CHIEF COMPLAINT: Hematemesis

PRESENT ILLNESS: This is a 67 year old male with a history of recently diagnosed
adenocarcinoma of the esophagus. The patient, over the past few
months, had had increased difficulty in swallowing and on
[**2191-10-3**] underwent upper endoscopy which revealed a large mass in
the lower third of the esophagus. Biopsy revealed this mass as
adenocarcinoma of the esophagus. The patient has continued to
have poor oral intake but today attempted to eat a regular meal.
At 5 PM today, he began coughing up blood. Per patient and
relative, he coughed up roughly 500 cc of blood. Coughing
associated with abdominal pain. He denied lightheadedness or
dizziness. He went to ED where he was tachycardic in 110-120,
with BP in 140-145 range. O2 saturation nl on room air with
normal respiratory rate. He coughed up more blood in ED. Hct
41.3 2 large bore PIV placed and 4 units typed and crossed. GI
[**Name (NI) 653**], admitted to ICU where he is to undergo upper
endoscopy and possible stenting of mass.
On ROS, denies CP or dyspnea. Reports worsened appetite and 20
lb weight loss over past few months. No diarrhea.

MEDICAL HISTORY: 1) Esophageal adenocarcinoma
2) Prostate cancer, s/p radical retropubic prostatectomy

MEDICATION ON ADMISSION: None.
All/ADR's: None known.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.3 BP 131/69 HR 81 RR 19 O2 96 on 2L
Gen: WD/WN male Caucasian in NAD
Eyes: Sclerae anicteric
Mouth: No blood seen, MMM
Neck: Supple, no LND, no bruits
Chest: CTA b/l good air movement
Heart: RR, S1S2 nl without murmur
Abdomen: Mild epigastric tenderness to palpation. Otherwise
non-tender. Non-distended. Bowel sounds absent.
Ext: No edema, distal pulses normal.

FAMILY HISTORY: Notable for brother who has multiple myeloma.

SOCIAL HISTORY: Patient does not drink or smoke. He is married, wife is health
care proxy.
Malignant neoplasm of lower third of esophagus,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Hypovolemia,Personal history of malignant neoplasm of prostate,Effusion of joint, lower leg
Mal neo lower 3rd esoph,Gastrointest hemorr NOS,Second malig neo liver,Mal neo lymph intra-abd,Ac posthemorrhag anemia,Hypovolemia,Hx-prostatic malignancy,Joint effusion-l/leg
Admission Date:  [**2191-10-7**]              Discharge Date:   [**2191-10-16**]

Date of Birth:  [**2124-2-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Hematemesis

Major Surgical or Invasive Procedure:
1) open g-tube placement [**10-12**]
2) emergent EGD [**10-7**]


History of Present Illness:
This is a 67 year old male with a history of recently diagnosed
adenocarcinoma of the esophagus. The patient, over the past few
months, had had increased difficulty in swallowing and on
[**2191-10-3**] underwent upper endoscopy which revealed a large mass in
the lower third of the esophagus. Biopsy revealed this mass as
adenocarcinoma of the esophagus. The patient has continued to
have poor oral intake but today attempted to eat a regular meal.
At 5 PM today, he began coughing up blood. Per patient and
relative, he coughed up roughly 500 cc of blood. Coughing
associated with abdominal pain. He denied lightheadedness or
dizziness. He went to ED where he was tachycardic in 110-120,
with BP in 140-145 range. O2 saturation nl on room air with
normal respiratory rate. He coughed up more blood in ED. Hct
41.3 2 large bore PIV placed and 4 units typed and crossed. GI
[**Name (NI) 653**], admitted to ICU where he is to undergo upper
endoscopy and possible stenting of mass.
On ROS, denies CP or dyspnea. Reports worsened appetite and 20
lb weight loss over past few months. No diarrhea.


Past Medical History:
1) Esophageal adenocarcinoma
2) Prostate cancer, s/p radical retropubic prostatectomy


Social History:
Patient does not drink or smoke. He is married, wife is health
care proxy.

Family History:
Notable for brother who has multiple myeloma.

Physical Exam:
VS: T 97.3 BP 131/69 HR 81 RR 19 O2 96 on 2L
Gen: WD/WN male Caucasian in NAD
Eyes: Sclerae anicteric
Mouth: No blood seen, MMM
Neck: Supple, no LND, no bruits
Chest: CTA b/l good air movement
Heart: RR, S1S2 nl without murmur
Abdomen: Mild epigastric tenderness to palpation. Otherwise
non-tender. Non-distended. Bowel sounds absent.
Ext: No edema, distal pulses normal.


Pertinent Results:
[**2191-10-7**]: Upper endoscopy:
Esophagus:
Contents: Clotted blood was seen in the esophagus at 30 cm from
the incisors, occluding theh esophagus. No active bleeding was
seen. Exam was interrupted due to the extent of the clot and
proximity to the airway..
Stomach:
Other Not examined.
Duodenum:
Other Not examined.
Impression: Blood clot in the esophagus at 30 cm from the
incisors. Exam interrupted at this point.

CBC trend:
[**2191-10-7**] 07:35PM BLOOD WBC-11.5* RBC-5.03 Hgb-15.1 Hct-41.3
MCV-82 MCH-30.0 MCHC-36.5* RDW-12.9 Plt Ct-391
[**2191-10-7**] 10:05PM BLOOD Hct-37.8*
[**2191-10-8**] 04:07AM BLOOD WBC-8.8 RBC-4.40* Hgb-13.0* Hct-36.8*
MCV-84 MCH-29.6 MCHC-35.3* RDW-12.9 Plt Ct-315
[**2191-10-8**] 09:55AM BLOOD Hct-36.1*
[**2191-10-8**] 04:33PM BLOOD Hct-37.6*
[**2191-10-9**] 03:30AM BLOOD WBC-7.9 RBC-4.40* Hgb-13.1* Hct-36.2*
MCV-82 MCH-29.8 MCHC-36.1* RDW-13.1 Plt Ct-284
[**2191-10-9**] 03:07PM BLOOD Hct-36.3*
[**2191-10-10**] 04:00AM BLOOD WBC-9.8 RBC-4.35* Hgb-13.0* Hct-36.2*
MCV-83 MCH-29.9 MCHC-36.0* RDW-12.8 Plt Ct-264
[**2191-10-11**] 06:00AM BLOOD WBC-8.0 RBC-4.21* Hgb-12.6* Hct-34.6*
MCV-82 MCH-30.0 MCHC-36.5* RDW-13.1 Plt Ct-298

RLE ultrasound: Negative for DVT.

PET-CT: [**2191-10-5**]:
There is focal abnormal uptake of FDG in the thickened
esophagus, liver and multiple nodes including aortocaval
consistent with metastatic disease.

There are FDG-avid right paraesophageal (SUVmax 12.9), right
paratracheal (SUVmax 8.9), right hilar (SUVmax 5.5) and
subcarinal nodes (SUVmax 15.2). The esophagus shows FDG-avid
extensive wall thickening (SUVmax 18.3) and there is retention
of contrast proximally and a fluid level.

There are FDG-avid lymph nodes in the abdomen: right retrocrural
(SUVmax 7.6), lesser curve of the stomach (SUVmax 7.3),
paraortic ( SUVmax 11.7), and aortocaval (SUVmax 5.9).

There is an FDG-avid hepatic focus (SUVmax 6.7)

Physiologic uptake is seen in the brain, heart and GI and GU
tracts.
There is a small non-FDG-avid right middle lobe nodule.

IMPRESSION: Findings are consistent with esophageal cancer with
a hepatic metastasis and extensive FDG-avid nodes in the chest
and abdomen including the aortocaval.


Brief Hospital Course:
This 67 year old gentleman with recently diagnosed
adenocarcinoma of esophagus presented to the ED with several
episodes of hematemesis. On presentation he was hemodynamically
stable, with respiratory status at baseline.  Hematocrit was
also at baseline.  He was admitted to MICU as the likely source
of bleed is tumor was not resolving.  In the MICU he underwent
urgent upper endoscopy; however, this procedure was terminated
as a large clot was visualized in the proximal esophagus.  He
was monitored for 3 more days in the MICU for any signs of
rebleeding, pt remained was aggressively controlled with
antiemetics along with IV protonix to prevent any vomiting or
reflux which may have led to rebleeding (which in turn would
have required intubation).  He had no episodes of bleeding in
the MICU.  His hct trended slowly downward but the patient
remained hemodynamically stable  Hematology/Oncology was
consulted and a PET-CT revealed metastatic disease.  As pt had
to remain NPO, surgery was consulted for G-tube placement. The
G-tube was placed on [**10-12**] and tube feeds were started on [**10-13**].
The patient was discharged in stable condition and tolerating
tube feeds, with an outpatient follow up appointment with Dr.
[**Last Name (STitle) 3274**] (oncology) on [**10-20**].

Medications on Admission:
None.
All/ADR's: None known.

Discharge Medications:
1. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO DAILY
(Daily) as needed.
Disp:*450 mL* Refills:*3*
2. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg suspension PO twice a day.
Disp:*1 month* Refills:*2*
3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
Disp:*1 month* Refills:*3*
4. Compazine 5 mg/5 mL Syrup Sig: Five (5) mL PO every four (4)
hours as needed for nausea.
Disp:*1 month* Refills:*0*
5. Morphine 10 mg/5 mL Solution Sig: 0.5-1 mL PO every four (4)
hours as needed for pain.
Disp:*1 month* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1) upper GI Bleeding
2) Esophageal adenocarcinoma


Discharge Condition:
stable and tolerating g-tube feeds


Discharge Instructions:
You were admitted with esophageal bleeding. Please take all of
your medications as prescribed. Please do not take anything
other than thin liquids by mouth unless instructed to do so by
your doctor.
.
If you experience nausea, vomiting, dark stool, dizziness,
fainting, abdominal pain, pain, infection or redness around the
site of the g-tube, chest pain or shortness of breath or any
other concerning symptoms please seek medical attention
immediately.

Followup Instructions:
Please keep your appointment with Dr. [**Last Name (STitle) 3274**]. His office phone
is [**Telephone/Fax (1) 15512**] in case you need to reschedule.

Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**0-0-**]
Date/Time:[**2191-10-20**] 10:30
{'Malignant neoplasm of lower third of esophagus,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Hypovolemia,Personal history of malignant neoplasm of prostate,Effusion of joint, lower leg'}


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: Hematemesis

PRESENT ILLNESS: This is a 67 year old male with a history of recently diagnosed
adenocarcinoma of the esophagus. The patient, over the past few
months, had had increased difficulty in swallowing and on
[**2191-10-3**] underwent upper endoscopy which revealed a large mass in
the lower third of the esophagus. Biopsy revealed this mass as
adenocarcinoma of the esophagus. The patient has continued to
have poor oral intake but today attempted to eat a regular meal.
At 5 PM today, he began coughing up blood. Per patient and
relative, he coughed up roughly 500 cc of blood. Coughing
associated with abdominal pain. He denied lightheadedness or
dizziness. He went to ED where he was tachycardic in 110-120,
with BP in 140-145 range. O2 saturation nl on room air with
normal respiratory rate. He coughed up more blood in ED. Hct
41.3 2 large bore PIV placed and 4 units typed and crossed. GI
[**Name (NI) 653**], admitted to ICU where he is to undergo upper
endoscopy and possible stenting of mass.
On ROS, denies CP or dyspnea. Reports worsened appetite and 20
lb weight loss over past few months. No diarrhea.

MEDICAL HISTORY: 1) Esophageal adenocarcinoma
2) Prostate cancer, s/p radical retropubic prostatectomy

MEDICATION ON ADMISSION: None.
All/ADR's: None known.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.3 BP 131/69 HR 81 RR 19 O2 96 on 2L
Gen: WD/WN male Caucasian in NAD
Eyes: Sclerae anicteric
Mouth: No blood seen, MMM
Neck: Supple, no LND, no bruits
Chest: CTA b/l good air movement
Heart: RR, S1S2 nl without murmur
Abdomen: Mild epigastric tenderness to palpation. Otherwise
non-tender. Non-distended. Bowel sounds absent.
Ext: No edema, distal pulses normal.

FAMILY HISTORY: Notable for brother who has multiple myeloma.

SOCIAL HISTORY: Patient does not drink or smoke. He is married, wife is health
care proxy. 

### Response:
{'Malignant neoplasm of lower third of esophagus,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of liver, secondary,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Acute posthemorrhagic anemia,Hypovolemia,Personal history of malignant neoplasm of prostate,Effusion of joint, lower leg'}
