CHIEF COMPLAINT: Bright red blood per rectum times three.

PRESENT ILLNESS: The patient is a 52 year old
male with past medical history of ETOH cirrhosis and in
[**9-29**], ultrasound with heterogeneous liver is noted.  History
of esophageal varices banded on [**2138-10-9**], and [**2138-10-11**].  He
presented to the Emergency Department on [**2138-11-12**], with
bright red blood per rectum.  Otherwise, no melena, no
hematemesis, no nausea, vomiting, abdominal pain since last
month. Review of systems was otherwise negative.  The patient
was taken to the Medical Intensive Care Unit and had an
esophagogastroduodenoscopy with no active bleeding noted, but
one varix was banded.  The patient was hemodynamically stable
and received two units of packed red blood cells with no
further episodes of bright red blood per rectum. The patient
had one more unit of blood in the Medical Intensive Care Unit
and had esophagogastroduodenoscopy in the unit which was
significant for nonbleeding varices and three grade II
varices.  Previously banded varices were noted.  Banding was
attempted but aborted.  The patient had evidence of positive
portal hypertensive gastropathy and normal structures
otherwise.  The patient was maintained on Octreotide and
intravenous Protonix and secondarily was transferred to the
medicine service for further care as well as repeat
colonoscopy.

MEDICAL HISTORY: 1.  Cirrhosis secondary to ETOH abuse.
2.  History of upper gastrointestinal bleed, on [**2138-11-11**],
grade II varices times three, no active bleeding, on
[**2138-10-21**], grade III varices times four, lower one third
gastroesophageal tube, [**2138-11-12**], positive active bleed, lower
esophageal sphincter, positive [**Last Name (un) **].
3.  Glucose intolerance.

MEDICATION ON ADMISSION: 1.  Megace.
2.  Ursodiol 300 mg twice a day.
3.  Sucralfate one gram three times a day.
4.  Thiamine.
5.  Folate.
6.  Nadolol 10 mg p.o. once daily.
7.  Spironolactone 50 mg one p.o. once daily.
8.  Protonix.
9.  Lasix 40 mg p.o. once daily.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Alcoholic cirrhosis of liver,Iron deficiency anemia secondary to blood loss (chronic),Esophageal varices in diseases classified elsewhere, with bleeding,Portal hypertension,Other specified intestinal malabsorption,Alcohol abuse, in remission,Benign neoplasm of colon,Other specified disorders of intestine
Alcohol cirrhosis liver,Chr blood loss anemia,Bleed esoph var oth dis,Portal hypertension,Intest malabsorption NEC,Alcohol abuse-in remiss,Benign neoplasm lg bowel,Intestinal disorders NEC
Admission Date:  [**2138-11-12**]     Discharge Date:  [**2138-11-15**]

Date of Birth:   [**2086-2-26**]     Sex:  M

Service:  GASTROENTEROLOGY

CHIEF COMPLAINT:  Bright red blood per rectum times three.

HISTORY OF PRESENT ILLNESS:  The patient is a 52 year old
male with past medical history of ETOH cirrhosis and in
[**9-29**], ultrasound with heterogeneous liver is noted.  History
of esophageal varices banded on [**2138-10-9**], and [**2138-10-11**].  He
presented to the Emergency Department on [**2138-11-12**], with
bright red blood per rectum.  Otherwise, no melena, no
hematemesis, no nausea, vomiting, abdominal pain since last
month. Review of systems was otherwise negative.  The patient
was taken to the Medical Intensive Care Unit and had an
esophagogastroduodenoscopy with no active bleeding noted, but
one varix was banded.  The patient was hemodynamically stable
and received two units of packed red blood cells with no
further episodes of bright red blood per rectum. The patient
had one more unit of blood in the Medical Intensive Care Unit
and had esophagogastroduodenoscopy in the unit which was
significant for nonbleeding varices and three grade II
varices.  Previously banded varices were noted.  Banding was
attempted but aborted.  The patient had evidence of positive
portal hypertensive gastropathy and normal structures
otherwise.  The patient was maintained on Octreotide and
intravenous Protonix and secondarily was transferred to the
medicine service for further care as well as repeat
colonoscopy.

PAST MEDICAL HISTORY:
1.  Cirrhosis secondary to ETOH abuse.
2.  History of upper gastrointestinal bleed, on [**2138-11-11**],
grade II varices times three, no active bleeding, on
[**2138-10-21**], grade III varices times four, lower one third
gastroesophageal tube, [**2138-11-12**], positive active bleed, lower
esophageal sphincter, positive [**Last Name (un) **].
3.  Glucose intolerance.

MEDICATIONS ON ADMISSION:
1.  Megace.
2.  Ursodiol 300 mg twice a day.
3.  Sucralfate one gram three times a day.
4.  Thiamine.
5.  Folate.
6.  Nadolol 10 mg p.o. once daily.
7.  Spironolactone 50 mg one p.o. once daily.
8.  Protonix.
9.  Lasix 40 mg p.o. once daily.

PHYSICAL EXAMINATION:  Vital signs revealed temperature 98.4,
pulse 86, blood pressure 122/92, respiratory rate 16, oxygen
saturation 98% in room air.  Generally, the patient is alert
and oriented times three in no acute distress.  Head, eyes,
ears, nose and throat is normocephalic and atraumatic.
Positive scleral icterus as well as subungual icterus.
Otherwise, no jugular venous distention.  The oropharynx is
otherwise clear.  The heart is regular rate and rhythm with
no murmurs, rubs or gallops.  The lungs are clear to
auscultation bilaterally.  The abdomen is soft, nontender,
nondistended, no hepatosplenomegaly. The extremities are free
of any cyanosis, clubbing or edema.  Neurologic examination
is nonfocal.  Cranial nerves II through XII are intact.
There is no asterixis.  The patient moves all extremities
spontaneously.

LABORATORY DATA:  On transfer from the Medical Intensive Care
Unit, hematocrit is 34.5, white blood cell count 7.4,
platelet count 93,000.  INR is 1.8.  Partial thromboplastin
time 44.3.  Sodium 135, potassium 4.3, chloride 104,
bicarbonate 22, blood urea nitrogen 9, creatinine 1.0,
glucose 86.  Calcium 8.6, magnesium 1.6 and phosphorus 3.0.

HOSPITAL COURSE:  On the floor, the patient had no further
episodes of bright red blood per rectum.  Serial hematocrit
remained negative.  Esophagogastroduodenoscopy was negative
for acute bleeding.  The patient was to have a colonoscopy
which was performed and revealed the mucosa with localized
granularity, friability and congestion with contact bleeding
noted in the hepatic flexure, ascending colon and cecum.  The
findings were compatible with colopathy secondary to portal
hypertension.  A single 7.0 millimeter nonbleeding polyp of
benign appearance was found in the sigmoid colon.
Impressions were granularity, friability and congestion of
the hepatic flexure, ascending colon and cecum compatible
with colopathy secondary to portal hypertension, polyp in
sigmoid colon; otherwise normal colonoscopy to the cecum.
The patient was watched post colonoscopy and was discharged
with follow-up in the [**Hospital **] Clinic.

FEN - The patient was initially NPO and then advanced to
clears with Boost and then could tolerate a regular diet by
the time of discharge.

Prophylaxis - For prophylaxis, the patient was maintained on
pneumatic boots, proton pump inhibitor, bowel regimen and
Carafate.

Code Status - The patient remained a full code.

DISCHARGE DIAGNOSES:
1.  Gastrointestinal bleed.
2.  Cirrhosis of the liver secondary to alcohol abuse.
3.  Anemia secondary to blood loss.

FOLLOW-UP PLANS:  Gastroenterology West, Room One on
[**2138-11-25**], at 8:30 a.m., Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**], in the endoscopy
suite on [**2138-11-25**], at 8:30 a.m.  Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 497**],
gastroenterology, on [**2138-12-5**], at 1:40 p.m.  The patient is
to see his primary care physician, [**Last Name (NamePattern4) **].  [**First Name8 (NamePattern2) **] [**Name (STitle) **], within
two weeks of discharge.

MAJOR SURGICAL INVASIVE PROCEDURES:
Esophagogastroduodenoscopy and colonoscopy.

MEDICATIONS ON DISCHARGE:
1.  Folic Acid 1 mg one p.o. once daily.
2.  Multivitamin one p.o. once daily.
3.  Thiamine 100 mg one p.o. once daily.
4.  Megace 40 mg one p.o. four times a day.
5.  Docusate 100 mg one p.o. three times a day as needed for
daily bowel movement.
6.  Sucralfate one gram one p.o. four times a day.
7.  Spironolactone 50 mg one p.o. once daily.
8.  Nadolol 20 mg one p.o. once daily.
9.  Pantoprazole 40 mg one p.o. q12hours.
10. Boost three times a day.
11. Lasix 40 mg one p.o. once daily.

DISCHARGE STATUS:  The patient is discharged to home.

CONDITION ON DISCHARGE:  Stable.  He is able to ambulate
without difficulty.  No desaturation.  He is tolerating a
regular diet.  He has had stable hematocrit with no further
evidence of melena or other evidence of bleeding.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], M.D.  [**MD Number(2) 22654**]

Dictated By:[**Last Name (NamePattern1) 5843**]

MEDQUIST36

D:  [**2139-1-23**]  10:20
T:  [**2139-1-24**]  14:40
JOB#:  [**Job Number 34983**]
{'Alcoholic cirrhosis of liver,Iron deficiency anemia secondary to blood loss (chronic),Esophageal varices in diseases classified elsewhere, with bleeding,Portal hypertension,Other specified intestinal malabsorption,Alcohol abuse, in remission,Benign neoplasm of colon,Other specified disorders of intestine'}


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 times three.

PRESENT ILLNESS: The patient is a 52 year old
male with past medical history of ETOH cirrhosis and in
[**9-29**], ultrasound with heterogeneous liver is noted.  History
of esophageal varices banded on [**2138-10-9**], and [**2138-10-11**].  He
presented to the Emergency Department on [**2138-11-12**], with
bright red blood per rectum.  Otherwise, no melena, no
hematemesis, no nausea, vomiting, abdominal pain since last
month. Review of systems was otherwise negative.  The patient
was taken to the Medical Intensive Care Unit and had an
esophagogastroduodenoscopy with no active bleeding noted, but
one varix was banded.  The patient was hemodynamically stable
and received two units of packed red blood cells with no
further episodes of bright red blood per rectum. The patient
had one more unit of blood in the Medical Intensive Care Unit
and had esophagogastroduodenoscopy in the unit which was
significant for nonbleeding varices and three grade II
varices.  Previously banded varices were noted.  Banding was
attempted but aborted.  The patient had evidence of positive
portal hypertensive gastropathy and normal structures
otherwise.  The patient was maintained on Octreotide and
intravenous Protonix and secondarily was transferred to the
medicine service for further care as well as repeat
colonoscopy.

MEDICAL HISTORY: 1.  Cirrhosis secondary to ETOH abuse.
2.  History of upper gastrointestinal bleed, on [**2138-11-11**],
grade II varices times three, no active bleeding, on
[**2138-10-21**], grade III varices times four, lower one third
gastroesophageal tube, [**2138-11-12**], positive active bleed, lower
esophageal sphincter, positive [**Last Name (un) **].
3.  Glucose intolerance.

MEDICATION ON ADMISSION: 1.  Megace.
2.  Ursodiol 300 mg twice a day.
3.  Sucralfate one gram three times a day.
4.  Thiamine.
5.  Folate.
6.  Nadolol 10 mg p.o. once daily.
7.  Spironolactone 50 mg one p.o. once daily.
8.  Protonix.
9.  Lasix 40 mg p.o. once daily.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Alcoholic cirrhosis of liver,Iron deficiency anemia secondary to blood loss (chronic),Esophageal varices in diseases classified elsewhere, with bleeding,Portal hypertension,Other specified intestinal malabsorption,Alcohol abuse, in remission,Benign neoplasm of colon,Other specified disorders of intestine'}
