CHIEF COMPLAINT: Bright red blood per rectum

PRESENT ILLNESS: This is a 44 year-old women with longstanding IDDM complicated
by ESRD s/p transplant in [**2147**] as well as a more recent
diagnosis of severe diffuse mesenteric ischemia who presented to
the ER last night with BRBPR. In addition she was admitted
[**6-28**]/to [**6-30**] with hematochezia. She was treated
conservatively with hydration and IV antibiotics for presumed
ischemic colitis and discharged home OFF antibiotics. She had
felt well up until the day prior to admission. No abdominal pain
or cramping. She did have some non-bloody diarrhea which has
resolved. She denies light headedness or syncope

MEDICAL HISTORY: -LRRT [**1-19**], 2 episodes acute rejection
-CAD s/p MI, EF 20%
-htn
-DM1
-[**4-24**] percutaneous balloon expandable stenting of the left
common iliac artery, percutaneous balloon angioplasty of the
right SFA and above-the-knee popliteal followed by stenting for
flow-limiting dissection of the distal SFA. Percutaneous balloon
angioplasty of theorigin of the right anterior tibialis.
-Mesenteric ischemia with superior mesenteric artery stenosis.
-squamous cell CA, right arm, left leg: removed
-BRBPR [**2152-7-14**], transfused. Colonoscopy: friable polyps and
ulcerated area. Bx'd

MEDICATION ON ADMISSION: pravachol 10', FK [**1-18**], Pred 5, Plavix 75, ASA 325', Lantus
16qam, RISS, Protonix

ALLERGIES: Levofloxacin

PHYSICAL EXAM: VS: 97.5, 93, 116/75, 20, 100%RA
Gen: NAD, A+Ox3
Skin: no rash, non-icteric
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-tender, non-distended no rebound, guarding
Rectal exam: clotted blood at anus
Extr: no edema

FAMILY HISTORY: N/C

SOCIAL HISTORY: married, currently not working. Lives in 2 level house. Has had
AllCare VNA in past.
Chronic vascular insufficiency of intestine,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Ulcer of heel and midfoot,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Kidney replaced by transplant,Pseudopolyposis of colon,Gastroparesis,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of other malignant neoplasm of skin,Family history of ischemic heart disease,Family history of malignant neoplasm of other genital organs,Family history of other specified malignant neoplasm,Family history of malignant neoplasm of gastrointestinal tract
Chr vasc insuff intest,End stage renal disease,Hyp kid NOS w cr kid V,Ulcer of heel & midfoot,DMI neuro nt st uncntrld,CHF NOS,Chr blood loss anemia,Kidney transplant status,Pseudopolyposis colon,Gastroparesis,Nephritis NOS in oth dis,Diabetic retinopathy NOS,Neuropathy in diabetes,Pure hypercholesterolem,Crnry athrscl natve vssl,Status-post ptca,Old myocardial infarct,Long-term use of aspirin,History of tobacco use,Hx-skin malignancy NEC,Fam hx-ischem heart dis,Fm hx genital malig NEC,Family hx-malignancy NEC,Family hx-gi malignancy
Admission Date:  [**2152-7-14**]              Discharge Date:   [**2152-7-17**]

Date of Birth:  [**2108-4-25**]             Sex:   F

Service: SURGERY

Allergies:
Levofloxacin

Attending:[**First Name3 (LF) 695**]
Chief Complaint:
Bright red blood per rectum

Major Surgical or Invasive Procedure:
[**2152-7-17**]: Colonoscopy


History of Present Illness:
This is a 44 year-old women with longstanding IDDM complicated
by ESRD s/p transplant in [**2147**] as well as a more recent
diagnosis of severe diffuse mesenteric ischemia who presented to
the ER last night with BRBPR. In addition she was admitted
[**6-28**]/to [**6-30**] with hematochezia. She was treated
conservatively with hydration and IV antibiotics for presumed
ischemic colitis and discharged home OFF antibiotics. She had
felt well up until the day prior to admission. No abdominal pain
or cramping. She did have some non-bloody diarrhea which has
resolved. She denies light headedness or syncope


Past Medical History:
-LRRT [**1-19**], 2 episodes acute rejection
-CAD s/p MI, EF 20%
-htn
-DM1
-[**4-24**] percutaneous balloon expandable stenting of the left
common iliac artery, percutaneous balloon angioplasty of the
right SFA and above-the-knee popliteal followed by stenting for
flow-limiting dissection of the distal SFA. Percutaneous balloon
angioplasty of theorigin of the right anterior tibialis.
-Mesenteric ischemia with superior mesenteric artery stenosis.
-squamous cell CA, right arm, left leg: removed
-BRBPR [**2152-7-14**], transfused. Colonoscopy: friable polyps and
ulcerated area. Bx'd


Social History:
married, currently not working. Lives in 2 level house. Has had
AllCare VNA in past.


Family History:
N/C

Physical Exam:
VS: 97.5, 93, 116/75, 20, 100%RA
Gen: NAD, A+Ox3
Skin: no rash, non-icteric
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-tender, non-distended no rebound, guarding
Rectal exam: clotted blood at anus
Extr: no edema

Pertinent Results:
[**2152-7-13**] 09:40PM WBC-9.5 RBC-4.62 Hgb-12.2 Hct-38.7 MCV-84
MCH-26.3* MCHC-31.4 RDW-14.7 Plt Ct-395
[**2152-7-14**] 01:45AM WBC-9.1 RBC-3.03*# Hgb-8.1*# Hct-25.5*# MCV-84
MCH-26.6* MCHC-31.6 RDW-15.2 Plt Ct-331
[**2152-7-13**] PT-13.8* PTT-25.0 INR(PT)-1.2*
[**2152-7-13**] Glucose-591* UreaN-32* Creat-1.5* Na-133 K-5.3* Cl-98
HCO3-24 AnGap-16
[**2152-7-17**] Glucose-169* UreaN-18 Creat-1.2* Na-138 K-4.1 Cl-105
HCO3-24 AnGap-13
[**2152-7-13**] ALT-32 AST-27 CK(CPK)-22* AlkPhos-120* TotBili-0.2
[**2152-7-17**] tacroFK-7.6

[**2152-7-17**] 05:32AM BLOOD WBC-5.4 RBC-4.53 Hgb-12.6 Hct-37.9 MCV-84
MCH-27.9 MCHC-33.3 RDW-15.6* Plt Ct-271
[**2152-7-17**] 05:32AM BLOOD Glucose-169* UreaN-18 Creat-1.2* Na-138
K-4.1 Cl-105 HCO3-24 AnGap-13
[**2152-7-17**] 05:32AM BLOOD Calcium-9.2 Phos-3.5 Mg-1.5*

Brief Hospital Course:
44 y/o female admitted with BRBPR and Hct drop from 38.7% to
25.5%. She was admitted to the SICU and received four units of
packed cells, with subsequent resonse to 40%. Over the next few
days her Hct remained stable with no further bleeding noted, Hct
at discharge was 37.9%.
GI was consulted and a colonoscopy was performed after an bowel
prep with IV hydration to prevent dehydration given ischemic
bowel. She tolerated the prep and underwent the colonoscopy on
[**7-17**].
Results as follows:
Presumed pseudopolyps scattered throughout the descending and
transverse colon (biopsy)
Severe circumferential ulceration beginning at 90cm (biopsy)
Otherwise normal colonoscopy to 90 cm
Recommendations: Follow up biopsies
Resume ASA/Plavix and consider right hemicolectomy as below
Additional notes: The patient likely bled from the ulcerated
area at 90cm and this is likely ischemic in nature. We elected
not to continue the exam because of the severity of the
inflammation and risk of perforation. Although the smaller left
sided pseudopolyps could have bled, these are less likely to
account for the magnitude of her HCT drop. Would restart
ASA/Plavix while awaiting biopsies. The risk of rebleeding is
exceedingly high but, so is the risk of infarction.

Post colonoscopy, vital signs were stable and she felt well
without any abdominal pain. Findings were communicated to the
surgeon. Aspirin and plavix were resumed and she was discharged
home with instruction to hydrate well and call with any
bleeding, abdominal pain or dizziness/lightheadedness.

Podiatry saw her to evaluate a right heel ulcer. This appeared
to be healing well.

She was discharged home in stable condition with a follow up
appointment arranged on [**7-20**] with Dr. [**Last Name (STitle) 816**].


Medications on Admission:
pravachol 10', FK [**1-18**], Pred 5, Plavix 75, ASA 325', Lantus
16qam, RISS, Protonix


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
2. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Silver Sulfadiazine 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
4. Tacrolimus 1 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
5. Insulin Glargine 100 unit/mL Solution Sig: Sixteen (16) units
Subcutaneous once a day: Continue sliding scale insulin per home
routine.
6. Pravachol 10 mg Tablet Sig: One (1) Tablet PO once a day.
7. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
8. Bactrim 80-400 mg Tablet Sig: One (1) Tablet PO once a day.
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
LGI bleeding
intestinal friable polyps, ulceration


Discharge Condition:
Good


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Please monitor for rectal bleeding or evidence of bleeding such
as nosebleeds or easy bruising as you are restarting the Aspirin
and Plavix.
Continue labwork per transplant clinic recommendations


Followup Instructions:
[**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2152-7-20**] 9:00
VASCULAR LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2152-8-2**] 11:00
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2152-8-2**]
12:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**] MD, [**MD Number(3) 709**]

Completed by:[**2152-7-17**]

Name:  [**Known lastname 6056**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 6057**]

Admission Date:  [**2152-7-14**]              Discharge Date:   [**2152-7-17**]

Date of Birth:  [**2108-4-25**]             Sex:   F

Service: SURGERY

Allergies:
Levofloxacin

Attending:[**First Name3 (LF) 48**]
Addendum:
CHF, chronic
Anemia secondary to lower GI bleeding

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 51**] MD, [**MD Number(3) 52**]

Completed by:[**2152-8-11**]
{'Chronic vascular insufficiency of intestine,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Ulcer of heel and midfoot,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Kidney replaced by transplant,Pseudopolyposis of colon,Gastroparesis,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of other malignant neoplasm of skin,Family history of ischemic heart disease,Family history of malignant neoplasm of other genital organs,Family history of other specified malignant neoplasm,Family history of malignant neoplasm of gastrointestinal tract'}


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: This is a 44 year-old women with longstanding IDDM complicated
by ESRD s/p transplant in [**2147**] as well as a more recent
diagnosis of severe diffuse mesenteric ischemia who presented to
the ER last night with BRBPR. In addition she was admitted
[**6-28**]/to [**6-30**] with hematochezia. She was treated
conservatively with hydration and IV antibiotics for presumed
ischemic colitis and discharged home OFF antibiotics. She had
felt well up until the day prior to admission. No abdominal pain
or cramping. She did have some non-bloody diarrhea which has
resolved. She denies light headedness or syncope

MEDICAL HISTORY: -LRRT [**1-19**], 2 episodes acute rejection
-CAD s/p MI, EF 20%
-htn
-DM1
-[**4-24**] percutaneous balloon expandable stenting of the left
common iliac artery, percutaneous balloon angioplasty of the
right SFA and above-the-knee popliteal followed by stenting for
flow-limiting dissection of the distal SFA. Percutaneous balloon
angioplasty of theorigin of the right anterior tibialis.
-Mesenteric ischemia with superior mesenteric artery stenosis.
-squamous cell CA, right arm, left leg: removed
-BRBPR [**2152-7-14**], transfused. Colonoscopy: friable polyps and
ulcerated area. Bx'd

MEDICATION ON ADMISSION: pravachol 10', FK [**1-18**], Pred 5, Plavix 75, ASA 325', Lantus
16qam, RISS, Protonix

ALLERGIES: Levofloxacin

PHYSICAL EXAM: VS: 97.5, 93, 116/75, 20, 100%RA
Gen: NAD, A+Ox3
Skin: no rash, non-icteric
Card: RRR
Lungs: CTA bilaterally
Abd: Soft, non-tender, non-distended no rebound, guarding
Rectal exam: clotted blood at anus
Extr: no edema

FAMILY HISTORY: N/C

SOCIAL HISTORY: married, currently not working. Lives in 2 level house. Has had
AllCare VNA in past. 

### Response:
{'Chronic vascular insufficiency of intestine,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Ulcer of heel and midfoot,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Kidney replaced by transplant,Pseudopolyposis of colon,Gastroparesis,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Background diabetic retinopathy,Polyneuropathy in diabetes,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of aspirin,Personal history of tobacco use,Personal history of other malignant neoplasm of skin,Family history of ischemic heart disease,Family history of malignant neoplasm of other genital organs,Family history of other specified malignant neoplasm,Family history of malignant neoplasm of gastrointestinal tract'}
