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metaboulie
/
c2n2_2018_with_prediction_test

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600
Otherwise normal colonoscopy to cecum .
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602
[ * * 2195 - 4 - 3 * * ] colonoscopy : Non bleediong diverticulosis of the whole colon .
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603
Bleeding angioectasias in the cecum treated with APC .
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Polyp in the transverse colon .
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605
Blood and stool throughout colon .
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606
Non bleeding posterior anal fissure .
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608
[ * * 2195 - 4 - 13 * * ] colonoscopy : Blood in the whole colon .
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609
Diverticulosis of the sigmoid colon and descending colon .
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610
Ulcers in the cecum .
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611
A large adherent blood clot was found in the cecum with surrounding oozing of bright red blood .
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612
Given the risk of uncontrollable bleeding in the setting of low platelets , the clot was not removed .
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613
Otherwise normal colonoscopy to cecum
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614
Brief Hospital Course : Ms .
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615
[ * * Known lastname 73078 * * ] is 79 year old pleasant woman with a Past medical history significant for MDS with AML transformation on Dacogen , diverticulosis , known cecal AVMs admitted from clinic on [ * * 2195 - 4 - 1 * * ] in the setting of a transfusion reaction to platelets with thrombocytopenia who was noted to develop bright red blood per rectum with acute hematocrit drop who underwent repeat colonoscopy showing non - bleeding diverticulosis of the entire colon and bleeding angioectasias of the cecum treated with Argon Plasma coagulation .
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616
She required a second colonoscopy for repeated bloody bowel movements which showed a clot adherent to the cecum .
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617
She remained stable for a while then had frequent bloody bowel movements again which was controlled by amicar drip for 8 hours .
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618
Gradually her platelets started to increase .
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619
After these events , she remained stable and was discharged home in stable condition .
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620
She will require HLA matched platelet transfusions in the future if needed .
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100549.txt
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621
.
[ 0 ]
[ "." ]
100549.txt
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[ "O" ]
622
# cecal AVMs : She was transferred to the ICU twice for bright red blood per rectum .
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100549.txt
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623
The patient developed BRBPR , and was found to have cecal AVMs on colonoscopy s/p APC .
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100549.txt
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624
Specifically , repeat colonoscopy demonstrated cecal angioectasias that were actively bleeding , non - bleeding colonic diverticula and small polyp .
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100549.txt
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625
Hemostasis achieved with Argon Plasma coagulation therapy on [ * * 2195 - 4 - 3 * * ] .
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100549.txt
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626
During her stay she required several units of PRBC and platelets .
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100549.txt
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627
After remaining stable , she was transferred back to the floor however she had the same situation again and was transferred back to the ICU where she had her second colonoscopy which showed a clot adherent to the cecum with oozing around the clot .
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100549.txt
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628
The clot was not removed ( not amenable to endoscopic management ) .
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100549.txt
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629
GI recommended surgical consult for possible resection however given her underlying disease and low platelet counts , they felt this will not be a favorable management .
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100549.txt
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630
After having stable H/H , she was transferred back to the floor .
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100549.txt
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631
While on the floor , she had a few bloody bowel movements however the night of [ * * 4 - 17 * * ] she had total of 450 cc bloody watery stools which required amicar drip for 8 hours ( her platelets were in the 40 - 50's ) .
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100549.txt
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632
CTA was negative .
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100549.txt
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633
Following this , she did not have any further significant bloody stools .
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100549.txt
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634
She remained vitally stable with stable H/H and gradually rising platelet count .
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100549.txt
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635
.
[ 0 ]
[ "." ]
100549.txt
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636
# thrombocytopenia : Secondary to chemotherapy and MDS/AML concerns .
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100549.txt
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637
Concern for consumptive process following transfusion of platelets in the setting of possible ITP vs .
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100549.txt
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[ "O", "O", "B-ADE", "I-ADE", "I-ADE", "I-ADE", "O", "B-Route", "O", "B-Drug", "O", "O", "O", "O", "O", "B-Reason", "O", "O" ]
[ "O", "O", "O", "O", "O", "O", "O", "B-Form", "O", "B-Drug", "O", "O", "O", "O", "O", "O", "O", "O" ]
638
TTP however Hematologic smear was without schistocytes and there was no evidence of renal failure or neurologic concerns ; no fevers .
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100549.txt
[ 2, 20055, 2250, 14528, 13862, 1734, 2615, 12604, 3021, 1690, 2100, 1734, 1982, 2739, 1685, 3296, 3624, 1781, 9877, 7728, 30, 1982, 7263, 1026, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
639
The patient also had two transfusion reactions to platelets when first admitted .
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100549.txt
[ 2, 1680, 2348, 2082, 2105, 2033, 7450, 4680, 1701, 8070, 2278, 2389, 6775, 17, 3 ]
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[ "O", "O", "O", "O", "O", "B-ADE", "I-ADE", "O", "B-Drug", "O", "O", "O", "O" ]
[ "O", "O", "O", "O", "B-ADE", "I-ADE", "I-ADE", "O", "B-Drug", "O", "O", "O", "O" ]
640
She was premedicated with anti - histamines .
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100549.txt
[ 2, 4612, 1734, 25626, 18892, 1715, 2000, 16, 8892, 1026, 17, 3 ]
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[ 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1 ]
[ -100, 0, 0, 0, -100, 0, 3, 12, 12, -100, 0, -100 ]
[ "O", "O", "O", "O", "O", "B-Drug", "I-Drug", "I-Drug", "I-Drug", "O" ]
[ "O", "O", "O", "O", "O", "B-Drug", "I-Drug", "I-Drug", "O", "O" ]
641
While the patient was actively bleeding , she was also given Amicar ( 2 grams IV with 1gram/hour IV infusion overnight on [ * * 2195 - 4 - 2 * * ] ) .
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100549.txt
[ 2, 2555, 1680, 2348, 1734, 11766, 5598, 15, 4612, 1734, 2082, 3501, 11892, 21272, 11, 21, 7140, 1026, 3880, 1715, 28171, 5802, 1034, 18, 6316, 3880, 4926, 16596, 1755, 36, 13, 13, 21960, 1009, 16, 23, 16, 21, 13, 13, 38, 12, 17, 3 ]
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642
This was repeated over the night of [ * * 4 - 17 * * ] as above .
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100549.txt
[ 2, 1805, 1734, 5333, 2150, 1680, 9030, 1685, 36, 13, 13, 23, 16, 2859, 13, 13, 38, 1732, 4670, 17, 3 ]
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643
She was found to have a positive PRA and required HLA matched platelets for all subsequent transfusions .
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100549.txt
[ 2, 4612, 1734, 2189, 1701, 1953, 42, 2595, 17627, 1690, 3424, 5998, 5078, 8070, 1725, 1948, 4336, 15695, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "O", "O", "O", "O", "O" ]
[ "O", "O", "O", "O", "O", "O", "B-Reason", "I-Reason", "O", "O", "B-Drug", "I-Drug", "I-Drug", "O", "O", "O", "O", "O" ]
644
Her twin sister was tested at Red Cross for potential candidate to donate platelets for her sister however since she takes aspirin and plavix , this was not a suitable option .
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100549.txt
[ 2, 3426, 11386, 16050, 1734, 3327, 1798, 2077, 3308, 1725, 2470, 7061, 1701, 4014, 1759, 8070, 1725, 3426, 16050, 2250, 3709, 4612, 10452, 9681, 1690, 5363, 14319, 15, 1805, 1734, 1888, 42, 5693, 7794, 17, 3 ]
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645
Of note , her platelet count was improving already and did not require further platelet transfusions .
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100549.txt
[ 2, 1685, 14766, 15, 3426, 4430, 6484, 1734, 6124, 7393, 1690, 2614, 1888, 4169, 2710, 4430, 15695, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "B-Form", "O" ]
646
Platelet count was in the 90's upon discharge .
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100549.txt
[ 2, 4430, 6484, 1734, 1682, 1680, 3680, 10, 60, 4188, 6101, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
647
.
[ 0 ]
[ "." ]
100549.txt
[ 2, 17, 3 ]
[ 0, 0, 0 ]
[ 1, 1, 1 ]
[ -100, 0, -100 ]
[ "O" ]
[ "O" ]
648
# transfusion reaction / PRA positive : The patient had transfusion reaction to platelet transfusion ( once in clinic , and once while on the floor ) .
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100549.txt
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649
She was premedicated with famotidine , benadryl , and hydrocortisone .
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100549.txt
[ 2, 4612, 1734, 25626, 18892, 1715, 2880, 4109, 1787, 15, 5633, 1773, 23675, 15, 1690, 20354, 17, 3 ]
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[ -100, 0, 0, 0, -100, 0, 3, -100, -100, 0, 3, -100, -100, 0, 0, 3, 0, -100 ]
[ "O", "O", "O", "O", "O", "B-Drug", "B-Drug", "I-Drug", "O", "B-Drug", "I-Drug", "I-Drug", "O", "O", "B-Drug", "O" ]
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650
A blood bank work up was initiated , and the patient was given group specific platelets .
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100549.txt
[ 2, 42, 2368, 12918, 2626, 2177, 1734, 7737, 15, 1690, 1680, 2348, 1734, 3501, 1922, 2264, 8070, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "I-Drug", "B-Drug", "O" ]
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "O" ]
651
She was found to be PRA positive and requires HLA matched platelets .
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100549.txt
[ 2, 4612, 1734, 2189, 1701, 1765, 17627, 2595, 1690, 5322, 5998, 5078, 8070, 17, 3 ]
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652
However , during her second episode of BRBPR on [ * * 4 - 12 * * ] , it was found that there was no more HLA matched platelets available in [ * * Location ( un ) 86 * * ] area .
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100549.txt
[ 2, 2250, 15, 2098, 3426, 2702, 10052, 1685, 2225, 4380, 1027, 1755, 36, 13, 13, 23, 16, 2265, 13, 13, 38, 15, 2021, 1734, 2189, 1760, 2100, 1734, 1982, 2051, 5998, 5078, 8070, 3367, 1682, 36, 13, 13, 5543, 11, 1824, 12, 5264, 13, 13, 38, 3222, 17, 3 ]
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653
Red Cross was contact[ * * Name ( NI ) * * ] for more HLA matched platelets .
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100549.txt
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "I-Drug", "I-Drug", "O" ]
654
Sister was a potential donor however it wasn't suitable given her anti - platelet therapy as above .
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100549.txt
[ 2, 16050, 1734, 42, 2470, 5459, 2250, 2021, 1734, 1024, 10, 61, 5693, 3501, 3426, 2000, 16, 4430, 2543, 1732, 4670, 17, 3 ]
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655
She did not require further platelet transfusions once her platelet count started to increase .
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100549.txt
[ 2, 4612, 2614, 1888, 4169, 2710, 4430, 15695, 6356, 3426, 4430, 6484, 8857, 1701, 2461, 17, 3 ]
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656
.
[ 0 ]
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100549.txt
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657
# MDS with AML transformation : While the patient was on the floor , it was noticed that her blast count was trending up and her neutrophil count was trending down .
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100549.txt
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658
It was then decided to start her on second cycle of Dacogen ( day 1 = [ * * 2195 - 4 - 8 * * ] ) .
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100549.txt
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659
The patient tolerated the Dacogen well , with little side effects .
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100549.txt
[ 2, 1680, 2348, 8451, 1680, 21891, 2116, 2300, 15, 1715, 4290, 3950, 2228, 17, 3 ]
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660
12 % blast cells on peripheral blood upon discharge .
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100549.txt
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661
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662
# GERD : The patient was continued on her home PPI .
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100549.txt
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[ "O", "B-Reason", "O", "O", "O", "O", "O", "O", "O", "O", "B-Drug", "O" ]
663
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[ 0 ]
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664
# constipation : The patient has a history of severe constipation , however , her home medications were held in the setting of her BRBPR and then restarted upon discharge given resolution of bloody bowel movements .
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100549.txt
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665
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100549.txt
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666
Transitional Issues : - The patient had transfusion reaction to platelets ; a blood bank work up was initiated and she was found to be PRA positive ; she will require HLA matched platelets for all subsequent transfusions .
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100549.txt
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667
Medications on Admission : 1 .
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100549.txt
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[ "O", "O", "O", "O", "O", "O" ]
668
loratadine 10 mg Tablet Sig : One ( 1 ) Tablet PO daily ( ) .
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100549.txt
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669
2 .
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100549.txt
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[ "O", "O" ]
670
omeprazole 20 mg Capsule , Delayed Release ( E.C. ) Sig : Two ( 2 ) Capsule , Delayed Release ( E.C. ) PO DAILY ( Daily ) .
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100549.txt
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671
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[ "O", "O" ]
672
polyethylene glycol 3350 17 gram Powder in Packet Sig : One ( 1 ) Powder in Packet PO QHS ( once a day ( at bedtime ) ) .
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100549.txt
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673
4 .
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100549.txt
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[ "O", "O" ]
674
magnesium hydroxide 400 mg/5 mL Suspension Sig : Thirty ( 30 ) ML PO QHS ( once a day ( at bedtime ) ) .
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100549.txt
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675
5 .
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100549.txt
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676
docusate sodium 100 mg Capsule Sig : One ( 1 ) Capsule PO BID ( 2
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100549.txt
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677
times a day ) .
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100549.txt
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678
6 .
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100549.txt
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679
allopurinol 300 mg Tablet Sig : 0.5 Tablet PO once a day .
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100549.txt
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680
Disp : * 30 Tablet ( s ) * Refills : * 0 *
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100549.txt
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681
Discharge Medications : 1 .
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100549.txt
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682
loratadine 10 mg Tablet Sig : One ( 1 ) Tablet PO daily ( ) .
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100549.txt
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683
2 .
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100549.txt
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684
omeprazole 40 mg Capsule , Delayed Release ( E.C. ) Sig : One ( 1 ) Capsule , Delayed Release ( E.C. ) PO once a day .
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100549.txt
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685
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100549.txt
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686
Miralax 17 gram Powder in Packet Sig : One ( 1 ) PO at bedtime as needed for constipation .
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100549.txt
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687
4 .
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100549.txt
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688
Milk of Magnesia 400 mg/5 mL Suspension Sig : Thirty ( 30 ) ml PO at bedtime as needed for constipation .
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100549.txt
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689
5 .
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690
docusate sodium 100 mg Capsule Sig : One ( 1 ) Capsule PO twice a day .
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100549.txt
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691
Discharge Disposition : Home
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100549.txt
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692
Discharge Diagnosis : myelodysplastic syndrome/acute myloid leukemia cecal atriovenous malformations Lower GI bleed
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100549.txt
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693
Discharge Condition : Mental Status : Clear and coherent .
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100549.txt
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694
Level of Consciousness : Alert and interactive .
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100549.txt
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695
Activity Status : Ambulatory - Independent .
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696
Discharge Instructions : Dear Ms .
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697
[ * * Known lastname 73078 * * ] ,
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100549.txt
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698
It was a pleasure taking care of you while you were hospitalized at [ * * Hospital1 18 * * ] .
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100549.txt
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699
You were admitted to the hospital because you had a transfusion reaction after getting platelets at clinic .
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[ "You", "were", "admitted", "to", "the", "hospital", "because", "you", "had", "a", "transfusion", "reaction", "after", "getting", "platelets", "at", "clinic", "." ]
100549.txt
[ 2, 17915, 1748, 6775, 1701, 1680, 2895, 3058, 17915, 2105, 42, 7450, 2856, 1970, 21327, 8070, 1798, 5455, 17, 3 ]
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[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-ADE", "I-ADE", "O", "O", "B-Drug", "O", "O", "O" ]
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-ADE", "I-ADE", "O", "O", "B-Drug", "O", "O", "O" ]