CHIEF COMPLAINT: GI Bleed

PRESENT ILLNESS: 67M DM, HTN, here w/ 2 days of lower GI bleed. USOH until two
days prior to transfer, developed loose stools with bright
blood. Subsequently that night, had another bout of bloody
stools - thought this might be due to hemorrhoids and did not
present for medical care at that time. Each bout was
approximately [**12-5**] cups of blood.

MEDICAL HISTORY: Diabetes Mellitus II
Hypertension

MEDICATION ON ADMISSION: Avandia
Metformin
Hyzaar
Diltiazem
Crestor
ASA 81

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.2 93 135/76 12 98% 2L
GENERAL: NAD, appearing pink and well-perfused
HEENT: EOMI, OMMM, no petechiae. Anicteric.
NECK: supple, no LAD, JVP flat.
CARDIOVASCULAR: S1, S2, reg, no MRG
LUNGS: CTAB, though distant sounds, barrel chested.
ABDOMEN: Soft, NT, ND, no rebound. Cherry angiomata.
EXTREMITIES: Warm, no CCE.
NEURO: A/OX3, strength and sensation grossly intact.

FAMILY HISTORY: NC

SOCIAL HISTORY: 40 Pack years. Etoh: 2 drinks/week. Works as sales rep,
woodworking company on the side.
Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery
Dvrtclo colon w hmrhg,Chr blood loss anemia,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Crnry athrscl natve vssl
Admission Date:  [**2159-3-22**]              Discharge Date:   [**2159-3-25**]

Date of Birth:  [**2091-6-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 30**]
Chief Complaint:
GI Bleed

Major Surgical or Invasive Procedure:
Colonoscopy
Tagged Red Cell Scan

History of Present Illness:
67M DM, HTN, here w/ 2 days of lower GI bleed. USOH until two
days prior to transfer, developed loose stools with bright
blood. Subsequently that night, had another bout of bloody
stools - thought this might be due to hemorrhoids and did not
present for medical care at that time. Each bout was
approximately [**12-5**] cups of blood.


One day prior to admission, had another bout of bloody stool and
subsequently had syncopal episode and fall - witnessed by wife.
Brief LOC of 30s, preceded by diaphoresis, but not CP, SOB,
palpitations, or other anginal symptoms. Presented to OSH where
he was noted initially to have a Hct of 28.3, which subsequently
dropped to 21.7. Given 6units PRBCs-> Hct to 30.9 (0800) and
taken to urgent colonoscopy on day of admission. Cscope revealed
diverticulosis, polyps, but not obvious source of bleed, and
blood throughout colon. Had brief episode of SBP to 60s during
colonoscopy. Planned for RBC scan, but transferred to [**Hospital1 18**] for
further care.

On arrival, 93 135/76 12 98% 2L, appearing well and without
distress. Initial Hct here was 31.5.

Pt notes that he has been having mild easy bruising/bleeding
with ASA 81 over last year and a half.


Past Medical History:
Diabetes Mellitus II
Hypertension


Social History:
40 Pack years. Etoh: 2 drinks/week. Works as sales rep,
woodworking company on the side.

Family History:
NC

Physical Exam:
VS 97.2 93 135/76 12 98% 2L
GENERAL: NAD, appearing pink and well-perfused
HEENT: EOMI, OMMM, no petechiae. Anicteric.
NECK: supple, no LAD, JVP flat.
CARDIOVASCULAR: S1, S2, reg, no MRG
LUNGS: CTAB, though distant sounds, barrel chested.
ABDOMEN: Soft, NT, ND, no rebound. Cherry angiomata.
EXTREMITIES: Warm, no CCE.
NEURO: A/OX3, strength and sensation grossly intact.


Pertinent Results:
[**2159-3-22**] 01:07PM   FIBRINOGE-180
[**2159-3-22**] 01:07PM   PT-12.8 PTT-25.8 INR(PT)-1.1
[**2159-3-22**] 01:07PM   PLT COUNT-101*
[**2159-3-22**] 01:07PM   WBC-16.1* RBC-3.78* HGB-11.5* HCT-31.5*
MCV-84 MCH-30.4 MCHC-36.4* RDW-14.7
[**2159-3-22**] 01:07PM   HAPTOGLOB-94
[**2159-3-22**] 01:07PM   ALBUMIN-2.9* CALCIUM-7.0* PHOSPHATE-2.9
MAGNESIUM-1.7
[**2159-3-22**] 01:07PM   CK-MB-NotDone cTropnT-<0.01
[**2159-3-22**] 01:07PM   LD(LDH)-127 CK(CPK)-79 TOT BILI-0.6
[**2159-3-22**] 01:07PM   estGFR-Using this
[**2159-3-22**] 01:07PM   GLUCOSE-148* UREA N-20 CREAT-0.9 SODIUM-141
POTASSIUM-4.0 CHLORIDE-109* TOTAL CO2-26 ANION GAP-10
[**2159-3-22**] 05:47PM   HCT-30.0*
.
[**3-23**] Colonoscopy
Multiple non-bleeding diverticula with medium openings were seen
in the sigmoid colon and descending colon.Diverticulosis
appeared to be of moderate severity.  Impression: Diverticulosis
of the sigmoid colon and descending colon Recommendations:
Advance diet. No source of bleeding

.
[**3-23**] Tagged red cell scan
INTERPRETATION: Following IV injection of autologous red blood
cells labeled with Technicium [**Age over 90 **]m, blood flow and dynamic images
of the abdomen for 105 minutes were obtained. Left lateral view
of the pelvis was also obtained.  Blood flow images show no
focal hyperemia in the abdomen. Dynamic blood pool images show
no abnormal uptake of tracer in the abdomen. IMPRESSION: No
evidence of GI bleed at the time of study.


Brief Hospital Course:
67M with a history of DM, HTN who presented to OSH with
hematochezia.  He received 7 units PRBC's at OSH, had a
colonoscopy there which showed diverticulosis but no acitve
bleed and was transferred from OSH to the [**Hospital1 18**] MICU on [**2158-3-22**].

.
GIB: The patient was initially admitted to the MICU with GI
consulting.  NG lavage was negative for blood. A colonoscopy and
tagged red cell scan were performed on [**3-23**] without evidence of
active bleed, but moderate diverticulosis. The bleed was thought
to be due to diverticular bleed, though an AVM is also possible.
 His Hct remained stable. He was transferred to the floor on
[**3-24**].  His Hct was stable on the floor and he had no further
BRBPR.  He will follow up with his PCP.
.
Type 2 DM: The patient was originally on a sliding scale
insulin.  His oral hypoglycemics were restarted on [**3-24**].
.
* HTN, hyperlipidemia: The patient was restarted on his home
medications on [**3-24**].

Medications on Admission:
Avandia
Metformin
Hyzaar
Diltiazem
Crestor
ASA 81


Discharge Medications:
1. Rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
5. Rosiglitazone 2 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours):
Generic okay.
8. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: GI Bleed.  Diverticulosis
Secondary: HTN, Hyperlipidemia, DM

Discharge Condition:
HCT stable, hemodynamically stable, tolerating regular diet.

Discharge Instructions:
During this admission you were treated for a GI Bleed, likely
from your diverticulosis.  You received blood transfusions.
.
We have not changed any of your medications; please continue to
take all of your medications as prescribed.
.
Please seek IMMEDIATE medical care if you develop black or
bloody stools, abdominal pain, fevers, or any other concerning
symptoms.
.
It is important for you to follow a high fiber diet and to avoid
constipation.

Followup Instructions:
Follow up with your PCP (Dr [**Last Name (STitle) 8026**] this week.  Call
[**Telephone/Fax (1) 72730**] for an appointment.
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}


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: GI Bleed

PRESENT ILLNESS: 67M DM, HTN, here w/ 2 days of lower GI bleed. USOH until two
days prior to transfer, developed loose stools with bright
blood. Subsequently that night, had another bout of bloody
stools - thought this might be due to hemorrhoids and did not
present for medical care at that time. Each bout was
approximately [**12-5**] cups of blood.

MEDICAL HISTORY: Diabetes Mellitus II
Hypertension

MEDICATION ON ADMISSION: Avandia
Metformin
Hyzaar
Diltiazem
Crestor
ASA 81

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.2 93 135/76 12 98% 2L
GENERAL: NAD, appearing pink and well-perfused
HEENT: EOMI, OMMM, no petechiae. Anicteric.
NECK: supple, no LAD, JVP flat.
CARDIOVASCULAR: S1, S2, reg, no MRG
LUNGS: CTAB, though distant sounds, barrel chested.
ABDOMEN: Soft, NT, ND, no rebound. Cherry angiomata.
EXTREMITIES: Warm, no CCE.
NEURO: A/OX3, strength and sensation grossly intact.

FAMILY HISTORY: NC

SOCIAL HISTORY: 40 Pack years. Etoh: 2 drinks/week. Works as sales rep,
woodworking company on the side. 

### Response:
{'Diverticulosis of colon with hemorrhage,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}
