CHIEF COMPLAINT: BRBPR

PRESENT ILLNESS: 73 yr old male with hx of CAD s/p recent ant MI with stent [**5-12**],
CHF, EF of 35% and a hx of GIB in [**2162**] who presents to the ED
with BRBPR. During the night prior to admission, pt had three
liquid bowel movements consisting of dark liquid with some
bright red blood and blood noted on the toilet paper. He denies
chest pain, abd pain, nausea but does have mild dizziness. Of
note, pt had an anterior MI with stent placement in [**5-12**] and
thus has been on ASA and plavix. When pt had a GIB in [**2162**], his
ASA was d/c'd. EGD at that time showed a duodenal ulcer and some
erosions while a colonoscopy showed only diverticula.
.
In [**Last Name (LF) **], [**First Name3 (LF) **] NG lavage was done and was negative though no bile
return noted either. Pt had 3 large bloody bowel movements in
the ED but remained hemodynamically stable. His hct was 31 and
he was tranfused one unit of PRBCs. He was also given one liter
of NS. GI evaluated the patient and brought him the endoscopy
suite for an EGD. Nothing was seen on EGD but after more
hematochezia (last episode ~6 p.m.), it was determined that the
pt was too unstable for the floor given that the source of the
bleed was still unknown and he was admitted to the MICU. In MICU
had been transfused 2U PRBCs since admission [**8-19**], remained HD
stable, has started Golytely prep and is still not clear, so he
will go for colonoscopy [**8-21**].

MEDICAL HISTORY: 1. CHF EF 15%
2. CAD s/p CABG and stent placement in [**5-12**]
3. HTN
4. h/o GIB in [**2162**]

MEDICATION ON ADMISSION: LASIX 40MG--2 tabs in in the morning and [**2-8**] in eve
QUININE SULFATE 260MG--At bedtime
RANITIDINE HCL 150MG--Qd-[**Hospital1 **] as needed for upset stomach
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
ASPIRIN 81 mg--1 tablet(s) by mouth once a day
DIOVAN 80 mg--1 tablet(s) by mouth once a day
ISOSORBIDE DINITRATE 10 mg--1 tablet(s) by mouth three times a
day
LIPITOR 80 mg--1 tablet(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth once a day
TOPROL XL 25 mg--[**2-8**] tablet(s) by mouth once a day

ALLERGIES: Ancef

PHYSICAL EXAM: On transfer from MICU
.
Tc 97.1, pt o/w afebrile BP 150-160/70s HR 58-65 RR 20, Sats
99RA. I/O not recorded since last evaluation.
Gen: elderly male, NAD
HEENT: PERRL, EOMI, anicteric, pale conjunctiva, MMM, OP clear
Neck: JVP at 10 cm, neck supple, no cervical lymphadenopathy
CV: RRR, 2/6 systolic murmur at RUSB heard earlier but not
appreciated on this encounter
Chest: CTAB with no crackles or wheeze, good air movement
throughout.
Abd: Obese, +BS, soft, NT/ND, no HSM
Ext: trace edema, warm, no palpable DP/PT but dopplerable this
AM

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with wife, denies current tobacco use, EtOH use or IVDU.
Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diverticulosis of colon (without mention of hemorrhage),Aortocoronary bypass status,Gout, unspecified,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Pure hypercholesterolemia
Gastrointest hemorr NOS,Ac posthemorrhag anemia,Chr airway obstruct NEC,Rheumatic heart failure,Mitral/aortic val insuff,Dvrtclo colon w/o hmrhg,Aortocoronary bypass,Gout NOS,Chr ischemic hrt dis NEC,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2167-8-19**]              Discharge Date:   [**2167-8-25**]

Date of Birth:  [**2094-6-13**]             Sex:   M

Service: MEDICINE

Allergies:
Ancef

Attending:[**First Name3 (LF) 663**]
Chief Complaint:
BRBPR

Major Surgical or Invasive Procedure:
1.  esophagogastroduodenoscopy (EGD)
2.  colonoscopy
3.  blood transfusion


History of Present Illness:
73 yr old male with hx of CAD s/p recent ant MI with stent [**5-12**],
CHF, EF of 35% and a hx of GIB in [**2162**] who presents to the ED
with BRBPR. During the night prior to admission, pt had three
liquid bowel movements consisting of dark liquid with some
bright red blood and blood noted on the toilet paper. He denies
chest pain, abd pain, nausea but does have mild dizziness. Of
note, pt had an anterior MI with stent placement in [**5-12**] and
thus has been on ASA and plavix. When pt had a GIB in [**2162**], his
ASA was d/c'd. EGD at that time showed a duodenal ulcer and some
erosions while a colonoscopy showed only diverticula.
.
In [**Last Name (LF) **], [**First Name3 (LF) **] NG lavage was done and was negative though no bile
return noted either. Pt had 3 large bloody bowel movements in
the ED but remained hemodynamically stable. His hct was 31 and
he was tranfused one unit of PRBCs. He was also given one liter
of NS. GI evaluated the patient and brought him the endoscopy
suite for an EGD. Nothing was seen on EGD but after more
hematochezia (last episode ~6 p.m.), it was determined that the
pt was too unstable for the floor given that the source of the
bleed was still unknown and he was admitted to the MICU. In MICU
had been transfused 2U PRBCs since admission [**8-19**], remained HD
stable, has started Golytely prep and is still not clear, so he
will go for colonoscopy [**8-21**].


Past Medical History:
1. CHF EF 15%
2. CAD s/p CABG and stent placement in [**5-12**]
3. HTN
4. h/o GIB in [**2162**]

Social History:
Lives with wife, denies current tobacco use, EtOH use or IVDU.

Family History:
NC

Physical Exam:
On transfer from MICU
.
Tc 97.1, pt o/w afebrile BP 150-160/70s HR 58-65 RR 20, Sats
99RA. I/O not recorded since last evaluation.
Gen: elderly male, NAD
HEENT: PERRL, EOMI, anicteric, pale conjunctiva, MMM, OP clear
Neck: JVP at 10 cm, neck supple, no cervical lymphadenopathy
CV: RRR, 2/6 systolic murmur at RUSB heard earlier but not
appreciated on this encounter
Chest: CTAB with no crackles or wheeze, good air movement
throughout.
Abd: Obese, +BS, soft, NT/ND, no HSM
Ext: trace edema, warm, no palpable DP/PT but dopplerable this
AM


Pertinent Results:
[**2167-8-19**] 11:49PM   CK(CPK)-40
[**2167-8-19**] 11:49PM   CK-MB-NotDone cTropnT-<0.01
[**2167-8-19**] 11:49PM   HCT-29.4*
[**2167-8-19**] 08:09PM   HCT-31.8*
[**2167-8-19**] 11:30AM   GLUCOSE-94 UREA N-59* CREAT-1.9* SODIUM-144
POTASSIUM-4.5 CHLORIDE-109* TOTAL CO2-25 ANION GAP-15
[**2167-8-19**] 11:30AM   CK-MB-3 cTropnT-0.01
[**2167-8-19**] 11:30AM   WBC-9.3 RBC-3.36* HGB-10.7* HCT-31.0* MCV-92
MCH-31.9 MCHC-34.6 RDW-15.1

Brief Hospital Course:
1. Gastrointestinal bleed, presumed small bowel: As detailed
predominantly in HPI.
In ED on admission, pt had an NG lavage which was negative,
though no bile return noted either. Pt had 3 large bloody bowel
movements in the ED but remained hemodynamically stable. His hct
was 31 and he was tranfused one unit of PRBCs. He was also given
one liter of NS. GI evaluated the patient and brought him the
endoscopy suite for an EGD. EGD unrevealing.  Once transferred
from the MICU to the floor, colonscopy demonstrated colonic
diverticula that had been noted on a prior study, but was
otherwise unremarkable. Pt's hematocrit continued to slowly
fall, though he remained HD stable. Angiography performed
[**2167-8-21**] showed small blush of tracer activity in the right upper
quadrant which does not persist. It was unclear whether this
represents bleeding into the large bowel, in the region of the
hepatic flexure, or into the small bowel.  It was interpreted as
"weakly positive", though there was no intervention deemed to be
necessary based on this study. The patient continued to have
some melenic stool with small hct drops, though was HD stable
throughout his hospitalization after transfer to the medicine
floor. He received multiple blood transfusions to maintain hct
>30.  As pt had remained HD stable >4 days despite small hct
drop, and no intervention was indicated based on available data,
pt was discharged in good condition with instructions to follow
up for hct checks, as well as for possible further GI
intervention.
.
2. Diverticuli: Stable throughout admission.
.
3. Coronary artery disease: Stable throughout admission.
Decision was made by attending physician to hold ASA and Plavix
in light of continued bleeding. Pt was discharged with
instructions to hold Plavix until speaking again with PCP
[**Name Initial (PRE) **].
.
4. HTN: remained stable. Pt maintained on home regimen as BP
tolerated.

Medications on Admission:
LASIX 40MG--2 tabs in in the morning and [**2-8**] in eve
QUININE SULFATE 260MG--At bedtime
RANITIDINE HCL 150MG--Qd-[**Hospital1 **] as needed for upset stomach
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
ASPIRIN 81 mg--1 tablet(s) by mouth once a day
DIOVAN 80 mg--1 tablet(s) by mouth once a day
ISOSORBIDE DINITRATE 10 mg--1 tablet(s) by mouth three times a
day
LIPITOR 80 mg--1 tablet(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth once a day
TOPROL XL 25 mg--[**2-8**] tablet(s) by mouth once a day


Discharge Medications:
1. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
2. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO every other
day.
3. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Toprol XL 25 mg Tablet Sustained Release 24HR Sig: 0.5 Tablet
Sustained Release 24HR PO once a day.
7. Lasix 40 mg Tablet Sig: Two (2) Tablet PO qAM.
8. Lasix 40 mg Tablet Sig: 1-2 Tablets PO qPM.
9. Outpatient Lab Work
[**9-1**]:  Hct

Please have results faxed to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital1 771**], fax # is ([**Telephone/Fax (1) 16691**].  The phone
number is ([**Telephone/Fax (1) 1300**] if needed.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1.  gastrointestinal bleed, presumed small bowel
2.  diverticuli
Secondary:
1.  coronary artery disease
2.  hypertension


Discharge Condition:
stable, tolerating po, stable hematocrit, no further BRBPR

Discharge Instructions:
To patient: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3
lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1500cc
.
If you notice more bright red blood in the stool, or if you feel
dizzy, lightheaded, or weak, call your primary care doctor or go
to the emergency room.
.
Your aspirin and Plavix have been stopped for now.  Please do
not take these medications until you are instructed to restart
them.  If your blood count is stable when tested next week, Dr.
[**First Name (STitle) **] may tell you to restart these medications.

Followup Instructions:
To patient: You need to have your blood drawn in 1 week. Please
have these results faxed to Dr.[**Name (NI) 17410**] office.
.
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Where: [**Hospital6 29**]
[**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2167-9-21**]
11:40
.
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Where: [**Hospital6 29**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 5003**] Date/Time:[**2167-10-13**] 10:30
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diverticulosis of colon (without mention of hemorrhage),Aortocoronary bypass status,Gout, unspecified,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: BRBPR

PRESENT ILLNESS: 73 yr old male with hx of CAD s/p recent ant MI with stent [**5-12**],
CHF, EF of 35% and a hx of GIB in [**2162**] who presents to the ED
with BRBPR. During the night prior to admission, pt had three
liquid bowel movements consisting of dark liquid with some
bright red blood and blood noted on the toilet paper. He denies
chest pain, abd pain, nausea but does have mild dizziness. Of
note, pt had an anterior MI with stent placement in [**5-12**] and
thus has been on ASA and plavix. When pt had a GIB in [**2162**], his
ASA was d/c'd. EGD at that time showed a duodenal ulcer and some
erosions while a colonoscopy showed only diverticula.
.
In [**Last Name (LF) **], [**First Name3 (LF) **] NG lavage was done and was negative though no bile
return noted either. Pt had 3 large bloody bowel movements in
the ED but remained hemodynamically stable. His hct was 31 and
he was tranfused one unit of PRBCs. He was also given one liter
of NS. GI evaluated the patient and brought him the endoscopy
suite for an EGD. Nothing was seen on EGD but after more
hematochezia (last episode ~6 p.m.), it was determined that the
pt was too unstable for the floor given that the source of the
bleed was still unknown and he was admitted to the MICU. In MICU
had been transfused 2U PRBCs since admission [**8-19**], remained HD
stable, has started Golytely prep and is still not clear, so he
will go for colonoscopy [**8-21**].

MEDICAL HISTORY: 1. CHF EF 15%
2. CAD s/p CABG and stent placement in [**5-12**]
3. HTN
4. h/o GIB in [**2162**]

MEDICATION ON ADMISSION: LASIX 40MG--2 tabs in in the morning and [**2-8**] in eve
QUININE SULFATE 260MG--At bedtime
RANITIDINE HCL 150MG--Qd-[**Hospital1 **] as needed for upset stomach
ALLOPURINOL 100 mg--1 tablet(s) by mouth every other day
ASPIRIN 81 mg--1 tablet(s) by mouth once a day
DIOVAN 80 mg--1 tablet(s) by mouth once a day
ISOSORBIDE DINITRATE 10 mg--1 tablet(s) by mouth three times a
day
LIPITOR 80 mg--1 tablet(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth once a day
TOPROL XL 25 mg--[**2-8**] tablet(s) by mouth once a day

ALLERGIES: Ancef

PHYSICAL EXAM: On transfer from MICU
.
Tc 97.1, pt o/w afebrile BP 150-160/70s HR 58-65 RR 20, Sats
99RA. I/O not recorded since last evaluation.
Gen: elderly male, NAD
HEENT: PERRL, EOMI, anicteric, pale conjunctiva, MMM, OP clear
Neck: JVP at 10 cm, neck supple, no cervical lymphadenopathy
CV: RRR, 2/6 systolic murmur at RUSB heard earlier but not
appreciated on this encounter
Chest: CTAB with no crackles or wheeze, good air movement
throughout.
Abd: Obese, +BS, soft, NT/ND, no HSM
Ext: trace edema, warm, no palpable DP/PT but dopplerable this
AM

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with wife, denies current tobacco use, EtOH use or IVDU. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Diverticulosis of colon (without mention of hemorrhage),Aortocoronary bypass status,Gout, unspecified,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Pure hypercholesterolemia'}
