CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75-year-old man
with a history of hypertension, type 2 diabetes mellitus, and
invasive adenocarcinoma of the gallbladder who is status post
recent admission for hemobilia and stent placement who
presented to the Emergency Department after one episode of
hematemesis.  The patient noted on the evening prior to
admission he ate dinner and then later developed nausea with
emesis times one consisting of partially digested food.  He
took Compazine.  One hour later the patient was talking on
the phone and had another episode of nausea followed by
vomiting of brownish material with blood clots.  He then came
to the Emergency Department where he was found to have a
hematocrit of 32 and INR of 1.3.  Intravenous access was
difficult, and therefore, a right femoral central venous
catheter was placed, and the patient was line resuscitated.
Nasogastric tube was placed, and lavage was performed which
did not clear after 2 L of saline.

MEDICAL HISTORY: 1.  Locally invasive gallbladder
adenocarcinoma diagnosed in [**2192-12-4**], on salvage
chemotherapy with 5FU and Leucovorin.  2.  Hypertension.  3.
Type 2 diabetes mellitus.  4.  Atrial and ventricular ectopy
on Amiodarone.

MEDICATION ON ADMISSION: ASA 81 mg p.o. q.d., Glyburide 5
mg p.o. q.d., Amiodarone 400 mg p.o. q.d., Lopressor 50 mg
p.o. b.i.d., Lasix 40 mg p.o. q.d., Compazine p.r.n.,
Imodium.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and four
children.  He denied alcohol, smoking, or intravenous drug
abuse.  He is a retired librarian.  The patient was born in
Barbados.
Aneurysm of other visceral artery,Malignant neoplasm of extrahepatic bile ducts,Malignant neoplasm of liver, secondary,Hematemesis,Atrial fibrillation,Other septicemia due to gram-negative organisms,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Visceral aneurysm NEC,Mal neo extrahepat ducts,Second malig neo liver,Hematemesis,Atrial fibrillation,Gram-neg septicemia NEC,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2193-2-19**]       Discharge Date:  [**2193-2-26**]

Date of Birth:   [**2118-1-11**]       Sex:  M

Service:  BLUMEGART INTERNAL MEDICINE

HISTORY OF PRESENT ILLNESS:  The patient is a 75-year-old man
with a history of hypertension, type 2 diabetes mellitus, and
invasive adenocarcinoma of the gallbladder who is status post
recent admission for hemobilia and stent placement who
presented to the Emergency Department after one episode of
hematemesis.  The patient noted on the evening prior to
admission he ate dinner and then later developed nausea with
emesis times one consisting of partially digested food.  He
took Compazine.  One hour later the patient was talking on
the phone and had another episode of nausea followed by
vomiting of brownish material with blood clots.  He then came
to the Emergency Department where he was found to have a
hematocrit of 32 and INR of 1.3.  Intravenous access was
difficult, and therefore, a right femoral central venous
catheter was placed, and the patient was line resuscitated.
Nasogastric tube was placed, and lavage was performed which
did not clear after 2 L of saline.

The GI Service was [**Name (NI) 653**], and the patient was
subsequently admitted to Blumegart for upper GI bleed in the
setting of invasive adenocarcinoma of the gallbladder.  The
patient received approximately 2 L normal saline in the
Emergency Department, as well as intravenous Zantac.

PAST MEDICAL HISTORY:  1.  Locally invasive gallbladder
adenocarcinoma diagnosed in [**2192-12-4**], on salvage
chemotherapy with 5FU and Leucovorin.  2.  Hypertension.  3.
Type 2 diabetes mellitus.  4.  Atrial and ventricular ectopy
on Amiodarone.

ALLERGIES:  NO KNOWN DRUG ALLERGIES.

MEDICATIONS ON ADMISSION:  ASA 81 mg p.o. q.d., Glyburide 5
mg p.o. q.d., Amiodarone 400 mg p.o. q.d., Lopressor 50 mg
p.o. b.i.d., Lasix 40 mg p.o. q.d., Compazine p.r.n.,
Imodium.

SOCIAL HISTORY:  The patient lives with his wife and four
children.  He denied alcohol, smoking, or intravenous drug
abuse.  He is a retired librarian.  The patient was born in
Barbados.

PHYSICAL EXAMINATION:  Vital signs:  The patient was
afebrile, with a heart rate of 68, blood pressure 130/76,
respirations 18, oxygen saturation 100% on room air.
General:  The patient was an elderly man in no acute
distress.  HEENT:  Pupils equal, round and reactive to light.
Extraocular movements intact.  The patient had a left-sided
ptosis.  Oral mucosa moist and pale.  Neck:  Supple.  No
jugular venous distention.  No bruits.  Chest:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rhythm
with ectopy.  Normal S1 and split S2.  There was a 2 out of 6
systolic ejection murmur heard best at the left lower sternal
border.  Abdomen:  The belly was soft, mildly distended,
nontender, with normal bowel sounds.  The liver span was 8
cm.  There was no splenomegaly.  The patient was guaiac
positive.  Extremities:  The patient had peripheral pulses
that were 2+ with mild pedal edema.  The patient had a right
femoral line in place in his groin.  Neurological:  The
patient was grossly intact.

LABORATORY DATA:  Initial studies indicated a white blood
cell count of 11.6, hematocrit 32.1, platelet count 270, with
a differential significant for 90% polys, 8% lymphocytes;
CHEM7 was remarkable only for a glucose of 286; INR 1.3; ALT
126, AST 162, alkaline phosphatase 331, total bilirubin 1.9.

Chest x-ray indicated no pneumonia or effusions.
Electrocardiogram indicated normal sinus rhythm at 64 with
right bundle branch block, a prolonged QTC at 493 msec.

HOSPITAL COURSE:  The patient was admitted to Blumegart
Internal Medicine Firm for work-up of upper GI bleed.  His
Aspirin was discontinued, and he was placed on intravenous
Protonix.  On hospital day #2, the patient's hematocrit was
stable, and his liver function tests were trending down.  He
received an upper endoscopy which indicated a normal
esophagus, clotted blood in the stomach, and erythema and
congestion of the duodenal mucosa with contact bleeding.
There was no active bleeding noted on exam.  The patient was
therefore switched to p.o. Protonix.

The patient was transfused 2 U of packed red blood cells with
a pretransfusion hematocrit of 29.6 and a posttransfusion
hematocrit of 30.0; although this was thought to be an
inappropriate response to a transfusion, his hematocrit
remained stable, and no further transfusions were attempted
at that time.

On hospital day #3, the patient started to complain of
moderately severe epigastric tenderness with associated
nausea.  He was then witnessed to have one episode of
hematemesis with approximately 50 cc of dark blood.  He was
then noted to have melena with a substantial amount of maroon
colored stool.  A repeat upper endoscopy was performed which
indicated red blood in the area of the papilla consistent
with hemobilia.  The patient was also noted to develop atrial
fibrillation with a rapid ventricular response and rate in
the 150s.  He was restarted on Lopressor with improved rate
control but remained in atrial fibrillation during the
remainder of his hospital stay.

The patient was then taken to the Interventional Radiology
Suite for emergent angiography of the celiac access which
revealed a right hepatic artery pseudoaneurysm.  Multiple
coils were deployed proximally to the pseudoaneurysm, as well
as infusion of Gelfoam pledgets.  The patient also received
coil and Gelfoam embolization distally to his right hepatic
artery pseudoaneurysm.  The patient was then transferred to
the Medical Intensive Care Unit for monitoring overnight.  He
remained hemodynamically stable, and his hematocrit remained
stable.

Blood cultures returned positive for gram-negative rods in 2
out of 2 bottles.  This organism was later identified as
Klebsiella pneumonia which was pansensitive.  The patient was
started on a two-week course of Ciprofloxacin and
Metronidazole.

On hospital day #4, the patient was returned to the floor in
stable condition; however, his hematocrit was noted to trend
down from 30 to 25 over the course of hospital day #5, and
the patient again received a transfusion of 2 U packed red
blood cells.  The patient's posttransfusion hematocrit
remained stable at 30 for the remainder of his hospital stay.

On hospital day #7, the patient was evaluated by Physical
Therapy and was thought to benefit from an acute stay at an
inpatient rehabilitation hospital.  At the time of this
dictation, it was planned that the patient will be discharged
to an acute rehabilitation setting for several days prior to
anticipated discharge to home.  While the patient was
in-house, the Oncology Service was aware of his status, and
the patient is to follow-up with his oncologist Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] following discharge.

The patient remained afebrile with a normal white count and
resolving liver function tests during his hospital stay.
Following several conversations with the patient and his
family, it was clear that although the patient was aware of
his grim diagnosis, that he wished to remain FULL CODE for
the time being.

At the time of discharge, the patient remained in atrial
fibrillation with a ventricular rate of approximately 100.
Although he was maintained on Lopressor, it was felt that the
patient's rate control should not be increased given his risk
of continued bleeding.

DISCHARGE DIAGNOSIS:
1.  Adenocarcinoma of the gallbladder with local invasion of
the liver.
2.  Hemobilia with right hepatic artery pseudoaneurysm,
status post embolization.
3.  Atrial fibrillation with rapid ventricular response.
4.  Hypertension.
5.  Type 2 diabetes mellitus.

DISCHARGE MEDICATIONS:  Ciprofloxacin 500 mg p.o. b.i.d. x 7
days, Flagyl 500 mg p.o. t.i.d. x 7 days, Lopressor 50 mg
p.o. b.i.d., Glyburide 5 mg p.o. q.d., Amiodarone 400 mg p.o.
q.d., Protonix 40 mg p.o. b.i.d.

DISPOSITION:  It was planned that the patient will be
discharged to an acute rehabilitation facility.

FOLLOW-UP:  He is to follow-up with Dr. [**Last Name (STitle) 1683**] within two
weeks and with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of Oncology within one week.

CONDITION ON DISCHARGE:  Improved.






                            [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 8873**] [**Name8 (MD) **], M.D.  [**MD Number(1) 8874**]

Dictated By:[**Last Name (NamePattern1) 194**]
MEDQUIST36

D:  [**2193-2-26**]  11:26
T:  [**2193-2-26**]  11:41
JOB#:  [**Job Number **]
{'Aneurysm of other visceral artery,Malignant neoplasm of extrahepatic bile ducts,Malignant neoplasm of liver, secondary,Hematemesis,Atrial fibrillation,Other septicemia due to gram-negative organisms,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: 

PRESENT ILLNESS: The patient is a 75-year-old man
with a history of hypertension, type 2 diabetes mellitus, and
invasive adenocarcinoma of the gallbladder who is status post
recent admission for hemobilia and stent placement who
presented to the Emergency Department after one episode of
hematemesis.  The patient noted on the evening prior to
admission he ate dinner and then later developed nausea with
emesis times one consisting of partially digested food.  He
took Compazine.  One hour later the patient was talking on
the phone and had another episode of nausea followed by
vomiting of brownish material with blood clots.  He then came
to the Emergency Department where he was found to have a
hematocrit of 32 and INR of 1.3.  Intravenous access was
difficult, and therefore, a right femoral central venous
catheter was placed, and the patient was line resuscitated.
Nasogastric tube was placed, and lavage was performed which
did not clear after 2 L of saline.

MEDICAL HISTORY: 1.  Locally invasive gallbladder
adenocarcinoma diagnosed in [**2192-12-4**], on salvage
chemotherapy with 5FU and Leucovorin.  2.  Hypertension.  3.
Type 2 diabetes mellitus.  4.  Atrial and ventricular ectopy
on Amiodarone.

MEDICATION ON ADMISSION: ASA 81 mg p.o. q.d., Glyburide 5
mg p.o. q.d., Amiodarone 400 mg p.o. q.d., Lopressor 50 mg
p.o. b.i.d., Lasix 40 mg p.o. q.d., Compazine p.r.n.,
Imodium.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with his wife and four
children.  He denied alcohol, smoking, or intravenous drug
abuse.  He is a retired librarian.  The patient was born in
Barbados. 

### Response:
{'Aneurysm of other visceral artery,Malignant neoplasm of extrahepatic bile ducts,Malignant neoplasm of liver, secondary,Hematemesis,Atrial fibrillation,Other septicemia due to gram-negative organisms,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
