CHIEF COMPLAINT: Bright red blood per rectum

PRESENT ILLNESS: An otherwise 50 year old lady s/p screening colonoscopy
yesterday with 3 polyps removed at [**Location (un) 2274**] presents after ~ 8
bloody bowel movements over night into this morning with
worsening lightheadedness and ? syncope between re-presentation
to [**Location (un) 2274**] this morning and transfer to the ED today.
.
In the ED, initial vs were: 98.4 84 130/92 20 100. Patient was
given 2 IVs in the ED, Type & Screen seen. Patient was seen by
GI who recommended ICU admission for serial hematocrits and
possible colonoscopy. Transfer VS: HR 78 121/75 12 100% RA.
.
On the floor, the patient is resting comfortably complaining
only of stomach growling and flatulence.  She has not had bowel
movements or bleeding since presentation.  She denies and
dyspnea or chest pain and has not stood up to know if she is
still weak or lightheaded.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: Anxiety
Insomnia
Sciatica/Spinal Stenosis s/p sacral laminectomy 4-5 years ago
s/p appendectomy
s/p salpingolysis
breast atypical hyperplasia
s/p breast implant

MEDICATION ON ADMISSION: Nicotine Inhaled
Ativan 1-2mg PO PRN ~ [**1-5**] weekly
Tylenol PRN back pain ~ 1-2x weekly
Tramadol 50mg PO PRN Back pain ~ 1 weekly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.4 BP: 130/92 P: 84 R: 20 18 O2: 100% RA
General: Well appearing,  no acute distress
HEENT: Conjunctiva not pale, MM dry
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Rectal: Small dried blood on skin, no output to bed
GU: no foley
Ext: warm, well perfused, 2+ pulses, no edema

FAMILY HISTORY: Father: COPD
Mother: CAD, Breast CA

SOCIAL HISTORY: Tobacco: Currently smokes ~ 8 cigarettes a day, 1/2-1 pack per
day history for ~ 20 years, attempting to quit
Alcohol:  1 drink/weekly
Denies illicit drug use
Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Benign neoplasm of colon,Anxiety state, unspecified,Insomnia, unspecified,Tobacco use disorder,Volume depletion, unspecified
Hemorrhage complic proc,Abn react-surg proc NEC,Benign neoplasm lg bowel,Anxiety state NOS,Insomnia NOS,Tobacco use disorder,Volume depletion NOS
Admission Date:  [**2126-8-6**]              Discharge Date:   [**2126-8-8**]

Date of Birth:  [**2075-10-28**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3574**]
Chief Complaint:
Bright red blood per rectum

Major Surgical or Invasive Procedure:
[**2126-8-7**] Colonoscopy with cauterization of active bleeding

History of Present Illness:
An otherwise 50 year old lady s/p screening colonoscopy
yesterday with 3 polyps removed at [**Location (un) 2274**] presents after ~ 8
bloody bowel movements over night into this morning with
worsening lightheadedness and ? syncope between re-presentation
to [**Location (un) 2274**] this morning and transfer to the ED today.
.
In the ED, initial vs were: 98.4 84 130/92 20 100. Patient was
given 2 IVs in the ED, Type & Screen seen. Patient was seen by
GI who recommended ICU admission for serial hematocrits and
possible colonoscopy. Transfer VS: HR 78 121/75 12 100% RA.
.
On the floor, the patient is resting comfortably complaining
only of stomach growling and flatulence.  She has not had bowel
movements or bleeding since presentation.  She denies and
dyspnea or chest pain and has not stood up to know if she is
still weak or lightheaded.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

Past Medical History:
Anxiety
Insomnia
Sciatica/Spinal Stenosis s/p sacral laminectomy 4-5 years ago
s/p appendectomy
s/p salpingolysis
breast atypical hyperplasia
s/p breast implant


Social History:
Tobacco: Currently smokes ~ 8 cigarettes a day, 1/2-1 pack per
day history for ~ 20 years, attempting to quit
Alcohol:  1 drink/weekly
Denies illicit drug use

Family History:
Father: COPD
Mother: CAD, Breast CA

Physical Exam:
Vitals: T: 98.4 BP: 130/92 P: 84 R: 20 18 O2: 100% RA
General: Well appearing,  no acute distress
HEENT: Conjunctiva not pale, MM dry
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Rectal: Small dried blood on skin, no output to bed
GU: no foley
Ext: warm, well perfused, 2+ pulses, no edema

Pertinent Results:
Endoscopy report from [**Location (un) 2274**] [**8-5**]: 12mm Sessile polyp in the
hepatic flexure. Polypectomy performed with saline
injection/snare cautery.  3-5mm polyp in sigmoid colon.
snared/retrieved 7mm polyp in rectum- snare cautery.

Admission Labs:
[**2126-8-6**] 10:45PM   HCT-28.0*
[**2126-8-6**] 03:59PM   WBC-10.7 RBC-2.60* HGB-8.0* HCT-24.2* MCV-93
MCH-30.6 MCHC-32.9 RDW-13.4
[**2126-8-6**] 03:59PM   PLT COUNT-318
[**2126-8-6**] 09:20AM   GLUCOSE-105* UREA N-13 CREAT-0.7 SODIUM-137
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-23 ANION GAP-13
[**2126-8-6**] 09:20AM   estGFR-Using this
[**2126-8-6**] 09:20AM   WBC-14.5* RBC-3.34* HGB-10.2* HCT-30.6*
MCV-92 MCH-30.5 MCHC-33.3 RDW-13.5
[**2126-8-6**] 09:20AM   NEUTS-75.4* LYMPHS-21.1 MONOS-2.3 EOS-1.0
BASOS-0.2
[**2126-8-6**] 09:20AM   PLT COUNT-365
[**2126-8-6**] 09:20AM   PT-13.2 PTT-25.8 INR(PT)-1.1
.
HCT Trend:
[**2126-8-6**] 09:20AM Hct-30.6*
[**2126-8-6**] 03:59PM Hct-24.2*
[**2126-8-6**] 10:45PM Hct-28.0*
[**2126-8-7**] 03:38AM Hct-26.9*
[**2126-8-7**] 12:03PM Hct-30.3*
[**2126-8-7**] 05:40PM Hct-29.2*
[**2126-8-8**] 06:35AM Hct-31.4*
.
Coags:
[**2126-8-7**] 03:38AM BLOOD PT-13.5* PTT-29.6 INR(PT)-1.2*
.
Discharge Labs:
[**2126-8-8**] 06:35AM BLOOD WBC-11.0 RBC-3.54* Hgb-10.6* Hct-31.4*
MCV-89 MCH-30.1 MCHC-33.9 RDW-16.8* Plt Ct-309
[**2126-8-8**] 06:35AM BLOOD Glucose-88 UreaN-4* Creat-0.6 Na-139
K-3.9 Cl-107 HCO3-25 AnGap-11
[**2126-8-8**] 06:35AM BLOOD Calcium-8.6 Phos-3.5 Mg-1.8

Brief Hospital Course:
50yo woman who presented with BRBPR and was initially admitted
to the ICU with a post-polypectomy LGIB.

1) Hematochezia: The patient was admitted to the ICU with
post-polypectomy bleed.  Her HCT continued to trend down.  She
had [**1-5**] more bloody bowel movements and received 3 units PRBCs,
with subsequent stabilization of her HCT. She underwent a
colonoscopy by GI the morning after admission.  Polypectomy site
with stigmata of recent bleeding was visualized during the
procedure and cauterized with good effect. HCT and VS remained
stable after the procedure and transfusion. She had no further
episodes of bleeding and did not require any additional
transfusions.  Coags were normal.  She was transferred from the
ICU to the general medicine floor on [**2126-8-7**] for one additional
night of observation.  Her HCT and VS were again stable
overnight, and she was discharged to home in good condition.

2) Back pain: Not an active issue at time of discharge.  She was
ordered for tylenol prn pain.

3) Anxiety: She was ordered for Ativan prn anxiety.

4) Smoking Cessation: She was counseled about quitting smoking,
and offered a nicotine patch during the admission, which she
declined.


Medications on Admission:
Nicotine Inhaled
Ativan 1-2mg PO PRN ~ [**1-5**] weekly
Tylenol PRN back pain ~ 1-2x weekly
Tramadol 50mg PO PRN Back pain ~ 1 weekly

Discharge Medications:
1. Lorazepam 1 mg Tablet Sig: 1-2 Tablets PO HS (at bedtime) as
needed for insomnia/anxiety.
2. Tramadol 50 mg Tablet Sig: One (1) Tablet PO once a day as
needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:Post polypectomy lower GI bleed
Secondary diagnosis: Anxiety


Discharge Condition:
AAOx3, hemodynamically stable, no further bleeding


Discharge Instructions:
You were admitted to the hospital with bleeding after your
colonoscopy. Your blood counts were low so you were transfused 3
units of blood. The site of bleeding in your colon was seen on a
repeat colonoscopy and treated.

We did not make any changes to your medications and counseled
you about quitting smoking.


Followup Instructions:
Please follow up with your primary care doctor in the next [**1-5**]
weeks. Call [**Telephone/Fax (1) 50515**] to make an appointment.
{'Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Benign neoplasm of colon,Anxiety state, unspecified,Insomnia, unspecified,Tobacco use disorder,Volume depletion, unspecified'}


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

PRESENT ILLNESS: An otherwise 50 year old lady s/p screening colonoscopy
yesterday with 3 polyps removed at [**Location (un) 2274**] presents after ~ 8
bloody bowel movements over night into this morning with
worsening lightheadedness and ? syncope between re-presentation
to [**Location (un) 2274**] this morning and transfer to the ED today.
.
In the ED, initial vs were: 98.4 84 130/92 20 100. Patient was
given 2 IVs in the ED, Type & Screen seen. Patient was seen by
GI who recommended ICU admission for serial hematocrits and
possible colonoscopy. Transfer VS: HR 78 121/75 12 100% RA.
.
On the floor, the patient is resting comfortably complaining
only of stomach growling and flatulence.  She has not had bowel
movements or bleeding since presentation.  She denies and
dyspnea or chest pain and has not stood up to know if she is
still weak or lightheaded.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, shortness of breath, or wheezing.
Denies chest pain, chest pressure, palpitations. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: Anxiety
Insomnia
Sciatica/Spinal Stenosis s/p sacral laminectomy 4-5 years ago
s/p appendectomy
s/p salpingolysis
breast atypical hyperplasia
s/p breast implant

MEDICATION ON ADMISSION: Nicotine Inhaled
Ativan 1-2mg PO PRN ~ [**1-5**] weekly
Tylenol PRN back pain ~ 1-2x weekly
Tramadol 50mg PO PRN Back pain ~ 1 weekly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.4 BP: 130/92 P: 84 R: 20 18 O2: 100% RA
General: Well appearing,  no acute distress
HEENT: Conjunctiva not pale, MM dry
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Rectal: Small dried blood on skin, no output to bed
GU: no foley
Ext: warm, well perfused, 2+ pulses, no edema

FAMILY HISTORY: Father: COPD
Mother: CAD, Breast CA

SOCIAL HISTORY: Tobacco: Currently smokes ~ 8 cigarettes a day, 1/2-1 pack per
day history for ~ 20 years, attempting to quit
Alcohol:  1 drink/weekly
Denies illicit drug use 

### Response:
{'Hemorrhage complicating a procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Benign neoplasm of colon,Anxiety state, unspecified,Insomnia, unspecified,Tobacco use disorder,Volume depletion, unspecified'}
