CHIEF COMPLAINT: Melena

PRESENT ILLNESS: 58 yo F otherwise healthy p/w black tarry stools one day prior
to admission. At 1500 she had a bowel movement at work and
noticed tarry stools. She felt fatigued and went home to sleep.
She then awoke at 3 AM on the floor of her bathroom. She could
not recall events prior to this. She called for her daughter who
took her blood pressure which was 80/40. She was then taken to
OSH. Initial BP 94/57 P 68. Reportedly Hct was 30.7 at the OSH.
NG lavage reportedly w/900 cc of coffee grounds. She was started
on octreotide gtt and given 80mg IV protonix. EGD was performed
which showed a submucosal mass in body of stomach w/superficial
ulcerat. It was clipped and injected w/epi. Received 1U PRBCs at
OSH +1U PRBCs enroute to [**Hospital1 18**]. Octreotide gtt continued on
transfer.
.
In ED VS 100.7 118/75 97 18 98% 2L. Second unit PRBCs was
stopped out of concern for febrile reaction. EKG w/sinus
tachycardia 103, no ischemic changes. Hct 30.6. VS prior to
transfer: 99.6 96 117/67 20 97% 2L.
.
In the MICU, pt remained hemodynamically stable overnight
w/stable hct and no further transfusion req'ts. Seen by GI and
surgery, CT scan showed lg mass at L gastric body. Octreotide
gtt dc'ed (no suspicion for varices.) Plan for endoscopic U/S
guided FNA in am. On transfer to the floor, VS 111/53 95 20
96%RA. Pt w/o complaints; denies abdom pain, continued tarry
stools or lightheadedness.

MEDICAL HISTORY: Hysterectomy
Bladder Suspension
Has had two colonscopies at age 50 and 55 which were reportedly
negative.

MEDICATION ON ADMISSION: Estrogen patch

ALLERGIES: Penicillins

PHYSICAL EXAM: ADMISSION PHYSICAL (MICU resident)
VS: 95 111/53 20 9% RA
GA: NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: RRR normal S1/S2. no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no rebound tenderness or guarding. no HSM.
Extremities: warm and well-perfused, no edema. DPs 2+.
Skin: no rashes
Neuro/Psych: A&Ox3, CNs II-XII grossly intact. no focal motor
deficits. sensation intact throughout

FAMILY HISTORY: Mother: H. pylori +, GERD/ulcers/esophageal strictures, Father:
MI age 81. Died of colon cancer at 83.

SOCIAL HISTORY: Denies h/o tobacco. Social drinker. Denies IVDU. Works as an
accountant
Neoplasm of uncertain behavior of connective and other soft tissue,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Acute posthemorrhagic anemia
Unc behav neo soft tissu,Chr stomach ulc w hem,Chr blood loss anemia,Ac posthemorrhag anemia
Admission Date:  [**2159-9-18**]              Discharge Date:   [**2159-9-21**]

Date of Birth:  [**2102-5-5**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
Endoscopy with ultrasound-guided fine needle biopsy of gastric
mass


History of Present Illness:
58 yo F otherwise healthy p/w black tarry stools one day prior
to admission. At 1500 she had a bowel movement at work and
noticed tarry stools. She felt fatigued and went home to sleep.
She then awoke at 3 AM on the floor of her bathroom. She could
not recall events prior to this. She called for her daughter who
took her blood pressure which was 80/40. She was then taken to
OSH. Initial BP 94/57 P 68. Reportedly Hct was 30.7 at the OSH.
NG lavage reportedly w/900 cc of coffee grounds. She was started
on octreotide gtt and given 80mg IV protonix. EGD was performed
which showed a submucosal mass in body of stomach w/superficial
ulcerat. It was clipped and injected w/epi. Received 1U PRBCs at
OSH +1U PRBCs enroute to [**Hospital1 18**]. Octreotide gtt continued on
transfer.
.
In ED VS 100.7 118/75 97 18 98% 2L. Second unit PRBCs was
stopped out of concern for febrile reaction. EKG w/sinus
tachycardia 103, no ischemic changes. Hct 30.6. VS prior to
transfer: 99.6 96 117/67 20 97% 2L.
.
In the MICU, pt remained hemodynamically stable overnight
w/stable hct and no further transfusion req'ts. Seen by GI and
surgery, CT scan showed lg mass at L gastric body. Octreotide
gtt dc'ed (no suspicion for varices.) Plan for endoscopic U/S
guided FNA in am. On transfer to the floor, VS 111/53 95 20
96%RA. Pt w/o complaints; denies abdom pain, continued tarry
stools or lightheadedness.

Past Medical History:
Hysterectomy
Bladder Suspension
Has had two colonscopies at age 50 and 55 which were reportedly
negative.

Social History:
Denies h/o tobacco. Social drinker. Denies IVDU. Works as an
accountant

Family History:
Mother: H. pylori +, GERD/ulcers/esophageal strictures, Father:
MI age 81. Died of colon cancer at 83.

Physical Exam:
ADMISSION PHYSICAL (MICU resident)
VS: 95 111/53 20 9% RA
GA: NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: RRR normal S1/S2. no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no rebound tenderness or guarding. no HSM.
Extremities: warm and well-perfused, no edema. DPs 2+.
Skin: no rashes
Neuro/Psych: A&Ox3, CNs II-XII grossly intact. no focal motor
deficits. sensation intact throughout

Pertinent Results:
LABS:
HCT 28.5
AST 12
ALT 10
Alk phos 42
Tbili 0.3
.
MICRO: H pylori negative
.
IMAGING
[**9-18**] CT abd/pelvis: Large mass (6 x 4 cm) appears to arise from
left gastric body; clip at site of apparent ulceration of mass
from [**Hospital **] Hospital earlier today. Displaces left liver edge
without evident invasion. [**Month (only) 116**] represent GIST, less likely
extrinsic mass. No other mass or lymphadenopathy.

[**9-20**] Endoscopic U/S
EUS findings:  A 4.6cm subepithelial, dumb-bell shaped,
hypoechoic mass was found in the stomach - FNA was performed.
The mass abutted but did not invade the liver.  No adjacent
lymph nodes were noted.
EUS appearance was suggestive of GIST.  A lymphoma,
neuroendocrine lumor and lymph node are also in the differential
diagnosis.

Brief Hospital Course:
# Upper GI bleed: Received 1.5 units PRBCs prior to admission.
The patient was initially admitted to the ICU but was able to
transfer to the floor shortly thereafter.  Hct remained stable
without further need for transfusion. She was started on a iv
ppi [**Hospital1 **].  The gastric mass was further visualized via CT
abdomen/pelvis per GenSurg recommendations, who saw the patient
in the ED.  The patient underwent ultrasound-guided FNA on [**9-20**]
(see imaging results above.) Cytology was ordered rush and the
patient will follow up as an outpatient with General Surgery in
clinic to schedule a resection based on cytology findings.  The
patient was stable overnight after the endoscopy and was
discharged home the evening of [**9-21**].

# Anemia secondary to acute GIB: The patient required no further
transfusions and her hematocrits remained stable from 27-30.


Medications on Admission:
Estrogen patch

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Upper gastrointestinal bleed
Gastric mass
Anemia secondary to acute blood loss


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


Discharge Instructions:
You were admitted to the hospital for a gastrointestinal bleed.
You were found to have a mass in your stomach that caused the
bleed.  You had an EGD with ultrasound and a biopsy of the mass
by our GI doctors.  The biopsy results are pending, but the
surgeons feel that you are safe to go home while you wait for
those results. As soon as the results are back you will be
scheduled for surgery.
.
We have made the following changes to your medications:
1) ADDED Pantoprazole 40mg twice a day to prevent further GI
bleeding.
.

Followup Instructions:
Please contact the [**Name2 (NI) **] Surgery office at Phone: ([**Telephone/Fax (1) 14957**] to schedule follow-up in 1 week.  If the pathology
results are back sooner, they will contact you to schedule
surgery.  Their office is located on the [**Hospital Ward Name 517**] in the
[**Hospital 1426**] Medical Office Building 3A.



Completed by:[**2159-9-24**]

Admission Date:  [**2159-9-25**]              Discharge Date:   [**2159-9-28**]

Date of Birth:  [**2102-5-5**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 4691**]
Chief Complaint:
GI bleed

Major Surgical or Invasive Procedure:
Wedge gastrectomy [**2159-9-25**]


History of Present Illness:
HPI: 57 y/o F previously healthy w/recent [**Hospital1 18**] admission
[**Date range (1) 9910**] for melena [**2-20**] bleeding gastric ulcer, on EGD thought
to
be due to GIST w/biopsies sent for cytology (pathology still
pending). Following stablization, discharged home with plan for
f/u in 1 week to discuss elective resection after return of
pathology results.
Over the several days after discharge, she felt progressively
short of breath, with palpitations on exertion, gradually
increasing. On [**9-25**], pt noticed blood in her stool and
experienced
an episode of syncope, after which she vomited a large amount of
bright red blood. She was taken to [**Hospital **] Hospital. Labs at the
time were notable for Hgb 4, Hct 12, INR 1.2. Pt received 2
units
PRBCs and 3L crystalloid and then transferred by [**Location (un) **] to
[**Hospital1 18**].


Past Medical History:
Hysterectomy
Bladder Suspension
Has had two colonscopies at age 50 and 55 which were reportedly
negative.

Social History:
Denies h/o tobacco. Social drinker. Denies IVDU. Works as an
accountant


Family History:
Mother: H. pylori +, GERD/ulcers/esophageal strictures, Father:
MI age 81. Died of colon cancer at 83.

Physical Exam:
PHYSICAL EXAMINATION upon admission: [**2159-9-25**]

Constitutional: Comfortable, not ill-appearing
Nasogastric tube in place, minimal bloody output
Chest: Clear to auscultation
Cardiovascular: Regular Rate and Rhythm, Normal first and
second heart sounds
Abdominal: Soft, Nontender
Skin: No rash, Warm and dry
Neuro: Speech fluent

Pertinent Results:
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2159-9-27**] 05:20    7.2 3.04* 8.8* 25.6* 84 29.0 34.5 18.8* 201
DIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas
[**2159-9-25**] 11:00    84.4*   11.7* 2.5 1.0 0.6
 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2159-9-27**] 05:20        201
Chemistry
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2159-9-27**] 05:20    144*1 9 0.5 138 4.1 103 30 9
[**2159-9-25**] 08:57PM   HCT-26.3*
[**2159-9-25**] 06:53PM   GLUCOSE-148* UREA N-20 CREAT-0.7 SODIUM-138
POTASSIUM-3.9 CHLORIDE-106 TOTAL CO2-25 ANION GAP-11
[**2159-9-25**] 06:53PM   CALCIUM-6.9* PHOSPHATE-3.5 MAGNESIUM-1.7
[**2159-9-25**] 06:53PM   HCT-23.2*
[**2159-9-25**] 05:32PM   HGB-7.8* calcHCT-23 O2 SAT-97 CARBOXYHB-1.6
[**2159-9-25**] 04:00PM   HCT-20.1*
[**2159-9-25**] 11:00AM   GLUCOSE-153* UREA N-23* CREAT-0.6 SODIUM-137
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-24 ANION GAP-13
[**2159-9-25**] 11:00AM   WBC-11.7*# RBC-2.49*# HGB-7.3*# HCT-22.1*
MCV-89 MCH-29.2 MCHC-32.9 RDW-16.8*
[**2159-9-25**] 11:00AM   PLT COUNT-279#

EKG: [**2159-9-25**]:

Normal sinus rhythm. T wave flattening in leads V3-V6. Compared
to the
previous tracing of [**2159-9-21**] no diagnostic interval change


Brief Hospital Course:
57 year old female who was admitted to the Acute Care Service on
[**2159-9-25**] after a recent discharge for a bleeding gastric ulcer
on EDG thought to be a GIST. She was to follow up in 1 week for
discussion of elective resection.

After discharge she reported bloody stool, shortness of breath
and experienced a syncopal episode. She was taken to an OSH
where she was transfused with 2 units of red blood cells.  She
was transferred to [**Hospital1 **] Hospital.

Upon admission, she received additional blood products and was
consulted by Surgery and Gastroenterology. She was made NPO and
given intravenous fluid. Prior studies from her previous
hospitalization did show a gastric mass.

She was taken to the operating room on [**2159-9-25**] where she
underwent a exploratory laparotomy and wedge resection of a
gastric mass.

Her operative and post-operative course was stable and she was
monitored in the Intensive Care Unit. She was moved to the floor
after it was assured that her hct was stable. Her NGT was
removed and her diet advanced. IS and early ambulation was
encouraged.

Upon discharge, she was tolerating a regular diet. She denies
nausea and vomitting.  She has been ambulating in the room.

Her abdominal dressing is removed and the incision appears
She will follow-up with Dr. [**Last Name (STitle) **] in 1 week.  She will continue
on PPI until her visit with him.

Medications on Admission:
[**Last Name (un) 1724**]: estrogen patch, pantoprazole 40'

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day for 7 days:
continue for 1 week until follow up with the Acute Care Service.



Discharge Disposition:
Home

Discharge Diagnosis:
Submucosal gastric mass


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


Discharge Instructions:
You are being discharged from the hospital with the following
instructions:
*you may start light exercise when you feel comfortable
*avoid heavy lifting ( any lifting which causes abdominal
discomfort)
*you may shower
*avoid driving while on pain medication and/or until you feel
comfortable operating a vehicle
*take your pain medication as prescribed and when needed
Please follow-up in the Emergency Room if you experience:
*fever
*chills
*abdominal pain
*increased redness from surgical site
*yellow, green, or bloody drainage from surgical site
*nausea/vomitting
*weakness
*bloody diarrhea/ bloody vomitus


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in 1 week. You can schedule
your appointement by calling #[**Telephone/Fax (1) 600**].  Please let the
office know that your appointment should be with Dr. [**Last Name (STitle) **]



Completed by:[**2159-10-4**]
{'Neoplasm of uncertain behavior of connective and other soft tissue,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Acute posthemorrhagic anemia'}


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: Melena

PRESENT ILLNESS: 58 yo F otherwise healthy p/w black tarry stools one day prior
to admission. At 1500 she had a bowel movement at work and
noticed tarry stools. She felt fatigued and went home to sleep.
She then awoke at 3 AM on the floor of her bathroom. She could
not recall events prior to this. She called for her daughter who
took her blood pressure which was 80/40. She was then taken to
OSH. Initial BP 94/57 P 68. Reportedly Hct was 30.7 at the OSH.
NG lavage reportedly w/900 cc of coffee grounds. She was started
on octreotide gtt and given 80mg IV protonix. EGD was performed
which showed a submucosal mass in body of stomach w/superficial
ulcerat. It was clipped and injected w/epi. Received 1U PRBCs at
OSH +1U PRBCs enroute to [**Hospital1 18**]. Octreotide gtt continued on
transfer.
.
In ED VS 100.7 118/75 97 18 98% 2L. Second unit PRBCs was
stopped out of concern for febrile reaction. EKG w/sinus
tachycardia 103, no ischemic changes. Hct 30.6. VS prior to
transfer: 99.6 96 117/67 20 97% 2L.
.
In the MICU, pt remained hemodynamically stable overnight
w/stable hct and no further transfusion req'ts. Seen by GI and
surgery, CT scan showed lg mass at L gastric body. Octreotide
gtt dc'ed (no suspicion for varices.) Plan for endoscopic U/S
guided FNA in am. On transfer to the floor, VS 111/53 95 20
96%RA. Pt w/o complaints; denies abdom pain, continued tarry
stools or lightheadedness.

MEDICAL HISTORY: Hysterectomy
Bladder Suspension
Has had two colonscopies at age 50 and 55 which were reportedly
negative.

MEDICATION ON ADMISSION: Estrogen patch

ALLERGIES: Penicillins

PHYSICAL EXAM: ADMISSION PHYSICAL (MICU resident)
VS: 95 111/53 20 9% RA
GA: NAD
HEENT: PERRLA. MMM. no LAD. no JVD. neck supple.
Cards: RRR normal S1/S2. no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, NT, +BS. no rebound tenderness or guarding. no HSM.
Extremities: warm and well-perfused, no edema. DPs 2+.
Skin: no rashes
Neuro/Psych: A&Ox3, CNs II-XII grossly intact. no focal motor
deficits. sensation intact throughout

FAMILY HISTORY: Mother: H. pylori +, GERD/ulcers/esophageal strictures, Father:
MI age 81. Died of colon cancer at 83.

SOCIAL HISTORY: Denies h/o tobacco. Social drinker. Denies IVDU. Works as an
accountant 

### Response:
{'Neoplasm of uncertain behavior of connective and other soft tissue,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Acute posthemorrhagic anemia'}
