CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: 67 year old male with hx of etoh cirrhosis presented from an OSH
after intubation/sedation for endoscopy showing grade 3 varices
that were injected but not banded.  He continued to have bright
red blood per his NGT.  Per history, he had recently been
discharged for an admission of acute alcoholic hepatitis with
ascites that required paracentesis.  He was at home when he had
abdominal pain, took some alka-seltzer then vomited blood at
home and in the ED.  He was intubated in the ED and admitted for
scope and workup.
.
In his ED course at [**Hospital 8**] hospital, the patient had an EGD
by Dr. [**Last Name (STitle) 55386**].  It revealed bleeding esophageal varices with
normal visualized stomach and duodenum.  Chemical coagulation
was attempted but by the end of the EGD, the varices were still
oozing.  His initial hct was 23.5 --> 21.1 --> 24.8 at 1130 pm
tonight.  INR initially was 4.2 --> 2.2 at 1130 pm.  He received
a total of 4 u PRBCs, 2 u FFP and a total of 10 L.
.
On arrival to the floor, he was intubated and sedated.  There
was bright red blood oozing from his NGT.

MEDICAL HISTORY: Cirrhosis (admitted [**Date range (1) 85269**] for acute alcoholic hepatitis with
new ascited; discriminant score was 53, MELD 24; started on
prednisone with rapid taper)
.
Ascites (last para [**8-11**] with 5L fluid removal)
.
ETOH abuse (last drink mid-[**Month (only) **], had gone on a drinking binge)
.
Recurrent pancreatitis
.
Vitiligo
.
Hx of Hep A infection
.
Hx of polio infection

MEDICATION ON ADMISSION: Spironolactone 100 mg [**Hospital1 **]
Lasix 20 mg daily
Hydroxyzine 50 mg qHS PRN
Lactulose 30 ml [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Diaphoretic
.
Eyes / Conjunctiva: PERRL, Pupils dilated
.
Head, Ears, Nose, Throat: Normocephalic, Endotracheal tube
.
Cardiovascular: (S1: Normal), (S2: Normal)
.
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
.
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Crackles : at based)
.
Abdominal: Bowel sounds present, Distended
.
Extremities: Right lower extremity edema: Absent, Left lower
extremity edema: Absent
.
Musculoskeletal: Muscle wasting
.
Skin:  Not assessed
.
Neurologic: Responds to: Not assessed, Movement: Not assessed,
Sedated, Tone: Not assessed

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient lives with sister; he has daughter in [**Name2 (NI) **]
[**Name (NI) **].  Current tobacco smoker, heavy alcohol use since age
12.  Last drink thought to be [**8-4**].  No hx of IVDU.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Shock, unspecified,Other ascites,Acidosis,Nontraumatic compartment syndrome of abdomen,Acute alcoholic intoxication in alcoholism, continuous,Vitiligo,Personal history of other infectious and parasitic diseases
Alcohol cirrhosis liver,Bleed esoph var oth dis,Acute respiratry failure,Ac kidny fail, tubr necr,Shock NOS,Ascites NEC,Acidosis,Nontrauma comp syn-abd,Ac alcohol intox-contin,Vitiligo,Prsnl hst oth nfct parst
Admission Date:  [**2161-8-18**]              Discharge Date:   [**2161-8-18**]

Date of Birth:  [**2094-7-19**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
hematemesis

Major Surgical or Invasive Procedure:
none.

History of Present Illness:
67 year old male with hx of etoh cirrhosis presented from an OSH
after intubation/sedation for endoscopy showing grade 3 varices
that were injected but not banded.  He continued to have bright
red blood per his NGT.  Per history, he had recently been
discharged for an admission of acute alcoholic hepatitis with
ascites that required paracentesis.  He was at home when he had
abdominal pain, took some alka-seltzer then vomited blood at
home and in the ED.  He was intubated in the ED and admitted for
scope and workup.
.
In his ED course at [**Hospital 8**] hospital, the patient had an EGD
by Dr. [**Last Name (STitle) 55386**].  It revealed bleeding esophageal varices with
normal visualized stomach and duodenum.  Chemical coagulation
was attempted but by the end of the EGD, the varices were still
oozing.  His initial hct was 23.5 --> 21.1 --> 24.8 at 1130 pm
tonight.  INR initially was 4.2 --> 2.2 at 1130 pm.  He received
a total of 4 u PRBCs, 2 u FFP and a total of 10 L.
.
On arrival to the floor, he was intubated and sedated.  There
was bright red blood oozing from his NGT.


Past Medical History:
Cirrhosis (admitted [**Date range (1) 85269**] for acute alcoholic hepatitis with
new ascited; discriminant score was 53, MELD 24; started on
prednisone with rapid taper)
.
Ascites (last para [**8-11**] with 5L fluid removal)
.
ETOH abuse (last drink mid-[**Month (only) **], had gone on a drinking binge)
.
Recurrent pancreatitis
.
Vitiligo
.
Hx of Hep A infection
.
Hx of polio infection

Social History:
The patient lives with sister; he has daughter in [**Name2 (NI) **]
[**Name (NI) **].  Current tobacco smoker, heavy alcohol use since age
12.  Last drink thought to be [**8-4**].  No hx of IVDU.

Family History:
non-contributory

Physical Exam:
General Appearance: Diaphoretic
.
Eyes / Conjunctiva: PERRL, Pupils dilated
.
Head, Ears, Nose, Throat: Normocephalic, Endotracheal tube
.
Cardiovascular: (S1: Normal), (S2: Normal)
.
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
.
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Crackles : at based)
.
Abdominal: Bowel sounds present, Distended
.
Extremities: Right lower extremity edema: Absent, Left lower
extremity edema: Absent
.
Musculoskeletal: Muscle wasting
.
Skin:  Not assessed
.
Neurologic: Responds to: Not assessed, Movement: Not assessed,
Sedated, Tone: Not assessed


Pertinent Results:
[**2161-8-18**] 11:11AM   TYPE-ART TEMP-35.3 RATES-24/ TIDAL VOL-450
PEEP-5 O2-50 PO2-73* PCO2-33* PH-7.07* TOTAL CO2-10* BASE XS--20
INTUBATED-INTUBATED
[**2161-8-18**] 11:11AM   LACTATE-12.7*
[**2161-8-18**] 11:11AM   freeCa-0.82*
[**2161-8-18**] 09:32AM   PO2-106* PCO2-29* PH-7.21* TOTAL CO2-12* BASE
XS--15
[**2161-8-18**] 09:32AM   LACTATE-11.8*
[**2161-8-18**] 07:01AM   GLUCOSE-119* UREA N-42* CREAT-2.3* SODIUM-138
POTASSIUM-4.8 CHLORIDE-103 TOTAL CO2-10* ANION GAP-30*
[**2161-8-18**] 07:01AM   CALCIUM-7.2* PHOSPHATE-7.1* MAGNESIUM-2.4
[**2161-8-18**] 03:15AM   FIBRINOGE-132*
[**2161-8-18**] 03:15AM   WBC-14.7* RBC-2.84* HGB-8.8* HCT-24.8* MCV-88
MCH-31.1 MCHC-35.5* RDW-16.3*

Brief Hospital Course:
67 y/o M with alcoholic cirrhosis who presents from OSH with
variceal bleed that could not be controlled with endoscopy
chemical coagulation.
.
# Upper gastrointestinal bleed:  The patient arrived in the MICU
after transfusion of 4 units of packed red blood cells at an
outside hospital with a Hct of 24.8.  He was transfused 5 more
units of packed red blood cells, 6 units of FFP, 1 unit of
cryoprecipitate and 2 units of platelets after arrival on the
floor without significant improvement of his Hct and frank upper
GI bleeding. An EGD was attempted and terminated as Hepatology
was unable to pass the EG junction as an NG tube was coiled in
the esophogus.  An attempt was made to place a [**State **] tube
without success.  A massive transfusion protocol was initiated
as the patient was actively bleeding and the mortality risk of
surgery wasc considered too great. The patient's family (sisters
and daughter) were contact[**Name (NI) **] and goals of care were discussed
-it was decided in early afternoon to make the patient comfort
measures only.  Pressure support was discontinued and the
patient expired at 6:02pm [**2161-8-18**] in the presence of his
sister and nephew.  [**Name (NI) 6**] autopsy was declined.
.
# Hypotension: The patient presented with significant
hypotension, BP  86/55 and HR 105, secondary to hypovolemic
shock from hemorrhagic upper GI bleed.  The patient was
initiated on levophed pressure support on admission to the MICU
and he was soon maximally dosed on levophed, phenylephrine and
vasopressin drips with persistently low pressures.  Volume
rescussitation was in the form of significant blood products.
His lactate was 11.1 on admission and trended up to 12.7.
.
# Respiratory Failure: The patient was intubated for airway
protection during the procedure at the outside hospital.  He
required large tital volumes to compensate for his acidosis.
.
# Abdominal Bloating: The patient presented with large [**Last Name (un) 2997**],
likely from third spacing from his large fluid resuccitation.
The patient was initiated on vancomycin and ceftriaxone to
provide antibiotic coverage for SBP.
.
# ARF: The patient presented with acute renal failure likely
multifactorial due to ATN from hypotension, obstruction from
abdominal compartment syndrome, prerenal from hypovolemia.
.
# ESLD: The patient's end stage liver disease was secondary to
etoh. The patient was ordered for thiamine, folate, vit K
supplementation


Medications on Admission:
Spironolactone 100 mg [**Hospital1 **]
Lasix 20 mg daily
Hydroxyzine 50 mg qHS PRN
Lactulose 30 ml [**Hospital1 **]

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Hemorrhagic Shock
Bleeding Esophogeal Varicies
Alcoholic Cirrhosis


Discharge Condition:
Expired.

Discharge Instructions:
Expired.

Followup Instructions:
Expired.

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Shock, unspecified,Other ascites,Acidosis,Nontraumatic compartment syndrome of abdomen,Acute alcoholic intoxication in alcoholism, continuous,Vitiligo,Personal history of other infectious and parasitic diseases'}


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: 67 year old male with hx of etoh cirrhosis presented from an OSH
after intubation/sedation for endoscopy showing grade 3 varices
that were injected but not banded.  He continued to have bright
red blood per his NGT.  Per history, he had recently been
discharged for an admission of acute alcoholic hepatitis with
ascites that required paracentesis.  He was at home when he had
abdominal pain, took some alka-seltzer then vomited blood at
home and in the ED.  He was intubated in the ED and admitted for
scope and workup.
.
In his ED course at [**Hospital 8**] hospital, the patient had an EGD
by Dr. [**Last Name (STitle) 55386**].  It revealed bleeding esophageal varices with
normal visualized stomach and duodenum.  Chemical coagulation
was attempted but by the end of the EGD, the varices were still
oozing.  His initial hct was 23.5 --> 21.1 --> 24.8 at 1130 pm
tonight.  INR initially was 4.2 --> 2.2 at 1130 pm.  He received
a total of 4 u PRBCs, 2 u FFP and a total of 10 L.
.
On arrival to the floor, he was intubated and sedated.  There
was bright red blood oozing from his NGT.

MEDICAL HISTORY: Cirrhosis (admitted [**Date range (1) 85269**] for acute alcoholic hepatitis with
new ascited; discriminant score was 53, MELD 24; started on
prednisone with rapid taper)
.
Ascites (last para [**8-11**] with 5L fluid removal)
.
ETOH abuse (last drink mid-[**Month (only) **], had gone on a drinking binge)
.
Recurrent pancreatitis
.
Vitiligo
.
Hx of Hep A infection
.
Hx of polio infection

MEDICATION ON ADMISSION: Spironolactone 100 mg [**Hospital1 **]
Lasix 20 mg daily
Hydroxyzine 50 mg qHS PRN
Lactulose 30 ml [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Diaphoretic
.
Eyes / Conjunctiva: PERRL, Pupils dilated
.
Head, Ears, Nose, Throat: Normocephalic, Endotracheal tube
.
Cardiovascular: (S1: Normal), (S2: Normal)
.
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
.
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Crackles : at based)
.
Abdominal: Bowel sounds present, Distended
.
Extremities: Right lower extremity edema: Absent, Left lower
extremity edema: Absent
.
Musculoskeletal: Muscle wasting
.
Skin:  Not assessed
.
Neurologic: Responds to: Not assessed, Movement: Not assessed,
Sedated, Tone: Not assessed

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient lives with sister; he has daughter in [**Name2 (NI) **]
[**Name (NI) **].  Current tobacco smoker, heavy alcohol use since age
12.  Last drink thought to be [**8-4**].  No hx of IVDU. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Shock, unspecified,Other ascites,Acidosis,Nontraumatic compartment syndrome of abdomen,Acute alcoholic intoxication in alcoholism, continuous,Vitiligo,Personal history of other infectious and parasitic diseases'}
