CHIEF COMPLAINT: Bright red blood per rectum

PRESENT ILLNESS: 82M w/ CAD, AFib, CHF, PVD, s/p partial colectomy presents to
[**Hospital1 18**] w/ 1 day h/o BRBPR. Pt was in usual state of health when
he experienced 4 episodes of BRBPR throughout day prior to
admission. Pt felt dizzy and [**Doctor First Name **] to ER. Pt denies prior
episodes. Denies N/V/F/C or hematemesis. Pt denies previous
history of BRBPR.

MEDICAL HISTORY: CAD
A Fib
CHF
PVD
Cataracts
histry of bleeding gastric ulcer

MEDICATION ON ADMISSION: Metoprolol 50mg PO QD
Amiodarone 200mg PO QD
Lipitor 10mg PO QD
ASA 325mg PO QD

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Vitals: T97.0 P73 BP93/55 RR16 SPO2 100%RA
PE:
Gen: NAD
HEENT: PERRLA, EOMI, mucus membranes dry
Neck: Supple, no JVD
CV: RRR, normal S1 and S2
Lungs: CTA b/l
ABD: Soft, NT/ND, NABS
EXT: 1+ b/l LE edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient denies ETOH, tobacco, drugs
Diverticulosis of colon with hemorrhage,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Bacteremia,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified
Dvrtclo colon w hmrhg,CHF NOS,Acute kidney failure NOS,Cellulitis of arm,Bacteremia,Urin tract infection NOS,Thrombocytopenia NOS,Streptococcus unspecf
Admission Date:  [**2170-9-21**]              Discharge Date:   [**2170-10-1**]


Service: [**Doctor First Name 147**]

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 4995**]
Chief Complaint:
Bright red blood per rectum

Major Surgical or Invasive Procedure:
EGD
Colonoscopy
Pill endoscopy


History of Present Illness:
82M w/ CAD, AFib, CHF, PVD, s/p partial colectomy presents to
[**Hospital1 18**] w/ 1 day h/o BRBPR. Pt was in usual state of health when
he experienced 4 episodes of BRBPR throughout day prior to
admission. Pt felt dizzy and [**Doctor First Name **] to ER. Pt denies prior
episodes. Denies N/V/F/C or hematemesis. Pt denies previous
history of BRBPR.

Past Medical History:
CAD
A Fib
CHF
PVD
Cataracts
histry of bleeding gastric ulcer

Social History:
Patient denies ETOH, tobacco, drugs

Family History:
Non-contributory

Physical Exam:
Vitals: T97.0 P73 BP93/55 RR16 SPO2 100%RA
PE:
Gen: NAD
HEENT: PERRLA, EOMI, mucus membranes dry
Neck: Supple, no JVD
CV: RRR, normal S1 and S2
Lungs: CTA b/l
ABD: Soft, NT/ND, NABS
EXT: 1+ b/l LE edema

Pertinent Results:
[**2170-10-1**] 05:35AM BLOOD Hct-30.5*
[**2170-9-30**] 06:50AM BLOOD Hct-31.1*
[**2170-9-29**] 03:28PM BLOOD Hct-32.1*
[**2170-9-28**] 05:30AM BLOOD WBC-5.0 RBC-3.48* Hgb-10.4* Hct-30.8*
MCV-88 MCH-29.9 MCHC-33.8 RDW-14.4 Plt Ct-176
[**2170-9-27**] 08:53PM BLOOD Hct-29.8*
[**2170-9-27**] 03:27PM BLOOD Hct-28.7*
[**2170-9-27**] 04:45AM BLOOD WBC-5.4 RBC-3.32* Hgb-10.4* Hct-29.1*
MCV-88 MCH-31.4 MCHC-35.8* RDW-14.9 Plt Ct-130*
[**2170-9-26**] 10:59PM BLOOD Hct-31.4*
[**2170-9-26**] 06:20PM BLOOD Hct-29.7*
[**2170-9-26**] 11:14AM BLOOD Hct-30.1*
[**2170-9-26**] 03:07AM BLOOD WBC-5.0 RBC-3.04* Hgb-9.4* Hct-26.7*
MCV-88 MCH-31.0 MCHC-35.3* RDW-14.9 Plt Ct-134*
[**2170-9-25**] 06:05PM BLOOD Hct-28.4*
[**2170-9-25**] 11:49AM BLOOD Hct-28.8*
[**2170-9-25**] 03:07AM BLOOD WBC-5.7 RBC-3.43* Hgb-10.5* Hct-30.9*
MCV-90 MCH-30.5 MCHC-33.9 RDW-15.4 Plt Ct-109*
[**2170-9-24**] 08:08PM BLOOD WBC-5.8 RBC-3.25* Hgb-10.3* Hct-29.1*
MCV-90 MCH-31.6 MCHC-35.3* RDW-15.5 Plt Ct-100*
[**2170-9-24**] 12:26PM BLOOD Hct-31.6*
[**2170-9-24**] 03:40AM BLOOD WBC-8.6 RBC-3.21* Hgb-10.0* Hct-29.2*
MCV-91 MCH-31.2 MCHC-34.3 RDW-15.6* Plt Ct-107*
[**2170-9-23**] 07:25PM BLOOD WBC-9.5 RBC-3.11* Hgb-9.7* Hct-27.6*
MCV-89 MCH-31.1 MCHC-35.1* RDW-15.6* Plt Ct-115*#
[**2170-9-23**] 03:32PM BLOOD WBC-9.4 RBC-3.63* Hgb-11.2* Hct-32.8*
MCV-90 MCH-30.9 MCHC-34.2 RDW-15.6* Plt Ct-64*
[**2170-9-23**] 03:37AM BLOOD WBC-7.7 RBC-3.19* Hgb-9.8* Hct-28.7*
MCV-90 MCH-30.7 MCHC-34.2 RDW-15.8* Plt Ct-117*
[**2170-9-22**] 08:52PM BLOOD Hct-28.9*
[**2170-9-22**] 03:17PM BLOOD Hct-32.3* Plt Ct-120*
[**2170-9-22**] 10:35AM BLOOD Hct-32.3*
[**2170-9-22**] 06:17AM BLOOD WBC-5.2 RBC-3.33* Hgb-10.5* Hct-30.5*
MCV-92 MCH-31.4 MCHC-34.3 RDW-15.8* Plt Ct-115*
[**2170-9-21**] 10:33PM BLOOD Hct-26.1*
[**2170-9-21**] 12:15PM BLOOD WBC-4.7 RBC-3.44* Hgb-11.0* Hct-32.8*
MCV-95# MCH-31.9 MCHC-33.5 RDW-13.4 Plt Ct-206
[**2170-9-23**] 07:25PM BLOOD Neuts-86.0* Bands-0 Lymphs-8.4* Monos-4.3
Eos-1.0 Baso-0.3
[**2170-9-21**] 12:15PM BLOOD Neuts-60.2 Lymphs-29.7 Monos-5.0 Eos-4.3*
Baso-0.8
[**2170-9-28**] 05:30AM BLOOD Plt Ct-176
[**2170-9-27**] 04:45AM BLOOD Plt Ct-130*
[**2170-9-26**] 03:07AM BLOOD Plt Ct-134*
[**2170-9-26**] 03:07AM BLOOD PT-12.7 PTT-29.5 INR(PT)-1.0
[**2170-9-25**] 03:07AM BLOOD Plt Ct-109*
[**2170-9-24**] 08:08PM BLOOD Plt Ct-100*
[**2170-9-24**] 03:40AM BLOOD Plt Ct-107*
[**2170-9-24**] 03:40AM BLOOD PT-13.6 PTT-29.6 INR(PT)-1.2
[**2170-9-23**] 07:25PM BLOOD Plt Smr-LOW Plt Ct-115*#
[**2170-9-23**] 07:25PM BLOOD PT-13.3 PTT-28.3 INR(PT)-1.1
[**2170-9-23**] 03:32PM BLOOD Plt Ct-64*
[**2170-9-23**] 03:37AM BLOOD Plt Ct-117*
[**2170-9-23**] 03:37AM BLOOD PT-13.1 PTT-29.2 INR(PT)-1.1
[**2170-9-22**] 03:17PM BLOOD Plt Ct-120*
[**2170-9-22**] 06:17AM BLOOD Plt Ct-115*
[**2170-9-22**] 06:17AM BLOOD PT-12.7 PTT-23.8 INR(PT)-1.0
[**2170-9-21**] 12:15PM BLOOD Plt Ct-206
[**2170-9-21**] 12:15PM BLOOD PT-12.2 PTT-25.3 INR(PT)-0.9
[**2170-9-23**] 07:25PM BLOOD FDP-0-10
[**2170-9-23**] 07:25PM BLOOD Fibrino-303 D-Dimer-1485*
[**2170-9-29**] 12:24AM BLOOD K-4.6
[**2170-9-28**] 05:30AM BLOOD Glucose-100 UreaN-17 Creat-0.7 Na-139
K-3.9 Cl-104 HCO3-28 AnGap-11
[**2170-9-27**] 04:45AM BLOOD Glucose-122* UreaN-19 Creat-0.8 Na-141
K-4.0 Cl-107 HCO3-25 AnGap-13
[**2170-9-27**] 01:08AM BLOOD Glucose-158* UreaN-19 Creat-0.8 Na-139
K-3.7 Cl-108 HCO3-24 AnGap-11
[**2170-9-26**] 03:07AM BLOOD Glucose-135* UreaN-22* Creat-1.0 Na-136
K-3.9 Cl-107 HCO3-23 AnGap-10
[**2170-9-25**] 03:07AM BLOOD Glucose-78 UreaN-30* Creat-1.4* Na-138
K-4.0 Cl-108 HCO3-19* AnGap-15
[**2170-9-24**] 08:08PM BLOOD Glucose-78 UreaN-31* Creat-1.6* Na-138
K-3.9 Cl-107 HCO3-19* AnGap-16
[**2170-9-24**] 03:40AM BLOOD Glucose-100 UreaN-27* Creat-1.5* Na-138
K-4.1 Cl-109* HCO3-21* AnGap-12
[**2170-9-23**] 03:37AM BLOOD Glucose-106* UreaN-24* Creat-1.0 Na-140
K-4.3 Cl-111* HCO3-21* AnGap-12
[**2170-9-22**] 03:17PM BLOOD Glucose-104 UreaN-28* Creat-1.0 Na-139
K-5.0 Cl-111* HCO3-23 AnGap-10
[**2170-9-22**] 06:17AM BLOOD Glucose-82 UreaN-27* Creat-1.0 Na-140
K-5.5* Cl-113* HCO3-23 AnGap-10
[**2170-9-21**] 12:15PM BLOOD Glucose-105 UreaN-26* Creat-1.3* Na-141
K-5.1 Cl-108 HCO3-25 AnGap-13
[**2170-9-27**] 04:45AM BLOOD ALT-8 AST-17 AlkPhos-73 TotBili-0.8
[**2170-9-27**] 01:08AM BLOOD ALT-7 AST-15 AlkPhos-72 TotBili-0.8
[**2170-9-24**] 08:08PM BLOOD CK(CPK)-45
[**2170-9-24**] 12:26PM BLOOD CK(CPK)-43
[**2170-9-24**] 03:40AM BLOOD CK(CPK)-36*
[**2170-9-23**] 07:25PM BLOOD LD(LDH)-116
[**2170-9-24**] 08:08PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2170-9-24**] 12:26PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2170-9-24**] 03:40AM BLOOD CK-MB-1 cTropnT-0.02*
[**2170-9-29**] 12:24AM BLOOD Mg-2.1
[**2170-9-28**] 05:30AM BLOOD Calcium-7.5* Phos-3.6# Mg-1.9
[**2170-9-27**] 04:45AM BLOOD Albumin-2.5* Calcium-7.5* Phos-5.3*
Mg-2.6
[**2170-9-27**] 01:08AM BLOOD Albumin-2.5* Calcium-7.8* Phos-4.4#
Mg-1.8
[**2170-9-26**] 03:07AM BLOOD Calcium-7.5* Phos-2.5* Mg-2.0
[**2170-9-25**] 03:07AM BLOOD Calcium-8.1* Phos-3.8 Mg-1.9
[**2170-9-24**] 08:08PM BLOOD Calcium-8.1* Phos-3.6 Mg-1.9
[**2170-9-24**] 03:40AM BLOOD Albumin-2.6* Calcium-7.6* Phos-4.0 Mg-2.1
[**2170-9-23**] 03:37AM BLOOD Calcium-7.8* Phos-2.6* Mg-1.6
[**2170-9-22**] 03:17PM BLOOD Calcium-8.1* Phos-2.8 Mg-1.9
[**2170-9-22**] 06:17AM BLOOD Albumin-2.8* Calcium-7.4* Phos-2.8 Mg-2.0
[**2170-9-21**] 12:15PM BLOOD Calcium-8.4 Phos-3.7 Mg-2.1
[**2170-9-23**] 07:25PM BLOOD Hapto-103
[**2170-9-27**] 04:45AM BLOOD Triglyc-63
[**2170-9-27**] 01:08AM BLOOD Triglyc-73
[**2170-9-21**] 12:15PM BLOOD Osmolal-301
[**2170-9-26**] 10:59PM BLOOD Vanco-11.7*
[**2170-9-22**] 03:17PM BLOOD Ethanol-NEG
[**2170-9-23**] 07:25PM BLOOD RedHold-HOLD
[**2170-9-23**] 03:32PM BLOOD RedHold-HOLD
[**2170-9-21**] 12:15PM BLOOD RedHold-HOLD
[**2170-9-21**] 12:15PM BLOOD RedHold-HOLD
[**2170-9-21**] 12:15PM BLOOD GreenHd-HOLD
[**2170-9-27**] 04:55AM BLOOD Type-ART pO2-97 pCO2-44 pH-7.41
calHCO3-29 Base XS-2
[**2170-9-26**] 12:41PM BLOOD Type-ART pO2-136* pCO2-41 pH-7.43
calHCO3-28 Base XS-3 Intubat-NOT INTUBA
[**2170-9-24**] 08:52PM BLOOD pH-7.33* Comment-GREEN TOP
[**2170-9-27**] 04:55AM BLOOD Glucose-130*
[**2170-9-26**] 12:41PM BLOOD Lactate-0.9
[**2170-9-25**] 03:02PM BLOOD Lactate-0.7
[**2170-9-26**] 12:41PM BLOOD O2 Sat-98
[**2170-9-27**] 04:55AM BLOOD freeCa-1.15
[**2170-9-26**] 12:41PM BLOOD freeCa-1.13
[**2170-9-24**] 08:52PM BLOOD freeCa-1.13
[**2170-9-24**] 12:26PM BLOOD HEPARIN DEPENDENT ANTIBODIES-
[**2170-9-24**] 10:56AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.013
[**2170-9-24**] 10:56AM URINE Blood-LG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR
[**2170-9-24**] 10:56AM URINE RBC-[**6-28**]* WBC-[**3-23**] Bacteri-OCC Yeast-NONE
Epi-0
[**2170-9-24**] 10:56AM URINE CastHy-0-2

[**2170-9-24**] 8:08 pm BLOOD CULTURE

                            **FINAL REPORT [**2170-9-30**]**

   AEROBIC BOTTLE (Final [**2170-9-30**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2170-9-27**]):
      STAPH AUREUS COAG +.
         SENSITIVITIES PERFORMED ON CULTURE # [**Numeric Identifier 110317**]
([**2170-9-24**]).
[**2170-9-24**] 6:12 pm BLOOD CULTURE

                            **FINAL REPORT [**2170-9-30**]**

   AEROBIC BOTTLE (Final [**2170-9-30**]):    NO GROWTH.

   ANAEROBIC BOTTLE (Final [**2170-9-27**]):
      REPORTED BY PHONE TO [**Doctor First Name **],SHUI -CC7B- @ 16:00
[**2170-9-25**].
      STAPH AUREUS COAG +.    FINAL SENSITIVITIES.
         PENICILLIN SENSITIVITY AVAILABLE ON REQUEST.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------<=0.25 S
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------  0.25 S
OXACILLIN-------------   0.5 S
[**2170-9-24**] 10:56AM URINE Hours-RANDOM UreaN-545 Creat-72 Na-102

[**2170-9-24**] 5:57 pm URINE      Source: Catheter.

                            **FINAL REPORT [**2170-9-28**]**

   URINE CULTURE (Final [**2170-9-27**]):
      THIS IS A CORRECTED REPORT ([**2170-9-28**]).
      STAPH AUREUS COAG +.    >100,000 ORGANISMS/ML..
         PENICILLIN SENSITIVITY AVAILABLE ON REQUEST.
         PREVIOUSLY REPORTED AS SENSITIVE TO PENICILLIN
([**2170-9-27**]).
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    10,000-100,000
ORGANISMS/ML..

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |          STAPHYLOCOCCUS,
COAGULASE NEGATIVE
                             |          |
GENTAMICIN------------ <=0.5 S    <=0.5 S
LEVOFLOXACIN----------  0.25 S   <=0.12 S
NITROFURANTOIN--------  <=16 S     <=16 S
OXACILLIN-------------   0.5 S   <=0.25 S
PENICILLIN------------           <=0.03 S

Brief Hospital Course:
1. BRBPR
The patient was admitted to the medical service and was admitted
to the medical intensive care unit for hemodynamic instability
secondary to bleeding per rectum. The patient had an initial
hematocrit of 32.8 and was given two large bore IV's and was
transfused w/ 1U PRBC's on HD 1. On HD 2, the patient was
transfused an addition 3U PRBC's in order to keep hematocrit
above 30. The patient underwent a bleeding scan, which was found
to be negative. On HD 3, the patient was transfused an
additional 3U PRBC's and underwent EGD and colonoscopy. EGD was
significant only for a small hiatal hernia and small diverticuli
on the duodenum. Colonoscopy demonstrated maroon colored blood
in the entire colon, a non-bleeding grade 1 internal hemorrhoid,
and multiple non-bleeding diverticula with medium to large
openings seen in the entire colon. The patient was transfused 3
U PRBC's on HD 4. The patient was transferred to the colorectal
surgical service on HD 5 and was started on vancomycin for
streptococcus baceteremia. The patient was transfused 2 U PRBC's
on HD 6. On HD 7, the patient underwent capsular endoscopy,
which showed good visualization of the small bowel without any
signs of bleeding. The patient was switched to IV oxacillin
following culture+sensitivities for bacteremia and was
transferred to the floor. Following this, the patient remained
hemodynamically stable. The patient did not experience any
furthery bouts of bloody stools and was discharged on HD 10 in
good condition.
2. CV
The patient was maintained on beta-blockade, atorvastatin and
heparin 5000U sc BID for DVT prophylaxis. The patient had
several EKG's, none of which demonstrated any abnormalities of
concern.

Medications on Admission:
Metoprolol 50mg PO QD
Amiodarone 200mg PO QD
Lipitor 10mg PO QD
ASA 325mg PO QD

Discharge Medications:
1. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
3. Pantoprazole Sodium 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*
4. Augmentin 500-125 mg Tablet Sig: One (1) Tablet PO four times
a day for 5 days.
Disp:*20 Tablet(s)* Refills:*0*

Patient may resume home medication regimen


Discharge Disposition:
Home

Discharge Diagnosis:
Lower GI bleed
Diverticulitis
Peripheral vascular disease
Complete heart block, s/p pacemaker placement
IMI


Discharge Condition:
Good

Discharge Instructions:
Please return to hospital if you experience bloody stools or
profuse bleeding from your rectum.
Please return if you begin to appear pale or if you experience
severe fatigue or lightheadedness. This may indicate anemia.

Followup Instructions:
Please follow up w/ your primary care physician following
discharge.
{'Diverticulosis of colon with hemorrhage,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Bacteremia,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, 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: Bright red blood per rectum

PRESENT ILLNESS: 82M w/ CAD, AFib, CHF, PVD, s/p partial colectomy presents to
[**Hospital1 18**] w/ 1 day h/o BRBPR. Pt was in usual state of health when
he experienced 4 episodes of BRBPR throughout day prior to
admission. Pt felt dizzy and [**Doctor First Name **] to ER. Pt denies prior
episodes. Denies N/V/F/C or hematemesis. Pt denies previous
history of BRBPR.

MEDICAL HISTORY: CAD
A Fib
CHF
PVD
Cataracts
histry of bleeding gastric ulcer

MEDICATION ON ADMISSION: Metoprolol 50mg PO QD
Amiodarone 200mg PO QD
Lipitor 10mg PO QD
ASA 325mg PO QD

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Vitals: T97.0 P73 BP93/55 RR16 SPO2 100%RA
PE:
Gen: NAD
HEENT: PERRLA, EOMI, mucus membranes dry
Neck: Supple, no JVD
CV: RRR, normal S1 and S2
Lungs: CTA b/l
ABD: Soft, NT/ND, NABS
EXT: 1+ b/l LE edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Patient denies ETOH, tobacco, drugs 

### Response:
{'Diverticulosis of colon with hemorrhage,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Cellulitis and abscess of upper arm and forearm,Bacteremia,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified'}
