CHIEF COMPLAINT: Melena

PRESENT ILLNESS: Mr. [**Known lastname 1022**] is a 67 year-old man presenting with melena. Recently
admitted in [**Hospital1 **] under Dr.[**Last Name (STitle) **] on [**2-2**] with RUQ pain and mildly
deranged LFTs. CT-showed thick walled GB with CBD upper normal
6.6mm. No pancreatitis.

MEDICAL HISTORY: 1. Diabetes type II
2. Hypertension
3. ESRD on dialysis via AV-fistula
4. CAD per d/c summary (endorses history of pacer but denies
heart attack, stents or cardiac cath)
5. Pacemaker placed for bradyarrhythmia
6. Ankle fracture from slip on ice several weeks ago

MEDICATION ON ADMISSION: Home medications
phos lo 667mg three tabs TID,
clonidine 0.2 mg [**Hospital1 **],
lisinopril 40 mg daily,
lasix 80 [**Hospital1 **],
atenolol 50 mg [**Hospital1 **],
diovan 80 mg [**Hospital1 **],
norvasc 10 mg daily,
humalog 30 mg qam, 15 mg qpm.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T:97.7  BP: 121/54 P:67 R: 16 O2: 100% on 2L NC
General: Alert, oriented, no acute distress, speaks minimal
english.
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased in the bases with scant crackles in bases
CV: Regular rate and rhythm, normal S1 + S2, holosystolic
murmur.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, Fistula w/ palpable thrill in LUE. No palmar erythema.
Cast on LLE
Rectal: Small amount soft brown stool
Skin: One small spider angioma on his L chest

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Originally from [**Country 10181**], lives with his wife. Retired from
[**Location (un) **] in [**2104**] as assembly worker. Has 2 sons and one
daughter. His daughter's phone number (Yokang [**Telephone/Fax (1) 65905**]).
Previously was heavy drinker/smoker 2ppd but quit 10 years ago.
Hemorrhage complicating a procedure,End stage renal disease,Acute pancreatitis,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to renal dialysis device, implant, and graft,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Renal dialysis status,Cardiac pacemaker in situ,Other orthopedic aftercare
Hemorrhage complic proc,End stage renal disease,Acute pancreatitis,Ac posthemorrhag anemia,Hyp kid NOS w cr kid V,Comp-ren dialys dev/grft,Abn react-surg proc NEC,Hyperpotassemia,CHF NOS,Crnry athrscl natve vssl,DMII renl nt st uncntrld,Renal dialysis status,Status cardiac pacemaker,Orthopedic aftercare NEC
Admission Date:  [**2118-2-8**]              Discharge Date:   [**2118-2-15**]

Date of Birth:  [**2050-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1253**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
ERCP with [**Hospital1 **]-CAP electrocautery ([**2118-2-10**])
AV fistulagram ([**2118-2-11**])


History of Present Illness:
Mr. [**Known lastname 1022**] is a 67 year-old man presenting with melena. Recently
admitted in [**Hospital1 **] under Dr.[**Last Name (STitle) **] on [**2-2**] with RUQ pain and mildly
deranged LFTs. CT-showed thick walled GB with CBD upper normal
6.6mm. No pancreatitis.

Re-presented to [**Hospital1 **] with abdominal pain and nausea with
deranged LFTs. Transferred here for ERCP on [**2118-2-7**] and then
transferred back to [**Hospital1 **]. Today he was noted to have 2
episodes of dark melanotic stools the second one was just after
dialysis about 1400. He did not have any hematemesis. They
planned on giving him 1 unit PRBCs prior to transfer. He did not
have any hemodynamic instability and his Hct went from 34 on
[**2-1**] to 32.4 on [**3-3**] to 31.4 today at 13:35.  He denies any
recent NSAID use, he has never had a significant GIB before but
has had some small amounts of BRBPR w/ constipation. He had
several episodes of dry heaves yesterday without hematemesis.
ERCP [**Numeric Identifier **] pager. Ref:Dr.[**Last Name (STitle) 27673**] ([**Telephone/Fax (1) **]- page operator).

On the floor, He denies any pain or current complaints.

Review of systems:
Negative other than above

Past Medical History:
1. Diabetes type II
2. Hypertension
3. ESRD on dialysis via AV-fistula
4. CAD per d/c summary (endorses history of pacer but denies
heart attack, stents or cardiac cath)
5. Pacemaker placed for bradyarrhythmia
6. Ankle fracture from slip on ice several weeks ago

Social History:
Originally from [**Country 10181**], lives with his wife. Retired from
[**Location (un) **] in [**2104**] as assembly worker. Has 2 sons and one
daughter. His daughter's phone number (Yokang [**Telephone/Fax (1) 65905**]).
Previously was heavy drinker/smoker 2ppd but quit 10 years ago.


Family History:
Non-contributory

Physical Exam:
Vitals: T:97.7  BP: 121/54 P:67 R: 16 O2: 100% on 2L NC
General: Alert, oriented, no acute distress, speaks minimal
english.
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased in the bases with scant crackles in bases
CV: Regular rate and rhythm, normal S1 + S2, holosystolic
murmur.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, Fistula w/ palpable thrill in LUE. No palmar erythema.
Cast on LLE
Rectal: Small amount soft brown stool
Skin: One small spider angioma on his L chest

Pertinent Results:
Admission Labs: [**2118-2-8**]

WBC-8.7 RBC-2.95* Hgb-9.8* Hct-28.9* MCV-98 MCH-33.2* MCHC-33.9
RDW-13.2 Plt Ct-168
PT-12.8 PTT-25.4 INR(PT)-1.1
Glucose-123* UreaN-43* Creat-8.6*# Na-139 K-4.3 Cl-97 HCO3-30
AnGap-16
ALT-104* AST-68* LD(LDH)-292* AlkPhos-163* TotBili-1.1
Albumin-3.7 Calcium-8.3* Phos-4.5 Mg-2.3

Nadir HCT ([**2118-2-10**]): 21

ERCP ([**2118-2-10**]): Evidence of a previous sphincterotomy was noted
in the major papilla. Erythema was noted at the apex of the
sphincterotomy.
A small amount of oozing blood was noted on the upper aspect of
the sphincterotomy, at approximately 2 oclock. [**Hospital1 **]-CAP
electrocautery was applied for hemostasis successfully.


Brief Hospital Course:
1. Upper GI bleeding with acute blood loss anemia. Transferred
from OSH after 2 episodes of melena status post sphincterotomy
at [**Hospital1 18**] on [**2-7**]. After initially stable HCT, dropped to 21 on
[**2118-2-10**] prompting repeat ERCP. This showed a small amount of
oozing blood on the upper aspect of the sphincterotomy site;
[**Hospital1 **]-CAP electrocautery was applied for hemostasis successfully.
.
In total, 4 units of pRBC were transfused.
.
Post-procedure he had severe abdominal pain with concern for
performation. Plain radiographs were read as possibly having a
very small amount of free air. CT abdomen was reassuring as no
air was seen.
- contin Amoxicillin-Clavulanic Acid 500 mg PO/NG Q12H for 7 day
course given concern for possible microperforation. D1=[**2-13**].
.
2. ESRD. Noted to have inadequate dialysis during initial
sessions. Underwent AV fistulagram with 2 areas peripheral
venous stenoses which were angioplastied. Pt's fistula function
improved on HD.
- due for HD [**2118-2-16**] (Wed)
.
3. Hypertension. Antihypertensive medications held initially
given his acute bleeding.
- continue Amlodipine 10 mg PO/NG DAILY
Currently holding clonidine 0.2 mg [**Hospital1 **], diovan 80 mg [**Hospital1 **],
atenolol 50 mg [**Hospital1 **], lisinopril 40 mg daily, lasix 80 [**Hospital1 **]
In discussion with Nephrology, expect pt's BP control will
improve as he contin to receive more effective HD, thus will not
resume additional BP Rx for now.
.
.
DISP: discharged to Rehab

Medications on Admission:
Home medications
phos lo 667mg three tabs TID,
clonidine 0.2 mg [**Hospital1 **],
lisinopril 40 mg daily,
lasix 80 [**Hospital1 **],
atenolol 50 mg [**Hospital1 **],
diovan 80 mg [**Hospital1 **],
norvasc 10 mg daily,
humalog 30 mg qam, 15 mg qpm.

OSH medications
Catapres 0.1mg [**Hospital1 **]
Renagel 800mg TID
Norvasc 10mg daily
Phoslo 667 TID
Zestril 40mg daily
diovan 80mg [**Hospital1 **]
Protonix 40mg IV daily
Ambien 5mg QHS
Zofran 4mg Q6 PRN N/V
Tylenol 650mg Q4
Labetalol 10-20mg Q4 IV PRN
Compazine 5-10mg IV Q6 PRN N/V


Discharge Medications:
1. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day for 7 days.
2. amoxicillin-pot clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO Q12H (every 12 hours) for 5 days.
3. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: Two
(2) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).

5. Humalog 100 unit/mL Solution Sig: as per sliding scale units
Subcutaneous QACHS.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2670**] Twin Oaks care and Rehab

Discharge Diagnosis:
1. GI bleeding, post sphincterotomy
2. Acute blood loss anemia
3. Post-procedure pancreatitis
4. Hypertension
5. Choledocholithiasis
6. ESRD on dialysis
7. Diabetes, type II


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted with bleeding after your recent ERCP. In order
to treat this you required another ERCP in which they were able
to find the area that was bleeding and your bleeding was
stopped. You also had a procedure on your fistula, and your
dialysis worked better.

Followup Instructions:
Department: TRANSPLANT CENTER
When: WEDNESDAY [**2118-3-2**] at 9:40 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], MD, PHD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Hemorrhage complicating a procedure,End stage renal disease,Acute pancreatitis,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to renal dialysis device, implant, and graft,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Renal dialysis status,Cardiac pacemaker in situ,Other orthopedic aftercare'}


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: Mr. [**Known lastname 1022**] is a 67 year-old man presenting with melena. Recently
admitted in [**Hospital1 **] under Dr.[**Last Name (STitle) **] on [**2-2**] with RUQ pain and mildly
deranged LFTs. CT-showed thick walled GB with CBD upper normal
6.6mm. No pancreatitis.

MEDICAL HISTORY: 1. Diabetes type II
2. Hypertension
3. ESRD on dialysis via AV-fistula
4. CAD per d/c summary (endorses history of pacer but denies
heart attack, stents or cardiac cath)
5. Pacemaker placed for bradyarrhythmia
6. Ankle fracture from slip on ice several weeks ago

MEDICATION ON ADMISSION: Home medications
phos lo 667mg three tabs TID,
clonidine 0.2 mg [**Hospital1 **],
lisinopril 40 mg daily,
lasix 80 [**Hospital1 **],
atenolol 50 mg [**Hospital1 **],
diovan 80 mg [**Hospital1 **],
norvasc 10 mg daily,
humalog 30 mg qam, 15 mg qpm.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T:97.7  BP: 121/54 P:67 R: 16 O2: 100% on 2L NC
General: Alert, oriented, no acute distress, speaks minimal
english.
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Decreased in the bases with scant crackles in bases
CV: Regular rate and rhythm, normal S1 + S2, holosystolic
murmur.
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema, Fistula w/ palpable thrill in LUE. No palmar erythema.
Cast on LLE
Rectal: Small amount soft brown stool
Skin: One small spider angioma on his L chest

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Originally from [**Country 10181**], lives with his wife. Retired from
[**Location (un) **] in [**2104**] as assembly worker. Has 2 sons and one
daughter. His daughter's phone number (Yokang [**Telephone/Fax (1) 65905**]).
Previously was heavy drinker/smoker 2ppd but quit 10 years ago. 

### Response:
{'Hemorrhage complicating a procedure,End stage renal disease,Acute pancreatitis,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other complications due to renal dialysis device, implant, and graft,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Renal dialysis status,Cardiac pacemaker in situ,Other orthopedic aftercare'}
