CHIEF COMPLAINT: Melena.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 805**] is a 74 year old
woman with an extensive past medical history including a
history of atrial fibrillation and flutter, seizure disorder,
dementia secondary to alcohol abuse and a history of lower GI
bleed with recently diagnosed diabetes mellitus who presents
to [**Hospital1 69**] from [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **]
after she was found to be passing large amounts of dark stool
with clots of blood.  The patient, upon presentation to the
Emergency Department denies abdominal pain or any other pain,
nausea, vomiting, diarrhea, or constipation.  She denies
fever or chills or dysuria.  She denies hematochezia.

MEDICAL HISTORY: 1.  Seizure disorder.
2.  History of atrial fibrillation/flutter.
3.  Osteoarthritis.
4.  Osteoporosis.
5.  Dementia felt to be secondary to alcohol abuse.
6.  History of lower GI bleed from diverticula.
7.  Diabetes mellitus, type 2, diagnosed in [**2117-4-13**].
8.  Cerebrovascular accident of the left frontal lobe with
    resulting ataxia and right hemi-CVA.
9.  History of falls.
10. Cataracts.
11. History of decubitus ulcer in the right buttock.
12. History of hyponatremia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is a resident of [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **].
Does not smoke.  Has a history of alcohol abuse (used to
drink one pint of vodka per day).  Son is involved in care.
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Diverticulosis of colon with hemorrhage,Helicobacter pylori [H. pylori],Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other convulsions,Atrial fibrillation,Hyposmolality and/or hyponatremia,Personal history of alcoholism
Chr stomach ulc w hem,Dvrtclo colon w hmrhg,Helicobacter pylori,Ac posthemorrhag anemia,Urin tract infection NOS,Convulsions NEC,Atrial fibrillation,Hyposmolality,Hx of alcoholism
Admission Date:  [**2117-12-19**]       Discharge Date:  [**2117-12-22**]

Date of Birth:   [**2043-11-11**]       Sex:  F

Service:  [**Hospital1 **] MED

CHIEF COMPLAINT:  Melena.

HISTORY OF PRESENT ILLNESS:  [**First Name8 (NamePattern2) **] [**Known lastname 805**] is a 74 year old
woman with an extensive past medical history including a
history of atrial fibrillation and flutter, seizure disorder,
dementia secondary to alcohol abuse and a history of lower GI
bleed with recently diagnosed diabetes mellitus who presents
to [**Hospital1 69**] from [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **]
after she was found to be passing large amounts of dark stool
with clots of blood.  The patient, upon presentation to the
Emergency Department denies abdominal pain or any other pain,
nausea, vomiting, diarrhea, or constipation.  She denies
fever or chills or dysuria.  She denies hematochezia.

At baseline, the patient is quite demented and most of her
history is thus obtained from the Emergency Department and
from paperwork from the nursing home.

In the Emergency Room, the patient was NG lavaged with no
coffee ground or bright red blood noted.  It was not
documented whether NG lavage revealed any bilious material.
The NG tube was subsequently removed.  The patient was noted
to be orthostatic.  She was typed and crossed and one unit of
packed red blood cells was given in the Emergency Department
as well as normal saline at 150 cc per hour.

The patient is admitted to Medicine at this point for further
treatment.

PAST MEDICAL HISTORY:
1.  Seizure disorder.
2.  History of atrial fibrillation/flutter.
3.  Osteoarthritis.
4.  Osteoporosis.
5.  Dementia felt to be secondary to alcohol abuse.
6.  History of lower GI bleed from diverticula.
7.  Diabetes mellitus, type 2, diagnosed in [**2117-4-13**].
8.  Cerebrovascular accident of the left frontal lobe with
    resulting ataxia and right hemi-CVA.
9.  History of falls.
10. Cataracts.
11. History of decubitus ulcer in the right buttock.
12. History of hyponatremia.

MEDICATIONS:
1.  Folate.
2.  MVI.
3.  Vitamin D.
4.  Glyburide 2.5 mg q. day.
5.  TUMS.
6.  Milk of Magnesia.
7.  Colace.
8.  Celebrex 200 mg twice a day.
9.  Dilantin 150 mg twice a day.
10. Trazodone 12.5 mg/37.5 mg.
11. Phenobarbital 75 mg q. day.
12. Diltiazem SR 120 mg q. day.
13. Aspirin 325 mg q. day.

SOCIAL HISTORY:  The patient is a resident of [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **].
Does not smoke.  Has a history of alcohol abuse (used to
drink one pint of vodka per day).  Son is involved in care.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  In the Emergency Department,
temperature 98.6 F.; blood pressure 140/60; pulse 73,
respiratory rate 20; O2 saturation 99% on room air.  In
general, this is an elderly female, alert, in bed, in no
acute distress.  Normocephalic, atraumatic.  Pupils surgical.
Extraocular muscles are intact.  Sclerae anicteric.  Mucous
membranes slightly dry.  Neck is supple with no
lymphadenopathy and no jugular venous distention.  Chest is
clear to auscultation bilaterally with scattered crackles
which clear with cough.  Cardiovascular:  Regular rhythm with
II/VI systolic ejection murmur.  Abdomen is soft, nontender,
nondistended.  Normoactive bowel sounds.  No palpable masses
noted with heme positive stool.  Extremities:  No cyanosis,
clubbing or edema.  Thready peripheral pulses with well
healed scar on the lateral surface of the right leg.
Neurological:  Alert, confused, knows name only.  Moves all
four extremities and follows commands.

LABORATORY:  Notable labs upon admission are white blood cell
count of 10,000, hematocrit of 30.8 down from baseline of 38,
platelets 337,000.  ALT 20, AST 25, LDH 249, alkaline
phosphatase of 161.  Potassium of 6.4 and upon repeat 5.7.

EKG is sinus at 75 beats per minute, intervals with PR
interval at 220; otherwise intervals within normal limits; [**Street Address(2) 12255**] depressions in V3, but no acute ST-T wave changes.

HOSPITAL COURSE:

1.      Gastrointestinal:  The patient was admitted to the
Medical Wards for further management of her GI bleeding.
Over the next 12 hours, the patient was noted to have two
more episodes of dark magenta stools with clots and had been
transfused a total of two units of packed red blood cells.
On the morning of [**12-19**], her hematocrit was 27.0, down
from 30 the evening before.  An upper endoscopy was performed
and a 1 cm antral ulcer was identified without any active
bleeding which was felt to the be the source of the patient's
bleeding (upper endoscopy was performed as the patient's BUN
was elevated and it was felt that an upper source of bleeding
may be possible).

The patient returned to the floor but continued to have
multiple episodes of magenta stools per rectum, which
progressively became more bright and red in quality,
concerning for a lower GI source of bleeding.  The patient
received two more units of packed red blood cells and her
hematocrit remained stable at 27 to 28.  The patient's
converted to atrial fibrillation and her blood pressures
began to drop into the 90s and she was transferred to the
Medical Intensive Care Unit for further evaluation.

A tagged red blood cell scan did not demonstrate any active
bleeding on the evening of [**12-20**].  A colonoscopy the
next day was non-diagnostic as the patient still had
significant amounts of stool in her colon.

The patient received two more units of red blood cells and
the output of bright red blood per rectum began to decrease.
On the morning of [**12-21**], the patient had a repeat
colonoscopy which demonstrated multiple diverticula
throughout the course of the colon, but did not show signs of
any active bleeding.

On the afternoon of [**12-21**], the patient was transferred
back to the Medical Floor where she remained until discharge
with a blood pressure stable in the 120s to 140s systolic
over 60s to 70s diastolic, a heart rate which was variable
between normal sinus rhythm and atrial fibrillation in the
120s to 130s, and with no further episodes of bright red
blood per rectum.

The patient was maintained on high-dose intravenous Protonix
for the first several days of her hospitalization, but will
continue Protonix 40 mg p.o. q. day as an outpatient.  The
patient also tested positive for H. pylori and will undergo a
course of eradication of this organism.  She will continue
Colace 100 mg p.o. twice a day to soften her stools.

2.      Cardiovascular:  The patient was noted to be in
paroxysmal atrial fibrillation after returning to the Floor
on [**12-21**].  Her atrial fibrillation is well controlled on
Diltiazem and she will be discharged on an increased dosage
of 180 mg of Cardizem CD p.o. q. day.

        Pulmonary:  The patient was noted to be in some
slight fluid overload, having been positive about eight
liters from the Intensive Care Unit upon presentation to the
Floor with some bilateral rales noted on examination.  The
patient auto-diuresed over the next 24 hours and was then
given 20 mg of Lasix with good urine output.  Upon discharge,
the patient was having good oxygen saturation on room air.

3.      Infectious Disease:  The patient was noted to have a
urinary tract infection by urinalysis and was treated with
three days of Bactrim while in hospital with good results.

4.      Neurology:  The patient was continued on her regular
doses of Dilantin and phenobarbital for her history of
seizure disorder.  Her levels were noted to be within normal
limits and she was continued on the same dose with no
complications.

5.      Fluids, electrolytes, nutrition:  The patient was
maintained on a clear liquid diet throughout much of her
hospitalization and upon transfer to the floor tolerated an
American Diabetic Association diet very well.

DISPOSITION:  The patient is discharged on the evening of
[**12-22**], back to [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] on the medications listed
below.

DISCHARGE DIAGNOSES:
1.  Peptic ulcer disease.
2.  Diverticulosis.
3.  Anemia.
4.  Dementia.
5.  Diabetes mellitus.
6.  Paroxysmal atrial fibrillation.
7.  Urinary tract infection.
8.  Seizure disorder.

DISCHARGE MEDICATIONS:
1.  Diltiazem CD, (Cardizem CD), 180 mg p.o. q. day.
2.  Colace 100 mg p.o. twice a day.
3.  Multivitamins one tablet p.o. q. day.
4.  Folate 1 mg p.o. q. day.
5.  Trazodone 37.5 mg p.o. q. h.s. p.r.n. insomnia.
6.  Vitamin D 800 IU p.o. q. day.
7.  TUMS 500 mg p.o. twice a day.
8.  Protonix 40 mg p.o. twice a day times 14 days and then q.
    day.
9.  Dilantin phenytoin 150 mg p.o. twice a day.
10. Phenobarbital 75 mg p.o. q. day.
11. Glyburide 2.5 mg p.o. q. day.
12. Clarithromycin 500 mg p.o. twice a day times 14 days.
13. Amoxicillin 1 gram p.o. twice a day times 14 days.
(Please note that aspirin and Celebrex have been discontinued
secondary to the patient's GI bleed).
14. Tylenol 650 mg p.o. q. four to six hours p.r.n. pain.

                            DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 11-500


Dictated By:[**Last Name (un) 106151**]
MEDQUIST36

D:  [**2117-12-22**]  15:29
T:  [**2117-12-22**]  16:05
JOB#:  [**Job Number **]
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Diverticulosis of colon with hemorrhage,Helicobacter pylori [H. pylori],Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other convulsions,Atrial fibrillation,Hyposmolality and/or hyponatremia,Personal history of alcoholism'}


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: Melena.

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 805**] is a 74 year old
woman with an extensive past medical history including a
history of atrial fibrillation and flutter, seizure disorder,
dementia secondary to alcohol abuse and a history of lower GI
bleed with recently diagnosed diabetes mellitus who presents
to [**Hospital1 69**] from [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **]
after she was found to be passing large amounts of dark stool
with clots of blood.  The patient, upon presentation to the
Emergency Department denies abdominal pain or any other pain,
nausea, vomiting, diarrhea, or constipation.  She denies
fever or chills or dysuria.  She denies hematochezia.

MEDICAL HISTORY: 1.  Seizure disorder.
2.  History of atrial fibrillation/flutter.
3.  Osteoarthritis.
4.  Osteoporosis.
5.  Dementia felt to be secondary to alcohol abuse.
6.  History of lower GI bleed from diverticula.
7.  Diabetes mellitus, type 2, diagnosed in [**2117-4-13**].
8.  Cerebrovascular accident of the left frontal lobe with
    resulting ataxia and right hemi-CVA.
9.  History of falls.
10. Cataracts.
11. History of decubitus ulcer in the right buttock.
12. History of hyponatremia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is a resident of [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **].
Does not smoke.  Has a history of alcohol abuse (used to
drink one pint of vodka per day).  Son is involved in care. 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Diverticulosis of colon with hemorrhage,Helicobacter pylori [H. pylori],Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other convulsions,Atrial fibrillation,Hyposmolality and/or hyponatremia,Personal history of alcoholism'}
