CHIEF COMPLAINT: rectal bleeding

PRESENT ILLNESS: Patient is a pleasant 79 year old male who presented earlier
today with complains of BRBPR. In the past several days he has
been experiencing abdominal cramps and was evaluated at the [**Hospital **]
Hospital, where patient stated he was admitted for about 2 days.
We do not have records from the visit. Patient reports there was
no bleeding per rectum on that admission. This morning he
noticed
bright blood with his bowel movements and felt little bit
lightheaded. At the [**Hospital1 18**] [**Location (un) 620**], his HCT was 40.8 and repeat
was 35. He had a CT abdomen and pelvis which showed active
bleeding at the sigmoid [**Location (un) 499**]. He was subsequently transferred
to
us for angiogram. Patients is hemodynamically stable. He has
continued bright red blood per rectum. He denies any fevers,
chills. He reports history of similar episode of BRBPR about 15
years ago, which was stopped. Patient had a colonoscopy at that
time. One and a half year ago he had another episode of BRBPR
rectum which seemed to originate from the internal hemorrhoids,
which were banded at that times. Patient has not had any
problems
with the hemorrhoids since.

MEDICAL HISTORY: PMH:
- sigmoid diverticulosis
- lower GI bleed 15 years ago
- internal hemorrhoids
- hypertension
- hyperlipidemia
- CAD s/p CABG in [**2123**]

MEDICATION ON ADMISSION: metoprolol 25 mg [**Hospital1 **], aspirin 81 mg once daily, lipitor 15 mg
once daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 98.2   HR 88   BP 123/88   RR 16   O2 sat 100% RA
gen: NAD
CV: RRR
pulm: CTA b/l
abd: mildly softly distended, hypoactive bowel sounds, minimally
tender, no rebound, no guarding
rectal: no external hemorrhoids, there is bright red blood in
the
rectum
extremities: no edema

FAMILY HISTORY: one out of six brothers had [**Name2 (NI) 499**] cancer in his 50s

SOCIAL HISTORY: no etoh, no smoking, lives alone, drives, is independent,
visits gym regularly, lifts weights
Hemorrhage of rectum and anus,Precipitous drop in hematocrit,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified
Rectal & anal hemorrhage,Drop, hematocrit, precip,Dvrtclo colon w/o hmrhg,Int hemorrhoid w/o compl,Hypertension NOS,Hyperlipidemia NEC/NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Other lung disease NEC
Admission Date:  [**2138-6-10**]              Discharge Date:   [**2138-6-12**]

Date of Birth:  [**2058-12-11**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
rectal bleeding

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Patient is a pleasant 79 year old male who presented earlier
today with complains of BRBPR. In the past several days he has
been experiencing abdominal cramps and was evaluated at the [**Hospital **]
Hospital, where patient stated he was admitted for about 2 days.
We do not have records from the visit. Patient reports there was
no bleeding per rectum on that admission. This morning he
noticed
bright blood with his bowel movements and felt little bit
lightheaded. At the [**Hospital1 18**] [**Location (un) 620**], his HCT was 40.8 and repeat
was 35. He had a CT abdomen and pelvis which showed active
bleeding at the sigmoid [**Location (un) 499**]. He was subsequently transferred
to
us for angiogram. Patients is hemodynamically stable. He has
continued bright red blood per rectum. He denies any fevers,
chills. He reports history of similar episode of BRBPR about 15
years ago, which was stopped. Patient had a colonoscopy at that
time. One and a half year ago he had another episode of BRBPR
rectum which seemed to originate from the internal hemorrhoids,
which were banded at that times. Patient has not had any
problems
with the hemorrhoids since.


Past Medical History:
PMH:
- sigmoid diverticulosis
- lower GI bleed 15 years ago
- internal hemorrhoids
- hypertension
- hyperlipidemia
- CAD s/p CABG in [**2123**]

PSH:
- CABG [**2123**]
- appendectomy 44 years ago
- TURP [**2121**]


Social History:
no etoh, no smoking, lives alone, drives, is independent,
visits gym regularly, lifts weights


Family History:
 one out of six brothers had [**Name2 (NI) 499**] cancer in his 50s


Physical Exam:
Temp 98.2   HR 88   BP 123/88   RR 16   O2 sat 100% RA
gen: NAD
CV: RRR
pulm: CTA b/l
abd: mildly softly distended, hypoactive bowel sounds, minimally
tender, no rebound, no guarding
rectal: no external hemorrhoids, there is bright red blood in
the
rectum
extremities: no edema


Pertinent Results:
[**2138-6-10**] 07:45PM   WBC-21.0* RBC-4.12* HGB-12.2* HCT-35.3*
MCV-86 MCH-29.7 MCHC-34.6 RDW-14.9
[**2138-6-10**] 07:45PM   PLT SMR-NORMAL PLT COUNT-218
[**2138-6-10**] 07:45PM   PT-12.6 PTT-23.5 INR(PT)-1.1
[**2138-6-10**] 07:45PM   GLUCOSE-116* UREA N-18 CREAT-1.1 SODIUM-131*
POTASSIUM-4.9 CHLORIDE-99 TOTAL CO2-27 ANION GAP-10

[**2138-6-10**]  CTA ABd/pelvis :
1. FOCUS OF ACTIVE EXTRAVASATION WITHIN THE SIGMOID [**Month/Day/Year **].
   SIGNIFICANT SIGMOID DIVERTICULOSIS.

2.  SIX MM RIGHT MIDDLE LOBE PULMONARY NODULE FOR WHICH
FOLLOW-UP
     CHEST CT IN ONE YEAR IS RECOMMENDED.


[**2138-6-10**] CT Angiogram :
1. [**Female First Name (un) 899**] angiography demonstrated conventional anatomy.
2. [**Female First Name (un) 899**] angiography and selective sigmoid branch angiography did
not
demonstrate any active extravasation. Specifically, branches
that were
corresponding to the area of concern on the prior CTA were
targeted, and no extravasation was identified.



Brief Hospital Course:
Mr. [**Known lastname 77996**] was evaluated by the Acute Care team in the
Emergency Room and admitted to the hospital for further work up
of his GI bleed.  He was admitted to the ICU and made NPO and
hydrated with IV fluids. On [**2138-6-10**] he underwent an angiogram
which demonstrated no active bleeding.  His hematocrit was 32 on
admission and remained in that range of 30-32.

Following transfer to the Surgical floor his hematocrit remained
stable.  He started a regular diet  and was having formed BM's
although he did have blood noted on the toilet paper.  The GI
service recommended a colonoscopy in 4 weeks as long as his
hematocrit was stable.  He also requested referral for a new PCP
and was given that information.  He will need a follow up chest
CT in 1 year as he had a 5mm RML nodule found on his CT scan
from [**Location (un) 620**].  He was discharged on [**2138-6-12**] and will follow up
with the GI service.

Medications on Admission:
metoprolol 25 mg [**Hospital1 **], aspirin 81 mg once daily, lipitor 15 mg
once daily


Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. atorvastatin 10 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. psyllium 1.7 g Wafer Sig: One (1) Wafer PO DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
GI bleed


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 with rectal bleeding and
your blood count decreased, indicating that you had an active
bleed.  An angiogram was done which showed no active bleeding at
this time and your blood count has been stable for the last 24
hours.
* Continue to eat a regular diet and stay well hydrated.  Make
sure that you take a stool softener daily.
* You will need a colonoscopy in one month and you can book it
with the [**Hospital **] Clinic for a convenient time.
* If you develop any increased bleeding, dizziness or any other
symptoms that concern you please call your doctor or return to
the Emergency Room.

Followup Instructions:
Call the [**Hospital **] Clinic at [**Telephone/Fax (1) 463**] for a follow up appointment
in 4 weeks with a colonoscopy.

Call [**Hospital6 733**] at [**Telephone/Fax (1) 250**] to arrange an
appointment with a primary care doctor. You will need a Chest CT
scan in one year to follow up on a small nodule in your right
lung.



Completed by:[**2138-6-12**]
{'Hemorrhage of rectum and anus,Precipitous drop in hematocrit,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified'}


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: rectal bleeding

PRESENT ILLNESS: Patient is a pleasant 79 year old male who presented earlier
today with complains of BRBPR. In the past several days he has
been experiencing abdominal cramps and was evaluated at the [**Hospital **]
Hospital, where patient stated he was admitted for about 2 days.
We do not have records from the visit. Patient reports there was
no bleeding per rectum on that admission. This morning he
noticed
bright blood with his bowel movements and felt little bit
lightheaded. At the [**Hospital1 18**] [**Location (un) 620**], his HCT was 40.8 and repeat
was 35. He had a CT abdomen and pelvis which showed active
bleeding at the sigmoid [**Location (un) 499**]. He was subsequently transferred
to
us for angiogram. Patients is hemodynamically stable. He has
continued bright red blood per rectum. He denies any fevers,
chills. He reports history of similar episode of BRBPR about 15
years ago, which was stopped. Patient had a colonoscopy at that
time. One and a half year ago he had another episode of BRBPR
rectum which seemed to originate from the internal hemorrhoids,
which were banded at that times. Patient has not had any
problems
with the hemorrhoids since.

MEDICAL HISTORY: PMH:
- sigmoid diverticulosis
- lower GI bleed 15 years ago
- internal hemorrhoids
- hypertension
- hyperlipidemia
- CAD s/p CABG in [**2123**]

MEDICATION ON ADMISSION: metoprolol 25 mg [**Hospital1 **], aspirin 81 mg once daily, lipitor 15 mg
once daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Temp 98.2   HR 88   BP 123/88   RR 16   O2 sat 100% RA
gen: NAD
CV: RRR
pulm: CTA b/l
abd: mildly softly distended, hypoactive bowel sounds, minimally
tender, no rebound, no guarding
rectal: no external hemorrhoids, there is bright red blood in
the
rectum
extremities: no edema

FAMILY HISTORY: one out of six brothers had [**Name2 (NI) 499**] cancer in his 50s

SOCIAL HISTORY: no etoh, no smoking, lives alone, drives, is independent,
visits gym regularly, lifts weights 

### Response:
{'Hemorrhage of rectum and anus,Precipitous drop in hematocrit,Diverticulosis of colon (without mention of hemorrhage),Internal hemorrhoids without mention of complication,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other diseases of lung, not elsewhere classified'}
