CHIEF COMPLAINT: Melena

PRESENT ILLNESS: 57 yo M with h/o DMII, HTN, family h/o [**First Name3 (LF) 499**] CA (last
colonoscopy [**2153**] with adenomatous polypectomy) presents with an
episode of "tarry black stool" at 3 AM on the day of admission.
He reports a feeling of urgency, chills, and diaphoresis prior
to the episode. He denies lightheadedness, SOB, or chest pain.
He was seen on [**2154-11-18**] by his PCP for intermittent epigastric
abdominal pain radiating across his abdomen and up into his
chest x1 year. No known precipitants. At times if feels like
"indigestion". The pain is associated with nausea and anorexia.
He reports decreased appetite x4-5 days. Four days ago, he took
Citrate resulting in nausea and emesis. He describes the emesis
as brown with purple clots. He also notes an episode of tarry
black stools two weeks ago. He denies BRBPR, weight loss, fever,
diarrhea, chest pain, or shortness of breath.
.
In the ED a rectal exam revealed melanotic stool. NG lavage
revealed coffee grounds. His vital signs were stable. HR
100's/SBP 140's. Hct was 33 (10 points below baseline). He was
typed and crossed and started on IV PPI. GI was consulted; he
was transferred to the [**Hospital Unit Name 153**] for an endoscopy.
.
Upon arrival to the [**Hospital Unit Name 153**] he feels well w/o complaints.

MEDICAL HISTORY: - DMII
- HTN
- erectile dysfunction
- s/p right total hip replacement [**3-9**] for OA

MEDICATION ON ADMISSION: Metformin 1000+500mg [**Hospital1 **]
Glyburide 5mg daily
Aspirin
Lisinopril 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc 98.5 BP 148/79 HR 90 RR 14 Sat 100 % RA
Gen: well appearing male, NAD
HENNT: MMM, anicteric, PERRL
Neck: no LAD, no JVD
CV: RRR, nl S1S2, No M/R/G
Lungs: CTAB
Abd: soft, right sided tenderness to deep palpation, ND, +BS, No
HSM, no rebound or guarding
Ext: no edema, strong DP/PT pulses bilaterally
Neuro: A&Ox3

FAMILY HISTORY: Father with [**Name2 (NI) 499**] cancer. Brother with h/o bleeding ulcer and
lymphoma.

SOCIAL HISTORY: Denies Tob or Illicit drug use. Occasional EtOH. Works as an
accountant. Not married. Has a daughter.
Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Esophagitis, unspecified,Unspecified gastritis and gastroduodenitis, with hemorrhage,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,Unspecified essential hypertension
Chr duoden ulcer w hem,Esophagitis, unspecified,Gstr/ddnts NOS w hmrhg,DMII neuro nt st uncntrl,Neuropathy in diabetes,Diabetic retinopathy NOS,Hypertension NOS
Admission Date:  [**2154-11-23**]              Discharge Date:   [**2154-11-25**]

Date of Birth:  [**2097-5-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Melena

Major Surgical or Invasive Procedure:
EGD


History of Present Illness:
57 yo M with h/o DMII, HTN, family h/o [**First Name3 (LF) 499**] CA (last
colonoscopy [**2153**] with adenomatous polypectomy) presents with an
episode of "tarry black stool" at 3 AM on the day of admission.
He reports a feeling of urgency, chills, and diaphoresis prior
to the episode. He denies lightheadedness, SOB, or chest pain.
He was seen on [**2154-11-18**] by his PCP for intermittent epigastric
abdominal pain radiating across his abdomen and up into his
chest x1 year. No known precipitants. At times if feels like
"indigestion". The pain is associated with nausea and anorexia.
He reports decreased appetite x4-5 days. Four days ago, he took
Citrate resulting in nausea and emesis. He describes the emesis
as brown with purple clots. He also notes an episode of tarry
black stools two weeks ago. He denies BRBPR, weight loss, fever,
diarrhea, chest pain, or shortness of breath.
.
In the ED a rectal exam revealed melanotic stool. NG lavage
revealed coffee grounds. His vital signs were stable. HR
100's/SBP 140's. Hct was 33 (10 points below baseline). He was
typed and crossed and started on IV PPI. GI was consulted; he
was transferred to the [**Hospital Unit Name 153**] for an endoscopy.
.
Upon arrival to the [**Hospital Unit Name 153**] he feels well w/o complaints.

Past Medical History:
- DMII
- HTN
- erectile dysfunction
- s/p right total hip replacement [**3-9**] for OA

Social History:
Denies Tob or Illicit drug use. Occasional EtOH. Works as an
accountant. Not married. Has a daughter.

Family History:
Father with [**Name2 (NI) 499**] cancer. Brother with h/o bleeding ulcer and
lymphoma.

Physical Exam:
Tc 98.5 BP 148/79 HR 90 RR 14 Sat 100 % RA
Gen: well appearing male, NAD
HENNT: MMM, anicteric, PERRL
Neck: no LAD, no JVD
CV: RRR, nl S1S2, No M/R/G
Lungs: CTAB
Abd: soft, right sided tenderness to deep palpation, ND, +BS, No
HSM, no rebound or guarding
Ext: no edema, strong DP/PT pulses bilaterally
Neuro: A&Ox3


Pertinent Results:
[**2154-11-23**] 05:10AM   WBC-10.5 RBC-3.71* HGB-11.4* HCT-32.9* MCV-89
MCH-30.6 MCHC-34.6 RDW-12.7
[**2154-11-23**] 05:10AM   NEUTS-71.7* LYMPHS-22.3 MONOS-5.3 EOS-0.4
BASOS-0.4
[**2154-11-23**] 05:10AM   PLT COUNT-259

[**2154-11-23**] 05:10AM   PT-13.4* PTT-23.7 INR(PT)-1.2
[**2154-11-23**] 05:10AM   GLUCOSE-191* UREA N-43* CREAT-1.1 SODIUM-138
POTASSIUM-5.1 CHLORIDE-104 TOTAL CO2-22 ANION GAP-17
[**2154-11-23**] 05:10AM   ALT(SGPT)-11 AST(SGOT)-22 ALK PHOS-76
AMYLASE-65 TOT BILI-0.6
[**2154-11-23**] 05:10AM   LIPASE-46

[**2154-11-23**] 12:00PM   HCT-29.9*
[**2154-11-23**] 05:15PM   HCT-29.9*
[**2154-11-23**] 11:30PM   HCT-28.0*

Brief Hospital Course:
1) Upper GI bleed:  Pt came in with a lower Hct than baseline
but was hemodynamically stable.  Pt was admitted to [**Hospital Unit Name 153**] where a
EGD was done.  This showed 2 duodenal ulcers which were
cauterized.  After this his pain improved though it did not
subside completely.  His Hct remained stable at 28-29 for the
entire hospital stay.  He had one melanotic BM on day of
discharge that was thought to be due to old blood passing.  He
ate with minimal discomfort thought to be due to persistent
ulcer.  There were no signs of active bleeding, howevere.  He
was kept on a PPI [**Hospital1 **].  His H. pylori serology was positive and
pt was discharged on PrevPac for 2 weeks.
.
2) DM2:  Initially, oral hypoglycemics were held.  When pt
started on clears, metformin was restarted.  Glyburide was held
and pt instructed to restart that when he is taking regular
solids for at least 24hours.
.
3) HTN:  Continued on lisinopril after acute bleeding episode
resolved.

Medications on Admission:
Metformin 1000+500mg [**Hospital1 **]
Glyburide 5mg daily
Aspirin
Lisinopril 40mg daily

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours):
start taking after completing PrePac (in 2 weeks).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Metformin 500 mg Tablet Sig: Two (2) Tablet PO QAM (once a
day (in the morning)).
4. Metformin 500 mg Tablet Sig: One (1) Tablet PO QPM (once a
day (in the evening)).
5. Prevpac 500-500-30 mg Combo Pack Sig: One (1) daily
administration pack PO twice a day for 2 weeks.
Disp:*1 pack* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Duodenal ulcer


Discharge Condition:
Good--tolerating POs, hematocrit stable.


Discharge Instructions:
Maintain a low-fat, low-residue (limiting the amount of fibre in
the diet. Foods that have a high fibre content are wholegrain
cereals, wholemeal bread/ biscuits, nuts, seeds, dried fruits,
and skin/stalks of fruits and vegetables. Milk should be
consumed in moderation.) diet for next 2 days.

You may continue to have black stools over the next 2-3 days,
however, if they persist beyond that or if pain persists or you
feel weak or dizzy at all, please come to the ER.  If you feel
weak or dizzy, stop taking your lisinopril, and come to the ER.

For your diabetes continue taking the metformin.  Wait 1 day
until you are eating regularly until you restart the glyburide.

You have been prescribed PrevPac (antibiotics plus antacid)
which you should take as instructed for 2 weeks.  Once you
complete that, fill the prescription for pantoprazole (Protonix)
and continue on that.

Do not take aspirin until you are evaluated again by Dr. [**Last Name (STitle) 10689**]
or Dr. [**Last Name (STitle) **].

Followup Instructions:
Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10689**] on [**12-3**] per your
previous appointment.
If you have any trouble seeing him, call Dr. [**Last Name (STitle) 107416**] office
([**Telephone/Fax (1) 250**]) to schedule an appointment. It is very important
that you see a doctor next week to have your hematocrit checked.
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Esophagitis, unspecified,Unspecified gastritis and gastroduodenitis, with hemorrhage,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,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: Melena

PRESENT ILLNESS: 57 yo M with h/o DMII, HTN, family h/o [**First Name3 (LF) 499**] CA (last
colonoscopy [**2153**] with adenomatous polypectomy) presents with an
episode of "tarry black stool" at 3 AM on the day of admission.
He reports a feeling of urgency, chills, and diaphoresis prior
to the episode. He denies lightheadedness, SOB, or chest pain.
He was seen on [**2154-11-18**] by his PCP for intermittent epigastric
abdominal pain radiating across his abdomen and up into his
chest x1 year. No known precipitants. At times if feels like
"indigestion". The pain is associated with nausea and anorexia.
He reports decreased appetite x4-5 days. Four days ago, he took
Citrate resulting in nausea and emesis. He describes the emesis
as brown with purple clots. He also notes an episode of tarry
black stools two weeks ago. He denies BRBPR, weight loss, fever,
diarrhea, chest pain, or shortness of breath.
.
In the ED a rectal exam revealed melanotic stool. NG lavage
revealed coffee grounds. His vital signs were stable. HR
100's/SBP 140's. Hct was 33 (10 points below baseline). He was
typed and crossed and started on IV PPI. GI was consulted; he
was transferred to the [**Hospital Unit Name 153**] for an endoscopy.
.
Upon arrival to the [**Hospital Unit Name 153**] he feels well w/o complaints.

MEDICAL HISTORY: - DMII
- HTN
- erectile dysfunction
- s/p right total hip replacement [**3-9**] for OA

MEDICATION ON ADMISSION: Metformin 1000+500mg [**Hospital1 **]
Glyburide 5mg daily
Aspirin
Lisinopril 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc 98.5 BP 148/79 HR 90 RR 14 Sat 100 % RA
Gen: well appearing male, NAD
HENNT: MMM, anicteric, PERRL
Neck: no LAD, no JVD
CV: RRR, nl S1S2, No M/R/G
Lungs: CTAB
Abd: soft, right sided tenderness to deep palpation, ND, +BS, No
HSM, no rebound or guarding
Ext: no edema, strong DP/PT pulses bilaterally
Neuro: A&Ox3

FAMILY HISTORY: Father with [**Name2 (NI) 499**] cancer. Brother with h/o bleeding ulcer and
lymphoma.

SOCIAL HISTORY: Denies Tob or Illicit drug use. Occasional EtOH. Works as an
accountant. Not married. Has a daughter. 

### Response:
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Esophagitis, unspecified,Unspecified gastritis and gastroduodenitis, with hemorrhage,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,Unspecified essential hypertension'}
