CHIEF COMPLAINT: anemia and hematuria

PRESENT ILLNESS: 86 Cantonese-speaking F with active T3 bladder cancer dxed [**2170**],
s/p debulking TUR with subsequent XRT who has had persistent
bleeding from her bladder tumors requiring multiple
transfusions, presents with gross hematuria x 1 month,
progressive SOB, pleuritic CP, cough x 1 week. She was seen
earlier in the month in the ED for similiar complaint([**2-28**]); HCT
as 32 at this time. She followed up in urology clinic last
Wednesday, at which point the bleeding continued; HCT was 27.
Today in the ED her HCT is down to 18. In addition she complains
of cough and SOB with pleuritic CP. Of note, last [**Month (only) 956**] she
presented to [**Hospital1 18**] with acute on chronic gross hematuria with
resultant severe symptomatic anemia and cardiac demand ischemia.
Her exertional dyspnea and ischemic EKG findings resolved
following PRBC transfusion.
.
In the ED, she received multiple units RBC, and had frankly
bloody urine and no clots in foley. She was afebrile, WBC 6.4.
UA was positive. CXR shows R scarring, unchanged from prior. For
SOB, CTA chest was performed for PE. Has unknown history of
pulmonary mets, and has history of MAC and mycobacterium
kansasii in her sputum.

MEDICAL HISTORY: - Bronchiectasis
- Bladder cancer diagnosed in [**2170**] - multiple bladder tumors,
papillary transitional cell CA, invasive into muscularis propria

MEDICATION ON ADMISSION: Iron
Antihypertensive regimen (unclear)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.8 / 158/69 / 100 / 18 / 100% 2L nc
GEN: Pale, in no acute distress, lying in bed comfortably
HEENT: No JVD, no LAD, dry mm
LUNGS: Rales in right middle area
HEART: 2/6 systolic flow murmur radiating up
ABD: Soft, quiet BS, ND NT, dull percussion of bladder and also
firm to palpation in suprapubic area
NEURO: Ambulatory
SKIN: No rash

FAMILY HISTORY: [**Name (NI) 1094**] son with nasopharyngeal cancer. Other 2 children are
healthy.

SOCIAL HISTORY: Cantonese speaking. Pt came to USA from [**Location (un) 6847**] in [**2145**]. She
has 3 grown children, all living in USA. She lives by herself.
Her daughter and son-in-law come to the house to help her with
showering, etc. She ambulates in the home.
Malignant neoplasm of other specified sites of bladder,Acute posthemorrhagic anemia,Other acute and subacute forms of ischemic heart disease, other,Late effects of respiratory or unspecified tuberculosis,Bronchiectasis without acute exacerbation,Unspecified essential hypertension
Malig neo bladder NEC,Ac posthemorrhag anemia,Ac ischemic hrt dis NEC,Late effect tb, resp/NOS,Bronchiectas w/o ac exac,Hypertension NOS
Admission Date:  [**2173-3-6**]              Discharge Date:   [**2173-3-11**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
anemia and hematuria

Major Surgical or Invasive Procedure:
TURBT, cystoscopy, and fulguration.

History of Present Illness:
86 Cantonese-speaking F with active T3 bladder cancer dxed [**2170**],
s/p debulking TUR with subsequent XRT who has had persistent
bleeding from her bladder tumors requiring multiple
transfusions, presents with gross hematuria x 1 month,
progressive SOB, pleuritic CP, cough x 1 week. She was seen
earlier in the month in the ED for similiar complaint([**2-28**]); HCT
as 32 at this time. She followed up in urology clinic last
Wednesday, at which point the bleeding continued; HCT was 27.
Today in the ED her HCT is down to 18. In addition she complains
of cough and SOB with pleuritic CP. Of note, last [**Month (only) 956**] she
presented to [**Hospital1 18**] with acute on chronic gross hematuria with
resultant severe symptomatic anemia and cardiac demand ischemia.
Her exertional dyspnea and ischemic EKG findings resolved
following PRBC transfusion.
.
In the ED, she received multiple units RBC, and had frankly
bloody urine and no clots in foley. She was afebrile, WBC 6.4.
UA was positive. CXR shows R scarring, unchanged from prior. For
SOB, CTA chest was performed for PE. Has unknown history of
pulmonary mets, and has history of MAC and mycobacterium
kansasii in her sputum.

Past Medical History:
- Bronchiectasis
- Bladder cancer diagnosed in [**2170**] - multiple bladder tumors,
papillary transitional cell CA, invasive into muscularis propria

- TB about 20 years ago in [**Location (un) 6847**], treated with unknown
medication ([**Doctor First Name **] per medicine notes)
- Hypertension - taking medication for 7-8 years
- Duodenal ulcer
- Subendocardial Ischemia/ CAD
- Urinary Tract Infection
- Porcelain gallbladder
.
PAST SURGICAL HISTORY:
s/p TURBT clot evac and fulguration [**2172-4-10**] (Dr. [**Last Name (STitle) 770**]

Social History:
Cantonese speaking. Pt came to USA from [**Location (un) 6847**] in [**2145**]. She
has 3 grown children, all living in USA. She lives by herself.
Her daughter and son-in-law come to the house to help her with
showering, etc. She ambulates in the home.

Family History:
[**Name (NI) 1094**] son with nasopharyngeal cancer. Other 2 children are
healthy.

Physical Exam:
97.8 / 158/69 / 100 / 18 / 100% 2L nc
GEN: Pale, in no acute distress, lying in bed comfortably
HEENT: No JVD, no LAD, dry mm
LUNGS: Rales in right middle area
HEART: 2/6 systolic flow murmur radiating up
ABD: Soft, quiet BS, ND NT, dull percussion of bladder and also
firm to palpation in suprapubic area
NEURO: Ambulatory
SKIN: No rash


Pertinent Results:
Admission labs:
139  106  15
--------------< 94
4.2  26  0.7
CK: 50  MB: Notdone  Trop-T: 0.02
.
     6.3
6.4 >----<  226
    18.6
.
Admission CXR:
1. Increased interstitial markings and cystic changes within the
upper lobes bilaterally, corresponding to patient's known
bronchiectasis seen on prior CT scans. The linear opacity in the
right middle lobe is again seen, likely corresponds to the area
of atelectasis and/or scar. No acute superimposed pulmonary
process is identified.
2. Stable compression deformity involving T12.
3. Porcelain gallbladder.
.
CTA chest: 1. Diffuse bronchiectasis. Multiple nodular and
tree-in-[**Male First Name (un) 239**] opacities are not significantly changed compared to
the prior examination. Infectious etiology should be considered
including [**Doctor First Name **], with tuberculosis once again a consideration.  2.
No evidence of pulmonary embolus.  3. Porcelain gallbladder and
gallstone. Further evaluation is recommended on an elective
basis
.
EKG: NSR, unchanged from previous
.
Micro: Urine Cx
ENTEROCOCCUS SP.
                             |
AMPICILLIN------------   <=2 S
NITROFURANTOIN--------  <=16 S
TETRACYCLINE----------   <=1 S
VANCOMYCIN------------     2 S
.
Trends:
Hct: 18 - 31.7
CK: 50 - 79 - 75 - 64
Trop: 0.02 - 0.12 - 0.12 - 0.06


Brief Hospital Course:
86 yo Cantonese-speaking F with active T3 bladder cancer dx'ed
[**2170**], s/p debulking TUR with subsequent XRT w/ persistent
bleeding from her bladder tumors requiring multiple
transfusions, presents with gross hematuria and Hct of 18.
Hospital course by problem.
.
# Gross hematuria: Secondary to known bladder tumors. Also has a
known large clot in bladder found on cystoscopy.  Has continued
to make good UOP since admission.  Hct continued to trend down
slowly w/ persistent hematuria.  Given her history of cardiac
ischemia in the setting of anemia, she was transfused for a goal
of hct >30. By [**2173-3-7**], she had received 3U prbcs and on [**3-9**]
she received another 1U PRBCs.  Continuous bladder irrigation
was performed.  She remained hemodynamically stable while in the
[**Hospital Unit Name 153**].  On [**2173-3-9**] she underwent cystoscopy, clot evaluation,
TURBT, and fulguration.  She tolerated this well and had her
foley removed the following morning.  Her urine was yellow and
she did not have further episodes of hematuria.
.
# Cards vascular: positive troponin:  Patient has a h/o demand
ischemia in the setting of anemia [**3-16**].  She had a mild
elevation in her CE which was thought to be [**3-12**] demand ischemia
in the setting of low hematocrit.  No ischemic EKG changes.  She
did, however, complain of SOB and pleuritic chest pain on
admission.  Flat CKs despite troponin elevation (max troponin
0.12).  As above, she was transfused PRBCs w/ Hct goal >30 in
setting of troponin leak.  She did not have further complaints
of chest pain or shortness of breath thereafter.  We did treat
with perioperative beta blockade which she tolerated well.
.
# UTI:  Urinalysis in the ED was consistent with infection.  She
had no previous positive urine cultures in system to raise
suspicion for resistant organism.  Ciprofloxacin was started
transiently while awaiting cultures.  Urine cultures from [**3-6**]
revealed 10-100K enterococcus. Ciprofloxacin was discontinued
and ampicillin was started (despite not >100K) given elevated
WBC count on admission (no left shift).  She will complete a 7
day course shortly after discharge.
.
# Code: FULL

Medications on Admission:
Iron
Antihypertensive regimen (unclear)

Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
- bladder cancer
- UTI
- anemia
Secondary:
- TB s/p treatment
- HTN
- duodenal ulcer
- subendocardial ischemia
- porcelain gallbladder
- s/p TURBT clot evacuation and fulguration.


Discharge Condition:
well


Discharge Instructions:
You were admitted to the hospital with bleeding out of your
bladder.  We gave you multiple transfusions and stabilized your
red blood cells.  You were evaluated by the urologists and
underwent a cystoscopy with fulguration.  You tolerated this
well.
.
Please followup with your PCP and urologist.  Please take your
medications as instructed.  Please contact your urologist or
return to the ED if you experience bloody urine, fevers, chills,
abdominal pain, chest pain, shortness of breath.

Followup Instructions:
Please followup with your Primary care physician [**Name Initial (PRE) 176**] 2 weeks.
[**Last Name (LF) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 8236**].

Please call and make a follow up appointment with Dr. [**Last Name (STitle) 60236**] in
[**4-11**] weeks. ([**Telephone/Fax (1) 164**])



Completed by:[**2173-3-11**]
{'Malignant neoplasm of other specified sites of bladder,Acute posthemorrhagic anemia,Other acute and subacute forms of ischemic heart disease, other,Late effects of respiratory or unspecified tuberculosis,Bronchiectasis without acute exacerbation,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: anemia and hematuria

PRESENT ILLNESS: 86 Cantonese-speaking F with active T3 bladder cancer dxed [**2170**],
s/p debulking TUR with subsequent XRT who has had persistent
bleeding from her bladder tumors requiring multiple
transfusions, presents with gross hematuria x 1 month,
progressive SOB, pleuritic CP, cough x 1 week. She was seen
earlier in the month in the ED for similiar complaint([**2-28**]); HCT
as 32 at this time. She followed up in urology clinic last
Wednesday, at which point the bleeding continued; HCT was 27.
Today in the ED her HCT is down to 18. In addition she complains
of cough and SOB with pleuritic CP. Of note, last [**Month (only) 956**] she
presented to [**Hospital1 18**] with acute on chronic gross hematuria with
resultant severe symptomatic anemia and cardiac demand ischemia.
Her exertional dyspnea and ischemic EKG findings resolved
following PRBC transfusion.
.
In the ED, she received multiple units RBC, and had frankly
bloody urine and no clots in foley. She was afebrile, WBC 6.4.
UA was positive. CXR shows R scarring, unchanged from prior. For
SOB, CTA chest was performed for PE. Has unknown history of
pulmonary mets, and has history of MAC and mycobacterium
kansasii in her sputum.

MEDICAL HISTORY: - Bronchiectasis
- Bladder cancer diagnosed in [**2170**] - multiple bladder tumors,
papillary transitional cell CA, invasive into muscularis propria

MEDICATION ON ADMISSION: Iron
Antihypertensive regimen (unclear)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.8 / 158/69 / 100 / 18 / 100% 2L nc
GEN: Pale, in no acute distress, lying in bed comfortably
HEENT: No JVD, no LAD, dry mm
LUNGS: Rales in right middle area
HEART: 2/6 systolic flow murmur radiating up
ABD: Soft, quiet BS, ND NT, dull percussion of bladder and also
firm to palpation in suprapubic area
NEURO: Ambulatory
SKIN: No rash

FAMILY HISTORY: [**Name (NI) 1094**] son with nasopharyngeal cancer. Other 2 children are
healthy.

SOCIAL HISTORY: Cantonese speaking. Pt came to USA from [**Location (un) 6847**] in [**2145**]. She
has 3 grown children, all living in USA. She lives by herself.
Her daughter and son-in-law come to the house to help her with
showering, etc. She ambulates in the home. 

### Response:
{'Malignant neoplasm of other specified sites of bladder,Acute posthemorrhagic anemia,Other acute and subacute forms of ischemic heart disease, other,Late effects of respiratory or unspecified tuberculosis,Bronchiectasis without acute exacerbation,Unspecified essential hypertension'}
