CHIEF COMPLAINT: Hematemesis

PRESENT ILLNESS: Mr. [**Known lastname **] is a 61 yo male with HCV cirrhosis followed at the
[**Hospital1 756**] and chronic alcohol abuse with ESLD and history of
varices.  He  reports feeling dizzy yesterday and having one
episode of bright red bloody emesis.  Then, last night he
developed abdominal discomfort, and today noticed much worsening
of his hematesis.  He also passed out when bending over.  He
denies preceeding presyncope, SOB, CP.  he was out for only a
short time.  He reports 2-3 days of chills and cough, but no
other focal infectious symptoms.  EMS was called and saw clots.
They gave him 500cc IVF and brought him to the [**Hospital1 18**] ED.

MEDICAL HISTORY: Nadolol 40
Lasix 20 daily
PPI 40 [**Hospital1 **]
Thiamine
Folate 1mg
MVI
Iron Sulfate 325mg [**Hospital1 **]

MEDICATION ON ADMISSION: Nadolol 40mg po daily
Lasix 20mg po daily
PPI 40mg po BID
Thiamine daily
Folate 1 mg daily
MVI daily
Iron Sulfate 325mg po BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam
Vitals: 98.4  131/78  105  100% on 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear.  NGT in place
with bright red blood
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1, pronounced S2, 3/6 SEM
loudest at apex, rubs, gallops
Abdomen:  soft, non-distended, bowel sounds present. Mild TTP
diffusely, no rebound tenderness or guarding.  Liver tip felt
below costal margin.  Spleen not palpable.
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
skin: diffuse psoriatic patches

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Reports 1-2 beers on the weekends.  He lives with his wife.  [**Name (NI) **]
has a history of IVDU, which is how he contracted HCV.
Gastroesophageal laceration-hemorrhage syndrome,Hypovolemia,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Aortic valve disorders,Portal hypertension,Precipitous drop in hematocrit,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified alcohol dependence, continuous,Tachycardia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other psoriasis
Mallory-weiss syndrome,Hypovolemia,Hpt C w/o hepat coma NOS,Alcohol cirrhosis liver,Aortic valve disorder,Portal hypertension,Drop, hematocrit, precip,Esoph varice oth dis NOS,Gastroduodenal dis NEC,Gstr/ddnts NOS w/o hmrhg,Alcoh dep NEC/NOS-contin,Tachycardia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Other psoriasis
Admission Date:  [**2161-5-28**]              Discharge Date:   [**2161-5-31**]

Date of Birth:  [**2099-7-15**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 949**]
Chief Complaint:
Hematemesis

Major Surgical or Invasive Procedure:
EGD - [**2161-5-29**]

History of Present Illness:
Mr. [**Known lastname **] is a 61 yo male with HCV cirrhosis followed at the
[**Hospital1 756**] and chronic alcohol abuse with ESLD and history of
varices.  He  reports feeling dizzy yesterday and having one
episode of bright red bloody emesis.  Then, last night he
developed abdominal discomfort, and today noticed much worsening
of his hematesis.  He also passed out when bending over.  He
denies preceeding presyncope, SOB, CP.  he was out for only a
short time.  He reports 2-3 days of chills and cough, but no
other focal infectious symptoms.  EMS was called and saw clots.
They gave him 500cc IVF and brought him to the [**Hospital1 18**] ED.

In the ED, initial vs were: 98.6  135  113/80  16  100
His HCT was 22.  His INR was 1.7.  Lactate 6.4.  BUN 25 with Cr
0.7.  His BP was stable in the ED, but he remained tachycardic.
He received 3L IVF.  He actively vomited clots.  An NG lavage
was performed and showed bright red blood with clots and did not
clear.  He had guaiac positive melena in ED. He was T/C x
several units, and was receiving one at the time of transfer.
He received 40mg of protonix and started on a drip, octreotide,
zofran, and 1g ceftriaxone.  Prior to transfer, his last BP was
127/74, HR 117.  He has 2 18G PIV.

On the floor, he was comfortable and not vomiting.  He remained
tachy but his blood pressure was stable.  250cc x 3 of NG lavage
improved until a flash of bright red blood at the end of the
lavage.

Past Medical History:
Nadolol 40
Lasix 20 daily
PPI 40 [**Hospital1 **]
Thiamine
Folate 1mg
MVI
Iron Sulfate 325mg [**Hospital1 **]

Social History:
Reports 1-2 beers on the weekends.  He lives with his wife.  [**Name (NI) **]
has a history of IVDU, which is how he contracted HCV.

Family History:
Noncontributory

Physical Exam:
Admission Physical Exam
Vitals: 98.4  131/78  105  100% on 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear.  NGT in place
with bright red blood
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1, pronounced S2, 3/6 SEM
loudest at apex, rubs, gallops
Abdomen:  soft, non-distended, bowel sounds present. Mild TTP
diffusely, no rebound tenderness or guarding.  Liver tip felt
below costal margin.  Spleen not palpable.
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
skin: diffuse psoriatic patches

Pertinent Results:
ADMISSION LABS

[**2161-5-28**] 09:36PM BLOOD WBC-7.4 RBC-2.32* Hgb-6.5* Hct-22.1*
MCV-95 MCH-28.2 MCHC-29.7* RDW-18.2* Plt Ct-152 Neuts-78.9*
Lymphs-13.0* Monos-7.8 Eos-0.1 Baso-0.2

[**2161-5-28**] 09:36PM BLOOD PT-18.9* PTT-32.0 INR(PT)-1.7*

[**2161-5-28**] 09:36PM BLOOD Glucose-165* UreaN-25* Creat-0.7 Na-142
K-4.2 Cl-106 HCO3-23 AnGap-17

[**2161-5-28**] 09:36PM BLOOD ALT-31 AST-51* AlkPhos-82 TotBili-1.1

EGD [**2161-5-29**]
Impression: [**Doctor First Name **]-[**Doctor Last Name **] tear; Varices at the lower third of
the esophagus and gastroesophageal junction; Erythema,
congestion, abnormal vascularity and mosaic appearance in the
whole stomach compatible with portal gastropathy; Erythema in
the antrum and stomach body compatible with gastritis; Erythema
and friability in the duodenal bulb and first part of the
duodenum compatible with duodenitis; Otherwise normal EGD to
second part of the duodenum
Recommendations: Esophageal varices without high risk stigmata.
Band ligation not performed. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] tear at GE junction
likely source of bleed without evidence of active bleeding.
Gastropathy, gastritis and duodenitis. Please continue IV PPI,
carafate, Octreotide overnight, abx.

ABDOMEN U.S. (COMPLETE STUDY) Study Date of [**2161-5-29**] 11:19 AM
1. Echogenic and nodular liver, compatible with the history of
cirrhosis.  Normal Doppler examination.
2. Trace perihepatic ascites. Pericholecystic fluid and wall
thickening is nonspecific in the setting of ascites.

Discharge Labs:
[**2161-5-31**] 06:50AM BLOOD WBC-5.4 RBC-3.27* Hgb-9.7* Hct-29.9*
MCV-92 MCH-29.5 MCHC-32.3 RDW-17.7* Plt Ct-69*
[**2161-5-31**] 06:50AM BLOOD Plt Ct-69*
[**2161-5-31**] 06:50AM BLOOD
[**2161-5-31**] 06:50AM BLOOD Glucose-101* UreaN-11 Creat-0.7 Na-137
K-3.8 Cl-105 HCO3-26 AnGap-10
[**2161-5-31**] 06:50AM BLOOD ALT-24 AST-35 AlkPhos-77 TotBili-1.7*
[**2161-5-31**] 06:50AM BLOOD Albumin-2.7* Calcium-7.2* Phos-2.4*
Mg-2.0
.


Brief Hospital Course:
Mr. [**Known lastname **] is a 61 yo male with HCV cirrhosis and a history of
alcohol abuse who presents with hematemesis, tachycardia, and a
HCT of 22.

#. Hematemesis: Initially concerning for variceal bleed given he
has a history of HCV cirrhosis and alcohol abuse as well as a
possible history of varices. HCT 22 with unclear baseline. He
was matched for 8 units and received a total of 3U PRBCs.
Elevated lactate likely related to volume depletion from
bleeding, improved to 3.3 on recheck.  Repeat HCT stablizized
after transfusion.  Also given 2U FFP for reversal of
coagulopathy.  On [**2161-5-29**] underwent EGD that revealed
[**Doctor First Name **]-[**Doctor Last Name **] tear and varices without evidence of variceal
bleeding.  Treated with Octreotide gtt, Protonix gtt and
Ceftrixone for 24 hours.  Was then continued on daily Protonix
and sucralfate.  Ultrasound revealed trace perihepatic ascites
but normal doppler flow through the portal vein.

#. Syncope: Initially attributed to volume depletion. Also has a
history of aortic stenosis with loud murmur heard throughout
precordium and radiating to carotids and back.  No further
episodes of lightheadedness after volume resuscitation.

#. Alcohol abuse: Per history was not overly significant in
recent past.  Kept on CIWA scale and given thiamine / folate.

#. HCV cirrhosis: INR 1.7 on admission consistent with cirrhosis
and liver decompensation.  Ultrasound as above consistent with
cirrhosis.

#. HTN: Initially held antihypertensives in setting of acute
bleeding.  Restarted Nadolol [**2161-5-30**].

# Aortic Stenosis: Unknown severity and followed by outpatient
provider.  [**Name10 (NameIs) **] not thought to be contributory to current
syncopal episode.  Referred for continued outpatient management.


Medications on Admission:
Nadolol 40mg po daily
Lasix 20mg po daily
PPI 40mg po BID
Thiamine daily
Folate 1 mg daily
MVI daily
Iron Sulfate 325mg po BID


Discharge Medications:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
5. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times
a day).
Disp:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
[**Doctor First Name **]-[**Doctor Last Name **] Tear
Acute Blood loss Anemia
EtOH Abuse
.
Secondary:
Hepatitis C cirrhosis
Severe Aortic Stenosis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted for hematemesis which was found to be the
result of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 329**]-[**Doctor Last Name **] tear in your esophagus. You received 3
blood transfusions, IV fluids and medications to help stop the
bleeding. You also reported a syncope event in the setting of
the bleed which is felt due to a combination of your known
severe aortic stenosis and the bleeding.
.
Your home medications were restarted prior to your discharge.
.
Please follow up with your medical team at [**Hospital6 13185**] for further care of your cirrhosis and aortic stenosis.

.
It is very important that you stop drinking alcohol as this is
worsening your health and putting your life in danger.

Followup Instructions:
Please follow up with your gastroenterologist at [**Hospital1 3372**]. You missed your appointment on [**2161-5-29**]. This
should be rescheduled. Please call their office on Tuesday, [**6-2**] to reschedule.
{'Gastroesophageal laceration-hemorrhage syndrome,Hypovolemia,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Aortic valve disorders,Portal hypertension,Precipitous drop in hematocrit,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified alcohol dependence, continuous,Tachycardia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other psoriasis'}


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: Mr. [**Known lastname **] is a 61 yo male with HCV cirrhosis followed at the
[**Hospital1 756**] and chronic alcohol abuse with ESLD and history of
varices.  He  reports feeling dizzy yesterday and having one
episode of bright red bloody emesis.  Then, last night he
developed abdominal discomfort, and today noticed much worsening
of his hematesis.  He also passed out when bending over.  He
denies preceeding presyncope, SOB, CP.  he was out for only a
short time.  He reports 2-3 days of chills and cough, but no
other focal infectious symptoms.  EMS was called and saw clots.
They gave him 500cc IVF and brought him to the [**Hospital1 18**] ED.

MEDICAL HISTORY: Nadolol 40
Lasix 20 daily
PPI 40 [**Hospital1 **]
Thiamine
Folate 1mg
MVI
Iron Sulfate 325mg [**Hospital1 **]

MEDICATION ON ADMISSION: Nadolol 40mg po daily
Lasix 20mg po daily
PPI 40mg po BID
Thiamine daily
Folate 1 mg daily
MVI daily
Iron Sulfate 325mg po BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam
Vitals: 98.4  131/78  105  100% on 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear.  NGT in place
with bright red blood
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1, pronounced S2, 3/6 SEM
loudest at apex, rubs, gallops
Abdomen:  soft, non-distended, bowel sounds present. Mild TTP
diffusely, no rebound tenderness or guarding.  Liver tip felt
below costal margin.  Spleen not palpable.
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
skin: diffuse psoriatic patches

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Reports 1-2 beers on the weekends.  He lives with his wife.  [**Name (NI) **]
has a history of IVDU, which is how he contracted HCV. 

### Response:
{'Gastroesophageal laceration-hemorrhage syndrome,Hypovolemia,Unspecified viral hepatitis C without hepatic coma,Alcoholic cirrhosis of liver,Aortic valve disorders,Portal hypertension,Precipitous drop in hematocrit,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified alcohol dependence, continuous,Tachycardia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other psoriasis'}
