Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: no known allergies / adverse drug reactions attending: chief complaint: nausea and jaundice major surgical or invasive procedure: esophageal ultrasound ercp eus history of present illness: mr. is an 83 year old italian speaking male with multiple chronic medical problems, including af on coumadin, cad, copd, and hx multiple exposures (+ppd, asbestos) who was transferred to the micu from the ed for managment of acute liver failure. the history was obtained from the , signout, and limited conversation with the patient. he was in his usual state of health until about , when he began to have nausea without vomiting and soft stools. he had been to a birthday celebration two days prior, where he had eaten chinese food. nobody else from that party got sick. he went to his pcp, labs showed alt 619, ast 249, ap 852, total bili 1.5, and inr 3.9. hepatits c igg was negative; hep a igm negative, igg positive; hep b surface ag neg, surf ab pos, core igm negative, core igg positive. this week, the family noticed that the patient had turned yellow. he had repeat labs, which apparently showed an inr around 10 and a tbili also around 10. on tuesday, three days prior to admission, he stopped taking coumadin as instructed. he does not have any acute complaints. he denies vomiting, but endorses nausea. however, he was seen to have non-bloody emesis in the ed. the family members did not think he was confused, although he had been napping more than usual. he was evaluated for increasing fatigue at his pcp's office in 6/. workup in ed notable for ruq us which showed dilated intra- and extra-hepatic ducts, and a dilated gb. in the ed, initial vitals were t:98.9, hr:64, bp:105/66, rr:18, sat 99% ra. the patient looked comfortable, without encephalopathy, with significant jaundice and icterus, irregular heart rate, belly distended but soft/nontender, liver 7-8 cm below costal margin. no ascites appreciated. ekg showed afib 72, old rbbb, left axis deviated. no medications given in the ed, no fluids in the ed, liver consult, ruq u/s showed "marked intra and extrahepatic biliary dilation of uncertain etiology. pancreas not visualized. dilated gallbladder with no evidence of cholecystitis. mrcp/ cross sectional imaging is recommended to evaluate etiology of biliary dilation." past medical history: a-fib rate controlled and on coumadin. s/p rca stent placement in , for positive stress test. cad s/p stent to rca renal insufficiency w/ variable baseline cr 1.1-1.6 aortic valve mass htn hypercholesterolemia copd osteoarthritis impaired glucose tolerance colonic polyps pulmonary nodule chronic subdural hematoma stroke right bundle branch block gerd ppd positive carotid stenoses dementia depression low back pain basal cell ca hip fracture social history: married for 50 years, former welder. immigrated from in . quit smoking 18 years ago. minimal alcohol. history of asbestos exposure. he has no history of recent travel. family history: unknown physical exam: physical exam on arrival: vitals: t:97.6, bp:116/72, hr:78, rr:21, o2:98%/ra gen: no apparent distress, responding appropriately to questions and commands heent: jaundiced, scleral icterus, no cervical/supraclavicular cardio: irregular, no m/r/g chest: ctab abd: slight distension, soft, non-tender, the liver edge is percussed two finger breaths below the costal margin, the liver edge is not palpable. ext: no c/c/e neuro: no asterixis discharge physical exam: vitals: t:97.7 tmax:97.7 bp:120/76 (100-129/60-89) p:82 (72-89) r:18 o2:95%/ra general: alert, oriented, no acute distress derm: jaundiced heent: sclera anicteric, mmm, oropharynx clear, underside of tongue is yellow neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cns2-12 intact, motor function grossly normal pertinent results: cbc: 09:35am blood wbc-10.6 rbc-4.72 hgb-14.2 hct-40.8 mcv-87 mch-30.1 mchc-34.8 rdw-16.5* plt ct-297 04:00pm blood wbc-9.0 rbc-4.51* hgb-13.0* hct-38.3* mcv-85 mch-28.8 mchc-33.9 rdw-17.1* plt ct-223 03:16am blood wbc-7.4 rbc-4.57* hgb-13.1* hct-38.0* mcv-83 mch-28.7 mchc-34.6 rdw-17.0* plt ct-225 12:15pm blood wbc-9.0 rbc-4.47* hgb-12.9* hct-37.3* mcv-83 mch-28.8 mchc-34.5 rdw-17.2* plt ct-249 07:20am blood wbc-9.8 rbc-4.64 hgb-13.5* hct-39.3* mcv-85 mch-29.1 mchc-34.4 rdw-17.4* plt ct-241 04:50am blood wbc-7.7 rbc-4.38* hgb-13.1* hct-38.0* mcv-87 mch-30.0 mchc-34.6 rdw-17.3* plt ct-260 05:45am blood wbc-8.8 rbc-4.17* hgb-12.1* hct-35.4* mcv-85 mch-29.0 mchc-34.2 rdw-17.4* plt ct-254 07:55am blood wbc-6.4 rbc-4.02* hgb-11.8* hct-35.0* mcv-87 mch-29.4 mchc-33.8 rdw-17.7* plt ct-261 06:05am blood wbc-6.6 rbc-3.60* hgb-10.5* hct-32.0* mcv-89 mch-29.1 mchc-32.8 rdw-17.7* plt ct-246 09:35am blood neuts-76.9* lymphs-16.7* monos-5.2 eos-0.7 baso-0.5 09:35am blood pt-89.5* inr(pt)-10.5* 09:35am blood plt ct-297 coags: 04:00pm blood pt-82.3* ptt-43.7* inr(pt)-9.5* 03:16am blood pt-71.2* ptt-44.6* inr(pt)-8.0* 12:15pm blood pt-21.9* ptt-28.0 inr(pt)-2.0* 12:15pm blood plt ct-249 07:20am blood pt-13.0 ptt-22.1 inr(pt)-1.1 07:20am blood plt ct-241 04:50am blood pt-13.2 ptt-22.0 inr(pt)-1.1 04:50am blood plt ct-260 05:45am blood pt-13.2 ptt-22.1 inr(pt)-1.1 05:45am blood plt ct-254 05:45am blood plt ct-254 07:55am blood pt-12.8 ptt-22.0 inr(pt)-1.1 07:55am blood plt ct-261 06:05am blood pt-13.6* ptt-31.6 inr(pt)-1.2* lytes: 04:00pm blood glucose-452* urean-47* creat-2.1* na-129* k-4.0 cl-95* hco3-21* angap-17 03:16am blood glucose-227* urean-39* creat-1.7* na-135 k-3.5 cl-102 hco3-22 angap-15 07:20am blood glucose-162* urean-33* creat-1.6* na-138 k-3.6 cl-99 hco3-25 angap-18 04:50am blood glucose-210* urean-33* creat-1.6* na-133 k-3.4 cl-98 hco3-25 angap-13 05:45am blood glucose-158* urean-27* creat-1.5* na-137 k-3.7 cl-102 hco3-23 angap-16 07:55am blood glucose-192* urean-31* creat-1.5* na-139 k-3.6 cl-104 hco3-22 angap-17 06:05am blood glucose-261* urean-35* creat-1.5* na-136 k-3.6 cl-104 hco3-24 angap-12 lft's: 09:35am blood alt-482* ast-333* alkphos-993* totbili-9.4* 04:00pm blood alt-444* ast-287* alkphos-911* totbili-9.3* dirbili-7.4* indbili-1.9 03:16am blood alt-427* ast-317* ld(ldh)-287* ck(cpk)-39* alkphos-925* totbili-10.2* 05:45am blood alt-205* ast-113* alkphos-645* totbili-16.0* 07:55am blood alt-163* ast-68* ld(ldh)-202 alkphos-616* totbili-10.5* 06:05am blood alt-123* ast-48* alkphos-536* totbili-6.6* lipase: 04:00pm blood lipase-118* ggt-1265* 07:20am blood lipase-74* 04:50am blood lipase-77* albumin: 04:00pm blood albumin-3.4* iron-129 ca, mg, phos: 03:16am blood calcium-8.8 phos-2.6* mg-1.9 07:20am blood calcium-9.1 phos-2.9 mg-2.0 04:50am blood calcium-9.0 phos-2.5* mg-2.0 05:45am blood albumin-2.9* calcium-8.9 phos-3.0 mg-1.9 06:05am blood calcium-8.3* phos-2.6* mg-1.9 fe studies: 04:00pm blood ferritn-228 03:16am blood caltibc-307 ferritn-264 trf-236\ liver studies: 03:16am blood ammonia-52 03:16am blood igm hav-negative 03:16am blood ama-negative smooth-positive * 03:16am blood cea-7.3* afp-2.9 03:16am blood igg-1363 iga-345 igm-87 04:00pm blood acetmnp-neg 03:16am blood hcv ab-negative ca -9: 4 (normal) ceruloplasmin: 46 (high) igg subclasses 1,2,3,4: pending hcv viral screen: negative mrsa screen: negative u/a: negative ecg : atrial fibrillation with controlled ventricular response. right bundle-branch block with left anterior fascicular block. non-specific st-t wave abnormalities. compared to the previous tracing of no diagnostic interval change. ruq us : impression: marked intra- and extra-hepatic biliary dilatation. distal point of obstruction not assessed. the pancreas is not visualized on this current examination. recommend mrcp/cross-sectional imaging for evaluation of the etiology of biliary dilation. cxr : lung volumes are relatively low. heart size and vascularity are normal. opacities at both lung bases appear chronic with no new infiltrates or pleural effusions. impression: no significant interval change allowing for technique. mrcp : impression: 1. marked intrahepatic and extrahepatic biliary ductal dilatation with marked dilation of the pancreatic duct associated with pancreatic atrophy. the appearances are highly concerning for a pancreatic head tumor, although no definite tumor can be identified. the smv, portal vein, and splenic vein appear to be patent. no lymphadenopathy or evidence of metastasis. consider ercp to further evaluate. 2. bilateral renal cysts. 3. 1.9-cm hepatic cyst. 4. small right pleural effusion. common bile duct brushings : diagnosis: suspicious for adenocarcinoma. very atypical glandular cells in crowded groups with high n:c ratio, irregular nuclear contours, and anisonucleosis. brief hospital course: assessment: mr. is an 83 year old man with a history of atrial fibrillation, cad, htn and renal insufficiency found to have biliary obstruction due to likely pancreatic adenocarcinoma in the uncinate pancreas. diagnoses: # pancreatic mass causing cholestasis and acute liver failure: the patient presented with elevated alt, ast, and lipase, with markedly elevated alkphos, ggt, and tbili. indirect bili was normal, and direct bili was increased, indicating a conjugated bilirubinema. this pattern of lfts is suggestive of cholestasis rather than primary liver dysfunction. the patient was jaundiced and described severe pruritis, consistent with hyperbilirubinemia. the most likely diagnosis is pancreatic cancer given the absence of abdominal pain, the severe biliary dilation, diarrhea, and 6 month history of weight loss. mrcp showed massively distended gallbladder, and atrophic pancreas, consistent with a potential mass in the pancreatic head. ercp yesterday showed an irregular stricture, consistent with tumor, with post-obstructive dilation. a stent was placed in the bile duct to allow for draining, and followup in two months is suggested for stent exchange. cytology brushings taken during ercp showed atypical glandular cells in crowded groups with high n:c ratio, irregular nuclear contours, and anisonucleosis, suspicious for adenocarcinoma. eus showed a mass with cystic component in the uncinate pancreas but a biopsy could not be taken. surgery was contact and they did not believe that the patient was a candidate for a whipple procedure. placement of the stent resulted in a decrease in bilirubin levels and relief of jaundice and pruritis. his lfts which were elevated on admission have also been trending downwards. the patient was feeling well on the day of discharge complaining of only mild jaundice. # atrial fibrillation: the patient has a history of atrial fibrillation for which he takes coumadin. his chads score is 5. he came in with an inr of 10, in the setting of acute liver failure and coumadin therapy. his coumadin was stopped, and he was given vitamin k, in order to reduce his inr to below 1.5 for ercp. in the post-procedure setting we placed the patient on lmwh to bridge back to coumadin. the daughter of the patient ensured that she would bring the patient in to see his pcp on to check his inr. # cad: the patient has a history of cad and is s/p rca stenting in and . he takes aspirin at home, and was continued on 81 mg of aspirin daily in the hospital. # acute on chronic renal insufficiency: his baseline creatinine is 1.1-1.6, but he came in with creatinine 2.1, and trended downwards. initial bun/cr>20 suggests a prerenal cause of his decreased renal function. the most recent cr is 1.5, and he is back to his baseline. # htn: patient has a history of hypertension controlled on medications at home, and he was on verapamil 40mg q8h in the hospital. # hypercholesterolemia: the patient a history of hl, for which he is on medications, and but we held simvastatin in the setting of acute liver failure. # copd: the patient does not take any home medications for his copd. # depression: patient has a history of depression controlled on medication at home, and we held his fluoxetine. transitional issues: 1. pt has igg classes 1,2,3,4 pending to check for autoimmune pancreatitis. 2. pt will need a definitive treatment plan for his very likely pancreatic adenocarcinoma. he has established care with our oncology department. 3. pt will need a lengthy discussion of goals of care at this point and will need further prognostic guidance from a specialist. daughter is very involved in his care and she is married to a radiologist who would like to attend the radiology conference in which mr. case is discussed. medications on admission: 1. acetaminophen-codeine - 300 mg-30 mg tablet - 1 tablet(s) by mouth q4-6 2. bimatoprost - 0.03 % drops - 1 gtt ou once a day 3. fluoxetine - 20 mg capsule - 1 capsule(s) by mouth every day for depression 4. fluoxetine - 10 mg capsule - 1 capsule(s) by mouth once a day for depression, add 20mg plus 10mg equals 30mg per day 5. fluticasone - 50 mcg spray, suspension - 1-2 puffs(s) intranasal once a day for sinus allergies 6. furosemide - 40 mg tablet - 1 tablet(s) by mouth every day 7. nitroglycerin - 0.4 mg/dose spray, non-aerosol - spray under tongue once a day as needed for repeat q 5 min prn ut dict for chest pain 8. simvastatin - 20 mg tablet - 1 tablet(s) by mouth once a day chol 9. verapamil - 180 mg cap,ext release pellets 24 hr - 1 cap(s) by mouth daily 10. warfarin - 2.5 mg tablet - 1 (one) tablet(s) by mouth once a day as needed for 3 days a week tues, thurs, sat 11. warfarin - 5 mg tablet - 1/2-1 tablet(s) by mouth once a day ut dict for afib, these are the correct instructions and cannot be altered by bioscrip request 12. aspirin - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day prevention discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). tablet, chewable(s) 2. verapamil 180 mg cap,ext release pellets 24 hr sig: one (1) cap,ext release pellets 24 hr po once a day. 3. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 4. enoxaparin 80 mg/0.8 ml syringe sig: seventy (70) mg subcutaneous q12h (every 12 hours): please continue to take until told by your primary doctor that your inr is at an appropriate level. disp:*14 syringes* refills:*0* 5. acetaminophen-codeine 300-30 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 6. bimatoprost 0.03 % drops sig: one (1) ou ophthalmic once a day. 7. fluoxetine 10 mg capsule sig: one (1) capsule po once a day: total fluoxetine dose = 30 mg. 8. fluoxetine 20 mg capsule sig: one (1) capsule po once a day: total fluoxetine dose = 30 mg. 9. fluticasone nasal 10. furosemide 40 mg tablet sig: one (1) tablet po once a day. 11. nitroglycerin 0.4 mg/dose spray, non-aerosol sig: one (1) spray translingual once a day as needed for chest pain: repeat after 5 mins if still have chest pain. 12. warfarin 5 mg tablet sig: one (1) tablet po once a day: please start taking 5 mg once daily and follow up with your primary care provideer tomorrow. discharge disposition: home with service facility: homecare discharge diagnosis: obstructive jaundice cholestatic liver failure possible pancreatic adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital following an episode of diarrhea and concerns from your family that your skin looked yellow. while you were here we determined that your liver tests returned as abnormally high. you underwent a number of diagnostic procedures and we determined that you had a blockage of your biliary tract from a likely cancerous mass compressing it. a biliary stent was placed to try and help reopen your bilary tract. this seems to have helped somewhat as your enzymes have come back closer to normal levels, but they have not completely normalized at this time. we would like for you to follow up in our oncology clinic. additionally, since we are restarting your anticoagulation, you will need to follow up with your primary care provider and have your inr checked both tomorrow and monday morning. the following changes were made to your medications: 1) restart your warfarin at 5 mg per day and follow up closely with your primary care provider regarding further dose changes 2) start enoxaparin (lovenox) 70 mg twice per day unitl your primary provider tells you it is safe to stop thank you for allowing us to participate in your care. we wish you a speedy recovery. followup instructions: department: adult specialties when: thursday at 1 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: - adult med when: wednesday at 1:15 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: center when: monday at 9:30 am with: visual field screening building: campus: east best parking: garage procedure: endoscopic retrograde cholangiopancreatography [ercp] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia acute and subacute necrosis of liver acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified long-term (current) use of anticoagulants other specified disorders of biliary tract obstruction of bile duct unspecified disease of pancreas 

Answer: The patient is high likely exposed to