CHIEF COMPLAINT: Hematemesis.

PRESENT ILLNESS: The patient is a 34-year-old
male with alcohol abuse history and depression; who, after
one year of sobriety had hematemesis in the context of a
binge drinking episode.  His drinking relapse (in 24 hours a
twelve pack of beer, five to six vodkas, several glasses of
wine) led to admission at [**Hospital6 1129**] for
detoxification where he (by report) had one small episode of
hematemesis without an esophagogastroduodenoscopy workup.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified
Alcohol abuse-unspec,Depressive disorder NEC
Admission Date:  [**2113-12-25**]     Discharge Date:  [**2113-12-29**]

Date of Birth:   [**2079-7-15**]     Sex:  M

Service:

CHIEF COMPLAINT:  Hematemesis.

HISTORY OF PRESENT ILLNESS:  The patient is a 34-year-old
male with alcohol abuse history and depression; who, after
one year of sobriety had hematemesis in the context of a
binge drinking episode.  His drinking relapse (in 24 hours a
twelve pack of beer, five to six vodkas, several glasses of
wine) led to admission at [**Hospital6 1129**] for
detoxification where he (by report) had one small episode of
hematemesis without an esophagogastroduodenoscopy workup.

He was discharged from [**Hospital6 1129**] four
days prior to admission and has had complaints of increasing
throat pain and dysphagia.  He took Tylenol for pain.  The
patient had increasing nausea, and vomiting, and retching for
48 hours.  He also complained of decreased oral intake and
dizziness.

On the morning of admission, he vomited a 12-ounce cup of
bright red blood on the subway and again at Starbucks.  He
called Emergency Medical Service, and in the ambulance he
threw up another 1.5 liters of bright red blood.

In the Emergency Department he was lavaged with 1500 cc with
clearing of the bright red blood.  He had a heart rate in the
130s and a systolic blood pressure of 100 to 120.  He
received normal saline times two.

The patient was transferred to the unit where he received 2
units of packed red blood cells with serial hematocrits.  An
esophagogastroduodenoscopy was attempted, but the patient was
unable to be sedated with Versed and Fentanyl.
Gastrointestinal recommended intubation in order to obtain
esophagogastroduodenoscopy.

PHYSICAL EXAMINATION ON PRESENTATION:  Upon examination,
temperature was 98.8, weight was 88.5 kg, heart rate was 102,
blood pressure was 108 to 136/62, with mean arterial
pressures in the 70s to 90, respiratory rate was 16,
saturating 100% on room air.  In general, this an obese male
in no acute distress.  His conjunctivae were pale, and his
mucosa were dry.  He had no jugular venous distention.
Normal first heart sound and second heart sound.  Tachycardic
but regular with positive fourth heart sound.  His lungs were
clear to auscultation bilaterally.  Gastrointestinal
examination revealed no hepatosplenomegaly.  No stigmata of
chronic alcohol use or liver failure.  No tenderness.
Tympanitic abdomen.  Extremities revealed no edema.  Strong
distal pulses.

PERTINENT LABORATORY DATA ON PRESENTATION:  Laboratory data
revealed his white blood cell count was 20, his hematocrit
was 33, and platelets were 443, and mean cell volume was 91.
INR was 1.  Sodium was 132, potassium was 4.5, chloride was
95, bicarbonate was 22, blood urea nitrogen was 35,
creatinine was 1, and blood glucose was 159.  ALT was 80, AST
was 29, alkaline phosphatase was 66, amylase was 65, lipase
was 26, bilirubin was 1.

RADIOLOGY/IMAGING:  Electrocardiogram showed left ventricular
hypertrophy, LAA.  No ST-T wave changes.  No Q waves.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit.  His hospital course was as follows:

1.  GASTROINTESTINAL BLEED:  The patient was transfused with
2 units of packed red blood cells upon initial presentation
and given intravenous fluids for his tachycardia.  He was
started on an octreotide drip at 50 mcg per hour and Protonix
intravenously.  He was discontinued off of all his
nonsteroidal antiinflammatory drugs.  He was evaluated by
Anesthesia for intubation for esophagogastroduodenoscopy.

His esophagogastroduodenoscopy showed an area of active
hemorrhage in the esophagus without surrounding ulceration in
the lower third portion.  The differential diagnosis included
a Dieulafoy's lesion.  4 X 1 E. Epinephrine injections were
applied for a partial hemostasis.  Electrocautery was applied
for successful hemostasis.  Fresh blood and old blood were
seen in the stomach.  Partial obstruction of view of the
mucosa via a large clot.  No active bleeding apparent.  The
duodenum showed fresh red blood.  Lavage cleared, and there
was no evidence of active bleeding.

The patient was successfully extubated.  The octreotide was
discontinued secondary to the absence of varices.  His
hematocrit was tracked serially, and follow-up hematocrits
were 32.8, and then 30.2; for which the patient then received
2 units.  It subsequently dropped to 29.3; after which he
received another unit, and then he dropped to 24.8 with a
repeat of 23.6.  Two units at that point were then
transfused.  The patient was hemodynamically stable.

Gastrointestinal was contact[**Name (NI) **] for a possible repeat
esophagogastroduodenoscopy given evidence of decreasing
hematocrit.  Given the patient's hemodynamic stability, it
was felt at that time that the patient would continue to be
monitored, as this may represent a re-equilibration of his
hematocrit after a massive gastrointestinal bleed.  Follow-up
hematocrit showed a decrease to 26.2 after 2 units, and the
patient was transfused another additional unit with an
increase to 29.2 with a subsequent hematocrit of 31.

The patient's hematocrit continued to be checked twice per
day with subsequent hematocrits decreasing to a low of 25.8.
The patient remained hemodynamically stable; although, he
reported passing bloody stools.  Gastrointestinal was again
contact[**Name (NI) **] who felt that the bloody stools were likely
residual from his upper gastrointestinal bleed.  given that
he was hemodynamically stable, they recommended a transfusion
of 1 unit of packed red blood cells.  His follow-up
hematocrit increased to 29, and he remained at a hematocrit
of 29 for his three follow-up hematocrit checks.

2.  ANXIETY/SUBSTANCE ABUSE:  The patient was maintained on
his Effexor of 75 mg p.o. q.d. as well as BuSpar 15 mg p.o.
b.i.d.   He was also given Ativan 2 mg p.o. q.4h. for a
possible alcohol/benzodiazepines withdrawal.

The patient continued to report issues of anxiety and had
sinus tachycardia.  Psychiatry was consulted to evaluate.
The patient was weaned off of his Ativan, and had his BuSpar
increased to 15 mg p.o. t.i.d.  The patient was recommended
for referral to [**Hospital6 733**] Psychiatry as well as
Alcohol Anonymous after discharge.  The patient continued to
have issues of anxiety, especially given the setting of his
decreasing hematocrit which was causing him distress.  He was
then started on Seroquel 25 mg p.o. q.h.s.

CONDITION AT DISCHARGE:  The patient was discharged in stable
condition.

DISCHARGE DIAGNOSES:
1.  Upper gastrointestinal bleed.
2.  Possible Dieulafoy ulcer.
3.  Anxiety.

MEDICATIONS ON DISCHARGE:  (His discharge medications
included)
1.  Protonix 40 mg p.o. b.i.d.
2.  BuSpar 15 mg p.o. t.i.d.
3.  Effexor 75 mg p.o. q.d.
4.  Seroquel 25 mg p.o. q.h.s.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was to follow
up with his new primary care physician (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]).




                          [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**], M.D.  [**MD Number(1) 736**]

Dictated By:[**Last Name (NamePattern1) 4988**]

MEDQUIST36

D:  [**2114-1-8**]  23:18
T:  [**2114-1-11**]  15:26
JOB#:  [**Job Number 34395**]
{'Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified'}


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: Hematemesis.

PRESENT ILLNESS: The patient is a 34-year-old
male with alcohol abuse history and depression; who, after
one year of sobriety had hematemesis in the context of a
binge drinking episode.  His drinking relapse (in 24 hours a
twelve pack of beer, five to six vodkas, several glasses of
wine) led to admission at [**Hospital6 1129**] for
detoxification where he (by report) had one small episode of
hematemesis without an esophagogastroduodenoscopy workup.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified'}
