CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is an 81-year-old man
with past medical history of polycythemia [**Doctor First Name **], coronary
artery disease status post myocardial infarction on [**11-7**],
deep venous thrombosis/pulmonary embolus on Coumadin, and
aspirin now presenting with black-tarry stools x2 days, one
was yesterday and one this morning.  The patient denies any
bright red blood per rectum, chest pain, shortness of breath,
abdominal pain, nausea, vomiting, lightheadedness, dizziness,
fevers, chills, history of gastrointestinal bleed in the
past.

MEDICAL HISTORY: 1. Polycythemia [**Doctor First Name **] in [**2151**].
2. Benign prostatic hypertrophy.
3. Left deep venous thrombosis complicated by pulmonary
embolus [**7-7**].
4. Coronary artery disease status post myocardial infarction
[**11-7**] with catheterization showing 80% left anterior
descending artery stenosis, stented.
5. Left total knee replacement [**7-7**].
6. Splenic infarct with fluid collection with negative
cultures.
7. Osteoarthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No coronary artery disease.  Brother with
prostate cancer.  Sister with breast cancer.  No colon
cancer.

SOCIAL HISTORY: The patient is a retired truck driver.  He
lived with his wife for 48 years.  The patient had a five
pack year history of smoking, quit 5 years ago.  The patient
has a history of social alcohol, no drug use.
Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Other specified hypotension,Polycythemia vera,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Subendocardial infarction, subsequent episode of care
Ac duodenal ulcer w hem,Ac posthemorrhag anemia,Pneumonia, organism NOS,Hypotension NEC,Polycythemia vera,Long-term use anticoagul,Hx-ven thrombosis/embols,Subendo infarct, subseq
Admission Date:  [**2161-12-27**]     Discharge Date:  [**2162-1-1**]


Service:  [**Doctor Last Name 1181**]

HISTORY OF PRESENT ILLNESS:  Patient is an 81-year-old man
with past medical history of polycythemia [**Doctor First Name **], coronary
artery disease status post myocardial infarction on [**11-7**],
deep venous thrombosis/pulmonary embolus on Coumadin, and
aspirin now presenting with black-tarry stools x2 days, one
was yesterday and one this morning.  The patient denies any
bright red blood per rectum, chest pain, shortness of breath,
abdominal pain, nausea, vomiting, lightheadedness, dizziness,
fevers, chills, history of gastrointestinal bleed in the
past.

REVIEW OF SYSTEMS:  Remarkable only for one week history of
direct cough, fatigue, chronic constipation, and three month
history of anorexia with decreased po intake.  He has had
routine colonoscopies in the past, one of which had a
positive polyp, the most recent one per note was negative.

In the Emergency Room, hematocrit was found to be 17, blood
pressure 74/30.  Patient was given 2 units of packed red
blood cells and 1 liter of normal saline with good response.
Nasogastric lavage was negative.  Two large Boar IVT were
placed.  GI was consulted.

PAST MEDICAL HISTORY:
1. Polycythemia [**Doctor First Name **] in [**2151**].
2. Benign prostatic hypertrophy.
3. Left deep venous thrombosis complicated by pulmonary
embolus [**7-7**].
4. Coronary artery disease status post myocardial infarction
[**11-7**] with catheterization showing 80% left anterior
descending artery stenosis, stented.
5. Left total knee replacement [**7-7**].
6. Splenic infarct with fluid collection with negative
cultures.
7. Osteoarthritis.

MEDICATIONS:
1. Lisinopril 5 mg q day.
2. Aspirin 325 mg q day.
3. Metoprolol 12.5 mg [**Hospital1 **].
4. Hydroxyurea 500 mg q day.
5. Flomax 0.4 mg q day.
6. Coumadin 5/2.5 qod.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  No coronary artery disease.  Brother with
prostate cancer.  Sister with breast cancer.  No colon
cancer.

SOCIAL HISTORY:  The patient is a retired truck driver.  He
lived with his wife for 48 years.  The patient had a five
pack year history of smoking, quit 5 years ago.  The patient
has a history of social alcohol, no drug use.

PHYSICAL EXAMINATION:  On admission, his physical examination
was temperature 95.3, blood pressure 120/47, pulse 76,
respiratory rate of 22, and sating 100% on room air.  The
patient is a pale-elderly man appearing fatigued, alert and
oriented times three, conversant in no acute distress.
HEENT:  Pupils are equal, round, and reactive to light.  Pale
conjunctivae.  Mucous membranes slightly dry, poor dentition.
Neck had no jugular venous distention and no LAD.  Lungs had
bibasilar crackles left greater than right.  Cardiovascular:
regular, rate, and rhythm, 1/6 systolic ejection murmur at
left lower sternal border.  Abdomen was soft, nontender,
nondistended, normoactive bowel sounds.  No masses or
hepatosplenomegaly.  Extremities:  No edema, no calf
tenderness, warm.  Neurologic:  The patient was alert and
oriented, nonfocal, 2+ patellar reflexes bilaterally,
downgoing toes.  Rectal had red-brown stool, guaiac positive
in the Emergency Department.

LABORATORIES ON ADMISSION:  White blood cell count 19.3,
hematocrit 17, platelets 988.  His baseline hematocrit is
between 33-37.  Differential was 92% neutrophils, 1 band, 1
lymphocyte, 5% monocytes, and 1% eosinophils.  His coags were
PT 21.4, INR of 3.0, PTT 31.8.  Sodium 140, potassium 4.7,
chloride 105, bicarb 22, BUN 69, creatinine 1.5, glucose 255.
Creatinine at baseline is 1.1-1.3.  Urinalysis showed trace
blood, negative nitrate, trace protein, small bilirubin, [**3-10**]
white blood cells, moderate bacteria, [**3-10**] squamous epithelial
cells.  ALT was 22, AST 17, alkaline phosphatase 54, total
bilirubin 0.4, amylase 37, lipase 35.

Chest x-ray showed left basilar PNA versus atelectasis.

Electrocardiogram showed normal sinus rhythm at 70 beats per
minute, left axis deviation, normal intervals, no ST changes.
T-wave flattening in inferior leads, left atrial hypertrophy.

HOSPITAL COURSE:  Patient was transferred to the MICU on
[**12-27**].  He was started on transfusions of red blood cells.
He received 5 units of packed red blood cells, 5 units of
fresh-frozen plasma, vitamin K to reverse the INR.  GI was
consulted.

A colonoscopy was performed the next day and it was negative.
EGD upper endoscopy revealed a nonbleeding 10 cm ulcer in the
duodenum.  Patient's Hydroxyurea, aspirin, and Coumadin were
discontinued.  The patient was started on levofloxacin and
clindamycin for questionable aspiration.  The patient
received a five day course of levofloxacin, two day course of
clindamycin.

Post-transfusion, the patient developed congestive heart
failure which was treated with Lasix with improvement.  The
patient was felt to be stable and transferred to the floor.
The patient had a Swallow evaluation which was negative.

Patient was feeling better on the floor.  He was evaluated by
PT and felt that he did not require rehab stay, and was able
to go home with VNA and home PT.  Hematology/Oncology was
consulted, who felt that his Hydroxyurea could be withheld
until his hematocrit returned to 35.  Patient's white blood
cell count was noted to trend up.  This was questionably due
to infection versus [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] .  According to
Hematology/Oncology, it is possible that [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] caused
elevated white blood cell count.  Patient will follow up with
his Hematology/Oncology doctor, Dr. [**Last Name (STitle) **] as an
outpatient at which time restarting Hydroxyurea will be
addressed.

Patient had no complaints.  He had no cough, fevers, or
chills.  It was felt that it was unlikely that he had
pneumonia, so levofloxacin was discontinued.  On discharge,
the patient was started on amoxicillin for 14 days and
clarithromycin for 10 days to treat presumed H. pylori.

At time of discharge, the results from the H. pylori were
still pending.  Status post endoscopy, the patient was
started on proton-pump inhibitor, which he should continue
for a few months.  Aspirin will continue to be withheld for
three weeks following endoscopy to allow for time for ulcer
to heal since patient has a history of coronary artery
disease with recent myocardial infarction.  Aspirin should be
restarted in the future.

Patient will be discharged to home with VNA services and PT
home evaluation.

DISCHARGE DIAGNOSES:
1. Gastrointestinal bleed status post endoscopy which
revealed nonbleeding duodenal ulcer.
2. Polycythemia [**Doctor First Name **].
3. Coronary artery disease status post myocardial infarction.
4. Deep venous thrombosis/pulmonary embolus [**7-7**].

DISCHARGE MEDICATIONS:
1. Lisinopril 5 mg po q day.
2. Metoprolol 12.5 mg po bid.
3. Protonix 40 mg po q day x2 months.
4. Flomax 0.4 mg po q day.
5. Amoxicillin 1 gram po bid x14 days.
6. Clarithromycin 500 mg po bid x10 days.

FOLLOWUP:  The patient is to follow up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 9536**] at number [**Telephone/Fax (1) 9537**] and with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 3237**].  It was discussed with the primary care
physician and Hematology/Oncology, who feels that the patient
has been on Coumadin for six months for his deep venous
thrombosis/PE, and there is no reason to continue the
anticoagulation therapy further at this time.  The patient is
to followup with his primary care physician in the next week
at which time his BUN, creatinine can be rechecked along with
his complete blood count to ensure that his hematocrit and
white blood cell count remains stable.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4122**], M.D.

Dictated By:[**Name8 (MD) 1010**]

MEDQUIST36

D:  [**2162-1-1**]  18:17
T:  [**2162-1-7**]  13:18
JOB#:  [**Job Number 9538**]
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Other specified hypotension,Polycythemia vera,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Subendocardial infarction, subsequent episode of care'}


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: 

PRESENT ILLNESS: Patient is an 81-year-old man
with past medical history of polycythemia [**Doctor First Name **], coronary
artery disease status post myocardial infarction on [**11-7**],
deep venous thrombosis/pulmonary embolus on Coumadin, and
aspirin now presenting with black-tarry stools x2 days, one
was yesterday and one this morning.  The patient denies any
bright red blood per rectum, chest pain, shortness of breath,
abdominal pain, nausea, vomiting, lightheadedness, dizziness,
fevers, chills, history of gastrointestinal bleed in the
past.

MEDICAL HISTORY: 1. Polycythemia [**Doctor First Name **] in [**2151**].
2. Benign prostatic hypertrophy.
3. Left deep venous thrombosis complicated by pulmonary
embolus [**7-7**].
4. Coronary artery disease status post myocardial infarction
[**11-7**] with catheterization showing 80% left anterior
descending artery stenosis, stented.
5. Left total knee replacement [**7-7**].
6. Splenic infarct with fluid collection with negative
cultures.
7. Osteoarthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No coronary artery disease.  Brother with
prostate cancer.  Sister with breast cancer.  No colon
cancer.

SOCIAL HISTORY: The patient is a retired truck driver.  He
lived with his wife for 48 years.  The patient had a five
pack year history of smoking, quit 5 years ago.  The patient
has a history of social alcohol, no drug use. 

### Response:
{'Acute duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Pneumonia, organism unspecified,Other specified hypotension,Polycythemia vera,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Subendocardial infarction, subsequent episode of care'}
