CHIEF COMPLAINT: melena

PRESENT ILLNESS: Patient is an 88 year old female with hsitory of hypertension,
constipation,and atypical chest pain, who was in her usual state
of health until she and was dizzy on standing after waking in
the morning. Shortly thereafter she began to vomit coffee ground
emesis with no preceeding nausea. She  had [**5-5**] total episodes of
moderate coffe ground emesis throuhgout day. No chest pain,
shortness of breath, dizziness, no palp, or dyspnea on exertion.
Otherwise the patient has been constipated for 3 days without
bowel movement. She was initially unsure of melena and on repeat
questioning reports small amount of melena x 1. The patient does
use ASA as needed but no recurrent use. No other NSAID use or
alcohol use. She also reported weakness/fatigue, lower extremity
edema, increased shortness of breath, and difficulty walking. In
the emergency department, the patient had a hematocrit of 30
which changed to 27.4 4 hours later. NG lavage with 320ml coffee
ground emesis that did not clear. Not orthostatic on admission
to ED, 99% RA, BP 104/76, HR 74 in Ed. Recieved 2 L NS in ED, 2
PIVS, protonix.

MEDICAL HISTORY: HTN
constipation
Raynauds
?dementia

MEDICATION ON ADMISSION: combipres 0.1 mg, oxazepam 10 mg qhs, colace, prn ASA

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Tc 97.3 Tm 98.3 BP 120/72 HR 63 RR 18 O2 98% RA
Gen - Alert, awake, pleasant in NAD
HEENT - anicteric, mucous membranes moist and intact
Neck - supple, no jugular venous distention
Chest - clear to auscultation bilaterally, no crackles/rhonchi
CV - Normal S1/S2, regular rate and rhythm, no murmurs, rubs or
gallops, 2+ pulses throughout
Abd - soft, nondistended, nontender with normoactive bowel
sounds,no masses
Extr - warm, no clubbing, cyanosis, or edema
Neuro - Alert, oriented to self and hospital. ambulating well.
denies loss of sensation, face symmetric, tongue non-deviated

FAMILY HISTORY: father with h/o MI

SOCIAL HISTORY: lives alone, nonsmoker, nondrinker
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Helicobacter pylori [H. pylori],Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other chest pain
Chr stomach ulc w hem,Ac posthemorrhag anemia,Thrombocytopenia NOS,Helicobacter pylori,Hypertension NOS,Mental disor NEC oth dis,Constipation NOS,Chest pain NEC
Admission Date:  [**2183-11-21**]              Discharge Date:   [**2183-11-27**]


Service: MED

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
melena

Major Surgical or Invasive Procedure:
EGD [**11-21**]


History of Present Illness:
Patient is an 88 year old female with hsitory of hypertension,
constipation,and atypical chest pain, who was in her usual state
of health until she and was dizzy on standing after waking in
the morning. Shortly thereafter she began to vomit coffee ground
emesis with no preceeding nausea. She  had [**5-5**] total episodes of
moderate coffe ground emesis throuhgout day. No chest pain,
shortness of breath, dizziness, no palp, or dyspnea on exertion.
Otherwise the patient has been constipated for 3 days without
bowel movement. She was initially unsure of melena and on repeat
questioning reports small amount of melena x 1. The patient does
use ASA as needed but no recurrent use. No other NSAID use or
alcohol use. She also reported weakness/fatigue, lower extremity
edema, increased shortness of breath, and difficulty walking. In
the emergency department, the patient had a hematocrit of 30
which changed to 27.4 4 hours later. NG lavage with 320ml coffee
ground emesis that did not clear. Not orthostatic on admission
to ED, 99% RA, BP 104/76, HR 74 in Ed. Recieved 2 L NS in ED, 2
PIVS, protonix.

Past Medical History:
HTN
constipation
Raynauds
?dementia


Social History:
lives alone, nonsmoker, nondrinker

Family History:
father with h/o MI

Physical Exam:
Tc 97.3 Tm 98.3 BP 120/72 HR 63 RR 18 O2 98% RA
Gen - Alert, awake, pleasant in NAD
HEENT - anicteric, mucous membranes moist and intact
Neck - supple, no jugular venous distention
Chest - clear to auscultation bilaterally, no crackles/rhonchi
CV - Normal S1/S2, regular rate and rhythm, no murmurs, rubs or
gallops, 2+ pulses throughout
Abd - soft, nondistended, nontender with normoactive bowel
sounds,no masses
Extr - warm, no clubbing, cyanosis, or edema
Neuro - Alert, oriented to self and hospital. ambulating well.
denies loss of sensation, face symmetric, tongue non-deviated


Pertinent Results:
[**2183-11-22**] HELICOBACTER PYLORI ANTIBODY TEST (Final [**2183-11-24**]):
POSITIVE BY EIA.
.
[**2183-11-22**] ECG: Sinus rhythm. Right bundle-branch block. Compared
to the previous tracing of [**2173-12-16**] bradycardia is no longer
present. Right bundle-branch block
patterning persists.
.
[**2183-11-27**] 06:15AM BLOOD Hct-31.4*
[**2183-11-26**] 04:00PM BLOOD Hct-34.9*
[**2183-11-26**] 06:25AM BLOOD WBC-3.8* RBC-3.48* Hgb-10.6* Hct-31.2*
MCV-90 MCH-30.3 MCHC-33.9 RDW-15.5 Plt Ct-153
[**2183-11-25**] 06:55AM BLOOD WBC-3.7* RBC-3.56* Hgb-10.9* Hct-31.2*
MCV-88 MCH-30.6 MCHC-34.9 RDW-15.2 Plt Ct-155
[**2183-11-24**] 08:45PM BLOOD Hct-32.3*
[**2183-11-24**] 06:30AM BLOOD WBC-4.5 RBC-3.15* Hgb-9.6* Hct-27.6*
MCV-88 MCH-30.4 MCHC-34.6 RDW-15.2 Plt Ct-140*
[**2183-11-23**] 07:00PM BLOOD Hct-30.1*
[**2183-11-23**] 12:34PM BLOOD Hct-31.5*
[**2183-11-23**] 06:30AM BLOOD WBC-5.2 RBC-3.31* Hgb-10.2* Hct-29.0*
MCV-88 MCH-30.7 MCHC-35.1* RDW-15.0 Plt Ct-134*
[**2183-11-22**] 10:48PM BLOOD Hct-26.2*
[**2183-11-22**] 12:42PM BLOOD Hct-29.6*
[**2183-11-22**] 04:21AM BLOOD WBC-7.4 RBC-3.44* Hgb-10.0* Hct-30.5*
MCV-89 MCH-29.2 MCHC-32.8 RDW-14.6 Plt Ct-155
[**2183-11-21**] 08:04PM BLOOD Hct-26.8*#
[**2183-11-21**] 01:06PM BLOOD Hct-18.5*#
[**2183-11-21**] 02:45AM BLOOD WBC-5.7 RBC-3.03* Hgb-8.7* Hct-25.8*
MCV-85 MCH-28.8 MCHC-33.8 RDW-14.4 Plt Ct-178
[**2183-11-20**] 11:15PM BLOOD WBC-7.4 RBC-3.24* Hgb-9.4* Hct-27.4*
MCV-84 MCH-29.0 MCHC-34.4 RDW-13.4 Plt Ct-201
[**2183-11-20**] 07:40PM BLOOD WBC-6.3 RBC-3.53* Hgb-10.2* Hct-30.3*
MCV-86 MCH-28.8 MCHC-33.6 RDW-13.4 Plt Ct-196
[**2183-11-26**] 06:25AM BLOOD Glucose-81 UreaN-12 Creat-0.8 Na-141
K-3.8 Cl-113* HCO3-24
[**2183-11-25**] 06:55AM BLOOD TotProt-5.3* Calcium-8.5 Phos-3.9 Mg-1.6
[**2183-11-25**] 06:55AM BLOOD VitB12-626 Folate-16.8
.

Brief Hospital Course:
88 year old female with history of hypertension who presented
with gastrointestinal bleeding likely due to gastroesophageal
junction ulceration.
.
Gastrointestinal bleeding: Patient was brought to the ICU from
the ED with #2 PIVs. She was on protonix iv bid and was made npo
for procedure. She self discontinued her NG tube overnight. Her
hematocrit dropped from 30 on admission to ED to 18 overnight
and she was transfused 2 units with good results. On [**11-21**], she
underwent uncomplicated EGD which demonstrated ulcerations at GE
junction, likely source of bleeding. Gastroenterology suggested
pantoprazole [**Hospital1 **] for 8 weeks, them once daily and scheduled her
for a repeat EGD [**1-15**] as outpatient (already arranged). Also,
future outpatient colonoscopy was suggested. Anti-hypertensive
medication, NSAIDS, and ASA were held.  The patient was
transfered to the regular medicine floor on [**11-23**] and overnight,
her hematocrit dropped from 29 to 26. She was again transfused 1
u PRBCs with increase to 29. Patient was tolerating clears at
this point with no nausea, vomiting, dizziness. She received
another unit of PRBCs on [**11-24**] to increase her hematocrit above
30. Since, her hematocrit has remained stable above 30.  She
continues to report having black stools but denies gross
bleeding, lightheadedness, or weakness. She will follow up with
the GI service for evaluation and repeat EGD.  She was started
on clarithromycin and amoxicillin on [**11-24**] for positive testing
for H. pylori serologies and will finish a two week course of
antibiotics at home.  She should continue the protonix twice
daily for a total of two months.  Her hematocrit should be
followed as an outpatient to help monitor for blood loss.  First
draw is scheduled for [**2183-12-1**].  She was educated to return to
the hospital for signs or symptoms of blood loss. The patient is
ambulating well and has good oral intake.  She has been afebrile
throughout her hospital stay and has an unremarkable physical
exam.  She received physical therapy and assistance with
strength building before discharge and will be getting home
nursing physical therapy, occupational therapy, and social work
assistance.  She needs a home safety evaluation since there is
concern for dementia and ability to continue caring for herself
at home alone safely.  She has a follow up appointment with her
PCP in about [**Name Initial (PRE) **] week and will need further neuropsychiatric
evaluation for dementia. She was discharged to home in good
condition with the assistance of her health care proxy.

Medications on Admission:
combipres 0.1 mg, oxazepam 10 mg qhs, colace, prn ASA

Discharge Medications:
1. Oxazepam 10 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
2. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day: Continue for 8
weeks then take one pill per day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Chlorthalidone 15 mg Tablet Sig: One (1) Tablet PO once a
day. Tablet(s)
4. Outpatient Lab Work
CBC.
5. Clarithromycin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
6. Amoxicillin 500 mg Capsule Sig: One (1) Capsule PO Q12H
(every 12 hours) for 10 days.
Disp:*20 Capsule(s)* Refills:*0*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary:
1. Blood Loss Anemia.
2. Gastro-Esophageal Ulceration.
3. Upper GI Bleed.
Secondary:
1. Hypertension.
2. Constipation.


Discharge Condition:
Good.

Discharge Instructions:
Continue to take all medications as directed. Please attend your
doctor [**First Name (Titles) 4314**] [**Last Name (Titles) 104351**] below.  If you experience worsening
nausea, vomiting more blood or coffee grounds material,
dizziness, or other concerning symptoms, please call your doctor
or return immediately to the ER.
You should avoid Aspirin as well as Motrin, ibuprofen, advil,
naproxen, other "NSAID" medications.

Followup Instructions:
1. Provider: [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], MD Where: [**First Name8 (NamePattern2) **] [**Hospital Ward Name **] BUILDING
([**Hospital Ward Name **]/[**Hospital Ward Name **] COMPLEX) ENDOSCOPY SUITE Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2184-1-15**] 7:30
2. Provider: [**Name Initial (NameIs) **] SUITE GI ROOMS Where: GI ROOMS Date/Time:[**2184-1-15**]
7:30
3. Follow up  with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) 123**] ([**Telephone/Fax (1) 104352**].  You have an
appointment scheduled for [**2183-12-11**] at 10AM.
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Helicobacter pylori [H. pylori],Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other chest pain'}


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: melena

PRESENT ILLNESS: Patient is an 88 year old female with hsitory of hypertension,
constipation,and atypical chest pain, who was in her usual state
of health until she and was dizzy on standing after waking in
the morning. Shortly thereafter she began to vomit coffee ground
emesis with no preceeding nausea. She  had [**5-5**] total episodes of
moderate coffe ground emesis throuhgout day. No chest pain,
shortness of breath, dizziness, no palp, or dyspnea on exertion.
Otherwise the patient has been constipated for 3 days without
bowel movement. She was initially unsure of melena and on repeat
questioning reports small amount of melena x 1. The patient does
use ASA as needed but no recurrent use. No other NSAID use or
alcohol use. She also reported weakness/fatigue, lower extremity
edema, increased shortness of breath, and difficulty walking. In
the emergency department, the patient had a hematocrit of 30
which changed to 27.4 4 hours later. NG lavage with 320ml coffee
ground emesis that did not clear. Not orthostatic on admission
to ED, 99% RA, BP 104/76, HR 74 in Ed. Recieved 2 L NS in ED, 2
PIVS, protonix.

MEDICAL HISTORY: HTN
constipation
Raynauds
?dementia

MEDICATION ON ADMISSION: combipres 0.1 mg, oxazepam 10 mg qhs, colace, prn ASA

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Tc 97.3 Tm 98.3 BP 120/72 HR 63 RR 18 O2 98% RA
Gen - Alert, awake, pleasant in NAD
HEENT - anicteric, mucous membranes moist and intact
Neck - supple, no jugular venous distention
Chest - clear to auscultation bilaterally, no crackles/rhonchi
CV - Normal S1/S2, regular rate and rhythm, no murmurs, rubs or
gallops, 2+ pulses throughout
Abd - soft, nondistended, nontender with normoactive bowel
sounds,no masses
Extr - warm, no clubbing, cyanosis, or edema
Neuro - Alert, oriented to self and hospital. ambulating well.
denies loss of sensation, face symmetric, tongue non-deviated

FAMILY HISTORY: father with h/o MI

SOCIAL HISTORY: lives alone, nonsmoker, nondrinker 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Helicobacter pylori [H. pylori],Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Constipation, unspecified,Other chest pain'}
