CHIEF COMPLAINT: 

PRESENT ILLNESS: This was a 57-year-old woman
with multiple medical problems, transferred from [**Hospital3 11531**] for rectal bleeding.  Her hematocrit was reportedly
12.7 at the outside hospital.  She was status post 2 units of
packed red blood cells and was apparently hemodynamically
stable on transfer with systolic blood pressure of
approximately 95.  Repeat hematocrit at [**Hospital1 190**] was 20.  The patient refused NG lavage in the
Emergency Department.  She was given 1 unit of packed red
blood cells and 1 unit of FFP for an elevated INR.
Currently, the patient complained of right lower quadrant
abdominal pain, which was at her baseline.  She denied
lightheadedness, chest pain, shortness of breath.  She
reported nausea and vomiting for 2 weeks, but denied any
large volume stools or increased frequency.  She stated that
she noted "red streaks" on the stool and denied dark tarry
stool.  Denied recent NSAID use or alcohol.  She had a
history of peptic ulcer disease 6 years ago and denied
transfusion at that time.

MEDICAL HISTORY: Chronic abdominal pain, status post
multiple abdominal surgeries.

MEDICATION ON ADMISSION: 1. Dilaudid.
2. Vistaril.
3. Lasix.

ALLERGIES: Multiple.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Thirty-pack-year tobacco history, quit 6
years ago, no alcohol.
Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified
Ac duodenal ulcer w hem,Ac posthemorrhag anemia,Chr airway obstruct NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Obesity NOS
Admission Date: [**2132-7-1**]        Discharge Date: [**2132-7-1**]

Date of Birth:  [**2075-1-4**]        Sex:  F

Service:  MED


HISTORY OF PRESENT ILLNESS:  This was a 57-year-old woman
with multiple medical problems, transferred from [**Hospital3 11531**] for rectal bleeding.  Her hematocrit was reportedly
12.7 at the outside hospital.  She was status post 2 units of
packed red blood cells and was apparently hemodynamically
stable on transfer with systolic blood pressure of
approximately 95.  Repeat hematocrit at [**Hospital1 190**] was 20.  The patient refused NG lavage in the
Emergency Department.  She was given 1 unit of packed red
blood cells and 1 unit of FFP for an elevated INR.
Currently, the patient complained of right lower quadrant
abdominal pain, which was at her baseline.  She denied
lightheadedness, chest pain, shortness of breath.  She
reported nausea and vomiting for 2 weeks, but denied any
large volume stools or increased frequency.  She stated that
she noted "red streaks" on the stool and denied dark tarry
stool.  Denied recent NSAID use or alcohol.  She had a
history of peptic ulcer disease 6 years ago and denied
transfusion at that time.

PAST MEDICAL HISTORY:  Chronic abdominal pain, status post
multiple abdominal surgeries.

DJD.

Anxiety.

Hypertension.

Obesity.

Type II diabetes.

Status post appendectomy, cholecystectomy, splenectomy, and
total abdominal hysterectomy.

ALLERGIES:  Multiple.

MEDICATIONS ON ADMISSION:
1. Dilaudid.
2. Vistaril.
3. Lasix.


FAMILY HISTORY:  Noncontributory.

SOCIAL HISTORY:  Thirty-pack-year tobacco history, quit 6
years ago, no alcohol.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 95.7 degrees,
heart rate 76, blood pressure 112/48, respiratory rate 16,
saturating 100% on room air.  General, was a chronically ill-
appearing woman in no acute distress.  Cardiac exam notable
for a 2/6 systolic murmur.  Abdominal exam notable for
diffuse tenderness, greatest in the right lower quadrant.
Guaiac positive per ED.  Extremities notable for 2 plus
pitting edema.  Rest of the exam was unremarkable.

LABORATORY DATA ON ADMISSION:  Notable for a hematocrit of
20.4, INR of 1.6, and potassium of 2.7.  Other labs were
within normal limits.

ASSESSMENT:  This is a 57-year-old woman with multiple
medical problems, who presented with bright red blood per
rectum, anemia, and mild coagulopathy who is currently
hemodynamically stable.

HOSPITAL COURSE:  GI.  The patient came in with bright red
blood per rectum, source of her anemia and GI bleed was
unclear.  The patient was treated with IV PPIs and transfused
to a hematocrit of over 25.  She refused placement of 2 large
bore IVs, central line, NG lavage, and EGD initially.  Her
hematocrit was initially stable overnight, and the patient
seemed to have stopped the GI bleeding; however, she then
developed large volume hematemesis as well as melena.  She
was transfused with at least 8 units of blood as well as FFP
and platelets in an effort to support her blood pressure and
hematocrit.  She agreed to central line placement and EGD,
although she did not want anything more aggressive than that.
She agreed to be intubated for a short time to allow for EGD
but was quite clear that she did not want any aggressive
measures.  The GI Service was consulted, and they performed
an EGD, which found a large duodenal ulcer that was the
source of bleeding.  They attempted to cauterize the vessel
and were able to slow the bleeding, but were not able to stop
it completely and recommended angiography as the next step.
After discussions with the patient's daughter, who was her
healthcare proxy, it became clear that this was more
aggressive than the patient had wanted.  Therefore, the
patient was extubated and care was withdrawn that evening,
and she died from respiratory failure at 22:30.

CONDITION ON DISCHARGE:  Dead.

DISCHARGE DIAGNOSIS:  Fatal upper gastrointestinal bleed
resulting in respiratory arrest and subsequent cardiac
arrest.



                        [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) **], [**MD Number(1) 4546**]

Dictated By:[**Last Name (NamePattern1) 49323**]
MEDQUIST36
D:  [**2132-7-19**] 15:59:22
T:  [**2132-7-20**] 23:57:47
Job#:  [**Job Number 106868**]
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified'}


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: 

PRESENT ILLNESS: This was a 57-year-old woman
with multiple medical problems, transferred from [**Hospital3 11531**] for rectal bleeding.  Her hematocrit was reportedly
12.7 at the outside hospital.  She was status post 2 units of
packed red blood cells and was apparently hemodynamically
stable on transfer with systolic blood pressure of
approximately 95.  Repeat hematocrit at [**Hospital1 190**] was 20.  The patient refused NG lavage in the
Emergency Department.  She was given 1 unit of packed red
blood cells and 1 unit of FFP for an elevated INR.
Currently, the patient complained of right lower quadrant
abdominal pain, which was at her baseline.  She denied
lightheadedness, chest pain, shortness of breath.  She
reported nausea and vomiting for 2 weeks, but denied any
large volume stools or increased frequency.  She stated that
she noted "red streaks" on the stool and denied dark tarry
stool.  Denied recent NSAID use or alcohol.  She had a
history of peptic ulcer disease 6 years ago and denied
transfusion at that time.

MEDICAL HISTORY: Chronic abdominal pain, status post
multiple abdominal surgeries.

MEDICATION ON ADMISSION: 1. Dilaudid.
2. Vistaril.
3. Lasix.

ALLERGIES: Multiple.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Thirty-pack-year tobacco history, quit 6
years ago, no alcohol. 

### Response:
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified'}
