CHIEF COMPLAINT: GI Bleed

PRESENT ILLNESS: 50 y.o. female presenting with weakness for 3 days. 3 days ago
had episode nausea followed closely by "bright red" emesis, but
she did not think this was blood. Since then, has been having
black stool and diarrhea and feeling progressively weak and
nauseated. This morning she gagged on her toothbrush and had
another episode of emesis that had blood specks in it so she
came to the ED. Denies any NSAID use, no history of GI bleed or
ulcer, no ETOH, no recent abdominal pain, nausea or retching.
.
She was managed medically for UGIbleed and underwent an EGD in
the ICU. EGD revealed
On arrival to the ICU, patient reports feeling more SOB and
having a lot of discomfort with the NG tube. She denies
abdominal pain, nausea or more emesis or diarrhea. She has had
no new medications recently.
.

MEDICAL HISTORY: eczematous dermatitis (previously thought to be psoriasis, but
biopsy on [**1-17**] showed subacute eczematous dermatitis)
Heart Murmur

MEDICATION ON ADMISSION: clobetasol cream

ALLERGIES: Latex

PHYSICAL EXAM: Vitals: T: BP: 145/90 P:121-105 R:26 18 O2:100% on RA
General: Alert, oriented, appears uncomfortable
HEENT: Sclera anicteric, NG tube in place
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachy, regular and rhythm, 2/6 systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds
hyperactive, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Mild scaling over left elbow.

FAMILY HISTORY: father with PUD, brother with GERD

SOCIAL HISTORY: Divorced, works as an office professional.
- Tobacco: 30pack year history
- Alcohol:denies
- Illicits:denies
Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Contact dermatitis and other eczema, unspecified cause
Dieulafoy les,stom&duod,Chr stomach ulc w hem,Mallory-weiss syndrome,Ac posthemorrhag anemia,Helicobacter pylori,Gstr/ddnts NOS w/o hmrhg,Dermatitis NOS
Admission Date:  [**2133-3-1**]              Discharge Date:   [**2133-3-3**]

Date of Birth:  [**2083-2-21**]             Sex:   F

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
GI Bleed

Major Surgical or Invasive Procedure:
endoscopy with clipping of bleeding vessel


History of Present Illness:
50 y.o. female presenting with weakness for 3 days. 3 days ago
had episode nausea followed closely by "bright red" emesis, but
she did not think this was blood. Since then, has been having
black stool and diarrhea and feeling progressively weak and
nauseated. This morning she gagged on her toothbrush and had
another episode of emesis that had blood specks in it so she
came to the ED. Denies any NSAID use, no history of GI bleed or
ulcer, no ETOH, no recent abdominal pain, nausea or retching.
.
She was managed medically for UGIbleed and underwent an EGD in
the ICU. EGD revealed
On arrival to the ICU, patient reports feeling more SOB and
having a lot of discomfort with the NG tube. She denies
abdominal pain, nausea or more emesis or diarrhea. She has had
no new medications recently.
.

Past Medical History:
eczematous dermatitis (previously thought to be psoriasis, but
biopsy on [**1-17**] showed subacute eczematous dermatitis)
Heart Murmur

Social History:
Divorced, works as an office professional.
- Tobacco: 30pack year history
- Alcohol:denies
- Illicits:denies

Family History:
 father with PUD, brother with GERD

Physical Exam:
Vitals: T: BP: 145/90 P:121-105 R:26 18 O2:100% on RA
General: Alert, oriented, appears uncomfortable
HEENT: Sclera anicteric, NG tube in place
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachy, regular and rhythm, 2/6 systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds
hyperactive, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Mild scaling over left elbow.

Pertinent Results:
Endoscopy report not accessible
  COMPLETE BLOOD COUNT 	WBC 	RBC 	Hgb 	Hct 	MCV 	MCH 	MCHC 	RDW
	Plt Ct
[**2133-3-3**] 07:13AM   	6.6 	3.87* 	11.7* 	34.4* 	89 	30.2 	
34.0 	15.9* 	148*
[**2133-3-2**] 04:15PM   	  	  	  	32.9* 	  	  	  	  	
[**2133-3-2**] 06:07AM   	  	  	  	31.4* 	  	  	  	  	
[**2133-3-2**] 01:58AM   	7.1 	3.36* 	10.8* 	30.1* 	89 	32.0 	35.8*
	16.0* 	144*1
[**2133-3-1**] 08:14PM   	  	  	  	31.2*# 	  	  	  	  	
RECEIVED AT 2234
[**2133-3-1**] 05:41PM   	5.7 	2.70* 	8.7* 	24.6* 	91 	32.1* 	35.2*
	14.1 	202
[**2133-3-1**] 01:30PM   	7.4# 	3.36* 	10.5*# 	30.5* 	91 	31.3
	34.5 	14.1 	248

Brief Hospital Course:
#Acute Blood loss anemia due to upper GI bleed: Patient denies
NSAIDs, ETOH use, prednisone use, history of GI bleed, also
denies any recent GI symptoms. Only true risk factor for ulcers
is H.Pylori +. Bleeding was addressed with endoscopy and
clipping. HCT remained stable for 36 hours. She was transitioned
from IV PPI to Oral PPI.  She was discharged on H. Pylori
eradication.
.
#Eczematous Dermatitis: Patient currently without flare, only
using clobetasol on her left elbow PRN.
-continue clobetasol


Medications on Admission:
clobetasol cream

Discharge Medications:
1. Clobetasol 0.05 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
2. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times
a day).
Disp:*120 Tablet(s)* Refills:*2*
3. Menthol-Cetylpyridinium 3 mg Lozenge Sig: One (1) Lozenge
Mucous membrane PRN (as needed) as needed for sore throat.
Disp:*30 Lozenge(s)* Refills:*5*
4. Amoxicillin 250 mg Capsule Sig: Four (4) Capsule PO Q12H
(every 12 hours) for 11 days.
Disp:*88 Capsule(s)* Refills:*0*
5. Clarithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q12H
(every 12 hours) for 11 days.
Disp:*44 Tablet(s)* Refills:*0*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day for 11 days.
Disp:*22 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Gastric Ulcer
Upper GI bleed
Dieulafoy's lesion

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


Discharge Instructions:
You were admitted to the MICU with GI bleeding.  You required
blood transfusion, you underwent endoscopy which revealed mild
gastritis, H.pylori infection, and a bleeding ulcer.  This ulcer
was clipped by the gastroenterologist.
.
The follwing changes were made to your medications:
Sucralfate 1 gram Tablet by mouth 4 times per day for the next
11 days
Amoxicillin 250 mg Capsule Sig: Four (4) Capsule by mouth twice
per day (every 12 hours) for 11 days.
Clarithromycin 250 mg Two (2) Tablet by mouth every 12 hours for
11 days.
Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) by mouth twice a day for the next
11 days.
Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, per day after the above finishes
.
YOU MUST STOP SMOKING.  You are interested in the patches, which
are over the counter.  Please start with 14mg per day for 2
weeks, then 7mg per day for two weeks.  You can call
1-800-trytostop to attempt to get these supplies for free.

Followup Instructions:
Please call Dr.[**Name (NI) 4279**] office at [**Telephone/Fax (1) 7976**] for follow-up
within the next week.



Completed by:[**2133-5-16**]
{'Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Contact dermatitis and other eczema, unspecified cause'}


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: GI Bleed

PRESENT ILLNESS: 50 y.o. female presenting with weakness for 3 days. 3 days ago
had episode nausea followed closely by "bright red" emesis, but
she did not think this was blood. Since then, has been having
black stool and diarrhea and feeling progressively weak and
nauseated. This morning she gagged on her toothbrush and had
another episode of emesis that had blood specks in it so she
came to the ED. Denies any NSAID use, no history of GI bleed or
ulcer, no ETOH, no recent abdominal pain, nausea or retching.
.
She was managed medically for UGIbleed and underwent an EGD in
the ICU. EGD revealed
On arrival to the ICU, patient reports feeling more SOB and
having a lot of discomfort with the NG tube. She denies
abdominal pain, nausea or more emesis or diarrhea. She has had
no new medications recently.
.

MEDICAL HISTORY: eczematous dermatitis (previously thought to be psoriasis, but
biopsy on [**1-17**] showed subacute eczematous dermatitis)
Heart Murmur

MEDICATION ON ADMISSION: clobetasol cream

ALLERGIES: Latex

PHYSICAL EXAM: Vitals: T: BP: 145/90 P:121-105 R:26 18 O2:100% on RA
General: Alert, oriented, appears uncomfortable
HEENT: Sclera anicteric, NG tube in place
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachy, regular and rhythm, 2/6 systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds
hyperactive, no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Mild scaling over left elbow.

FAMILY HISTORY: father with PUD, brother with GERD

SOCIAL HISTORY: Divorced, works as an office professional.
- Tobacco: 30pack year history
- Alcohol:denies
- Illicits:denies 

### Response:
{'Dieulafoy lesion (hemorrhagic) of stomach and duodenum,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Gastroesophageal laceration-hemorrhage syndrome,Acute posthemorrhagic anemia,Helicobacter pylori [H. pylori],Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Contact dermatitis and other eczema, unspecified cause'}
