]

Dictated By:[**Known firstname **]

MEDQUIST36

D:  [**2152-1-16**]  07:28
T:  [**2152-1-16**]  09:37
JOB#:  [**Job Number 53924**]
{'Hemorrhage of gastrointestinal tract, unspecified,Acute vascular insufficiency of intestine,Peripheral vascular complications, not elsewhere classified,Embolism and thrombosis of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified peritonitis,Anemia, unspecified,Esophageal reflux,Unspecified essential hypertension'}


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: 

PRESENT ILLNESS: Briefly, the patient is a
79-year-old gentleman who presented with bright red blood per
rectum.  He has had multiple episodes of this prior to
admission and presented slightly tachycardic.

MEDICAL HISTORY: 1.  Peptic ulcer disease.
2.  Coronary artery disease.
3.  Hypertension.
4.  Arthritis.

MEDICATION ON ADMISSION: (His medications on admission
included)
1.  Toprol-XL 100 mg by mouth once per day.
2.  Aspirin 81 mg by mouth once per day.
3.  Accupril 20 mg by mouth once per day.
4.  Imdur 60 mg by mouth once per day.
5.  Protonix 40 mg by mouth once per day.
6.  Pravachol 10 mg by mouth once per day.
7.  Hydrochlorothiazide 25 mg by mouth three times per day.
8.  Vioxx by mouth as needed.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute vascular insufficiency of intestine,Peripheral vascular complications, not elsewhere classified,Embolism and thrombosis of iliac artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Unspecified peritonitis,Anemia, unspecified,Esophageal reflux,Unspecified essential hypertension'}
