CHIEF COMPLAINT: Hematochezia

PRESENT ILLNESS: 65F w/ diverticulosis, DMII, HTN, Hyperlipidemia, and h/o
recurrent LGIB (no known etilogy after colonoscopy, EGD, T-RBC
scan) with sudden LGIB at 2pm on DOA. Similar to prev LGIB with
red blood and the stool mixed with blood. Occurred spontaneously
while sitting on couch. No CP, SOB, syncope, presyncope, N/V,
diarrhea. No fevers, chills, wt loss, change in stool caliber.

MEDICAL HISTORY: LGIB ([**7-/2183**], [**5-18**], [**4-19**]), Diverticulosis, DMII, HTN,
Hyperlipidemia, DJD (Hip/Knee), GERD.

MEDICATION ON ADMISSION: Acetaminophen PRN, Multivitamins 1 CAP PO QD, Moexipril HCl 15
mg PO QD
Pantoprazole 40 mg PO Q24H, Hydrochlorothiazide 12.5 mg PO QD,
HCTZ 12mg PO QD, Glucosamine, Metformin 500mg [**Hospital1 **], Nifedipine
120mg QD, Glyburide 5mg PO QD,
Atorvastatin 10 mg PO QD.

ALLERGIES: Dairy

PHYSICAL EXAM: 

FAMILY HISTORY: Son (age 44) has idiopathic LGIBs. No FHx of colitis, Crohn's,
ulcerative colitis. No bleeding disorders. No CRC. No heart
disease. No congenital disorders. No AVMs.

SOCIAL HISTORY: Lives with husband. [**Name (NI) 4084**] smoked or drank. No IVDU or drugs. Has
three kids.
Blood in stool,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Barrett's esophagus,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Blood in stool,Ac posthemorrhag anemia,Dvrtclo colon w/o hmrhg,Int hemorrhoid w/o compl,Barrett's esophagus,Diaphragmatic hernia,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2187-7-25**]              Discharge Date:   [**2187-7-31**]

Date of Birth:  [**2122-3-13**]             Sex:   F

Service: MED

Allergies:
Dairy

Attending:[**First Name3 (LF) 1865**]
Chief Complaint:
Hematochezia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
65F w/ diverticulosis, DMII, HTN, Hyperlipidemia, and h/o
recurrent LGIB (no known etilogy after colonoscopy, EGD, T-RBC
scan) with sudden LGIB at 2pm on DOA. Similar to prev LGIB with
red blood and the stool mixed with blood. Occurred spontaneously
while sitting on couch. No CP, SOB, syncope, presyncope, N/V,
diarrhea. No fevers, chills, wt loss, change in stool caliber.

Past Medical History:
LGIB ([**7-/2183**], [**5-18**], [**4-19**]), Diverticulosis, DMII, HTN,
Hyperlipidemia, DJD (Hip/Knee), GERD.

Social History:
Lives with husband. [**Name (NI) 4084**] smoked or drank. No IVDU or drugs. Has
three kids.

Family History:
Son (age 44) has idiopathic LGIBs. No FHx of colitis, Crohn's,
ulcerative colitis. No bleeding disorders. No CRC. No heart
disease. No congenital disorders. No AVMs.

Brief Hospital Course:
A/P: 65F w/ recurrent and idiopathic LGIB.

1.  GIB:  Pt likely with lower GIB [**12-18**] diverticulosis.  Pt had
one more episode of hematochezia [**7-25**] while drinking go lytely.
HCT 29 [**7-25**] AM.  HCT's checked q8 hours and pt put on bowel rest
with PPI.  Pt was hemodynamically stable except for tachycardia
to the 120's.  ?[**Last Name (un) 97049**]-Jegers (involving S.I.) based on +family
hx (son with multiple episodes GIB of unknown etiology) and
macules over lips and buccal mucosa?
[**7-26**] --> HCT 22 in AM.  Recieved 3 units PRBC, hct then 36.6  EGD
revealed small hiatal hernia with short segment of Barrett's
esophagus.  Colonoscopy revealed blood throughout the colon
without definite bleeding site.  +diverticuli, but none
bleeding.  TI seen, but not intubated.  TRBC study did not
reveal any active bleeding.  Pt moved to [**Hospital Unit Name 153**] [**7-26**] for
hemodynamic monitoring.
[**7-27**] --> HCT 29.8, given 1U PRBC.  Hemodynamically stable.
Started on clear liquid diet.
[**7-28**] --> HCT 35.8.  No further episodes of bleeding.  HD stable.
 Scheduled for capsule endoscopy [**7-30**].
[**7-29**] --> 36.1.  No bleeding.  Awaiting pill endoscopy tomorrow.

[**7-30**] --> 37.6.  No bleeding.  Tolerated pill endoscopy without
problems.  Tolerated full dinner at night.  No BM.
[**7-31**] --> 35.7.  No bleeding.  Will d/c with follow up in [**Hospital **]
clinic [**8-8**].

2.  GERD:  Pt with Barrett's esophagus on EGD.  Put on po
protonix.  Likely will need H.pylori eradication with triple
therapy as outpt.  Also, may need surveilence EGD's to screen
for dysplasia.  Will d/c pt with anti-reflux medications.

3.  DM:  On RISS.

4.  HTN:  Holding ACE-I, hctz, nifedipine [**12-18**] GIB.  Will d/c pt
on ACE-inhibitor. but will hold hctz and nifedipine until [**Hospital **]
clinic appointment.

5.  Hypercholesterolemia:  On atarvostatin.  Last lipid panel
quite good.


Medications on Admission:
Acetaminophen PRN, Multivitamins 1 CAP PO QD, Moexipril HCl 15
mg PO QD
Pantoprazole 40 mg PO Q24H, Hydrochlorothiazide 12.5 mg PO QD,
HCTZ 12mg PO QD, Glucosamine, Metformin 500mg [**Hospital1 **], Nifedipine
120mg QD, Glyburide 5mg PO QD,
Atorvastatin 10 mg PO QD.

Discharge Medications:
1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Moexipril HCl 15 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Lower GI bleed of unknown source


Discharge Condition:
Stable

Discharge Instructions:
If you have these symptoms, call your doctor or come to the
emergency room:

1.  bloody diarrhea
2.  black, tarry stools
3.  dizziness
4.  blurry vision
5.  abdominal pain
6.  bloody vomitus


Followup Instructions:
[**Hospital **] clinic:  [**8-8**] with



Completed by:[**2187-7-31**]
{"Blood in stool,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Barrett's esophagus,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension"}


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: Hematochezia

PRESENT ILLNESS: 65F w/ diverticulosis, DMII, HTN, Hyperlipidemia, and h/o
recurrent LGIB (no known etilogy after colonoscopy, EGD, T-RBC
scan) with sudden LGIB at 2pm on DOA. Similar to prev LGIB with
red blood and the stool mixed with blood. Occurred spontaneously
while sitting on couch. No CP, SOB, syncope, presyncope, N/V,
diarrhea. No fevers, chills, wt loss, change in stool caliber.

MEDICAL HISTORY: LGIB ([**7-/2183**], [**5-18**], [**4-19**]), Diverticulosis, DMII, HTN,
Hyperlipidemia, DJD (Hip/Knee), GERD.

MEDICATION ON ADMISSION: Acetaminophen PRN, Multivitamins 1 CAP PO QD, Moexipril HCl 15
mg PO QD
Pantoprazole 40 mg PO Q24H, Hydrochlorothiazide 12.5 mg PO QD,
HCTZ 12mg PO QD, Glucosamine, Metformin 500mg [**Hospital1 **], Nifedipine
120mg QD, Glyburide 5mg PO QD,
Atorvastatin 10 mg PO QD.

ALLERGIES: Dairy

PHYSICAL EXAM: 

FAMILY HISTORY: Son (age 44) has idiopathic LGIBs. No FHx of colitis, Crohn's,
ulcerative colitis. No bleeding disorders. No CRC. No heart
disease. No congenital disorders. No AVMs.

SOCIAL HISTORY: Lives with husband. [**Name (NI) 4084**] smoked or drank. No IVDU or drugs. Has
three kids. 

### Response:
{"Blood in stool,Acute posthemorrhagic anemia,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Barrett's esophagus,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension"}
