CHIEF COMPLAINT: 

PRESENT ILLNESS: Briefly, this is a 36-year-old
male with a history of gastrointestinal bleed five years ago
secondary to nonsteroidal anti-inflammatory use versus H.
pylori, which is not thought to have been treated at the
time.  The patient had [**12-26**] week episodes of epigastric pain
noted to be worse after coughing and chest pain.

MEDICAL HISTORY: Only a gastrointestinal bleed
secondary to nonsteroidal anti-inflammatory use.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker and drinks about
two beers a day.
Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Other shock without mention of trauma,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute gastric ulcer with hemorrhage, without mention of obstruction,Other specified cardiac dysrhythmias,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene
Ac duodenal ulcer w hem,Ac posthemorrhag anemia,Shock w/o trauma NEC,Acidosis,React-oth vasc dev/graft,Ac stomach ulcer w hem,Cardiac dysrhythmias NEC,Esophageal reflux,Diaphragmatic hernia
Admission Date:  [**2130-2-24**]       Discharge Date:  [**2130-3-9**]

Date of Birth:   [**2093-10-30**]       Sex:  M

Service:  BLUE SURGERY

HISTORY OF PRESENT ILLNESS:  Briefly, this is a 36-year-old
male with a history of gastrointestinal bleed five years ago
secondary to nonsteroidal anti-inflammatory use versus H.
pylori, which is not thought to have been treated at the
time.  The patient had [**12-26**] week episodes of epigastric pain
noted to be worse after coughing and chest pain.

He presented to an outside hospital on the [**9-24**] with
a feeling of lightheadedness while at work.  The patient went
to the bathroom, passed a maroon stool, and was taken to an
outside hospital Emergency Department by his coworkers.  On
presentation, his systolic blood pressure was in the 80s.
The patient was diaphoretic.  The patient was fluid
resuscitated, and nasogastric lavage showed coffee-ground
material, hematocrit of 38.2.  EGD revealed a duodenal ulcer,
injected Epinephrine, and stopped bleeding.

The patient was transferred to the Intensive Care Unit.
Started on Prevacid [**Hospital1 **].  On the [**9-25**], the patient is
noted to have decreased blood pressure of 90/60, hematocrit
down to 32.9.  EGD revealed a gastroesophageal junction ulcer
which is again injected.

On the evening of that same day, patient had an episode of
hypotension of 60/40 with a heart rate of 40.  Hematocrit was
noted to be down to 28.5.  Vitamin K was given, and on the
morning of [**2130-2-24**], the patient was given 4 units of
packed red blood cells.  The patient had further episodes of
melanotic stool and continued to be pale.  Hematocrit down to
26.

Patient had a third EGD which revealed a healing nonbleeding
ulcer and there was blood visualized in the fundus, and on
approximately 4 pm, was found to have a blood pressure of
67/26 with a heart rate of 60, continued to be transfused and
his hematocrit was 23.  The patient presented for further
management to [**Hospital1 69**] with his
10th unit of packed red blood cells still not feeling very
well.

PAST MEDICAL HISTORY:  Only a gastrointestinal bleed
secondary to nonsteroidal anti-inflammatory use.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON TRANSFER:
1. Librax q6h.
2. Pepcid 30 mg po bid.

SOCIAL HISTORY:  The patient is a nonsmoker and drinks about
two beers a day.

PHYSICAL EXAMINATION:  On examination, the patient was
afebrile.  Vital signs stable.  Blood pressure of 88/41.  The
patient was diaphoretic and pale, regular, rate, and rhythm.
Clear to auscultation.  Abdomen was soft, nontender,
nondistended with positive bowel sounds.

LABORATORIES:  Electrolytes were within normal limits as were
the LFTs, but his hematocrit was 29.2 on admission to [**Hospital1 1444**] with a white count of 15.4,
platelets 143.

Surgery was consulted on the same day of admission.  Patient
was noted to have a hematocrit bumped to 29 status post an
angiogram showing no active bleeding consistent with
an ulcer bleeding which had stopped at the present time.  The
hematocrit continued to be followed.

The patient had an EGD which showed a hiatal hernia likely of
the distal esophagus just above the gastroesophageal
junction, which was oozing and received thermal therapy with
some blood in the stomach, friability of the anterior bulb,
which also received thermal therapy,, and there is an ulcer
in the junction of the first and second portion of the
duodenum, thermal therapy and injection.  Normal EGD of the
third part of the duodenum.

The likely source of significant bleeding was felt to be in
the duodenum between the first and second portion which was
actively bleeding.  Hemostasis was achieved by BICAP
Epinephrine injection.

In the evening of hospital day #2, the patient continued to
bleed and had continued blood transfusions and continued
melena.  Patient underwent a duodenotomy showing a bleeding
ulcer in the duodenum and a gastrostomy tube placement
without complication.  The patient continued to do well
postoperatively, was transferred to the floor on
postoperative day #2.  The patient had maintenance IV fluids,
began to ambulate.

The patient was started on TPN and Foley was discontinued on
postoperative day #6.  The patient continued to do well.  The
patient had PICC line placed for TPN use, which eventually
was discontinued due to some question of mechanical phlebitis
versus cellulitis.  Patient was given antibiotics and
erythema around the site of the PICC line was resolved.

The patient had a drain study done on postoperative day #10
which showed no leaks and good flow through the anastomosis.
The patient's G tube and nasogastric tube were clamped.  The
patient was started on sips.  On postoperative day #11,
nasogastric tube was discontinued.  The patient advanced to
clears on to regular diet.

On postoperative day #12, the patient was tolerating a
regular diet, soft solids, ambulating well with good oral
pain control, and felt to be ready for discharge to home.
Follow up with Dr. [**Last Name (STitle) **] in [**11-24**] weeks.

DISCHARGE INSTRUCTIONS:  The patient was instructed not to
eat any heavy foods for one months' time.

DISCHARGE MEDICATIONS:
1. Percocet 1-2 tablets po q4-6h prn pain.
2. Protonix 40 mg q day.
3. Colace 100 mg po bid.

FOLLOW-UP INSTRUCTIONS:  The patient is instructed for a
followup with Dr. [**Last Name (STitle) **] and also Dr. [**Last Name (STitle) **],
gastrointestinal specialist for followup.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  Home.

DISCHARGE DIAGNOSIS:
1. Status post exploratory laparotomy.
2. Duodenotomy.
3. Oversew of a  bleeding ulcer in duodenum.
4. Gastrostomy tube.



                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2130-3-9**]  19:13
T:  [**2130-3-10**]  07:41
JOB#:  [**Job Number 49326**]
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Other shock without mention of trauma,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute gastric ulcer with hemorrhage, without mention of obstruction,Other specified cardiac dysrhythmias,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene'}


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: Briefly, this is a 36-year-old
male with a history of gastrointestinal bleed five years ago
secondary to nonsteroidal anti-inflammatory use versus H.
pylori, which is not thought to have been treated at the
time.  The patient had [**12-26**] week episodes of epigastric pain
noted to be worse after coughing and chest pain.

MEDICAL HISTORY: Only a gastrointestinal bleed
secondary to nonsteroidal anti-inflammatory use.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a nonsmoker and drinks about
two beers a day. 

### Response:
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Other shock without mention of trauma,Acidosis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Acute gastric ulcer with hemorrhage, without mention of obstruction,Other specified cardiac dysrhythmias,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene'}
