CHIEF COMPLAINT: rectal bleeding

PRESENT ILLNESS: 81 yr male had colonoscopy in Nedeham on [**1-17**], 8mm polyp in
cecum with ooze after polypectomy s/p local cauterization comes
back with profuse post polypectomy bleeding, Hct of 19 ,
hypotension.

MEDICAL HISTORY: 1. Atrial fibrillation, status post pacer [**2191**]
2. hypertension
3. s/p hernia repair.
4. coronary artery disease status post coronary artery bypass
      graft in [**2193-3-28**], three vessels, unknown anatomy
      h/o inferior myocardial infarction, history of
      echoin [**2194-7-28**] with ejection fraction 50 percent with
      moderate tricuspid regurgitation, biatrial enlargement,
mild
      left ventricular hypertrophy, moderate mitral
regurgitation,
      moderate pulmonary artery systolic hypertension, and
aortic
      sclerosis.
      Nuclear stress test in [**2196-3-28**] with a moderate to large
fixed
      inferior defect without reversibility.
5. Hyperlipidemia.
6. History of first degree AV delay and right bundle branch
block.
7. symptomatic bradycardia and complete heart block
necessitating
8. Guidant pacemaker, history of cardioversion in [**Month (only) **]
[**2194**], atrial fibrillation to normal sinus rhythm.
9. CRI
10. History of anemia with hematocrit 35 and MCV 73 also in
[**2193**].

MEDICATION ON ADMISSION: ASA, Coumadin, Gemfibrozil 600', Atorvastatin 40'', Famotidine
20'', Metoprolol 75'', lisinopril 20', albuteral, atrovent,

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.4/98.5    70    120/60   18   98%RA
gen: NAD, AAOx3
CV: + s1s2
Pulm: CTA b/l
Abd: mildly distended, nontender
Ext: no c/c/e

FAMILY HISTORY: No known history of coronary artery disease or blood disease.

SOCIAL HISTORY: The patient is married.  Retired and worked for the town of
[**Location (un) 620**] Sewer Department.  He drinks alcohol occasionally but
does not smoke
Diseases of tricuspid valve,Hemorrhage complicating a procedure,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified
Tricuspid valve disease,Hemorrhage complic proc,Atrial fibrillation,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Status cardiac pacemaker,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS
Admission Date:  [**2200-1-19**]              Discharge Date:   [**2200-1-23**]

Date of Birth:  [**2118-1-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 3223**]
Chief Complaint:
rectal bleeding

Major Surgical or Invasive Procedure:
selective angiography [**1-19**], [**1-20**] (the latter with
embolization)

History of Present Illness:
81 yr male had colonoscopy in Nedeham on [**1-17**], 8mm polyp in
cecum with ooze after polypectomy s/p local cauterization comes
back with profuse post polypectomy bleeding, Hct of 19 ,
hypotension.

Past Medical History:
1. Atrial fibrillation, status post pacer [**2191**]
2. hypertension
3. s/p hernia repair.
4. coronary artery disease status post coronary artery bypass
      graft in [**2193-3-28**], three vessels, unknown anatomy
      h/o inferior myocardial infarction, history of
      echoin [**2194-7-28**] with ejection fraction 50 percent with
      moderate tricuspid regurgitation, biatrial enlargement,
mild
      left ventricular hypertrophy, moderate mitral
regurgitation,
      moderate pulmonary artery systolic hypertension, and
aortic
      sclerosis.
      Nuclear stress test in [**2196-3-28**] with a moderate to large
fixed
      inferior defect without reversibility.
5. Hyperlipidemia.
6. History of first degree AV delay and right bundle branch
block.
7. symptomatic bradycardia and complete heart block
necessitating
8. Guidant pacemaker, history of cardioversion in [**Month (only) **]
[**2194**], atrial fibrillation to normal sinus rhythm.
9. CRI
10. History of anemia with hematocrit 35 and MCV 73 also in
[**2193**].


Social History:
The patient is married.  Retired and worked for the town of
[**Location (un) 620**] Sewer Department.  He drinks alcohol occasionally but
does not smoke


Family History:
No known history of coronary artery disease or blood disease.

Physical Exam:
99.4/98.5    70    120/60   18   98%RA
gen: NAD, AAOx3
CV: + s1s2
Pulm: CTA b/l
Abd: mildly distended, nontender
Ext: no c/c/e

Pertinent Results:
[**2200-1-19**] 09:50AM BLOOD WBC-6.0 RBC-2.33*# Hgb-6.2*# Hct-19.1*#
MCV-82# MCH-26.7* MCHC-32.4 RDW-17.9* Plt Ct-97*#
[**2200-1-19**] 01:45PM BLOOD WBC-5.4 RBC-2.94*# Hgb-8.5*# Hct-25.0*#
MCV-85 MCH-28.8 MCHC-33.8 RDW-16.9* Plt Ct-81*
[**2200-1-19**] 05:28PM BLOOD WBC-5.6 RBC-2.84* Hgb-8.2* Hct-22.7*
MCV-80* MCH-28.9 MCHC-36.2* RDW-16.1* Plt Ct-47*
[**2200-1-19**] 11:45PM BLOOD Hct-24.8* Plt Ct-83*#
[**2200-1-20**] 12:45AM BLOOD WBC-5.1 RBC-3.17* Hgb-9.3* Hct-25.7*
MCV-81* MCH-29.5 MCHC-36.4* RDW-15.9* Plt Ct-83*
[**2200-1-20**] 04:41AM BLOOD Hct-28.8*
[**2200-1-20**] 07:27AM BLOOD Hct-27.9*
[**2200-1-19**] 09:50AM BLOOD PT-15.6* PTT-24.9 INR(PT)-1.4*
[**2200-1-19**] 05:28PM BLOOD PT-14.2* PTT-25.8 INR(PT)-1.2*
[**2200-1-20**] 07:27AM BLOOD PT-14.7* PTT-25.4 INR(PT)-1.3*
[**2200-1-19**] 09:50AM BLOOD Glucose-106* UreaN-53* Creat-2.7*# Na-139
K-7.0* Cl-108 HCO3-20* AnGap-18
[**2200-1-20**] 12:45AM BLOOD ALT-11 AST-15 AlkPhos-47 Amylase-48
TotBili-2.6*
[**2200-1-20**] 12:45AM BLOOD Lipase-25
[**2200-1-20**] 12:45AM BLOOD Albumin-2.8* Calcium-7.5* Phos-2.9 Mg-1.6

[**1-19**]  angiography: No evidence of active contrast extravasation
in the superior or inferior mesenteric artery territories. No
evidence of other vascular malformations.

[**1-20**] angiography:
Active arterial bleeding in the proximal right colon at the
level consistent with the patient's recent polypectomy site,
site embolized
.
[**2200-1-23**] 06:45AM BLOOD Hct-27.5*

Brief Hospital Course:
The patient was admitted and was transfused throughout the night
to maintain hemodynamic stability; he also received concomitant
fresh frozen plasma when appropriate.

Neuro: no issues, acetaminophen for pain control
CV: The patient came to [**Hospital1 18**] with massive lower GI bleeding,
for which he received over 6 units initially in the ED. The
patient was admitted to the ICU for serial hematocrit checks,
and constant vital sign monitoring.  The patient was taken to
angiography to localize the bleeding site, which was not
initially localized; for details, please see report.   On [**1-20**],
the patient was taken back to angiography, where the site of
bleeding near the prior polypectomy site, and was embolized; for
more details, please see report.  The patient's hematocrit
stabilized after a total of 18 units; it was felt that the
patient would not tolerate an operation given his extensive
cardiac history.  His hematocrit was monitored every 4-6 hours,
and remained stable until [**2200-1-22**], when his hematocrit dropped
from 27.4 to 24.8; the patient was transfused 2 units, and his
hematocrit rose to 29.2.  The patient was having no more bloody
or melenic stools.
Pulm: Stable, the patient had one episode of wheezing, during
which his vital signs were stable.  The patient had not received
any respiratory treatments, and could not remember his
medication at home.
GI/GU: The patient was initially made NPO, and received
famotidine.   Once the patient's hematocrit had stabilized, he
was given clear liquids; his diet was advanced as his hematocrit
continued to remain stable, which he tolerated well.  His urine
output was routinely monitored with a Foley catheter in place.
Heme: As previously mentioned, serial hematocrits were
performed, and the patient was transfused when necessary; he
also received concomitant FFP when appropriate.  The patient was
constantly monitored.
Endo: The patient was initially put on an insulin drip for close
blood sugar monitoring.  He was changed to a sliding scale once
they were controlled.
Proph:  The patient received famotidine for GI prophylaxis, and
had pneumoboots as anticoagulation was not an immediate option.

On discharge, the patient's hematocrit was stable, and the
patient was no longer having any bloody bowel movements or
bright red blood per rectum.  The patient was afebrile, vital
signs stable, ambulating, tolerating regular diet, urinating,
and doing well.


Medications on Admission:
ASA, Coumadin, Gemfibrozil 600', Atorvastatin 40'', Famotidine
20'', Metoprolol 75'', lisinopril 20', albuteral, atrovent,


Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Pravastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
8. Niacin 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
9. Amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
profuse post polypectomy bleeding/ lower GI bleed

Discharge Condition:
stable

Discharge Instructions:
You may have several dark or marroon bowel movements following
your discharge, which is normal.

Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You may see dark/black material when you have a bowel
movement; please seek medical attention if you have a large
bright red bowel movement (not dark marroon however)
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
.
* Please resume all regular home medications except coumadin.
You may restart your Coumadin and Aspirin on Saturday [**2200-1-25**].
* Continue to ambulate several times per day.


Followup Instructions:
You should follow up with your primary care doctor 1-2 weeks
after discharge. Follow-up with your PCP regarding your Coumadin
and monitoring your INR. Have your INR cheched on Wednesday
[**2200-1-29**]

Please follow up with Dr. [**Last Name (STitle) 519**] as needed; call ([**Telephone/Fax (1) 5323**] to
schedule an appointment if necessary.

                             [**Known firstname **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2200-2-3**]
{'Diseases of tricuspid valve,Hemorrhage complicating a procedure,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}


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: rectal bleeding

PRESENT ILLNESS: 81 yr male had colonoscopy in Nedeham on [**1-17**], 8mm polyp in
cecum with ooze after polypectomy s/p local cauterization comes
back with profuse post polypectomy bleeding, Hct of 19 ,
hypotension.

MEDICAL HISTORY: 1. Atrial fibrillation, status post pacer [**2191**]
2. hypertension
3. s/p hernia repair.
4. coronary artery disease status post coronary artery bypass
      graft in [**2193-3-28**], three vessels, unknown anatomy
      h/o inferior myocardial infarction, history of
      echoin [**2194-7-28**] with ejection fraction 50 percent with
      moderate tricuspid regurgitation, biatrial enlargement,
mild
      left ventricular hypertrophy, moderate mitral
regurgitation,
      moderate pulmonary artery systolic hypertension, and
aortic
      sclerosis.
      Nuclear stress test in [**2196-3-28**] with a moderate to large
fixed
      inferior defect without reversibility.
5. Hyperlipidemia.
6. History of first degree AV delay and right bundle branch
block.
7. symptomatic bradycardia and complete heart block
necessitating
8. Guidant pacemaker, history of cardioversion in [**Month (only) **]
[**2194**], atrial fibrillation to normal sinus rhythm.
9. CRI
10. History of anemia with hematocrit 35 and MCV 73 also in
[**2193**].

MEDICATION ON ADMISSION: ASA, Coumadin, Gemfibrozil 600', Atorvastatin 40'', Famotidine
20'', Metoprolol 75'', lisinopril 20', albuteral, atrovent,

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.4/98.5    70    120/60   18   98%RA
gen: NAD, AAOx3
CV: + s1s2
Pulm: CTA b/l
Abd: mildly distended, nontender
Ext: no c/c/e

FAMILY HISTORY: No known history of coronary artery disease or blood disease.

SOCIAL HISTORY: The patient is married.  Retired and worked for the town of
[**Location (un) 620**] Sewer Department.  He drinks alcohol occasionally but
does not smoke 

### Response:
{'Diseases of tricuspid valve,Hemorrhage complicating a procedure,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}
