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: history of present illness: mr. is a pleasant 46-year-old gentleman with history of roux-en-y hepaticojejunostomy performed on , who was discharged on , in excellent condition who returns to the hospital today after acute onset of abdominal pain in the early morning around 5:00 a.m. he describes this pain as , sharp, epigastric and radiating to both right upper quadrant and right lower quadrant. the pain is constant in nature. while this episode began mr. also felt dizzy and almost passed out. he is brought in by his family for further evaluation. on arrival he feels better than he felt earlier in the day. he denies fevers, however, complains of some nausea and dry heaves. mr. is well known to our service. he has a history of hypertension, kidney stones and a duodenal ulcer. he also has a history of exploratory laparotomy in , ankle surgery in and arthroscopy in and a rotator cuff repair in . his troubles began when he cholecystectomy on , when he suffered a common bile duct injury. he primary repair of this common duct transection with a t-tube which was complicated by a bile duct leak. he was transferred to in on the gastroenterology service for further care. he endoscopic retrograde cholangiopancreatography which showed extravasation of bile at the middle third of the bile duct. this was treated with stent placement. he had been doing well in time symptomatically, however, he over time developed stricture which was 10 mm long in the common hepatic duct. his symptoms at this time included persistent early morning diarrhea. however, he denied any fevers, chills, nausea, vomiting or constipation. he was referred to dr. for repair of this 10 mm bile duct stricture. he repair of this stricture through a roux-en-y hepaticojejunostomy on , after which he had an uncomplicated postoperative course. his diet was advanced and he was discharged to home on . he is now returning to the hospital with symptoms described above. past medical history: 1. hypertension. 2. duodenal ulcer. 3. common bile duct injury 4. history of kidney stones. past surgical history: 1. exploratory laparotomy in . 2. left ankle surgery in . 3. left knee arthroscopy in . 4. rotator cuff repair in . 5. laparoscopic converted to open cholecystectomy . 6. roux-en-y hepaticojejunostomy and tru-cut liver biopsy . allergies: no known drug allergies. social history: a married gentleman who works as a captain in the state prison. takes two to three drinks per day and has smoking habit of half to one pack per day for 30 years. medications on admission: 1. zestril 10 mg q. day. 2. protonix 40 mg q. day. 3. colace p.r.n. 4. percocet p.r.n. physical examination on admission: mr. is a pleasant middle-aged man in no acute distress, however, appears tired. he is alert and oriented times three. his heart is regular. his lungs are clear. his abdomen shows distention and diffuse tenderness with maximum in the supraumbilical area. his extremities are without edema. laboratory on admission: white count 30.0, hematocrit 32.2, platelet count 595. pt 13.3, ptt 22, inr 1.2. electrolytes: sodium 143, potassium 4.4, chloride 107, bicarb 25, bun 18, creatinine 1.0, glucose 132. ast 260, alt 257, alk phos 238, total bilirubin 0.6, amylase 31, lipase 23. laboratory at discharge: white count 8.8, hematocrit 31.9, platelet count 440. sodium 136, potassium 4.4, chloride 103, bicarb 25, bun 17, creatinine 0.5, glucose 125. ast 27, alt 55, alk phos 237, total bilirubin 0.3, amylase 75, lipase 73. pt 13, ptt 27, inr 1.1. concise summary of hospital course: mr. had an extensively complicated hospital course which is described in detail below. on admission mr. presented with acute onset of upper abdominal pain and episode of dizziness. he went to an outside hospital where his white count was 30 and hematocrit was 32. he was sent in to for further evaluation. on admission he received an abdominal ct scan which was significant for a large intraperitoneal hematoma around the duodenum extending into the mesentery. the initial assessment at this time was a mesenteric bleed and/or cholangitis. mr. , since he was in stable condition, was admitted to the floor with close observation. over the next 24 hours mr. hematocrit drifted to a low of 25. in the meantime, however, he continued to be stable and had adequate urine output. this hematocrit drop was assessed to be secondary to the hematoma formation and mr. was transfused with an appropriate rise in the hematocrit. his abdominal ct scan was repeated which showed a stable hematoma as found in the prior ct. in our effort to elucidate the etiology of the hematoma, mr. a ct angiogram of the right upper quadrant. the ct angiogram was negative for any pseudoaneurysm formation or any vessel injury that was obvious. while being followed on the floor on , mr. had an episode of coffee ground emesis and grossly bloody bowel movements. a gastroenterology consult was obtained and an esophagogastroduodenoscopy was performed. the egd was significant for the presence of a fresh blood clot in the duodenum which was assessed to be consistent with either an ulcer or an eroding vessel. a repeat endoscopy was scheduled at this time. over the next several days mr. condition once again improved and he was slowly progressed to regular diet. however, on , mr. had an acute change of events when he once again vomited bright red blood. he was emergently taken to the intensive care unit where he received resuscitation with multiple units of blood transfusion. considering the fact that the brisk upper gi bleed may be from a duodenal ulcer or, more significantly, from a developing pseudoaneurysm, a decision was to take mr. back to the operating room. mr. was taken back where he received an exploratory laparotomy, evacuation of a large intra-abdominal hematoma, take-down of the hepatic flexure and kocherization of the duodenum, repair of a duodenal perforation and suture ligation of the right hepatic artery and repair of the hepaticojejunostomy. the intraoperative observation was especially notable for a large vessel which began bleeding and was likely the source of the hematoma. the estimated blood loss for the operation was 5,000 cc and multiple units of blood were transfused. the abdomen was packed at the end of the procedure and was left open after placement of drains. mr. was then transferred to the intensive care unit with an open abdomen in an intubated, sedated and paralyzed condition. the remainder of the intensive care unit course was significant for a left pneumothorax requiring a left chest tube placement on . mr. hemodynamics and hematocrit remained stable after this operation and he was able to diurese. on , four days after his re-exploration, mr. was taken back to the operating room where his abdomen was closed and prior silastic placed at the prior operation was removed. over the next several days mr. had slow but steady recovery and was extubated on . as he was recovering in the intensive care unit on , mr. was found to once again have bright red blood per his ng tube. his hematocrit at this time dropped from 30 to a low of 22.6. this required a re-intubation, transfusion of an additional six units of blood and interventional radiology angiogram requiring embolization of the gastroduodenal artery. the remainder of the icu course was significant for a left lower lobe pneumonia which was treated with a change of antibiotics from vancomycin, zosyn and gentamicin to meropenem. mr. hematocrit remained stable and his respiratory status improved on antibiotics. his vent was weaned and he was extubated on . with continued improvement, he was transferred to the floor on and with continued stability was eventually discharged to home on home tpn. of note, at the end of his hospitalization mr. was found to have a right cephalic vein thrombosis which was attributed to his picc line placement. this will be followed as an outpatient. the summary of mr. hospital course described by systems. neurologically, mr. was admitted alert and oriented times three. after prolonged hospital course which required two intubations and extended icu course he is now being discharged once again alert and oriented and tolerating his pain on oral percocet. cardiovascular: despite his upper gi bleeds and intra-abdominal bleeds, mr. did not suffer any cardiac injury. he has a history of hypertension and is being discharged from the hospital on lopressor 25 twice a day. respiratory: mr. hospital course was significant for two intubations and an episode of left lower lobe pneumonia which was treated with antibiotics. he is being discharged without any respiratory complaints. he continues on antibiotics for his abdominal prophylaxis. gastrointestinal: mr. was admitted with a presumed diagnosis of either cholangitis or mesenteric bleed. his hospital course was revealing for a diagnosis of intra-abdominal hematoma secondary to arterial bleed in the right upper quadrant. this bleed is presumed to be from the right hepatic or a branch of the right hepatic artery. his hospital course was also significant for an upper gi bleed requiring embolization of the gastroduodenal artery. given his condition after exploratory laparotomy, mr. has been maintained as an npo except medication status. he is being treated with tpn for his nutrition and he is being discharged to home on tpn. his liver functions have returned to condition and his hepaticojejunostomy is functioning normally at discharge. infectious disease: mr. , due to his abdominal hematoma and evacuation of this hematoma, was placed on broad spectrum antibiotics including vancomycin, gentamicin, zosyn and fluconazole. the covert organisms during his hospital course were klebsiella, alpha strep, enterococcus, and coag negative staph. once he developed a left lower lobe pneumonia his antibiotic coverage was switched to meropenem and fluconazole per infectious disease recommendation. mr. is being discharged on oral ciprofloxacin to be continued until further follow up. renal: mr. continued to have adequate renal function during his hospital course. he is being discharged with normal renal clearance. nutrition: mr. , on discharge, is receiving gold calories in his tpn which he will continue. right upper arm deep venous thrombosis: at the time of discharge mr. has a clot in his right cephalic vein. this clot does not extend into the major venous structures of the chest and he will have follow up of this cephalic vein clot. discharge medications: 1. lopressor 25 mg p.o. b.i.d. 2. percocet one to two p.o. q. 4-6h. p.r.n. 3. ciprofloxacin 500 mg p.o. q. day. 4. azulfidine 5 mg p.o. q. hs. p.r.n. 5. protonix 40 mg p.o. b.i.d. 6. albuterol one to two puffs q. 6h. p.r.n. 7. tylenol p.r.n. 8. tpn at continuous infusion. nursing care: mr. is being discharge with wet to dry dressing on his abdominal wound which has been open for a small wound infection. he will receive dressing changes at home. follow up: with dr. in the clinic. discharge diagnoses: 1. intra-abdominal bleed. 2. exploratory laparotomy. 3. hepaticojejunostomy leak status post repair. 4. pneumonia. 5. upper gi bleed. 6. hypertension. 7. total parenteral nutrition. , m.d.,ph.d. 02-366 dictated by: medquist36 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine closed [endoscopic] biopsy of bronchus endoscopic control of gastric or duodenal bleeding reopening of recent laparotomy site transcatheter embolization for gastric or duodenal bleeding suture of artery delayed closure of granulating abdominal wound other cholangiogram revision of anastomosis of small intestine suture of laceration of duodenum diagnoses: pneumonia, organism unspecified other postoperative infection hemorrhage complicating a procedure iatrogenic pneumothorax other complications due to other vascular device, implant, and graft hemorrhage of gastrointestinal tract, unspecified unspecified intestinal obstruction 

Answer: The patient is high likely exposed to