CHIEF COMPLAINT: rectal bleeding

PRESENT ILLNESS: HPI:70F with h/o multiple LGIB's with 8 hrs h/o rectal bleeding
in the bowel x 2, also passing clots. No f/c. No abd pain. No
lightheadedness. her stools have been loose mixed with blood.
Of note, the patient's last c-scope was in [**2189**] where she was
noted to have Grade 1 internal hemorrhoids and Diverticulosis of
the entire colon.  She also has a family history of bleeding
with her son and daughter having the same problem.

MEDICAL HISTORY: LGIB x 4 ([**7-/2183**], [**5-17**], [**4-18**], [**2186**]), Diverticulosis, DMII, HTN,
Hyperlipidemia, DJD (Hip/Knee), GERD.

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - 1 (One) Tablet(s) by mouth once a day
ATORVASTATIN - 40 mg Tablet - [**11-18**] Tablet(s) by mouth once a day
GLYBURIDE - 5MG Tablet - ONE Tablet(s) by mouth q am, one half
tab at night
HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day
HYDROCORTISONE ACETATE - 25 mg Suppository - 1 supp rectally
twice a day as needed
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth q am, one q pm
MULTIVITAMINS -  TABLET
NIFEDIPINE [NIFEDICAL XL] - 60 mg Tablet Extended Rel 24 hr - 2
Tab(s) by mouth once a day
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s)
by mouth once a day

ALLERGIES: Dairy

PHYSICAL EXAM: VS: 97.8 142/78 86 18 100%RA
Gen: Well appearing, no acute distress, awake, alert,
appropriate, and oriented x 3
Skin: warm to touch, no apparent rashes
HEENT: No conjunctival pallor, no scleral jaundice, OP clear, no
cervical LAD
CV: RRR, no m/r/g, pulses 2+ in LE
Lungs: clear to auscultation, no w/r/r
Abd: soft, NT, normal BS, ND, +guaiac stool
Ext: 1+ PE bilateral lower extremities
Neuro: Gait, strength and sensation intact bilaterally

FAMILY HISTORY: Son (age 50) and daughter 46(s/p colectomy) have 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.
Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Other transfusion reaction,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Dvrtclo colon w hmrhg,Ac posthemorrhag anemia,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp uncntrld,Transfusion reaction NEC,Abn react-procedure NEC
Admission Date:  [**2192-10-23**]              Discharge Date:   [**2192-10-31**]

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

Service: MEDICINE

Allergies:
Dairy

Attending:[**First Name3 (LF) 2751**]
Chief Complaint:
rectal bleeding

Major Surgical or Invasive Procedure:
Colonoscopy [**2192-10-24**]


History of Present Illness:
HPI:70F with h/o multiple LGIB's with 8 hrs h/o rectal bleeding
in the bowel x 2, also passing clots. No f/c. No abd pain. No
lightheadedness. her stools have been loose mixed with blood.
Of note, the patient's last c-scope was in [**2189**] where she was
noted to have Grade 1 internal hemorrhoids and Diverticulosis of
the entire colon.  She also has a family history of bleeding
with her son and daughter having the same problem.

In ER: BP 153/64. HCT 29. GI called in ER. access is 2 PIV's.
HCT 32 then 30.

Has been eating without pain, nausea, vomitting, diarrhea
stopped. No cp, sob, orthostasis. + Bilateral le edema (not
unusual per her).

ROS:
-Constitutional: [x]WNL []Weight loss []Fatigue/Malaise []Fever
[]Chills/Rigors []Nightweats []Anorexia
-Cardiac: [x]WNL []Chest pain []Palpitations []LE edema
[]Orthopnea/PND []DOE
-Respiratory: [x]WNL []SOB []Pleuritic pain []Hemoptysis []Cough

-Gastrointestinal: [x]WNL []Nausea []Vomiting []Abdominal pain
[]Abdominal Swelling []Diarrhea []Constipation []Hematemesis
[]Hematochezia []Melena
-Musculoskeletal: [x]WNL []Myalgias []Arthralgias []Back pain
-Neurological: [x]WNL []Numbness of extremities []Weakness of
extremities []Parasthesias []Dizziness/Lightheaded []Vertigo
[]Confusion []Headache


Past Medical History:
LGIB x 4 ([**7-/2183**], [**5-17**], [**4-18**], [**2186**]), 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 50) and daughter 46(s/p colectomy) have LGIBs. No FHx
of colitis, Crohn's, ulcerative colitis. No bleeding disorders.
No CRC. No heart disease. No congenital disorders. No AVMs.

Physical Exam:
VS: 97.8 142/78 86 18 100%RA
Gen: Well appearing, no acute distress, awake, alert,
appropriate, and oriented x 3
Skin: warm to touch, no apparent rashes
HEENT: No conjunctival pallor, no scleral jaundice, OP clear, no
cervical LAD
CV: RRR, no m/r/g, pulses 2+ in LE
Lungs: clear to auscultation, no w/r/r
Abd: soft, NT, normal BS, ND, +guaiac stool
Ext: 1+ PE bilateral lower extremities
Neuro: Gait, strength and sensation intact bilaterally


Pertinent Results:
[**2192-10-23**] 10:44PM   PT-12.4 PTT-23.2 INR(PT)-1.0
[**2192-10-23**] 06:40PM   GLUCOSE-150* UREA N-30* CREAT-1.1 SODIUM-142
POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-28 ANION GAP-15
[**2192-10-23**] 06:40PM   estGFR-Using this
[**2192-10-23**] 06:40PM   WBC-8.7 RBC-3.29* HGB-9.5* HCT-30.4* MCV-92
MCH-28.8 MCHC-31.2 RDW-13.3 -> [**2192-10-29**]: hct 26->25->28
[**2192-10-23**] 06:40PM   NEUTS-70.7* LYMPHS-23.7 MONOS-4.2 EOS-1.0
BASOS-0.4
[**2192-10-23**] 06:40PM   PLT COUNT-421

Colonoscopy [**2192-10-24**]:
Impression: Multiple diverticula were seen throughout the colon
especially the sigmoid and descending colon.
Diverticulosis appeared to be of moderate severity.
The lumen of the sigmoid and descending colon contained blood
and blood clots.
The transverse colon contained a small amount of blood only, and
the right side of the colon contained brown stool, indicating
that the source of bleeding is in the left colon.
Despite vigorous washing and flushing, the site of the bleeding
could not be found.

GI Bleeding Scan [**2192-10-25**]:
INTERPRETATION: Following intravenous injection of autologous
red blood cells labeled with Tc-[**Age over 90 **]m, blood flow and dynamic
images of the abdomen for 90 minutes were obtained. A left
lateral view of the pelvis was also obtained. Blood flow images
shows no abnormality.
Dynamic blood pool images shows no abnormality.
IMPRESSION: No scintigraphic evidence of bleeding.

GI Bleeding Scan [**2192-10-26**]:
INTERPRETATION: Following intravenous injection of autologous
red blood cells labeled with Tc-[**Age over 90 **]m, blood flow and dynamic
images of the abdomen were obtained for 70 minutes. A left
lateral view of the abdomen was also obtained. Blood flow images
are normal.
Dynamic blood pool images show abnormal tracer activity at the
splenic flexure at 52 minutes compatible with bleeding. This is
confirmed on the static left lateral view of the abdomen.
IMPRESSION: Bleeding from the splenic flexure at 52 minutes.

GI Bleeding Scan [**2192-10-27**]: Negative for GI bleed.

[**2192-10-31**] 11:23AM BLOOD WBC-7.5 RBC-3.01* Hgb-8.8* Hct-27.1* Plt
Ct-324
[**2192-10-30**] 06:45AM BLOOD Glucose-109* UreaN-10 Creat-0.8 Na-143
K-3.6 Cl-108 HCO3-25 AnGap-14

Brief Hospital Course:
70F with BRBPR and history of diverticulosis who presents with a
lower GI bleed.

1. Acute Blood Loss Anemia/GI Bleed: Pt. was initially admitted
on [**2192-10-23**] for BRBPR. Initially thought most likely a
diverticular bleed given her history.  A colonoscopy was
performed [**2192-10-24**] which showed diffuse moderate divertulosis, a
clot in the transverse and left colon, however the site of the
bleeding could not be determined. Surgery was consulted who
recommended tagged RBC scan, which was negative [**10-25**], repeated
[**10-26**] showed ? splenic flexure bleeding, and negative again
[**10-27**]. During this time her blood counts persistently dropped
requiring a total of 6 Unit PRBC transfusions. On [**10-28**] she was
transferred to the ICU but her counts stabilized and she
required no further transfusions. She was transferred out again
[**10-29**]. GI and surgery both followed. Hemicolectomy was discussed
if bleeding does not stop.  Her HCT remained stable on the floor
after several repeat tests with no clinical evidence of
rebleeding. She will follow up with her PCP early next week for
check up and repeat HCT, and will follow up with [**Hospital **] clinic in
[**Month (only) 404**].  She was instructed to reach her PCP or return to ER
with any recurrent bleeding or other danger signs. Was intructed
to not take aspirin or NSAIDs. She will take iron 325mg twice
daily.

HYPERTENSION, BENIGN: Held HCTZ, Lisinopril, Nifedical and
atenolol in house initially.  Restarted Lisinopril on discharge
with instructions to continue to hold other three medications
until follow up with PCP next week.

Secondary Diagnosis: 272.4 HYPERLIPIDEMIA
Continued statin

Secondary Diagnosis: 250.00 DIABETES TYPE II, UNCONTROLLED, W/O
COMPLICATIONS
Held oral hypoglycemic in house, continued Metformin on
discharge.  Was covered in house with insuling sliding scale.


Medications on Admission:
ATENOLOL - 25 mg Tablet - 1 (One) Tablet(s) by mouth once a day
ATORVASTATIN - 40 mg Tablet - [**11-18**] Tablet(s) by mouth once a day
GLYBURIDE - 5MG Tablet - ONE Tablet(s) by mouth q am, one half
tab at night
HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day
HYDROCORTISONE ACETATE - 25 mg Suppository - 1 supp rectally
twice a day as needed
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth q am, one q pm
MULTIVITAMINS -  TABLET
NIFEDIPINE [NIFEDICAL XL] - 60 mg Tablet Extended Rel 24 hr - 2
Tab(s) by mouth once a day
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s)
by mouth once a day


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Glyburide 5 mg Tablet Sig: One (1) Tablet PO twice a day:
take [**11-18**] tab at night.
3. Lisinopril 30 mg Tablet Sig: One (1) Tablet PO once a day.
4. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.
5. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO every twelve (12) hours.


Discharge Disposition:
Home

Discharge Diagnosis:
Acute Blood Loss Anemia/Diverticular Bleed
Hypertension, benign
Type 2 Diabetes, poorly controlled with complications
Hyperlipidemia
Diverticulosis


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


Discharge Instructions:
You were admitted with a GI bleed.  Your underwent a colonoscopy
which showed bleeding and diverticulosis.  You underwent a
bleeding scan which did not precisely pinpoint your bleed.  The
surgeons evaluated you.  The cause of your bleeding was likely
due to a diverticular bleed.  You required blood transfusion,
last given [**2192-10-27**] and you were observed in ICU without further
intervention.  With supoprtive care your bleeding stopped and
your blood counts remained stable.
.
Please resume medications as indicated on your medication sheet.
 Make a note of the blood pressure medications you should NOT
take until you are further instructed by your PCP at your
appointment next week (Atenolol, HCTZ, Nifedipine).  Please
follow up with your PCP.

Call your doctor or return to the hospital if you have the
symptoms listed below.

Followup Instructions:
Appointment #1
MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Specialty: Internal Medicine/ PCP
[**Name Initial (PRE) 2897**]/ Time: Wednesday, [**11-7**], 11am
Location: [**Hospital Ward Name 23**] Building, [**Location (un) **] Central Suite
Phone number: [**Telephone/Fax (1) 250**]
.
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2192-11-17**] 11:15
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1879**], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2193-1-15**] 10:00
Provider: [**Name10 (NameIs) **] IMAGING Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2193-1-16**] 9:00
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Other transfusion reaction,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: rectal bleeding

PRESENT ILLNESS: HPI:70F with h/o multiple LGIB's with 8 hrs h/o rectal bleeding
in the bowel x 2, also passing clots. No f/c. No abd pain. No
lightheadedness. her stools have been loose mixed with blood.
Of note, the patient's last c-scope was in [**2189**] where she was
noted to have Grade 1 internal hemorrhoids and Diverticulosis of
the entire colon.  She also has a family history of bleeding
with her son and daughter having the same problem.

MEDICAL HISTORY: LGIB x 4 ([**7-/2183**], [**5-17**], [**4-18**], [**2186**]), Diverticulosis, DMII, HTN,
Hyperlipidemia, DJD (Hip/Knee), GERD.

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - 1 (One) Tablet(s) by mouth once a day
ATORVASTATIN - 40 mg Tablet - [**11-18**] Tablet(s) by mouth once a day
GLYBURIDE - 5MG Tablet - ONE Tablet(s) by mouth q am, one half
tab at night
HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 Tablet(s) by mouth once a
day
HYDROCORTISONE ACETATE - 25 mg Suppository - 1 supp rectally
twice a day as needed
LISINOPRIL - 30 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth q am, one q pm
MULTIVITAMINS -  TABLET
NIFEDIPINE [NIFEDICAL XL] - 60 mg Tablet Extended Rel 24 hr - 2
Tab(s) by mouth once a day
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 Capsule(s)
by mouth once a day

ALLERGIES: Dairy

PHYSICAL EXAM: VS: 97.8 142/78 86 18 100%RA
Gen: Well appearing, no acute distress, awake, alert,
appropriate, and oriented x 3
Skin: warm to touch, no apparent rashes
HEENT: No conjunctival pallor, no scleral jaundice, OP clear, no
cervical LAD
CV: RRR, no m/r/g, pulses 2+ in LE
Lungs: clear to auscultation, no w/r/r
Abd: soft, NT, normal BS, ND, +guaiac stool
Ext: 1+ PE bilateral lower extremities
Neuro: Gait, strength and sensation intact bilaterally

FAMILY HISTORY: Son (age 50) and daughter 46(s/p colectomy) have 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:
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Other transfusion reaction,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
