CHIEF COMPLAINT: Bright red blood per rectum

PRESENT ILLNESS: Mr. [**Known lastname 85972**] is a 74M with HTN who p/w BRBPR to an OSH on
[**4-6**]. He awoke from sleepy with urge to move his bowels and
noticed significant amount of red blood in the toilet. He felt a
little lightheaded with standing. At that time, no abdominal
discomfort though earlier in the weak he had a mild episode of
LUQ discomfort, intermittent and positional, felt like sore
muscle that he attributed to overexertion from weight lifting.
Denies any other bleeding, history of liver disease, or prior
GIB. No NSAID or anticoagulant use. He reports a colonoscopy at
[**Hospital1 2025**] [**12/2179**] that showed per his report 3 benign polyps.

MEDICAL HISTORY: HTN
Prostate CA s/p XRT [**2167**] and lupron
Inguinal hernias s/p repair ?umbilical hernia

MEDICATION ON ADMISSION: Lisinopril 10 mg daily
Multivitamin

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals 99.4 79 105/46 14 97% on RA
General Pleasant elderly man, no distress
HEENT NC/AT, PEARL, EOMI, pale conjunctiva, anicteric, MMM
Neck Cordis in place R neck
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds no organomegaly or mass
R groin bandage c/d/i, no femoral bruit
Rectal frank red blood on exam, no mass
Extrem Warm no edema palpable distal pulses
Neuro Alert and answering appropriately, CN 2-12 intact, full
strength in bilateral upper and lower extremities, sensation
intact to light touch, no dysmetria, no pronator drift.
[**Doctor Last Name **] no rash or jaundice

FAMILY HISTORY: Mother with unknown abdominal cancer

SOCIAL HISTORY: Married with children. Former office manager. Exercises
regularly.
- Tobacco: former smoker, quit 50 years prior (1ppdx5-10 years)
- Alcohol: 1 glass wine/day, plus 1 mixed drink on weekend
Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Other convulsions,Myoclonus
Dvrtclo colon w hmrhg,Ac posthemorrhag anemia,Hypertension NOS,History of tobacco use,Hx-prostatic malignancy,Convulsions NEC,Myoclonus
Admission Date:  [**2180-4-7**]              Discharge Date:   [**2180-4-11**]

Date of Birth:  [**2105-8-18**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
Bright red blood per rectum

Major Surgical or Invasive Procedure:
1) 10 units packed red blood cell transfusion
2) colonoscopy [**4-9**]


History of Present Illness:
Mr. [**Known lastname 85972**] is a 74M with HTN who p/w BRBPR to an OSH on
[**4-6**]. He awoke from sleepy with urge to move his bowels and
noticed significant amount of red blood in the toilet. He felt a
little lightheaded with standing. At that time, no abdominal
discomfort though earlier in the weak he had a mild episode of
LUQ discomfort, intermittent and positional, felt like sore
muscle that he attributed to overexertion from weight lifting.
Denies any other bleeding, history of liver disease, or prior
GIB. No NSAID or anticoagulant use. He reports a colonoscopy at
[**Hospital1 2025**] [**12/2179**] that showed per his report 3 benign polyps.

At the OSH ER, initial vitals were 98.7 68 138/60 20 99% on RA.
Hct 37.4 with unknown baseline, Plts 274, INR 1.1. Abdomen was
soft, nontender. Rectal exam showed maroon stool that was
grossly guiac positive. Per report, after attempting to get up
to the commodate, patient fell back onto stretcher and had a
"seizure": left eye deviation and "tonic-clonic" movements.
Entire episode lasted about 10 seconds and was accompanied by
urinary incontinence. Repeat BP was 78/60, HR 90's and he was
treated with saline bolus with improvement in BP to 100/60. He
was admitted to the MICU.

Bleeding scan done and showed blush in left abdomen felt to be
likely splenic flexure or descending colon. Colonoscopy was
attempted, unable to pass beyond 50cm due to increased
resistance. No prep had been done. Hemorrhoids and multiple
diverticula were noted, along with dark red and brighter red
blood present - but no discrete site of bleeding was found.
Appearance said not to be suggestive of radiation proctitis.
Patient had undergone complete colonoscopy at [**Hospital1 2025**] within the
last year.

Overnight, 2BMs with clots. Large bloody stool this AM, SBP to
60s, patient syncopized. He recalls feeling dizzy, sweaty and
weak in the setting of a BM, but can't recall further details -
his wife also not present. Given 5units PRBCS, 1L saline,
started on dopa.  Sent to IR for embolization, unable to
localize source. Hct last 34, nadir 27.3. INR 1.3. Total 7units
of PRBCs, 1 unit FFP. Started on ondansetron. Vitals prior to
transfer 97.6 (99.2) 60-110's 90-150/40-60 2L
.
On evaluation at [**Hospital1 18**], he reports feeling well, though anxious.


Past Medical History:
HTN
Prostate CA s/p XRT [**2167**] and lupron
Inguinal hernias s/p repair ?umbilical hernia

Social History:
Married with children. Former office manager. Exercises
regularly.
- Tobacco: former smoker, quit 50 years prior (1ppdx5-10 years)
- Alcohol: 1 glass wine/day, plus 1 mixed drink on weekend

Family History:
Mother with unknown abdominal cancer

Physical Exam:
Vitals 99.4 79 105/46 14 97% on RA
General Pleasant elderly man, no distress
HEENT NC/AT, PEARL, EOMI, pale conjunctiva, anicteric, MMM
Neck Cordis in place R neck
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds no organomegaly or mass
R groin bandage c/d/i, no femoral bruit
Rectal frank red blood on exam, no mass
Extrem Warm no edema palpable distal pulses
Neuro Alert and answering appropriately, CN 2-12 intact, full
strength in bilateral upper and lower extremities, sensation
intact to light touch, no dysmetria, no pronator drift.
[**Doctor Last Name **] no rash or jaundice

Pertinent Results:
OSH INITIAL DATA

Labs (OSH)
On presentation to OSH
CBC 8.3>34.5<274
Chem 137/4.5/107/22/17/1.0
INR 1.1, PTT 27
AST 20, ALT 15, ALK 29, Tbil 0.9
.
Tagged RBC cell scan, OSH
Cine loop imaging of abdomen demonstrates transient faint blush
of
scintigraphic activity in the left lateral abdomen. This blush
of
activity is primarily vertically oriented with subtle horizontal

component on frames 23 through 27. Scintigraphic findings are
considered indicative of subtle gastrointestinal hemorrhage
likely at
or in region of splenic flexure as opposed to jejunal. Clinical
history provided indicates lower gastrointestinal hemorrhage.
Conclusion: Positive nuclear medicine tagged red blood cell
study with transient blush of scintigraphic activity in the left
abdomen likely reflecting occult hemorrhage in region of splenic
flexure/proximal descending colon.
.
CXR at OSH: clear, no acute process
.
EKG at OSH: SR @71, left axis, LAFB with incomplete RBBB
borderline 1st degree AV block, no ST changes suggestive of
acute ischemia
.
Colonoscopy: Diverticulosis of the colon, otherwise normal
colonoscopy to cecum

Brief Hospital Course:
This 74M with HTN and prostate CA presented to an OSH with BRBPR
was transferred to [**Hospital1 18**] for further management in the MICU,
found to have multiple non bleeding severe diverticulosis on
colonoscopy.

MICU COURSE
Patient received in total 10 units PRBCs at OSH and in MICU. Hct
stabilized at 30-32, patient was prepped for colonoscopy with
go-lytely and underwent bedside colonoscopy on [**4-9**] which showed
no blood in colon by severe diverticulosis from sigmoid to the
ascending colon. Hct remained stable after the procedure.
Surgery followed along but did not intervene.
.
*LGIB/Acute Blood Loss Anemia : Most likely due to diverticular
bleed GI, IR team & surgery followed along. He did not have any
additional bleeding. He was transfered out of the MICU on
hospital day 2 after his colonoscopy. He had no further
bleeding. Twice daily Hct were checked and were stable. He
tolerated a regular diet and ambulated without difficulty. Given
the extent of the diverticular disease noted on colonoscopy, and
the high risk of recurrent bleed, an outpatient general surgery
follow-up was made to discuss possible prophylactic colectomy.
.
* Question seizure
Normal neuro exam at throughout hospitalization. In setting of
hypotension, cerebral hypoperfusion could potentially cause
seizure. At the same time, it is possible to have some myoclonic
movements with syncope (eg [**1-25**] volume depletion with bleeding or
vagal with bowel movement) so not clear that this was a seizure.
no further seizure activity was noted.
.
* HTN: Home antihypertensives were held in setting of GIB. On
hospital day 2 his blood pressures started to trend up and he
was hemodynamically stable so the Lisinopril was re-started.




Medications on Admission:
Lisinopril 10 mg daily
Multivitamin

Discharge Medications:
1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Multivitamin 1 Tablet PO DAILY

Discharge Disposition:
Home

Discharge Diagnosis:
Diverticulosis
Lower GI bleed


Discharge Condition:
Activity Status: Ambulatory - Independent.
Level of Consciousness: Alert and interactive.
Mental Status: Clear and coherent.


Discharge Instructions:
Mr [**Last Name (Titles) 85973**], it was a pleasure taking care of you. You were
admitted to the hospital for brisk gastrointestinal
(GI)bleeding. It is likely that the bleeding came from
outpouchings in your colon called Diverticulosis. You required
many units of red blood cells transfused to stabilize you. A
colonoscopy was done and it showed many significant
diverticulosis in your colon so it is unclear which specific
outpouching was responsible for the bleeding. Because so many
were seen you are at risk for having more GI bleeding. You
should follow up a general surgeon to discuss possible surgical
treatment.
No changes were made to your medications.

Followup Instructions:
You should follow up with Dr [**Last Name (STitle) 46557**] in General surgery. He will
discuss possible surgical treatments to prevent future bleeding.
An appointment has been made for you:
Name: [**Last Name (LF) **],[**First Name3 (LF) **] S
Appointment: [**Last Name (LF) 766**], [**4-17**], 2:30pm
Location: [**Location (un) 2274**]-[**Location (un) **]
Address: 2 [**Location (un) **] CENTER DR, [**Location (un) **],[**Numeric Identifier 29936**]
Phone: [**Telephone/Fax (1) 41132**]



Completed by:[**2180-4-11**]
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Other convulsions,Myoclonus'}


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: Bright red blood per rectum

PRESENT ILLNESS: Mr. [**Known lastname 85972**] is a 74M with HTN who p/w BRBPR to an OSH on
[**4-6**]. He awoke from sleepy with urge to move his bowels and
noticed significant amount of red blood in the toilet. He felt a
little lightheaded with standing. At that time, no abdominal
discomfort though earlier in the weak he had a mild episode of
LUQ discomfort, intermittent and positional, felt like sore
muscle that he attributed to overexertion from weight lifting.
Denies any other bleeding, history of liver disease, or prior
GIB. No NSAID or anticoagulant use. He reports a colonoscopy at
[**Hospital1 2025**] [**12/2179**] that showed per his report 3 benign polyps.

MEDICAL HISTORY: HTN
Prostate CA s/p XRT [**2167**] and lupron
Inguinal hernias s/p repair ?umbilical hernia

MEDICATION ON ADMISSION: Lisinopril 10 mg daily
Multivitamin

ALLERGIES: Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: Vitals 99.4 79 105/46 14 97% on RA
General Pleasant elderly man, no distress
HEENT NC/AT, PEARL, EOMI, pale conjunctiva, anicteric, MMM
Neck Cordis in place R neck
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds no organomegaly or mass
R groin bandage c/d/i, no femoral bruit
Rectal frank red blood on exam, no mass
Extrem Warm no edema palpable distal pulses
Neuro Alert and answering appropriately, CN 2-12 intact, full
strength in bilateral upper and lower extremities, sensation
intact to light touch, no dysmetria, no pronator drift.
[**Doctor Last Name **] no rash or jaundice

FAMILY HISTORY: Mother with unknown abdominal cancer

SOCIAL HISTORY: Married with children. Former office manager. Exercises
regularly.
- Tobacco: former smoker, quit 50 years prior (1ppdx5-10 years)
- Alcohol: 1 glass wine/day, plus 1 mixed drink on weekend 

### Response:
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Other convulsions,Myoclonus'}
