CHIEF COMPLAINT: GIB

PRESENT ILLNESS: This is a 44 y/o M with a PMHx of etoh cirrhosis c/b esophageal
varices s/p banding x5 of 3 esophageal varices on [**2137-7-15**] who
presented to an OSH today with bloody BM x1, followed by melena.
He was found to have a hct of 29.6 and transfused 3u pRBCs prior
to tx to [**Hospital1 18**]. Denied any N/V, hematemesis, abd pain, f/chills.

MEDICAL HISTORY: 1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year
6. Anemia - baseline hct 29-36

MEDICATION ON ADMISSION: Nadolol 20 qD
Protonix 40 [**Hospital1 **]
Lasix 20 qD
Aldactone 50 qD
Levaquin 500 qD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.6 BP122/53 HR73 RR19 o2: 100% 2L NC
GEN: NAD, sleeping but arousable
HEENT: Anicteric sclera
NECK: no elev JVP
CV: regular, nml s1,s2. no murmurs
RESP: CTAB. no c/w/r
ABD: Soft, NTND. No TTP. No HSM
EXT: No edema.
NEURO: AAOx3.
RECTAL: Frank blood in vault; exam performed in ED.

FAMILY HISTORY: M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

SOCIAL HISTORY: Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic)
Alcohol cirrhosis liver,Bleed esoph var oth dis,Thrombocytopenia NOS,Chr blood loss anemia
Admission Date:  [**2137-7-22**]              Discharge Date:   [**2137-7-24**]

Date of Birth:  [**2093-6-29**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 297**]
Chief Complaint:
GIB

Major Surgical or Invasive Procedure:
EGD: Varices at the lower third of the esophagus.  4 small
shallow ulcers seen in the lower third of esophagus compatible
with superficial ulceration from recent banding.
Granularity, friability, erythema, congestion, petechiae and
mosaic appearance in the whole stomach compatible with portal
gastropathy
Otherwise normal EGD to second part of the duodenum


History of Present Illness:
This is a 44 y/o M with a PMHx of etoh cirrhosis c/b esophageal
varices s/p banding x5 of 3 esophageal varices on [**2137-7-15**] who
presented to an OSH today with bloody BM x1, followed by melena.
He was found to have a hct of 29.6 and transfused 3u pRBCs prior
to tx to [**Hospital1 18**]. Denied any N/V, hematemesis, abd pain, f/chills.

.
In the ED, VS were: T98.9, HR74, BP117/61, RR20, 100%2LNC. He
was tx'ed 1u pRBC, continued on his octreotide and protonix
gtt's and transferred to the ICU for emergent EGD and
monitoring.


Past Medical History:
1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year
6. Anemia - baseline hct 29-36


Social History:
Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family.

Family History:
M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

Physical Exam:
VS: T98.6 BP122/53 HR73 RR19 o2: 100% 2L NC
GEN: NAD, sleeping but arousable
HEENT: Anicteric sclera
NECK: no elev JVP
CV: regular, nml s1,s2. no murmurs
RESP: CTAB. no c/w/r
ABD: Soft, NTND. No TTP. No HSM
EXT: No edema.
NEURO: AAOx3.
RECTAL: Frank blood in vault; exam performed in ED.


Pertinent Results:
[**2137-7-22**] 09:55PM   HCT-25.9*
[**2137-7-22**] 01:45PM   GLUCOSE-118* UREA N-14 CREAT-0.6 SODIUM-136
POTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-22 ANION GAP-12
[**2137-7-22**] 01:45PM   ALT(SGPT)-19 AST(SGOT)-26 LD(LDH)-172 ALK
PHOS-56 AMYLASE-20 TOT BILI-1.6* DIR BILI-0.5* INDIR BIL-1.1
[**2137-7-22**] 01:45PM   LIPASE-24
[**2137-7-22**] 01:45PM   ALBUMIN-3.0*
[**2137-7-22**] 01:45PM   WBC-3.4* RBC-3.18* HGB-10.2* HCT-27.1* MCV-85
MCH-32.1* MCHC-37.6* RDW-15.7*
[**2137-7-22**] 01:45PM   NEUTS-73.3* LYMPHS-19.2 MONOS-5.6 EOS-1.8
BASOS-0.1
[**2137-7-22**] 01:45PM   POIKILOCY-1+
[**2137-7-22**] 01:45PM   PLT COUNT-73*

Brief Hospital Course:
44yo male with PMH of alcoholic cirrhosis c/b esophageal varices
s/p banding x5 of 3 esophageal varices on [**2137-7-15**] who
presented to an OSH with bloody BM x1, followed by melena. He
was found to have a hct of 29.6 (GI bleed with blood loss
anemia) and transfused 2u pRBCs.  He was transferred to [**Hospital1 18**]
where he was hemodynamically stable. He was admitted to the MICU
for closer monitoring and emergent EGD.  He was continued on
Protonix and Octreotide gtt.  EGD showed 4 small shallow ulcers
seen in the lower third of esophagus compatible with superficial
ulceration from recent banding. There was no active ebleeding.
He was monitored in the ICU and had no further episodes of
bleeding and remained hemodynamically stable.  IV protonix and
octreotide were continued for 48 hours and then discontinued.
The patient was discharged home with a 5day course of Levaquin
for prophylaxis given variceal bleed.  He has a follow up
appointment with Dr. [**Last Name (STitle) 497**] for [**2137-8-8**].



Medications on Admission:
Nadolol 20 qD
Protonix 40 [**Hospital1 **]
Lasix 20 qD
Aldactone 50 qD
Levaquin 500 qD


Discharge Medications:
1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 days.
Disp:*2 Tablet(s)* Refills:*0*
2. Sucralfate 1 g Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
4. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
6. Aldactone 50 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. Upper GI bleed [**2-7**] ulcers
2. Portal Gastropathy

Secondary Diagnosis:
1. Alcoholic Cirrhosis
2. Esophageal Varices s/p banding


Discharge Condition:
stable


Discharge Instructions:
Please take all medications as prescribed and go to all
scheduled follow-up appointments.

Please call your PCP or go to the ER if you experience any
further bleeding, lightheadedness or anything else that concerns
you.

Followup Instructions:
Provider: [**Name10 (NameIs) **] WEST,ROOM TWO GI ROOMS Date/Time:[**2137-8-8**] 2:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2137-8-8**] 2:00
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic)'}


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: GIB

PRESENT ILLNESS: This is a 44 y/o M with a PMHx of etoh cirrhosis c/b esophageal
varices s/p banding x5 of 3 esophageal varices on [**2137-7-15**] who
presented to an OSH today with bloody BM x1, followed by melena.
He was found to have a hct of 29.6 and transfused 3u pRBCs prior
to tx to [**Hospital1 18**]. Denied any N/V, hematemesis, abd pain, f/chills.

MEDICAL HISTORY: 1. Esophageal varices- hospitalized ? 3 times for variceal
bleeding. Diagnosed at [**Hospital 1562**] Hospital 5 years ago with GIB,
diagnosed with varices. Last ICU stay 3 years ago.
2. History of alcoholism- sober 4 years.
3. Varicose veins
4. Right breast cyst removal-benign
5. Recent intentional weight loss of 85 lbs over past year
6. Anemia - baseline hct 29-36

MEDICATION ON ADMISSION: Nadolol 20 qD
Protonix 40 [**Hospital1 **]
Lasix 20 qD
Aldactone 50 qD
Levaquin 500 qD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T98.6 BP122/53 HR73 RR19 o2: 100% 2L NC
GEN: NAD, sleeping but arousable
HEENT: Anicteric sclera
NECK: no elev JVP
CV: regular, nml s1,s2. no murmurs
RESP: CTAB. no c/w/r
ABD: Soft, NTND. No TTP. No HSM
EXT: No edema.
NEURO: AAOx3.
RECTAL: Frank blood in vault; exam performed in ED.

FAMILY HISTORY: M: EtOH abuse; MU: EtOH abuse; F: UGIB s/p gastrectomy from
ulcers

SOCIAL HISTORY: Former bartender. Now works as resident supervisor at DSS. Quit
smoking 20 years ago. Quit EtOH 4 years ago, "drank vodka
heavily" per family. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Thrombocytopenia, unspecified,Iron deficiency anemia secondary to blood loss (chronic)'}
