CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 69 year-old man who
presents again for a chief complaint of rectal bleeding.  He
was recently admitted on [**2157-2-27**] to [**2157-3-3**] for rectal bleeding
and he represents for continued episodes of rectal bleeding.
Colonoscopy performed on the previous admission was noted to have
an ulcer at the anorectal verge and then was transfused a total
of 7 units of packed red blood cells. His
esophagogastroduodenoscopy revealed mild gastritis. Surgery was
also consulted at that time for evaluation and recommended
conservative management.  He was hemodynamically stable when he
was discharged and was given the time for his ulcer to heal since
it may have been secondary to rectal tube trauma and a biopsy was
to be performed at four to six weeks post discharge.  However, at
the nursing home on the morning of admission the staff noted a
large episode of bright red blood per rectum.  He was transferred
back to the [**Hospital1 69**] Emergency
Department for further management and evaluation.  He denies any
abdominal pain, lightheadedness, shortness of breath, chest pain,
fevers, throughout this process.  On arrival to the Emergency
Department he had a blood pressure of 43/25, heart rate of
70, aggressive fluid hydration was given as well as 2 units
of packed red blood cells.  His blood pressure rose to 120/55.
His admission hematocrit was 30.1.  Gastrointestinal and surgery
consults were obtained in the Emergency Department.

MEDICAL HISTORY: 1.  Anorectal ulcer.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  Obesity.
5.  Obstructive sleep apnea.
6.  Depression.
7.  Status post left parietal cerebrovascular accident.
8.  Gout.
9.  Rhabdomyolysis.
10.  Decubitus ulcers.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is estranged from his wife, not a smoker,
former alcohol use, former real estate worker.
Unspecified hemorrhoids with other complication,Hemorrhage of rectum and anus,Hematoma complicating a procedure,Peripheral vascular complications, not elsewhere classified,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Hemrrhoid NOS w comp NEC,Rectal & anal hemorrhage,Hematoma complic proc,Surg comp-peri vasc syst,Sleep apnea NOS,Obesity NOS,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2157-3-5**]       Discharge Date:  [**2157-3-10**]

Date of Birth:   [**2087-8-27**]       Sex:  M

Service:  MEDICINE
HISTORY OF PRESENT ILLNESS:  This is a 69 year-old man who
presents again for a chief complaint of rectal bleeding.  He
was recently admitted on [**2157-2-27**] to [**2157-3-3**] for rectal bleeding
and he represents for continued episodes of rectal bleeding.
Colonoscopy performed on the previous admission was noted to have
an ulcer at the anorectal verge and then was transfused a total
of 7 units of packed red blood cells. His
esophagogastroduodenoscopy revealed mild gastritis. Surgery was
also consulted at that time for evaluation and recommended
conservative management.  He was hemodynamically stable when he
was discharged and was given the time for his ulcer to heal since
it may have been secondary to rectal tube trauma and a biopsy was
to be performed at four to six weeks post discharge.  However, at
the nursing home on the morning of admission the staff noted a
large episode of bright red blood per rectum.  He was transferred
back to the [**Hospital1 69**] Emergency
Department for further management and evaluation.  He denies any
abdominal pain, lightheadedness, shortness of breath, chest pain,
fevers, throughout this process.  On arrival to the Emergency
Department he had a blood pressure of 43/25, heart rate of
70, aggressive fluid hydration was given as well as 2 units
of packed red blood cells.  His blood pressure rose to 120/55.
His admission hematocrit was 30.1.  Gastrointestinal and surgery
consults were obtained in the Emergency Department.

PAST MEDICAL HISTORY:
1.  Anorectal ulcer.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  Obesity.
5.  Obstructive sleep apnea.
6.  Depression.
7.  Status post left parietal cerebrovascular accident.
8.  Gout.
9.  Rhabdomyolysis.
10.  Decubitus ulcers.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Celexa 20 mg po q day, multivitamin, thiamine,
folate, Lisinopril 20 mg po q day, Protonix, Mirtazapine 15
mg, iron sulfate 325 mg b.i.d., vitamin C 500 mg b.i.d., zinc
sulfate 120 mg po q day, subQ heparin, Metformin 1 gram
b.i.d., aspirin suppositories.

SOCIAL HISTORY:  He is estranged from his wife, not a smoker,
former alcohol use, former real estate worker.

PHYSICAL EXAMINATION:  He was an elderly man in no acute
distress.  HEENT pupils are equal, round and reactive to
light.  Extraocular movements intact.  Dry mucous membranes.
Oropharynx clear.  Lungs clear to auscultation bilaterally
with no adventitious sounds.  Neck veins were flat.  No
lymphadenopathy.  Cardiovascular S1 and S2, regular.  No
murmurs, rubs or gallops.  Abdomen soft, nontender,
nondistended with normoactive bowel sounds . Extremities no
edema.  Neurological alert and oriented times three.

LABORATORIES ON ADMISSION:  White blood cell count 8.5,
hematocrit 30.1, which is a drop from 31.6 on his last
admission.  Platelets 297, INR 1.  His chem 7 sodium 141,
potassium 4.3, chloride 108, bicarb 24, BUN 18, creatinine
.7, 160 for glucose.

HOSPITAL COURSE:  The patient was admitted to the MICU.  He was
transfused a total of 7 units of packed red blood cells on
[**2157-3-5**] for his gastrointestinal bleed.  He had an emergent
colonoscopy, which showed clots of blood mixed with stool at 40
cm from the rectum and three deep circular nonbleeding ulcers 4
to 8 mm in the rectum and anus.  He subsequently went to the
Operating Room on [**2157-3-8**] for ligation of the rectal veins to
eliminate the possibility of the anorectal ulcer causing the
bleed.  The etiology of the blood mixed stool at 40 cm is still
unclear, therefore an angiogram of the abdomen was performed on
[**2157-3-9**] and contrast was given to the SMA and [**Female First Name (un) 899**], which showed
no extravasation, no early draining veins and no AV
malformations.  His hematocrit had remained stable throughout
hospitalization since his 7 unit transfusion on [**2157-3-5**].

Neuro:  He still has residual weakness on the right side from his
left parietal cerebrovascular accident, which may be slightly
worsened.  He states he has increased heaviness in his right
foot.  He has not had physical therapy while he was in the MICU
and may be decondition.  Given his condition and his hypotensive
state on admission most likely easily brings out his right sided
weakness and no repeat imaging was necessary at this time.
Physical therapy was reconsulted.

He has depression, but is not suicidal.  He is to follow up with
his psychiatrist at [**Hospital3 7**] and continue Celexa and
Mirtazapine.

Endocrine:  He is a diabetic on a regular insulin sliding scale.
At the nursing home he can be titrated up on his Metformin at 1
gram b.i.d. once he is fully taking po.

Cardiovascular:  Hypertension - his Lisinopril was stopped in the
hospital due to his hypotensive state.  Lisinopril was resumed on
[**2157-3-9**] at 10 mg q day, but can be increased to 20 mg q day.

Infectious disease:  The patient had increased erythema and pain
on his left wrist, which was thought to be secondary to a
thrombophlebitis from an arterial line that was placed in the
MICU.  The patient was started on oxacillin on [**2157-3-10**].  He
should also continue with warm compresses and elevation of that
hand. Rheumatology had been consulted to rule out a septic joint,
but his joint by physical examination was not consistent with
septic joint and was not tapped at this time.

Sacral decubitus ulcer, which is a stage two.  He is to
continue dressing changes t.i.d. with DuoDerm gel, log roll
precautions two q hours at the [**Doctor First Name **] Air mattress.  He also has
a right heel necrotic ulcer, which is dry, but should have
Podus boots to relieve the pressure at all times.

DISCHARGE CONDITION:  Stable.

DISCHARGE DIAGNOSES:
1.  Lower gastrointestinal bleed.
2.  Anorectal ulcer status post rectal vein ligation.
3.  Colonic polyp at 50 cm from the rectum.
4.  Diabetes mellitus type 2.
5.  Hypertension.
6.  Right sided weakness secondary to left parietal infarct.
7.  Depression.
8.  Gout.
9.  Thrombophlebitis of the left wrist.
10.  Sacral decubitus ulcer.
11.  Obesity.
12.  Obstructive sleep apnea.

FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) 1728**] his
primary care physician.  [**Name10 (NameIs) **] is also to follow up with
(gastrointestinal) Dr. [**Last Name (STitle) 93644**].

DISCHARGE MEDICATIONS:  Celexa 20 mg po q day, multivitamin
one tab q day, regular insulin sliding scale to be switched
and titrated to Metformin when the patient is fully taking
po. He was previously at 1 gram b.i.d., Thiamine 100 mg q
day, folic acid 1 mg po q day, Protonix 40 mg q.d.,
Mirtazapine 15 mg q.h.s., ferrous sulfate 325 mg q.d.,
vitamin C 500 mg q.d., zinc sulfate 220 mg q day, Colace 100
mg b.i.d., Senna one tab po b.i.d. as needed, Lisinopril 20
mg po q day and Keflex 500 mg po q 6 hours for seven to ten
days.

OTHER TREATMENTS:  The patient requires t.i.d. dressing
changes with DuoDerm gel to his stage two sacral decubitus
ulcer and to try to keep that area dry.  Log roll precautions
q two hours.  [**Doctor First Name **] Air mattress, Podus boots.  The patient
will also need physical therapy rehab for his left parietal
infarct and right sided weakness.

The patient should follow up with his new primary care
physician as previous.






                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Doctor Last Name 18900**]
MEDQUIST36

D:  [**2157-3-10**]  10:23
T:  [**2157-3-10**]  10:36
JOB#:  [**Job Number **]

cc:[**Doctor Last Name 18875**]

Name:  [**Known lastname 14764**], [**Known firstname **]                 Unit No:  [**Numeric Identifier 14765**]

Admission Date:  [**2157-3-5**]     Discharge Date:

Date of Birth:   [**2087-8-27**]     Sex:  M

Service: Medicine
ADDENDUM: (To last dictation on [**2157-3-10**]).

The patient was to be discharged to [**Hospital1 **] on [**2157-3-10**], but
given his left hand thrombophlebitis, we kept him overnight to
monitor.  We started him on intravenous Oxacillin, monitor his
hematocrit one more day.  On the morning of [**2157-3-11**], the
patient's hematocrit had come down from 35.0 to 31.0, and his
subsequent evening hematocrit was 27.1.  Another technetium
tagged red blood cell scan was performed that evening which was
negative.  The patient was transfused two units of packed red
blood cells, but had no further bleeding.

A complete dictation summary will follow at the time of




                          [**Name6 (MD) 1034**] [**Name8 (MD) 1035**], M.D.  [**MD Number(1) 1036**]

Dictated By:[**Name8 (MD) 14767**]

MEDQUIST36

D:  [**2157-3-12**]  10:16
T:  [**2157-3-12**]  10:40
JOB#:  [**Job Number 14768**]


Name:  [**Known lastname 14764**], [**Known firstname **]                     Unit No:  [**Numeric Identifier 14765**]

Admission Date:  [**2157-3-14**]     Discharge Date:  [**2157-3-16**]

Date of Birth:   [**2087-8-27**]     Sex:  M

Service: Medicine
NOTE:  This addendum will cover the hospital course from [**3-14**]
until [**3-16**].

HOSPITAL COURSE:  On [**3-14**], the patient underwent placement of
PICC line in right basilic vein.  He also underwent an ultrasound
of the erythematous nodule on his left wrist.  No pseudoaneurysm
was noted.  The nodule was consistent with a hematoma superficial
to the plane of the radial artery.  On [**3-15**], the patient was
taken to the Operating Room for debridement of the nodule. Nodule
was found to be an infected hematoma with no involvement of the
radial artery. Gram stain shows 2+ gram positive cocci in pairs.
Cultures are still pending.  The patient has been treated with
Unasyn and vancomycin.  Wound is currently dressed.  The

DISCHARGE CONDITION:  Stable

DISCHARGE DIAGNOSES:  As noted in previous discharge summary.
1.  Lower gastrointestinal bleed
2.  Anal rectal ulcer status post rectal band ligation
3.  Colonic polyp at 50 cm from the rectum
4.  Diabetes mellitus type II
5.  Hypertension
6.  Right sided weakness secondary to left parietal infarct
7.  Depression
8.  Gallop
9.  Infected hematoma of left wrist, status post debridement
10. Sacral decubitus ulcer
11. Obesity
12. Obstructive sleep apnea

FOLLOW UP:  Patient will follow up with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], his
new primary care physician.  [**Name10 (NameIs) **] number ([**Telephone/Fax (1) 14769**].  He will
also follow up with gastroenterologist, Dr. [**Last Name (STitle) 5503**], phone
number ([**Telephone/Fax (1) 14770**].  The patient will also follow up with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], vascular surgeon, phone number ([**Telephone/Fax (1) 14771**].

DISCHARGE MEDICATIONS:  Same as noted in previous discharge
summary.  The patient will not take Keflex.  Rather, he will
continue vancomycin to complete two week course.




                          [**Name6 (MD) 1034**] [**Name8 (MD) 1035**], M.D.  [**MD Number(1) 1036**]

Dictated By:[**Last Name (NamePattern1) 14772**]

MEDQUIST36

D:  [**2157-3-16**]  08:25
T:  [**2157-3-16**]  08:24
JOB#:  [**Job Number 14773**]
{'Unspecified hemorrhoids with other complication,Hemorrhage of rectum and anus,Hematoma complicating a procedure,Peripheral vascular complications, not elsewhere classified,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: 

PRESENT ILLNESS: This is a 69 year-old man who
presents again for a chief complaint of rectal bleeding.  He
was recently admitted on [**2157-2-27**] to [**2157-3-3**] for rectal bleeding
and he represents for continued episodes of rectal bleeding.
Colonoscopy performed on the previous admission was noted to have
an ulcer at the anorectal verge and then was transfused a total
of 7 units of packed red blood cells. His
esophagogastroduodenoscopy revealed mild gastritis. Surgery was
also consulted at that time for evaluation and recommended
conservative management.  He was hemodynamically stable when he
was discharged and was given the time for his ulcer to heal since
it may have been secondary to rectal tube trauma and a biopsy was
to be performed at four to six weeks post discharge.  However, at
the nursing home on the morning of admission the staff noted a
large episode of bright red blood per rectum.  He was transferred
back to the [**Hospital1 69**] Emergency
Department for further management and evaluation.  He denies any
abdominal pain, lightheadedness, shortness of breath, chest pain,
fevers, throughout this process.  On arrival to the Emergency
Department he had a blood pressure of 43/25, heart rate of
70, aggressive fluid hydration was given as well as 2 units
of packed red blood cells.  His blood pressure rose to 120/55.
His admission hematocrit was 30.1.  Gastrointestinal and surgery
consults were obtained in the Emergency Department.

MEDICAL HISTORY: 1.  Anorectal ulcer.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  Obesity.
5.  Obstructive sleep apnea.
6.  Depression.
7.  Status post left parietal cerebrovascular accident.
8.  Gout.
9.  Rhabdomyolysis.
10.  Decubitus ulcers.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is estranged from his wife, not a smoker,
former alcohol use, former real estate worker. 

### Response:
{'Unspecified hemorrhoids with other complication,Hemorrhage of rectum and anus,Hematoma complicating a procedure,Peripheral vascular complications, not elsewhere classified,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
