CHIEF COMPLAINT: GI bleed

PRESENT ILLNESS: 78M w/ history of a. fib, HTN, hyperlipidemia, and BPH presents
with one week of intermittent upper abdominal "mild heartburn"
and progressive weakness, and black stool. He reports that he
normally walks [**1-4**] mile walk several times a week and has been
more tired at the end of these walks during the days PTA.
Furthermore, upon returning from his walk on [**2191-9-29**], he noted
"black tarry stool". He denies any episodes like this previously
nor does he endorse a history of bright red blood in his stool.
He further denies prior ulcers or stomach problems of any kind.
He takes ASA daily, but denies use of other NSAIDs.
.
Following the above episode on [**2191-9-29**], the pt. went to see his
primary doctor who did a rectal exam. He was found to be guaiac
positive and he was sent to the [**Hospital1 **] [**Location (un) 620**] ED. In the ED labs
revealed initial hematocrit of 40.1 and an INR of 2.4. He
received 2u FFP and had another black BM in the ED. A repeat hct
was 34.6. At that time, the patient had an SBP in the mid 90s
that responded to IVF and was in the 110s upon transfer to the
[**Hospital1 18**] [**Location (un) 86**].
.
Upon admission, NG lavage revealed coffee grounds. GI was
consulted and an EGD was performed. The EGD revealed no active
bleeding, but old blood in the stomach. An esophageal mass was
noted and was biopsied. He received 2U prbcs, 2U FFP on [**2191-9-30**]
and hct has been stable since that time.
.
ROS: negative for f/c/n/v, no cp, no sob, no HA, no visual
changes, no hearing changes, no diarrhea prior to day of
presentation, no cough, ? slight weight loss over last week.

MEDICAL HISTORY: - BPH
- HTN
- a. fib, on coumadin, but not on meds for rate control
- Hypercholesterolemia
**never had a colonoscopy**
.
All:  penicillin-hives

MEDICATION ON ADMISSION: - ASA 81 qday
- coumadin 5mg qhs
- lisinopril 20 qday
- zocor 20 qday

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: 97.3 130/60 84 18 97% RA
General: WD, WN, NAD, pleasant man
HEENT: OP clear, MMM
Neck: supple, no LAD
Car: S1, S2, RRR, +II/VI systolic murmur at RUSB
Resp: CTAB, no w/c/r
Abd: soft, nontender, non-distended, well healed RLQ scars
Ext: no pretibial edema, DP 2+ bilaterally
Neuro: A+OX3, CN grossly intact

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives at home with his wife of "52ish" years. Three children and
7 grandchildren all live near by. No tobacco. [**3-6**] drinks per
week.
Other esophagitis,Aortocoronary bypass status,Iron deficiency anemia secondary to blood loss (chronic),Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anticoagulants causing adverse effects in therapeutic use
Other esophagitis,Aortocoronary bypass,Chr blood loss anemia,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,BPH w/o urinary obs/LUTS,Adv eff anticoagulants
Admission Date:  [**2191-9-29**]              Discharge Date:   [**2191-10-2**]

Date of Birth:  [**2113-8-28**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
GI bleed

Major Surgical or Invasive Procedure:
Upper endoscopy


History of Present Illness:
78M w/ history of a. fib, HTN, hyperlipidemia, and BPH presents
with one week of intermittent upper abdominal "mild heartburn"
and progressive weakness, and black stool. He reports that he
normally walks [**1-4**] mile walk several times a week and has been
more tired at the end of these walks during the days PTA.
Furthermore, upon returning from his walk on [**2191-9-29**], he noted
"black tarry stool". He denies any episodes like this previously
nor does he endorse a history of bright red blood in his stool.
He further denies prior ulcers or stomach problems of any kind.
He takes ASA daily, but denies use of other NSAIDs.
.
Following the above episode on [**2191-9-29**], the pt. went to see his
primary doctor who did a rectal exam. He was found to be guaiac
positive and he was sent to the [**Hospital1 **] [**Location (un) 620**] ED. In the ED labs
revealed initial hematocrit of 40.1 and an INR of 2.4. He
received 2u FFP and had another black BM in the ED. A repeat hct
was 34.6. At that time, the patient had an SBP in the mid 90s
that responded to IVF and was in the 110s upon transfer to the
[**Hospital1 18**] [**Location (un) 86**].
.
Upon admission, NG lavage revealed coffee grounds. GI was
consulted and an EGD was performed. The EGD revealed no active
bleeding, but old blood in the stomach. An esophageal mass was
noted and was biopsied. He received 2U prbcs, 2U FFP on [**2191-9-30**]
and hct has been stable since that time.
.
ROS: negative for f/c/n/v, no cp, no sob, no HA, no visual
changes, no hearing changes, no diarrhea prior to day of
presentation, no cough, ? slight weight loss over last week.

Past Medical History:
- BPH
- HTN
- a. fib, on coumadin, but not on meds for rate control
- Hypercholesterolemia
**never had a colonoscopy**
.
All:  penicillin-hives

Social History:
Lives at home with his wife of "52ish" years. Three children and
7 grandchildren all live near by. No tobacco. [**3-6**] drinks per
week.

Family History:
non-contributory

Physical Exam:
Vitals: 97.3 130/60 84 18 97% RA
General: WD, WN, NAD, pleasant man
HEENT: OP clear, MMM
Neck: supple, no LAD
Car: S1, S2, RRR, +II/VI systolic murmur at RUSB
Resp: CTAB, no w/c/r
Abd: soft, nontender, non-distended, well healed RLQ scars
Ext: no pretibial edema, DP 2+ bilaterally
Neuro: A+OX3, CN grossly intact

Pertinent Results:
[**2191-9-30**] 12:50AM BLOOD WBC-9.3 RBC-3.22*# Hgb-10.6*# Hct-31.9*#
MCV-99* MCH-32.8* MCHC-33.2 RDW-14.4 Plt Ct-149*
[**2191-9-30**] 01:33PM BLOOD Hct-25.8*
[**2191-10-2**] 01:03PM BLOOD Hct-33.3*
[**2191-10-1**] 03:06AM BLOOD PT-17.2* PTT-25.2 INR(PT)-1.6*
[**2191-10-2**] 07:25AM BLOOD PT-14.6* PTT-24.4 INR(PT)-1.3*
[**2191-9-30**] 12:50AM BLOOD Glucose-130* UreaN-70* Creat-1.5* Na-141
K-5.4* Cl-112* HCO3-21* AnGap-13
[**2191-10-2**] 07:25AM BLOOD Glucose-104 UreaN-38* Creat-1.2 Na-141
K-4.1 Cl-108 HCO3-24 AnGap-13
[**2191-9-30**] 12:50AM BLOOD ALT-32 AST-20 LD(LDH)-158 AlkPhos-58
TotBili-0.4
[**2191-10-2**] 10:05AM BLOOD %HbA1c-6.2*
.
[**2191-9-30**] EGD:
1. There was heaped up mucosa noted at the GE junction
2. Old blood in the stomach body
3. Normal mucosa in the first part of the duodenum and second
part of the duodenum
4. Otherwise normal EGD to second part of the duodenum

Brief Hospital Course:
78M w/HTN and hyperlipidemia presenting with first episode of GI
bleed -> hct from 40.1 -> 31.9.
.
# Acute Blood Loss Anemia secondary to Acute Esophagitis due to
NSAIDs:
Tarry stool and coffee grounds from NG lavage.  His ASA and
coumadin were stopped.  EGD revealed esophagitis but no active
bleed.  Patient's Hct was closely followed and remained stable
after receiving 2 units packed red cells and FFP.  He was put on
a PPI [**Hospital1 **].  At the time he left, his stool was brown and Hct
stable.  On discharge, he was given follow-up with GI and
advised to watch for bloody or tarry stools.  He also has never
had colonoscopy and will need screening colonoscopy as an
outpatient. Previously normal hct (last normal in [**3-/2191**] and
initially normal on presentation to [**Hospital1 18**] [**Location (un) 620**]).  Thus, is
acute and appears [**2-4**] to GI blood loss.
.
# Acute Renal Failure:
Pt. w/ baseline Cr approximately 1.1.  Creatinine bumped to 1.5
and likely represented prerenal etiology as resolved with IVFs
and more significantly after prbc and ffp transfusion.  His BUN
was elevated likely in the setting of GI bleed. At the time of
discharge, his Cr was back to baseline.
.
# Hypertension - Benign:
Given GI bleed, patient's antihypertensive meds were initially
held due to worries of his bleeding.  At the time of discharge,
his ACE inhibitor was restarted.
.
# Atrial Fibrillation:
Patient's CHADS2 score is 2; in the light of his gastritis with
GI bleed, his coumadin was stopped.
.
# Hyperlipidemia: Continue statin at home dose.

Medications on Admission:
- ASA 81 qday
- coumadin 5mg qhs
- lisinopril 20 qday
- zocor 20 qday

Discharge Medications:
1. Zocor 20 mg Tablet Sig: One (1) Tablet PO once a day.
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day: Please
discuss length of treatment with your GI doctor at the follow-up
appointment.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: GI Bleed
Secondary Diagnoses: Atrial fibrillation on coumadin, HTN


Discharge Condition:
Improved.  Patient's hematocrit had been stable for almost 48
hours.  He was not tachycardic, and his blood pressure was
110s-130s systolic.  He was not dizzy or lightheaded when he
stood up.  He was no longer bleeding actively from his bowels.


Discharge Instructions:
You were admitted with a bleed from your gastrointestinal tract.
Your aspirin and coumadin were stopped while you were here.  You
also had an endoscopy done and tissue was sent for pathology.
1. Please take all medications as prescribed.  Do not take
aspirin and coumadin until you are instructed to do so by a
doctor.
2. Please attend all follow up appointments listed below.
3. Return to the hospital if you develop bright red bleeding
from your rectum, lightheadedness, fevers, or any other
concerning symptom.

Followup Instructions:
1. Please call GI at [**Telephone/Fax (1) 463**] and ask for an appointment
with Dr. [**Last Name (STitle) 2473**] in [**1-4**] weeks.  It will help if you let them
know you were seen by him during your admission.
2. Please call Dr. [**Last Name (STitle) 58**], your primary dotor, and arrange
for an appointment in 2 weeks.



Completed by:[**2191-11-13**]
{'Other esophagitis,Aortocoronary bypass status,Iron deficiency anemia secondary to blood loss (chronic),Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anticoagulants causing adverse effects in therapeutic use'}


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: GI bleed

PRESENT ILLNESS: 78M w/ history of a. fib, HTN, hyperlipidemia, and BPH presents
with one week of intermittent upper abdominal "mild heartburn"
and progressive weakness, and black stool. He reports that he
normally walks [**1-4**] mile walk several times a week and has been
more tired at the end of these walks during the days PTA.
Furthermore, upon returning from his walk on [**2191-9-29**], he noted
"black tarry stool". He denies any episodes like this previously
nor does he endorse a history of bright red blood in his stool.
He further denies prior ulcers or stomach problems of any kind.
He takes ASA daily, but denies use of other NSAIDs.
.
Following the above episode on [**2191-9-29**], the pt. went to see his
primary doctor who did a rectal exam. He was found to be guaiac
positive and he was sent to the [**Hospital1 **] [**Location (un) 620**] ED. In the ED labs
revealed initial hematocrit of 40.1 and an INR of 2.4. He
received 2u FFP and had another black BM in the ED. A repeat hct
was 34.6. At that time, the patient had an SBP in the mid 90s
that responded to IVF and was in the 110s upon transfer to the
[**Hospital1 18**] [**Location (un) 86**].
.
Upon admission, NG lavage revealed coffee grounds. GI was
consulted and an EGD was performed. The EGD revealed no active
bleeding, but old blood in the stomach. An esophageal mass was
noted and was biopsied. He received 2U prbcs, 2U FFP on [**2191-9-30**]
and hct has been stable since that time.
.
ROS: negative for f/c/n/v, no cp, no sob, no HA, no visual
changes, no hearing changes, no diarrhea prior to day of
presentation, no cough, ? slight weight loss over last week.

MEDICAL HISTORY: - BPH
- HTN
- a. fib, on coumadin, but not on meds for rate control
- Hypercholesterolemia
**never had a colonoscopy**
.
All:  penicillin-hives

MEDICATION ON ADMISSION: - ASA 81 qday
- coumadin 5mg qhs
- lisinopril 20 qday
- zocor 20 qday

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: 97.3 130/60 84 18 97% RA
General: WD, WN, NAD, pleasant man
HEENT: OP clear, MMM
Neck: supple, no LAD
Car: S1, S2, RRR, +II/VI systolic murmur at RUSB
Resp: CTAB, no w/c/r
Abd: soft, nontender, non-distended, well healed RLQ scars
Ext: no pretibial edema, DP 2+ bilaterally
Neuro: A+OX3, CN grossly intact

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives at home with his wife of "52ish" years. Three children and
7 grandchildren all live near by. No tobacco. [**3-6**] drinks per
week. 

### Response:
{'Other esophagitis,Aortocoronary bypass status,Iron deficiency anemia secondary to blood loss (chronic),Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anticoagulants causing adverse effects in therapeutic use'}
