CHIEF COMPLAINT: Hematemesis

PRESENT ILLNESS: 58 yo F with h/o alcohol abuse, hepatitis C presents with
episode of hematemesis this morning.
Patient was at hotel and had been drinking alcohol with a
friend. She had one episode of emesis, whoch was brown in color,
she thought it was the beer she had been drinking. She then
because nauseous and dizzy and had episode of bright red
hematemesis. She may have lost conciousness. Her friend called
EMS and she was brought to the [**Hospital1 18**] ED. On route EMS noted her
systolic blood pressure to be in the 50s.
.
On arrival to the [**Hospital1 18**] ED, her BP was 68/58. She was boluesed
2L NS and repeat VS HR 70, BP 78/41, RR 16, SpO2 99%/2L. Access
was obtained with 22g, 18g x 3. Initial Hct was 28. She was
bolused a total of 3L and given 2U PRBC. She was started on a
pantoprazole drip at 8mg/hr and a octreotide drip at 50. NG
lavage was performed which demonstrated dark blood. GI was
consulted, and planned for EGD in the ICU.
.
On arrival, patient is awake and mentating well, and complaining
of no symptoms.

MEDICAL HISTORY: - Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Alcohol abuse: has been using about 1 pint brandy per day for
more than a year. She had tried detox once. Denies withdrawal
seizures.
- Hypertension

MEDICATION ON ADMISSION: Atenolol
Fioricet
ASA
[**Name10 (NameIs) 69871**]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 96.5 BP: 90/44 HR: 86 RR: 13 O2sat 100% RA
GEN: NAD, NG tube in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated. No pass-pointing on
finger to nose. 2+DTR's-patellar and biceps
.
On discharge:
BP 120s/80s; Hr 80s. No N/V, no further hematemesis.

FAMILY HISTORY: Sister with diabetes.

SOCIAL HISTORY: Lives in [**Location 686**]. Long history of alcohol abuse, over 10
years. Current smoker. Denies other drug use. Has been in
alcohol detox once - relaped shortly thereafter. Drinks [**2-8**] to 1
pint brandy per day.
Gastroesophageal laceration-hemorrhage syndrome,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension
Mallory-weiss syndrome,Portal hypertension,Esoph varice oth dis NOS,Chrnc hpt C wo hpat coma,Alcoh dep NEC/NOS-contin,Hypertension NOS
Admission Date:  [**2150-4-8**]              Discharge Date:   [**2150-4-10**]

Date of Birth:  [**2091-12-3**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 949**]
Chief Complaint:
Hematemesis

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
58 yo F with h/o alcohol abuse, hepatitis C presents with
episode of hematemesis this morning.
Patient was at hotel and had been drinking alcohol with a
friend. She had one episode of emesis, whoch was brown in color,
she thought it was the beer she had been drinking. She then
because nauseous and dizzy and had episode of bright red
hematemesis. She may have lost conciousness. Her friend called
EMS and she was brought to the [**Hospital1 18**] ED. On route EMS noted her
systolic blood pressure to be in the 50s.
.
On arrival to the [**Hospital1 18**] ED, her BP was 68/58. She was boluesed
2L NS and repeat VS HR 70, BP 78/41, RR 16, SpO2 99%/2L. Access
was obtained with 22g, 18g x 3. Initial Hct was 28. She was
bolused a total of 3L and given 2U PRBC. She was started on a
pantoprazole drip at 8mg/hr and a octreotide drip at 50. NG
lavage was performed which demonstrated dark blood. GI was
consulted, and planned for EGD in the ICU.
.
On arrival, patient is awake and mentating well, and complaining
of no symptoms.


Past Medical History:
- Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Alcohol abuse: has been using about 1 pint brandy per day for
more than a year. She had tried detox once. Denies withdrawal
seizures.
- Hypertension


Social History:
Lives in [**Location 686**]. Long history of alcohol abuse, over 10
years. Current smoker. Denies other drug use. Has been in
alcohol detox once - relaped shortly thereafter. Drinks [**2-8**] to 1
pint brandy per day.

Family History:
Sister with diabetes.

Physical Exam:
VS: Temp: 96.5 BP: 90/44 HR: 86 RR: 13 O2sat 100% RA
GEN: NAD, NG tube in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated. No pass-pointing on
finger to nose. 2+DTR's-patellar and biceps
.
On discharge:
BP 120s/80s; Hr 80s. No N/V, no further hematemesis.


Pertinent Results:
On admission:
[**2150-4-8**] 04:00PM BLOOD WBC-6.2 RBC-2.76* Hgb-9.3* Hct-28.3*
MCV-103*# MCH-33.9* MCHC-33.0 RDW-18.6* Plt Ct-89*
[**2150-4-8**] 06:57PM BLOOD Hct-31.7*
[**2150-4-9**] 12:16AM BLOOD Hct-28.6*
[**2150-4-9**] 04:26AM BLOOD WBC-6.1 RBC-3.12* Hgb-10.6* Hct-30.2*
MCV-97 MCH-34.0* MCHC-35.0 RDW-19.2* Plt Ct-81*
[**2150-4-9**] 12:01PM BLOOD Hct-27.9*
[**2150-4-8**] 04:00PM BLOOD PT-19.5* PTT-31.4 INR(PT)-1.8*
[**2150-4-9**] 04:26AM BLOOD PT-19.2* PTT-31.6 INR(PT)-1.7*
[**2150-4-8**] 04:00PM BLOOD Glucose-143* UreaN-17 Creat-1.2* Na-137
K-4.3 Cl-105 HCO3-19* AnGap-17
[**2150-4-9**] 04:26AM BLOOD Glucose-129* UreaN-16 Creat-0.9 Na-138
K-4.4 Cl-109* HCO3-22 AnGap-11
[**2150-4-8**] 04:00PM BLOOD ALT-31 AST-111* AlkPhos-107* TotBili-1.4
[**2150-4-9**] 04:26AM BLOOD ALT-28 AST-92* AlkPhos-99 TotBili-1.8*
[**2150-4-8**] 04:00PM BLOOD Albumin-2.5* Calcium-8.2* Phos-3.7 Mg-1.7
[**2150-4-9**] 04:26AM BLOOD Albumin-2.5* Calcium-7.4* Phos-3.4
Mg-1.3*
[**2150-4-8**] 04:09PM BLOOD Glucose-139* Lactate-5.1* K-4.1
[**2150-4-9**] 12:21AM BLOOD Lactate-2.7*
.
EGD:
Impression: Varices at the lower third of the esophagus
[**Doctor First Name **]-[**Doctor Last Name **] tear
Blood in the stomach body
Mosaic appearance in the stomach body compatible with mild
portal hypertensive gastropathy
Normal mucosa in the whole duodenum
Otherwise normal EGD to third part of the duodenum
Additional notes: 1. Estimated blood loss: 10 cc
2. Specimens: none
3. Final diagnosis: 3 columns of grade [**2-8**] varices non-bleeding,
[**Doctor First Name **]-[**Doctor Last Name **] tear which was likely cause of bleeding
.
On discharge:
[**2150-4-10**] 04:35AM BLOOD WBC-4.5 RBC-2.88* Hgb-9.6* Hct-27.8*
MCV-96 MCH-33.3* MCHC-34.6 RDW-19.4* Plt Ct-63*
[**2150-4-9**] 04:26AM BLOOD PT-19.2* PTT-31.6 INR(PT)-1.7*
[**2150-4-10**] 04:35AM BLOOD Glucose-116* UreaN-12 Creat-0.8 Na-138
K-3.6 Cl-107 HCO3-24 AnGap-11
[**2150-4-10**] 04:35AM BLOOD ALT-29 AST-86* AlkPhos-93 TotBili-2.0*
.
MELD 15 on day of discharge

Brief Hospital Course:
58 yo female with h/o hepatitis C, alcohol abuse presents with
single episode of hematemesis; EGD showed [**Doctor First Name **]-[**Doctor Last Name **] tear
(likely cause of bleed) as well as non-bleeding esophageal
varices.
.
1. UGI bleed/[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Tear: Received EGD on admission after
she had hypotension in the ED.  After 2 u PRBCs and fluid
resuscitation, her BPs improved.  The scope showed [**Doctor First Name 329**] [**Doctor Last Name **]
tear without active bleeding but with blood in the stomach.  EGD
also revealed 3 columns of grade [**2-8**] varices that were not
bleeding. Bleeding was thought to be [**3-11**] [**Doctor First Name 329**]-[**Doctor Last Name **] tear. She
remained hemodynamically stable thereafter.  She was treated
with octreotide gtt for one day, IV PPI, carafate and zofran.
She started nadolol once her BPs were stable. She was
transferred to the floor where Hct and BP was stable. She was
discharged on Nadolol and to complete 5-days of ciprofloxacin.
She was also discharged on PPI.
.
2. Esophageal Varices: Discharged to complete 5-days of
ciprofloxacin. Also started on PPI to continue as an outpatient.
Patient was counseled about the importance of alcohol cessation.
She was started on nadolol 20 mg qday. She was scheduled with
hepatology follow-up. Aspirin was held until further
conversation with PCP. [**Name10 (NameIs) 69871**] was stopped.
.
3. Hepatitis C: Per report, hepatitis C for 8 years. No history
of treatment. Patient was scheduled with hepatology follow-up
and counseled about the importance of alcohol cessation.
.
4. Alcohol Abuse: Long history of alcohol abuse, no known
seizures from withdrawal. Social work was consulted. The patient
was encouraged to attend AA meetings and to follow up with her
primary MD about her substance abuse issues.
.
5. Hypertension: Started Nadolol on discharge and discontinued
atenolol.
.
Transitional Issues:
- Hepatitis C and Cirrhosis f/u
- HTN management
- substance abuse issues


Medications on Admission:
Atenolol
Fioricet
ASA
[**Name10 (NameIs) 69871**]

Discharge Medications:
1. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a
day for 3 days.
Disp:*6 Tablet(s)* Refills:*0*
2. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Zofran 4 mg Tablet Sig: One (1) Tablet PO every 6-8 hours as
needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
8. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) patch
Transdermal once a day for 3 weeks: PCP can write Rx for
step-down patch dose.
Disp:*21 patches* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Hematemesis
Esophageal varices
[**Doctor First Name **]- [**Doctor Last Name **] tear
Alcohol abuse
.
Secondary:
Hepatitis C


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


Discharge Instructions:
It was a pleasure caring for you at the [**Hospital1 827**]. You were admitted after you vomited blood
(hematemesis). The GI doctors performed [**Name5 (PTitle) **] [**Name5 (PTitle) **] and found
that you had a tear near your stomach from vomiting that was
causing the bleeding. They also saw that you have esophageal
varices (enlarged veins in your esophagus) - this is a result of
chronic liver disease - from Hepatitis C and alcohol. You will
need to follow-up with a liver doctor for this problem (info
below). The best way to be sure this problem does not worsen is
to stop drinking alcohol. If you continue to drink alcohol,
these veins could bleed and you could become very sick or even
die. We encourage you to attend AA meetings to help you stop
drinking.
.
We made the following changes to your medications:
We STARTED Nadolol (to help improve pressure causing the
enlarged veins)
We STARTED Multivitamin
We STARTED Folic Acid
We STARTED Thiamine
We STARTED Ciprofloxacin (antibiotic) to be taken for 3 more
days
We STOPPED Atenolol
We STOPPED Aspirin (discuss restarting this medicine with your
primary MD)
We STOPPED [**Name5 (PTitle) 69871**]/ibuprofen/advil (these medicines can worsen
bleeding)
You should take Fioricet carefully because it contains Tylenol.
Take no more than 2g Tylenol per day.
.
Your follow-up information is listed below.

Followup Instructions:
Department: [**Hospital 7975**] [**Hospital **] HEALTH CENTER
When: THURSDAY [**2150-4-16**] at 2:00 PM
With: [**Name6 (MD) **] [**Last Name (NamePattern4) 8268**], MD [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: LIVER CENTER
When: THURSDAY [**2150-4-23**] at 11:45 AM
With: [**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Gastroesophageal laceration-hemorrhage syndrome,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension'}


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: 58 yo F with h/o alcohol abuse, hepatitis C presents with
episode of hematemesis this morning.
Patient was at hotel and had been drinking alcohol with a
friend. She had one episode of emesis, whoch was brown in color,
she thought it was the beer she had been drinking. She then
because nauseous and dizzy and had episode of bright red
hematemesis. She may have lost conciousness. Her friend called
EMS and she was brought to the [**Hospital1 18**] ED. On route EMS noted her
systolic blood pressure to be in the 50s.
.
On arrival to the [**Hospital1 18**] ED, her BP was 68/58. She was boluesed
2L NS and repeat VS HR 70, BP 78/41, RR 16, SpO2 99%/2L. Access
was obtained with 22g, 18g x 3. Initial Hct was 28. She was
bolused a total of 3L and given 2U PRBC. She was started on a
pantoprazole drip at 8mg/hr and a octreotide drip at 50. NG
lavage was performed which demonstrated dark blood. GI was
consulted, and planned for EGD in the ICU.
.
On arrival, patient is awake and mentating well, and complaining
of no symptoms.

MEDICAL HISTORY: - Hepatitis C, diagnosed ~ 8 years ago, never treated. Unknown
how she got it, denies IVDU, transfusions. Never had liver bx.
- Alcohol abuse: has been using about 1 pint brandy per day for
more than a year. She had tried detox once. Denies withdrawal
seizures.
- Hypertension

MEDICATION ON ADMISSION: Atenolol
Fioricet
ASA
[**Name10 (NameIs) 69871**]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: Temp: 96.5 BP: 90/44 HR: 86 RR: 13 O2sat 100% RA
GEN: NAD, NG tube in place
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated. No pass-pointing on
finger to nose. 2+DTR's-patellar and biceps
.
On discharge:
BP 120s/80s; Hr 80s. No N/V, no further hematemesis.

FAMILY HISTORY: Sister with diabetes.

SOCIAL HISTORY: Lives in [**Location 686**]. Long history of alcohol abuse, over 10
years. Current smoker. Denies other drug use. Has been in
alcohol detox once - relaped shortly thereafter. Drinks [**2-8**] to 1
pint brandy per day. 

### Response:
{'Gastroesophageal laceration-hemorrhage syndrome,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Chronic hepatitis C without mention of hepatic coma,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension'}
