CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: Briefly, 63W h/o diverticulitis s/p colectomy, PUD p/w n/v and
bloody diarrhea. Recently discharged from [**Hospital1 18**] ([**2160-3-12**]) for
n/v/diarrhea. Since discharge, worsening abd pain, vomitting and
diarrhea w/blood. Decreased PO.
.
Last admission, thorough w/u by GI incl colonscopy w/bx and
MRI/MRA. MRI/MRA -> stenosis celiac artery. Pt started on
ursodiol, cholestyramine and cont on anti-diarrhea meds, PPI and
other bowel meds.
.
In ED, tachycardic, NGT placed and NG lavage was negative. Pt
rec'd ativan, morphine, and protonix in the ED. Also rec'd
baracath to prepare for CT scan but then had a large episode of
BRBPR. A right femoral line was placed, given 1L NS. Repeat HCT
was 21.2 from 33. Rec'd 1U PRBCs in ED and transferred to MICU
for further monitoring.
.
In MICU, she complained of pain in her throat, continued nausea,
diarrhea. Denied abd pain, CP or SOB.

MEDICAL HISTORY: 1. PUD 2. Diverticulitis s/p partial colectomy '[**56**] 3. Depression
4. HTN 5. Hypothyroidism 6. Raynaud's syndrome 7. Fibroids 8.
Asthma 9. H/o hepatitis 10. H/o TIA 11. [**Year (2 digits) 12588**] seizures 12. H/o
internal carotid artery dissection 13. presumed infectious
colitis [**2-14**] 14. History of necrotizing fasciitis

MEDICATION ON ADMISSION: 1. Duloxetine DR 60mg QD
2. Fexofenadine 60mg PO BID
3. Albuterol INH 1-2 Puffs Q6H PRN
4. Triamterene-Hydrochlorothiazide 37.5-25 mg PO DAILY
5. Fluticasone-Salmeterol INH [**Hospital1 **]
6. Levothyroxine 150 mcg PO DAILY
7. Gabapentin 200mg PO TID
8. Montelukast 10mg PO HS
9. Metaxalone 400mg PO BID
10. Pantoprazole 40 mg DR PO BID
11. Hyoscyamine Sulfate 0.250mg SL QID
12. Calcium Carbonate 500mg PO TID
13. Amphetamine-Dextroamphetamine SR 80mg PO daily
14. Cholestyramine-Sucrose 4g PO BID
15. Ursodiol 300 mg PO BID
16. Aspirin 81 mg Chewable PO DAILY
17. Lidocaine HCl 2 % Solution to Mucous membrane TID
18. Tramadol 50mg PO QD
19. Atenolol 25mg PO QD
20. Opium Tincture Ten (10) Drops PO Q6H
21. Loperamide 2mg PO QID
22. Bismuth Subsalicylate 786mg Chewable PO TID
23. Diphenoxylate-Atropine 2.5-0.025 mg PO Q6H
24. Adderall XR 60 mg PO daily

ALLERGIES: Penicillins / Iodine; Iodine Containing / Sulfonamides /
Percocet / Latex

PHYSICAL EXAM: 97.7    125/84    89     27    100RA     -570 24hrs/+2.5L LOS
Gen alert, orientedx3, NAD
HEENT PERRL, MM dry, OP clear
Neck left EJ in place, no lymphadenopathy, no thyromegally
Lungs Clear to auscultation bilaterally
CV RRR, nl S1S2, no murmers
Abd soft, non-tender, hyperactive BS
Ext no edema, well healed wound on right leg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Retired [**Hospital1 18**] pathologist (on disability); lives with her
husband Denies [**Name2 (NI) **], EtOH, illicit drug usage.
Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Asthma, unspecified type, unspecified,Personal history of other diseases of circulatory system
Hemorrhage complic proc,Thrombocytopenia NOS,Abn react-procedure NOS,Hypertension NOS,Hypothyroidism NOS,Depressive disorder NEC,Periph vascular dis NOS,Asthma NOS,Hx-circulatory dis NEC
Admission Date:  [**2160-3-13**]              Discharge Date:   [**2160-3-19**]

Date of Birth:  [**2096-12-17**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Iodine; Iodine Containing / Sulfonamides /
Percocet / Latex

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Briefly, 63W h/o diverticulitis s/p colectomy, PUD p/w n/v and
bloody diarrhea. Recently discharged from [**Hospital1 18**] ([**2160-3-12**]) for
n/v/diarrhea. Since discharge, worsening abd pain, vomitting and
diarrhea w/blood. Decreased PO.
.
Last admission, thorough w/u by GI incl colonscopy w/bx and
MRI/MRA. MRI/MRA -> stenosis celiac artery. Pt started on
ursodiol, cholestyramine and cont on anti-diarrhea meds, PPI and
other bowel meds.
.
In ED, tachycardic, NGT placed and NG lavage was negative. Pt
rec'd ativan, morphine, and protonix in the ED. Also rec'd
baracath to prepare for CT scan but then had a large episode of
BRBPR. A right femoral line was placed, given 1L NS. Repeat HCT
was 21.2 from 33. Rec'd 1U PRBCs in ED and transferred to MICU
for further monitoring.
.
In MICU, she complained of pain in her throat, continued nausea,
diarrhea. Denied abd pain, CP or SOB.

Past Medical History:
1. PUD 2. Diverticulitis s/p partial colectomy '[**56**] 3. Depression
4. HTN 5. Hypothyroidism 6. Raynaud's syndrome 7. Fibroids 8.
Asthma 9. H/o hepatitis 10. H/o TIA 11. [**Year (2 digits) 12588**] seizures 12. H/o
internal carotid artery dissection 13. presumed infectious
colitis [**2-14**] 14. History of necrotizing fasciitis

Social History:
Retired [**Hospital1 18**] pathologist (on disability); lives with her
husband Denies [**Name2 (NI) **], EtOH, illicit drug usage.

Family History:
non-contributory

Physical Exam:
97.7    125/84    89     27    100RA     -570 24hrs/+2.5L LOS
Gen alert, orientedx3, NAD
HEENT PERRL, MM dry, OP clear
Neck left EJ in place, no lymphadenopathy, no thyromegally
Lungs Clear to auscultation bilaterally
CV RRR, nl S1S2, no murmers
Abd soft, non-tender, hyperactive BS
Ext no edema, well healed wound on right leg


Pertinent Results:
EKG: sinus tachycardia at 100, no ST T wave changes, compared to
prior.
.
COLONOSCOPY [**2159-2-15**]: showed normal mucosa in the colon,
diverticulosis of the ascending colon and descending colon,
previous end to end [**Last Name (un) **]-colonic anastomosis of the descending
colon. Otherwise normal colonoscopy to cecum to terminal ileum.

.
COLONOSCOPY [**2160-3-11**]: Tortuous colon. Liquid prep in the colon.
Normal mucosa in the colon.
.
EGD on [**2160-2-15**] showed small hiatal hernia, small cyst was seen on
the epiglottis, vocal cord appeared mildly edematous, normal
mucosa in the duodenum, mild erythema in the antrum compatible
with gastritis, erythema and erosion in the stomach body,
otherwise normal egd to second part of the duodenum.
.
MRI/MRA Abdomen: [**2160-3-3**]: Moderate stenosis at the origin of the
celiac artery, with mild post-stenotic dilatation. The superior
mesenteric artery and inferior mesenteric artery are of normal
caliber.


Brief Hospital Course:
63 yo W with extensive medical history including diverticulitis,
PUD, presents to the ED with nausea/vomiting/diarrhea found to
have BRBPR. s/p 6U PRBCs. Now stable and being transferred to
floor [**2160-3-16**].
.
1. GI bleed - Having new onset BRBPR could be from biopsy site
vs. diverticulitis (although recent negative colonoscopy) vs.
anastomosis site vs ischemic colitis..
- [**3-14**]: had 2 tagged RBC scans - no clear source of lbeeding
Treated initially with IV ppi, transitioned to PO. BLeeding
resolved without further intervention.
.
2. Chronic diarrhea/abdominal pain - previous infectious work-up
negative, imaging negative, diarrhea osm c/w with osmotic
diarrhea. Mod celiac artery stenosis thought to be unrelated.
Non-specific focal active colitis thought to be [**3-13**] diarrhea,
non-specific.  Unable to measure stool output to confirm
diarrhea as patient not fully complying with saving stools.
.
3. Thromobocytopenia - platelets improved to 240s from nadir in
low 100s, now off of any heparin products. HIT antibody
negative.
.
4. Asthma- stable. continue singulair and [**Doctor First Name 130**]. Albuterol INH
PRN.
.
5. HTN  - held all anti hypertensive medications while having
active GI bleed.  Restarted prior to discharge.
.
6. Hypothyroidism
- continue levoxyl at current dose
.
7. Depression- will continue home meds for now.
.
8. Elevated INR - Unclear why elevated INR on repeat lab draw,
will continue to follow.
.
11. Prophylaxis - pt maintained on PPI, pneumoboots

Medications on Admission:
1. Duloxetine DR 60mg QD
2. Fexofenadine 60mg PO BID
3. Albuterol INH 1-2 Puffs Q6H PRN
4. Triamterene-Hydrochlorothiazide 37.5-25 mg PO DAILY
5. Fluticasone-Salmeterol INH [**Hospital1 **]
6. Levothyroxine 150 mcg PO DAILY
7. Gabapentin 200mg PO TID
8. Montelukast 10mg PO HS
9. Metaxalone 400mg PO BID
10. Pantoprazole 40 mg DR PO BID
11. Hyoscyamine Sulfate 0.250mg SL QID
12. Calcium Carbonate 500mg PO TID
13. Amphetamine-Dextroamphetamine SR 80mg PO daily
14. Cholestyramine-Sucrose 4g PO BID
15. Ursodiol 300 mg PO BID
16. Aspirin 81 mg Chewable PO DAILY
17. Lidocaine HCl 2 % Solution to Mucous membrane TID
18. Tramadol 50mg PO QD
19. Atenolol 25mg PO QD
20. Opium Tincture Ten (10) Drops PO Q6H
21. Loperamide 2mg PO QID
22. Bismuth Subsalicylate 786mg Chewable PO TID
23. Diphenoxylate-Atropine 2.5-0.025 mg PO Q6H
24. Adderall XR 60 mg PO daily


Discharge Medications:
1. Sertraline 50 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
5. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Hyoscyamine Sulfate 0.125 mg Tablet, Sublingual Sig: Two (2)
Tablet, Sublingual Sublingual QID (4 times a day).
7. Cholestyramine-Sucrose 4 g Packet Sig: One (1) Packet PO BID
(2 times a day).
8. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times
a day).
9. Diphenoxylate-Atropine 2.5-0.025 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours).
10. 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*
11. Compazine 10 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Four (4) Capsule, Sustained Release PO once a day: only take if
persistent diarrhea.
Disp:*60 Capsule, Sustained Release(s)* Refills:*0*
13. Outpatient Lab Work
Please check eletrolyte panel (chem 7) sometime between [**3-21**] and
[**3-24**], send results to Dr. [**Last Name (STitle) 107054**], [**First Name3 (LF) **] tel # [**Telephone/Fax (1) 250**].


Discharge Disposition:
Expired

Discharge Diagnosis:
diarrhea


Discharge Condition:
stable


Discharge Instructions:
Please follow-up with your doctor [**First Name (Titles) 3**] [**Last Name (Titles) 1988**], you have a
[**Last Name (Titles) 1988**] appointment in clinic next week with Dr. [**Last Name (STitle) **].
Call Dr. [**Last Name (STitle) 665**] if you have worsening of you current symptoms
including diarrhea, nausea/vomiting, abdominal pain.  Please
have your labs checked in the next few days to make sure that
your electrolytes are stable.  Call or report to the hospital
for fever, chills, worsenining abdominal pain, especially if
more localized, bloody diarrhea, or any other concerning
symptoms.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2160-3-26**] 2:30
Provider: [**Name10 (NameIs) **] FIELD SCREENING Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2160-4-2**] 2:00
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2160-4-2**] 2:30



Completed by:[**2162-7-19**]
{'Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Asthma, unspecified type, unspecified,Personal history of other diseases of circulatory system'}


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: BRBPR

PRESENT ILLNESS: Briefly, 63W h/o diverticulitis s/p colectomy, PUD p/w n/v and
bloody diarrhea. Recently discharged from [**Hospital1 18**] ([**2160-3-12**]) for
n/v/diarrhea. Since discharge, worsening abd pain, vomitting and
diarrhea w/blood. Decreased PO.
.
Last admission, thorough w/u by GI incl colonscopy w/bx and
MRI/MRA. MRI/MRA -> stenosis celiac artery. Pt started on
ursodiol, cholestyramine and cont on anti-diarrhea meds, PPI and
other bowel meds.
.
In ED, tachycardic, NGT placed and NG lavage was negative. Pt
rec'd ativan, morphine, and protonix in the ED. Also rec'd
baracath to prepare for CT scan but then had a large episode of
BRBPR. A right femoral line was placed, given 1L NS. Repeat HCT
was 21.2 from 33. Rec'd 1U PRBCs in ED and transferred to MICU
for further monitoring.
.
In MICU, she complained of pain in her throat, continued nausea,
diarrhea. Denied abd pain, CP or SOB.

MEDICAL HISTORY: 1. PUD 2. Diverticulitis s/p partial colectomy '[**56**] 3. Depression
4. HTN 5. Hypothyroidism 6. Raynaud's syndrome 7. Fibroids 8.
Asthma 9. H/o hepatitis 10. H/o TIA 11. [**Year (2 digits) 12588**] seizures 12. H/o
internal carotid artery dissection 13. presumed infectious
colitis [**2-14**] 14. History of necrotizing fasciitis

MEDICATION ON ADMISSION: 1. Duloxetine DR 60mg QD
2. Fexofenadine 60mg PO BID
3. Albuterol INH 1-2 Puffs Q6H PRN
4. Triamterene-Hydrochlorothiazide 37.5-25 mg PO DAILY
5. Fluticasone-Salmeterol INH [**Hospital1 **]
6. Levothyroxine 150 mcg PO DAILY
7. Gabapentin 200mg PO TID
8. Montelukast 10mg PO HS
9. Metaxalone 400mg PO BID
10. Pantoprazole 40 mg DR PO BID
11. Hyoscyamine Sulfate 0.250mg SL QID
12. Calcium Carbonate 500mg PO TID
13. Amphetamine-Dextroamphetamine SR 80mg PO daily
14. Cholestyramine-Sucrose 4g PO BID
15. Ursodiol 300 mg PO BID
16. Aspirin 81 mg Chewable PO DAILY
17. Lidocaine HCl 2 % Solution to Mucous membrane TID
18. Tramadol 50mg PO QD
19. Atenolol 25mg PO QD
20. Opium Tincture Ten (10) Drops PO Q6H
21. Loperamide 2mg PO QID
22. Bismuth Subsalicylate 786mg Chewable PO TID
23. Diphenoxylate-Atropine 2.5-0.025 mg PO Q6H
24. Adderall XR 60 mg PO daily

ALLERGIES: Penicillins / Iodine; Iodine Containing / Sulfonamides /
Percocet / Latex

PHYSICAL EXAM: 97.7    125/84    89     27    100RA     -570 24hrs/+2.5L LOS
Gen alert, orientedx3, NAD
HEENT PERRL, MM dry, OP clear
Neck left EJ in place, no lymphadenopathy, no thyromegally
Lungs Clear to auscultation bilaterally
CV RRR, nl S1S2, no murmers
Abd soft, non-tender, hyperactive BS
Ext no edema, well healed wound on right leg

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Retired [**Hospital1 18**] pathologist (on disability); lives with her
husband Denies [**Name2 (NI) **], EtOH, illicit drug usage. 

### Response:
{'Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Peripheral vascular disease, unspecified,Asthma, unspecified type, unspecified,Personal history of other diseases of circulatory system'}
