CHIEF COMPLAINT: Melena

PRESENT ILLNESS: 81F CAD s/p "silent MI", here w/ melena after course of NSAIDs.
USOH until three days prior to admission, developed melena,
weakness, gnawing discomfort in epigastrium, no CP, SOB. Guaiac
pos in PCP office and sent to ED. Found to have decrease in Hct
to 31.5 from baseline ~37.

MEDICAL HISTORY: HTN
Hyperlipidemia
CAD s/p "silent MI"
Osteoarthritis

MEDICATION ON ADMISSION: Atenolol 12.5
Lipitor 80
Lisinopril 10
ASA 325
Ibuprofen

ALLERGIES: Naproxen

PHYSICAL EXAM: VS 67 118/45 16 98%2L
GENERAL: NAD sleepy after scope
HEENT: EOMI, OMMM
NECK: Supple, no LAD
CARDIOVASCULAR: S1, S2, reg, I/VI systolic, no RG
LUNGS: CTAB
ABDOMEN: Soft, NT, ND, active bowel sounds.
EXTREMITIES: Warm, no CCE
NEURO: sleepy, but arousable

FAMILY HISTORY: NC

SOCIAL HISTORY: Occasional alcohol.  Does not smoke.  Independent ADLs.
Other specified gastritis, with hemorrhage,Acute posthemorrhagic anemia,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia
Oth spf gastrt w hmrhg,Ac posthemorrhag anemia,Adv eff analgesic NOS,Hypertension NOS,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS
Admission Date:  [**2110-5-5**]              Discharge Date:   [**2110-5-7**]


Service: MEDICINE

Allergies:
Naproxen

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy

History of Present Illness:
81F CAD s/p "silent MI", here w/ melena after course of NSAIDs.
USOH until three days prior to admission, developed melena,
weakness, gnawing discomfort in epigastrium, no CP, SOB. Guaiac
pos in PCP office and sent to ED. Found to have decrease in Hct
to 31.5 from baseline ~37.

Given IV protonix and brought to unit for EGD, which revealed
gastritis, shallow ulcer, but no active bleeding. Recommended IV
PPI [**Hospital1 **], [**Hospital1 **] Hct while in house, NPO overnight, then f/u scope
in two months while on PPI.


Past Medical History:
HTN
Hyperlipidemia
CAD s/p "silent MI"
Osteoarthritis


Social History:
Occasional alcohol.  Does not smoke.  Independent ADLs.

Family History:
NC

Physical Exam:
VS 67 118/45 16 98%2L
GENERAL: NAD sleepy after scope
HEENT: EOMI, OMMM
NECK: Supple, no LAD
CARDIOVASCULAR: S1, S2, reg, I/VI systolic, no RG
LUNGS: CTAB
ABDOMEN: Soft, NT, ND, active bowel sounds.
EXTREMITIES: Warm, no CCE
NEURO: sleepy, but arousable


Pertinent Results:
[**2110-5-5**] 11:57PM   HCT-25.8*
[**2110-5-5**] 07:15PM   HCT-27.7*
[**2110-5-5**] 04:50PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2110-5-5**] 04:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-TR
[**2110-5-5**] 04:50PM URINE  RBC-0 WBC-[**2-2**] BACTERIA-MOD YEAST-NONE
EPI-[**5-10**]
[**2110-5-5**] 02:15PM   GLUCOSE-106* UREA N-15 CREAT-0.8 SODIUM-140
POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-27 ANION GAP-14
[**2110-5-5**] 02:15PM   CALCIUM-9.9 PHOSPHATE-3.7 MAGNESIUM-2.2
[**2110-5-5**] 02:15PM   WBC-6.6 RBC-3.30* HGB-11.2* HCT-31.5* MCV-96
MCH-34.0* MCHC-35.6* RDW-13.5
[**2110-5-5**] 02:15PM   NEUTS-64.9 LYMPHS-28.4 MONOS-4.8 EOS-1.6
BASOS-0.3
[**2110-5-5**] 02:15PM   MACROCYT-1+
[**2110-5-5**] 02:15PM   PLT COUNT-269
[**2110-5-5**] 02:15PM   PT-11.6 PTT-21.3* INR(PT)-1.0

EGD:
Small hiatal hernia
Ulcer in the stomach body and antrum
Erythema, friability, congestion and erosion in the antrum and
stomach body compatible with erosive gastritis
Erythema, friability and congestion in the proximal bulb

Brief Hospital Course:
81F with erosive gastritis likely [**1-2**] NSAIDS.

* Gastritis: Noted to have shallow nonbleeding ulcers by EGD,
continued on PPI [**Hospital1 **].  Initially found to have continued Hct
drop overnight, and as such was kept in ICU for further
observation.  Transfused two units, and bumped appropriately.

No further episodes of melena, and tolerated PO diet with no
difficulty.

Counseled to avoid NSAIDs, however, allowed to continue taking
ASA for presumed secondary prevention of CAD.

* CAD: N tachycardia or demand ischemia noted during this
admission.

* FEN: NPO initially, then soft diet in AM following scope.

Discharged to home following observation and transfusion.  To
return in [**5-8**] weeks for followup endoscopy.

Medications on Admission:
Atenolol 12.5
Lipitor 80
Lisinopril 10
ASA 325
Ibuprofen


Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Lipitor 80 mg Tablet Sig: One (1) Tablet PO once a day.
3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. Atenolol  Oral
5. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Gastritis
Melena
Blood loss anemia

Discharge Condition:
Patient had stable hct at discharge.  No further bleeding or
melena.

Discharge Instructions:
Please take your medications as prescribed. Please do not take
any ibuprofen (Advil or Motrin).  You may still take tylenol for
pain.
.
Please call your doctor or return to the ER if you have chest
pain, shortness of breath, dizziness, black stools or bloody
stools, blood when you vomit or have other concerning symptoms.

Followup Instructions:
You should follow-up to have an endoscopy in 6 weeks.
.
You should follow-up with your primary care doctor, Dr. [**Last Name (STitle) **]
[**Name (STitle) 1728**], in [**12-2**] weeks. His phone number is [**Telephone/Fax (1) 904**].
{'Other specified gastritis, with hemorrhage,Acute posthemorrhagic anemia,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}


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: Melena

PRESENT ILLNESS: 81F CAD s/p "silent MI", here w/ melena after course of NSAIDs.
USOH until three days prior to admission, developed melena,
weakness, gnawing discomfort in epigastrium, no CP, SOB. Guaiac
pos in PCP office and sent to ED. Found to have decrease in Hct
to 31.5 from baseline ~37.

MEDICAL HISTORY: HTN
Hyperlipidemia
CAD s/p "silent MI"
Osteoarthritis

MEDICATION ON ADMISSION: Atenolol 12.5
Lipitor 80
Lisinopril 10
ASA 325
Ibuprofen

ALLERGIES: Naproxen

PHYSICAL EXAM: VS 67 118/45 16 98%2L
GENERAL: NAD sleepy after scope
HEENT: EOMI, OMMM
NECK: Supple, no LAD
CARDIOVASCULAR: S1, S2, reg, I/VI systolic, no RG
LUNGS: CTAB
ABDOMEN: Soft, NT, ND, active bowel sounds.
EXTREMITIES: Warm, no CCE
NEURO: sleepy, but arousable

FAMILY HISTORY: NC

SOCIAL HISTORY: Occasional alcohol.  Does not smoke.  Independent ADLs. 

### Response:
{'Other specified gastritis, with hemorrhage,Acute posthemorrhagic anemia,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}
