CHIEF COMPLAINT: loss of consciousness/melenic stools

PRESENT ILLNESS: HPI: Mr. [**Known lastname 4972**] is a 44 year old male with a history of HCV/EtOH
cirrhosis s/p OLT [**2149-1-13**].  He was brought to the ED following a
syncopal episode.  He reports that he has been having black,
tarry stools for the last 3 days that became heavy today.  There
is no bright red blood.  He has been nauseous since last night,
but has not vomited.  He has become progressively more fatigued
and weak over the past few days.  This morning, he was too tired
to walk to the bathroom.  He stood to use his urinal, became
dizzy, fainted, and fell to the ground.  He landed on his left
wrist and ankle, which are painful now.  He is also complaining
of headache, but it is unknown if he hit his head as the fall
was
not witnessed.  He does not have abdominal pain. He underwent
EGD
in [**1-8**], which demonstrated mild portal gastropathy and grade 1
nonbleeding varices.

MEDICAL HISTORY: - transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
-OLT [**2149-1-13**] c/b HA stenosis, stented
-[**11-6**] admit to [**Hospital **] Hospital for rehab/?depression
-[**5-8**] candidiasis
-[**5-8**] syncopal episode attributed to UGI bleeding

MEDICATION ON ADMISSION: colace 100", prednisone 12.5', plavix 75', ASA 325', Gemfibrozil
600", Bactrim, MMF 500", Valcyte 900', protonix 40', Prograf 6",
insulin sliding scale, NPH 10U qAM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T98 BP100/61 HR105 RR17
Gen: pale, appears tired, speaking slowly
HEENT: no icterus, dry mucous membranes
Pulm: clear to auscultation bilaterally
CVS: tachycardic, regular rhythm, no murmurs/rubs/gallops
Abd: soft, nontender, nondistended, +bowel sounds, well-healed
subcostal incisions, guiaic positive as per ED, NG lavage not
grossly bloody
Ext: no edema, no clubbing, no cyanosis

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with mother in [**Name (NI) 86**]. Denies etoh, drugs
disabled chem engineer
Alcoholic cirrhosis of liver,Blood in stool,Iron deficiency anemia secondary to blood loss (chronic),Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Liver replaced by transplant,Candidal esophagitis,Syncope and collapse
Alcohol cirrhosis liver,Blood in stool,Chr blood loss anemia,Chrnc hpt C wo hpat coma,Alcoh dep NEC/NOS-contin,Liver transplant status,Candidal esophagitis,Syncope and collapse
Admission Date:  [**2149-5-30**]              Discharge Date:   [**2149-6-4**]

Date of Birth:  [**2104-8-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1384**]
Chief Complaint:
loss of consciousness/melenic stools

Major Surgical or Invasive Procedure:
ercp

History of Present Illness:
HPI: Mr. [**Known lastname 4972**] is a 44 year old male with a history of HCV/EtOH
cirrhosis s/p OLT [**2149-1-13**].  He was brought to the ED following a
syncopal episode.  He reports that he has been having black,
tarry stools for the last 3 days that became heavy today.  There
is no bright red blood.  He has been nauseous since last night,
but has not vomited.  He has become progressively more fatigued
and weak over the past few days.  This morning, he was too tired
to walk to the bathroom.  He stood to use his urinal, became
dizzy, fainted, and fell to the ground.  He landed on his left
wrist and ankle, which are painful now.  He is also complaining
of headache, but it is unknown if he hit his head as the fall
was
not witnessed.  He does not have abdominal pain. He underwent
EGD
in [**1-8**], which demonstrated mild portal gastropathy and grade 1
nonbleeding varices.

Past Medical History:
- transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
-OLT [**2149-1-13**] c/b HA stenosis, stented
-[**11-6**] admit to [**Hospital **] Hospital for rehab/?depression
-[**5-8**] candidiasis
-[**5-8**] syncopal episode attributed to UGI bleeding

Social History:
lives with mother in [**Name (NI) 86**]. Denies etoh, drugs
disabled chem engineer


Family History:
NC

Physical Exam:
T98 BP100/61 HR105 RR17
Gen: pale, appears tired, speaking slowly
HEENT: no icterus, dry mucous membranes
Pulm: clear to auscultation bilaterally
CVS: tachycardic, regular rhythm, no murmurs/rubs/gallops
Abd: soft, nontender, nondistended, +bowel sounds, well-healed
subcostal incisions, guiaic positive as per ED, NG lavage not
grossly bloody
Ext: no edema, no clubbing, no cyanosis


Pertinent Results:
[**2149-5-30**] 12:20PM   WBC-5.5 RBC-2.07*# HGB-6.7*# HCT-19.6*#
MCV-95 MCH-32.5* MCHC-34.3 RDW-20.0*
[**2149-5-30**] 12:20PM   ALT(SGPT)-60* AST(SGOT)-38 ALK PHOS-75
AMYLASE-13 TOT BILI-0.2
[**2149-5-30**] 12:20PM   ALBUMIN-3.6 CALCIUM-9.4 PHOSPHATE-4.9*
MAGNESIUM-1.4*
[**2149-5-30**] 12:20PM   LIPASE-7
[**2149-5-30**] 12:20PM   PLT COUNT-160
[**2149-5-30**] 12:20PM   PT-11.5 PTT-23.4 INR(PT)-1.0
[**2149-6-4**] 06:25AM BLOOD WBC-3.8* RBC-3.27* Hgb-10.7* Hct-30.8*
MCV-94 MCH-32.6* MCHC-34.7 RDW-19.5* Plt Ct-89*
[**2149-6-4**] 06:25AM BLOOD Plt Ct-89*
[**2149-6-4**] 06:25AM BLOOD Glucose-117* UreaN-26* Creat-1.3* Na-144
K-4.8 Cl-111* HCO3-26 AnGap-12
[**2149-6-4**] 06:25AM BLOOD ALT-42* AST-30 AlkPhos-62 TotBili-0.3
[**2149-6-1**] 03:37AM BLOOD FK506->30.0
[**2149-6-2**] 05:45AM BLOOD FK506-30.0*
[**2149-6-3**] 06:10AM BLOOD FK506-19.9
[**2149-6-4**] 06:25AM BLOOD FK506-10.2

Brief Hospital Course:
An NG was placed while in the ED for lavage. No blood was
detected. He received 2 units of PRBC while in the ED for a Hct
of 19.6. Hct increased to 23.6. An EGD was performed with no
active bleeding noted. Serial hematocrits were done. He was
transferred to the SICU for management until [**6-1**]. Another 2
units of PRBC were given with hct increase to 31.8. A CT without
contrast revealed gaseous distention of the small and large
bowel consistent with recent EGD procedure. No evidence of
perforation or free fluid collections within the abdominal
cavity. Submillimeter nonobstructive right renal calculi or
vascular calcification was noted.
ASA and plavix (for hepatic artery stent) were held.

On [**6-1**] potassium was 6.7. Repeat K+ was 5.7. IV lasix, saline,
insulin and bicarb were given. K+_decreased to 4.8.

A CT of the head showed no acute intracranial pathology. EKG was
normal. A CT of the left ankle and left wrist were negative for
fractures. Ortho was consulted for persistent left foot pain. PT
was consulted and recommended crutches for foot pain limiting
ambulation.

IV protonix was started [**Hospital1 **]. Fluconazole was started for
esophageal candidiasis. Consequently, prograf levels increased
to 30. Prograf was held for elevated levels since fluconazole
was started on [**2149-6-3**].

On [**2149-6-4**], his FK level was 10.2.  He was discharged on FK of
3mg Q 12 hours with strict instructions to follow up on [**2149-6-5**]
and have an FK level drawn, as well as a CBC and chem-7.

Of note, a CT scan from [**2149-6-3**] was negative for any source of GI
bleeding, such as pseudoaneurysm.

Medications on Admission:
colace 100", prednisone 12.5', plavix 75', ASA 325', Gemfibrozil
600", Bactrim, MMF 500", Valcyte 900', protonix 40', Prograf 6",
insulin sliding scale, NPH 10U qAM

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
UGI bleeding
L foot synovial injury


Discharge Condition:
good


Discharge Instructions:
Please call the transplant office [**Telephone/Fax (1) 673**] if you experience
fevers, chills, nausea, vomiting, black or bloody stools,
abdominal pain, jaundice, too low or too high glucoses,
dizziness or any concerns.



Completed by:[**2149-6-4**]
{'Alcoholic cirrhosis of liver,Blood in stool,Iron deficiency anemia secondary to blood loss (chronic),Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Liver replaced by transplant,Candidal esophagitis,Syncope and collapse'}


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: loss of consciousness/melenic stools

PRESENT ILLNESS: HPI: Mr. [**Known lastname 4972**] is a 44 year old male with a history of HCV/EtOH
cirrhosis s/p OLT [**2149-1-13**].  He was brought to the ED following a
syncopal episode.  He reports that he has been having black,
tarry stools for the last 3 days that became heavy today.  There
is no bright red blood.  He has been nauseous since last night,
but has not vomited.  He has become progressively more fatigued
and weak over the past few days.  This morning, he was too tired
to walk to the bathroom.  He stood to use his urinal, became
dizzy, fainted, and fell to the ground.  He landed on his left
wrist and ankle, which are painful now.  He is also complaining
of headache, but it is unknown if he hit his head as the fall
was
not witnessed.  He does not have abdominal pain. He underwent
EGD
in [**1-8**], which demonstrated mild portal gastropathy and grade 1
nonbleeding varices.

MEDICAL HISTORY: - transjugular liver biopsy in [**2144-8-2**]
- H/o SBP -> on prophylaxis
- H/o encephalopathy
- H/o ascites
- jaundice starting in [**2148-6-1**]
- ? no EtOH since [**Month (only) 958**] to [**2148-7-2**], h/o cocaine in [**2141**]
-OLT [**2149-1-13**] c/b HA stenosis, stented
-[**11-6**] admit to [**Hospital **] Hospital for rehab/?depression
-[**5-8**] candidiasis
-[**5-8**] syncopal episode attributed to UGI bleeding

MEDICATION ON ADMISSION: colace 100", prednisone 12.5', plavix 75', ASA 325', Gemfibrozil
600", Bactrim, MMF 500", Valcyte 900', protonix 40', Prograf 6",
insulin sliding scale, NPH 10U qAM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T98 BP100/61 HR105 RR17
Gen: pale, appears tired, speaking slowly
HEENT: no icterus, dry mucous membranes
Pulm: clear to auscultation bilaterally
CVS: tachycardic, regular rhythm, no murmurs/rubs/gallops
Abd: soft, nontender, nondistended, +bowel sounds, well-healed
subcostal incisions, guiaic positive as per ED, NG lavage not
grossly bloody
Ext: no edema, no clubbing, no cyanosis

FAMILY HISTORY: NC

SOCIAL HISTORY: lives with mother in [**Name (NI) 86**]. Denies etoh, drugs
disabled chem engineer 

### Response:
{'Alcoholic cirrhosis of liver,Blood in stool,Iron deficiency anemia secondary to blood loss (chronic),Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Liver replaced by transplant,Candidal esophagitis,Syncope and collapse'}
