CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: Mr. [**Known lastname 77244**] is a 38 year-old man with a history of alcoholic
cirrhosis, grade 1 esophogeal varices, duodenal ulcer, and
[**Doctor First Name **]-[**Doctor Last Name **] tear who presents with melena and
light-headedness.  He is a patient of Dr.[**Name (NI) 37497**] and was
seen in clinic as recently as [**2176-7-3**].  At that time, he
presented for a routine visit and admitted to continued alcohol
consumption, and he was advised to abstain.  He continued
consuming, however, and had his last drink on [**2176-7-7**], having "a
few beers" that evening.  He presented to the ED today after his
partner noticed [**Name2 (NI) **] black stools.  He has had two bowel
movements over this interval but denied nausea, vomiting, or
abdominal pain.
.
Of note, he has a history of multiple prior GI bleeds, with a
perforated duodenal ulcer bleed that led to a Billroth 1
procedure.  In [**2174**], he had an upper GIB that was secondary to a
[**Doctor First Name **]-[**Last Name (un) **] tear.  In [**2175-11-8**], he presented to [**Hospital1 18**] with
hematemesis and was found to have grade 1 esophogeal varices and
gastric varices on EGD.  His last EGD was performed in [**Month (only) 404**]
[**2176**] and demonstrated three cords of grade 1 varices in the
esophagus and gastric varices measuing 2 cm and 0.5 cm, none of
which were bleeding.
.
On presentation, VS in the ED were 98 106/62 96 16 100%nrb.  His
hct on presentation was He had bloody emesis (500cc) and was
bolused with pantoprazole and started on octreotide gtt.  He
also received zofran, versed, and was intubated for airway
protection.  An OG tube was placed and had drainage of 40-50 cc
partially clotted blood.  Two 18 guage and one 20 guage PIV were
placed.  He was transfused 1 u PRBC.  Hepatology was consulted
and he was admitted to the MICU.
.
On arrival, VS were HR 100 BP 90s/60.  Central venous access was
attained with placement of a right IJ sepsis line ([**Location (un) 109**]).  He was
emergently scoped (EGD) by hepatology and was found to have
three cords of nonbleeding grade 1 esopheal varices, nonbleeding
gastric varices, and clotted blood in the fundus.  He was
transfused an additional unit of blood and FFP.
.
Review of systems:  unable to obtain
.

MEDICAL HISTORY: Cirrhosis
Gastric varices
h/o alcohol abuse
Duodenal ulcer, status post Billroth I performed in DR [**Last Name (STitle) **] [**2170**]

MEDICATION ON ADMISSION: FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
NADOLOL - 20 mg Tablet - 1 Tablet(s) by mouth once a day
MULTIVITAMIN - 1  Tablet(s) by mouth once a day
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet, Delayed
Release (E.C.) - 1 Tablet(s) by mouth qam
THIAMINE HCL - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a
day
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation to MICU:
Vitals: T: 98.4 BP: 90/55 P: 109 R: 18 O2: 100%
General: intubated
HEENT: ETT in place, sclera anicteric, MMM, oropharynx with OGT
and bloody secretions from OGT and around mouth
Neck: supple, no JVD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachy, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, distended, bowel sounds present, no organomegaly

FAMILY HISTORY: Noncontributory. Denies any known ETOH-ism in other siblings or
close family members. [**Name (NI) **] known liver or GI diseases in family
per patient.

SOCIAL HISTORY: Lives with girlfriend. [**Name (NI) 1403**] as a stone [**Doctor Last Name 3456**]. He has a prior
history of heavy ETOH use, usually beer, stopped briefly after
duodenal ulcer/surgery in [**Country 13622**] Republic in [**2170**] but
continued to struggle with ETOH-ism. Currently, he reports
occasional beer ([**4-10**] /week) or wine with dinner, but consumed 8
beers at a football game the week prior to admission. No history
of DTs, hallucinations or seizures. Attended AA for a period of
but last meeting about 6 months ago. Patient admits to
intermittent intranasal cocaine use. Denies IVDU. He has never
used tobacco.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acute respiratory failure,Hematemesis,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, continuous
Alcohol cirrhosis liver,Esoph varice oth dis NOS,Acute respiratry failure,Hematemesis,Portal hypertension,Ac posthemorrhag anemia,Alcoh dep NEC/NOS-contin
Admission Date:  [**2176-7-8**]              Discharge Date:   [**2176-7-13**]

Date of Birth:  [**2137-10-30**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
hematemesis


Major Surgical or Invasive Procedure:
[**2176-7-9**] TIPS procedure:
Placement of 10 mm x 7 cm x 2 cm Viatorr TIPS shunt dilated to
10 mm.
Embolization of two gastric varices. Reduction of porta systemic
gradient from 15 mmHg to 10 mmHg.


History of Present Illness:
Mr. [**Known lastname 77244**] is a 38 year-old man with a history of alcoholic
cirrhosis, grade 1 esophogeal varices, duodenal ulcer, and
[**Doctor First Name **]-[**Doctor Last Name **] tear who presents with melena and
light-headedness.  He is a patient of Dr.[**Name (NI) 37497**] and was
seen in clinic as recently as [**2176-7-3**].  At that time, he
presented for a routine visit and admitted to continued alcohol
consumption, and he was advised to abstain.  He continued
consuming, however, and had his last drink on [**2176-7-7**], having "a
few beers" that evening.  He presented to the ED today after his
partner noticed [**Name2 (NI) **] black stools.  He has had two bowel
movements over this interval but denied nausea, vomiting, or
abdominal pain.
.
Of note, he has a history of multiple prior GI bleeds, with a
perforated duodenal ulcer bleed that led to a Billroth 1
procedure.  In [**2174**], he had an upper GIB that was secondary to a
[**Doctor First Name **]-[**Last Name (un) **] tear.  In [**2175-11-8**], he presented to [**Hospital1 18**] with
hematemesis and was found to have grade 1 esophogeal varices and
gastric varices on EGD.  His last EGD was performed in [**Month (only) 404**]
[**2176**] and demonstrated three cords of grade 1 varices in the
esophagus and gastric varices measuing 2 cm and 0.5 cm, none of
which were bleeding.
.
On presentation, VS in the ED were 98 106/62 96 16 100%nrb.  His
hct on presentation was He had bloody emesis (500cc) and was
bolused with pantoprazole and started on octreotide gtt.  He
also received zofran, versed, and was intubated for airway
protection.  An OG tube was placed and had drainage of 40-50 cc
partially clotted blood.  Two 18 guage and one 20 guage PIV were
placed.  He was transfused 1 u PRBC.  Hepatology was consulted
and he was admitted to the MICU.
.
On arrival, VS were HR 100 BP 90s/60.  Central venous access was
attained with placement of a right IJ sepsis line ([**Location (un) 109**]).  He was
emergently scoped (EGD) by hepatology and was found to have
three cords of nonbleeding grade 1 esopheal varices, nonbleeding
gastric varices, and clotted blood in the fundus.  He was
transfused an additional unit of blood and FFP.
.
Review of systems:  unable to obtain
.


Past Medical History:
Cirrhosis
Gastric varices
h/o alcohol abuse
Duodenal ulcer, status post Billroth I performed in DR [**Last Name (STitle) **] [**2170**]

Social History:
Lives with girlfriend. [**Name (NI) 1403**] as a stone [**Doctor Last Name 3456**]. He has a prior
history of heavy ETOH use, usually beer, stopped briefly after
duodenal ulcer/surgery in [**Country 13622**] Republic in [**2170**] but
continued to struggle with ETOH-ism. Currently, he reports
occasional beer ([**4-10**] /week) or wine with dinner, but consumed 8
beers at a football game the week prior to admission. No history
of DTs, hallucinations or seizures. Attended AA for a period of
but last meeting about 6 months ago. Patient admits to
intermittent intranasal cocaine use. Denies IVDU. He has never
used tobacco.


Family History:
 Noncontributory. Denies any known ETOH-ism in other siblings or
close family members. [**Name (NI) **] known liver or GI diseases in family
per patient.

Physical Exam:
On Presentation to MICU:
Vitals: T: 98.4 BP: 90/55 P: 109 R: 18 O2: 100%
General: intubated
HEENT: ETT in place, sclera anicteric, MMM, oropharynx with OGT
and bloody secretions from OGT and around mouth
Neck: supple, no JVD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachy, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, distended, bowel sounds present, no organomegaly

Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
.


Pertinent Results:
[**2176-7-8**] 07:15PM   WBC-8.6# RBC-3.04*# HGB-9.7*# HCT-28.7*#
MCV-95 MCH-31.8 MCHC-33.6 RDW-16.6*
[**2176-7-8**] 07:15PM   NEUTS-77.2* LYMPHS-17.4* MONOS-4.7 EOS-0.3
BASOS-0.4
[**2176-7-8**] 07:15PM   PLT COUNT-141*#
.
[**2176-7-8**] 07:15PM   PT-16.9* PTT-26.8 INR(PT)-1.5*
.
[**2176-7-8**] 07:15PM   GLUCOSE-233* UREA N-36* CREAT-0.9 SODIUM-140
POTASSIUM-4.3 CHLORIDE-105 TOTAL CO2-24 ANION GAP-15
[**2176-7-8**] 07:15PM   ALT(SGPT)-58* AST(SGOT)-86* ALK PHOS-102
AMYLASE-41 TOT BILI-1.4
.
HCt trend:
[**2176-7-8**] 07:15PM BLOOD Hct-28.7*#
[**2176-7-8**] 10:34PM BLOOD Hct-26.2*
[**2176-7-9**] 04:45AM BLOOD Hct-27.8*
[**2176-7-9**] 10:16AM BLOOD Hct-25.6*
[**2176-7-9**] 07:25PM BLOOD Hct-26.6*
[**2176-7-10**] 01:15AM BLOOD Hct-24.6*
[**2176-7-10**] 06:12AM BLOOD Hct-27.1*
[**2176-7-10**] 11:20AM BLOOD Hct-25.8*
[**2176-7-10**] 05:01PM BLOOD Hct-26.2*
[**2176-7-10**] 11:29PM BLOOD Hct-24.4*
[**2176-7-11**] 04:23AM BLOOD Hct-25.9*
[**2176-7-11**] 09:48AM BLOOD Hct-26.3*
.
CXR (my read): ETT in place ~5 cm above [**Female First Name (un) 5309**], no infiltrate
.
EGD [**2176-7-8**]:  three cords of nonbleeding grade 1 esopheal
varices, nonbleeding gastric varices, and clotted blood in the
fundus
.
EGD [**2-16**]:  three cords of grade I varices, varices at the
fundus, otherwise normal EGD to second part of the duodenum
.
Colonoscopy [**12-15**]:  Diverticulosis of the sigmoid colon.
Otherwise normal colonoscopy to cecum
.
EKG:  NSR, nl axis, old 1 mm qwaves in III, avf

Brief Hospital Course:
# GI bleed: Patient presented with Hct of 29, down from a
baseline of 49 with h/o prior GI bleeds secondary to multiple
etiologies, including perforated duodenal ulcer and
[**Doctor First Name **]-[**Doctor Last Name **] tear. This episode likely secondary to gastric
variceal bleed as clots and blood in fundus on EGD though no
active bleeding seen. He required 4 units of PRBCs 2 U of
platelets initially and an additional 2 U on day 2 and 3 of
hospital stay.  He was taken for TIPS procedure with Hct
remaining in 25-27 range and was transitioned off ppi drip and
octreotide drip.  His respiratory status improved and he was
extubated without problems. His hematocrit remained stable and
he did not require further transfusions during admission. The
patient was discharged with pantoprazole po daily.

.
# Alcoholic cirrhosis:  Has portal hypertension with varices on
EGD.  On nadolol as outpatient. Also with good synthetic
function overall with albumin of 4 and INR of 1.4 at baseline.
Now status post TIPS procedure which the patient tolerated well.
He was continued on lactulose, PPI, and ciprofloxacin for
prophylaxis.

.
# Alcoholism:  Known to be currently drinking 4-6 beers three
days per week per his girlfriend.  [**Name (NI) 60563**] with valium was started
in setting of alcoholic cirrhosis but patient required no doses
during his stay. Thiamine, multivitamin, folic acid was started.
Social work consult was called for abuse issues and coping.
.

# Respiratory failure:  Intubated for airway protection in
setting of massive upper GIB.  No history of lung disease at
baseline. The patient was extubated successfully without further
complications.
.
# Follow-up: the patient has a scheduled US one week post-TIPS
for evaluation. He has appointments scheduled with his PCP and
hepatology clinic.

Medications on Admission:
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
NADOLOL - 20 mg Tablet - 1 Tablet(s) by mouth once a day
MULTIVITAMIN - 1  Tablet(s) by mouth once a day
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet, Delayed
Release (E.C.) - 1 Tablet(s) by mouth qam
THIAMINE HCL - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a
day
.


Discharge Medications:
1. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day).
Disp:*2700 ML(s)* Refills:*2*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
Disp:*60 Tablet(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Alcohol abuse
Alcoholic cirrhosis
Variceal bleeding


Discharge Condition:
hemodynamically stable, afebrile


Discharge Instructions:
You were admitted to the hospital with dark stools and bloody
vomiting, concerning for GI bleeding. This was likely caused by
alcohol use. You were admitted to the Intensive Care Unit and
treated for low blood counts (anemia). You will need to continue
taking your medications and abstain from alcohol in order to
avoid further bleeding and damage to your liver.

Please take all your medications as prescribed.  The following
changes were made to your medication regimen.
1. Please take lactulose 15-30 mL three times a day (can titrate
to [**3-12**] bowel movements per day)

Please make sure to keep your scheduled appointments with your
doctor.

If you experience nausea, vomiting, dark  stools,
lightheadedness/dizziness, fevers, or any other concerning
symptoms please call your doctor or return to the emergency
room.
If you experience bright red blood while vomiting or black,
[**Month/Day (3) **] stools call 911 or go to your nearest emergency room.

Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7869**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2176-7-31**]
4:00

Provider: [**Name Initial (NameIs) 703**] (H3) GENERAL 2 RADIOLOGY Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2176-7-17**] 2:15.  This is for your liver ultrasound.
The appointment is located in the [**Hospital Unit Name **] ([**Hospital Ward Name **]) on
the [**Location (un) 470**].  You cannot eat or drink for six hours prior this
appointment.

Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2176-7-31**] 3:10
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acute respiratory failure,Hematemesis,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, continuous'}


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: hematemesis

PRESENT ILLNESS: Mr. [**Known lastname 77244**] is a 38 year-old man with a history of alcoholic
cirrhosis, grade 1 esophogeal varices, duodenal ulcer, and
[**Doctor First Name **]-[**Doctor Last Name **] tear who presents with melena and
light-headedness.  He is a patient of Dr.[**Name (NI) 37497**] and was
seen in clinic as recently as [**2176-7-3**].  At that time, he
presented for a routine visit and admitted to continued alcohol
consumption, and he was advised to abstain.  He continued
consuming, however, and had his last drink on [**2176-7-7**], having "a
few beers" that evening.  He presented to the ED today after his
partner noticed [**Name2 (NI) **] black stools.  He has had two bowel
movements over this interval but denied nausea, vomiting, or
abdominal pain.
.
Of note, he has a history of multiple prior GI bleeds, with a
perforated duodenal ulcer bleed that led to a Billroth 1
procedure.  In [**2174**], he had an upper GIB that was secondary to a
[**Doctor First Name **]-[**Last Name (un) **] tear.  In [**2175-11-8**], he presented to [**Hospital1 18**] with
hematemesis and was found to have grade 1 esophogeal varices and
gastric varices on EGD.  His last EGD was performed in [**Month (only) 404**]
[**2176**] and demonstrated three cords of grade 1 varices in the
esophagus and gastric varices measuing 2 cm and 0.5 cm, none of
which were bleeding.
.
On presentation, VS in the ED were 98 106/62 96 16 100%nrb.  His
hct on presentation was He had bloody emesis (500cc) and was
bolused with pantoprazole and started on octreotide gtt.  He
also received zofran, versed, and was intubated for airway
protection.  An OG tube was placed and had drainage of 40-50 cc
partially clotted blood.  Two 18 guage and one 20 guage PIV were
placed.  He was transfused 1 u PRBC.  Hepatology was consulted
and he was admitted to the MICU.
.
On arrival, VS were HR 100 BP 90s/60.  Central venous access was
attained with placement of a right IJ sepsis line ([**Location (un) 109**]).  He was
emergently scoped (EGD) by hepatology and was found to have
three cords of nonbleeding grade 1 esopheal varices, nonbleeding
gastric varices, and clotted blood in the fundus.  He was
transfused an additional unit of blood and FFP.
.
Review of systems:  unable to obtain
.

MEDICAL HISTORY: Cirrhosis
Gastric varices
h/o alcohol abuse
Duodenal ulcer, status post Billroth I performed in DR [**Last Name (STitle) **] [**2170**]

MEDICATION ON ADMISSION: FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
NADOLOL - 20 mg Tablet - 1 Tablet(s) by mouth once a day
MULTIVITAMIN - 1  Tablet(s) by mouth once a day
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet, Delayed
Release (E.C.) - 1 Tablet(s) by mouth qam
THIAMINE HCL - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a
day
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Presentation to MICU:
Vitals: T: 98.4 BP: 90/55 P: 109 R: 18 O2: 100%
General: intubated
HEENT: ETT in place, sclera anicteric, MMM, oropharynx with OGT
and bloody secretions from OGT and around mouth
Neck: supple, no JVD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: tachy, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, distended, bowel sounds present, no organomegaly

FAMILY HISTORY: Noncontributory. Denies any known ETOH-ism in other siblings or
close family members. [**Name (NI) **] known liver or GI diseases in family
per patient.

SOCIAL HISTORY: Lives with girlfriend. [**Name (NI) 1403**] as a stone [**Doctor Last Name 3456**]. He has a prior
history of heavy ETOH use, usually beer, stopped briefly after
duodenal ulcer/surgery in [**Country 13622**] Republic in [**2170**] but
continued to struggle with ETOH-ism. Currently, he reports
occasional beer ([**4-10**] /week) or wine with dinner, but consumed 8
beers at a football game the week prior to admission. No history
of DTs, hallucinations or seizures. Attended AA for a period of
but last meeting about 6 months ago. Patient admits to
intermittent intranasal cocaine use. Denies IVDU. He has never
used tobacco. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Acute respiratory failure,Hematemesis,Portal hypertension,Acute posthemorrhagic anemia,Other and unspecified alcohol dependence, continuous'}
