CHIEF COMPLAINT: CC:[**CC Contact Info 31168**]
Major Surgical or Invasive Procedure:
endoscopy with variceal banding x2

PRESENT ILLNESS: HPI: Mr. [**Name14 (STitle) 31169**] is a 71 y/o man with PMH notable for PSC
complicated by cirrhosis with known gastric varices who
presented to the [**Location (un) 620**] ED earlier this evening with diarrhea
and maroon stools after taking a laxative earlier today. He also
reported vomiting "cranberry juice" earlier today as well. He
reported no chest pain, difficulty breathing, or abdominal pain.
Of note, recent EGD (last admission, done [**12-28**]) demonstrated
esophageal varices and amotility of the esophagus.
.
In the [**Location (un) 620**] ED, vitals were HR 60, BP 70/40, RR 12. He
received 4 L NS. He was found to have a hct down to 29.1 (35.1
on [**12-31**]). His INR is 2.1. He also had a potassium of 6 (not
hemolyzed) which was treated with calcium gluconate, kayexalate.
He received 40 mg omeprazole IV X 1. He was transfused with 1 U
PRBCs prior to transfer. Repeat BP prior transfer not
documented. In the ambulance, the patient's blood pressure is
documented as 77/46 and then up to 160/133 (?). His FSBS was
110.
.
On arrival to the ICU, the patient is without complaint. He
denies any nausea, vomiting, hematemesis, or abdominal pain. He
denies any dizziness or lightheadedness. He had a frankly
melenotic stool on arrival to the ICU and BPs down to the 70s.
Attempted to place arterial line but unsucessful. Contact[**Name (NI) **]
Liver team to evaluate for EGD tonight given likelihood of
variceal bleeding.

MEDICAL HISTORY: PMH:
# Cirrhosis due to PSC:
- dx [**2178**] (s/p multiple ERCPs; atypical cytology in [**2178**], repeat
neg for atypical cells in [**2180**] and [**2181**])
- portal htn, portal gastropathy, ascites
- no EGDs, but multiple ERCPs with limited views of normal
esophagus
# CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
# Chronic systolic heart failure, EF 36%
# Ulcerative colitis x 10-15 years
# Recurrent mild intermittent cholangitis
# GERD
# h/o Lyme disease [**8-24**]
# Hypercholesterolemia
# Hypertension
# Raynaud's disease s/p multiple finger and toe amputations
# OSA
# Esophageal stricture
# Depression
# ADHD

MEDICATION ON ADMISSION: MEDS: (from d/c summary [**12-31**])
* Furosemide 20 mg PO DAILY (Daily): Hold until [**1-4**].
* Spironolactone 50 mg PO DAILY (Daily): Hold until [**1-4**]. .
* Mesalamine 800 mg PO TID
* Sertraline 75 mg PO DAILY
* Simvastatin 10 mg PO DAILY
* Aspirin 81 mg PO DAILY
* Ursodiol 600 mg in AM and 900 mg in pm.
* Ritalin 5 mg PO once a day as needed.
* Colace 100 mg PO twice a day.
* Metoclopramide 5 mg PO TID W/MEALS (3 TIMES A DAY WITH MEALS).

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: T: 95.6 ax BP: 74/45 HR: 65 RR: 11 O2 100% RA
Gen: Pleasant, chronically illappearing male in no distress,
able to talk in full sentences
HEENT: + scleral icterus, MM slightly dry
NECK: supple, no elevation in JVP
CV: bradycardic, regular, no appreciable murmur
LUNGS: clear bilaterally
ABD: distended, + fluid wave, nontender to palpation, RUQ with
biliary drain with oozing around drain
EXT: dp pulses 2+ bilaterally
SKIN: + jaundice
NEURO: alert, interactive, face symmetric, moving all
extremities

FAMILY HISTORY: Mother died of peritonitis. His father died from complications
of heart disease.

SOCIAL HISTORY: SH: (from OMR) He is a retired carpenter. He is married and has
three grown children. He has no tobacco history. He drank 3 oz
EtOH daily
for 50 yrs, until appx [**2183**]. Denies illicit drug use. Lives with
wife, 1 son.
Biliary cirrhosis,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Unspecified protein-calorie malnutrition,Other candidiasis of other specified sites,Other suppurative peritonitis,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other ascites,Chronic systolic heart failure,Stricture and stenosis of esophagus,Awaiting organ transplant status,Portal hypertension,Obstruction of bile duct,Orthostatic hypotension,Dysphagia, oropharyngeal phase,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Old myocardial infarction,Pure hypercholesterolemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Encounter for palliative care
Biliary cirrhosis,Food/vomit pneumonitis,Bleed esoph var oth dis,Ac posthemorrhag anemia,Protein-cal malnutr NOS,Candidiasis site NEC,Suppurat peritonitis NEC,Acute kidney failure NOS,Hyperosmolality,Ascites NEC,Chr systolic hrt failure,Esophageal stricture,Await organ transplnt st,Portal hypertension,Obstruction of bile duct,Orthostatic hypotension,Dysphagia, oropharyngeal,Cor ath unsp vsl ntv/gft,Status-post ptca,Unilat inguinal hernia,Old myocardial infarct,Pure hypercholesterolem,Hypertension NOS,Obstructive sleep apnea,Encountr palliative care
Admission Date:  [**2185-1-3**]              Discharge Date:   [**2185-2-5**]

Date of Birth:  [**2113-2-21**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides)

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
CC:[**CC Contact Info 31168**]
Major Surgical or Invasive Procedure:
endoscopy with variceal banding x2

History of Present Illness:
HPI: Mr. [**Name14 (STitle) 31169**] is a 71 y/o man with PMH notable for PSC
complicated by cirrhosis with known gastric varices who
presented to the [**Location (un) 620**] ED earlier this evening with diarrhea
and maroon stools after taking a laxative earlier today. He also
reported vomiting "cranberry juice" earlier today as well. He
reported no chest pain, difficulty breathing, or abdominal pain.
Of note, recent EGD (last admission, done [**12-28**]) demonstrated
esophageal varices and amotility of the esophagus.
.
In the [**Location (un) 620**] ED, vitals were HR 60, BP 70/40, RR 12. He
received 4 L NS. He was found to have a hct down to 29.1 (35.1
on [**12-31**]). His INR is 2.1. He also had a potassium of 6 (not
hemolyzed) which was treated with calcium gluconate, kayexalate.
He received 40 mg omeprazole IV X 1. He was transfused with 1 U
PRBCs prior to transfer. Repeat BP prior transfer not
documented. In the ambulance, the patient's blood pressure is
documented as 77/46 and then up to 160/133 (?). His FSBS was
110.
.
On arrival to the ICU, the patient is without complaint. He
denies any nausea, vomiting, hematemesis, or abdominal pain. He
denies any dizziness or lightheadedness. He had a frankly
melenotic stool on arrival to the ICU and BPs down to the 70s.
Attempted to place arterial line but unsucessful. Contact[**Name (NI) **]
Liver team to evaluate for EGD tonight given likelihood of
variceal bleeding.


Past Medical History:
PMH:
# Cirrhosis due to PSC:
- dx [**2178**] (s/p multiple ERCPs; atypical cytology in [**2178**], repeat
neg for atypical cells in [**2180**] and [**2181**])
- portal htn, portal gastropathy, ascites
- no EGDs, but multiple ERCPs with limited views of normal
esophagus
# CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
# Chronic systolic heart failure, EF 36%
# Ulcerative colitis x 10-15 years
# Recurrent mild intermittent cholangitis
# GERD
# h/o Lyme disease [**8-24**]
# Hypercholesterolemia
# Hypertension
# Raynaud's disease s/p multiple finger and toe amputations
# OSA
# Esophageal stricture
# Depression
# ADHD


Social History:
SH: (from OMR) He is a retired carpenter. He is married and has
three grown children. He has no tobacco history. He drank 3 oz
EtOH daily
for 50 yrs, until appx [**2183**]. Denies illicit drug use. Lives with
wife, 1 son.


Family History:
Mother died of peritonitis. His father died from complications
of heart disease.

Physical Exam:
PE: T: 95.6 ax BP: 74/45 HR: 65 RR: 11 O2 100% RA
Gen: Pleasant, chronically illappearing male in no distress,
able to talk in full sentences
HEENT: + scleral icterus, MM slightly dry
NECK: supple, no elevation in JVP
CV: bradycardic, regular, no appreciable murmur
LUNGS: clear bilaterally
ABD: distended, + fluid wave, nontender to palpation, RUQ with
biliary drain with oozing around drain
EXT: dp pulses 2+ bilaterally
SKIN: + jaundice
NEURO: alert, interactive, face symmetric, moving all
extremities


Pertinent Results:
Labs on Admission:
[**2185-1-3**] 09:07PM   PT-19.7* PTT-42.0* INR(PT)-1.8*
[**2185-1-3**] 09:07PM   PLT COUNT-266
[**2185-1-3**] 09:07PM   NEUTS-91.6* LYMPHS-4.1* MONOS-4.1 EOS-0.1
BASOS-0.1
[**2185-1-3**] 09:07PM   WBC-20.0*# RBC-2.66*# HGB-9.5*# HCT-26.7*
MCV-100* MCH-35.5* MCHC-35.4* RDW-15.9*
[**2185-1-3**] 09:07PM   ALT(SGPT)-36 AST(SGOT)-67* LD(LDH)-151 ALK
PHOS-87 TOT BILI-4.4*
[**2185-1-3**] 09:07PM   GLUCOSE-246* UREA N-36* CREAT-1.0 SODIUM-134
POTASSIUM-4.8 CHLORIDE-99 TOTAL CO2-20* ANION GAP-20
.
Studies:
Echo: [**1-4**] The left atrium is moderately dilated. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal. LV systolic function appears depressed
(ejection fraction 40 percent) secondary to hypokinesis (and
dyssynchrony) of the interventricular septum. The right
ventricular cavity is small (extrinsic compression cannot be
ruled out). The aortic valve leaflets (3) are mildly thickened
but aortic stenosis is not present. The mitral valve leaflets
are mildly thickened. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. Tricuspid regurgitation is present
but cannot be quantified. There is no pericardial effusion.
.
US abd: Moderate ascites.
.
CXR: Lungs low in volume, aside from small region of atelectasis
at the left base, clear. Probable small pleural effusions. Upper
lungs clear.
Cardiomediastinal silhouette unremarkable. Right upper quadrant
drains noted. No pneumothorax.
.
Para US guided: PFI: Uneventful ultrasound-guided paracentesis.
Approximately 3 liters were removed. Samples were sent for
laboratory analysis as ordered by the referring team.
.


Brief Hospital Course:
71 y/o man with PSC complicated by cirrhosis with known
esophageal varices and multiple epidoses of UGIB and banding
this admission, polymicrobial SBP, now with recurrent UGIB.
.
# GI bleed: During his initial presentation, he had a large
amount of melena and vomitted "cranberry juice" EGD performed on
arrival to the ICU demonstrated cherry red spots (stigmata of
recent bleeding). Two varices were banded during EGD. Bleeding
could have also been secondary to recent biopsy. Treated with
octreotide and IV protonix. Transfused 1 U PTA, 2 U pRBC, 2 U
FFP. No evidence of bleeding after banding. Covered with Cipro
for SBP in setting of GI bleed. Biliary drain in place PTA,
significant drainage of ascites from around drain. Culture of
fluid from biliary drain grew polymicrobials but no polys making
infection less likely. Given uptrending WBC GI wants para to r/o
SBP. Given unclear [**Name2 (NI) 4394**] pockets of US to be done by IR this
afternoon. To check bili on ascites as well to check for leak
from biliary tree. IR evaluated billiary drain, said ok.
Continued to leak large amount of ascites from around the site.
Per GI and IR no other intervention for leak.  The patient was
transferred to the floor, but ultimately returned to the ICU
after a subsequent episode of UGIB.  At that time, it was
determined to reverse his DNR/DNI status and pursue endoscopy
which required intubation.  He was transfused an additional 3
units PRBC and 2 units FFP.  The patient was continued on PPI
and octreotide gtt.  It was apparent that the patient had
aspirated blood given it was suctioned from the ET tube after
intubation.  The family was contact[**Name (NI) **] and the decision was made
to make the patient DNR again, with comfort being the goal.
Mechanical ventilation was discontinued.
.
# Hypotension: Related to blood loss as above. Received a total
of 6 L NS (4 l at [**Location (un) 620**] and 2 L here on arrival) in addition
to total of 3 U prbcs. Arterial line placed by Liver team prior
to endoscopy with SBPs ~ [**11-8**] points higher than cuff
pressures.  The patient was maintained on pressor support on
transfer back to the MICU.  After discussion with the family,
and the patient was made comfort measures only, the pressors
were discontinued.
.
# SBP/Leukocytosis: Diagnosed [**2185-1-5**], patient was on Cipro ppx
as outpatient and recently increased dose due to variceal bleed.
Placed on Aztreonam [**2176**] mg IV Q8H 5 days (Day 1 [**2185-1-5**] -
[**2185-1-10**]) due to Cipro resistance and pt's allergies. WBC count
kept rising, leading to repeat tap - SBP w GNR. Started on
Vanc/[**Last Name (un) **] [**1-11**].  No other evidence of infection causing
leukocytosis, Cdiff negative, blood and urine cultures negative,
no PNA seen on CXR.  The patient was continued on vanco/[**Last Name (un) 2830**] to
cover for aspiration pna and peritonitis as well as caspofungin
for esophagitis and peritonitis with [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 563**].
.
# Hypernatremia:  Consistent with poor PO intake.  Improved with
fluid challenge therefore most likely hypovolemic hyponatremia.
No fluid restriction. Hold diuretics Started D5W temporarily.
Discontinued all IV fluids.
.
# ESLD/cirrhosis: On liver transplant list. Complicated by
ascites, portal gastropathy, and SBP. No clear history of
encephalopathy. The patient was continued on ursodiol [**Hospital1 **],
lactulose 30 mg daily.  Spironolactone, lasix and nadolol were
held in the setting of hypotension.  Lactulose was continued.
.
# Biliary strictures: Pull back cholangiography on [**1-10**]
demonstrated no obstruction. PTC drain removed by IR [**2185-1-10**].
Bili peaked [**1-13**].  Trended LFTs.
.
# Ulcerative colitis:  Continued outpatient Mesalamine.
.
# CAD s/p CABG:  Continued statin. Held ASA and BB in setting of
bleed.
.
# Hyperlipidemia:  Continued outpatient dose statin.
.
# Depression/ADHD:  Continued sertraline. Held Ritalin.
.
# PPx: pneumoboots, ppi, lactulose
.
# Access: PIVs
.
# COMM:  with patient and wife, [**Name (NI) 31170**] [**Telephone/Fax (1) 31171**]

Medications on Admission:
MEDS: (from d/c summary [**12-31**])
* Furosemide 20 mg PO DAILY (Daily): Hold until [**1-4**].
* Spironolactone 50 mg PO DAILY (Daily): Hold until [**1-4**]. .
* Mesalamine 800 mg PO TID
* Sertraline 75 mg PO DAILY
* Simvastatin 10 mg PO DAILY
* Aspirin 81 mg PO DAILY
* Ursodiol 600 mg in AM and 900 mg in pm.
* Ritalin 5 mg PO once a day as needed.
* Colace 100 mg PO twice a day.
* Metoclopramide 5 mg PO TID W/MEALS (3 TIMES A DAY WITH MEALS).

* Nadolol 20 mg PO DAILY (Daily).
* Ciprofloxacin 500 mg PO once a day: Start [**2185-1-1**] (when you
complete Cipro 500 twice a day)
* Omeprazole 40 mg PO twice a day
* Lactulose (30) ML PO ONCE (Once)
.
ALLERGIES: pcn / sulfa


Discharge Disposition:
Expired

Discharge Diagnosis:
Upper GI Bleed
End Stage Liver Disease

Discharge Condition:
expired

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2185-2-7**]
{'Biliary cirrhosis,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Unspecified protein-calorie malnutrition,Other candidiasis of other specified sites,Other suppurative peritonitis,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other ascites,Chronic systolic heart failure,Stricture and stenosis of esophagus,Awaiting organ transplant status,Portal hypertension,Obstruction of bile duct,Orthostatic hypotension,Dysphagia, oropharyngeal phase,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Old myocardial infarction,Pure hypercholesterolemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Encounter for palliative care'}


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: CC:[**CC Contact Info 31168**]
Major Surgical or Invasive Procedure:
endoscopy with variceal banding x2

PRESENT ILLNESS: HPI: Mr. [**Name14 (STitle) 31169**] is a 71 y/o man with PMH notable for PSC
complicated by cirrhosis with known gastric varices who
presented to the [**Location (un) 620**] ED earlier this evening with diarrhea
and maroon stools after taking a laxative earlier today. He also
reported vomiting "cranberry juice" earlier today as well. He
reported no chest pain, difficulty breathing, or abdominal pain.
Of note, recent EGD (last admission, done [**12-28**]) demonstrated
esophageal varices and amotility of the esophagus.
.
In the [**Location (un) 620**] ED, vitals were HR 60, BP 70/40, RR 12. He
received 4 L NS. He was found to have a hct down to 29.1 (35.1
on [**12-31**]). His INR is 2.1. He also had a potassium of 6 (not
hemolyzed) which was treated with calcium gluconate, kayexalate.
He received 40 mg omeprazole IV X 1. He was transfused with 1 U
PRBCs prior to transfer. Repeat BP prior transfer not
documented. In the ambulance, the patient's blood pressure is
documented as 77/46 and then up to 160/133 (?). His FSBS was
110.
.
On arrival to the ICU, the patient is without complaint. He
denies any nausea, vomiting, hematemesis, or abdominal pain. He
denies any dizziness or lightheadedness. He had a frankly
melenotic stool on arrival to the ICU and BPs down to the 70s.
Attempted to place arterial line but unsucessful. Contact[**Name (NI) **]
Liver team to evaluate for EGD tonight given likelihood of
variceal bleeding.

MEDICAL HISTORY: PMH:
# Cirrhosis due to PSC:
- dx [**2178**] (s/p multiple ERCPs; atypical cytology in [**2178**], repeat
neg for atypical cells in [**2180**] and [**2181**])
- portal htn, portal gastropathy, ascites
- no EGDs, but multiple ERCPs with limited views of normal
esophagus
# CAD s/p MI with PTCA in [**2167**] and CABG in [**2176**]
# Chronic systolic heart failure, EF 36%
# Ulcerative colitis x 10-15 years
# Recurrent mild intermittent cholangitis
# GERD
# h/o Lyme disease [**8-24**]
# Hypercholesterolemia
# Hypertension
# Raynaud's disease s/p multiple finger and toe amputations
# OSA
# Esophageal stricture
# Depression
# ADHD

MEDICATION ON ADMISSION: MEDS: (from d/c summary [**12-31**])
* Furosemide 20 mg PO DAILY (Daily): Hold until [**1-4**].
* Spironolactone 50 mg PO DAILY (Daily): Hold until [**1-4**]. .
* Mesalamine 800 mg PO TID
* Sertraline 75 mg PO DAILY
* Simvastatin 10 mg PO DAILY
* Aspirin 81 mg PO DAILY
* Ursodiol 600 mg in AM and 900 mg in pm.
* Ritalin 5 mg PO once a day as needed.
* Colace 100 mg PO twice a day.
* Metoclopramide 5 mg PO TID W/MEALS (3 TIMES A DAY WITH MEALS).

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: T: 95.6 ax BP: 74/45 HR: 65 RR: 11 O2 100% RA
Gen: Pleasant, chronically illappearing male in no distress,
able to talk in full sentences
HEENT: + scleral icterus, MM slightly dry
NECK: supple, no elevation in JVP
CV: bradycardic, regular, no appreciable murmur
LUNGS: clear bilaterally
ABD: distended, + fluid wave, nontender to palpation, RUQ with
biliary drain with oozing around drain
EXT: dp pulses 2+ bilaterally
SKIN: + jaundice
NEURO: alert, interactive, face symmetric, moving all
extremities

FAMILY HISTORY: Mother died of peritonitis. His father died from complications
of heart disease.

SOCIAL HISTORY: SH: (from OMR) He is a retired carpenter. He is married and has
three grown children. He has no tobacco history. He drank 3 oz
EtOH daily
for 50 yrs, until appx [**2183**]. Denies illicit drug use. Lives with
wife, 1 son. 

### Response:
{'Biliary cirrhosis,Pneumonitis due to inhalation of food or vomitus,Esophageal varices in diseases classified elsewhere, with bleeding,Acute posthemorrhagic anemia,Unspecified protein-calorie malnutrition,Other candidiasis of other specified sites,Other suppurative peritonitis,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Other ascites,Chronic systolic heart failure,Stricture and stenosis of esophagus,Awaiting organ transplant status,Portal hypertension,Obstruction of bile duct,Orthostatic hypotension,Dysphagia, oropharyngeal phase,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent),Old myocardial infarction,Pure hypercholesterolemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Encounter for palliative care'}
