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: patient recorded as having no known allergies to drugs attending: chief complaint: weakness major surgical or invasive procedure: colonoscopy endoscopy endoscopic ultrasound and pancreas biopsy history of present illness: please see nightfloat h&p for full hpi, pmh, meds, sh, fh. briefly, pt is a 72 y/o african-american m with cri, h/o nephrolithiasis, who presented with weakness. his weakness has been progressive over the week prior to admission, is present in his upper and lower extremities, makes it difficult for him to stand, and is accompanied by pain. he reports inability to grasp objects with his hands and he feels that his fingers are stiff. he has never experienced this before. he also had a recent episode of 2 days of abdominal pain, starting at his umbilicus and then moving to his rlq. this was accompanied by n/v x 1. it has been resolved for 2-3 days and was not accompanied by a change in bowels. he has chronically loose bowels which have worsened over the past 2 months. he has loose stools after each meal, up to 10x per day. he denies brbpr, melena. past medical history: nephrolithiasis- s/p surgery perforated ulcer- s/p surgery "ileitis" in s/p surgery s/p thumb surgery social history: no tobacco, rare etoh. lives alone. supportive family. family history: nc physical exam: vs: t: 96.9f bp 126/84 hr: 107 rr: 22 sao2: 100% ra gen: middle-aged man in nad, awake, alert heent: eomi, perrl, sclera anicteric, conjunctivae clear, op moist and without lesion neck: supple, no jvd cv: reg rate, normal s1, s2. no m/r/g. chest: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, nt, nd, no hsm ext: 1+ ble edema skin: diffusely erythematous/scaly skin over face pertinent results: admission labs: na 144, k 1.9, cl 122, bicarb 01, bun 32, cr 4.6, glucose 109 wbc 11.6, hct 34.8, plt 256 discharge labs: na 141 k 5.5 cl 116 bicarb 19, bun 12, cr 2.3, glucose 73 wbc 11.6, hct 34.8, plt 197 calcium 7.5, mag 1.2 (repleted), phos 3.4 ast 39 alt 69 bili 0.6 albumin 2.8 pth 667 gastrin 222 ( 90) vip pending 5-hiaa normal niacin pending copper: slightly over neg igf-1 normal hepatitis a,b,c serologies negative reports: liver or gallbladder us (single organ) 6:55 pm findings: grayscale evaluation of the liver demonstrates diffusely increased echogenicity without focal hepatic lesions or masses. there is no intra- or extra-hepatic biliary dilation. the cbd measures 7 mm appropriate for patient's age. there is no choledocholithiasis. there is a 1.3 cm gallbladder stone without pericholecystic fluid or gallbladder wall edema to indicate acute cholecystitis. son sign was absent. the extrahepatic portal vein is patent with wall-to-wall hepatopetal flow and normal waveform. however, there is prominent perihepatic collateral vessels extending into the porta hepatis, which may replace the main portal vein suggesting possible cavernous transformation of the portal venous system. the limited visualization of the renal parenchyma demonstrates normal echogenicity. impression: 1. diffusely echogenic liver may represent fatty infiltration; however, more advanced liver disease including cirrhosis and advanced fibrosis cannot be excluded on this study. 2. prominent perihepatic collateral apparently immediately distal to the extrahepatic and possibly replacing the main portal vein raise the possibility of cavernous transformation of the portal vein, related to underlying chronic portal hypertension. 3. cholelithiasis without acute cholecystitis. 4. normal echogenicity of right renal parenchyma argues against chronic medical renal disease (could the patient's acute renal failure reflect hepatorenal syndrome?) . chest (pa & lat) 7:07 pm pa and lateral view, chest: the lungs are clear. there are no focal consolidations. there is no pleural effusion or pneumothorax. minimal atelectasis is noted at the left lower lobe. cardiomediastinal silhouette and pulmonary vasculature is normal. the aorta is markedly elognated and unfolded. the pulmonary vasculature is unremarkable without evidence of pulmonary edema. there is diffuse osteopenia with loss of height of mid thoracic vertebra ad resultant kyphosis. impression: no acute cardiopulmonary process. . ecg study date of 5:33:52 pm sinus rhythm. possible old inferior myocardial infarction. left anterior fascicular block. intraventricular conduction delay. no previous tracing available for comparison. tracing #1 . ecg study date of 3:07:12 am sinus rhythm. occasional premature atrial contractions. compared to the previous tracing atrial ectopy is new. tracing #2 . renal u.s. 8:37 am renal ultrasound: bilateral sub-1.6 cm kidney cysts are noted. the right kidney measures 8.9 cm without evidence of hydronephrosis, stone or mass. the left kidney measures 9.8 cm, evidence of hydronephrosis, stone or mass. an enlarged prostate measuring 5.1 x 5.4 x 6.6 cm and encroaches into the bladder. the spleen measures 12.9 cm and is otherwise unremarkable. there is cholelithiasis without evidence of cholecystitis. impression: 1. no hydronephrosis. 2. a large prostate protrudes into the bladder. . chest (portable ap) 9:14 am the recently placed left picc distal tip probably projects at the expected location of the mid svc. no pneumothorax, pleural effusion or focal consolidation is noted. the cardiac silhouette and hilar contours are normal. the aorta is tortuous. impression: satisfactory position of left picc with no complication. -------------------- v/q scan: impression: the above findings are consistent with a moderate to high likelihood of pulmonary embolism. colonoscopy: normal. stricture at ileocolonic anastamosis, unable to pass scope through. pathology: a. anastomotic area: 1. fragment of enteric mucosa with fibrosis, atrophic changes and active inflammation involving the surface epithelium. 2. fragment of unremarkable colonic mucosa. b. random: fragments of unremarkable colonic mucosa. upper endoscopy: erythema and congestion of the mucosa were noted in the stomach. these findings are compatible with gastritis. cold forceps biopsies were performed for histology at the stomach antrum. 3 cords of grade 1 varicees. pathology revealed chronic active gastritis with h pylori present. . endoscopic ultrasound: eus was performed using a linear echoendoscope at 7.5 mhz frequency: the head of the pancreas were imaged from the duodenal bulb and the second duodenum. the body and tail were imaged from the gastric body and fundus. the uncinate process of the pancreas could not be imaged. pancreas parenchyma: the parenchyma in the uncinate pancreas was homogenous, with a normal ??????salt and pepper?????? appearance. no discrete mass lesions or changes suggestive of chronic pancreatitis were noted. pancreas duct: the pancreas duct measured 3 mm in maximum diameter in the head of the pancreas and 1.7 mm in maximum diameter in the body of the pancreas. the duct was normal in echotexture and contour. no intra-ductal stones were noted. no dilated side-branches were noted. multiple, dilated, tortuous abnormal vessels were noted in the portal hepatis. these may represent varices or cavernous transformation of the portal vein. duodenum mucosal biopsy: no diagnostic abnormalities recognized, but nearly all the surface epithelium has been stripped off and is not present for evaluation of villous architecture. multiple levels have been examined. brief hospital course: a/p: 72 yo male with cri, s/p colectomy for crohn's disease, nephrolithiasis who presents with acute renal failure and hepatitis. #diarrhea: acute on chronic by history. patient reported frequent loose stools for many years at home (since his bowel resection) and could not recall any substantial change that precipitated his presentation to the hospital. further history was obtained from his long time friend who reported that he had had a substantial increase in gas, bloating, diarrhea in the past week that was associated with his other presenting complaints. patient's diarrhea persisted in the hospital reaching as much as 5l per day in the icu and persisted even when he was npo. his stool osms in the icu initially showed a gap of 68 (suggesting secretory diarrhea) this history prompted an extensive work-up for secretory diarrhea illnesses. causes considered included neuroendocrine tumors 90), vipp, ivf1 normal, 5-hiaa normal, niacin (for pellagra) pending], bacterial toxins, crohn's, microscopic(lymphocytic) colitis, hyperthyroidism (normal tsh). stool cultures were negative. small bowel barium follow-through revealed hypermotility as well as chronic malabsorption as suggested by the increased number of folds in the ileum. egd/colonoscopy w biopsies only showed mild gastritis and h pylori. colon biopsy was normal. after aggressive elecrolyte repletion his diarrhea slowed down to 5-10 small bm's per day. his stool gap increased to 114, closer to a secretory type diarrhea. given his history of bowel resection and oxalate stones (indicating probabale disruption in enterohepatic bile acid circulation) we started the patient on cholestyramine (presuming osmotic diarrhea from non-absorbed bile acids) and immodium for symptomatic relief. # acute renal failure on chronic kidney disease: as per osh records patient's cr is baseline 3.5. renal team consulted who felt that chronic kidney disease may be due to chronic hypokalemia from chronic diarrhea. spoke with patient's pcp who confirmed this history. patient's cr steadily returned to baseline 2.4 and at time of discharge. # electrolytes: patient with severe hypokalemia, and non-anion gap metabolic acidosis with bicarbonate level in the single digits. this was felt to be from his severe diarrhea as well as a renal concentrating defect from his hypokalemia (according to the nephrology team). he was in the icu for many days where he received aggressive elecrolyte repletion and eventually had some stabilization in his electrolyte panel. his potassium was slightly high (5.5) on discharge after daily 60meq per day of potassium repletion. he may need further potassium repletion at a later date (would recommend either aldactone or 20meq of potassium per day). # proximal muscle weakness: thought secondary to electrolyte disturbances arising from acute on chronic diarrhea and chronic kidney disease. improved with resolution of his electrolytes. ultimately, serologic tests such as rf, for evidence of dermatomyositis, polymyositis were negative. given symptomatic improvement and that ck's trended to baseline a muscle biopsy was deferred. # transaminitis/pancreatitis: patient with no known liver disease. imaging demonstrated inflammation of the pancreatic head c/w pancreatitis or possibly an underlying mass lesion. also noted cholelithiasis. patient was never with clinical cholecystitis or pancreatitis in the hospital but did report abdominal pain prior to admission. it was felt that he had likely passed an obstructed stone at home leading to the elevated enzymes, ct findings without overt evidence of acute pancreatitis. endoscopic ultrasound was performed to exclude an underlying pancreatic mass and showed no evidence of any abnormalities. viral hepatitis panels, auto-immune liver serologies, iron studies were all negative. serum copper was mildly elevated. patient declined hiv testing. endoscopy did reveal grade 1 varices consistent with chronic liver disease. he was started on nadalol 20mg po daily. he will follow-up in the liver center. #pe: post-icu stay patient was with resting sinus tachycardia of 100-110 bpm that was unexplained. during periods of exertion his hr would rise to 130-140bpm. patient underwent v/q scan which showed moderate-high probability for pe and so patient was started on heparin gtt. he was transitioned to coumadin (2.5mg po daily) and after 3 days of this he was supratherapeutic with inr of 4.9. he is instructed to hold coumadin until he sees his pcp on monday. i would suspect that a regimen of coumadin 1mg po daily may be adequate for him given the evidence of liver dysfunction and likely malabsorption from his chronic diarrhea. # hyperparathyroidism: patient had relatively normal calcium and phosphorus, but was found to have a very very high pth level (667). he was started on calcitriol. this level should be followed by his nephrologist. medications on admission: none discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po bid (2 times a day). disp:*180 tablet, chewable(s)* refills:*2* 2. niacin 100 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 weeks. disp:*14 tablet(s)* refills:*0* 3. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po qweek () for 8 weeks. disp:*30 capsule(s)* refills:*0* 5. cholestyramine-sucrose 4 gram packet sig: one (1) packet po tid (3 times a day): do not take within 1 hour of your other medications. (this medicine can prevent absorption of other drugs). disp:*90 packet(s)* refills:*2* 6. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. loperamide 2 mg capsule sig: capsules po every six (6) hours as needed for for diarrhea. disp:*100 capsule(s)* refills:*2* 8. sodium citrate-citric acid 500-300 mg/5 ml solution sig: ninety (90) ml po qid (4 times a day). disp:* ml(s)* refills:*2* 9. coumadin 1 mg tablet sig: one (1) tablet po once a day: please do not take until you see dr. . he will check your inr. disp:*30 tablet(s)* refills:*2* 10. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 14 days: for treatment of h pylori. disp:*28 tablet(s)* refills:*0* 11. amoxicillin 500 mg tablet sig: two (2) tablet po twice a day for 14 days: for treatment of h pylori. disp:*56 tablet(s)* refills:*0* 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day for 14 days: for treatment of h pylori. disp:*28 capsule, delayed release(e.c.)(s)* refills:*0* 13. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: do not start until you have seen your doctor . disp:*30 tab sust.rel. particle/crystal(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: diarrhea pulmonary embolus acute renal failure hyperparathyroidism pancreatitis chronic liver disease nos with portal hypertension discharge condition: good discharge instructions: you were admitted to the hospital with severe weakness, electrolyte abnormalities, and diarrhea. an extensive evaluation did not show a conclusive cause of your problems. we think that many of your symptoms may have been due to your electrolyte problems from long standing diarrhea. you will need to see many doctors in follow-up for these problems. in addition we have started many new medications to help the diarrhea and your electrolyte problems. additionally, we found that you have a blood clot in your lungs. you will need to be on coumadin to thin your blood. your primary care doctor will follow your inr (coumadin level). because your blood is thin, do not take any coumadin until dr. checks your blood on monday. lastly, we found that you have gastritis (inflammation of the stomach) due to infection with h pylori. you should finish a course of antibiotics for this. please seek medical attention if you have any further weakness, worsening diarrhea, fevers, chills, abdominal pain, or other worrisome symptoms. followup instructions: please see dr. on at 11am. . you will need to see the following specialists nephrology: provider: ,md, phd: date/time: 10:00 hepatology (liver): , md phone: date/time: 8:30 gastroenterology: , md phone: date/time: 4:00 md procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine diagnoses: acidosis acute kidney failure, unspecified portal hypertension hypopotassemia chronic kidney disease, stage iii (moderate) hyperparathyroidism, unspecified diarrhea other pulmonary embolism and infarction acute pancreatitis unspecified chronic liver disease without mention of alcohol 

Answer: The patient is high likely exposed to