CHIEF COMPLAINT: black stool

PRESENT ILLNESS: 65 yr old male with hx of crohn's disease who presents to ED
with one day of dizziness and black diarrhea. Pt states that on
the afternoon of admission, he acutely developed vertigo and
nausea and then had an episode of black diarrhea which was
associated with diaphoresis and near syncope. He notes that a BM
that morning was darker than normal. Pt denies previous hx of GI
bleed, no recent NSAID use. No fevers, chills, abd pain.
*
In the ED, NG lavage was positive for dark black liquid that did
not clear with 250cc of normal saline. Pt's HR was initially 112
to decreased to 80s after fluid; he received a total of 3L in
the ED. GI service was consulted in ED and attempted EGD but due
to a large clot in the fundus that could not be mobilized; they
could not visualize the source of bleeding. He was admitted to
the MICU overnight for scope in the am.

MEDICAL HISTORY: 1. Crohn's disease since age of 24; hx of ileo-cutaneous fistula
(flares 1-2x/yr)
2. hx of herniated disk
3. hx of hip arthritis
4. HTN

MEDICATION ON ADMISSION: 1. Mercaptopurine 50mg qd x 6yrs
2. ASA 81mg qd
3. Felodipine 10mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: temp 98.8, BP 95/42, HR 101, R 12, O2 100%RA
Gen: NAD, AO x 3
HEENT: PERRL, dry MM
CV: RRR, nl murmurs
Chest: clear
Abd: +BS, soft, NTND; guaic pos black stool
Ext: 1+ pedal edema

FAMILY HISTORY: mother died of ovarian cancer
father died of pancreatic cancer
no hx of IBD

SOCIAL HISTORY: occasional alcohol
previous tobacco hx, quit 16 yrs ago
Esophageal hemorrhage,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Regional enteritis of unspecified site,Unspecified essential hypertension
Esophageal hemorrhage,Ac posthemorrhag anemia,Diaphragmatic hernia,Gstr/ddnts NOS w/o hmrhg,Regional enteritis NOS,Hypertension NOS
Admission Date:  [**2198-7-16**]              Discharge Date:   [**2198-7-16**]

Date of Birth:  [**2132-10-18**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Endoscopy


History of Present Illness:
65 yr old male with hx of crohn's disease who presents to ED
with one day of dizziness and black diarrhea. Pt states that on
the afternoon of admission, he acutely developed vertigo and
nausea and then had an episode of black diarrhea which was
associated with diaphoresis and near syncope. He notes that a BM
that morning was darker than normal. Pt denies previous hx of GI
bleed, no recent NSAID use. No fevers, chills, abd pain.
*
In the ED, NG lavage was positive for dark black liquid that did
not clear with 250cc of normal saline. Pt's HR was initially 112
to decreased to 80s after fluid; he received a total of 3L in
the ED. GI service was consulted in ED and attempted EGD but due
to a large clot in the fundus that could not be mobilized; they
could not visualize the source of bleeding. He was admitted to
the MICU overnight for scope in the am.

Past Medical History:
1. Crohn's disease since age of 24; hx of ileo-cutaneous fistula
(flares 1-2x/yr)
2. hx of herniated disk
3. hx of hip arthritis
4. HTN


Social History:
occasional alcohol
previous tobacco hx, quit 16 yrs ago


Family History:
mother died of ovarian cancer
father died of pancreatic cancer
no hx of IBD


Physical Exam:
Exam: temp 98.8, BP 95/42, HR 101, R 12, O2 100%RA
Gen: NAD, AO x 3
HEENT: PERRL, dry MM
CV: RRR, nl murmurs
Chest: clear
Abd: +BS, soft, NTND; guaic pos black stool
Ext: 1+ pedal edema


Pertinent Results:
initial HCT = 34.6, dropped to 28.7 then after 2 unit pRBCs and
3 L IVF returned to Hct 31.4.

Brief Hospital Course:
65 yr old male with hx of crohn's disease who presents with one
day of melena and dizziness
.
1. UGIB: Pt s/p EGD in ED showing nl esophagus, antrum and
duodenum but a large clot in the fundus that could not be
mobilized. Per GI recs, given erythromycin x 8hrs to break up
clot and rescoped in am showing erosions in the pre-pyloric
region and
Grade III esophagitis in the gastroesophageal junction.  They
recommended no aspirin for 4 weeks. Protonix 40 mg before
breakfast and dinner for one month and then Protonix 40 mg
before breakfast long term. Patient was discharged on day #2
with stable hemodynamics and rising hematocrit.
.
2. Crohn's disease: stable; continued mercaptopurine outpt dose.
.
3. HTN: held felodipine in setting of GI bleed.


Medications on Admission:
1. Mercaptopurine 50mg qd x 6yrs
2. ASA 81mg qd
3. Felodipine 10mg qd


Discharge Medications:
1. Pantoprazole Sodium 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*
2. take all medications as prior to hospitalization.

Discharge Disposition:
Home

Discharge Diagnosis:
Upper GI Bleed
Erosions


Discharge Condition:
stable

Discharge Instructions:
Do not take aspirin for at least 4 weeks. Please talk with your
gastroenterologist before restarting your aspirin.
Take protonix 40 mg po before breakfast and dinner daily.

Followup Instructions:
Follow up with your gastroenterologist within the next week in
[**Location (un) 64399**]. Please have your hematocrit checked.


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Esophageal hemorrhage,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Regional enteritis of unspecified site,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: black stool

PRESENT ILLNESS: 65 yr old male with hx of crohn's disease who presents to ED
with one day of dizziness and black diarrhea. Pt states that on
the afternoon of admission, he acutely developed vertigo and
nausea and then had an episode of black diarrhea which was
associated with diaphoresis and near syncope. He notes that a BM
that morning was darker than normal. Pt denies previous hx of GI
bleed, no recent NSAID use. No fevers, chills, abd pain.
*
In the ED, NG lavage was positive for dark black liquid that did
not clear with 250cc of normal saline. Pt's HR was initially 112
to decreased to 80s after fluid; he received a total of 3L in
the ED. GI service was consulted in ED and attempted EGD but due
to a large clot in the fundus that could not be mobilized; they
could not visualize the source of bleeding. He was admitted to
the MICU overnight for scope in the am.

MEDICAL HISTORY: 1. Crohn's disease since age of 24; hx of ileo-cutaneous fistula
(flares 1-2x/yr)
2. hx of herniated disk
3. hx of hip arthritis
4. HTN

MEDICATION ON ADMISSION: 1. Mercaptopurine 50mg qd x 6yrs
2. ASA 81mg qd
3. Felodipine 10mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: temp 98.8, BP 95/42, HR 101, R 12, O2 100%RA
Gen: NAD, AO x 3
HEENT: PERRL, dry MM
CV: RRR, nl murmurs
Chest: clear
Abd: +BS, soft, NTND; guaic pos black stool
Ext: 1+ pedal edema

FAMILY HISTORY: mother died of ovarian cancer
father died of pancreatic cancer
no hx of IBD

SOCIAL HISTORY: occasional alcohol
previous tobacco hx, quit 16 yrs ago 

### Response:
{'Esophageal hemorrhage,Acute posthemorrhagic anemia,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Regional enteritis of unspecified site,Unspecified essential hypertension'}
