CHIEF COMPLAINT: UGIB, Acute leukemia

PRESENT ILLNESS: 80 yo M with cutis leukemia presents with UGIB. Pt had 1 episode
of hematemasis and melana on day of presentation. He was c/o
feeling more fatigued, unable to do ADLs due to fatigue, feeling
"really sick", "wiped out", feeling very dizzy and light headed.
He was having difficulty walking, problems with his balance and
gait instability. He denied any fevers/chills but has had
sweats. No sick contacts or recent travelling. On morning of
admission pt had an acute episode of brown emesis without any
nausea. 2 days PTA pt noticed black stools, no frank blood in
stools or urine and no episodes of hematemesis. His weight has
been steady. He denies any back pain, + HA but no visual
changes, no floaters or blurry vision. He presented to an OSH
due to increasing lethargy, fatigue and episode of coffee ground
emesis and melena.
.
OSH Course: ?. no records sent from ED to [**Hospital Unit Name 153**].
.
ED Course: Initial VS: 97.0 BP 109/65 HR 74 18;  NGL grossly
positive with ~250cc bright red blood, protonix 40 IV x1, GI
aware. Heme Onc C/S. Pt remained HD stable in ED. Admitted to
ICU for further monitoring.

MEDICAL HISTORY: .
PastOncHx
#MDS/Myeloproliferative Disease - He noticed a LLE rash in early
[**Month (only) 116**]. He went to his PCP and had an US which was negative for
DVT. He was given a tetanus shot and started on Keflex. The rash
did not improve. He underwent a skin biopsy on [**5-15**] with the
final dx of "atypical dermal mononuclear infiltrate with
monocytic features - findings c/w leukemia cutis". He was seen
by Dr. [**First Name (STitle) **] in Oncology at [**Location (un) 73424**] Cancer Center. Per
report -CBC on [**5-14**] -WBC 9800 51N 28Bands 18Mono. H/H 11.8/35.
PLT [**Numeric Identifier 73425**]. He had a bone marrow bx on [**6-16**] which was notable
for Markedly hypercellular marrow with orderly maturation, mild
dysmegakaryopoiesis and slightly decreased iron stores. No
blasts noted. Aspirate had <1% ringed sideroblasts. Flow - nl
study - no increased blasts. No clonal abnormalities. Negative
JAK2 mutation. WBC on [**6-16**] was 11.
#Prostate cancer s/p Turp and Lupron x 1 yr (last [**10-26**])
.
-Sarcoid [**2144**]
-Endocarditis [**2182**]
-S/P CABG - 2 vessel/AVR
-S/P L THR
-S/P herniorrhaphy
-S/P cataract surgery

MEDICATION ON ADMISSION: -ASA 81 mg daily
-Atenolol 25 mg daily
-Tricor 145 mg daily
-Calcium/Vitamin D
-MVI
-Omega3

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on admission:
VS: 98.9 BP 126/74 HR 70 RR 19 96% 4LNC
GEN: Comfortably lying in bed in NAD
HEENT:MMM, OP clear-no mucositis, no oral lesions, no cervical
LAD, R eye w/echymosis over lid-no orbital edema or conjunctival
bleed
RESP: CTABL, no crackles, no wheezing
CV: Reg Nml S1, S2, no M/R/G, Sternotomy scar well healed
ABD: Soft ND/NT +BS
EXT/skin: LLE swollen, non-pitting edema, large 3x3cm raised
violacious mass on lower LLE shin, large raised
papules/indurated on posterior knee, thigh and inguinal area on
L side, diffuse indurated papules ~.5mm x1cm lesions on chest,
abdomen, legs and back
NEURO: A&O x3, no focal deficits

FAMILY HISTORY: -no known CA in family, no bleeding d/o

SOCIAL HISTORY: -He is married and lives with his wife. [**Name (NI) 73426**] [**Name2 (NI) **] II Veteran,
?toxin exposure during war, unclear about occupational exposures
-He chews [**1-24**] cigars/day x60 years, +ETOH 4-5oz whiskey per day,
however no ETOH in few weeks.
Acute myeloid leukemia, without mention of having achieved remission,Hemorrhage of gastrointestinal tract, unspecified,Sarcoidosis,Retention of urine, unspecified,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Defibrination syndrome,Personal history of malignant neoplasm of prostate,Hip joint replacement,Aortocoronary bypass status
Ac myl leuk wo achv rmsn,Gastrointest hemorr NOS,Sarcoidosis,Retention urine NOS,Chronic kidney dis NOS,Acute kidney failure NOS,Defibrination syndrome,Hx-prostatic malignancy,Joint replaced hip,Aortocoronary bypass
Admission Date:  [**2195-7-7**]              Discharge Date:   [**2195-7-9**]

Date of Birth:  [**2114-10-20**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
UGIB, Acute leukemia


Major Surgical or Invasive Procedure:
leukophareisis
CVVH

History of Present Illness:
80 yo M with cutis leukemia presents with UGIB. Pt had 1 episode
of hematemasis and melana on day of presentation. He was c/o
feeling more fatigued, unable to do ADLs due to fatigue, feeling
"really sick", "wiped out", feeling very dizzy and light headed.
He was having difficulty walking, problems with his balance and
gait instability. He denied any fevers/chills but has had
sweats. No sick contacts or recent travelling. On morning of
admission pt had an acute episode of brown emesis without any
nausea. 2 days PTA pt noticed black stools, no frank blood in
stools or urine and no episodes of hematemesis. His weight has
been steady. He denies any back pain, + HA but no visual
changes, no floaters or blurry vision. He presented to an OSH
due to increasing lethargy, fatigue and episode of coffee ground
emesis and melena.
.
OSH Course: ?. no records sent from ED to [**Hospital Unit Name 153**].
.
ED Course: Initial VS: 97.0 BP 109/65 HR 74 18;  NGL grossly
positive with ~250cc bright red blood, protonix 40 IV x1, GI
aware. Heme Onc C/S. Pt remained HD stable in ED. Admitted to
ICU for further monitoring.


Past Medical History:
.
PastOncHx
#MDS/Myeloproliferative Disease - He noticed a LLE rash in early
[**Month (only) 116**]. He went to his PCP and had an US which was negative for
DVT. He was given a tetanus shot and started on Keflex. The rash
did not improve. He underwent a skin biopsy on [**5-15**] with the
final dx of "atypical dermal mononuclear infiltrate with
monocytic features - findings c/w leukemia cutis". He was seen
by Dr. [**First Name (STitle) **] in Oncology at [**Location (un) 73424**] Cancer Center. Per
report -CBC on [**5-14**] -WBC 9800 51N 28Bands 18Mono. H/H 11.8/35.
PLT [**Numeric Identifier 73425**]. He had a bone marrow bx on [**6-16**] which was notable
for Markedly hypercellular marrow with orderly maturation, mild
dysmegakaryopoiesis and slightly decreased iron stores. No
blasts noted. Aspirate had <1% ringed sideroblasts. Flow - nl
study - no increased blasts. No clonal abnormalities. Negative
JAK2 mutation. WBC on [**6-16**] was 11.
#Prostate cancer s/p Turp and Lupron x 1 yr (last [**10-26**])
.
-Sarcoid [**2144**]
-Endocarditis [**2182**]
-S/P CABG - 2 vessel/AVR
-S/P L THR
-S/P herniorrhaphy
-S/P cataract surgery

Social History:
-He is married and lives with his wife. [**Name (NI) 73426**] [**Name2 (NI) **] II Veteran,
?toxin exposure during war, unclear about occupational exposures
-He chews [**1-24**] cigars/day x60 years, +ETOH 4-5oz whiskey per day,
however no ETOH in few weeks.

Family History:
-no known CA in family, no bleeding d/o

Physical Exam:
on admission:
VS: 98.9 BP 126/74 HR 70 RR 19 96% 4LNC
GEN: Comfortably lying in bed in NAD
HEENT:MMM, OP clear-no mucositis, no oral lesions, no cervical
LAD, R eye w/echymosis over lid-no orbital edema or conjunctival
bleed
RESP: CTABL, no crackles, no wheezing
CV: Reg Nml S1, S2, no M/R/G, Sternotomy scar well healed
ABD: Soft ND/NT +BS
EXT/skin: LLE swollen, non-pitting edema, large 3x3cm raised
violacious mass on lower LLE shin, large raised
papules/indurated on posterior knee, thigh and inguinal area on
L side, diffuse indurated papules ~.5mm x1cm lesions on chest,
abdomen, legs and back
NEURO: A&O x3, no focal deficits

Brief Hospital Course:
1. AML with monocytic differentiation:
- Heme onc followed patient. Patient received Leukophoresis, and
Hydroxyurea with WBC decreasing from 170 initially to 51
thousand.
.
2. UGIB: gastric ulcer vs. cutis leukemia infiltration, PLT wnl
although appear to be non functional. serial Hct q2-4hr were
drawn. GI following was following patient. Patient was given
protone pump inhibitor.
.
3. ARF: It remained unclear what patients baseline was, however
creatinine worsening 4.2 to 5 probably due to tumor lysis
syndrome. Renal consult followed patient, and  CVVH was
initiated to balance electrolyte dearrangement secondary to
tumor lysis syndrome. CVVH was discontinued after a discussion
with patients wife regarding patients own wishes and thoughts
about comfort meassures vs. aggressive managment. Ms. [**Known lastname **]
clearly stated that comfort has priority and aggressive
managment in the setting of poor prognosis would have not been
patients wishes.
.
4. Hematuria: Foley catheter was changed urology team, with
continues bladder irrigations. Patient had signs of urethral
obstruction
.
Given multi-organ system dysfunction, severe alteration of
patients mental status and progression of dysfunction extensive
discussions were conducted wtih patient's wife.  She expressed
that patient would not want continued aggressive measures in the
absence of meaningful chance of return to pre-morbid baseline
function.  This was shared with the patient's primary oncology
team and decision was made to maintain patient comfort as the
primary goal of care in the setting of progressive respiratory
decline and likely ongoing aspiration in the setting of imparied
mental status.  Patient died in respiratory failure in the
morning of [**2195-7-9**]


Medications on Admission:
-ASA 81 mg daily
-Atenolol 25 mg daily
-Tricor 145 mg daily
-Calcium/Vitamin D
-MVI
-Omega3

Discharge Disposition:
Expired

Discharge Diagnosis:
.


Discharge Condition:
.

Discharge Instructions:
.

Followup Instructions:
.
{'Acute myeloid leukemia, without mention of having achieved remission,Hemorrhage of gastrointestinal tract, unspecified,Sarcoidosis,Retention of urine, unspecified,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Defibrination syndrome,Personal history of malignant neoplasm of prostate,Hip joint replacement,Aortocoronary bypass status'}


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: UGIB, Acute leukemia

PRESENT ILLNESS: 80 yo M with cutis leukemia presents with UGIB. Pt had 1 episode
of hematemasis and melana on day of presentation. He was c/o
feeling more fatigued, unable to do ADLs due to fatigue, feeling
"really sick", "wiped out", feeling very dizzy and light headed.
He was having difficulty walking, problems with his balance and
gait instability. He denied any fevers/chills but has had
sweats. No sick contacts or recent travelling. On morning of
admission pt had an acute episode of brown emesis without any
nausea. 2 days PTA pt noticed black stools, no frank blood in
stools or urine and no episodes of hematemesis. His weight has
been steady. He denies any back pain, + HA but no visual
changes, no floaters or blurry vision. He presented to an OSH
due to increasing lethargy, fatigue and episode of coffee ground
emesis and melena.
.
OSH Course: ?. no records sent from ED to [**Hospital Unit Name 153**].
.
ED Course: Initial VS: 97.0 BP 109/65 HR 74 18;  NGL grossly
positive with ~250cc bright red blood, protonix 40 IV x1, GI
aware. Heme Onc C/S. Pt remained HD stable in ED. Admitted to
ICU for further monitoring.

MEDICAL HISTORY: .
PastOncHx
#MDS/Myeloproliferative Disease - He noticed a LLE rash in early
[**Month (only) 116**]. He went to his PCP and had an US which was negative for
DVT. He was given a tetanus shot and started on Keflex. The rash
did not improve. He underwent a skin biopsy on [**5-15**] with the
final dx of "atypical dermal mononuclear infiltrate with
monocytic features - findings c/w leukemia cutis". He was seen
by Dr. [**First Name (STitle) **] in Oncology at [**Location (un) 73424**] Cancer Center. Per
report -CBC on [**5-14**] -WBC 9800 51N 28Bands 18Mono. H/H 11.8/35.
PLT [**Numeric Identifier 73425**]. He had a bone marrow bx on [**6-16**] which was notable
for Markedly hypercellular marrow with orderly maturation, mild
dysmegakaryopoiesis and slightly decreased iron stores. No
blasts noted. Aspirate had <1% ringed sideroblasts. Flow - nl
study - no increased blasts. No clonal abnormalities. Negative
JAK2 mutation. WBC on [**6-16**] was 11.
#Prostate cancer s/p Turp and Lupron x 1 yr (last [**10-26**])
.
-Sarcoid [**2144**]
-Endocarditis [**2182**]
-S/P CABG - 2 vessel/AVR
-S/P L THR
-S/P herniorrhaphy
-S/P cataract surgery

MEDICATION ON ADMISSION: -ASA 81 mg daily
-Atenolol 25 mg daily
-Tricor 145 mg daily
-Calcium/Vitamin D
-MVI
-Omega3

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: on admission:
VS: 98.9 BP 126/74 HR 70 RR 19 96% 4LNC
GEN: Comfortably lying in bed in NAD
HEENT:MMM, OP clear-no mucositis, no oral lesions, no cervical
LAD, R eye w/echymosis over lid-no orbital edema or conjunctival
bleed
RESP: CTABL, no crackles, no wheezing
CV: Reg Nml S1, S2, no M/R/G, Sternotomy scar well healed
ABD: Soft ND/NT +BS
EXT/skin: LLE swollen, non-pitting edema, large 3x3cm raised
violacious mass on lower LLE shin, large raised
papules/indurated on posterior knee, thigh and inguinal area on
L side, diffuse indurated papules ~.5mm x1cm lesions on chest,
abdomen, legs and back
NEURO: A&O x3, no focal deficits

FAMILY HISTORY: -no known CA in family, no bleeding d/o

SOCIAL HISTORY: -He is married and lives with his wife. [**Name (NI) 73426**] [**Name2 (NI) **] II Veteran,
?toxin exposure during war, unclear about occupational exposures
-He chews [**1-24**] cigars/day x60 years, +ETOH 4-5oz whiskey per day,
however no ETOH in few weeks. 

### Response:
{'Acute myeloid leukemia, without mention of having achieved remission,Hemorrhage of gastrointestinal tract, unspecified,Sarcoidosis,Retention of urine, unspecified,Chronic kidney disease, unspecified,Acute kidney failure, unspecified,Defibrination syndrome,Personal history of malignant neoplasm of prostate,Hip joint replacement,Aortocoronary bypass status'}
