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: penicillins / heparin agents attending: chief complaint: nausea/vomiting major surgical or invasive procedure: abdominal aorta and bilateral pelvic run-off, aortic dissection fenestration including transluminal balloon angioplasty, superior mesenteric artery angiography and stenting and intervascular ultrasound of aorta and iliac arteries. bilateral renal artery stent. abdominal aorta and bilateral pelvic runoff, aortic dissection and fenestration, removal and replacement of right renal stent, intravascular ultrasound of aorta. exploratory laparotomy, ascending aorta to superior mesenteric artery bypass, resection of distal ileum, right colon, and transverse colon, ileostomy. subtotal colectomy and small bowel resection. reexploration of abdomen with distal colon resection and distal small-bowel resection and temporary abdominal closure. exploratory laparotomy with abdominal washout and temporary closure. exploratory laparotomy, small bowel resection with end-to-end small bowel anastomosis, revision of ileostomy, gastrojejunostomy tube placement and abdominal closure. tracheostomy hickman catheter placemant, hit positive postoperative sacral decubitus postoperative fevers ?? etology history of present illness: the patient is a 54 year old female with a history of hypertension and recent discharge from hospital 14 days ago with a type b aortic dissection treated medically who presented to hospital on with persistent nausea and vomiting and intensified back pain radiating down her spine. at , a ct-a was performed which showed no pe and a dissection extending below the diaphragm. the patient was transferred to for further management. the patient's symptoms began 3 weeks ago with band-like chest pain radiating to her back with diaphoresis. she was found at to have a type b dissection (unknown extension) and was admitted to the icu and discharged 14 days ago on po labetalol, nifedipine, protonix and clonidine (doses unknown). since her discharge, the patient has been feeling increasingly weak with intermittent nausea and bilious vomiting and has been unable to tolerate a po diet at home. she also noted hematemesis within the past few days. she denies any blood in her stool recently but notes green diarrhea x 14 days with a history of blood in her stool at . the patient states that she has been compliant with all her medications at home. she states her back pain recently intensified as well. at , the patient was having bilious emesis with specks of blood with a blood pressure of 160 systolic. she was placed on a labetalol drip at 1 mg but then developed sinus bradycardia to the 50s. as a result, nipride was started and was at 0.1 on exam. the blood pressure in her left arm was 100/58 and in the right, 160/68 with a hr of 79 on nipride alone. the patient was pain-free on exam. a repeat ct chest and a/p was performed that showed a large, well-perfused false lumen extending distal to the left subclavian with the left renal artery and inferior mesenteric artery branching from the false lumen. the superior mesenteric artery did extend from the true lumen, however, is partially occluded by the intimal flap. there was no bowel wall thickening. the dissection extends inferiorly into the bilateral external iliacs into the groin. vascular and cardiac surgery was consulted. vascular surgery decided to monitor medically for now. past medical history: hypertension hepatitis ?unknown type s/p appendectomy h/o right shoulder surgery social history: the patient works as a manager for fried kitchen. she admits to smoking 1 ppd x 38 years but has not smoked since her admission to 3 weeks ago. she admits to a history of heavy alcohol use in the past x 1 year with 4-5 beer/hard liquor 4 x a week. she denies any history of illicit drug use. the patient is not married and has four children and lives alone. family history: no family history of aortic dissection/marfan's. physical exam: a/o x 3,nad ncat, perrl, eomi neg lesions nares, oral pharnyx, auditory supple, farom, neg lymphandopathy, supraclavicular nodes cta b/l rrr without murmers soft, nttp, neg cva, pos bs palp dp/pt b/l pertinent results: echo findings: left atrium: normal la size. no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. right atrium/interatrial septum: normal ra size. left ventricle: symmetric lvh. mild regional lv systolic dysfunction. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. simple atheroma in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. moderately dilated descending aorta descending aorta intimal flap/aortic dissection. flow in false lumen. aortic valve: normal aortic valve leaflets (3). trace ar. mitral valve: normal mitral valve leaflets with trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the patient was sedated for the tee. medications and dosages are listed above (see test information section). local anesthesia was provided by benzocaine topical spray. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions: the left atrium is normal in size. no spontaneous echo contrast orthrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. there is symmetric left ventricular hypertrophy. lv systolic function appears mildly depressed with inferior/infero-lateral hypokinesis. there are simple atheroma in the ascending aorta and aortic arch without evidence of aortic dissection. the descending thoracic aorta is moderately dilated. a mobile density is seen in descending aorta consistent with an intimal flap/aortic dissection. there is flow in the large false lumen. there is a fenestration/communication between the true/false lumen at approx. 35 cm from the incisors that may represent the point of initial intimal tear. the dissection extends proximally and ends at the takeoff of the left subclavian artery without compromising subclavian flow. there is partial thombosis of the false lumen just distal to the left subclavian artery. the dissection extends distally to abdominal aorta and extends beyond what was visualized (50 cm from the incisors).the true lumen is significantly narrowed at times but distal flow is not clearly compromised. both coronary artery ostia were visualized in their appropriate orientation with normal color doppler signal (pulse wave doppler was not performed).the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. impression: thoracic aortic dissection limited to the descending aorta (type b). large false lumen that is partially thrombosed proximally. there is no clear evidence of distal flow compromise but clinical correlation is suggested. renal u.s. reason: aortic dissection, assess renal flow medical condition: 54 year old woman with extensive descending dissection to external iliacs bilaterally with left renal off of false lumen now with decreased urine output reason for this examination:please assess renal flow indication: assess renal vascular flow, s/p aortic dissection. renal ultrasound: the right kidney measures 10.3 cm. the left kidney measures 10.3 cm. no hydronephrosis or stones. no perinephric fluid collection identified. duplex ultrasound: color doppler son was performed of the renal vasculature. normal flow is demonstrated in the right and left renal arteries. normal waveforms are identified within the left and right main renal arteries. impression: normal renal ultrasound. normal flow and waveforms are demonstrated in the main renal arteries bilaterally. cta chest w&w/o c & recons medical condition: 54 year old woman with type b aortic dissection by ct from osh but scan did not find distal extent. reason for this examination: eval extent of dissection indication: type b aortic dissection by ct from outside hospital but scan did not find distal extent. evaluate dissection. technique: contiguous axial images through the chest were obtained without contrast. subsequently, following the administration of 150 cc of optiray contrast, contiguous axial images through the chest, abdomen, and pelvis were obtained during opacification of the aorta and its branches. multiplanar reconstructions were obtained. cta of the chest: there is a type b aortic dissection present. the dissection begins just distal to the left subclavian artery origin of the aorta. there is a large false lumen seen to the left and a smaller true lumen. there is a fenestration in the intimal flap seen on series 3, image 18. thus, the true and false lumens communicate. the celiac axis arises from the true lumen, though the intimal flap is abutting the origin of the celiac axis. the dissection extends into the celiac axis. the sma similarly arises from the true lumen, though the intimal flap is protruding into the ostium of the origin of the sma. the dissection extends into the sma and the sma is quite small. the right renal artery arises from the true lumen, and the intimal flap extends slightly into the ostium of the right renal artery. this is best seen on series 4, image 295. the left renal artery arises from the false lumen. more inferiorly, the arises from the false lumen. the dissection extends into both common iliac arteries. the dissection extends into the common external and iliac arteries on the right side. the dissection also extends into the external and internal iliac arteries on the left side. the intimal flap extends through the right external iliac artery and is seen clearly to about the level of the acetabulum. beyond this point, it is difficult to assess. the intimal flap is no longer seen definitely in the mid portion of the left external iliac artery. there is low-density material fill to the origin of the left subclavian artery. the dissection does not clearly extend into the left subclavian artery. ct of the chest without and with contrast: there is atelectasis within the lungs dependently. no consolidations. there are very small pleural effusions at the bases posteriorly. no pericardial effusion. ct of the abdomen with contrast: the liver, gallbladder, spleen, pancreas, and adrenals are normal. the kidneys enhance symmetrically and excrete normally, despite the left renal artery arising from the false lumen. no free air or free fluid within the abdomen. the noncontrast opacified loops of bowel are containing some fluid but are otherwise unremarkable. ct of the pelvis with contrast: the bladder, uterus, rectum, and sigmoid are unremarkable. within the cecum, there is a rounded enhancing structure of unclear etiology. no pathologically enlarged lymph nodes within the pelvis. bone windows: there are no suspicious osteolytic or sclerotic lesions. multiplanar reformatted images were essential in delineating the anatomy and pathology in this case. impression: extensive type b aortic dissection. the dissection arises distal to the left subclavian artery. there is a fenestration between the true and false lumen. the celiac and sma arise from the true lumen, though the dissection extends into these vessels. the residual sma is quite small. the right renal artery arises from the true lumen and the left renal artery from the false. the arises from the false lumen. the dissection extends into the external and internal iliac arteries bilaterally. brief hospital course: the patient is a 54 year old female with a history of htn, type b descending dissection who presents with persistent nausea/vomiting with possible left renal and superior mesenteric artery involvement. 1. type b dissection - appreciate vascular and cardiac surgery input. the patient is at higher risk for bowel ischemia given the nature of the near occlusion of the sma by the intimal flap. in addition, there is potential renal involvement of the left renal artery as it already extends from a large false lumen. at this time, the patient will be medically managed with a nipride drip with a goal sbp 100-120. labetalol gtt was attempted in the er without success and was limited by sinus bradycardia to the 50s. - we will continue to monitor for signs of renal failure or bowel ischemia. - on , the patient's urine output dropped to 15-20 cc/hr from 60-70. a stat renal ultrasound with doppler flow was obtained to evalaute renal perfusion in the setting of a left renal artery previously seen to be coming from the false lumen. in addition, her lactate was checked tid which rose from 0.7 to 1.1 on . vascular and cardiac surgery were called and made aware. then the patient developed severe left arm pain and concern was that her dissection was extending proximally. - on the pt went to the angiography suite and underwent successful fenestration of her abdominal aortic false lumen, and fenestration and stenting of her sma. - -- pt underwent stenting of both renal arteries as the aortic dissection had spread and had stenosed both renal arteries. -- abdominal aorta and bilateral pelvic runoff, aortic dissection and fenestration, removal and replacement of right renal stent, intravascular ultrasound of aorta. -- pts. bowel ischemia worsened, went to the or for exploratory laparotomy, ascending aorta to superior mesenteric artery bypass, resection of distal ileum, right colon, and transverse colon, ileostomy, and subtotal colectomy and small bowel resection. over the next week the pt underwent several laparotomies/washouts and revisions of her ileostomy. finally, a gj tube was placed for enteral feeding. -- pt underwent a ct angiogram which demonstrated a widely patent sma graft, and a stable aortic dissection. 2. chf, ef unknown - the patient has 10 cm jvp on exam with no known ef. meanwhile, we will keep the patient euvolemic. an echo was perfomed on which showed an inferior wall that was hypokinetic and there was concern that her right coronary artery was being affected by a dissection. as a result, a tee was to be performed on and cardiac surgery was made aware. 3. transaminitis - the patient reports a history of hepatitis that was contracted from eating food in a hospital during her delivery in . we will recheck a hepatitis panel and trend her lfts. we do not know her baseline. if her lfts continue to climb, we may consider a ruq ultrasound with concern for ischemia with known celiac involvement. 4. coffee-ground emesis - the patient will remain npo for now with iv protonix . the patient is hemodynamically stable at present. we will check her hct tid for now. patient icu to vicu/floor after prolonged complicated postoperative course and trach removal -. patient remined on tpn for nutritional support because of short bowel syndrome.viedo swallow exams negative for aspiration. pt/ot continued to work with patient.await medicade application approval for final dipos planning to rehabiltitaion. id consulted for persistant fevers.patient delined and line and blood cultures sent.finalization of cultrues negative. placement of hickman catheter and repositioning of gj tube. tpn was restarted and cycling of tube feeds began. patient continued to progress. to rehabilitation for continued care stable. medications on admission: protonix qd, labetalol 2 tablets , nifedipine 1 tablet po bid, clonidine 1 tablet tid discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic qhs (once a day (at bedtime)). 2. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 5. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 6. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 7. acetaminophen 160 mg/5 ml elixir sig: po q4-6h (every 4 to 6 hours) as needed. 8. epoetin alfa 3,000 unit/ml solution sig: 3000 (3000) units injection qmowefr (monday -wednesday-friday). 9. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours) as needed. 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. scopolamine base 1.5 mg patch 72hr sig: one (1) patch 72hr transdermal q3days (). 12. opium 10 % tincture sig: twenty (20) drop po asdir (). 13. levocarnitine 330 mg tablet sig: 1.5 tablets po q500cc tubefeeds (). 14. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 15. papain-urea 830,000-10 unit-% spray, non-aerosol sig: one (1) appl topical daily (daily). 16. lorazepam 1 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for agitation. 17. metoclopramide 10 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 18. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 19. dolasetron mesylate 12.5 mg iv q8h:prn nausea 20. insulin regular human 100 unit/ml solution sig: as directed injection every four (4) hours: glucose <60 amp d50% glucoses 61-150/0u glucoses 151-200/2u glucoses 201-250/4u glucoses 251-300/6u glucoses >400 md. discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: 1) aortic dissection with mesenteric ischemia, s/p aortic fenestration and sma grafting 2) b/l renal stenosis secondary to aortic dissection, s/p bil. stents 3) bowel ischemia, s/p multiple small bowel resections, ileostomy 4) sacreal decubitus ulcer 5) short gut syndrome discharge condition: stable followup instructions: follow up with dr as directed, please call . procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances other partial resection of small intestine other partial resection of small intestine left heart cardiac catheterization enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries other and unspecified partial excision of large intestine temporary ileostomy temporary tracheostomy other gastroenterostomy without gastrectomy aortography revision of stoma of small intestine open and other right hemicolectomy insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) open and other resection of transverse colon other intra-abdominal vascular shunt or bypass injection or infusion of oxazolidinone class of antibiotics re-entry operation (aorta) re-entry operation (aorta) diagnoses: other postoperative infection acute kidney failure, unspecified hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified atrial fibrillation atherosclerosis of renal artery other complications due to other vascular device, implant, and graft pressure ulcer, lower back anticoagulants causing adverse effects in therapeutic use acute vascular insufficiency of intestine cholangitis other and unspecified postsurgical nonabsorption dissection of aorta, thoracic mechanical complication of colostomy and enterostomy chronic vascular insufficiency of intestine 

Answer: The patient is high likely exposed to