CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: Mr [**Known lastname **] is a 65M with hx of etoh cirrhosis with hx of varices
and upper gi bleed, s/p variceal sclerotherapy/banding in [**2118**]
who presented to his PCP this week with c/o intermittent BRBPR.
Labs were drawn and notable for a crit of 16, therefore he was
instructed to go to the ED.
.
In the ED initial vs were: 98.6 66 122/63 16 100%, he denied
melena, hematemesis, recent BRBPR, currently, however did report
periodic bright red blood per rectum.  He denied abd pain and
weakness and was guiaic negative and he was hemodynamically
stable.  Labs were notable for a crit of 19.6 and creatinine of
1.4.  He was transferred to the ICU for EGD and monitoring.
.
On the floor, pt is asymptomatic and confirms that he has not
had any recent hematemesis or rectal bleeding.  The last episode
of BRBPR was a week ago and pt attributed it to hemorrhoids
while straining.
.
Review of systems:
(+) Per HPI, also endorses chills and weakness
(-) 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, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: 1. EtOH cirrhosis: decompensated with varices, h/o variceal
bleed [**3-12**] s/p banding
2. Hypertension

MEDICATION ON ADMISSION: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Vitals: T:99.3 BP:104/53 P:54 R:11 O2:100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pale conjunctiva

FAMILY HISTORY: no known

SOCIAL HISTORY: Lives with wife, [**Name (NI) **].  [**Name2 (NI) **] drink sometime between [**Date range (1) 66379**]
per wife.  She is not aware of how much he drinks daily.
Occasional tobacco use.  Wife reports no history of drug use.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute kidney failure, unspecified,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Iron deficiency anemia secondary to blood loss (chronic)
Alcohol cirrhosis liver,Bleed esoph var oth dis,Acute kidney failure NOS,Alcoh dep NEC/NOS-unspec,Hypertension NOS,Chr blood loss anemia
Admission Date:  [**2120-5-3**]              Discharge Date:   [**2120-5-5**]

Date of Birth:  [**2055-1-28**]             Sex:   M

Service: MEDICINE

Allergies:
Amoxicillin

Attending:[**First Name3 (LF) 12174**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
Five units of blood transfusion ([**2120-5-3**])
Esophagogastroduodenoscopy with banding of esophageal varices
([**2120-5-4**])


History of Present Illness:
Mr [**Known lastname **] is a 65M with hx of etoh cirrhosis with hx of varices
and upper gi bleed, s/p variceal sclerotherapy/banding in [**2118**]
who presented to his PCP this week with c/o intermittent BRBPR.
Labs were drawn and notable for a crit of 16, therefore he was
instructed to go to the ED.
.
In the ED initial vs were: 98.6 66 122/63 16 100%, he denied
melena, hematemesis, recent BRBPR, currently, however did report
periodic bright red blood per rectum.  He denied abd pain and
weakness and was guiaic negative and he was hemodynamically
stable.  Labs were notable for a crit of 19.6 and creatinine of
1.4.  He was transferred to the ICU for EGD and monitoring.
.
On the floor, pt is asymptomatic and confirms that he has not
had any recent hematemesis or rectal bleeding.  The last episode
of BRBPR was a week ago and pt attributed it to hemorrhoids
while straining.
.
Review of systems:
(+) Per HPI, also endorses chills and weakness
(-) 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, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.


Past Medical History:
1. EtOH cirrhosis: decompensated with varices, h/o variceal
bleed [**3-12**] s/p banding
2. Hypertension

Social History:
Lives with wife, [**Name (NI) **].  [**Name2 (NI) **] drink sometime between [**Date range (1) 66379**]
per wife.  She is not aware of how much he drinks daily.
Occasional tobacco use.  Wife reports no history of drug use.


Family History:
no known


Physical Exam:
Vitals: T:99.3 BP:104/53 P:54 R:11 O2:100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pale conjunctiva

Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, 1/6 SEM loudest at
the apex
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Rectal: + hemorrhoids, no gross bleeding
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
Admission Labs
[**2120-5-3**] 01:30PM   PT-18.3* PTT-27.8 INR(PT)-1.7*
[**2120-5-3**] 01:30PM   PLT COUNT-206#
[**2120-5-3**] 01:30PM   HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-1+
MACROCYT-NORMAL MICROCYT-2+ POLYCHROM-NORMAL OVALOCYT-1+
SCHISTOCY-OCCASIONAL TEARDROP-OCCASIONAL
[**2120-5-3**] 01:30PM   HAPTOGLOB-76
[**2120-5-3**] 01:30PM   ALBUMIN-3.8
[**2120-5-3**] 05:00PM   WBC-6.1 RBC-2.13* HGB-3.9* HCT-15.4* MCV-73*
MCH-18.5* MCHC-25.5* RDW-23.0*
[**2120-5-3**] 05:00PM   PLT COUNT-178
.
Discharge Labs
[**2120-5-5**] 06:55AM BLOOD WBC-6.5 RBC-3.51* Hgb-8.4* Hct-27.0*
MCV-77* MCH-24.1* MCHC-31.3 RDW-20.9* Plt Ct-158
[**2120-5-5**] 06:55AM BLOOD Glucose-83 UreaN-10 Creat-1.0 Na-134
K-3.9 Cl-105 HCO3-21* AnGap-12
.
Pertinent Labs
[**2120-5-3**] 05:00PM BLOOD WBC-6.1 RBC-2.13* Hgb-3.9* Hct-15.4*
MCV-73* MCH-18.5* MCHC-25.5* RDW-23.0* Plt Ct-178
[**2120-5-4**] 06:00AM BLOOD WBC-5.6 RBC-3.33*# Hgb-7.9*# Hct-25.1*#
MCV-76* MCH-23.7*# MCHC-31.4# RDW-20.9* Plt Ct-154
.
Pertinent Reports
EGD ([**2120-5-4**]): Varices at the lower third of the esophagus
(ligation). Otherwise normal EGD to third part of the duodenum

Brief Hospital Course:
65 year old male with alcoholic cirrhosis complicated by ascites
and variceal bleeding s/p sclerotherpy and banding [**2118**] admitted
with hematocrit drop due to UGIB.
.
1. Bright red blood per rectum.  He was transfused two units of
packed red blood cells in the ED and transferred to the MICU. In
the MICU, he received three more units of packed red blood
cells. He was started on IV pantoprazole 40 mg [**Hospital1 **] and IV
Ceftriaxone 1 gm q24. EGD was performed next morning which
showed 4 Grade II varices in distal esophagus with stigmata of
recent bleeding. He had three varices banded. He was started on
carafate and continued on IV PPI and Ceftriaxone. His HCT
remained stable and no hemodynamic compromise noted. He was
transferred to the floor for monitoring.  His hematocrit stayed
stable.  He was restarted on nadolol 20 mg po qdaily for
secondary prevention of variceal bleeding. He was discharged
with sucralfate for 10 days and pantoprazole 40 mg po BID.
.
2. Microcytic anemia: Iron deficiency anemia due to problem #1.
Discharged on iron sulfate 325 mg po TID and supplementation
with folic acid 1 mg po qdaily and thiamin 100 mg po qdaily.
.
3. Alcoholic cirrhosis: MELD of 15.
.
Follow up issues:
1. Please follow up with Dr. [**Name (NI) **] in two weeks for repeat
EGD.


Medications on Admission:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.

2. Omeprazole 20 q day
3. Diovan 160 q day
4. Nadolol 20 mg daily


Discharge Medications:
1. nadolol 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. sucralfate 100 mg/mL Suspension Sig: Ten (10) mL PO every six
(6) hours for 10 days.
Disp:*500 mL* Refills:*0*
6. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
7. Iron (ferrous sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO three times a day.
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis
1. Esophageal variceal bleeding
.
Secondary Diagnosis
1. Alcoholic cirrhosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital due to low blood count.  It
was thought to be due to esophageal variceal bleeding.  You were
given five units of packed red blood cells.  Hepatology
performed esophagogastroduodenoscopy which showed varices in
your distal esophagus which were banded.
.
Following medication changes were made to your medical regimen
CONTINUE NADOLOL 20 mg by mouth once a day
CONTINUE THIAMINE 100 mg by mouth once a day
CONTINUE DIOVAN 160 mg by mouth once a day
INCREASE OMEPRAZOLE to 40 mg by mouth twice a day
START FOLIC ACID 1 mg by mouth once a day
START FERROUS SULFATE 325 mg by mouth three times a day
START SUCRALFATE 1 gm suspension four times a day for 10 days
(End date: [**2120-5-13**])

Followup Instructions:
Please follow up with Dr. [**Name (NI) **] in two weeks for repeat
esophagogastroduodenoscopy
[**Hospital1 18**]-Division of Gastroenterology/Liver Center  View Map
[**Last Name (NamePattern1) 77317**]
[**Location (un) 86**], [**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 2422**]
Fax: [**Telephone/Fax (1) 21335**]

Department: ENDO SUITES
When: FRIDAY [**2120-6-28**] at 11:00 AM

Department: DIGESTIVE DISEASE CENTER
When: FRIDAY [**2120-6-28**] at 11:00 AM
With: [**Name6 (MD) **] [**Last Name (NamePattern4) 2424**], MD [**Telephone/Fax (1) 463**]
Building: [**First Name8 (NamePattern2) **] [**Hospital Ward Name 1950**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 3202**]
Campus: EAST     Best Parking: Main Garage
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute kidney failure, unspecified,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Iron deficiency anemia secondary to blood loss (chronic)'}


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: BRBPR

PRESENT ILLNESS: Mr [**Known lastname **] is a 65M with hx of etoh cirrhosis with hx of varices
and upper gi bleed, s/p variceal sclerotherapy/banding in [**2118**]
who presented to his PCP this week with c/o intermittent BRBPR.
Labs were drawn and notable for a crit of 16, therefore he was
instructed to go to the ED.
.
In the ED initial vs were: 98.6 66 122/63 16 100%, he denied
melena, hematemesis, recent BRBPR, currently, however did report
periodic bright red blood per rectum.  He denied abd pain and
weakness and was guiaic negative and he was hemodynamically
stable.  Labs were notable for a crit of 19.6 and creatinine of
1.4.  He was transferred to the ICU for EGD and monitoring.
.
On the floor, pt is asymptomatic and confirms that he has not
had any recent hematemesis or rectal bleeding.  The last episode
of BRBPR was a week ago and pt attributed it to hemorrhoids
while straining.
.
Review of systems:
(+) Per HPI, also endorses chills and weakness
(-) 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, or weakness.
Denies nausea, vomiting, diarrhea, constipation, abdominal pain,
or changes in bowel habits. Denies dysuria, frequency, or
urgency. Denies arthralgias or myalgias. Denies rashes or skin
changes.

MEDICAL HISTORY: 1. EtOH cirrhosis: decompensated with varices, h/o variceal
bleed [**3-12**] s/p banding
2. Hypertension

MEDICATION ON ADMISSION: 1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.

ALLERGIES: Amoxicillin

PHYSICAL EXAM: Vitals: T:99.3 BP:104/53 P:54 R:11 O2:100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pale conjunctiva

FAMILY HISTORY: no known

SOCIAL HISTORY: Lives with wife, [**Name (NI) **].  [**Name2 (NI) **] drink sometime between [**Date range (1) 66379**]
per wife.  She is not aware of how much he drinks daily.
Occasional tobacco use.  Wife reports no history of drug use. 

### Response:
{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Acute kidney failure, unspecified,Other and unspecified alcohol dependence, unspecified,Unspecified essential hypertension,Iron deficiency anemia secondary to blood loss (chronic)'}
