CHIEF COMPLAINT: Bright Red blood per rectum

PRESENT ILLNESS: MC is a 78 year old woman with significant PMH of IDDM, HTN,
elevated cholesterol, CRI.  She was in her normal state of
health until 2 days prior to admission when she noticed bright
red blood coming from her rectum.  She spoke with her PCP who
arranged outpatient colonoscopy.  However, on the day of
admission she had a BM with a large amount of bright red blood.
She reported weakness at that time ??????my legs gave out?????? and she
was brought to the emergency room.

MEDICAL HISTORY: IDDM
HTN
elevated cholesterol
CRI
bilat TKA
multiple skin lesions removed by general and plastic surgery
hypothyroid

MEDICATION ON ADMISSION: Lasix
Synthroid
Lipitor
ASA
prozac
atenolol
Metolozone
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam: T 98.7, HR 90, BP 120/74, RR14,  Sat 100%
No acute distress, obese African American woman
Mildly pale conjuntiva
MMM
3/6 SEM, no S3,S4
Soft, NT, ND, no masses, normo-active bowel sounds
No rashes or edema

FAMILY HISTORY: No colon CA, otherwise unremarkable

SOCIAL HISTORY: Lives at home with husband, non-[**Name2 (NI) 1818**], no ETOH
Retired
Diverticulosis of colon with hemorrhage,Pneumonia due to Pseudomonas,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Dvrtclo colon w hmrhg,Pseudomonal pneumonia,Acidosis,CHF NOS,Aortic valve disorder,Cholelith w cholecys NEC,Ac posthemorrhag anemia,Urin tract infection NOS,DMII wo cmp nt st uncntr,Long-term use of insulin,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2162-10-12**]              Discharge Date:   [**2162-11-16**]

Date of Birth:  [**2084-10-17**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Bright Red blood per rectum

Major Surgical or Invasive Procedure:
viseral angiography
colonoscopy
Upper endoscopy
left colectomy
CVL placement
PICC placement
Tracheostomy


History of Present Illness:
MC is a 78 year old woman with significant PMH of IDDM, HTN,
elevated cholesterol, CRI.  She was in her normal state of
health until 2 days prior to admission when she noticed bright
red blood coming from her rectum.  She spoke with her PCP who
arranged outpatient colonoscopy.  However, on the day of
admission she had a BM with a large amount of bright red blood.
She reported weakness at that time ??????my legs gave out?????? and she
was brought to the emergency room.

Past Medical History:
IDDM
HTN
elevated cholesterol
CRI
bilat TKA
multiple skin lesions removed by general and plastic surgery
hypothyroid

Social History:
Lives at home with husband, non-[**Name2 (NI) 1818**], no ETOH
Retired

Family History:
No colon CA, otherwise unremarkable

Physical Exam:
Physical Exam: T 98.7, HR 90, BP 120/74, RR14,  Sat 100%
No acute distress, obese African American woman
Mildly pale conjuntiva
MMM
3/6 SEM, no S3,S4
Soft, NT, ND, no masses, normo-active bowel sounds
No rashes or edema


Pertinent Results:
[**2162-10-12**] 10:50PM   HCT-23.6*
[**2162-10-12**] 03:15PM   GLUCOSE-124* UREA N-74* CREAT-2.7* SODIUM-139
POTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-28 ANION GAP-16
[**2162-10-12**] 03:15PM   CALCIUM-8.8 PHOSPHATE-4.2 MAGNESIUM-2.0
[**2162-10-12**] 01:49PM   K+-3.8
[**2162-10-12**] 01:49PM   HGB-8.7* calcHCT-26
[**2162-10-12**] 01:35PM   GLUCOSE-163* UREA N-76* CREAT-2.6*#
SODIUM-136 POTASSIUM-5.9* CHLORIDE-97 TOTAL CO2-27 ANION GAP-18
[**2162-10-12**] 01:35PM   WBC-7.3# RBC-2.71*# HGB-8.3*# HCT-24.6*#
MCV-91 MCH-30.8 MCHC-34.0 RDW-13.3
[**2162-10-12**] 01:35PM   NEUTS-73.2* LYMPHS-23.1 MONOS-2.8 EOS-0.5
BASOS-0.3
[**2162-10-12**] 01:35PM   PLT COUNT-255
[**2162-10-12**] 01:35PM   PT-13.6* PTT-22.2 INR(PT)-1.2

Brief Hospital Course:
Pt patient was admitted to the medial service and to the MICU.
She was transfused 2 units of PRBC, which she had a poor
response to.  Gastroenterology was consulted for possible
endoscopy.  She received another 3 units of blood prior to
endoscopy, which was only showed blood in the lumen of the
bowel, no active bleeding.  Upper endoscopy was unremarkable.
The patient had tagged red cell scan on HD2 which was
inconclusive.  Capsule endoscopy was inconclusive as well.  This
was unsuccessful as well.  On HD 3 the surgical service was
consulted for possible operative management of the bleed.  We
recommended repeat tagged RBC scan, which was suggestive of a
bleed in the region of the splenic flexure.  The patient was
then brought to IR for an attempt to coil any active lesions.
They we able to see the SMA which showed no active
extravagation, but from the arteriogram was only supplying up to
the right colon.  Since the bleeding scan was suggestive of a
splenic flexure source, [**Female First Name (un) 899**] angio was attempted, but was
unsuccessful.  The over the next day, the patient continued to
drop her HCT, requiring continued transfusion.  She was then
brought to the operating room on HD 6 (after a total of 14 units
of blood) for left colectomy, transverse colostomy, and
cholecystectomy of a gall bladder incidentally full of stones.
She was left intubated at the end of the case

On POD 1 she received multiple boluses for low urine output and
hypotension, but her Hct was stable at 31.  Otherwise did well.
POD 2 a vent wean was attempted but the patient became acidoic
(pH 7.2) on CPAP, so she was put onto AC.  POD 3 brought a
corrected acidosis, and echo was done showing a normal EF, but
severe AS.  By POD 4 she was 35L positive, and her HCT had
drifted to 27.  Lasix was started, with good mobilization.  On
POD 6 her ostomy started to function, so TF were begun.
Throughout this time, a slow vent wean had been in progress.  On
POD 9 she had to be put back on AC, as she once again became
acidoic.  POD 10 lasix drip was started, and we were able to
remove a great deal of fluid (-3L).  By POD 12 she was on a
minimum of vent support, so extubation was attempted.
Unfortunately, this failed, and an urgent reintubation was
performed.  POD 15 she received tracheostomy in the OR, this was
uneventful.  POD 17 she spiked a fever to 101.9.  She was
started empirically on Vancomycin and zosyn.  Cultures were
drawn, CXR which showed infiltrate was taken and her CVL was
resited.  Cultures grew back pseudomonas sensitive to Zosyn, so
Vanco was d/c??????ed.  She was bronched as well, which was
unremarkable.  BAL grew out the same pseudomonas.  She has
finished a 10 course of Zosyn, and remained afebrile.  We have
been able to wean her to CPAP 5/5 and are now starting trach
mask trial.


Medications on Admission:
Lasix
Synthroid
Lipitor
ASA
prozac
atenolol
Metolozone
Insulin

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
2. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg PO DAILY (Daily).
3. Ferrous Sulfate 300 mg/5 mL Liquid Sig: Five (5) ml PO DAILY
(Daily).
4. Acetaminophen 160 mg/5 mL Solution Sig: Twenty (20) ml PO
Q4-6H (every 4 to 6 hours) as needed for fever. ml
5. Levothyroxine Sodium 50 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Benzocaine 20 % Paste Sig: One (1) Appl Mucous membrane  PRN
(as needed).
7. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO QID (4 times a
day).
8. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
10. Hydromorphone 2 mg/mL Syringe Sig: 1-4 mg Injection Q6H
(every 6 hours) as needed.
11. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

12. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Potassium Chloride 20 mEq Packet Sig: Two (2) packets PO TID
(3 times a day).
15. Furosemide 40 mg Tablet Sig: Three (3) Tablet PO Q 8H (Every
8 Hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 86**]

Discharge Diagnosis:
Lower GI bleed
Ventilator aquired pneumonia


Discharge Condition:
Good


Discharge Instructions:
Take all medications as directed.  Wean off ventilator as
tolerated.  Return to ER if you experience increasing pain,
shortness of breath, poor functioning of ileostomy, bleeding or
any other concering signs

Followup Instructions:
See Dr. [**Last Name (STitle) **] in [**2-11**] weeks, call his office for an appointment
[**Telephone/Fax (1) **]



Completed by:[**2162-11-16**]
{'Diverticulosis of colon with hemorrhage,Pneumonia due to Pseudomonas,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified acquired hypothyroidism,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: Bright Red blood per rectum

PRESENT ILLNESS: MC is a 78 year old woman with significant PMH of IDDM, HTN,
elevated cholesterol, CRI.  She was in her normal state of
health until 2 days prior to admission when she noticed bright
red blood coming from her rectum.  She spoke with her PCP who
arranged outpatient colonoscopy.  However, on the day of
admission she had a BM with a large amount of bright red blood.
She reported weakness at that time ??????my legs gave out?????? and she
was brought to the emergency room.

MEDICAL HISTORY: IDDM
HTN
elevated cholesterol
CRI
bilat TKA
multiple skin lesions removed by general and plastic surgery
hypothyroid

MEDICATION ON ADMISSION: Lasix
Synthroid
Lipitor
ASA
prozac
atenolol
Metolozone
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam: T 98.7, HR 90, BP 120/74, RR14,  Sat 100%
No acute distress, obese African American woman
Mildly pale conjuntiva
MMM
3/6 SEM, no S3,S4
Soft, NT, ND, no masses, normo-active bowel sounds
No rashes or edema

FAMILY HISTORY: No colon CA, otherwise unremarkable

SOCIAL HISTORY: Lives at home with husband, non-[**Name2 (NI) 1818**], no ETOH
Retired 

### Response:
{'Diverticulosis of colon with hemorrhage,Pneumonia due to Pseudomonas,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Calculus of gallbladder with other cholecystitis, without mention of obstruction,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
