CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 31823**] is a 74-year-old
male, who is status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**] by Dr. [**Last Name (STitle) 468**], who
presented to the Emergency Department after two episodes of
melanic stools.  The patient had been having normal,
nonbloody bowel movements since the time of discharge from
this hospital on [**2186-8-9**].  The patient states that he began
developing abdominal pain which was sharp in nature without
radiation and located in the epigastrium at approximately 6
pm, the day prior to admission.  He states that this pain was
relieved with a bowel movement.  The patient denied nausea,
vomiting, fevers, and chills, but did complain of diaphoresis
and dizziness.  There was no history of fall or loss of
consciousness.

MEDICAL HISTORY: 1. Periampullary carcinoma status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**].
2. Hypertension.
3. Gastroesophageal reflux disease.
4. Pancreatitis.
5. Urinary retention.
6. Remote history of thyroglossal cyst removal.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of ampulla of vater,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction
Mal neo ampulla of vater,Chr duoden ulcer w hem
Admission Date:  [**2186-8-18**]     Discharge Date:  [**2186-8-20**]

Date of Birth:   [**2112-5-20**]     Sex:  M

Service:  GENERAL SURGERY GOLD

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 31823**] is a 74-year-old
male, who is status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**] by Dr. [**Last Name (STitle) 468**], who
presented to the Emergency Department after two episodes of
melanic stools.  The patient had been having normal,
nonbloody bowel movements since the time of discharge from
this hospital on [**2186-8-9**].  The patient states that he began
developing abdominal pain which was sharp in nature without
radiation and located in the epigastrium at approximately 6
pm, the day prior to admission.  He states that this pain was
relieved with a bowel movement.  The patient denied nausea,
vomiting, fevers, and chills, but did complain of diaphoresis
and dizziness.  There was no history of fall or loss of
consciousness.

At the time of arrival, the patient's vitals are 114/67,
blood pressure in the supine position which became 100/palp
in the sitting position.  The patient received 1 liter of
normal saline in route to the hospital, which relieved his
dizziness.  The patient did have symptoms of urinary
retention on [**2186-8-11**], and was seen at [**Hospital3 **], where
Foley catheter was placed.  Of note, the patient saw his
urologist the day prior to admission, who recommended that
the Foley catheter remain in place for approximately [**2-6**] more
weeks.

PAST MEDICAL HISTORY:
1. Periampullary carcinoma status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**].
2. Hypertension.
3. Gastroesophageal reflux disease.
4. Pancreatitis.
5. Urinary retention.
6. Remote history of thyroglossal cyst removal.

MEDICATIONS:
1. Protonix 40 mg po q day.
2. Vicodin prn pain.
3. Metoprolol 25 mg po bid.
4. Lisinopril 5 mg po q day.
5. Colace 100 mg po bid.
6. ........... 10 mg po qid.
7. Flomax 0.4 mg po q hs.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 97.8, blood
pressure 119/79, heart rate 83, respiratory rate 20, and
oxygen saturation 100% on 2 liters.  General:  Patient is
calm, comfortable, and in no acute distress.  HEENT:
Anicteric sclerae, pink conjunctivae, clear oropharynx, dry
mucous membranes.  Neck is supple and nontender, no
lymphadenopathy.  Heart:  Regular, rate, and rhythm without
murmurs.  Lungs are clear to auscultation bilaterally.
Abdomen is soft, nondistended, and nontender, normoactive
bowel sounds.  There are Steri-Strips in the epigastrium
which are clean, dry, and intact.  Rectal examination reveals
normal tone, positive gross blood, no stool.  Genitourinary
examination:  Normal external genitalia.  There is a Foley
catheter in place.  Extremities:  No clubbing, cyanosis, or
edema, 2+ dorsalis pedis pulses bilaterally.

LABORATORIES:  Hematocrit 24.3, which was down from 36.0 on
the date of discharge.  PT 13.2, PTT 25, INR 1.2.

ELECTROCARDIOGRAM:  Normal sinus rhythm at 80 beats per
minute, there is an isolated ST depression in lead V3.  This
is similar to his prior electrocardiogram.

HOSPITAL COURSE:  The patient presented to the Emergency
Department on [**2186-8-18**].  The patient was resuscitated with IV
fluids and required 5 units of packed red blood cells to
maintain his hematocrit.  In the Emergency Department, a
nasogastric tube was placed, which revealed coffee-grounds,
but no active bleeding.  The patient was started on IV
Protonix, and was admitted to the Intensive Care Unit for
monitoring.

On the date of admission, the patient was taken to the GI
Laboratory, where endoscopy was performed.  This demonstrated
a single oozing 6 mm ulcer in the anastomotic site of the
jejunal limb with an adherent clot.  The clot was removed and
hemostasis was achieved using Epinephrine and electrocautery.

The patient spent one night in the Intensive Care Unit for
monitoring, was started on clear liquids the following day,
and was transferred to the [**Hospital3 **] floor in good
condition.  The patient maintained stable vital signs, was
able to tolerate a house diet, and maintained his hematocrit
at 34 x2.  He was then discharged to home on [**2186-8-20**] in
stable condition, and told to followup with Dr. [**Last Name (STitle) 468**] in
approximately one week.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to home.

DISCHARGE DIAGNOSES:
1. Status post pylorus preserving pancreaticoduodenectomy.
2. Upper gastrointestinal bleed.
3. Hypertension.
4. Gastroesophageal reflux disease.
5. Pancreatitis.
6. Urinary retention.
7. Status post thyroglossal cyst removal.

DISCHARGE MEDICATIONS:
1. Pantoprazole 40 mg po bid.
2. Metoprolol 12.5 mg po bid.
3. Lisinopril 5 mg po q day.
4. Vicodin prn pain.
5. Colace 100 mg po bid.
6. Reglan 10 mg po qid.
7. Flomax 0.4 mg po q hs.

FOLLOW-UP PLANS:  The patient was instructed to followup with
Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 468**] in approximately one week.  He was told to
see his outpatient urologist for Foley catheter removal.  He
was told to followup with his primary care physician
regarding the dosing of his blood pressure medications.  He
was also instructed to return to the Emergency Department if
he developed blood in his stool, dizziness, or
lightheadedness.



                          [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 4984**]

Dictated By:[**Last Name (NamePattern1) 26023**]

MEDQUIST36

D:  [**2186-8-20**]  11:47
T:  [**2186-8-22**]  09:00
JOB#:  [**Job Number 47731**]
{'Malignant neoplasm of ampulla of vater,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 31823**] is a 74-year-old
male, who is status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**] by Dr. [**Last Name (STitle) 468**], who
presented to the Emergency Department after two episodes of
melanic stools.  The patient had been having normal,
nonbloody bowel movements since the time of discharge from
this hospital on [**2186-8-9**].  The patient states that he began
developing abdominal pain which was sharp in nature without
radiation and located in the epigastrium at approximately 6
pm, the day prior to admission.  He states that this pain was
relieved with a bowel movement.  The patient denied nausea,
vomiting, fevers, and chills, but did complain of diaphoresis
and dizziness.  There was no history of fall or loss of
consciousness.

MEDICAL HISTORY: 1. Periampullary carcinoma status post pylorus preserving
pancreaticoduodenectomy [**2186-8-1**].
2. Hypertension.
3. Gastroesophageal reflux disease.
4. Pancreatitis.
5. Urinary retention.
6. Remote history of thyroglossal cyst removal.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of ampulla of vater,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction'}
