CHIEF COMPLAINT: Black tarry stools

PRESENT ILLNESS: Ms. [**Known lastname 101213**] is a 60-year-old female with a h/o ESRD on
hemodialysis and hypertension presenting with 2 days of melena
and coffee-ground emesis. Patient reports four days prior to
admission she began to feel fatigued and a decreased appetite.
Two days prior to admission, she reports black stools after
hemodialysis (3-4 episodes) as well as three episodes of
vomiting with a small amount of dark-red blood. She was
evaluated at an OSH and discharged home (no labs were drawn). On
the day of admission, patient had a recurrence of black, tarry
stools and immediately went to [**Hospital1 18**] ED. Patient did not report
hematemesis on the day of admission.
.
In the ED, vitals signs were stable. NG lavage could not be
performed because the patient did not tolerate the procedure.
Hct was initialy 16.7 in the ED.  She was transfused 2units
PRBCs. GI consult scheduled an EGD immediately and she was
tranferred to the MICU. She denied a history of NSAIDS, EtOH,
previous GI bleeding, and she has never had an EGD or c-scope.
ROS was positive for mild peri-umbilical abdominal pain, mild
dysphagia to pills in last several months-weeks, increasing
fatigue recently, and depression.
.
Patient was hemodynamically stable when tranferred to the MICU,
hct at 21.9. She had a bedside EGD, was placed on PPI [**Hospital1 **], and
had [**Hospital1 **] hct checks. EGD was revealing for bleeding ulcers that
were clipped and cauterized (see full report below). Oxygen
saturation dropped post-procedure and patient was
hyperventilating, CXR revealed left left lower lobe collapse.
Prior to arriving to the floor, patient underwent hemodialysis
and was tranferred to medicine.

MEDICAL HISTORY: 1. IgA nephropathy in [**2169**] - hemodialysis dependant since [**2193**].
2. S/p renal transplant in [**2173**], acute on chronic rejection in
[**1-25**], now ESRD on hemodialysis. Has left permacath placed
several months ago.
3. Hypertension
4. Depression
5. s/p rheumatic fever in childhood
6. h/o seizure in [**5-26**] [**2-21**] HTN per pt, has not been on
anti-seizure meds in many months (without further seizures).

MEDICATION ON ADMISSION: 1.  asa 81mg daily
2.  labetalol 400mg tid
3.  lisinopril 40mg qd
4.  sevalamer 1600mg tid

ALLERGIES: Dilantin

PHYSICAL EXAM: VITALS: T 98.4, HR 98, BP 178/80 99 100%RA
GENERAL: Awake, alert, oriented x3 with flat affect in moderate
distress complaining of headache.
HEENT: PERRL, EOMI, MMM with clear OP.
SKIN: No rashes, jaundice, petechiae.
CHEST: Lungs clear to auscultation on upper lung fields.
Moderate aeration. Decreased breath sounds on lower lung fields.

FAMILY HISTORY: - Mother with lung cancer, died  at age 64.
- Many aunts/uncles with cancer.
- Sister with breast cancer, survived.
- No family h/o renal problems.

SOCIAL HISTORY: Lives alone in [**Location (un) 686**] with no family in the area. No health
insurance recently. Works at a part-time coffee shop manager.
She reports prior distant h/o tobacco (quit 23yrs ago, [**1-21**]
PPDx20yrs) and illicit drug use (marijuana & cocaine), seldomly
drinks EtOH. Has had difficulties with insurance in the past.
Acute duodenal ulcer with hemorrhage, without mention of obstruction,End stage renal disease,Pulmonary collapse,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Suicidal ideation,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Other esophagitis,Depressive disorder, not elsewhere classified
Ac duodenal ulcer w hem,End stage renal disease,Pulmonary collapse,Ac posthemorrhag anemia,Hyp kid NOS w cr kid V,Suicidal ideation,Stomach ulcer NOS,Other esophagitis,Depressive disorder NEC
Admission Date:  [**2195-2-27**]              Discharge Date:   [**2195-3-3**]

Date of Birth:  [**2134-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Dilantin

Attending:[**First Name3 (LF) 2145**]
Chief Complaint:
Black tarry stools

Major Surgical or Invasive Procedure:
EGD s/p epinephrine injection and clipping


History of Present Illness:
Ms. [**Known lastname 101213**] is a 60-year-old female with a h/o ESRD on
hemodialysis and hypertension presenting with 2 days of melena
and coffee-ground emesis. Patient reports four days prior to
admission she began to feel fatigued and a decreased appetite.
Two days prior to admission, she reports black stools after
hemodialysis (3-4 episodes) as well as three episodes of
vomiting with a small amount of dark-red blood. She was
evaluated at an OSH and discharged home (no labs were drawn). On
the day of admission, patient had a recurrence of black, tarry
stools and immediately went to [**Hospital1 18**] ED. Patient did not report
hematemesis on the day of admission.
.
In the ED, vitals signs were stable. NG lavage could not be
performed because the patient did not tolerate the procedure.
Hct was initialy 16.7 in the ED.  She was transfused 2units
PRBCs. GI consult scheduled an EGD immediately and she was
tranferred to the MICU. She denied a history of NSAIDS, EtOH,
previous GI bleeding, and she has never had an EGD or c-scope.
ROS was positive for mild peri-umbilical abdominal pain, mild
dysphagia to pills in last several months-weeks, increasing
fatigue recently, and depression.
.
Patient was hemodynamically stable when tranferred to the MICU,
hct at 21.9. She had a bedside EGD, was placed on PPI [**Hospital1 **], and
had [**Hospital1 **] hct checks. EGD was revealing for bleeding ulcers that
were clipped and cauterized (see full report below). Oxygen
saturation dropped post-procedure and patient was
hyperventilating, CXR revealed left left lower lobe collapse.
Prior to arriving to the floor, patient underwent hemodialysis
and was tranferred to medicine.

Past Medical History:
1. IgA nephropathy in [**2169**] - hemodialysis dependant since [**2193**].
2. S/p renal transplant in [**2173**], acute on chronic rejection in
[**1-25**], now ESRD on hemodialysis. Has left permacath placed
several months ago.
3. Hypertension
4. Depression
5. s/p rheumatic fever in childhood
6. h/o seizure in [**5-26**] [**2-21**] HTN per pt, has not been on
anti-seizure meds in many months (without further seizures).

Social History:
Lives alone in [**Location (un) 686**] with no family in the area. No health
insurance recently. Works at a part-time coffee shop manager.
She reports prior distant h/o tobacco (quit 23yrs ago, [**1-21**]
PPDx20yrs) and illicit drug use (marijuana & cocaine), seldomly
drinks EtOH. Has had difficulties with insurance in the past.

Family History:
- Mother with lung cancer, died  at age 64.
- Many aunts/uncles with cancer.
- Sister with breast cancer, survived.
- No family h/o renal problems.

Physical Exam:
VITALS: T 98.4, HR 98, BP 178/80 99 100%RA
GENERAL: Awake, alert, oriented x3 with flat affect in moderate
distress complaining of headache.
HEENT: PERRL, EOMI, MMM with clear OP.
SKIN: No rashes, jaundice, petechiae.
CHEST: Lungs clear to auscultation on upper lung fields.
Moderate aeration. Decreased breath sounds on lower lung fields.

CV: Regular rhythm, tachycardic, 2/6 systolic murmur best heard
at upper sternal border with radiation to right carotid.
ABDOMEN: Normal bowel sounds, slightly hard abdominal muscles,
no distension, no tenderness, scar from prior transplant on
right.
RECTAL: Guaiac positive stool in ED.
EXTREM: No clubbing, cynosis, edema. Warm. No peripheral edema.
NEURO: AAOx3. CN II-XII grossly intact.

Pertinent Results:
LABS at admission:
[**2195-2-27**] 09:30AM   PT-13.4 PTT-23.8 INR(PT)-1.1
[**2195-2-27**] 09:30AM   PLT COUNT-214
[**2195-2-27**] 09:30AM   NEUTS-66.0 LYMPHS-29.0 MONOS-3.8 EOS-1.0
BASOS-0.3
[**2195-2-27**] 09:30AM   WBC-4.9 RBC-1.65*# HGB-5.5*# HCT-16.7*#
MCV-101*# MCH-33.4*# MCHC-33.0 RDW-18.0*
[**2195-2-27**] 09:30AM   CALCIUM-9.2 PHOSPHATE-5.8* MAGNESIUM-1.9
[**2195-2-27**] 09:30AM   estGFR-Using this
[**2195-2-27**] 09:30AM   GLUCOSE-103 UREA N-99* CREAT-6.0*# SODIUM-140
POTASSIUM-6.0* CHLORIDE-96 TOTAL CO2-28 ANION GAP-22*
[**2195-2-27**] 09:49AM   HGB-5.6* calcHCT-17
[**2195-2-27**] 11:39AM   K+-4.4
[**2195-2-27**] 03:57PM   PLT COUNT-170
[**2195-2-27**] 03:57PM   WBC-4.9 RBC-2.31*# HGB-7.5*# HCT-21.9*#
MCV-95 MCH-32.3* MCHC-34.1 RDW-17.1*
[**2195-2-27**] 03:57PM   CALCIUM-9.3 PHOSPHATE-6.0* MAGNESIUM-1.9
[**2195-2-27**] 03:57PM   GLUCOSE-89 UREA N-101* CREAT-6.4* SODIUM-141
POTASSIUM-4.9 CHLORIDE-98 TOTAL CO2-28 ANION GAP-20
[**2195-2-27**] 05:48PM   VoidSpec-UNLABELED
[**2195-2-27**] 05:48PM   VoidSpec-UNLABELED
[**2195-2-27**] 10:24PM   HCT-21.3*
[**2195-2-27**] 10:24PM   POTASSIUM-4.8
....
IMAGING:
CHEST (PORTABLE AP) Study Date of [**2195-2-27**] 6:48 PM
The mediastinum is shifted to the left, which in combination
with new left
retrocardiac opacity is consistent with left lower lobe
collapse.  Also
partial collapse of the left upper lobe is present obscuring the
aortic arch. The right lung  areation is preserved.  There is
interval improvement of pulmonary edema and decrease in
bilateral pleural effusions.
.
ECG Study Date of [**2195-2-27**]  8:26:06 AM
Sinus rhythm. Left ventricular hypertrophy with repolarization
change.
Compared to the previous tracing of [**2194-7-31**] no change.
.
CHEST (PORTABLE AP) Study Date of [**2195-2-28**] 3:55 AM
 REASON FOR EXAMINATION:  Followup of a patient with left lower
lobe bronchus
impaction.

Portable AP chest radiograph compared to the previous study
obtained on
[**2195-2-27**] at 7:13.

The mediastinum currently is positioned more centrally with
partial but
significant improvement of left lower lobe collapse.  Still
present left
retrocardiac opacities consistent with partial atelectasis as
well as there is opacity in the left upper lobe consistent with
non-resolving atelectasis. There is no appreciable failure.
Small bilateral pleural effusions are present.
.
ECG Study Date of [**2195-2-28**]  10:48:58 AM
Sinus rhythm. Left ventricular hypertrophy. Compared to the
previous tracing no change.



Brief Hospital Course:
60-year-old female with a h/o ESRD [**2-21**] IgA nephropathy,
HD-dependent, anemia, and hypertension presenting from the MICU
with upper GI bleed [**2-21**] bleeding duodenal ulcer s/p clipping and
cauterization.
.
# Upper GI bleed [**2-21**] bleeding ulcer: Patient presented with both
melena and intermittent hematemesis x2 days consistent with a
clinical picture of an upper GI bleed. Her hematocrit at
admission was 16. Patient received 4units of PRBCs and remained
hemodynamically stable. EGD was revealing for esophagitis,
non-bleeding gastric ulcer, and a large bleeding vessel in the
duodenal bulb, which was clipped and cauterized. Per GI
recommendations, she was on an IV PPI infusion x72hrs.  Several
days into her hospital stay, the patient had
gastroccult-positive emesis x1 episode. She then tolerated her
renal diet well and did not have any more vomiting episodes. H.
pylori antibody test returned negative. Patient had no bowel
movements as an inpatient. She will be taking a PPI [**Hospital1 **] x1
month, and daily thereafter. She has a follow-up EGD on [**4-24**] with GI. As part of outpatient health maintenance, she has
never had a colonoscopy.  She was asked to discuss this with her
PCP.
.
# Acute blood loss anemia: Patient had a hematocrit of 16.7 at
admission, [**2-21**] UGIB. She was transfused 4units PRBCs and IVF.
Patient's hematocrit continued to rise and she was discharged
with a stable hematocrit at 27.4
.
# ESRD - Patient has a h/o IgA nephropathy in [**2169**], and a renal
transplant in [**2173**]. She suffered transplant rejection in [**2193**]
and has since then been receiving hemodialysis TID/[**Year (4 digits) 20515**] in
[**Location (un) **]. She reports good adherence to hemodialysis outpatient
treatments. She had hemodialysis x2 while inpatient, and her
blood pressure dropped after each treatment to an SBP in the
150s. While she was inpatient, renal followed her and
recommended the addition of Calcium Acetate 667mg TID/with meals
given high phosphate levels.
.
# Depression - Per patient, she reported depression to MICU and
to medicine team. She states that since the beginning of HD in
[**2193**], she's noticed worsening mood over recent months. She
reports it also has to do with the lack of a strong social
support - her sister lives in [**Country 26467**] and other family members
are in [**Location (un) **]. She admits to suicidal ideations in the last
couple of months (with an overdose of labetalol). She denies
homicidal ideations. She keeps a $20 [**Doctor First Name **] on her at home in case
if she ever felt actively suicidal, she would get a taxi to the
emergency room. She was treated with anti-depressants in the
past but they caused restless leg syndrome. Given the concern
for suicidal ideation, she was monitored with a sitter while
inpatient. She was seen by psychiatry and social work.
Psychiatry reported patient does have chronic depression with
passive suicidal ideation. They felt that she was of no imminent
risk to self but does have mood disorders and needs outpatient
follow-up. She was cleared for discharge and a follow-up
appointment was made with psychiatry urgent care. Social work
will be setting up longer term referral to a therapist.
.
# HTN - At home patient is on labetalol 200mg QID and lisinopril
40mg daily to control her elevated blood pressure. She reports a
h/o seizures in the past due to severe hypertension. In the
MICU, her blood pressure kept rising and was only moderately
controlled with hydralazine. In the setting of a GI bleed, her
hypertensive regimen was held. However, after her first
inpatient hemodialysis and upon transfer to the floor, her blood
pressure rose dramatically (SBPs 180-190s) and she was given
10mg IV hydralazine to a minimum effect, she also reported a
severe headache and nausea. Labetalol 200mg QID was re-started
with a stable hematocrit at 27.5, and her symptoms resolved and
blood pressure dropped to SBPs 140s. Lisinopril was also
restarted and only had a minimum effect on the blood pressure.
Labetalol dosage was increased to 400mg QID. Her blood pressures
continued to stay with SBPs in the 170-180s. It is unclear what
her baseline blood pressure on medications is at home. She
received IV metoprolol for acute control. Refractory high BP
could be [**2-21**] increases in intravascular fluid after multiple
tranfusions. After 2nd inpatient hemodialysis patient's blood
pressure dropped to 150/79. Patient was discharged on an
increased regimen of labetalol. Per renal, a possible future
medication that might be beneficial for this patient would be a
CCB, such as amlodipine.
.
# Headache: Patient reports h/o HA 2-3x per week. She does not
have a h/o migranes. No hearing or visual disturbances, but they
are associated with nausea. Since arrival to the floor, she had
several severe headaches that woke her up. She reports that she
usually experiences headaches near the end of her dialysis
treatment, and both headaches s/p dialysis treatment were
similar in character. However, there were other headaches that
were not associated with acute elevations in BP or hemodialysis
treatments. She was managed with morphine for pain control.
.
# Left lower lobe lung collapse: After patient had EGD procedure
in the MICU, her oxygen saturation dropped and she began to
hyperventilate. 1st CXR revealed LLL collapse, 2nd CXR revealed
resolving LLL collapse and LUL non-resolving atelectasis. While
inpatient she had good oxygen saturation (95-100% on RA), did
incentive spirometry x10/hr, and ambulated. Clinically, she was
much improved at discharge.
.
# Dysphagia: Patient reported dyspaghia for the last several
months-weeks. Per EGD report, this could be [**2-21**] esophageal ring.
Patient has a scheduled endoscopy within the next 8 weeks for
the follow-up of the ulcers and this could also be addressed at
this point. Also, she should continue on a PPI indefinitely (see
above).

Medications on Admission:
1.  asa 81mg daily
2.  labetalol 400mg tid
3.  lisinopril 40mg qd
4.  sevalamer 1600mg tid


Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours) for
30 days.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Sevelamer HCl 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
3. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Labetalol 200 mg Tablet Sig: Two (2) Tablet PO QID (4 times a
day).
Disp:*240 Tablet(s)* Refills:*2*
5. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Capsule(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day: please start
Rx after finishing Rx for pantoprazole 40 mg twice a day for 1
month.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Bleeding duodenal ulcer
Non-bleeding gastric ulcer
Esophagitis
s/p LLL lung collapse

Secondary diagnosis:
Hypertension
Depression with passive suicidal ideation
ESRD on dialysis


Discharge Condition:
Good, BPs improved, other VSS, ambulating without difficulty, no
further SI.


Discharge Instructions:
You were admitted with a bleeding duodenal ulcer and had an
endoscopy where the gastroenterologists were able to stop the
bleeding. As a result of the bleeding, you had several units of
blood transfused. You were also continued on dialysis and your
blood pressure medication was increased for better control of
your blood pressure.

The following changes have been made to your medications:
1) You are being started on a proton pump inhibitor called
pantoprazole. You will need to take a 40 mg pill twice a day for
one month. After that, you will take one pill once a day.
2) Your blood pressure medication labetalol was increased to 400
mg four times a day.
3) You were started on calcium acetate which will need to be
taken 3 times a day with meals. This is to help decrease the
amount of phosphate in your blood.

Please call your physician if you experience any of the
following: recurrence of foul smelling black stools, bright red
blood in your vomit or stools, lightheadedness, chest pain,
shortness of breath, and worsening abdominal pain.

Followup Instructions:
You have the following appointments:

1) Psychiatry Urgent Care on Friday [**2194-3-6**], 2:30 pm with Dr.
[**Last Name (STitle) 10166**]. Please report to the [**Hospital Unit Name **], [**Location (un) **]. The [**Hospital Unit Name **] is located on the [**Hospital Ward Name 516**] at [**Location (un) **].
You can call [**Telephone/Fax (1) 14439**]

2) Please continue to keep all outpt HD appts.

3) [**4-24**] arrive at 8:30am for a 9:30 am repeat endoscopy
with Dr. [**First Name4 (NamePattern1) 2795**] [**Last Name (NamePattern1) 908**].  Please go to [**Location (un) **] of the [**Hospital Ward Name 121**]
building on the [**Hospital Ward Name 517**].  Please call [**Telephone/Fax (1) **] if this
date is a problem.  Please do not eat or drink after midnight on
the morning of the procedure.

4) Please call your PCP [**Last Name (NamePattern4) **]. [**Known firstname **] [**First Name5 (NamePattern1) 5969**] [**Last Name (NamePattern1) 101209**] at [**Telephone/Fax (1) 101214**] to
reestablish primary care.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**]
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,End stage renal disease,Pulmonary collapse,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Suicidal ideation,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Other esophagitis,Depressive disorder, not elsewhere classified'}


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: Black tarry stools

PRESENT ILLNESS: Ms. [**Known lastname 101213**] is a 60-year-old female with a h/o ESRD on
hemodialysis and hypertension presenting with 2 days of melena
and coffee-ground emesis. Patient reports four days prior to
admission she began to feel fatigued and a decreased appetite.
Two days prior to admission, she reports black stools after
hemodialysis (3-4 episodes) as well as three episodes of
vomiting with a small amount of dark-red blood. She was
evaluated at an OSH and discharged home (no labs were drawn). On
the day of admission, patient had a recurrence of black, tarry
stools and immediately went to [**Hospital1 18**] ED. Patient did not report
hematemesis on the day of admission.
.
In the ED, vitals signs were stable. NG lavage could not be
performed because the patient did not tolerate the procedure.
Hct was initialy 16.7 in the ED.  She was transfused 2units
PRBCs. GI consult scheduled an EGD immediately and she was
tranferred to the MICU. She denied a history of NSAIDS, EtOH,
previous GI bleeding, and she has never had an EGD or c-scope.
ROS was positive for mild peri-umbilical abdominal pain, mild
dysphagia to pills in last several months-weeks, increasing
fatigue recently, and depression.
.
Patient was hemodynamically stable when tranferred to the MICU,
hct at 21.9. She had a bedside EGD, was placed on PPI [**Hospital1 **], and
had [**Hospital1 **] hct checks. EGD was revealing for bleeding ulcers that
were clipped and cauterized (see full report below). Oxygen
saturation dropped post-procedure and patient was
hyperventilating, CXR revealed left left lower lobe collapse.
Prior to arriving to the floor, patient underwent hemodialysis
and was tranferred to medicine.

MEDICAL HISTORY: 1. IgA nephropathy in [**2169**] - hemodialysis dependant since [**2193**].
2. S/p renal transplant in [**2173**], acute on chronic rejection in
[**1-25**], now ESRD on hemodialysis. Has left permacath placed
several months ago.
3. Hypertension
4. Depression
5. s/p rheumatic fever in childhood
6. h/o seizure in [**5-26**] [**2-21**] HTN per pt, has not been on
anti-seizure meds in many months (without further seizures).

MEDICATION ON ADMISSION: 1.  asa 81mg daily
2.  labetalol 400mg tid
3.  lisinopril 40mg qd
4.  sevalamer 1600mg tid

ALLERGIES: Dilantin

PHYSICAL EXAM: VITALS: T 98.4, HR 98, BP 178/80 99 100%RA
GENERAL: Awake, alert, oriented x3 with flat affect in moderate
distress complaining of headache.
HEENT: PERRL, EOMI, MMM with clear OP.
SKIN: No rashes, jaundice, petechiae.
CHEST: Lungs clear to auscultation on upper lung fields.
Moderate aeration. Decreased breath sounds on lower lung fields.

FAMILY HISTORY: - Mother with lung cancer, died  at age 64.
- Many aunts/uncles with cancer.
- Sister with breast cancer, survived.
- No family h/o renal problems.

SOCIAL HISTORY: Lives alone in [**Location (un) 686**] with no family in the area. No health
insurance recently. Works at a part-time coffee shop manager.
She reports prior distant h/o tobacco (quit 23yrs ago, [**1-21**]
PPDx20yrs) and illicit drug use (marijuana & cocaine), seldomly
drinks EtOH. Has had difficulties with insurance in the past. 

### Response:
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,End stage renal disease,Pulmonary collapse,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Suicidal ideation,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Other esophagitis,Depressive disorder, not elsewhere classified'}
