CHIEF COMPLAINT: BRBPR, lightheadedness

PRESENT ILLNESS: 80 year-old woman with HCV cirrhosis and IVDU admitted with
rectal bleeding. Patient has had BRBPR since Tuesday morning. It
started out as thick and dark with streaks of red. She continued
to have her usual [**4-18**] BMs daily with the same black stools with
streaks of blood.  BEcause she was feeling dizzy when she stood
up, she decided to go to PCP [**Name Initial (PRE) 1262**]. PCP referred her to our
ED but she didnt want to go yesterday but decided to come today.

MEDICAL HISTORY: COPD followed by Dr. [**Last Name (STitle) **]
Cervical Spondylosis
HCV
Med non-compliance
HTN
GERD
Hypothyroid
Osteoporosis
S/P bilateral hip replacement
CKD, baseline Cr 1.1

MEDICATION ON ADMISSION: (Per note from [**Hospital1 778**] Health on [**2193-5-2**])
Protonix 40mg daily
Methadone 125mg daily
Levoxyl 137mcg daily
Lisinopril 10mg [**Hospital1 **]
Fosamax 70mg weekly
Loratadine 10mg daily
Colace 200mg [**Hospital1 **]
MVI
Proair HFA 108mcg 2 puffs q4-6hrs prn SOB
Advair 500-50 [**Hospital1 **]
Naproxen 375mg Q8h
Atrovent 17mcg 1-2 puffs q6hrs prn
Oscal D3 500/200 daily
Tylenol 1000mg q6hrs prn pain
Lexapro 10 vs 20 vs 30 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: T:99.3 PO BP:167/72 P:77 R: 18 O2: 98%Ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dryMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
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
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father with emphysema

SOCIAL HISTORY: She lives alone but her son is involved in her care. She smokes
currently but does not drink. She has a prior history of IVDU
and is on methadone. Her methadone administrator is [**First Name8 (NamePattern2) 2048**]
[**Last Name (NamePattern1) 1968**] ([**Telephone/Fax (1) 64437**]).
Diverticulosis of colon with hemorrhage,Opioid type dependence, continuous,Other specified gastritis, without mention of hemorrhage,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Internal hemorrhoids without mention of complication,Hyperpotassemia,Anemia, unspecified,Chronic hepatitis C without mention of hepatic coma,Cervical spondylosis without myelopathy,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement
Dvrtclo colon w hmrhg,Opioid dependence-contin,Oth spf gstrt w/o hmrhg,Adv eff medicinal NOS,Angio stm/dudn w/o hmrhg,Diaphragmatic hernia,Esophageal reflux,Int hemorrhoid w/o compl,Hyperpotassemia,Anemia NOS,Chrnc hpt C wo hpat coma,Cervical spondylosis,Chronic kidney dis NOS,Hy kid NOS w cr kid I-IV,Chr airway obstruct NEC,Tobacco use disorder,Hypothyroidism NOS,Osteoporosis NOS,Joint replaced hip
Admission Date:  [**2193-5-2**]              Discharge Date:   [**2193-5-6**]

Date of Birth:  [**2112-8-6**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1928**]
Chief Complaint:
BRBPR, lightheadedness

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy (EGD) [**2193-5-3**]
Colonoscopy [**2193-5-3**]
Colonoscopy [**2193-5-6**]

History of Present Illness:
80 year-old woman with HCV cirrhosis and IVDU admitted with
rectal bleeding. Patient has had BRBPR since Tuesday morning. It
started out as thick and dark with streaks of red. She continued
to have her usual [**4-18**] BMs daily with the same black stools with
streaks of blood.  BEcause she was feeling dizzy when she stood
up, she decided to go to PCP [**Name Initial (PRE) 1262**]. PCP referred her to our
ED but she didnt want to go yesterday but decided to come today.


On exam in the ED initial vs:T:98 HR:86 BP:164/74 RR:16 O2Sat100
 She had maroon stool, guaiac +++ on rectal exam. 2 EJ PIVs were
inserted. She had an NG lavage that returned no blood. She
remained hemodynamically stable in ED. Pressures 140s systolic
or better for majority of time in ED. Sat 95% RA and stable. Gi
was consulted and recommended serial hcts only. No scope today
unless profuse bleeding.

On the floor, patient had no complaints. She denies nausea and
vomiting. She has no h/o GIB and a colonscopy in [**2186**] was wnl
per her report. She has been taking advil 2tabs twice daily for
back pain for the last few months and before that was on
naproxen. She denies ETOH use.

Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bladder
habits. No dysuria. Denied arthralgias or myalgias.

Past Medical History:
COPD followed by Dr. [**Last Name (STitle) **]
Cervical Spondylosis
HCV
Med non-compliance
HTN
GERD
Hypothyroid
Osteoporosis
S/P bilateral hip replacement
CKD, baseline Cr 1.1

Social History:
She lives alone but her son is involved in her care. She smokes
currently but does not drink. She has a prior history of IVDU
and is on methadone. Her methadone administrator is [**First Name8 (NamePattern2) 2048**]
[**Last Name (NamePattern1) 1968**] ([**Telephone/Fax (1) 64437**]).

Family History:
Father with emphysema

Physical Exam:
Vitals: T:99.3 PO BP:167/72 P:77 R: 18 O2: 98%Ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dryMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
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
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
[**2193-5-2**]
LACTATE-1.7 K+-4.4
GLU-99 UREA N-27* CR-1.2* SODIUM-137 POTASSIUM-5.3* CHLORIDE-99
CO2-31
cTropnT-<0.01
WBC-8.3 RBC-3.88* HGB-12.1 HCT-35.8* MCV-92 PLT-148*
NEUTS-71.0* LYMPHS-17.6* MONOS-7.6 EOS-3.2 BASOS-0.6
PT-11.3 PTT-20.9* INR(PT)-0.9

EGD [**2193-5-3**]:
Impression: Normal mucosa in the esophagus
Erythema and nodularity in the antrum compatible with antral
gastritis Normal mucosa in the duodenum
A few scattered non bleeding AVMs were noted in the second part
of duodenum
Small hiatal hernia
Otherwise normal EGD to third part of the duodenum

Colonoscopy [**2193-5-3**]: !Procedure was incomplete due to poor prep!
Impression: Stool in the colon
Normal mucosa in the colon up to 40 cm
Diverticulosis of the sigmoid colon
Otherwise normal colonoscopy to descending colon

Colonoscopy [**2193-5-6**]:
Grade 2 internal hemorrhoids
Diverticulosis of the transverse colon, descending colon,
sigmoid colon and distal ascending colon
Otherwise normal colonoscopy to cecum

Discharge labs:
[**2193-5-6**] 05:31AM BLOOD WBC-5.5 RBC-3.16* Hgb-10.2* Hct-29.7*
MCV-94 MCH-32.2* MCHC-34.3 RDW-14.1 Plt Ct-122*
[**2193-5-6**] 05:31AM BLOOD Glucose-85 UreaN-11 Creat-1.0 Na-140
K-3.4 Cl-100 HCO3-34* AnGap-9
[**2193-5-6**] 05:31AM BLOOD Calcium-9.0 Phos-2.5* Mg-1.6

Brief Hospital Course:
Mrs. [**Last Name (STitle) 64438**] is an 80 yo F with h/o HCV, COPD, and GERD
admitted with BRBPR.

# LGIB: NG lavage negative.  BRBPR possibly from diverticular
bleed. She remained hemodynamically stable and the bleed had
resolved by the time she was admitted to the [**Hospital Unit Name 153**]. EGD revealed
antral gastritis and a colonoscopy showed diverticulosis (bowel
prep was not adequate, so a complete study could not be
performed).  She was treated with IV PPI [**Hospital1 **].  The patient was
observed over the weekend and had stable Hct between 28-31.  She
had a repeat colonoscopy on [**5-6**] which showed diverticulosis but
no active bleed was found.  No bleeding lesions were seen.  She
was restarted on a regular diet and tolerated this well prior to
discharge.  She was transitioned to Pantoprazole 40mg daily on
discharge.   She was also instructed to stop naprosyn given her
EGD report with antral gastritis.  She can follow up with her
PMD regarding restarting naprosyn in the future.

She has follow up appointment scheduled with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 26211**] on
[**5-14**] with CBC check at that time as well.  She will also
follow up with GI in [**2193-5-16**].

# HCV: Previously followed by Dr. [**Last Name (STitle) **]. Coags normal
indicating good liver synthetic function.

# HTN: Lisinopril intially held for GIB, restarted when BP
stable. This was restarted at her home dose on the floor.

# H/O IVDU: Has been on methadone for 40 years.  She was
continued on her methadone dose of 120mg daily.

# COPD: Advair was continued

# Hypothyroidism: Levothyroxine was continued

# Osteoporosis: Vitamin D and calcium was restarted on discharge

# GERD: As above, the pt was started on IV pantoprazole 40mg
[**Hospital1 **], then transitioned to 40mg daily

# Smoking dependence: Nicotine patch

# Code status:  RESUSCITATE but DO NOT INTUBATE (confirmed with
patient).
The patient was encouraged to either be entirely full code or
DNR/DNI.  She will discuss further with her son at a later time
and reconsider.

Medications on Admission:
(Per note from [**Hospital1 778**] Health on [**2193-5-2**])
Protonix 40mg daily
Methadone 125mg daily
Levoxyl 137mcg daily
Lisinopril 10mg [**Hospital1 **]
Fosamax 70mg weekly
Loratadine 10mg daily
Colace 200mg [**Hospital1 **]
MVI
Proair HFA 108mcg 2 puffs q4-6hrs prn SOB
Advair 500-50 [**Hospital1 **]
Naproxen 375mg Q8h
Atrovent 17mcg 1-2 puffs q6hrs prn
Oscal D3 500/200 daily
Tylenol 1000mg q6hrs prn pain
Lexapro 10 vs 20 vs 30 daily

Discharge Medications:
1. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. Methadone 40 mg Tablet, Soluble Sig: Three (3) Tablet,
Soluble PO DAILY (Daily).
5. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Levothyroxine 137 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Please take this medication 2 hours after your calcium.

7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Ferrous Sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily): Please take this medication in the
afternoon 2 hours after your calcium.  Please note, that you
should not take this medication at the same time as your thyroid
and calcium medictions.
Disp:*30 Tablet(s)* Refills:*0*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.
11. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig: [**2-16**]
puffs Inhalation every six (6) hours as needed for shortness of
breath or wheezing.
12. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain: Do NOT exceed 2grams of Tylenol in 24
hours .
13. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
14. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
15. loratidine  Sig: One (1)   once a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Diverticulosis
GI bleed

Hepatitis C
COPD
Hypertension


Discharge Condition:
Mental Status: Clear and coherent
Level of Consciousness: Alert and interactive
Activity Status: Ambulatory - requires assistance or aid (walker
or cane)


Discharge Instructions:
You were admitted for evaluation and management of GI bleed.  An
endoscopy was performed on [**2193-5-3**] that revealed gastritis
(inflammation in the lining of your stomach), but no bleeding.
A colonoscopy was attempted but not completed on [**2193-5-3**] because
of incomplete bowel prep.  A repeat colonoscopy was performed on
[**2193-5-6**] that revealed diverticulosis and this is the likely
source of your GI bleed.  Your diet was advanced after your
colonoscopy and you tolerated this well.

Medication changes:
1. Please stop taking Naproxen as you had inflammation on your
EGD.  Naproxen can worsen this.  Please discuss this with your
primary care doctor at your next visit.

Followup Instructions:
Name: [**Last Name (LF) 26211**], [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: [**Hospital6 5242**] CENTER
Address: [**Last Name (un) **], [**Location (un) **],[**Numeric Identifier 6425**]
Phone: [**Telephone/Fax (1) 64439**]
Appointment: [**2193-5-14**] 9:20am

Department: DIV. OF GASTROENTEROLOGY
When: WEDNESDAY [**2193-6-12**] at 3:00 PM
With: [**First Name8 (NamePattern2) **] [**Name8 (MD) 10314**], 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
{'Diverticulosis of colon with hemorrhage,Opioid type dependence, continuous,Other specified gastritis, without mention of hemorrhage,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Internal hemorrhoids without mention of complication,Hyperpotassemia,Anemia, unspecified,Chronic hepatitis C without mention of hepatic coma,Cervical spondylosis without myelopathy,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement'}


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: BRBPR, lightheadedness

PRESENT ILLNESS: 80 year-old woman with HCV cirrhosis and IVDU admitted with
rectal bleeding. Patient has had BRBPR since Tuesday morning. It
started out as thick and dark with streaks of red. She continued
to have her usual [**4-18**] BMs daily with the same black stools with
streaks of blood.  BEcause she was feeling dizzy when she stood
up, she decided to go to PCP [**Name Initial (PRE) 1262**]. PCP referred her to our
ED but she didnt want to go yesterday but decided to come today.

MEDICAL HISTORY: COPD followed by Dr. [**Last Name (STitle) **]
Cervical Spondylosis
HCV
Med non-compliance
HTN
GERD
Hypothyroid
Osteoporosis
S/P bilateral hip replacement
CKD, baseline Cr 1.1

MEDICATION ON ADMISSION: (Per note from [**Hospital1 778**] Health on [**2193-5-2**])
Protonix 40mg daily
Methadone 125mg daily
Levoxyl 137mcg daily
Lisinopril 10mg [**Hospital1 **]
Fosamax 70mg weekly
Loratadine 10mg daily
Colace 200mg [**Hospital1 **]
MVI
Proair HFA 108mcg 2 puffs q4-6hrs prn SOB
Advair 500-50 [**Hospital1 **]
Naproxen 375mg Q8h
Atrovent 17mcg 1-2 puffs q6hrs prn
Oscal D3 500/200 daily
Tylenol 1000mg q6hrs prn pain
Lexapro 10 vs 20 vs 30 daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: T:99.3 PO BP:167/72 P:77 R: 18 O2: 98%Ra
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dryMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
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
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father with emphysema

SOCIAL HISTORY: She lives alone but her son is involved in her care. She smokes
currently but does not drink. She has a prior history of IVDU
and is on methadone. Her methadone administrator is [**First Name8 (NamePattern2) 2048**]
[**Last Name (NamePattern1) 1968**] ([**Telephone/Fax (1) 64437**]). 

### Response:
{'Diverticulosis of colon with hemorrhage,Opioid type dependence, continuous,Other specified gastritis, without mention of hemorrhage,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Angiodysplasia of stomach and duodenum without mention of hemorrhage,Diaphragmatic hernia without mention of obstruction or gangrene,Esophageal reflux,Internal hemorrhoids without mention of complication,Hyperpotassemia,Anemia, unspecified,Chronic hepatitis C without mention of hepatic coma,Cervical spondylosis without myelopathy,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement'}
