CHIEF COMPLAINT: GI bleed

PRESENT ILLNESS: 75 y/o man with PMH significant for esophageal cancer, GI
bleeding, and hepatocellular carcinoma admitted to the MICU
through the ED for GI bleeding. In pertinent recent history, the
pt was admitted to [**Hospital1 18**] for a probable upper GI bleed from
[**3-14**] to [**3-21**]. His varices could not be banded at that time due
to an esophageal stricture. Pt reports that he had been doing
well at home. On Monday, he came to the hospital and had an
infusion of Procrit. Following this, he felt very tired and
continued to feel more and more fatigued on Tues and Wed. He
also notes that his stool became dark on Tuesday. Pt reports
that he had one soft block stool per day over the next two days.
No BRBPR or hematoemesis. Pt denies abdominal pain, nausea, and
vomiting. He does report that his appetite has been very poor
over the last three days. In further discussion, pt reports that
he has felt mildly lightheaded since Tuesday. No vertigo. He
denies CP and SOB. Had difficulty moving around at home for the
last two days because of his severe fatigue but not because of
SOB. He reports mild pain in his right hip which he attributes
to his arthritis. No LE pain or swelling. No dysuria or
hematuria.

MEDICAL HISTORY: 1. GI bleeding- Pt was recently admitted to [**Hospital1 18**] from
[**Date range (1) 55482**] with a bleed thought to be due to esophageal
varices. Pt could not be successfully banded due to a esophageal
stricture that limited the passage of the banding device. He
retired MICU observation and a total of 9 units of PRBC.
2. Esophageal cancer- Was diagnosed in 05/[**2197**]. Pt was treated
with radiation and cucurrent cisplatin and continuous 5-Fu. He
underwent treatment from [**2198-6-13**] to [**2198-7-20**].
3. Hepatocellular carcinoma- Was diagnosed in 02/[**2198**]. Pt is s/p
chemoembolization in 03/[**2198**]. Per recent notes from Dr. [**First Name (STitle) **],
it appears that the pt had a good local result but has
progressive pulmonary mets. These may be from his esophageal CA
but as his CEA is also rising it cannot be excluded that they
are from his HCC.
4. Arthritis
5. Seasonal allergies
6. HTN

MEDICATION ON ADMISSION: 1. Nadolol 40 mg [**Hospital1 **]
2. Thiamine 100 mg daily
3. Folic acid 1 mg daily
4. Albuterol MDI 1-2 puffs Q4-6H PRN wheezing
5. Spironolactone 25 mg daily
6. Isosorbide dinitrate 10 mg [**Hospital1 **]
7. Extra strength tylenol QID PRN
8. Lasix 40 mg daily
9. Ambien 5 mg QHS PRN
10. Protonix 40 mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.3  91  100/46  20  94% RA
Gen- Alert and oriented. NAD. Resting comfortably on the
strecher.
HEENT- NC AT. PERRL. Mildly dry mucous membranes.
Cardiac- RRR. No m,r,g.
Abdomen- Soft. NT. ND. Positive bowel sounds.
Pulm- Diffuse crackles throughout lower half of lungs
bilaterally.
Extremities- No c/c/e. 2+ DP pulses bilaterally.

FAMILY HISTORY: Pt's grandfather died of an unknown cancer. He has a brother
with "heart disease" and a sister with breast cancer.

SOCIAL HISTORY: Pt is married and lives with his wife. [**Name (NI) **] is the retired owner
of a fish market. He drank a large amount of ETOH until [**2176**]
when he quit and was sober until [**2189**]. However, he resumed
drinking at that time until quiting again in 01/[**2198**]. Pt smoked
3 to 4 PPD from 30 years before quiting 35 years ago.
Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of bone and bone marrow,Hypercalcemia,Barrett's esophagus,Alcohol abuse, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of esophagus
Alcohol cirrhosis liver,Bleed esoph var oth dis,Mal neo liver, primary,Sec mal neo peritoneum,Secondary malig neo bone,Hypercalcemia,Barrett's esophagus,Alcohol abuse-unspec,Hypertension NOS,Hx-esophageal malignancy
Name:  [**Known lastname 10377**],[**Known firstname 133**] E                Unit No:   [**Numeric Identifier 10378**]

Admission Date:  [**2199-4-25**]              Discharge Date:   [**2199-4-29**]

Date of Birth:  [**2123-7-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1472**]
Addendum:
Mr. [**Known lastname **] [**Last Name (Titles) 10379**], diagnosed by biopsy, is secondary to his
extensive alcohol use.  His varicies are due to alcoholic
[**Last Name (Titles) 10379**].

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 42**] VNA

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1473**]

Completed by:[**2199-5-15**]

Admission Date:  [**2199-4-25**]              Discharge Date:   [**2199-4-29**]

Date of Birth:  [**2123-7-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
GI bleed

Major Surgical or Invasive Procedure:
Endoscopy


History of Present Illness:
75 y/o man with PMH significant for esophageal cancer, GI
bleeding, and hepatocellular carcinoma admitted to the MICU
through the ED for GI bleeding. In pertinent recent history, the
pt was admitted to [**Hospital1 18**] for a probable upper GI bleed from
[**3-14**] to [**3-21**]. His varices could not be banded at that time due
to an esophageal stricture. Pt reports that he had been doing
well at home. On Monday, he came to the hospital and had an
infusion of Procrit. Following this, he felt very tired and
continued to feel more and more fatigued on Tues and Wed. He
also notes that his stool became dark on Tuesday. Pt reports
that he had one soft block stool per day over the next two days.
No BRBPR or hematoemesis. Pt denies abdominal pain, nausea, and
vomiting. He does report that his appetite has been very poor
over the last three days. In further discussion, pt reports that
he has felt mildly lightheaded since Tuesday. No vertigo. He
denies CP and SOB. Had difficulty moving around at home for the
last two days because of his severe fatigue but not because of
SOB. He reports mild pain in his right hip which he attributes
to his arthritis. No LE pain or swelling. No dysuria or
hematuria.

In the ED, the pt's VS were 96.3  91  100/46  20  94% RA. Pt was
started on an octreotide drip. Blood is coming up for
transfusion. GI is planning to see the pt. He will be
transferred to the MICU for further care.

Past Medical History:
1. GI bleeding- Pt was recently admitted to [**Hospital1 18**] from
[**Date range (1) 55482**] with a bleed thought to be due to esophageal
varices. Pt could not be successfully banded due to a esophageal
stricture that limited the passage of the banding device. He
retired MICU observation and a total of 9 units of PRBC.
2. Esophageal cancer- Was diagnosed in 05/[**2197**]. Pt was treated
with radiation and cucurrent cisplatin and continuous 5-Fu. He
underwent treatment from [**2198-6-13**] to [**2198-7-20**].
3. Hepatocellular carcinoma- Was diagnosed in 02/[**2198**]. Pt is s/p
chemoembolization in 03/[**2198**]. Per recent notes from Dr. [**First Name (STitle) **],
it appears that the pt had a good local result but has
progressive pulmonary mets. These may be from his esophageal CA
but as his CEA is also rising it cannot be excluded that they
are from his HCC.
4. Arthritis
5. Seasonal allergies
6. HTN

Social History:
Pt is married and lives with his wife. [**Name (NI) **] is the retired owner
of a fish market. He drank a large amount of ETOH until [**2176**]
when he quit and was sober until [**2189**]. However, he resumed
drinking at that time until quiting again in 01/[**2198**]. Pt smoked
3 to 4 PPD from 30 years before quiting 35 years ago.

Family History:
Pt's grandfather died of an unknown cancer. He has a brother
with "heart disease" and a sister with breast cancer.

Physical Exam:
96.3  91  100/46  20  94% RA
Gen- Alert and oriented. NAD. Resting comfortably on the
strecher.
HEENT- NC AT. PERRL. Mildly dry mucous membranes.
Cardiac- RRR. No m,r,g.
Abdomen- Soft. NT. ND. Positive bowel sounds.
Pulm- Diffuse crackles throughout lower half of lungs
bilaterally.
Extremities- No c/c/e. 2+ DP pulses bilaterally.

Pertinent Results:
[**2199-4-25**] 11:05AM BLOOD WBC-4.2 RBC-2.83* Hgb-8.4* Hct-25.6*
MCV-90 MCH-29.7 MCHC-32.8 RDW-18.1* Plt Ct-191
[**2199-4-25**] 06:49PM BLOOD Hct-29.4*
[**2199-4-25**] 10:36PM BLOOD Hct-28.9*
[**2199-4-25**] 11:05AM BLOOD Neuts-79.7* Lymphs-12.6* Monos-6.1
Eos-1.4 Baso-0.2
[**2199-4-25**] 11:05AM BLOOD Plt Ct-191
[**2199-4-25**] 11:05AM BLOOD PT-13.7* PTT-27.0 INR(PT)-1.2
[**2199-4-25**] 11:05AM BLOOD Glucose-127* UreaN-21* Creat-0.7 Na-140
K-4.0 Cl-106 HCO3-27 AnGap-11
[**2199-4-25**] 11:05AM BLOOD ALT-33 AST-71* AlkPhos-139* Amylase-45
TotBili-1.0
[**2199-4-25**] 11:05AM BLOOD Lipase-25
[**2199-4-25**] 11:05AM BLOOD Albumin-3.2* Calcium-12.2* Phos-3.3
Mg-1.6

CHEST (PORTABLE AP)  [**2199-4-25**]:
FINDINGS: Central venous line remains in place. Cardiac and
mediastinal contours are unchanged. Note is made of faint
opacity in the right lower lobe, which may represent aspiration
or aspiration pneumonia. Note is made of multiple small nodular
opacities in bilateral lungs, probably representing metastatic
disease noted on the prior chest CT.
IMPRESSION: Faint opacity in right lower lobe, which may
represent aspiration versus aspiration pneumonia. Multiple
nodular opacities in bilateral lungs, probably representing
metastatic disease noted on prior chest CT in this patient with
HCC.

DISCHARGE LABS:

[**2199-4-29**] 10:00AM BLOOD WBC-3.8* RBC-3.57* Hgb-11.3* Hct-32.6*
MCV-91 MCH-31.6 MCHC-34.6 RDW-18.3* Plt Ct-147*
[**2199-4-29**] 10:00AM BLOOD Glucose-117* UreaN-9 Creat-0.5 Na-134
K-3.9 Cl-102 HCO3-24 AnGap-12
[**2199-4-29**] 10:00AM BLOOD Albumin-3.1* Calcium-10.0 Phos-2.3*
Mg-1.4*
[**2199-4-29**] 10:00AM BLOOD PTH-8*

Brief Hospital Course:
1. GI bleeding- Pt with melanotic stools and a Hct drop from 32
on [**4-22**] to 25.6 on arrival in the ED. Bleeding is most probably
from his know esophageal varices. However, this is very
difficult as they could not be banded in the past secondary to
esophageal strictures. GI was consulted and an EGD was
performed.  Varicies in esophagus showed the "red [**Last Name (un) 23199**] sign"
(red streaks).  No intervention was made but iv octreotide was
administered for four days and his hct remained stable.

2. Hepatocellular carcinoma- Pt is s/p chemoembolization. His
most recent CT scan from [**4-16**] showed tumor thrombus occluding
the portal vein and nodular implants along the hepatic capsule
along with mesenteric stranding consistent with peritoneal
carcinoma. Pt also has significant increase in size and number
of bilateral pulmonary nodules and a new lytic foci in the left
iliac bone and increased size of lytic foci in the right
sacroiliac joint and the thoracic spine. However, unclear if
these are due to the HCC or esophageal CA. Pt's AFP is
significantly increased at 6654. The last value was 1187 from
[**2199-3-14**].

3. Hypercalcemia- This is a new finding for the pt, it is likely
hypercalcemia of malignancy. The patient was given 3 days of
caclitonin IM.  His PTH was low but PTHrp was not sent.  The pt
also had hypomagnesemia which may be secondary to the
hypercalcemia.  Starting a bisphosphonate may be considered as
an outpatient if his calcium remains elevated.

4. Esophageal carcinoma- Pt was treated for this in [**2197**]. [**Month (only) 116**] be
reason for the pulmonary and bone mets but these are most
probably due to the HCC.

5. HTN- antihypertensive medications were held in the setting of
the acute bleed.  They were restarted on discharge.

6. FEN- the patient was initially kept NPO and diet was advanced
as tolerated once his hct stabilized.

7. Proph- Pneumoboots; PPI.

8. Code- Full. Discussed at length with the pt and his daughter
who is his health care proxy. [**Name (NI) **] would wish to be recussitated
but not maintained on life support long term with no meaniful
hope of recovery.

Medications on Admission:
1. Nadolol 40 mg [**Hospital1 **]
2. Thiamine 100 mg daily
3. Folic acid 1 mg daily
4. Albuterol MDI 1-2 puffs Q4-6H PRN wheezing
5. Spironolactone 25 mg daily
6. Isosorbide dinitrate 10 mg [**Hospital1 **]
7. Extra strength tylenol QID PRN
8. Lasix 40 mg daily
9. Ambien 5 mg QHS PRN
10. Protonix 40 mg [**Hospital1 **]

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Pantoprazole Sodium 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*
3. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
4. Magnesium Oxide 250 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
5. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO once a
day.
6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.

7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
8. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO
twice a day.
9. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
10. Nadolol 40 mg Tablet Sig: One (1) Tablet PO twice a day.
11. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
GI Bleed


Discharge Condition:
Stable, afebrile, hct was stable for >3 days.

Discharge Instructions:
Please call 911 if you have any bloody vomiting or become
dizzy/lightheaded.  Please seek medical attention for
fevers>101.4 or for anything else medically concerning.

Please take your medications as directed.

Followup Instructions:
Please see your oncologist in [**12-16**] weeks for follow-up.

1) Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] MULTI-SPECIALTY MULTI-SPECIALTY
THORACIC UNIT-CC9 Where: CLINICAL CTR. - 9TH FL. MULTI
Date/Time:[**2199-5-2**] 9:30   Provider: [**Name Initial (NameIs) 4426**] 16  Date/Time:[**2199-5-2**]
10:30
2) Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], RN Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2199-5-2**] 10:30


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{"Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of bone and bone marrow,Hypercalcemia,Barrett's esophagus,Alcohol abuse, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of esophagus"}


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: 75 y/o man with PMH significant for esophageal cancer, GI
bleeding, and hepatocellular carcinoma admitted to the MICU
through the ED for GI bleeding. In pertinent recent history, the
pt was admitted to [**Hospital1 18**] for a probable upper GI bleed from
[**3-14**] to [**3-21**]. His varices could not be banded at that time due
to an esophageal stricture. Pt reports that he had been doing
well at home. On Monday, he came to the hospital and had an
infusion of Procrit. Following this, he felt very tired and
continued to feel more and more fatigued on Tues and Wed. He
also notes that his stool became dark on Tuesday. Pt reports
that he had one soft block stool per day over the next two days.
No BRBPR or hematoemesis. Pt denies abdominal pain, nausea, and
vomiting. He does report that his appetite has been very poor
over the last three days. In further discussion, pt reports that
he has felt mildly lightheaded since Tuesday. No vertigo. He
denies CP and SOB. Had difficulty moving around at home for the
last two days because of his severe fatigue but not because of
SOB. He reports mild pain in his right hip which he attributes
to his arthritis. No LE pain or swelling. No dysuria or
hematuria.

MEDICAL HISTORY: 1. GI bleeding- Pt was recently admitted to [**Hospital1 18**] from
[**Date range (1) 55482**] with a bleed thought to be due to esophageal
varices. Pt could not be successfully banded due to a esophageal
stricture that limited the passage of the banding device. He
retired MICU observation and a total of 9 units of PRBC.
2. Esophageal cancer- Was diagnosed in 05/[**2197**]. Pt was treated
with radiation and cucurrent cisplatin and continuous 5-Fu. He
underwent treatment from [**2198-6-13**] to [**2198-7-20**].
3. Hepatocellular carcinoma- Was diagnosed in 02/[**2198**]. Pt is s/p
chemoembolization in 03/[**2198**]. Per recent notes from Dr. [**First Name (STitle) **],
it appears that the pt had a good local result but has
progressive pulmonary mets. These may be from his esophageal CA
but as his CEA is also rising it cannot be excluded that they
are from his HCC.
4. Arthritis
5. Seasonal allergies
6. HTN

MEDICATION ON ADMISSION: 1. Nadolol 40 mg [**Hospital1 **]
2. Thiamine 100 mg daily
3. Folic acid 1 mg daily
4. Albuterol MDI 1-2 puffs Q4-6H PRN wheezing
5. Spironolactone 25 mg daily
6. Isosorbide dinitrate 10 mg [**Hospital1 **]
7. Extra strength tylenol QID PRN
8. Lasix 40 mg daily
9. Ambien 5 mg QHS PRN
10. Protonix 40 mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.3  91  100/46  20  94% RA
Gen- Alert and oriented. NAD. Resting comfortably on the
strecher.
HEENT- NC AT. PERRL. Mildly dry mucous membranes.
Cardiac- RRR. No m,r,g.
Abdomen- Soft. NT. ND. Positive bowel sounds.
Pulm- Diffuse crackles throughout lower half of lungs
bilaterally.
Extremities- No c/c/e. 2+ DP pulses bilaterally.

FAMILY HISTORY: Pt's grandfather died of an unknown cancer. He has a brother
with "heart disease" and a sister with breast cancer.

SOCIAL HISTORY: Pt is married and lives with his wife. [**Name (NI) **] is the retired owner
of a fish market. He drank a large amount of ETOH until [**2176**]
when he quit and was sober until [**2189**]. However, he resumed
drinking at that time until quiting again in 01/[**2198**]. Pt smoked
3 to 4 PPD from 30 years before quiting 35 years ago. 

### Response:
{"Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Malignant neoplasm of liver, primary,Secondary malignant neoplasm of retroperitoneum and peritoneum,Secondary malignant neoplasm of bone and bone marrow,Hypercalcemia,Barrett's esophagus,Alcohol abuse, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of esophagus"}
