CHIEF COMPLAINT: black stools and weakness x 7 days.

PRESENT ILLNESS: 87 yo f w/ h/o CHF, htn, afib, and h/o recent fall resulting in
a compression [**Hospital **] transferred from [**Hospital3 **] for c/o black
stools w/ hct 16.3 and INR 32.3 due to no available ICU beds at
[**Hospital1 392**]. Patient was AF, bp 130/44 and hr 87. She received 2 U
PRBC, 40 IV protonix, and 10 mg IV vit K for this. On arrival to
[**Hospital1 18**] ER, hct 25.2 and INR 2.1. BP 150/54 and hr 70. Patient
received additional 5 mg SQ vit K, in addition to 2 U FFP. NG
lavage was done and yielded coffee ground emesis w/ the first
250 cc, followed by a pink-tinged fluid with the second 250 cc.
On hx patient reports no po x 2 weeks due to nausea w/o c/o pain
w/ eating. She has never had black stools in the past. She is on
coumadin and her level was low 3 weeks ago (per her report) and
thus her coumadin was increased. Patient denies any diarrhea w/
the black stool. She is N but no V, and she denies abd pain. No
h/o NSAIDs and no h/o PUD. No BRBPR or hematemesis. She also
denies c/o LH, COP, or SOB. However, she has been completely
exhausted for the past week.

MEDICAL HISTORY: ## CHF
## HTN
## afib on coumadin
## h/o compression fx due to fall
## s/p recent fall (2 wks ago)

MEDICATION ON ADMISSION: coumadin 1 mg po qd
lasix 40 mg po qam, 20 mg po qpm
atenolol 100 mg po qd
amlodipine 5 mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1 hr 71 bp 155/65 rr 18 O2 92% RA (100% on 4L NC)
genrl: in nad, pleasant
heent: perrla (3->2 mm), MMM, OP clear, NGT in place (120 cc
lavage continues to produce coffee grounds)
neck: no JVD
cv: rrr, no m/r/g
pulm: cta bilaterally
abd: nabs, soft, nt/nd, no masses/hsm
rectal: black, guiac positive stool surrounding anus
extr: no [**Location (un) **]
neuro: a, o x 3, strength and soft touch sensation [**6-5**] grossly
in UE/LE

FAMILY HISTORY: NC

SOCIAL HISTORY: + h/o tob: [**11-20**] pk yr hx, quit 25 yrs ago.
No Etoh x 4 yrs, occasional in the past.
Married and has 1 daughter. Contact for emergencies: [**Name (NI) **] [**Name (NI) **]
(sister).
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Acute posthemorrhagic anemia
Chr stomach ulc w hem,CHF NOS,Atrial fibrillation,Hypertension NOS,Long-term use anticoagul,Ac posthemorrhag anemia
Admission Date:  [**2149-11-29**]              Discharge Date:   [**2149-12-3**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
black stools and weakness x 7 days.

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy


History of Present Illness:
87 yo f w/ h/o CHF, htn, afib, and h/o recent fall resulting in
a compression [**Hospital **] transferred from [**Hospital3 **] for c/o black
stools w/ hct 16.3 and INR 32.3 due to no available ICU beds at
[**Hospital1 392**]. Patient was AF, bp 130/44 and hr 87. She received 2 U
PRBC, 40 IV protonix, and 10 mg IV vit K for this. On arrival to
[**Hospital1 18**] ER, hct 25.2 and INR 2.1. BP 150/54 and hr 70. Patient
received additional 5 mg SQ vit K, in addition to 2 U FFP. NG
lavage was done and yielded coffee ground emesis w/ the first
250 cc, followed by a pink-tinged fluid with the second 250 cc.
On hx patient reports no po x 2 weeks due to nausea w/o c/o pain
w/ eating. She has never had black stools in the past. She is on
coumadin and her level was low 3 weeks ago (per her report) and
thus her coumadin was increased. Patient denies any diarrhea w/
the black stool. She is N but no V, and she denies abd pain. No
h/o NSAIDs and no h/o PUD. No BRBPR or hematemesis. She also
denies c/o LH, COP, or SOB. However, she has been completely
exhausted for the past week.


Past Medical History:
## CHF
## HTN
## afib on coumadin
## h/o compression fx due to fall
## s/p recent fall (2 wks ago)


Social History:
+ h/o tob: [**11-20**] pk yr hx, quit 25 yrs ago.
No Etoh x 4 yrs, occasional in the past.
Married and has 1 daughter. Contact for emergencies: [**Name (NI) **] [**Name (NI) **]
(sister).


Family History:
NC



Physical Exam:
T 99.1 hr 71 bp 155/65 rr 18 O2 92% RA (100% on 4L NC)
genrl: in nad, pleasant
heent: perrla (3->2 mm), MMM, OP clear, NGT in place (120 cc
lavage continues to produce coffee grounds)
neck: no JVD
cv: rrr, no m/r/g
pulm: cta bilaterally
abd: nabs, soft, nt/nd, no masses/hsm
rectal: black, guiac positive stool surrounding anus
extr: no [**Location (un) **]
neuro: a, o x 3, strength and soft touch sensation [**6-5**] grossly
in UE/LE


Pertinent Results:
[**2149-11-29**] 02:42PM   WBC-16.8* RBC-2.81* HGB-9.0* HCT-25.2* MCV-90
MCH-31.9 MCHC-35.6* RDW-16.0*  PLT COUNT-281
[**2149-11-29**] 02:42PM   NEUTS-82.8* LYMPHS-13.3* MONOS-3.5 EOS-0.3
BASOS-0.2
[**2149-11-29**] 02:42PM   PT-17.5* PTT-26.8 INR(PT)-2.1
[**2149-11-29**] 02:42PM   GLUCOSE-115* UREA N-45* CREAT-1.0 SODIUM-141
POTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-30 ANION GAP-14
.
[**2149-12-3**] 05:03AM BLOOD WBC-11.7* RBC-3.53* Hgb-11.4* Hct-32.7*
MCV-93 MCH-32.2* MCHC-34.8 RDW-15.5 Plt Ct-325
[**2149-12-3**] 05:03AM BLOOD Plt Ct-325
[**2149-12-3**] 05:03AM BLOOD Glucose-91 UreaN-21* Creat-1.0 Na-139
K-4.2 Cl-99 HCO3-31 AnGap-13
[**2149-12-3**] 05:03AM BLOOD Mg-1.8
.
CXR [**2149-11-29**]:
[**Hospital 93**] MEDICAL CONDITION:
87 year old woman with bibasilar crackles w/ h/o chf
REASON FOR THIS EXAMINATION:
r/o CHF
HISTORY: Bibasilar crackles, rule out CHF.

CHEST, SINGLE AP VIEW. No previous chest x-rays on PACS record
for comparison.

The lungs are hyperinflated. There is moderate to moderately
severe cardiomegaly. There is subsegmental atelectasis and/or
scarring at both bases. There is minimal blunting of both
costophrenic angles. There is no CHF or frank consolidation. I
doubt the presence of an infectious infiltrate. There is right
upper hilar peribronchial cuffing. Linear atelectasis or
scarring noted in the right mid zone. An NG tube is present, tip
over proximal stomach. There is osteopenia and an old ununited
left clavicle fracture.

IMPRESSION: Hyperinflation and cardiomegaly. Right upper hilar
peribronchial cuffing. No CHF. Doubt acute infectious
infiltrate.
.
CT HEAD W/O CONTRAST  [**2149-11-29**] 4:59 PM

CT HEAD W/O CONTRAST

Reason: r/o ich

[**Hospital 93**] MEDICAL CONDITION:
87 year old woman with recent head trauma, INR 35
REASON FOR THIS EXAMINATION:
r/o ich
CONTRAINDICATIONS for IV CONTRAST: None.

CT HEAD

INDICATION: Recent head trauma, INR 35.

No prior studies are available for comparison.

TECHNIQUE: Non-contrast head CT.

FINDINGS: There is no intraparenchymal or extra-axial
hemorrhage. There is no shift of normally midline structures,
mass effect or hydrocephalus. There is mild prominence of the
ventricles and sulci consistent with age-related involutional
change. Encephalomalacic changes are demonstrated in the
anterior and medial portions of the frontal lobes bilaterally.
There is also encephalomalacic change demonstrated in the left
occipital lobe. Periventricular white matter hypodensities are
also noted consistent with chronic small vessel ischemic change.
The visualized paranasal sinuses and osseous structures are
within normal limits.

IMPRESSION:
1. No intracranial hemorrhage or mass effect.
2. Encephalomalacic changes in the bifrontal lobes and left
occipital lobe.
.
CXR [**2149-11-29**]:
Atrial fibrillation
Modest nonspecific intraventricular conduction delay
Modest ST-T wave changes with probable QT interval prolonged
although is
difficult to measure - are nonspecific but clinical correlation
is suggested for possible in part metabolc/drug effect.
No previous tracing available for comparison

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
78 0 118 446/479 0 -21 107
.
Patient: [**Known firstname 2127**] [**Known lastname 780**]
Ref.Phys.:
Birth Date: [**2062-8-14**] (87 years) Instrument: GIF XQ140
gastroscope
ID#: [**Numeric Identifier 62551**] ASA Class: P2
Medications: Cetacaine topical spray
Meperidine 25mg
Midazolam 1mg

Procedure: The procedure, indications, preparation and potential
complications were explained to the patient, who indicated her
understanding and signed the corresponding consent forms. A
physical exam was performed. The patient was administered
Conscious sedation anesthesia. The patient was placed in the
left lateral decubitus position and an endoscope was introduced
through the mouth and advanced under direct visualization until
the second part of the duodenum was reached. Careful
visualization of the upper GI tract was performed. The procedure
was not difficult. The patient tolerated the procedure well.
There were no complications.
Findings: Esophagus:
 Lumen: A small size hiatal hernia was seen.
 Excavated Lesions A single non-bleeding 6mm ulcer was found in
the gastroesophageal junction.
Stomach:
 Contents: Old blood was seen in the stomach. No sites of active
bleeding were identified.
Duodenum: Normal duodenum.
Impression: Blood in the stomach
Ulcer in the gastroesophageal junction
Small hiatal hernia


Brief Hospital Course:
87 yo f w/ h/o CHF, HTN, fib, and h/o recent fall transferred
from OSH w/ likely UGI in setting of elevated INRX (on
Coumadin).
.
## UGI:  The patient's HCT was 16.3 with INR 32.3 at OSH. The
patient received 2 units of PR BC, Protonix 40 mg iv, and 10 mg
IV Vit K at the OSH.  Due to no ICU availability, the patient
was transferred to [**Hospital1 18**]. On arrival to [**Hospital1 18**], her HCT was 25.2
with INR 2.1.  She received additional mg sc Vit K and 2 u FFP.
NG lavage showed coffee ground emesis followed by a pink-tinged
fluid. CT of head was neg for bleeds.  The patient was started
on Protonix 40 mg iv bid and observed overnight in the MICU, and
GI did not feel that urgent EGD was necessary as the patient was
hemodynamically stable with stable HCT after blood transfusion.
The patient was transferred to the floor in a hemodynamically
stable and hct was stable at 33.2.  EGD was performed on [**12-1**]
which showed an ulcer at GE junction and old blood in the
stomach without signs of active bleeding.  The patient was
switched to po Protonix [**Hospital1 **] after the procedure and hct
continued to remain stable at the time of discharge.  The
patient is to follow up with Dr. [**First Name (STitle) 1356**], her PCP, [**Name10 (NameIs) **] decide on
when to restart coumadin and close monitor of INR when she gets
placed on coumadin again.
.
## CHF: After a total of 4 units of PRBC transfusion, the
patient became hypoxemic and required supplemental O2 to keep O2
sat above 92.  Her lung exam was consistent with pulmonary
edema.  She was given IV lasix and her hypoxemia resolved.  Once
satting 95-97% on RA, she was restarted on her outpatient po
lasix regimen.
.
## Afib: Held beta blocker initially given UGIB. Once stable
hemodynamically, outpatient atenolol 100mg qday and amlodipine
5mg qday were restarted for rate control.  No coumadin was given
during this hospitalization. GI felt that she can be restarted
on coumadin but with close monitor of INR with goal of [**3-6**].
.
## HTN: No antihypertensives given while in the MICU.  Received
lasix iv for pulmonary edema and gradually added her outpatient
antihypertensives, atenolol, amlodipine, and lasix.
.
## S/p recent fall: Head CT w/o bleed or shift. The patient did
not have other musculoskeletal pain anywhere.
.
## Leukocytosis: No clear sources and the patient remained
afebrile. WBC continued to trend down and at the time of
discharge, wbc was 11.7.  Ua/ucx and bcx and CXR were negative
for infection.
.
## PPX: pneumoboots, ppi
- PT recommended outpatient PT as the patient became
deconditioned during this hospitalization.  The patient was
discharged home with PT services.
.
## FEN: Cardiac diet. Repleted 'lytes/prn.
.
## Full code (confirmed w/ patient)



Medications on Admission:
coumadin 1 mg po qd
lasix 40 mg po qam, 20 mg po qpm
atenolol 100 mg po qd
amlodipine 5 mg po qd


Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Furosemide 40 mg Tablet Sig: One (1) Tablet PO qam.
Disp:*30 Tablet(s)* Refills:*2*
3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO QPM (once a
day (in the evening)).
Disp:*30 Tablet(s)* Refills:*2*
4. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
6. Ativan 0.5 mg Tablet Sig: [**2-2**] Tablet PO once a day as needed
for anxiety for 10 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Home Health Care

Discharge Diagnosis:
Principal:
1. Upper GI bleed.
2. Gastric Ulcer.
3. Blood Loss Anemia.

Secondary:
1. Atrial Fibrillation.
2. Heart Failure (EF unknown)
3. Hypertension.
4. Vertebral Compression Fracture.


Discharge Condition:
Stable. Hematocrit stable at 32.7.


Discharge Instructions:
Return to the emergency department or call your primary care
physician if you develop chest pain, shortness of breath, blood
in your stools, abdominal pain, nausea, vomiting, bloody sputum,
or any other worrisome symptoms.

Do not take coumadin until you see you primary care physician
tells you so.  You may resume all your blood pressure
medications as previously prescribed.  We've added Protonix 40mg
twice a day for your stomach ulcer.  You have a follow-up
appointment with Dr. [**First Name (STitle) 1356**] on [**2149-12-4**], Thursday at 10:50 am.
Discuss with your primary care physician about starting calcium,
vitamin D, and possibly bisphophonates for osteoporosis.


Followup Instructions:
1. Provider: [**Name10 (NameIs) 1356**], [**Name11 (NameIs) **] [**Name Initial (NameIs) **]. Phone number: [**Telephone/Fax (1) 17465**].
Date/Time: [**2149-12-4**] at 10:50am.
2. Outpatient H. Pylori antibody assay - to be performed by Dr.
[**First Name (STitle) 1356**].
3. Please ask Dr. [**First Name (STitle) 1356**] to start you on calcium and vitamin D
supplementation for osteoporosis. She may also add another
medication callled a Bisphosphonate for this as well.
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Acute posthemorrhagic anemia'}


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: black stools and weakness x 7 days.

PRESENT ILLNESS: 87 yo f w/ h/o CHF, htn, afib, and h/o recent fall resulting in
a compression [**Hospital **] transferred from [**Hospital3 **] for c/o black
stools w/ hct 16.3 and INR 32.3 due to no available ICU beds at
[**Hospital1 392**]. Patient was AF, bp 130/44 and hr 87. She received 2 U
PRBC, 40 IV protonix, and 10 mg IV vit K for this. On arrival to
[**Hospital1 18**] ER, hct 25.2 and INR 2.1. BP 150/54 and hr 70. Patient
received additional 5 mg SQ vit K, in addition to 2 U FFP. NG
lavage was done and yielded coffee ground emesis w/ the first
250 cc, followed by a pink-tinged fluid with the second 250 cc.
On hx patient reports no po x 2 weeks due to nausea w/o c/o pain
w/ eating. She has never had black stools in the past. She is on
coumadin and her level was low 3 weeks ago (per her report) and
thus her coumadin was increased. Patient denies any diarrhea w/
the black stool. She is N but no V, and she denies abd pain. No
h/o NSAIDs and no h/o PUD. No BRBPR or hematemesis. She also
denies c/o LH, COP, or SOB. However, she has been completely
exhausted for the past week.

MEDICAL HISTORY: ## CHF
## HTN
## afib on coumadin
## h/o compression fx due to fall
## s/p recent fall (2 wks ago)

MEDICATION ON ADMISSION: coumadin 1 mg po qd
lasix 40 mg po qam, 20 mg po qpm
atenolol 100 mg po qd
amlodipine 5 mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1 hr 71 bp 155/65 rr 18 O2 92% RA (100% on 4L NC)
genrl: in nad, pleasant
heent: perrla (3->2 mm), MMM, OP clear, NGT in place (120 cc
lavage continues to produce coffee grounds)
neck: no JVD
cv: rrr, no m/r/g
pulm: cta bilaterally
abd: nabs, soft, nt/nd, no masses/hsm
rectal: black, guiac positive stool surrounding anus
extr: no [**Location (un) **]
neuro: a, o x 3, strength and soft touch sensation [**6-5**] grossly
in UE/LE

FAMILY HISTORY: NC

SOCIAL HISTORY: + h/o tob: [**11-20**] pk yr hx, quit 25 yrs ago.
No Etoh x 4 yrs, occasional in the past.
Married and has 1 daughter. Contact for emergencies: [**Name (NI) **] [**Name (NI) **]
(sister). 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Congestive heart failure, unspecified,Atrial fibrillation,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Acute posthemorrhagic anemia'}
