CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: 77M with a history of recent LGIB who underwent a colonoscopy
the day prior to admission during which 7 polyps were resected
presented to the ED with BRBPR x 2. He denies CP, palpitations,
sweats, nausea, abdominal pain, or SOB. He denies taking any
NSAIDs or ASA. He reports that he is an easy bleeder.
.
In the ED his initial vital signs were T 98.4 P 88 BP 186/83 R
26 O2 sat 100% on RA. An initial HCT was at his baseline of 41.
He was also hyponatremic, likely from his bowel prep.
Coagulation profile was not done. He was bolused 1 L NS despite
his hypertension and stable HCT. He had an additional episode of
BRBPR in the ED. A second PIV was placed at that time. GI was
consulted, and recommended no transfusions for now and
colonoscopy in the near future. He was admitted to the MICU to
facilitate colonoscopy.
.
In the MICU the patient feels well and continues to deny fevers,
chills, sweats, palpitations, chest pain, shortness of breath,
or abdominal pain. He is refusing bowel prep. GI was contact[**Name (NI) **],
and agreed to hold off on bowel prep until the morning. He will
be monitored overnight in the MICU.

MEDICAL HISTORY: 1. GERD
2. R arthritis
3. Hypertension
4. Glaucoma
5. BPH
6. Depression

MEDICATION ON ADMISSION: - Finasteride 5 mg PO DAILY
- Pantoprazole 40 mg PO Q24H
- Lisinopril 5 mg PO DAILY
- Lorazepam 0.5 mg PO HS:PRN
- Prozac 20 mg PO DAILY

ALLERGIES: Aspirin / Penicillins / Ampicillin / Motrin / Naproxen

PHYSICAL EXAM: VS: 97.5, 98, 22, 136/74, 100%RA
GEN: NAD, Awake alert and conversant
HEENT: EOMI, MMM
CV: RRR, S1S2 normal, no M/R/G
PULM: CTABL
ABD: NABS, S, NT, ND,
PR: Dark bloody stool, guiaic positive, no masses felt
Ext: Pulses 2+, no edema

FAMILY HISTORY: - Mother with lung cancer, but never smoked
- Father with cirrhosis

SOCIAL HISTORY: Home: Lives in [**Location **], MA with wife
Occupation: Retired Presbyterian minister, PhD from BU and was a
fellow at [**University/College **] Divinity School.
EtOH: Denies
Drugs: Denies
Tobacco: Denies
Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Unspecified essential hypertension,Esophageal reflux,Tachycardia, unspecified,Rheumatoid arthritis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dysthymic disorder,Unspecified glaucoma,Internal hemorrhoids without mention of complication,Personal history of colonic polyps,Diverticulosis of colon (without mention of hemorrhage),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Hemorrhage complic proc,Ac posthemorrhag anemia,Hyposmolality,Hypertension NOS,Esophageal reflux,Tachycardia NOS,Rheumatoid arthritis,BPH w/o urinary obs/LUTS,Dysthymic disorder,Glaucoma NOS,Int hemorrhoid w/o compl,Prsnl hst colonic polyps,Dvrtclo colon w/o hmrhg,Abn react-surg proc NEC
Admission Date:  [**2197-1-7**]              Discharge Date:   [**2197-1-12**]

Date of Birth:  [**2119-3-13**]             Sex:   M

Service: MEDICINE

Allergies:
Aspirin / Penicillins / Ampicillin / Motrin / Naproxen

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
flexible sigmoidoscopy, colonoscopy

History of Present Illness:
77M with a history of recent LGIB who underwent a colonoscopy
the day prior to admission during which 7 polyps were resected
presented to the ED with BRBPR x 2. He denies CP, palpitations,
sweats, nausea, abdominal pain, or SOB. He denies taking any
NSAIDs or ASA. He reports that he is an easy bleeder.
.
In the ED his initial vital signs were T 98.4 P 88 BP 186/83 R
26 O2 sat 100% on RA. An initial HCT was at his baseline of 41.
He was also hyponatremic, likely from his bowel prep.
Coagulation profile was not done. He was bolused 1 L NS despite
his hypertension and stable HCT. He had an additional episode of
BRBPR in the ED. A second PIV was placed at that time. GI was
consulted, and recommended no transfusions for now and
colonoscopy in the near future. He was admitted to the MICU to
facilitate colonoscopy.
.
In the MICU the patient feels well and continues to deny fevers,
chills, sweats, palpitations, chest pain, shortness of breath,
or abdominal pain. He is refusing bowel prep. GI was contact[**Name (NI) **],
and agreed to hold off on bowel prep until the morning. He will
be monitored overnight in the MICU.

Past Medical History:
1. GERD
2. R arthritis
3. Hypertension
4. Glaucoma
5. BPH
6. Depression

Social History:
Home: Lives in [**Location **], MA with wife
Occupation: Retired Presbyterian minister, PhD from BU and was a
fellow at [**University/College **] Divinity School.
EtOH: Denies
Drugs: Denies
Tobacco: Denies


Family History:
- Mother with lung cancer, but never smoked
- Father with cirrhosis

Physical Exam:
VS: 97.5, 98, 22, 136/74, 100%RA
GEN: NAD, Awake alert and conversant
HEENT: EOMI, MMM
CV: RRR, S1S2 normal, no M/R/G
PULM: CTABL
ABD: NABS, S, NT, ND,
PR: Dark bloody stool, guiaic positive, no masses felt
Ext: Pulses 2+, no edema


Pertinent Results:
ADMISSION LABS:
[**2197-1-6**] 10:43PM BLOOD WBC-8.0 RBC-4.66 Hgb-14.3 Hct-41.8 MCV-90
MCH-30.7 MCHC-34.2 RDW-13.6 Plt Ct-306
[**2197-1-7**] 03:11AM BLOOD WBC-8.0 RBC-4.32* Hgb-13.3* Hct-38.7*
MCV-90 MCH-30.9 MCHC-34.4 RDW-13.6 Plt Ct-298
[**2197-1-7**] 09:19AM BLOOD WBC-7.8 RBC-3.78* Hgb-11.3* Hct-33.8*
MCV-89 MCH-29.8 MCHC-33.4 RDW-13.7 Plt Ct-329
[**2197-1-6**] 10:43PM BLOOD Glucose-92 UreaN-18 Creat-1.1 Na-128*
K-4.8 Cl-92* HCO3-25 AnGap-16
[**2197-1-7**] 03:11AM BLOOD Calcium-8.3* Phos-3.3 Mg-2.0 Iron-43*
[**2197-1-7**] 03:11AM BLOOD calTIBC-282 VitB12-1117* Folate-GREATER
TH Ferritn-149 TRF-217
===
DISCHARGE LABS: [**2197-1-12**]
WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
7.3 3.35* 9.9* 29.9* 89 29.6 33.1 15.6* 328
Glucose UreaN Creat Na K Cl HCO3 AnGap
165* 8 1.0 136 3.5 101 27 12
----
KUB [**1-7**]: Stool filling of the ascending colon, air filling of
multiple
non-distended or slightly distended small bowel loops. Sparse
small air-fluid levels. No evidence of free air, no evidence of
pathological calcifications.
 .
Colonoscopy [**2197-1-5**]: Findings: Protruding Lesions A single
sessile 12 mm polyp of benign appearance was found in the cecum.
A single-piece polypectomy was performed using a hot snare. The
polyp was completely removed. Two sessile 8mm polyps of benign
appearance were found in the ascending colon. Single-piece
polypectomy was performed using a cold snare on one and cold
biopsy forcepts on the other. The polyps were completely
removed. A single sessile 10 mm polyp of benign appearance was
found in the transverse colon. A single-piece polypectomy was
performed using a hot snare. The polyp was completely removed.
Two sessile 10mm polyps of benign appearance were found in the
distal transverse colon. Single-piece polypectomies were
performed using a hot snare. The polyps were completely removed.
A single sessile 18 mm polyp of benign appearance was found in
the descending colon. A single-piece polypectomy was performed
using a hot snare. The polyp was completely removed. Grade 1
internal & external hemorrhoids were noted. Excavated Lesions
Multiple diverticula were seen in the sigmoid colon and
ascending colon. Diverticulosis appeared to be of mild severity.
Impression: Diverticulosis of the sigmoid colon and ascending
colon
Grade 1 internal & external hemorrhoids
Polyp in the cecum (polypectomy)
Polyps in the ascending colon (polypectomy)
Polyp in the transverse colon (polypectomy)
Polyps in the distal transverse colon (polypectomy)
Polyp in the descending colon (polypectomy)
Recommendations: Follow-up biopsy results
colonoscopy in 3 years due to multiple polyps
.
Flexible sigmoidoscopy [**2197-1-7**]: Clotted blood was seen in the
colon. The distal polypectomy site could not be located due to
clot and stool, however there appeared to be less blood more
proximal to the decending colon suggesting that this is the
bleeding source. No active bleeding was seen.
Impression: Blood in the colon
Recommendations: serial hematocrits; golytely prep for
colonoscopy now. If pt rebleeds, colonoscopy once prep is
complete. If no rebleeding will follow conservatively
.
Colonoscopy [**2197-1-8**]: Fresh and clotted blood was seen
throughout the colon. No active bleeding was seen. 3 post
polypectomy sites were located which may have been the source of
bleeding. The cecal and decending colon sites were both large
clean based ulcers at the site of >1cm hot snare polypectomies.
The splenic flexure site had and adherant clot which could not
be removed. All sites were clipped with no evidence of bleeding,
in addition the splenic flexure and decending colon sites were
cauterized.
.
GI Bleeding Study [**2197-1-10**]:
1. No source for lower gastrointestinal bleeding localized at 90
minutes.
2. Tortuous aorta with collateralization of vessels compatible
with
atherosclerotic changes.


Brief Hospital Course:
77M s/p colonoscopy with polypectomies presented with rectal
bleeding requiring another colonoscopy for post-polypectomy
cauterization and clipping.

# Lower GI bleed: Bleeding related to recent polypectomies. The
patient underwent sigmoidoscopy and then colonoscopy with clips
placed and polepectomy sites sclerosed, as noted in above
colonoscopy reports. Serial hematocrits following this second
colonscopy remained stable. Patient had large amount of bloody
stool on [**1-10**] prompting nuclear GI bleeding study that was
negative for active bleeding. Hct trending up at time of
discharge. Patient given rx to have CBC checked at PCP's office
on [**2197-1-16**]. He will follow up with his gastroenterologist on
[**2197-1-18**].

# Hypertension: Patient had isolated episode of hypertension
with SBP of 170. Following this pressure stable on outpatient
regimen of lisinopril.

# Depression and anxiety: Patient continued on home Prozac 20mg
PO daily and Lorazepam.
.
# BPH: Continue home finasteride 5mg PO daily

code status FULL

Medications on Admission:
- Finasteride 5 mg PO DAILY
- Pantoprazole 40 mg PO Q24H
- Lisinopril 5 mg PO DAILY
- Lorazepam 0.5 mg PO HS:PRN
- Prozac 20 mg PO DAILY

Discharge Medications:
1. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
5. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
7. Outpatient Lab Work
Please check a CBC and forward results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**]
Office Phone: [**Telephone/Fax (1) 2205**]
Office Fax: [**Telephone/Fax (1) 7922**]


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Lower gastrointestinal bleed
Secondary: Colon polyps, benign prostatic hypertrophy,
hypertension


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 rectal bleeding which
we believed was due to bleeding from the sites where you had
polyps removed. You had a repeat colonoscopy and the bleeding
sites were clipped on [**1-8**]. Your blood counts have remained
stable. On [**1-10**] you had another bloody bowel movement but a
nuclear scan did not indicate any active bleeding. Since that
bowel movement your blood counts have remained stable. You are
tolerating a solid diet.

No medication changes were made.

Followup Instructions:
Please go to Dr.[**Name (NI) 2935**] office on [**2197-1-16**] and have blood
drawn anytime after 9am. You are being provided with a lab slip.
Dr. [**Last Name (STitle) 2204**] will get this lab result.

We made you an appointment with gastroenterology:

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 10314**], MD and Dr. [**Last Name (STitle) 9916**]
Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2197-1-18**] 2:30

You were previously scheduled to see:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**] [**2196-2-1**] at 2:40PM



Completed by:[**2197-1-12**]
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Unspecified essential hypertension,Esophageal reflux,Tachycardia, unspecified,Rheumatoid arthritis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dysthymic disorder,Unspecified glaucoma,Internal hemorrhoids without mention of complication,Personal history of colonic polyps,Diverticulosis of colon (without mention of hemorrhage),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: 77M with a history of recent LGIB who underwent a colonoscopy
the day prior to admission during which 7 polyps were resected
presented to the ED with BRBPR x 2. He denies CP, palpitations,
sweats, nausea, abdominal pain, or SOB. He denies taking any
NSAIDs or ASA. He reports that he is an easy bleeder.
.
In the ED his initial vital signs were T 98.4 P 88 BP 186/83 R
26 O2 sat 100% on RA. An initial HCT was at his baseline of 41.
He was also hyponatremic, likely from his bowel prep.
Coagulation profile was not done. He was bolused 1 L NS despite
his hypertension and stable HCT. He had an additional episode of
BRBPR in the ED. A second PIV was placed at that time. GI was
consulted, and recommended no transfusions for now and
colonoscopy in the near future. He was admitted to the MICU to
facilitate colonoscopy.
.
In the MICU the patient feels well and continues to deny fevers,
chills, sweats, palpitations, chest pain, shortness of breath,
or abdominal pain. He is refusing bowel prep. GI was contact[**Name (NI) **],
and agreed to hold off on bowel prep until the morning. He will
be monitored overnight in the MICU.

MEDICAL HISTORY: 1. GERD
2. R arthritis
3. Hypertension
4. Glaucoma
5. BPH
6. Depression

MEDICATION ON ADMISSION: - Finasteride 5 mg PO DAILY
- Pantoprazole 40 mg PO Q24H
- Lisinopril 5 mg PO DAILY
- Lorazepam 0.5 mg PO HS:PRN
- Prozac 20 mg PO DAILY

ALLERGIES: Aspirin / Penicillins / Ampicillin / Motrin / Naproxen

PHYSICAL EXAM: VS: 97.5, 98, 22, 136/74, 100%RA
GEN: NAD, Awake alert and conversant
HEENT: EOMI, MMM
CV: RRR, S1S2 normal, no M/R/G
PULM: CTABL
ABD: NABS, S, NT, ND,
PR: Dark bloody stool, guiaic positive, no masses felt
Ext: Pulses 2+, no edema

FAMILY HISTORY: - Mother with lung cancer, but never smoked
- Father with cirrhosis

SOCIAL HISTORY: Home: Lives in [**Location **], MA with wife
Occupation: Retired Presbyterian minister, PhD from BU and was a
fellow at [**University/College **] Divinity School.
EtOH: Denies
Drugs: Denies
Tobacco: Denies 

### Response:
{'Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Unspecified essential hypertension,Esophageal reflux,Tachycardia, unspecified,Rheumatoid arthritis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dysthymic disorder,Unspecified glaucoma,Internal hemorrhoids without mention of complication,Personal history of colonic polyps,Diverticulosis of colon (without mention of hemorrhage),Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
