CHIEF COMPLAINT: lightheadedness x 24h

PRESENT ILLNESS: This is a 58yo generally healthy male who presented with c/o
lightheadedness x 24h, admitted to [**Hospital Unit Name 153**] for melena.  He reported
3 episodes of dark stools yesterday.  No BRBPR or hematochezia.
He endorses nausea and palpitations; no CP or SOB.  No syncope
or LOC.  Takes ASA 81 mg daily and 2 glasses wine per week; no
other NSAIDs.  No fever or chills.  No abdominal pain.  No sick
contacts.
.
In the ED, he was tachycardic with a normal BP.  Hct returned at
18.8, and he was started on 2 units pRBCs.  Rectal exam showed
melena; NG lavage was negative.  EKG showed RBBB with mild
inferolat ST depressions.  He received IV protonix 40 mg and 2L
NS.  GI was consulted.  He also was febrile to 101 (prior to
receiving blood).
.
On arrival he reports feeling improved.  No lightheadedness.  No
more BMs since arrival to ED.  No history of heartburn,
hepatitis.  No prior EGD/colonoscopies.
.

MEDICAL HISTORY: h/o diarrhea last year

MEDICATION ON ADMISSION: MVI
ASA 81 mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Well nourished
Eyes / Conjunctiva: PERRL, Conjunctiva pale, Anicteric sclera
Head, Ears, Nose, Throat: OP clear with dry MM.
Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4,
(Murmur: No(t) Systolic)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : )
Abdominal: Soft, Non-tender, Bowel sounds present, No(t)
Distended, No masses
Extremities: Right: Absent, Left: Absent
Skin:  Not assessed, No(t) Jaundice

FAMILY HISTORY: No colon Ca, gastric Ca, IBD, hepatitis.  Mom with diabetes.

SOCIAL HISTORY: 2 glasses wine per week.  [**2-11**] ppd tobacco.  No illict drugs.
not working, came to US from [**Country **] 8 yr ago
.
Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Other and unspecified noninfectious gastroenteritis and colitis
Chr duoden ulcer w hem,Noninf gastroenterit NEC
Admission Date:  [**2178-3-11**]              Discharge Date:   [**2178-3-12**]

Date of Birth:  [**2119-3-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
lightheadedness x 24h


Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
This is a 58yo generally healthy male who presented with c/o
lightheadedness x 24h, admitted to [**Hospital Unit Name 153**] for melena.  He reported
3 episodes of dark stools yesterday.  No BRBPR or hematochezia.
He endorses nausea and palpitations; no CP or SOB.  No syncope
or LOC.  Takes ASA 81 mg daily and 2 glasses wine per week; no
other NSAIDs.  No fever or chills.  No abdominal pain.  No sick
contacts.
.
In the ED, he was tachycardic with a normal BP.  Hct returned at
18.8, and he was started on 2 units pRBCs.  Rectal exam showed
melena; NG lavage was negative.  EKG showed RBBB with mild
inferolat ST depressions.  He received IV protonix 40 mg and 2L
NS.  GI was consulted.  He also was febrile to 101 (prior to
receiving blood).
.
On arrival he reports feeling improved.  No lightheadedness.  No
more BMs since arrival to ED.  No history of heartburn,
hepatitis.  No prior EGD/colonoscopies.
.


Past Medical History:
h/o diarrhea last year


Social History:
2 glasses wine per week.  [**2-11**] ppd tobacco.  No illict drugs.
not working, came to US from [**Country **] 8 yr ago
.


Family History:
No colon Ca, gastric Ca, IBD, hepatitis.  Mom with diabetes.


Physical Exam:
General Appearance: Well nourished
Eyes / Conjunctiva: PERRL, Conjunctiva pale, Anicteric sclera
Head, Ears, Nose, Throat: OP clear with dry MM.
Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4,
(Murmur: No(t) Systolic)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : )
Abdominal: Soft, Non-tender, Bowel sounds present, No(t)
Distended, No masses
Extremities: Right: Absent, Left: Absent
Skin:  Not assessed, No(t) Jaundice


Pertinent Results:
[**2178-3-11**] 10:19AM   GLUCOSE-102 UREA N-21* CREAT-0.6 SODIUM-141
POTASSIUM-3.7 CHLORIDE-113* TOTAL CO2-22 ANION GAP-10
[**2178-3-11**] 02:05PM   HCT-25.2*
[**2178-3-11**] 10:19AM   CK-MB-2 cTropnT-<0.01
[**2178-3-11**] 10:19AM   PLT COUNT-180
[**2178-3-11**] 10:19AM   WBC-8.1 RBC-2.51* HGB-7.9* HCT-22.4* MCV-89
MCH-31.6 MCHC-35.4* RDW-14.3
[**2178-3-11**] 12:35AM   WBC-7.1 RBC-2.10*# HGB-6.8*# HCT-18.8*#
MCV-90 MCH-32.4* MCHC-36.1* RDW-13.6
[**2178-3-11**] 12:35AM   CK-MB-3 cTropnT-<0.01
.
Discharge labs [**3-12**]
WBC 7.3, Hct 32.3, Plts 186
BUN/Cr 12/0.7
Hct repeated 32.9
.
CXR [**3-11**]: Single frontal view shows no evidence of pneumonia or
other acute cardiopulmonary disease.
.
EKG: sinus @ 100, nl axis/intervals.  incom RBBB, borderline
LVH.

EGD [**2178-3-11**]:Two cratered ulcers in the duodenal bulb.
No fresh or old blood was found.
Otherwise normal EGD to second part of the duodenum

Brief Hospital Course:
58yoM who p/w w/ weakness and lightheadedness x 24h found to
have HCT 18.8. In the ED, he was transfused 2 units of prbcs and
his HCT increased appropriately. He was admitted to the [**Hospital Unit Name 153**] for
monitoring where he had not futher episodes of melenotic stools.
GI followed and performed an EGD which showed 2 cratered ulcers
at the duodenal bulb.  He was initially maintained on IV PPI
until the day of discharge when GI recommended he be switched
over to PO PPI. His HCT remained stable throughout the remainder
of his hospitalization. He was set up for an outpt colonoscopy.
Also during this admission, he ruled out for MI. His ASA was
held. He was transiently febrile upon his admission which was
thought possibly to be due to resolving gastroenteritis. All cx
were negative as was his CXR. He remained afebrile without a
leukocytosis for the remainder of his admission.

Medications on Admission:
MVI
ASA 81 mg

Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day for 8 weeks:
duration to be determined by gastroenterology clinic.
Disp:*120 Capsule, Delayed Release(E.C.)(s)* Refills:*3*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1. gastrointestinal bleeding


Discharge Condition:
Good, with stable hematocrit and no gross active bleeding


Discharge Instructions:
You were in the intensive care unit because of blood in your
stools. You were seen by the gastroenterology doctors [**First Name (Titles) **] [**Name5 (PTitle) 21110**] [**Name5 (PTitle) **] endoscopy study to look for the source of bleeding.
You were found to have ulcers in the duodenum (the first part of
the small intestine). You will need to take an acid-reducing
medicine called omeprazole to reduce the risk of ulcer bleeding.
It is important that you keep your appointment for a colonoscopy
to make sure there is no other source of bleeding. We strongly
encourage you to stop smoking. Please talk to your primary care
doctor if you need help quitting.

Please do not restart your aspirin until you have seen the
gastroenterology doctors and have [**Name5 (PTitle) 19301**] told that you may take
aspirin. Please take all of your medications as directed and
keep your follow up  appointments.

Followup Instructions:
Your colonoscopy is scheduled for [**2178-4-21**] at 8:30. Call
[**Telephone/Fax (1) 463**] for the GI department if you have any questions.

Provider: [**Name10 (NameIs) **] WEST,ROOM THREE GI ROOMS Date/Time:[**2178-4-21**] 8:30
Provider: [**Name10 (NameIs) **] PROCEDURES FELLOW Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2178-4-21**] 8:30


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Other and unspecified noninfectious gastroenteritis and colitis'}


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: lightheadedness x 24h

PRESENT ILLNESS: This is a 58yo generally healthy male who presented with c/o
lightheadedness x 24h, admitted to [**Hospital Unit Name 153**] for melena.  He reported
3 episodes of dark stools yesterday.  No BRBPR or hematochezia.
He endorses nausea and palpitations; no CP or SOB.  No syncope
or LOC.  Takes ASA 81 mg daily and 2 glasses wine per week; no
other NSAIDs.  No fever or chills.  No abdominal pain.  No sick
contacts.
.
In the ED, he was tachycardic with a normal BP.  Hct returned at
18.8, and he was started on 2 units pRBCs.  Rectal exam showed
melena; NG lavage was negative.  EKG showed RBBB with mild
inferolat ST depressions.  He received IV protonix 40 mg and 2L
NS.  GI was consulted.  He also was febrile to 101 (prior to
receiving blood).
.
On arrival he reports feeling improved.  No lightheadedness.  No
more BMs since arrival to ED.  No history of heartburn,
hepatitis.  No prior EGD/colonoscopies.
.

MEDICAL HISTORY: h/o diarrhea last year

MEDICATION ON ADMISSION: MVI
ASA 81 mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Well nourished
Eyes / Conjunctiva: PERRL, Conjunctiva pale, Anicteric sclera
Head, Ears, Nose, Throat: OP clear with dry MM.
Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4,
(Murmur: No(t) Systolic)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : )
Abdominal: Soft, Non-tender, Bowel sounds present, No(t)
Distended, No masses
Extremities: Right: Absent, Left: Absent
Skin:  Not assessed, No(t) Jaundice

FAMILY HISTORY: No colon Ca, gastric Ca, IBD, hepatitis.  Mom with diabetes.

SOCIAL HISTORY: 2 glasses wine per week.  [**2-11**] ppd tobacco.  No illict drugs.
not working, came to US from [**Country **] 8 yr ago
. 

### Response:
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Other and unspecified noninfectious gastroenteritis and colitis'}
