CHIEF COMPLAINT: GIB

PRESENT ILLNESS: 50y/o F with metastatic breast cancer to liver, patient of Dr.
[**Last Name (STitle) 88694**] who has been treated with 8 cycles of CAF, alternating
Xeloda/Taxotere, Caboplatin and Gemcitabine and recently has
been treated with Taxol for last month. Avastin was added as
well, first and only dose [**2122-11-20**]. She as seen in Heme/[**Hospital **]
clinic today by Dr. [**Last Name (STitle) 3274**] who sent her to the ED for c/o one
week of black stools.
She has been having [**12-25**] stools per day that have been soft,
black and sticky. She usually has [**12-25**] stools per day. No
diarrhea, no hematochezia. She denies any lightheadedness of
dizzyness but states that just yesterday she noted SOB with
walking up one flight of stairs. No chest pain. No vomiting, no
hematuria, +intermittent nausea and axiety. Last week she also
had one episode of confusion and forgetfullness which resolved,
has not had any other episodes since. No c/o morning HA's, she
does get tension headaches frequently which have not changed in
character. She denies any visual changes or blurryness, no
dysphagia, no odynophagia, no epistaxis, no sob at rest, no abd
pain, no ruq pain, no back pain, no dysuria, no hematuria.
Patient does have external hemorrhoids which cause her pain
often with her BM's. She has noticed increased abd girth over
the past week.
In Dr. [**Last Name (STitle) 88694**] office her hct was 16, baseline mid 30's. Guiac
positive in office. In ED she was guiac negative, NGL was
negative with 600cc. Last dark stool yesterday. She was given 4
Units of blood in the ED, started on protonix 40mg, given ativan
1mg x2, and annusol cream.

MEDICAL HISTORY: 1. Breast cancer:
-breast augmentation in 79 w/ silicone implants, implants
replaced 2 years ago with saline implants.
-diagnosed [**2120**] w/ breast cancer after noted sharp pains in L
breast, skin color changes, and mass appreciated by PCP in [**Name Initial (PRE) **]
breast.
-ER negative, PR negative, HER2/neu negative
2. ADHD

MEDICATION ON ADMISSION: Medications on Admission
1. concerta 54mg'
2. wellbutrin 150mg [**Hospital1 **]
3. lactulose 30ml'
4. ativan
5. phenergan.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
T: 98.4, P: 107, BP: 116/70, R: 20, Sats: 100%
GEN: pale thin lady, NAD
HEENT: alopecia appreciated, EOMI, PERRLA, sclera anicteric,
conj clear, MMM, o/p clear
CV: RRR, no m/r/g
PULM: CTA b/l, crackles appreciated at bases but clear with
cough. Good insp effort.
ABD: Distended, round, +BS, mild ascites(+fluid shift), NT/ND,
unable to appreciated liver or spleen.
EXT: no c/c/e, DP/PT +2 b/l.
NEURO: CN II-XII grossly intact, sensation grossly intact to
light touch, strenght [**3-26**] in all four ext flex/ext. Cerebellar:
FTN/[**Doctor First Name **] intact.

FAMILY HISTORY: Lung ca in sister at age 29, Father died of prostate cancer at
age 84, Maternal grandparents both died of throat cancer.

SOCIAL HISTORY: no tob, occ etoh. Financial consultant, lives with her husband
and 4 children
Esophageal varices with bleeding,Malignant neoplasm of liver, secondary,Malignant neoplasm of other specified sites of female breast,Other specified gastritis, without mention of hemorrhage
Esophag varices w bleed,Second malig neo liver,Malign neopl breast NEC,Oth spf gstrt w/o hmrhg
Admission Date:  [**2122-12-4**]              Discharge Date:   [**2122-12-7**]

Date of Birth:  [**2072-5-28**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
GIB

Major Surgical or Invasive Procedure:
EGD s/p banding of varices


History of Present Illness:
50y/o F with metastatic breast cancer to liver, patient of Dr.
[**Last Name (STitle) 88694**] who has been treated with 8 cycles of CAF, alternating
Xeloda/Taxotere, Caboplatin and Gemcitabine and recently has
been treated with Taxol for last month. Avastin was added as
well, first and only dose [**2122-11-20**]. She as seen in Heme/[**Hospital **]
clinic today by Dr. [**Last Name (STitle) 3274**] who sent her to the ED for c/o one
week of black stools.
She has been having [**12-25**] stools per day that have been soft,
black and sticky. She usually has [**12-25**] stools per day. No
diarrhea, no hematochezia. She denies any lightheadedness of
dizzyness but states that just yesterday she noted SOB with
walking up one flight of stairs. No chest pain. No vomiting, no
hematuria, +intermittent nausea and axiety. Last week she also
had one episode of confusion and forgetfullness which resolved,
has not had any other episodes since. No c/o morning HA's, she
does get tension headaches frequently which have not changed in
character. She denies any visual changes or blurryness, no
dysphagia, no odynophagia, no epistaxis, no sob at rest, no abd
pain, no ruq pain, no back pain, no dysuria, no hematuria.
Patient does have external hemorrhoids which cause her pain
often with her BM's. She has noticed increased abd girth over
the past week.
In Dr. [**Last Name (STitle) 88694**] office her hct was 16, baseline mid 30's. Guiac
positive in office. In ED she was guiac negative, NGL was
negative with 600cc. Last dark stool yesterday. She was given 4
Units of blood in the ED, started on protonix 40mg, given ativan
1mg x2, and annusol cream.


Past Medical History:
1. Breast cancer:
-breast augmentation in 79 w/ silicone implants, implants
replaced 2 years ago with saline implants.
-diagnosed [**2120**] w/ breast cancer after noted sharp pains in L
breast, skin color changes, and mass appreciated by PCP in [**Name Initial (PRE) **]
breast.
-ER negative, PR negative, HER2/neu negative
2. ADHD

Social History:
no tob, occ etoh. Financial consultant, lives with her husband
and 4 children

Family History:
Lung ca in sister at age 29, Father died of prostate cancer at
age 84, Maternal grandparents both died of throat cancer.

Physical Exam:
PE:
T: 98.4, P: 107, BP: 116/70, R: 20, Sats: 100%
GEN: pale thin lady, NAD
HEENT: alopecia appreciated, EOMI, PERRLA, sclera anicteric,
conj clear, MMM, o/p clear
CV: RRR, no m/r/g
PULM: CTA b/l, crackles appreciated at bases but clear with
cough. Good insp effort.
ABD: Distended, round, +BS, mild ascites(+fluid shift), NT/ND,
unable to appreciated liver or spleen.
EXT: no c/c/e, DP/PT +2 b/l.
NEURO: CN II-XII grossly intact, sensation grossly intact to
light touch, strenght [**3-26**] in all four ext flex/ext. Cerebellar:
FTN/[**Doctor First Name **] intact.


Pertinent Results:
Admit Labs:
[**2122-12-4**] 11:35AM BLOOD WBC-4.5# RBC-1.56*# Hgb-5.2*# Hct-16.2*#
MCV-104* MCH-33.6* MCHC-32.4 RDW-17.2* Plt Ct-160#
[**2122-12-4**] 01:10PM BLOOD Fibrino-252
[**2122-12-4**] 11:35AM BLOOD Gran Ct-2780
[**2122-12-4**] 03:50PM BLOOD Ret Aut-2.6
[**2122-12-4**] 11:35AM BLOOD Glucose-123* UreaN-10 Creat-0.4 Na-137
K-3.8 Cl-105 HCO3-25 AnGap-11
[**2122-12-4**] 11:35AM BLOOD ALT-45* AST-48* LD(LDH)-424* AlkPhos-142*
TotBili-0.5
[**2122-12-4**] 02:30PM BLOOD calTIBC-217* Hapto-126 Ferritn-585*
TRF-167*
[**2122-12-4**] 11:35AM BLOOD CA 27.29-88
.
D/C CBC:
[**2122-12-7**] 07:15AM BLOOD WBC-3.1* RBC-4.14* Hgb-13.6 Hct-38.3
MCV-93 MCH-32.8* MCHC-35.5* RDW-17.9* Plt Ct-107*
.
Hepatitis W/U:
HBsAb-POSITIVE
HBcAb-PND
.
Liver U/S w/ duplex:
IMPRESSION:
1. Portal vein patent, demonstrating hepatopetal flow.
2. Liver diffusely infiltrated with metastatic disease.
3. Large amount of ascites.
.
EGD:
Varices at the lower third of the esophagus
Erythema and congestion in the stomach compatible with Portal
Gastropathy
.
MRI Brain:
Final read pending at discharge


Brief Hospital Course:
# Bleeding esophageal varices: Patient was noted to have a
hematocrit of 16 on admission to the ICU.  She received 6 units
of PRBCs.  Her NG lavage was negative.  She had a EGD which
showed esophageal varices which were then banded.  She had no
further bleeding, her hct remained stable, and her dyspnea
resolved.  She was started on Nadolol, Protonix, and a 10 day
course of levofloxacin given risk for SBP with esophageal
varices. The patient will follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] as an
outpatient in approximately one week  and will need to be
rescoped in a few weeks for further banding.  Hct at discharge
was 38.
.
# Ascites - Patient had noted increased abdominal distention
prior to admission.  U/S noted a large amount of ascites, but no
hepatic vein thrombosis.  Most likely cause of  her ascites was
the liver metastasis.  Given a remote hx of IVDU, hepatitis
serologies were sent, HepBsAb(+) and HepC pending at dischage.
Patient had a diagnostic paracentesis with no microorganisms
seen, no growth to date at dicharge, final results pending.
Patient was started on Lasix and Aldactone and will follow up
with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to address the need for therapeutic
paracentesis as an outpatient.
.
# Breast cancer - Patient did not receive any chemotherapy
during this admission.  She will follow up with Dr. [**Last Name (STitle) 3274**]
regarding further treatment.  Due to difficulty in obtaining IV
access in this patient she may benefit from placement of a
port-a-cath depending on future treatment plans.
.
# Previous mental status changes - Patient did not exhibit any
further difficulty with word finding or any other significant
mental status changes during her hospitalization.   A brain MRI
was performed on the morning of discharge to evaluate for
leptomeningeal carcinomatosis.  Patient will follow up with Dr.
[**Last Name (STitle) 3274**] to obtain the results from this study.


Medications on Admission:
Medications on Admission
1. concerta 54mg'
2. wellbutrin 150mg [**Hospital1 **]
3. lactulose 30ml'
4. ativan
5. phenergan.


Discharge Medications:
1. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO DAILY
(Daily).
2. Methylphenidate 20 mg Tablet Sustained Release Sig: Three (3)
Tablet Sustained Release PO daily ().
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

4. Prochlorperazine 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for nausea.
5. Nadolol 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
7. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
8. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
9. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO BID (2 times a day).
10. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
12. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1)
Appl Rectal PRN (as needed).
13. Promethazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for nausea.


Discharge Disposition:
Home

Discharge Diagnosis:
Esophageal bleed
Esophageal varices
Metastatic breast cancer


Discharge Condition:
Good, stable hematocrit


Discharge Instructions:
If you develop fevers, chills, lightheadedness, dizziness,
shortness of breath, or if you notice bright red blood in your
stool or dark tarry stools, call your primary care doctor or
return to the emergency room immediately.
.
You will need to be seen by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in
Gastroenterology within one week.  Please call ([**Telephone/Fax (1) 107211**] to
make a follow up appointment.
.
You have a follow up appt with Dr. [**Last Name (STitle) 3274**] on [**2122-12-11**] at 11:30
AM.

Followup Instructions:
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 15108**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2122-12-11**] 11:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4425**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2122-12-11**]
12:30
Provider: [**Name Initial (NameIs) 4426**] 17  Date/Time:[**2122-12-11**] 12:30


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]

Completed by:[**2122-12-13**]
{'Esophageal varices with bleeding,Malignant neoplasm of liver, secondary,Malignant neoplasm of other specified sites of female breast,Other specified gastritis, without mention of hemorrhage'}


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: GIB

PRESENT ILLNESS: 50y/o F with metastatic breast cancer to liver, patient of Dr.
[**Last Name (STitle) 88694**] who has been treated with 8 cycles of CAF, alternating
Xeloda/Taxotere, Caboplatin and Gemcitabine and recently has
been treated with Taxol for last month. Avastin was added as
well, first and only dose [**2122-11-20**]. She as seen in Heme/[**Hospital **]
clinic today by Dr. [**Last Name (STitle) 3274**] who sent her to the ED for c/o one
week of black stools.
She has been having [**12-25**] stools per day that have been soft,
black and sticky. She usually has [**12-25**] stools per day. No
diarrhea, no hematochezia. She denies any lightheadedness of
dizzyness but states that just yesterday she noted SOB with
walking up one flight of stairs. No chest pain. No vomiting, no
hematuria, +intermittent nausea and axiety. Last week she also
had one episode of confusion and forgetfullness which resolved,
has not had any other episodes since. No c/o morning HA's, she
does get tension headaches frequently which have not changed in
character. She denies any visual changes or blurryness, no
dysphagia, no odynophagia, no epistaxis, no sob at rest, no abd
pain, no ruq pain, no back pain, no dysuria, no hematuria.
Patient does have external hemorrhoids which cause her pain
often with her BM's. She has noticed increased abd girth over
the past week.
In Dr. [**Last Name (STitle) 88694**] office her hct was 16, baseline mid 30's. Guiac
positive in office. In ED she was guiac negative, NGL was
negative with 600cc. Last dark stool yesterday. She was given 4
Units of blood in the ED, started on protonix 40mg, given ativan
1mg x2, and annusol cream.

MEDICAL HISTORY: 1. Breast cancer:
-breast augmentation in 79 w/ silicone implants, implants
replaced 2 years ago with saline implants.
-diagnosed [**2120**] w/ breast cancer after noted sharp pains in L
breast, skin color changes, and mass appreciated by PCP in [**Name Initial (PRE) **]
breast.
-ER negative, PR negative, HER2/neu negative
2. ADHD

MEDICATION ON ADMISSION: Medications on Admission
1. concerta 54mg'
2. wellbutrin 150mg [**Hospital1 **]
3. lactulose 30ml'
4. ativan
5. phenergan.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
T: 98.4, P: 107, BP: 116/70, R: 20, Sats: 100%
GEN: pale thin lady, NAD
HEENT: alopecia appreciated, EOMI, PERRLA, sclera anicteric,
conj clear, MMM, o/p clear
CV: RRR, no m/r/g
PULM: CTA b/l, crackles appreciated at bases but clear with
cough. Good insp effort.
ABD: Distended, round, +BS, mild ascites(+fluid shift), NT/ND,
unable to appreciated liver or spleen.
EXT: no c/c/e, DP/PT +2 b/l.
NEURO: CN II-XII grossly intact, sensation grossly intact to
light touch, strenght [**3-26**] in all four ext flex/ext. Cerebellar:
FTN/[**Doctor First Name **] intact.

FAMILY HISTORY: Lung ca in sister at age 29, Father died of prostate cancer at
age 84, Maternal grandparents both died of throat cancer.

SOCIAL HISTORY: no tob, occ etoh. Financial consultant, lives with her husband
and 4 children 

### Response:
{'Esophageal varices with bleeding,Malignant neoplasm of liver, secondary,Malignant neoplasm of other specified sites of female breast,Other specified gastritis, without mention of hemorrhage'}
