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: mental status changes, jaundice major surgical or invasive procedure: none history of present illness: mr. is a 64 year old male with metastatic prostate ca (mets to liver, skull), dvt/pe in past now on coumadin, transferred to with weakness and jaundice x 2 days. he is in from visiting family. he had been feeling well until 1 week ago prior to coming to the east coast. he had visited his md 2 days prior to getting on the plane and reportedly had complete lab work done which was insignificant. the day he flew from his wife noted that he had no urine output all day. he refused food and drink, complaining that he had difficulty swallowing. he continued to have poor uop (1x/day) over the next week, developed dizziness and confusion. per his wife he was unable to remember which medications he takes and this is very different from his baseline where he is very knowledgeable about his medical condition. finally, two days prior to admission she noted that he looked "yellow". at that time he developed nausea, emesis - which was brown in color, and weakness. he has become so weak that he is unable to perform adls. he had regular bms. he denies any fevers, chills, chest pain, or shortness of breath. . he initially presented to outside ed. while there he was given vitamin k x1 for inr 10, lactulose x1 for ammonia 60s. he also underwent ct head which was normal. ct abd/pelvis showed hepatomegaly, suggestive of multiple metastatic deposits, patchy sclerotic deposits throughout visualized bony structures c/w metastatic disease. moderate ascites. he was also placed on 4l o2 for unclear reasons. . at ed he was afebrile, bp 104/71, hr 79, rr 23, o2 sat 100% on 4l nc. physical exam was notable for guaiac positive. ekg with sinus tachycardia, lateral infarct - age undetermined. labs were notable for elevated ast>alt, t. bili, alk phos, hyponatremia, hyperkalemia, and acute renal failure. he was given 2u ffp. ruq us showed no flow seen within the portal vein, suggesting thrombosis. ct head negative for bleed. blood and urine cultures were sent. . old records which were faxed from clinic indicate that he was seen by dr. on . his note from that time indicates that he was started on androgen deprivation, treated with taxotere, caf, taxotere again, navelbine and carboplatin/taxotere. he has also undergone multiple courses of palliative radiation therapy. past medical history: history of dvt, pe on coumadin metastatic prostate ca - metastatic to bone, liver. diagnosed in , biopsy revealed 7, psa 600. bilateral knee replacement social history: soc hx: drinks gallon vodka every other day, last drink 6 days ago. denies any history of alcohol withdrawal, seizures. he is married and lives in . family history: unable to obtain due to patient confusion. physical exam: vs t 96.5, bp 113/66, hr 112, rr 24, o2 sat 99% on 4l nc gen: jaundiced male in nad, diaphoretic heent: icteric sclerae, no lymphadenopathy, dry mm, eomi, pupils small but reactive. cv: tachycardic, nl s1 s2, no m/r/g lung: clear bilaterally abd: distended, diffusely tender to palpation, no ascites, liver edge palpable 2-3 cm below costal margin ext: cool to touch b/l upper and lower extremities, trace edema b/l. neuro: +asterixis, easily arousable, oriented x2 (date and name) unable to name hospital. cn ii-xii intact. 5/5 strength, nl sensation, 2+ reflexes. skin: scattered petechiae, ecchymoses along b/l le. rectal: guaiac positive pertinent results: 08:44pm comments-green top 08:44pm lactate-6.0* 08:40pm glucose-112* urea n-54* creat-1.9* sodium-120* potassium-5.6* chloride-85* total co2-21* anion gap-20 08:40pm estgfr-using this 08:40pm alt(sgpt)-111* ast(sgot)-339* ck(cpk)-854* alk phos-1153* amylase-27 tot bili-10.1* 08:40pm ctropnt-0.02* 08:40pm ck-mb-7 08:40pm albumin-2.6* calcium-8.8 magnesium-2.3 08:40pm ammonia-96* 08:40pm wbc-13.3* rbc-2.92* hgb-9.8* hct-29.2* mcv-100* mch-33.7* mchc-33.7 rdw-22.5* 08:40pm neuts-86* bands-4 lymphs-3* monos-4 eos-0 basos-0 atyps-0 metas-2* myelos-1* nuc rbcs-1* 08:40pm hypochrom-1+ anisocyt-2+ poikilocy-normal macrocyt-2+ microcyt-normal polychrom-1+ 08:40pm plt smr-very low plt count-28* 08:40pm pt-104.8* ptt-43.8* inr(pt)-14.6* 08:25pm urine color-amber appear-clear sp -1.015 08:25pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-sm urobilngn-8* ph-5.0 leuk-neg 08:25pm urine rbc-* wbc-0-2 bacteria-mod yeast-none epi-0-2 08:25pm urine amorph-few 03:12am blood wbc-7.6 rbc-2.83* hgb-9.2* hct-26.2* mcv-93 mch-32.4* mchc-34.9 rdw-21.4* plt ct-43* 09:47pm blood wbc-10.7 rbc-3.54* hgb-11.6* hct-32.5* mcv-92 mch-32.8* mchc-35.7* rdw-21.4* plt ct-39* 04:33pm blood wbc-14.5* rbc-3.54* hgb-11.7* hct-33.8* mcv-96 mch-33.2* mchc-34.7 rdw-21.2* plt ct-47* 03:15am blood wbc-16.8* rbc-3.79* hgb-12.4* hct-36.9* mcv-97 mch-32.6* mchc-33.5 rdw-22.0* plt ct-43* 03:12am blood pt-15.3* ptt-25.8 inr(pt)-1.4* 03:12am blood pt-15.5* ptt-22.8 inr(pt)-1.4* 03:15am blood pt-19.0* ptt-24.0 inr(pt)-1.8* 03:12am blood glucose-87 urean-58* creat-1.6* na-131* k-4.6 cl-95* hco3-21* angap-20 05:19pm blood glucose-94 urean-55* creat-1.4* na-133 k-4.1 cl-97 hco3-20* angap-20 03:15am blood glucose-117* urean-73* creat-2.0* na-135 k-5.0 cl-97 hco3-7* angap-36* 05:52am blood alt-76* ast-256* ld(ldh)-1437* alkphos-689* totbili-7.7* 03:12am blood alt-103* ast-317* ld(ldh)-1804* alkphos-827* amylase-25 totbili-14.8* 03:15am blood alt-168* ast-535* ld(ldh)-2412* alkphos-910* amylase-35 totbili-18.3* 01:26am blood ctropnt-0.02* 08:40pm blood ammonia-96* 03:12am blood ammonia-114* 05:52am blood hbsag-negative igm hbc-negative igm hav-negative 08:44pm blood comment-green top 04:21pm blood type-art po2-83* pco2-34* ph-7.46* caltco2-25 base xs-0 intubat-not intuba 10:34pm blood type-art po2-82* pco2-33* ph-7.47* caltco2-25 base xs-0 intubat-not intuba 09:51pm blood type-art po2-90 pco2-27* ph-7.47* caltco2-20* base xs--1 10:45am blood type-art temp-36.1 rates-/28 po2-71* pco2-24* ph-7.48* caltco2-18* base xs--2 intubat-not intuba 09:23pm blood type-art temp-37.8 po2-95 pco2-18* ph-7.45 caltco2-13* base xs--8 intubat-not intuba comment-temp = 98. 02:13am blood type-art temp-38.4 po2-146* pco2-13* ph-7.34* caltco2-7* base xs--15 intubat-not intuba 08:44pm blood lactate-6.0* 03:32am blood lactate-3.2* 09:23pm blood lactate-9.8* . . studies: ct head (osh): negative . ct abd/pelvis (osh): mets to liver . ruq us: 1. nodular, heterogeneous liver consistent with provided history of liver metastases. 2. no evidence of intrahepatic biliary dilatation or cholecystitis. 3. no flow seen within portal vein, suggesting thrombosis. this could be further evaluated with cross sectional imaging. 4. ascites. . brief hospital course: assessment and plan: 64 year old male with history of metastatic prostate ca with hepatic mets, dvt/pe on coumadin presents with acute renal failure, hepatic failure resulting in encephalopathy and coagulopathy. clinical picture is likely chronic liver dysfunction due to alcohol (? alcoholic cirrhosis) and with chronic/subacute portal vein thrombosis resulting in current liver failure and encephalopathy. . # gi bleed: coffee ground emesis, melena in micu, guaiac positive in ed. hematocrit trended down from 29 to 25 to 21 in 12hr period, but hematocrit remained stable after 3u prbc. coagulopathy corrected over first night admission. egd on showed portal gastropathy and avm which was clipped. pt continued to have melena, no blood via ng tube. hematocrit stable. pt followed iwth hematocrits and transfusion goal >27. he was placed on ppi. gi consult placed, and felt given gi pathology not a candidate for anticoagulation now or in the future. . # hepatitis/hepatic failure/mental status: pt remained confused throughout hospital course, felt encephalopathy. lfts from in ast/alt 214/81. on admission, elevated ast>alt worse than prior. mixed picture related to portal vein thrombosis in setting of underlying liver disease (alcoholic hepatitis vs mets?). no evidence of cholecystitis on initial ruq us, however now with increasing lfts and t. bili. coagulopathy corrected with vitamin k and ffp. hepatitis serologies negative. lactate rising throughout admission, etiology unclear. documented evidence of liver metastases. ruq us from admission may represent cirrhosis, felt likely from etoh. given initial improvement followed by worsening of lfts and bilirubin, repeated ruq us to ensure there is now no acalculous cholecystitis. pt treated with pentoxyfiline, and lactulose, titrated to bms to improve encephalopathy. however mental status progressively worsened ultimately requiring intubation. per liver service, prognosis was felt to be poor. goals of care switched to comfort measures only, pt expired on . . . # acute renal failure: creatinine from labs on is 1.4. creatinine on admission 1.9. pt felt likely pre-renal due to dehydration and relative hypovolemia from hepatic failure. mild left sided grade 1 hydronephrosis. no initial concern for hrs, and creatinine stable. . # pulmonary - right pleural effusion: noted on cxr on admission. likely hepatic hydrothorax. pt ultimately intubated worsening mental status for airway protection, though some increasing difficulty maintaining oxygenation, felt volume overload and abdominal fluid. goals of care modified as above, and pt expired . . # nsvt: has increasing frequency of ectopy. treated with beta blocker prn. . # ascites: noted on ruq ultrasound. bladder pressure 23. abdomen remains soft. s/p paracentesis. no signs of sbp, however has been on abx. pt continue to be treated empirically for sbp as tap was done on abx. initially on broad spectrum antibiotics, however tapered to ceftriaxone. changed to ciprofloxacin as ceftriaxone can exacerbate cholestasis. complete 7 day course. . # diarrhea: increased frequency, sent for cdiff (negative), held lactulose in setting of diarrhea. stool cultures sent, though unremarkable. . # portal vein thrombosis: can cause elevated alt and jaundice in patients with underlying liver disease (in this case mets and etoh). due to metastatic ca. seen on ruq us. per liver, thrombosis is likely chronic. no anticoagulation due to gi bleed. . # etoh abuse: gallon vodka qod x 5 yrs. on had tachycardia and agitiation - concern that these were symptoms of withdrawal. pt treated with lorazepam prn for ciwa>10. iv thiamine, folic acid . # metastatic prostate ca: mets to bone, unclear if mets to liver. this would be uncommon. plan was to call osh to get imaging of metastatic disease. . # cardiac ## ischemia: no active issues. no enzyme bump. ## rhythm: sinus tachycardia likely from vasodilation with increasing frequency of ectopy. pt was treated with prn beta blockade. ## pump: pt initialy euvolemic on exam, but noted to have right pleural effusion on cxr. he became progressively more volume overloaded after intubation poor mental status. however tolerated diuresis. . # elevated white blood cell count: on admission was slightly elevated with 86% neutrophils with 4% bands. +lactate, though no evidence of compartment syndrome (bladder pressure 23, but belly soft). pt was treated empirically for sbp. negative ua, no infiltrate on cxr. . # hyponatremia: na on admission 120, resolved with fluid restriction and maintenance fluid. pt continue maintenance normal saline with free water restriction. . # thrombocytopenia: due to acute alcohol vs. splenic sequestration. - transfuse platelets for <30 as patient is acutely bleeding. . # anemia: macrocytic, likely from etoh use. unknown baseline. pt received 3u prbc in setting of gib as above, then hct stablized. . # hyperkalemia: resolved after admission with kayexalate. . # fen: pt started tf after intubation. # ppx: holding anticoagulants at this time due to gib but ok for pneumoboots, protonix , lactulose as bowel regimen . # access: piv x3, aline. no cvl due to agitation. . # code: initially full. however after extensive family discussion regarding poor prognosis from liver disease, decision made to switch goals of care to comfort measures only. pt expired . . # comm: wife medications on admission: dexamethasone 4mg coumadin 2.5mg daily percocet prn ms contin 120mg tid prednisone 5mg lexapro 20mg daily discharge medications: pt expired discharge disposition: expired discharge diagnosis: alcohol cirrhossis discharge condition: expired discharge instructions: pt expired followup instructions: pt expired procedure: percutaneous abdominal drainage arterial catheterization insertion of other (naso-)gastric tube alcohol detoxification transfusion of packed cells diagnoses: hyperpotassemia thrombocytopenia, unspecified unspecified pleural effusion acute and subacute necrosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia personal history of malignant neoplasm of prostate paroxysmal ventricular tachycardia personal history of venous thrombosis and embolism encounter for palliative care angiodysplasia of intestine with hemorrhage hepatic encephalopathy knee joint replacement secondary malignant neoplasm of bone and bone marrow acute alcoholic hepatitis unspecified deficiency anemia alcohol withdrawal portal vein thrombosis 

Answer: The patient is high likely exposed to