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: haldol / darvon / keppra attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: egd colonoscopy tips endotracheal intubation and mechanical ventilation history of present illness: ms. is a 62 year-old woman with a history of hcv cirrhosis, polysubstance abuse, and history of hemorrhoidal bleeding presented with 1-2 wks brbpr and discovery of hct 18 at pcp's office. her creatinine was 1.1. in the ed, she was found to have a hct of 10% and acute renal failure with creatinine of 1.6. she had a femoral cordis placed. she was given ivf and had emergency released blood transfused. her bp was as low as 80/40, but stabilized with ivf to 100/60. she refused ng lavage. past medical history: 1) iron deficiency anemia 2) gi bleed - presumed secondary to hemorrhoids 3) sigmoid diverticulosis 4) schatzki's ring 5) duoenal polyps and duodenitis 6) mgus 7) ?etoh/ hcv cirrhosis followed by dr. (vl 9k in ) 8) psychotic disorder 9) remote polysubstance abuse - etoh, cocaine, marijuana 10) copd 11) compex partial seizures social history: she lives alone, 10 blocks from her daughter. she smokes several cigaretts per day, and occasionally uses etoh, marijuana, and cocaine. she is originally from , and changed her name when she became a practicing muslim, which she says she currently still practices. she worked as an administrative assistant when she was younger, but is now on ssdi (for schizophrenia and seizure disorder, per pt, both now quiescent). family history: mother: asthma, grandmother with diabetes, htn. no family history of liver disease or bleeding disorders. great aunt with epilepsy physical exam: physical exam on discharge gen: awake and alert. oriented to month, year, person. tangential speech. easily re-directed. heent: mucous membranes moist. eomi. pupils equal and reactive. marked scleral icterus. neck: bandage in place. heart: regular rate and rhythm. normal s1, s2. no murmurs. chest: diffuse crackles bilaterally abd: soft. nt/nd. extremities: 1+ peripheral edema neuro: cn ii-xii intact. moving all extremities. tangential speech but easily directed. pertinent results: echo -the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60-70%) there is no ventricular septal defect. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate pulmonary hypertension; dilated hypocontractile right ventricle . chest x-ray :severe infiltrative pulmonary abnormality has worsened radiographically but this may be a function of extubation and the end of positive pressure ventilatory support which has produced slightly lower lung volumes. small bilateral pleural effusions may be present. heart size is normal. mediastinal vascular engorgement is moderate and unchanged. no pneumothorax. tip of the right supraclavicular central venous line projects over the upper svc. brief hospital course: # gastrointestinal bleed: pt admitted with significant lower gi bleed at hemorrhoids likely thought secondary hepatitis c associated cirrhosis. she underwent egd with two cords of grade i varices identified, no stigmata of bleeding. colonoscopy led to rectal prolapse and bleeding thought likely from rectal varices. a tips by interventional radiology was performed with the intention of relieving portal hypertension and rectal variceal bleeding. rectal bleed recurred on , with rectal foley placed by surgery later expelled with valsalva. hepatology placed a rectal to tension, which controlled bleeding. ultrasound revealed patents tips and it was thought that bleeding may be secondary to hemorrhoids versus varices. patient was transfused intermittely to maintain stable hematocrit. subsequently discontinued with no significant bleeding since. hematocrit is stable at discharge at 30.8. . # respiratory distress: on in the setting of acute re-bleed, ms. was intubated secondary to wheezing, severe shortness of breath, and increasing rales. vancomycin, cefepime, flagyl started to cover for nosocomial pna. metronidazole later discontinued. endotracheal suction removed particulate matter consistent with aspiration. she also demonstrated fluid overload and pulmonary edema. she has received intermittent furosemide to relieve pulmonary vascular congestion. to maximize respiratory capacity, she was started on standing ipratropium mdi 6 puff ih q4h, albuterol 6 puff ih q4h, fluticasone propionate 110mcg 2 puff ih . on , pt noted to have respiratory distress likely flash pulmonary edema after administration of d5w 250ml over 2 hours for hypernatremia; stat cxr demonstrated increased opacities. she was extubated on and was saturating well on nasal cannula. vancomycin and cefepime were discontinued on after a 12 day course. . # hypernatremia: on , ms. was noted to have increasing sodium (147), and therefore free water boluses were begun and iv d5w administered. because of pulmonary vascular congestion, iv fluids were discontinued were and free water boluses titrated to maintain stable sodium. once patient was extubated, iv fluid boluses were discontinued in favor of oral free water repletion. sodium is 148 on the day of discharge. . # acute renal failure: creatinine was noted to be gradually increasing, with consideration of acute interstitial nephritis/acute tubular necrosis in setting of hypotension or, given positive rare eosinophils in urine, of new drug. creatinine gradually improved as overall condition improved. creatinine is 1.7 on the day of discharge. electrolytes and renal function should be monitored daily for the next several days given new oral diuretic regimen. . # tachycardia: pt demonstrated episodic tachycardia to 160s-170s during suctioning, but persistent tachycardia as well into 100s even without stimulation. in addition, pt developed concomitant hypertension into the 190s-220s. pt received haldol for agitation, hydralazine 10 mg iv x2, dilt 10 mg iv x1. she was started on metoprolol which was discontinued in favor of the non-selective blockade with labetalol 100mg po bid given patient's recent cocaine use. . # coagulopathy: ms. has had persistently abnormal coagulation factors. this was thought likely secondary to poor synthetic function in the setting of hepatic failure. vitamin k was initially given to correct any component of nutritional deficiency with little effect. she was transfused with ffp in times of acute bleeding with a goal of inr < 2.5. at the time of discharge, ms. inr was stable at 2.4. . # hcv cirrhosis: pt not on medical therapy for hcv cirrhosis. paracentesis results during hospitalization demonstrated no evidence of spontaenous bacterial peritonitis. pt is s/p tips and there is concern that tips may have worsened encephalopathy noted during admission. lactulose continued for encephalopathy prevention. total bilirubin reached a peak of 11 on and has been trending downward to 8.2 at time of discharge. she should continue lactulose and rifaximin. and follow-up with dr. of hepatology . . # altered mental status- following extubation, ms. has had intermittent delirium which is likely a combination of hepatic encephalopathy and delirium associated with prolonged hospital stay. if needed, recommend low dose haldol for behavioral control with attention to qt interval on electrocardiogram. qt interval 438 on day of discharge. . # substance abuse: pt continued using cocaine, marijuana, and etoh. sw consult pending. hiv was tested given risk factors and was negative. . # full code . # communication: daughter (hcp), son ) medications on admission: none discharge medications: 1. insulin lispro 100 unit/ml solution : per sliding scale subcutaneous asdir (as directed). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po tid (3 times a day) as needed for agitation. 4. beclomethasone dipropionate 80 mcg/actuation aerosol : one (1) inhalation 2 puffs () as needed for sob. 5. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical tid (3 times a day) as needed for itching. 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q6h (every 6 hours). 7. albuterol sulfate 0.083 % (0.83 mg/ml) solution : inhalation q2h (every 2 hours) as needed. 8. ipratropium bromide 0.02 % solution : inhalation q6h (every 6 hours). 9. lactulose 10 gram/15 ml syrup : thirty (30) ml po qid (4 times a day). 10. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 11. labetalol 100 mg tablet : one (1) tablet po bid (2 times a day). 12. haloperidol lactate 5 mg/ml solution : one (1) injection (0.5mg) tid (3 times a day) as needed for agitation. 13. lasix 40 mg tablet : one (1) tablet po once a day. tablet(s) 14. spironolactone 50 mg tablet : one (1) tablet po once a day. tablet(s) discharge disposition: extended care facility: hospital discharge diagnosis: lower gastrointestinal bleed cirrhosis hepatic encephalopathy respiratory distress/ aspiration pneumonia acute renal failure hypernatremia coagulopathy secondary to liver failure hepatitis c hepatic cirrhosis discharge condition: good discharge instructions: per hepatology recommendations, ms. should begin lasix 40mg po daily and spironolactone 50mg po daily, and electrolytes and creatinine should be checked daily for the next several days. these medications may be titrated up as tolerated by electrolytes, renal function and blood pressure. she should follow-up with dr. in hepatology clinic on friday, as described below. she should continue on lactulose and rifaximin for hepatic encephalopathy. haldol at low dose as needed for agitation. please take all medications as prescribed. return to the hospital for: . * bleeding * frank blood in stools * tarry black stools * bloody emesis * fevers, chills * abdominal pain * nausea, vomiting * worsening cough * decline in mental status followup instructions: , morning- appointment with dr. of hepatology of the at . call ( with questions. primary care dr. on at 1:45 pm at community health center. phone ( procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage colonoscopy injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified portal hypertension chronic airway obstruction, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus epilepsy, unspecified, without mention of intractable epilepsy hepatic encephalopathy hyperosmolality and/or hypernatremia internal hemorrhoids with other complication external hemorrhoids with other complication other and unspecified coagulation defects chronic diastolic heart failure 

Answer: The patient is high likely exposed to