CHIEF COMPLAINT: hematemesis

PRESENT ILLNESS: Ms. [**Known lastname 94926**] is an 87 year old Russian-speaking woman with history
of breast cancer, esophageal cancer (requiring esophogeal
stent), afib, DMII, apparently went to Pul office to drain
pleural effusuion, but was noted to have small episode of
hematemesis, Dr. [**Last Name (STitle) **] was called and advised to come to ED
for further evaluation. Pt suwsequently had another episode of
hematemesis in ED.Claims to have dark stools day pta. Denied CP
but have exertional SOB. Denied HA, recent ASA use, denied abd
pain.
.
Last EGD on [**1-10**] demonstrated narrowing in the distal esophagus
suggestive of granulation tissue, and a metal stent was
successfully deployed distal to the previous stent.

MEDICAL HISTORY: 1. Right breast cancer, status post radiation therapy excision
in [**2130-12-4**].
2. Hypertension.
3. History of exertional angina; negative Persantine thallium in

MEDICATION ON ADMISSION: 1. Aspirin 325mg daily
2. Lasix 20mg PO daily
3. Glipizide SR 2.5mg q 24
4. Lisinopril 10mg once daily
5. Metoprolol tartrate 300mg once daily
6. Ranitidine 15mg/mL
7. Valacardine
8. Calcium carbonate 500mg TID

ALLERGIES: Codeine / Benzodiazepines

PHYSICAL EXAM: vital - T 98.6, BP 118/74, HR 94, RR 16, O2 93% on room air.
gen -In no distress.
heent - Sclera anicteric, moist mucus membranes, OP clear
cv: Irregular, S1 S2 present, no murmurs, rubs, gallops
pulm - Decreased on right.crackles in bases
abd - Soft, non-tender , good BS, rectal- guaiac positive, brown
stool
ext - Warm. Mild edema.
neuro -awake and alert

FAMILY HISTORY: Esophageal cancer in father - 80s

SOCIAL HISTORY: Lives at elderly home, nurse helps with ADLs. Her daughter is
very supportive and active in her care. She denies history of
tobacco use.
Malignant neoplasm of other specified part of esophagus,Pressure ulcer, lower back,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acute respiratory failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified essential hypertension
Mal neo esophagus NEC,Pressure ulcer, low back,Gastrointest hemorr NOS,Ac posthemorrhag anemia,Pleural effusion NOS,Acute respiratry failure,DMII wo cmp nt st uncntr,Atrial fibrillation,Hx of breast malignancy,Hypertension NOS
Admission Date:  [**2138-4-14**]              Discharge Date:   [**2138-4-18**]


Service: MEDICINE

Allergies:
Codeine / Benzodiazepines

Attending:[**First Name3 (LF) 5893**]
Chief Complaint:
hematemesis

Major Surgical or Invasive Procedure:
tracheal intubation, central venous catheter placement, and
radial arterial catheter placement

History of Present Illness:
Ms. [**Known lastname 94926**] is an 87 year old Russian-speaking woman with history
of breast cancer, esophageal cancer (requiring esophogeal
stent), afib, DMII, apparently went to Pul office to drain
pleural effusuion, but was noted to have small episode of
hematemesis, Dr. [**Last Name (STitle) **] was called and advised to come to ED
for further evaluation. Pt suwsequently had another episode of
hematemesis in ED.Claims to have dark stools day pta. Denied CP
but have exertional SOB. Denied HA, recent ASA use, denied abd
pain.
.
Last EGD on [**1-10**] demonstrated narrowing in the distal esophagus
suggestive of granulation tissue, and a metal stent was
successfully deployed distal to the previous stent.

Daughter informed us that pt apparently does not know about her
diagnosis and prefers not to inform her.


Past Medical History:
1. Right breast cancer, status post radiation therapy excision
in [**2130-12-4**].
2. Hypertension.
3. History of exertional angina; negative Persantine thallium in

[**2132-4-2**].
4. Back pain.
5. Carpal tunnel.
6. History of positive PPD.
7. Glaucoma.
8. History of atrial fibrillation with hypokalemia during
previous hospitalization.
9. DM diet-controlled Hb A1c 7.1 in [**12-8**]
10. Obesity.
11. Osteopenia.
12. s/p cholecystectomy in [**Country 532**].
13. Squamous cell esophogeal cancer with esophageal obstruction
requiring stent


Social History:
Lives at elderly home, nurse helps with ADLs. Her daughter is
very supportive and active in her care. She denies history of
tobacco use.


Family History:
Esophageal cancer in father - 80s

Physical Exam:
vital - T 98.6, BP 118/74, HR 94, RR 16, O2 93% on room air.
gen -In no distress.
heent - Sclera anicteric, moist mucus membranes, OP clear
cv: Irregular, S1 S2 present, no murmurs, rubs, gallops
pulm - Decreased on right.crackles in bases
abd - Soft, non-tender , good BS, rectal- guaiac positive, brown
stool
ext - Warm. Mild edema.
neuro -awake and alert


Pertinent Results:
[**2138-4-14**] 01:45PM   WBC-13.0* RBC-3.65* HGB-10.0* HCT-30.1*
MCV-82 MCH-27.4 MCHC-33.2 RDW-14.4
[**2138-4-14**] 01:45PM   NEUTS-83.5* LYMPHS-11.8* MONOS-3.8 EOS-0.6
BASOS-0.3
[**2138-4-14**] 01:45PM   PLT COUNT-360
[**2138-4-14**] 01:45PM   PT-13.7* PTT-23.8 INR(PT)-1.2*
[**2138-4-14**] 01:45PM   GLUCOSE-155* UREA N-17 CREAT-0.6 SODIUM-139
POTASSIUM-4.5 CHLORIDE-101 TOTAL CO2-29 ANION GAP-14
[**2138-4-14**] 01:45PM   ALT(SGPT)-12 AST(SGOT)-34 ALK PHOS-77 TOT
BILI-0.4
[**2138-4-14**] 01:45PM   LIPASE-11
[**2138-4-14**] 01:45PM   ALBUMIN-3.1*

SINGLE AP UPRIGHT RADIOGRAPH OF THE CHEST: There are bilateral
moderate-sized pleural effusions unchanged. There is also
bilateral lower lobe atelectasis also largely unchanged. There
is also minimal pleural fluid extending into the right minor
fissure. There is no pneumothorax. Cardiomediastinal silhouette
is obscured by the left lower lobe atelectasis and effusion.
Pulmonary vasculature is within normal limits. There is no
evidence of volume overload. Esophageal stent is noted. There is
mild dextroconvex thoracic scoliosis.

IMPRESSION: Moderate bilateral pleural effusions and lower lobe
atelectasis, both of which are unchanged allowing for slight
differences in technique.

Atrial fibrillation with rapid ventricular response.
Non-specific ST-T wave changes. Poor R wave progression. Suspect
arm lead reversal. Compared to the previous tracing of [**2138-1-19**]
the ventricular rate is faster and the arm leads are reversed.


Brief Hospital Course:
87 year old Russian-speaking female with h/o breast cancer,
esophageal cancer (requiring esophogeal stent), afib, DMII, s/p
EGD with additional stent placement adm with dyspnea and large
recurrent right pleural effusion s/p pleurodesis with small
volume hematemesis in pulmonary clinic.

Hematemesis: Patient was intubated for airway control. Two large
bore PIV, active type and cross. Pt was transfused to keep Hct
>=30 given coronary disease. She briefly required pressors for
hemodynamic support. GI consult team attempted EGD, which
revealed large clot adherent to the wall of the esophagus distal
to the patent esophageal stent. GI attending recommended to
family that any attempt at further intervention would likely
result in massive GI bleeding and catastrophic outcome. Extended
family flew in from abroad to visit with patient and then the
entire family, after reviewing the options for end of life care,
decided that she would have wanted to be made comfortable given
her pre-terminal condition. Planning for home hospice was
offered, but the family was justifiably concerned about the
possibility of further hematemesis and therefore asked that she
remain intubated while all medications other than analgesics and
anxiolytics were stopped. Mechanical ventilation was changed to
T-piece oxygen. She subsequently expired with family at her
bedside.

Medications on Admission:
1. Aspirin 325mg daily
2. Lasix 20mg PO daily
3. Glipizide SR 2.5mg q 24
4. Lisinopril 10mg once daily
5. Metoprolol tartrate 300mg once daily
6. Ranitidine 15mg/mL
7. Valacardine
8. Calcium carbonate 500mg TID


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
esophageal cancer

Discharge Condition:
expired

Discharge Instructions:
n/a

Followup Instructions:
n/a
{'Malignant neoplasm of other specified part of esophagus,Pressure ulcer, lower back,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acute respiratory failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified essential hypertension'}


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: hematemesis

PRESENT ILLNESS: Ms. [**Known lastname 94926**] is an 87 year old Russian-speaking woman with history
of breast cancer, esophageal cancer (requiring esophogeal
stent), afib, DMII, apparently went to Pul office to drain
pleural effusuion, but was noted to have small episode of
hematemesis, Dr. [**Last Name (STitle) **] was called and advised to come to ED
for further evaluation. Pt suwsequently had another episode of
hematemesis in ED.Claims to have dark stools day pta. Denied CP
but have exertional SOB. Denied HA, recent ASA use, denied abd
pain.
.
Last EGD on [**1-10**] demonstrated narrowing in the distal esophagus
suggestive of granulation tissue, and a metal stent was
successfully deployed distal to the previous stent.

MEDICAL HISTORY: 1. Right breast cancer, status post radiation therapy excision
in [**2130-12-4**].
2. Hypertension.
3. History of exertional angina; negative Persantine thallium in

MEDICATION ON ADMISSION: 1. Aspirin 325mg daily
2. Lasix 20mg PO daily
3. Glipizide SR 2.5mg q 24
4. Lisinopril 10mg once daily
5. Metoprolol tartrate 300mg once daily
6. Ranitidine 15mg/mL
7. Valacardine
8. Calcium carbonate 500mg TID

ALLERGIES: Codeine / Benzodiazepines

PHYSICAL EXAM: vital - T 98.6, BP 118/74, HR 94, RR 16, O2 93% on room air.
gen -In no distress.
heent - Sclera anicteric, moist mucus membranes, OP clear
cv: Irregular, S1 S2 present, no murmurs, rubs, gallops
pulm - Decreased on right.crackles in bases
abd - Soft, non-tender , good BS, rectal- guaiac positive, brown
stool
ext - Warm. Mild edema.
neuro -awake and alert

FAMILY HISTORY: Esophageal cancer in father - 80s

SOCIAL HISTORY: Lives at elderly home, nurse helps with ADLs. Her daughter is
very supportive and active in her care. She denies history of
tobacco use. 

### Response:
{'Malignant neoplasm of other specified part of esophagus,Pressure ulcer, lower back,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Unspecified pleural effusion,Acute respiratory failure,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified essential hypertension'}
