CHIEF COMPLAINT: Bright red blood per rectum.

PRESENT ILLNESS: This is a 72-year-old female
with history of hypertension, diabetes type 2, and
diverticulosis by colonoscopy in [**7-10**], who presents with
large volume of BRBPR x2 this a.m.  The patient was unclear
about amount of bleeding, but quantifies it as cupfuls.  She
had 2 more episodes in the ED with 1 episode about 200 cc [**Name8 (MD) **]
RN.  In the ED, her hematocrit was noted to be 37.2 (baseline
36 to 37) and hemodynamically stable with blood pressure
129/88 and pulse 95.  Unfortunately, she failed NG lavage.
She has never had prior GI bleeding and denied chest pain,
shortness of breath, lightheadedness, abdominal pain,
nausea/vomiting, palpitations, recent fevers and chills,
recent NSAID use, GERD, anticoagulation, ETOH.  She received
1.5 liters of normal saline following resuscitation in ED and
was transferred to the floor.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN WITH UNCLEAR REACTION.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives in [**Location 96323**] with husband
(who is currently hospitalized in Rehab Center with CVA), no
tobacco or ETOH.
Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Acidosis,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign neoplasm of colon,Internal hemorrhoids without mention of complication,Other specified hypotension,Hypocalcemia,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Dvrtclo colon w hmrhg,Ac posthemorrhag anemia,Acidosis,Cardiac dysrhythmias NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Benign neoplasm lg bowel,Int hemorrhoid w/o compl,Hypotension NEC,Hypocalcemia,Abn react-procedure NEC
Admission Date: [**2140-5-16**]        Discharge Date: [**2140-5-21**]

Date of Birth:  [**2068-1-22**]        Sex:  F

Service:  MED


CHIEF COMPLAINT:  Bright red blood per rectum.

HISTORY OF PRESENT ILLNESS:  This is a 72-year-old female
with history of hypertension, diabetes type 2, and
diverticulosis by colonoscopy in [**7-10**], who presents with
large volume of BRBPR x2 this a.m.  The patient was unclear
about amount of bleeding, but quantifies it as cupfuls.  She
had 2 more episodes in the ED with 1 episode about 200 cc [**Name8 (MD) **]
RN.  In the ED, her hematocrit was noted to be 37.2 (baseline
36 to 37) and hemodynamically stable with blood pressure
129/88 and pulse 95.  Unfortunately, she failed NG lavage.
She has never had prior GI bleeding and denied chest pain,
shortness of breath, lightheadedness, abdominal pain,
nausea/vomiting, palpitations, recent fevers and chills,
recent NSAID use, GERD, anticoagulation, ETOH.  She received
1.5 liters of normal saline following resuscitation in ED and
was transferred to the floor.

PAST MEDICAL HISTORY:  Hypertension.

NIDDM.

Diverticulosis with no history of GI bleed (colonoscopy,
[**7-10**], showing diverticula of sigmoid and descending colon
and grade 1 internal hemorrhoids, otherwise normal to cecum).

Seborrheic keratosis.

MEDICATIONS:  On admission,
1. Hydrochlorothiazide 50 mg p.o. q.d.
2. KCl 20 mEq p.o. q.d.
3. Glyburide 5 mg p.o. q.d.
4. Prazosin 1 mg p.o. b.i.d.
5. Moexipril 15 mg p.o. q.d.
6. MDI.
7. Calcium carbonate.


ALLERGIES:  PENICILLIN WITH UNCLEAR REACTION.

SOCIAL HISTORY:  The patient lives in [**Location 96323**] with husband
(who is currently hospitalized in Rehab Center with CVA), no
tobacco or ETOH.

PHYSICAL EXAMINATION:  On admission, vital signs, blood
pressure 124/79, pulse 74, respirations 18, 97 percent on
room air with blood pressure and pulse changing to 99/58 with
pulse of 81 during course of examination.  General:  NAD,
resting on the stretcher, alert and oriented x3.  HEENT:
PERRLA, EOMI, MMM, clear oropharynx, anicteric sclerae.
Neck:  Supple, no JVD, no lymphadenopathy.  Cardiovascular:
Regular rate and rhythm, normal S1 and S2; no murmurs, rubs,
or gallop.  Lungs:  Clear to auscultation bilaterally.
Abdomen:  Normoactive bowel sounds, soft, nontender,
nondistended.  No hepatosplenomegaly.  Extremities:  No
clubbing, cyanosis, or edema, 2 plus PT pulses.  Rectal:
Skin tag at anus with bright red blood noted, good sphincter
tone.

LABORATORY DATA:  On admission, significant for white count
of 4.3 with 16 neutrophils, 33 lymphocytes, 4 monocytes, 4
eosinophils.  Hematocrit 37.2, platelets 311.  Chemistry is
notable for BUN 26, creatinine 0.9.

On [**2140-5-16**], ECG, normal sinus rhythm at 79 beats per minute,
normal axis and intervals, left atrial enlargement, frequent
PACs, no ST-T wave changes from prior ECG.

HOSPITAL COURSE:  Bright red blood per rectum.  Patient was
typed and crossed for several units of packed red cells and
was ensured adequate peripheral IV access and given normal
saline for volume resuscitation.  Over the course of the
evening, she had several more episodes of hematochezia while
attempting to prep for colonoscopy for the following day.
Her hematocrit dropped to 24 over the next several hours and
the patient was sent for packed red blood cell scan given the
active bleeding.  This localized the area of bleeding to the
distal transverse colon just proximal to the splenic flexure.
She was then immediately sent to angiography, which
unfortunately was unable to localize the bleed.  She was
monitored in the MICU for the next several days and
transfused several units of packed red cells for continually
decreasing hematocrit.  She had a colonoscopy on [**2140-5-17**]
showing extensive diverticulosis in the entire colon, though
more concentrated in the left colon, and fresh blood in the
rectosigmoid colon to about 50 cm from the anal verge, but
most concentrated from about 40 to 50 cm and no bleeding
proximally.  While fresh blood was continually seen, no
specific bleeding diverticulum was identified.  She
stabilized over the next few days and continued on IV
Protonix, though the most likely source of bleeding was from
the sigmoid or descending colon, secondary to diverticulosis.
After her hematocrit stabilized with no further episodes of
hematochezia, the patient was transferred to the floor and
prepared for discharge.  Surgery had evaluated the patient
earlier, but did not wish to operate  at this time.  However,
we discussed with the patient that these episodes were likely
to recur and should they recur surgery may be indicated in
the future.

Anemia.  The patient was transfused a total of 8 units of
packed red blood cells during this admission.  She was
started on iron supplements on discharge.

NIDDM.  She was on sliding scale insulin, but will restart
her p.o. hypoglycemics on discharge.

Prophylaxis.  The patient will not need to continue PPI at
home as unlikely to have upper GI lesions.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:  Diverticulosis.

Lower gastrointestinal bleed.

Hypertension.

Diabetes, non-insulin dependent.

Internal hemorrhoids.

DISCHARGE MEDICATIONS:
1. Hydrochlorothiazide 50 mg p.o. q.d.
2. KCl 20 mEq p.o. q.d.
3. Glyburide 5 mg p.o. q.d.
4. Prazosin 1 mg p.o. b.i.d.
5. Moexipril 15 mg p.o. q.d.
6. MDI.
7. Calcium carbonate.
8. Iron 325 mg 1 tablet p.o. t.i.d.
9. Colace 100 mg p.o. b.i.d.


FOLLOW-UP PLANS:  The patient was advised to follow up with
her primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3649**], in the next few days.
She was advised from the GI team to eat a high-fiber diet,
but that these episodes may recur.  She was instructed to
return to the Emergency Department immediately should she
experience any further bright red blood per rectum.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6756**], [**MD Number(1) 93373**]

Dictated By:[**Last Name (NamePattern1) 7193**]
MEDQUIST36
D:  [**2140-6-1**] 11:00:25
T:  [**2140-6-1**] 12:47:56
Job#:  [**Job Number **]








Admission Date: [**2140-5-22**]        Discharge Date: [**2140-5-25**]

Date of Birth:  [**2068-1-22**]        Sex:  F

Service:  MED


CHIEF COMPLAINT:  Bright red blood per rectum.

HISTORY OF PRESENT ILLNESS:  The patient is a 72-year-old
female with recent discharge after diverticular bleed
presents with repeated bright red blood per rectum.  During
the last admission, the patient had colonoscopy on [**2140-5-17**]
showing fresh blood in the left colon up to 50 cm with
extensive diverticulosis.  She had packed red blood cells
again on [**2140-5-16**] showing active bleeding at the distal
transverse colon proximal to the splenic flexure and then in
angio, which was unable to visualize active bleeding.  On the
morning of admission, the patient had 3 episodes of passing
clots (greater than size of a quarter).  She denies
dizziness, lightheadedness, nausea, vomiting, diarrhea,
fevers, chills, chest pain, or shortness of breath.  She does
report hearing a rapid heartbeat.  In the ED, vital signs
stable and hematocrit noted to be 24 down from 28 on
discharge.  She was given 2 units of packed red cells.

PAST MEDICAL HISTORY:  Diverticulosis, status post recent GI
bleed.

Diabetes type II.

Hypertension.

MEDICATIONS:
1. Protonix 40 mg by mouth every day.
2. Minipress 1 mg by mouth every day.
3. Moexipril 15 mg by mouth every day.
4. Hydrochlorothiazide 50 mg by mouth every day.
5. Glyburide 5 mg by mouth every day.
6. Iron supplements 3 times a day.
7. Potassium 20 mEq by mouth every day.


ALLERGIES:  Penicillin.

SOCIAL HISTORY:  Husband in hospital in [**Location (un) 38**] status post
stroke, 6 children.

PHYSICAL EXAMINATION:  Temperature 97 degrees, blood pressure
122/72, pulse 75, respirations 14, and O2 saturation 100
percent on 2 liters.  In general, a well-appearing female in
no acute distress.  HEENT:  PERRL, anicteric.  Moist mucous
membranes.  Throat without erythema.  Cardiovascular:
Regular rate and rhythm.  Normal S1 and S2.  Chest:  Clear to
auscultation bilaterally.  Abdomen:  Normoactive bowel
sounds, soft, nontender, and nondistended.  Extremities:
Pitting edema [**12-11**] plus bilaterally, 2 plus DPs.  Rectal:
Bright red blood seen at anus.

LABORATORY DATA:  Laboratory data on admission is significant
for white count 4.6 with 76 percent neutrophils, 19 percent
lymphocytes, 3 percent monocytes, hematocrit 24.7, and
platelets 269.  Chemistry is notable for potassium of 3.7,
BUN 17, creatinine 0.8, glucose 119, CK 389, MB of 7, and
troponin less than 0.01.

RADIOGRAPHIC STUDIES:  EKG, no ST- or T-wave changes.  Sinus
tachycardia at 96 beats per minute.

HOSPITAL COURSE:  Bright red blood per rectum.  The patient
was prepped for repeat colonoscopy, which showed multiple
diverticula with large openings in the sigmoid and descending
colon, but no blood seen anywhere, as well as a single
sessile 6 mm non-bleeding polyp of benign appearance in the
descending colon, which was excised.  No intervention was
performed at that time and the patient did not have any
further bleeding.  Her hematocrit remained stable at 32 on
discharge.  Again, she was recommended to eat a very high-
fiber diet and take Colace.  A left hemicolectomy was
discussed with her in case of re-bleed and the patient is
aware that she may have to have this done in the future as it
is very likely that she will re-bleed.

Hypertension.  Her blood pressure medications were held, and
she was advised to not take them until she follows up with
her primary care doctor in the next week.

Type II diabetes.  Oral hypoglycemics were held while n.p.o.,
but she will resume her normal medications on discharge.

Diet.  Repleted electrolytes and the patient was tolerating
solids by discharge.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:  Lower gastrointestinal bleed likely
secondary to diverticulosis.

Diabetes.

Hypertension.

Blood loss anemia.

DISCHARGE MEDICATIONS:  As per admission medications with the
addition of Colace 100 mg by mouth 2 times a day.

FOLLOW-UP PLANS:  The patient was advised to call PCP for
[**Name9 (PRE) 702**] in the next week to monitor hematocrit and blood
pressure.



                        [**First Name11 (Name Pattern1) 1528**] [**Last Name (NamePattern4) **], [**MD Number(1) 93373**]

Dictated By:[**Last Name (NamePattern1) 7193**]
MEDQUIST36
D:  [**2140-5-27**] 16:19:48
T:  [**2140-5-28**] 06:31:23
Job#:  [**Job Number 96324**]
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Acidosis,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign neoplasm of colon,Internal hemorrhoids without mention of complication,Other specified hypotension,Hypocalcemia,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: This is a 72-year-old female
with history of hypertension, diabetes type 2, and
diverticulosis by colonoscopy in [**7-10**], who presents with
large volume of BRBPR x2 this a.m.  The patient was unclear
about amount of bleeding, but quantifies it as cupfuls.  She
had 2 more episodes in the ED with 1 episode about 200 cc [**Name8 (MD) **]
RN.  In the ED, her hematocrit was noted to be 37.2 (baseline
36 to 37) and hemodynamically stable with blood pressure
129/88 and pulse 95.  Unfortunately, she failed NG lavage.
She has never had prior GI bleeding and denied chest pain,
shortness of breath, lightheadedness, abdominal pain,
nausea/vomiting, palpitations, recent fevers and chills,
recent NSAID use, GERD, anticoagulation, ETOH.  She received
1.5 liters of normal saline following resuscitation in ED and
was transferred to the floor.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN WITH UNCLEAR REACTION.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives in [**Location 96323**] with husband
(who is currently hospitalized in Rehab Center with CVA), no
tobacco or ETOH. 

### Response:
{'Diverticulosis of colon with hemorrhage,Acute posthemorrhagic anemia,Acidosis,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Benign neoplasm of colon,Internal hemorrhoids without mention of complication,Other specified hypotension,Hypocalcemia,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
