CHIEF COMPLAINT: BRPBR

PRESENT ILLNESS: 62yo Russian cardiologist who presented with bright red blood
per rectum since 7pm the day prior to admission. She is admitted
to the ICU for monitoring and preparation for colonoscopy. She
has 4 more episodes BRBPR. She describes clots with bright red
blood. Patient claims that she estimated blood loss of 2 L. She
was hemodynamically stable in the ED and had been given 1U of
PRBC and 2L NS She denies melena/hemetemesis/CP/SOB/dizziness.
She had colonoscopy  [**2-10**] with removal of 2 polyps and had not
been bleeding until the day before.
Of note, she was recently discovered to have elevated
transminases on routine exam. Further workup revelas negative
Hep B&C + AMA, - [**Doctor First Name **] +RF. She had an MRI which showed
hemangioma. Liver biopsy confirms primary biliary cirrhosis. She
is foollowed by Dr.[**Last Name (STitle) 59294**].

MEDICAL HISTORY: 1. appendectomy
2. primary biliary cirrhosis
3. atypical liver hmangioma
4. s/p rectal polypectomy at 32yo
5. rheumatoid arthritis

MEDICATION ON ADMISSION: no home meds

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen-NAD, pleasant
HEENT-anicteric, oral mucosa moist, neck supple
CV-RRR, no r/m/g
resp-CTAB
[**Last Name (un) 103**]-+BS, soft, NT/ND, no HSM
neuro-A+O x3, PERL, EOMI, moves all 4 limbs, CNII-XII intact
skin-no rash
extremities-DP 2+ bilaterally, no pitting edema

FAMILY HISTORY: colon cancer

SOCIAL HISTORY: She currently is single. She does not smoke. She does not
drink alcohol. She has no drug allergies.
Hemorrhage complicating a procedure,Biliary cirrhosis,Hypopotassemia,Hemorrhage of gastrointestinal tract, unspecified,Rheumatoid arthritis,Acute posthemorrhagic anemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Hemorrhage complic proc,Biliary cirrhosis,Hypopotassemia,Gastrointest hemorr NOS,Rheumatoid arthritis,Ac posthemorrhag anemia,Abn react-surg proc NEC
Admission Date:  [**2129-2-18**]              Discharge Date:   [**2129-2-20**]

Date of Birth:  [**2066-11-24**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5644**]
Chief Complaint:
BRPBR

Major Surgical or Invasive Procedure:
none

History of Present Illness:
62yo Russian cardiologist who presented with bright red blood
per rectum since 7pm the day prior to admission. She is admitted
to the ICU for monitoring and preparation for colonoscopy. She
has 4 more episodes BRBPR. She describes clots with bright red
blood. Patient claims that she estimated blood loss of 2 L. She
was hemodynamically stable in the ED and had been given 1U of
PRBC and 2L NS She denies melena/hemetemesis/CP/SOB/dizziness.
She had colonoscopy  [**2-10**] with removal of 2 polyps and had not
been bleeding until the day before.
Of note, she was recently discovered to have elevated
transminases on routine exam. Further workup revelas negative
Hep B&C + AMA, - [**Doctor First Name **] +RF. She had an MRI which showed
hemangioma. Liver biopsy confirms primary biliary cirrhosis. She
is foollowed by Dr.[**Last Name (STitle) 59294**].

Past Medical History:
1. appendectomy
2. primary biliary cirrhosis
3. atypical liver hmangioma
4. s/p rectal polypectomy at 32yo
5. rheumatoid arthritis


Social History:
She currently is single. She does not smoke. She does not
drink alcohol. She has no drug allergies.


Family History:
colon cancer

Physical Exam:
Gen-NAD, pleasant
HEENT-anicteric, oral mucosa moist, neck supple
CV-RRR, no r/m/g
resp-CTAB
[**Last Name (un) 103**]-+BS, soft, NT/ND, no HSM
neuro-A+O x3, PERL, EOMI, moves all 4 limbs, CNII-XII intact
skin-no rash
extremities-DP 2+ bilaterally, no pitting edema

Pertinent Results:
[**2129-2-18**] 05:55AM   WBC-8.7 RBC-3.65* HGB-11.1* HCT-33.3* MCV-91
MCH-30.3 MCHC-33.2 RDW-13.1
[**2129-2-18**] 05:55AM   PLT COUNT-180
[**2129-2-18**] 04:29AM   HGB-9.8* calcHCT-29
[**2129-2-18**] 12:57AM   PT-12.8 PTT-27.4 INR(PT)-1.0
[**2129-2-17**] 11:05PM   GLUCOSE-93 UREA N-16 CREAT-0.6 SODIUM-140
POTASSIUM-3.7 CHLORIDE-104 TOTAL CO2-30* ANION GAP-10
[**2129-2-17**] 11:05PM   ALT(SGPT)-122* AST(SGOT)-89* LD(LDH)-184 ALK
PHOS-543* AMYLASE-96 TOT BILI-0.5
[**2129-2-17**] 11:05PM   LIPASE-36
[**2129-2-17**] 11:05PM   WBC-11.3*# RBC-4.22 HGB-12.8 HCT-37.6 MCV-89
MCH-30.4 MCHC-34.1 RDW-13.2
[**2129-2-17**] 11:05PM   NEUTS-54.0 LYMPHS-40.8 MONOS-2.9 EOS-1.8
BASOS-0.5
[**2129-2-17**] 11:05PM   PLT COUNT-218

U/S [**2-14**]:hemangioma

polypectomy [**2-14**]: adenoma

liver bx [**2-15**]:
Liver, core biopsy:
1.  Moderate portal mixed cell inflammation, predominantly
composed of lymphocytes with scattered plasma cells and
neutrophils, with extension into lobules (interface hepatitis).
2.  Focal bile duct damage and mononuclear cell infiltrate.
3.  Occasional necrotic hepatocytes.
4.  No granulomas seen.
5.  Trichrome stain:  Mild increase in portal fibrosis with
focal bridging.
6.  Iron stain:  Focal iron deposition in Kupffer cells.Note:
Possible etiologies include primary biliary cirrhosis, and
drug-induced liver injury.  Clinical correlation is suggested.

Discharge labs:
[**2129-2-20**] 06:15AM BLOOD WBC-6.9 RBC-3.70* Hgb-11.1* Hct-31.9*
MCV-86 MCH-29.9 MCHC-34.7 RDW-13.2 Plt Ct-190
[**2129-2-20**] 06:15AM BLOOD Plt Ct-190
[**2129-2-20**] 06:15AM BLOOD Glucose-105 UreaN-12 Creat-0.7 Na-140
K-4.0 Cl-107 HCO3-25 AnGap-12
[**2129-2-20**] 06:15AM BLOOD Calcium-9.3 Phos-3.1 Mg-2.0

Brief Hospital Course:
1. BRBPR - 62 year old previously healthy female with recent
diagnosis of primary biliary cirrhosis presented with BRBPR s/p
polypectomy.  Her bleeding was felt to be due to the polypectomy
8 days ago, she was hemodynamically stable, platelets and coag
were normal.  On admission two large bore IVs were placed.  She
was transferred to the ICU for observation.  She was transfused
with a total of 1 unit PRBCs and fluid.  Serial HCTs showed
appropriate correction with no further bleeding.  Her gastric
lavage was negative, she was prepped for colonoscopy however her
HCT was stable so the colonoscopy was never performed.  On
hospital day #2 she was stable and transferred to the floor.
She tolerated regular diet.  On hospital day 3 she had no
further bleeding for over 60 hours and was discharged home.  She
was advised to avoid aspirin and NSAIDS for two weeks.

2. liver - On admission the patient was not aware of diagnosis
of PBC.  She will need to follow up with GI as scheduled to
initiate treatment of PBC.  She also had an atypical liver
hemangioma, which will require follow up U/S in 6 months.


Medications on Admission:
no home meds

Discharge Medications:
none

Discharge Disposition:
Home

Discharge Diagnosis:
Lower GI bleed post polypectomy
Secondary diagnosis
PBC


Discharge Condition:
Good

Discharge Instructions:
Return to the hospital with any lightheadedness, bleeding, or
other concerning symptoms.
Do not take any aspirin or NSAIDS for two more weeks.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6970**], MD Where: LM [**Hospital Unit Name 22399**] Phone:[**Telephone/Fax (1) 1983**] Date/Time:[**2129-2-21**] 4:30
{'Hemorrhage complicating a procedure,Biliary cirrhosis,Hypopotassemia,Hemorrhage of gastrointestinal tract, unspecified,Rheumatoid arthritis,Acute posthemorrhagic anemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: BRPBR

PRESENT ILLNESS: 62yo Russian cardiologist who presented with bright red blood
per rectum since 7pm the day prior to admission. She is admitted
to the ICU for monitoring and preparation for colonoscopy. She
has 4 more episodes BRBPR. She describes clots with bright red
blood. Patient claims that she estimated blood loss of 2 L. She
was hemodynamically stable in the ED and had been given 1U of
PRBC and 2L NS She denies melena/hemetemesis/CP/SOB/dizziness.
She had colonoscopy  [**2-10**] with removal of 2 polyps and had not
been bleeding until the day before.
Of note, she was recently discovered to have elevated
transminases on routine exam. Further workup revelas negative
Hep B&C + AMA, - [**Doctor First Name **] +RF. She had an MRI which showed
hemangioma. Liver biopsy confirms primary biliary cirrhosis. She
is foollowed by Dr.[**Last Name (STitle) 59294**].

MEDICAL HISTORY: 1. appendectomy
2. primary biliary cirrhosis
3. atypical liver hmangioma
4. s/p rectal polypectomy at 32yo
5. rheumatoid arthritis

MEDICATION ON ADMISSION: no home meds

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen-NAD, pleasant
HEENT-anicteric, oral mucosa moist, neck supple
CV-RRR, no r/m/g
resp-CTAB
[**Last Name (un) 103**]-+BS, soft, NT/ND, no HSM
neuro-A+O x3, PERL, EOMI, moves all 4 limbs, CNII-XII intact
skin-no rash
extremities-DP 2+ bilaterally, no pitting edema

FAMILY HISTORY: colon cancer

SOCIAL HISTORY: She currently is single. She does not smoke. She does not
drink alcohol. She has no drug allergies. 

### Response:
{'Hemorrhage complicating a procedure,Biliary cirrhosis,Hypopotassemia,Hemorrhage of gastrointestinal tract, unspecified,Rheumatoid arthritis,Acute posthemorrhagic anemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
