CHIEF COMPLAINT: GI bleed

PRESENT ILLNESS: 67 yo M with h/o HTN, AF on coumadin, dilated CM, EF 50%, CAD,
PUD s/p gatrectomy/Billroth II in [**2172**] p/w BRBPR with 15 pt drop
in Hct, hemodynamically stable in ED, +non clearing NG lavage
with red blood and clots (800cc). GI was consulted. Pt received
FFP and vitamin K for INR 2.4.
Pt had been fine until last night when he developed nausea with
vomiting X 1 with streak of blood per wife.  [**Name (NI) **] drank about 2
liters of water per his wife.  Overnight, he had a grossly
bloody bowel movement that he reported to his wife in AM. It
occurred again this AM- large volume with bright red blood.  +
LH + dizziness -CP -SOB - abd pain -fever -dysuria

MEDICAL HISTORY: Past Medical History:
HTN
Smoking
Polycythemia [**1-20**] OSA?
OSA refractory to CPAP
hx iron deficiency anemia
CrI with bl CR 1.3-1.5 [**1-20**] HTN
CAD: last cath [**6-20**] documenting mild to mod diffuse CAD, but no

MEDICATION ON ADMISSION: MEDS on admission:
aspirin 81mg PO QD
celexa 20mg QD
nefidipine 60mg PO QD
TUMS/calcium 600mg
synthroid 150mcg PO QD
coreg 6.25mg [**Hospital1 **]
vitamin C [**Hospital1 **]
calcetriol 0.5mg [**Hospital1 **]
Coumadin
Lipitor 10mg PO QD
clonopin 1mg HS
Imdur 120mg HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: no distress, well -appearing
VS: 97.1  87  178/81  [**12-10**] 99% RA
HEENT: EOMI, anicteric, PERRL, MMM
Neck: supple, -lad, JVP not elevated
lungs: CTA bilat
heart: irreg with reg rate - murmurs
abd: soft NT ND -hsm, + hyperactive BS
ext: -e/c/c, 2 + DP bilat
neuro: intact grossly,

FAMILY HISTORY: NC

SOCIAL HISTORY: tobacco *40 pack year hx, 1ppd now
rare EOTH
lives with wife in JP
former engineer, married
Gastroesophageal laceration-hemorrhage syndrome,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Orthostatic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Mallory-weiss syndrome,Chr blood loss anemia,Subendo infarct, initial,CHF NOS,Atrial fibrillation,Orthostatic hypotension,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2196-4-1**]              Discharge Date:   [**2196-4-12**]

Date of Birth:  [**2128-5-23**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
GI bleed

Major Surgical or Invasive Procedure:
EGD with epineprhine injection

History of Present Illness:
67 yo M with h/o HTN, AF on coumadin, dilated CM, EF 50%, CAD,
PUD s/p gatrectomy/Billroth II in [**2172**] p/w BRBPR with 15 pt drop
in Hct, hemodynamically stable in ED, +non clearing NG lavage
with red blood and clots (800cc). GI was consulted. Pt received
FFP and vitamin K for INR 2.4.
Pt had been fine until last night when he developed nausea with
vomiting X 1 with streak of blood per wife.  [**Name (NI) **] drank about 2
liters of water per his wife.  Overnight, he had a grossly
bloody bowel movement that he reported to his wife in AM. It
occurred again this AM- large volume with bright red blood.  +
LH + dizziness -CP -SOB - abd pain -fever -dysuria


Past Medical History:
Past Medical History:
HTN
Smoking
Polycythemia [**1-20**] OSA?
OSA refractory to CPAP
hx iron deficiency anemia
CrI with bl CR 1.3-1.5 [**1-20**] HTN
CAD: last cath [**6-20**] documenting mild to mod diffuse CAD, but no

obstructing lesions, MI x 2
EF 50% most recently, down to 25% in 99
Atrial fibrillation on coumadin
medullary thyorid CA s/p thyroidectomy
parathyroid adenoma s/p partial parathyroidectomy
TURP [**9-/2191**]
BPH
PUD s/p gastrectomy/Billroth II [**2172**]
s/p CCY
ventral hernia
Raynaud's
hematuria with hx epidymitis
depression
[**Last Name (un) **] [**2193-8-20**] with grade I int hemorrhoids and polyp at hepatic
flexure ([**6-17**] normal except for erythema in rectum)
EGD [**2193-8-20**] with erythema of entire remaining stomach ([**6-17**]
with gastritis)


Social History:
tobacco *40 pack year hx, 1ppd now
rare EOTH
lives with wife in JP
former engineer, married


Family History:
NC

Physical Exam:
PE: no distress, well -appearing
VS: 97.1  87  178/81  [**12-10**] 99% RA
HEENT: EOMI, anicteric, PERRL, MMM
Neck: supple, -lad, JVP not elevated
lungs: CTA bilat
heart: irreg with reg rate - murmurs
abd: soft NT ND -hsm, + hyperactive BS
ext: -e/c/c, 2 + DP bilat
neuro: intact grossly,


Pertinent Results:
[**2196-4-1**] 09:13PM   HCT-27.3*
[**2196-4-1**] 05:22PM   GLUCOSE-85 UREA N-70* CREAT-1.5* SODIUM-143
POTASSIUM-4.4 CHLORIDE-112* TOTAL CO2-25 ANION GAP-10
[**2196-4-1**] 05:22PM   CK(CPK)-71
[**2196-4-1**] 05:22PM   CK-MB-NotDone cTropnT-<0.01
[**2196-4-1**] 11:10AM   PLT COUNT-152
[**2196-4-1**] 11:10AM   PT-20.7* PTT-33.8 INR(PT)-2.7

Admission Chest X ray: unremarkable
.
EGD: [**2196-4-2**] - [**Doctor First Name **]-[**Doctor Last Name **] tear (injection, thermal
therapy, ligation). Blood in the stomach. Recommendations: High
dose (double dose) PPI, Surgical consultation. There is no
further endoscopic treatment for this lesion if he rebleeds.
Serial HCT, continue to transfuse, reverse coagulopathy, ICU
care.
.
[**2196-4-6**]  GI BLEEDING STUDY - IMPRESSION: No visible source of
GI bleed.
.
EKG: 76 afib, LAD, IVCD, strain pattern V4-6, AVL, I,  V5-AVL
deeper than priors, V4 strain new.

Brief Hospital Course:
67 y/o M w/ CAD and AFib on Coumadin and ASA, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]-[**Doctor Last Name **]
tear with BRBPR and NSTEMI
.
UPPER GI BLEED: Pt was admitted to the MICU. EGD on [**2196-4-1**]
without active bleeding, but f/u EGD [**2196-4-2**] with [**Doctor First Name **]-[**Doctor Last Name **]
tear s/p injection, thermal therapy, and ligation. He recieved a
total of 9U of PRBC's, the last on [**2196-4-2**] with stable Hct. He
was c/o of the MICU on [**2196-4-5**], and was noted to have several
episodes of BRBPR the following day. He was orthostatic to BP
60/p, and there was concern for re-bleeding of [**Doctor First Name **]-[**Doctor Last Name **]
tear. He was transferred back to the MICU. NGT lavage was
negative for blood, and f/u bleeding scan was negative. The
patient did not have any further episodes of melena or BRBPR,
and Hct remained stable throughout the remainder of his stay. He
will f/u with GI for repeat EGD and colonoscopy.
.
CARDIOLOGY - Pt was noted to have NSTEMI with increased troponin
of 0.63 and peak CK of 286, felt to be related to stress in pt
pt with known CAD and UGIB. His cardiac enzymes trended down. He
was continued on BB and statin. After cardiology consult,
patient will have oupt stress. He will restart ASA therapy [**4-13**].
He also has a history of afib and coumadin was held in the
setting of GIB. He will need to discuss restarting Couamdin as
outpatient.
.
HTN/orthostasis - Will hold OP meds given orthostatic
hypotension from hypovolemia. Restarted Carvedilol. Pt
aggressively hydrated and dizziness improved.

Endocrine - on levoxyl

CRI- stable with Cr 1.5. Likely secondary to HTN.

FEN- encourage po fluids


Medications on Admission:
MEDS on admission:
aspirin 81mg PO QD
celexa 20mg QD
nefidipine 60mg PO QD
TUMS/calcium 600mg
synthroid 150mcg PO QD
coreg 6.25mg [**Hospital1 **]
vitamin C [**Hospital1 **]
calcetriol 0.5mg [**Hospital1 **]
Coumadin
Lipitor 10mg PO QD
clonopin 1mg HS
Imdur 120mg HS


Discharge Medications:
1. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. 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*
3. Citalopram Hydrobromide 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
5. Levothyroxine Sodium 150 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
GI bleed
Orthostatic hypotension
Non ST elevation MI
HTN
OSA
atrial fibrillation


Discharge Condition:
stable

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet

You are still dehydrated. Please drink plenty of fluids and
water, at least 8 cups per day. Please notify your doctor if you
have any bleeding from your stools. Restart your aspirin
tomorrow. Do not take your coumadin, imdur or nifedipine until
Dr. [**Last Name (STitle) 3357**] tells you to.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 3357**] in 2 weeks.
Follow up with the gastrointestinal doctors for a repeat EGD and
colonoscopy. Please call Dr. [**First Name4 (NamePattern1) 7306**] [**Last Name (NamePattern1) 7307**] [**Telephone/Fax (1) 1954**] for an
appointment.
Please f/u with outpatient cardiac stress test.


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]

Completed by:[**2196-4-12**]
{'Gastroesophageal laceration-hemorrhage syndrome,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Orthostatic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,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: GI bleed

PRESENT ILLNESS: 67 yo M with h/o HTN, AF on coumadin, dilated CM, EF 50%, CAD,
PUD s/p gatrectomy/Billroth II in [**2172**] p/w BRBPR with 15 pt drop
in Hct, hemodynamically stable in ED, +non clearing NG lavage
with red blood and clots (800cc). GI was consulted. Pt received
FFP and vitamin K for INR 2.4.
Pt had been fine until last night when he developed nausea with
vomiting X 1 with streak of blood per wife.  [**Name (NI) **] drank about 2
liters of water per his wife.  Overnight, he had a grossly
bloody bowel movement that he reported to his wife in AM. It
occurred again this AM- large volume with bright red blood.  +
LH + dizziness -CP -SOB - abd pain -fever -dysuria

MEDICAL HISTORY: Past Medical History:
HTN
Smoking
Polycythemia [**1-20**] OSA?
OSA refractory to CPAP
hx iron deficiency anemia
CrI with bl CR 1.3-1.5 [**1-20**] HTN
CAD: last cath [**6-20**] documenting mild to mod diffuse CAD, but no

MEDICATION ON ADMISSION: MEDS on admission:
aspirin 81mg PO QD
celexa 20mg QD
nefidipine 60mg PO QD
TUMS/calcium 600mg
synthroid 150mcg PO QD
coreg 6.25mg [**Hospital1 **]
vitamin C [**Hospital1 **]
calcetriol 0.5mg [**Hospital1 **]
Coumadin
Lipitor 10mg PO QD
clonopin 1mg HS
Imdur 120mg HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: no distress, well -appearing
VS: 97.1  87  178/81  [**12-10**] 99% RA
HEENT: EOMI, anicteric, PERRL, MMM
Neck: supple, -lad, JVP not elevated
lungs: CTA bilat
heart: irreg with reg rate - murmurs
abd: soft NT ND -hsm, + hyperactive BS
ext: -e/c/c, 2 + DP bilat
neuro: intact grossly,

FAMILY HISTORY: NC

SOCIAL HISTORY: tobacco *40 pack year hx, 1ppd now
rare EOTH
lives with wife in JP
former engineer, married 

### Response:
{'Gastroesophageal laceration-hemorrhage syndrome,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Orthostatic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
