CHIEF COMPLAINT: GI bleed

PRESENT ILLNESS: 85 yo female witih history of GERD who presents from the
[**Hospital3 2558**] after nurse [**First Name (Titles) 13431**] [**Last Name (Titles) **] stool in diaper this
morning. She also reports 1 episode of coffee ground emesis
yesterday and current epigastric pain. She reports intermittent
nausea x 1 month, along with recent diarrhea, though she cannot
characterize this as she wears a diaper. She uses OTC PPI
intermittently and is on SQ heparin, likely secondary to recent
hip fracture in [**Month (only) 216**]. She denies any history of alcohol use or
NSAID use.

MEDICAL HISTORY: herpes zoster R face [**7-22**]
polychondritis
osteoporosis with compression fracture - not on treatment except
ca and vit D
bells palsy [**2174**]
pancreatic cyst
hiatal hernia
melanoma
Left hip hemiarthroplasty [**7-22**]
hysterectomy
right THR

MEDICATION ON ADMISSION: MVI
colace 100mg [**Hospital1 **]
senna 2 tabs at bedtime
vit D3 800 units daily
calcium carbonate 500mg QID
heparin SQ TID
fibercap one tab TID
tylenol 500mg PO QID
ferrous sulfate 325mg daily
tylenol 500 mg QID
remeron 15 mg qHS

ALLERGIES: Niacin / Ultram / Valacyclovir / Neurontin

PHYSICAL EXAM: per admitting resident:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives at [**Hospital3 2558**] since recent hip arthroplasty
Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Do not resuscitate status,Osteoporosis, unspecified,Hip joint replacement,Personal history of malignant melanoma of skin
Chr duoden ulcer w hem,Hyposmolality,Ac posthemorrhag anemia,Diaphragmatic hernia,Esophageal reflux,Do not resusctate status,Osteoporosis NOS,Joint replaced hip,Hx-malig skin melanoma
Admission Date:  [**2179-10-9**]              Discharge Date:   [**2179-10-12**]

Date of Birth:  [**2094-2-16**]             Sex:   F

Service: MEDICINE

Allergies:
Niacin / Ultram / Valacyclovir / Neurontin

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

Major Surgical or Invasive Procedure:
endoscopy

History of Present Illness:
85 yo female witih history of GERD who presents from the
[**Hospital3 2558**] after nurse [**First Name (Titles) 13431**] [**Last Name (Titles) **] stool in diaper this
morning. She also reports 1 episode of coffee ground emesis
yesterday and current epigastric pain. She reports intermittent
nausea x 1 month, along with recent diarrhea, though she cannot
characterize this as she wears a diaper. She uses OTC PPI
intermittently and is on SQ heparin, likely secondary to recent
hip fracture in [**Month (only) 216**]. She denies any history of alcohol use or
NSAID use.

On presentation, her vital signs: 96.6, 100, 108/52, 18, 100%.
Exam was notable for diffuse abdominal tenderness, worse in
epigastric area, and dark maroon stools in rectal vault. She was
started on a PPI drip and received zofran 8mg. Her hct has been
stable with lactate 1.4. Potassium was markedly elevated though
this was a hemolyzed specimen. Repeat K 4.5.

Pt is DNR/DNI, however she wishes to reverse this for EGD. She
was evaluated by GI in the ED and will have bedside scope on
arrival.

Review of systems:
(+) Per HPI, also endorses multiple months of shortness of
breath, also generalized weakness. She has been bed bound since
[**Month (only) **] when she had a femur fracture.
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough or wheezing. Denies chest pain, chest
pressure, palpitations, or weakness.  Denies dysuria, frequency,
or urgency.  Denies rashes or skin changes.


Past Medical History:
herpes zoster R face [**7-22**]
polychondritis
osteoporosis with compression fracture - not on treatment except
ca and vit D
bells palsy [**2174**]
pancreatic cyst
hiatal hernia
melanoma
Left hip hemiarthroplasty [**7-22**]
hysterectomy
right THR


Social History:
lives at [**Hospital3 2558**] since recent hip arthroplasty

Family History:
Noncontributory

Physical Exam:
per admitting resident:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

DISCHARGE EXAM:
General: Alert, oriented, flat affect
HEENT: Sclera anicteric, MMM
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
labs on admission:
[**2179-10-9**] 12:45PM   WBC-9.0 RBC-3.20* HGB-10.2*# HCT-29.8* MCV-93
MCH-32.0 MCHC-34.4 RDW-14.1
[**2179-10-9**] 12:45PM   NEUTS-72.2* LYMPHS-21.2 MONOS-5.1 EOS-0.5
BASOS-1.0
[**2179-10-9**] 12:45PM   PLT COUNT-418#
[**2179-10-9**] 12:45PM   PT-14.0* PTT-31.3 INR(PT)-1.2*
[**2179-10-9**] 12:45PM   GLUCOSE-123* UREA N-43* CREAT-0.7 SODIUM-130*
POTASSIUM-7.0* CHLORIDE-97 TOTAL CO2-17* ANION GAP-23*
[**2179-10-9**] 03:00PM   ALT(SGPT)-11 AST(SGOT)-13 LD(LDH)-118 ALK
PHOS-68 TOT BILI-0.2
[**2179-10-9**] 03:00PM   LACTATE-1.4

Hct trend:
[**2179-10-9**] 12:45PM Hct-29.8
[**2179-10-9**] 07:20PM Hct-25.7
[**2179-10-10**] 03:10AM Hct-20.9
[**2179-10-10**] 10:51AM Hct-30.7
[**2179-10-10**] 02:38PM Hct-34.0
[**2179-10-10**] 10:02PM Hct-30.8
[**2179-10-12**] 04:44AM Hct-34.1

Imaging:
CXR: [**10-9**]
moderately enlarged heart and large hiatal hernia. The lungs are
clear, with limited visualization in the retrocardiac region due
to the superimposed hiatal hernia.

EGD: [**10-9**]
A single cratered non-bleeding 18 mm ulcer was found in the
distal bulb.
Impression:
Medium hiatal hernia
Ulcer in the distal bulb
Otherwise normal EGD to third part of the duodenum

HIP FILMS:Stable-appearing left hip hemiarthroplasty.

Brief Hospital Course:
85 y/oF with large hiatal hernia and GERD who was admitted with
GI bleed.

GI bleed: Patient presented with coffee ground emesis and
melanotic stools with Hct near recent baseline of 27- 28.  Home
heparin SC was discontinued.  She was initially started on a
protonix gtt and underwent emergent EGD in the ICU which
revealed a single nonbleed duondenal ulcer which was thought to
be the etiology of her bleed.  Following endoscopy, she was
monitored with serial Hcts.  Hct did drop to 20 on [**10-10**] but
this was thought to represent re- equilibration following fluid
resuscitation rather than continued active bleeding.  She
received 2 UpRBC with Hct stabilizing at 30 initially, then up
to 34 at discharge.  She passed a maroon stool the morning after
admission but this was thought to be secondary to old blood and
her hematocrit was stable.  She did not pass any other [**Month/Year (2) **]
stool.  Protonix gtt was switched to [**Hospital1 **] dosing and her hct
remained stable for remainder of her stay.

asymptomatic bacturia: patient was admitted with asymptomatic
bacturia with urine cx growing entercoccus sensitive to
ampicillin.  She was given a prescription for 3d course of
ampicillin.

metabolic abnormalities: initially presented with hyponatremia,
anion gap metabolic acidosis, and hyperkalemia in setting of
hemolyzed sample. All normalized with IVF suggesting that she
was intravascularly depleted. Anion gap attributed to ketosis
and poor nutrition.

hip arthroplasty: pt has significant weakness and bilateral LE
atrophy.  ortho was consulted and recommended plain films of hip
which showed no new changes.  she was discharged to rehab to
improve her LE strength.


Medications on Admission:
MVI
colace 100mg [**Hospital1 **]
senna 2 tabs at bedtime
vit D3 800 units daily
calcium carbonate 500mg QID
heparin SQ TID
fibercap one tab TID
tylenol 500mg PO QID
ferrous sulfate 325mg daily
tylenol 500 mg QID
remeron 15 mg qHS


Discharge Medications:
1. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
2. docusate sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
3. senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime.
4. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
5. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed
for indigestion.
6. Fiber-Caps 0.52 g Capsule Sig: One (1) Capsule PO three times
a day.
7. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours).
8. ferrous sulfate 325 mg (65 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
10. pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
11. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day): inject subcutaneously.
12. ampicillin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 3 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Primary Diagnosis:
upper GI bleed from duodenal ulcer (H. pylori negative, likely
secondary to hiatal hernia)


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


Discharge Instructions:
Thank you for letting us take part in your care at [**Hospital1 771**].  You came to the hospital because you
had bleeding from your GI tract. You were given a blood
transfusion and your red blood cell count stabilized. You had an
upper GI scope which showed an ulcer in your duodenum, which is
likely what caused your bleeding.  You had no further bleeding
episodes so you were sent home.  You should follow up with a GI
doctor in one month.

You were found to have a urinary tract infection while you were
in the hospital so you should complete a 3 day course of
antibiotics for this (prescription below).

The following changes were made to your medications:
STARTED
pantoprazole 20mg by mouth twice a day
ampicillin 500mg by mouth every 6 hours for 3 days for urinary
tract infection.

Followup Instructions:
Department: DIV. OF GASTROENTEROLOGY
When: TUESDAY [**2179-11-16**] at 1:30 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 22337**], MD [**Telephone/Fax (1) 463**]
Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Do not resuscitate status,Osteoporosis, unspecified,Hip joint replacement,Personal history of malignant melanoma of skin'}


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: GI bleed

PRESENT ILLNESS: 85 yo female witih history of GERD who presents from the
[**Hospital3 2558**] after nurse [**First Name (Titles) 13431**] [**Last Name (Titles) **] stool in diaper this
morning. She also reports 1 episode of coffee ground emesis
yesterday and current epigastric pain. She reports intermittent
nausea x 1 month, along with recent diarrhea, though she cannot
characterize this as she wears a diaper. She uses OTC PPI
intermittently and is on SQ heparin, likely secondary to recent
hip fracture in [**Month (only) 216**]. She denies any history of alcohol use or
NSAID use.

MEDICAL HISTORY: herpes zoster R face [**7-22**]
polychondritis
osteoporosis with compression fracture - not on treatment except
ca and vit D
bells palsy [**2174**]
pancreatic cyst
hiatal hernia
melanoma
Left hip hemiarthroplasty [**7-22**]
hysterectomy
right THR

MEDICATION ON ADMISSION: MVI
colace 100mg [**Hospital1 **]
senna 2 tabs at bedtime
vit D3 800 units daily
calcium carbonate 500mg QID
heparin SQ TID
fibercap one tab TID
tylenol 500mg PO QID
ferrous sulfate 325mg daily
tylenol 500 mg QID
remeron 15 mg qHS

ALLERGIES: Niacin / Ultram / Valacyclovir / Neurontin

PHYSICAL EXAM: per admitting resident:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives at [**Hospital3 2558**] since recent hip arthroplasty 

### Response:
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Hyposmolality and/or hyponatremia,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Do not resuscitate status,Osteoporosis, unspecified,Hip joint replacement,Personal history of malignant melanoma of skin'}
