CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 22 year old
female who underwent an open gastric bypass on [**2147-7-5**], at
[**Hospital6 1708**] for morbid obesity.  The patient
had a relatively uneventful postoperative course.
Approximately seven to ten days ago, she was diagnosed with
pulmonary embolism and was readmitted to the [**Hospital6 8866**] and started on anticoagulation.  The patient
was discharged on Lovenox and Coumadin.  On the day of
admission, her INR was found to be 4.1.  The patient was
advised to skip her dose of Coumadin where she was monitored.
On the same day, the patient felt some epigastric pain and
had four episodes of coffee ground emesis.  Notably, she also
had two black stools.  The patient presented to the Emergency
Department at [**Hospital1 69**].
Initially when the patient presented, her hematocrit was 35.5
and as noted, her INR was 4.1.  The patient was admitted and
started on gastrointestinal bleed protocol and started on
intravenous Protonix, given fresh frozen plasma to reverse
her anticoagulation and had plans to follow her coagulation
studies.  The patient was admitted initially to the Medicine
service.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Intestinal bypass or anastomosis status,Unspecified essential hypertension,Asthma, unspecified type, unspecified
Chr marginal ulcer w hem,Pulm embol/infarct NEC,Chr blood loss anemia,Intestinal bypass status,Hypertension NOS,Asthma NOS
Admission Date:  [**2147-7-24**]     Discharge Date:  [**2147-7-28**]

Date of Birth:   [**2124-11-2**]     Sex:  F

Service:

ADMISSION DIAGNOSES:
1.  Upper gastrointestinal bleed.
2.  History of pulmonary embolus.
3.  History of deep vein thrombosis.
4.  Morbid obesity, status post gastric bypass surgery.
5.  Asthma.
6.  Hypertension.
7.  Migraine headaches.

DISCHARGE DIAGNOSES:
1.  Upper gastrointestinal bleed.
2.  Blood loss anemia.
3.  History of pulmonary embolus.
4.  History of deep vein thrombosis.
5.  Morbid obesity, status post gastric bypass surgery.
6.  Asthma.
7.  Hypertension.
8.  Migraine headaches.

HISTORY OF PRESENT ILLNESS:  The patient is a 22 year old
female who underwent an open gastric bypass on [**2147-7-5**], at
[**Hospital6 1708**] for morbid obesity.  The patient
had a relatively uneventful postoperative course.
Approximately seven to ten days ago, she was diagnosed with
pulmonary embolism and was readmitted to the [**Hospital6 8866**] and started on anticoagulation.  The patient
was discharged on Lovenox and Coumadin.  On the day of
admission, her INR was found to be 4.1.  The patient was
advised to skip her dose of Coumadin where she was monitored.
On the same day, the patient felt some epigastric pain and
had four episodes of coffee ground emesis.  Notably, she also
had two black stools.  The patient presented to the Emergency
Department at [**Hospital1 69**].
Initially when the patient presented, her hematocrit was 35.5
and as noted, her INR was 4.1.  The patient was admitted and
started on gastrointestinal bleed protocol and started on
intravenous Protonix, given fresh frozen plasma to reverse
her anticoagulation and had plans to follow her coagulation
studies.  The patient was admitted initially to the Medicine
service.

PHYSICAL EXAMINATION:  Notably on her admission examination,
temperature was 98.8, heart rate 124, blood pressure 150/80,
respiratory rate 16, oxygen saturation 99% in room air.  She
was alert and oriented in no acute distress.  Sclera were
anicteric.  The oropharynx was without erythema.  The neck
was supple without adenopathy.  The lungs were clear
bilaterally.  The heart was tachycardic but it was normal in
rhythm with S1 and S2 and no murmurs, rubs or gallops.  The
abdomen was soft, tender in the epigastrium, midline incision
was well healed.

LABORATORY DATA:  As noted previously.

HOSPITAL COURSE:  The patient was admitted to the Medicine
service and underwent an endoscopy by Gastroenterology which
showed some blood which could have been secondary to an ulcer
or at staple line.  The patient had serial hematocrit levels
followed as noted previously.  Her next hematocrit after the
initial one drawn dropped to 27.6.  The patient was
transfused with two units of blood and also given fresh
frozen plasma as previously noted for this.  The patient
remained on the Internal Medicine service but was
subsequently transferred over to surgery where her
conservative management continued with proton pump
inhibitors, intravenous fluids, and serial hematocrit checks.
Essentially the patient's course subsequent to her initial
episode of bleeding was unremarkable.  She no longer had any
episodes of bleed and her hematocrit stabilized between 26.0
and 27.0.  She underwent placement of a temporary inferior
vena cava filter which was without complications for her
history of deep vein thrombosis and as the patient could no
longer be anticoagulated.  She tolerated the procedure well.
Again, as noted, the patient was transferred to the surgery
service where conservative management with keeping her NPO
and following serial hematocrit checks continued.  By
hospital day number five, the patient was started on a diet
and was able to take a Stage III diet without any difficulty.
Her hematocrit was stable and last recorded at 27.9.  Her
coagulation studies had returned to within normal limits.  IT
was determined the patient should follow-up for endoscopy
with gastroenterology in five days and also follow-up with
Dr. [**Last Name (STitle) **] next week.  She was discharged to home in good
condition on Zantac Elixir, take 10 mg p.o. twice a day.




                          [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D.  [**MD Number(1) 8285**]

Dictated By:[**Last Name (NamePattern1) 13262**]

MEDQUIST36

D:  [**2147-7-28**]  18:05
T:  [**2147-7-29**]  14:23
JOB#:  [**Job Number 22788**]
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Intestinal bypass or anastomosis status,Unspecified essential hypertension,Asthma, unspecified type, unspecified'}


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: The patient is a 22 year old
female who underwent an open gastric bypass on [**2147-7-5**], at
[**Hospital6 1708**] for morbid obesity.  The patient
had a relatively uneventful postoperative course.
Approximately seven to ten days ago, she was diagnosed with
pulmonary embolism and was readmitted to the [**Hospital6 8866**] and started on anticoagulation.  The patient
was discharged on Lovenox and Coumadin.  On the day of
admission, her INR was found to be 4.1.  The patient was
advised to skip her dose of Coumadin where she was monitored.
On the same day, the patient felt some epigastric pain and
had four episodes of coffee ground emesis.  Notably, she also
had two black stools.  The patient presented to the Emergency
Department at [**Hospital1 69**].
Initially when the patient presented, her hematocrit was 35.5
and as noted, her INR was 4.1.  The patient was admitted and
started on gastrointestinal bleed protocol and started on
intravenous Protonix, given fresh frozen plasma to reverse
her anticoagulation and had plans to follow her coagulation
studies.  The patient was admitted initially to the Medicine
service.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction,Other pulmonary embolism and infarction,Iron deficiency anemia secondary to blood loss (chronic),Intestinal bypass or anastomosis status,Unspecified essential hypertension,Asthma, unspecified type, unspecified'}
