CHIEF COMPLAINT: bright red blood per rectum

PRESENT ILLNESS: 76-year-old man with history of diverticulosis, prostate cancer,
stroke on Aggrenox, DM2, hypertension presented with BRBPR.
Patient reported having 2 episodes of bleeding with bowel
movements the night of presentation, claiming that toilet bowl
was filled with bright red blood. Denies abdominal pain,
lightheadedness, chest pain, shortness of breath.

MEDICAL HISTORY: # diverticulosis: h/o ?diverticulitis, s/p sigmoid resection
many years ago
# hemorrhoids: remote
# hypertension
# prostate cancer: dx'ed [**2156**], [**Doctor Last Name **] 8, s/p external beam XRT
and hormonal therapy in [**2157**]
# SVT: intermittent, with palpitations, declined beta blocker,
followed by Dr. [**Last Name (STitle) **]
# stroke: dx'ed [**2156**], small lacunar infarct in the left internal
capsular region in close proximity to the posterior limb
# hypercholesterolemia
# polio
# DM2

MEDICATION ON ADMISSION: atorvastatin 40 mg daily
Aggrenox 25-200 mg [**Hospital1 **]
folic acid
glyburide-metformin 1.25-250 mg [**Hospital1 **]
lisinopril 40 mg daily
ranitidine 150 mg [**Hospital1 **]
docusate
iron

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL:  elderly man lying in bed in NAD, pleasantly talkative
HEENT:  EOMI, PERRL, OP moist without lesion
Neck: no JVD, supple
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, bowel sounds present, well-healed
incisional scar
EXT: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives by self. No smoking or drinking. Very active and
independent at baseline.
Other specified disorders of rectum and anus,Diverticulosis of colon with hemorrhage,Late effect of radiation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Other specified cardiac dysrhythmias,Other late effects of cerebrovascular disease
Rectal & anal dis NEC,Dvrtclo colon w hmrhg,Late effect of radiation,Hx-prostatic malignancy,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Cardiac dysrhythmias NEC,Late effect CV dis NEC
Admission Date:  [**2162-3-19**]              Discharge Date:   [**2162-3-20**]

Date of Birth:  [**2085-8-29**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
bright red blood per rectum

Major Surgical or Invasive Procedure:
sigmoidoscopy

History of Present Illness:
76-year-old man with history of diverticulosis, prostate cancer,
stroke on Aggrenox, DM2, hypertension presented with BRBPR.
Patient reported having 2 episodes of bleeding with bowel
movements the night of presentation, claiming that toilet bowl
was filled with bright red blood. Denies abdominal pain,
lightheadedness, chest pain, shortness of breath.

Patient had a colonoscopy many years ago--he doesn't remember
when-- which was reportedly "normal". However he does have a
history of diverticulosis and underwent sigmoid resection years
ago for ?diverticulitis. Never had BRBPR until now. He also
reports a remote history of hemorrhoids.

In the ED, initial VS: T 98.4, HR 104, BP 155/73, RR 20, 97%RA.
Negative NG lavage, rectal exam with bloody stools. Hct 34.5
(baseline high 30s-low 40s). BUN 24, Cr 1.4 (baseline ?1.3-1.4).
INR 1.1. GI was made aware. Had 2 more bowel movements in ED
with blood. Ordered for blood but not transfused yet in ED.

On arrival, he was stable, talking pleasantly.

ROS: Denies fever, chills, night sweats, headache, vision
changes, rhinorrhea, congestion, sore throat, cough, shortness
of breath, chest pain, abdominal pain, nausea, vomiting,
diarrhea, constipation, melena, dysuria, hematuria.

Past Medical History:
# diverticulosis: h/o ?diverticulitis, s/p sigmoid resection
many years ago
# hemorrhoids: remote
# hypertension
# prostate cancer: dx'ed [**2156**], [**Doctor Last Name **] 8, s/p external beam XRT
and hormonal therapy in [**2157**]
# SVT: intermittent, with palpitations, declined beta blocker,
followed by Dr. [**Last Name (STitle) **]
# stroke: dx'ed [**2156**], small lacunar infarct in the left internal
capsular region in close proximity to the posterior limb
# hypercholesterolemia
# polio
# DM2

Social History:
lives by self. No smoking or drinking. Very active and
independent at baseline.

Family History:
non-contributory

Physical Exam:
GENERAL:  elderly man lying in bed in NAD, pleasantly talkative
HEENT:  EOMI, PERRL, OP moist without lesion
Neck: no JVD, supple
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, bowel sounds present, well-healed
incisional scar
EXT: no c/c/e


Pertinent Results:
Sigmoidoscopy: Mucosa: Erythema noted in the rectum consistent
with radiation proctitis. Scope advanced to distal sigmoid colon
with no bleeding identified. Brown stool was seen at this point.


Impression: Abnormal mucosa in the colon. Otherwise normal
sigmoidoscopy to distal sigmoid colon.

Recommendations: Monitor Hct and vitals. If re-bleeds, bleeding
scan. If stable, will proceed with elective colonoscopy.
Additional notes: The attending was present for the entire
procedure. The patient's reconciled home medication list is
appended to this report.

[**2162-3-20**] 03:47AM BLOOD WBC-6.5 RBC-3.77* Hgb-12.0* Hct-34.7*
MCV-92 MCH-31.7 MCHC-34.4 RDW-14.5 Plt Ct-186
[**2162-3-19**] 11:40PM BLOOD Hct-33.6*
[**2162-3-19**] 04:20PM BLOOD Hct-33.5*
[**2162-3-19**] 09:55AM BLOOD Hct-33.5*
[**2162-3-19**] 05:10AM BLOOD Hct-31.1*
[**2162-3-19**] 02:00AM BLOOD WBC-9.5 RBC-3.58* Hgb-12.0* Hct-34.5*
MCV-96 MCH-33.6* MCHC-34.9 RDW-12.9 Plt Ct-234
[**2162-3-20**] 03:47AM BLOOD Glucose-135* UreaN-20 Creat-1.3* Na-136
K-4.3 Cl-104 HCO3-24 AnGap-12
[**2162-3-19**] 02:00AM BLOOD Glucose-108* UreaN-24* Creat-1.4* Na-136
K-4.3 Cl-104 HCO3-22 AnGap-14

Brief Hospital Course:
Lower GI Bleed: The patient had a few episodes of BRBPR.  His
hct never dropped below 30 and he was hemodynamically stable.
He was given 1 unit PRBC and underwent a sigmoidoscopy in the
ICU which revealed possible radiation proctitis.  In addition it
is possible he has another source of bleeding such as polyp,
tumor or diverticulosis.  He will require an elective
colonoscopy. The patient will call his PCP's office on Monday
[**3-22**] to set this up.   He will hold off on aggrenox until his
full colonoscopy and will discuss restarting with his PCP.

SVT: the patient had 3-5 episodes of SVT, all less than a few
minutes, which broke with vagal maneuvers.  He was started on
lopressor 25mg po tid and discharged on toprol xl 100mg daily.
His oupt cardiologist was informed of this and he has had this
in the past and has not been treated for this.  To make room for
this beta blocker his ACEi (lisinopril 40mg po daily) was held.


Medications on Admission:
atorvastatin 40 mg daily
Aggrenox 25-200 mg [**Hospital1 **]
folic acid
glyburide-metformin 1.25-250 mg [**Hospital1 **]
lisinopril 40 mg daily
ranitidine 150 mg [**Hospital1 **]
docusate
iron

Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

2. Glyburide-Metformin 1.25-250 mg Tablet Sig: One (1) Tablet PO
once a day.
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
primary:  lower gastrointestinal bleeding
secondary:  supraventricular tachycardia


Discharge Condition:
stable, amulatory, normal mental status


Discharge Instructions:
You were admitted to the hospital because of bleeding from your
rectum.  You received one unit of blood, and your blood counts
stabilized.  A sigmoidoscopy showed that you may have some
damage from prior radiation causing the bleeding, or this may be
related to something else further in the colon.  You will need
to have a colonoscopy as an outpatient to evaluate this further.
 Your bleeding stopped, and you were discharged to home.

The following medications were changed:
1) Aggrenox was stopped - please discuss when to restart this
with
2) Metoprolol 100 XL 100 mg daily was started - this is for your
rapid heart rate
3) Lisinopril - This was stopped because metoprolol will likely
control your blood pressure.


Followup Instructions:
Your primary care doctor, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6164**], [**First Name3 (LF) **] be calling you on
Monday to arrange an appointment.  If you do not hear from him,
please call him at [**Telephone/Fax (1) 5723**].  You will need a colonoscopy as
an outpatient, which Dr. [**First Name (STitle) 6164**] will schedule.

Also, please follow up with your cardiologist as previously
scheduled:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], MD Phone:[**Telephone/Fax (1) 5068**] Date/Time:[**2162-6-17**] 3:00



Completed by:[**2162-3-20**]
{'Other specified disorders of rectum and anus,Diverticulosis of colon with hemorrhage,Late effect of radiation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Other specified cardiac dysrhythmias,Other late effects of cerebrovascular disease'}


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: 76-year-old man with history of diverticulosis, prostate cancer,
stroke on Aggrenox, DM2, hypertension presented with BRBPR.
Patient reported having 2 episodes of bleeding with bowel
movements the night of presentation, claiming that toilet bowl
was filled with bright red blood. Denies abdominal pain,
lightheadedness, chest pain, shortness of breath.

MEDICAL HISTORY: # diverticulosis: h/o ?diverticulitis, s/p sigmoid resection
many years ago
# hemorrhoids: remote
# hypertension
# prostate cancer: dx'ed [**2156**], [**Doctor Last Name **] 8, s/p external beam XRT
and hormonal therapy in [**2157**]
# SVT: intermittent, with palpitations, declined beta blocker,
followed by Dr. [**Last Name (STitle) **]
# stroke: dx'ed [**2156**], small lacunar infarct in the left internal
capsular region in close proximity to the posterior limb
# hypercholesterolemia
# polio
# DM2

MEDICATION ON ADMISSION: atorvastatin 40 mg daily
Aggrenox 25-200 mg [**Hospital1 **]
folic acid
glyburide-metformin 1.25-250 mg [**Hospital1 **]
lisinopril 40 mg daily
ranitidine 150 mg [**Hospital1 **]
docusate
iron

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL:  elderly man lying in bed in NAD, pleasantly talkative
HEENT:  EOMI, PERRL, OP moist without lesion
Neck: no JVD, supple
CARDIAC: RR, normal S1/S2, no m/r/g
LUNG: CTAB
ABDOMEN: soft, NT, ND, bowel sounds present, well-healed
incisional scar
EXT: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives by self. No smoking or drinking. Very active and
independent at baseline. 

### Response:
{'Other specified disorders of rectum and anus,Diverticulosis of colon with hemorrhage,Late effect of radiation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Other specified cardiac dysrhythmias,Other late effects of cerebrovascular disease'}
