CHIEF COMPLAINT: 

PRESENT ILLNESS: An 81-year-old male with a
history of rectal cancer status post sigmoid colectomy in
[**2192**], presents with melena and left foot cellulitis.  The
patient states that he has been short of breath x 2 weeks
with worsening symptoms in this past week.  In his usual
state of health, he would walk his dogs 2-3 times a day.  In
the past week he stopped walking his dogs, found that he
cannot walk to his door nor walk up the stairs without
feeling tired.  He also notes that his stools were darker
than usual (2 stools per day, intermittent black) for the
past 7-10 days, but did not think much of it.  At this time,
he also developed redness and tenderness in his left middle
toe.  He went to [**Hospital 1263**] Hospital for evaluation of his left
foot cellulitis, when the doctor noticed that he was short of
breath (CBC showed a hematocrit of 22).  Positive for nausea
(dry heaves), lightheadedness with positional change,
ethanol, and generalized malaise.  Negative for fever,
chills, vomiting, hematemesis, epistaxis, syncope, BRBPR,
history of XRT in the esophagus region, history of PUD,
history of GERD.  The patient decided that he wanted to be
admitted to the [**Hospital3 55759**] Center at this point.

MEDICAL HISTORY: Type 2 diabetes.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives at home alone, drinks [**1-19**]
glasses of wine per day, stopped smoking 44 years ago.
Other specified gastritis, with hemorrhage,Retention of urine, unspecified,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus
Oth spf gastrt w hmrhg,Retention urine NOS,Chr airway obstruct NEC,Chr blood loss anemia,Chr duoden ulcer w hem,Gout NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Hx-rectal & anal malign
Admission Date: [**2198-6-9**]        Discharge Date: [**2198-6-11**]


Service:  MED


HISTORY OF PRESENT ILLNESS:  An 81-year-old male with a
history of rectal cancer status post sigmoid colectomy in
[**2192**], presents with melena and left foot cellulitis.  The
patient states that he has been short of breath x 2 weeks
with worsening symptoms in this past week.  In his usual
state of health, he would walk his dogs 2-3 times a day.  In
the past week he stopped walking his dogs, found that he
cannot walk to his door nor walk up the stairs without
feeling tired.  He also notes that his stools were darker
than usual (2 stools per day, intermittent black) for the
past 7-10 days, but did not think much of it.  At this time,
he also developed redness and tenderness in his left middle
toe.  He went to [**Hospital 1263**] Hospital for evaluation of his left
foot cellulitis, when the doctor noticed that he was short of
breath (CBC showed a hematocrit of 22).  Positive for nausea
(dry heaves), lightheadedness with positional change,
ethanol, and generalized malaise.  Negative for fever,
chills, vomiting, hematemesis, epistaxis, syncope, BRBPR,
history of XRT in the esophagus region, history of PUD,
history of GERD.  The patient decided that he wanted to be
admitted to the [**Hospital3 55759**] Center at this point.

EMERGENCY DEPARTMENT COURSE:  Temperature 99.5 degrees, pulse
113, blood pressure 143/61, respiratory rate 16, 97 percent
on room air, and hematocrit 23.  RECTAL EXAM:  Guaiac
positive.  NG lavage:  Coffee ground with 500 cc lavage.
EGD:  Several nonbleeding erosions in body of stomach but
duodenum/esophagus within normal limits.  Received 4 units of
packed red blood cells.  Started on clindamycin 600 mg x1 for
cellulitis.  The patient was then transferred to the SICU.

SICU COURSE:  T-max ?, pulse 80, blood pressure 127/45,
respiratory rate of 16, 99 percent on room air, hematocrit of
26.6 to 29.0 to 31.8.  Was started on Augmentin for
cellulitis.

PAST MEDICAL HISTORY:
Type 2 diabetes.

Hypertension.

Gout.

Rectal carcinoma status post sigmoid colectomy on [**2-/2192**].

Chronic renal insufficiency.

Status post appendectomy.

Skin cancer.

Asthma.

SOCIAL HISTORY:  The patient lives at home alone, drinks [**1-19**]
glasses of wine per day, stopped smoking 44 years ago.

ALLERGIES:  No known drug allergies.

MEDICATIONS:
1. Lisinopril.
2. Lasix 20 q.d.
3. Flovent.
4. Wellbutrin.
5. Allopurinol.
6. Aspirin.
7. Glyburide 7.5 units q.a.m./5units q.p.m.
8. Metformin 500 mg q.d.
9. Singulair q.d.
10.      Prazosin 1 tablet q.d.


PHYSICAL EXAMINATION:  On initial exam, patient had a T-max
of 98.4 degrees, pulse of 64, blood pressure of 122/60,
respiratory rate of 22, 97 percent on room air.  The patient
had diffuse wheezing with resolving left foot erythema.  The
remainder of the exam was unremarkable.

LABORATORY DATA:  Chem-10 was significant for a BUN of 32,
creatinine of 1.4, which had decreased from 1.8, calcium of
7.5, with an albumin of 3.2.  Hematocrit was 31.8, initially
at 29.  PT, PTT and INR all within normal limits.

IMPRESSION:  An 81-year-old male with a history of rectal
carcinoma status post sigmoid colectomy admitted for upper
gastrointestinal bleed and left foot cellulitis.

Upper gastrointestinal bleed.  Unclear source.
Esophagogastroduodenoscopy revealed only erosion.  The
patient was monitored by serial hematocrits, 4 units of blood
was transfused in the ED.  The patient was started on clears
and IV Protonix b.i.d. was given.  Once hematocrit was stable
greater than 30, Protonix was switched to p.o. and patient
was restarted on his medications withholding aspirin.

Cellulitis.  Left toe erythema was improving once the patient
was on the floor.  The patient was continued on Augmentin for
a 7-day course.  Cultures remained negative during this time
frame.

DISCHARGE MEDICATIONS:  Same as admission with the addition
of,
1. Augmentin 500/125 mg 1 tab q.d. for the remaining 5 days.
2. Protonix 40 mg p.o. q.d.
3. Colace.
4. Aspirin was withheld.


DISPOSITION:  To home.

DISCHARGE STATUS:  The patient was ambulating, mentating,
eating and drinking normally.

DISCHARGE DIAGNOSIS:  Upper gastrointestinal bleed secondary
to erosion within the stomach and duodenum.


DISCHARGE FOLLOWUP:  The patient was asked to follow up with
his PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] within the week.



                        [**Name6 (MD) **] [**Name8 (MD) **], [**MD Number(1) 6648**]

Dictated By:[**Last Name (NamePattern1) 56096**]
MEDQUIST36
D:  [**2198-6-13**] 08:36:15
T:  [**2198-6-13**] 10:14:23
Job#:  [**Job Number 111629**]
{'Other specified gastritis, with hemorrhage,Retention of urine, unspecified,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}


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: An 81-year-old male with a
history of rectal cancer status post sigmoid colectomy in
[**2192**], presents with melena and left foot cellulitis.  The
patient states that he has been short of breath x 2 weeks
with worsening symptoms in this past week.  In his usual
state of health, he would walk his dogs 2-3 times a day.  In
the past week he stopped walking his dogs, found that he
cannot walk to his door nor walk up the stairs without
feeling tired.  He also notes that his stools were darker
than usual (2 stools per day, intermittent black) for the
past 7-10 days, but did not think much of it.  At this time,
he also developed redness and tenderness in his left middle
toe.  He went to [**Hospital 1263**] Hospital for evaluation of his left
foot cellulitis, when the doctor noticed that he was short of
breath (CBC showed a hematocrit of 22).  Positive for nausea
(dry heaves), lightheadedness with positional change,
ethanol, and generalized malaise.  Negative for fever,
chills, vomiting, hematemesis, epistaxis, syncope, BRBPR,
history of XRT in the esophagus region, history of PUD,
history of GERD.  The patient decided that he wanted to be
admitted to the [**Hospital3 55759**] Center at this point.

MEDICAL HISTORY: Type 2 diabetes.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives at home alone, drinks [**1-19**]
glasses of wine per day, stopped smoking 44 years ago. 

### Response:
{'Other specified gastritis, with hemorrhage,Retention of urine, unspecified,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}
