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: known periampullary adenocarcinoma. major or invasive procedure: : exploratory laparotomy with open pancreatic biopsy, cholecystectomy, fiducial placement, gastrojejunostomy and roux-en-y hepaticojejunostomy. . : flexible bronchoscopy. history of present illness: mr. was recently evaluated by my colleague when admitted to with obstructive jaundice. he was managed there with an ercp performed by dr. , which demonstrated a large mass at the major papilla with a stricture the lower through the common bile duct, obviously concerning for malignancy. he also underwent a cta of the abdomen, which demonstrated the likely ampullary carcinoma with associated pancreatitis changes. there was, however, no evidence of vascular involvement and no metastases to preclude the attempt at resection. once his jaundice has begun to resolve, plans were made for him to be discharged home with outpatient followup to arrange for an operative date. time has become available for the and therefore, we have moved up clinic appointment for today so that i could speak with him in more detail about the upcoming intervention. today, mr. reports that he is eating okay, but finds that he has had diminished appetite as well as some abdominal pain going on since with gradual increase in severity of the symptoms. past medical history: pmhx: copd, current smoker . pshx: (r) knee arthroscopy, umbilical hernia repair social history: lives alone, son lives in ri, son and sister are hcp. reports 0.5-1 pack h/o smoking x60 years. reports drinks/day. denies illicit drug abuse. family history: non-contributory physical exam: pre-admission examination: look well in nad. he continues to have some, but improved jaundiced, from when i have last seen him. his abdomen is scaphoid with a well-healed umbilical incision from his umbilical hernia repair of several years ago. examination otherwsie unremarkable. . at discharge: vs: 98.4 po, 101, 151/78, 18, 95% ra gen: thin male in nad. heent: sclerae anicteric. o-p clear. neck: supple. lungs: cta(b) cor: rrr abd: (r)subcostal incision with staples c/d/i. (r) lateral incisional woiung clean, granulating. w->d dressing placed. bsx4. appropriately tender to palpation along incision, otherwise soft/nt/nd. extrem: no c/c/e neuro: a+ox3. pertinent results: on admission: 12:10pm wbc-8.2# rbc-4.27* hgb-13.4* hct-40.6 mcv-95 mch-31.4 mchc-33.0 rdw-16.3* 12:10pm alt(sgpt)-106* ast(sgot)-133* alk phos-430* amylase-70 tot bili-4.2* 12:10pm glucose-106* urea n-11 creat-0.7 sodium-132* potassium-4.2 chloride-96 total co2-26 anion gap-14 01:40pm pt-11.5 ptt-30.8 inr(pt)-1.0 03:00pm urine rbc-1 wbc-2 bacteria-none yeast-none epi-1 03:00pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-4* ph-5.5 leuk-neg 03:00pm urine color-dkamb appear-hazy sp -1.024 09:45am freeca-1.10* 10:50pm glucose-129* lactate-2.0 na+-133* k+-3.8 cl--104 10:50pm freeca-1.06* 03:21pm glucose-133* urea n-14 creat-0.7 sodium-135 potassium-5.3* chloride-103 total co2-26 anion gap-11 03:21pm wbc-11.7* rbc-3.89* hgb-12.4* hct-36.8* mcv-95 mch-31.9 mchc-33.7 rdw-15.9* 03:21pm plt count-380 03:21pm pt-12.0 inr(pt)-1.0 12:46pm glucose-123* lactate-1.2 na+-134* k+-4.4 cl--101 12:46pm hgb-12.1* calchct-36 12:46pm freeca-1.10* . imaging: sinus tachycardia, rate 102. left anterior hemiblock. right bundle-branch block. inferior wall myocardial infarction of indeterminate age cannot be excluded. compared to the previous tracing of no significant change. intervals axes: rate pr qrs qt/qtc p qrs t 102 136 126 364/437 76 -45 59 . cxr: no evidence of acute process. copd. . ap cxr: et tube in standard placement. epidural catheter unchanged in position. right jugular line tip projects over the mid svc. lateral aspect of right lower chest is excluded from the examination. the imaged portions of lungs and pleura are normal. heart size is normal. apparent narrowing of the lower trachea is more likely a projection of a posterior osteophyte,rather than a tracheal lesion. nasogastric tube passes into the stomach and out of view. . ap cxr: cardiomediastinal contours are normal. the lungs are grossly clear and hyperexpanded. there are no new lung abnormalities, pneumothorax, or pleural effusion. ng tube tip is in the stomach. a right ij catheter tip is in the svc. skin staples project in the upper abdomen. brief hospital course: the patient was admitted to the general service on for evaluation and treatment of periampullary adenocarcinoma. on this date, the patient underwent exploratory laparotomy with open pancreatic biopsy, cholecystectomy, fiducial placement, gastrojejunostomy and roux-en-y hepaticojejunostomy for an intra-operative finding of ampullary cancer metastatic to common hepatic arterial lymph node, which went well without complication (reader referred to the operative note for details). due to depressed mental status, the patient was brought to the pacu intubated. when awake, he was extubated, but experienced hypertension, tachycardia, desaturation to 85% and increased work of breathing. the patient was re-intubated for hypercapnic respiratory distress. post re-intubation cxr revealed a small apparent narrowing of the trachea just distal to the tip of the ett, conceivably related to recent preceding intubation. the patient was transferred to the sicu in stable condition npo with an ng tube, on iv fluids, with a foley catheter in place, and a dilaudid/bupivacaine epidural for pain control. in the sicu, the epidural was changed just to bupivacaine by aps due to sedation. later, fentanyl iv was added to the pain control regimen due to ineffective pain control. . due to the findings on re-intubation cxr, intervention pulmonology was consulted. on , a flexible bronchoscopy was performed, which did not show subglottic tracheal stenosis of the trachea endoscopically to any significant degree. the mild extrinsic compression was felt to represent lymphadenopathy. the patient was successfully extubated, and later transferred to the inpatient floor. . neuro: as above, the patient ultimately received a bupivacaine epidural with fentanyl iv post-operatively with good effect and adequate pain control. prior to transfer to the inpatient floor, the bupivacaine epidural and fentanyl were discontinued, and the patient wasgiven morphine iv prn with continued good pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. . cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. . pulmonary: re-intubated in pacu as outlined above. after extubation, patient required albuterol and atrovent nebulizer treatments, aggressive respiratory toilet, and his symbicort mdi was initiated. cxr on revealed that the lungs were grossly clear and hyperexpanded. there were no new lung abnormalities, pneumothorax, or pleural effusion. waened off supplemental oxygen on . the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. . gi/gu/fen: post-operatively, the patient was made npo on iv fluids. he required multiple iv fluid boluses for low urine output and tachycardia with good response. after his ng tube was discontinued on , he was started on sips of clears. his diet was progressively advanced to regular by , which was well tolerated. foley catheter was discontinued on ; he was usbsequently able to void without problem. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. . id: the patient's white blood count and fever curves were closely watched for signs of infection. wound care: (r) lateral subcostal incision opened on ; moist-to-dry dressing started. wound remained clean and granulated. remainder incision with staples c/d/i. patient was discharged home with moist-to-dry dressing changes. no antibiotic required. . hematology: the patient's complete blood count was examined routinely; no transfusions were required. . prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. . at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. he was discharged home with vna services. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation 2. aspirin 81 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain for 2 weeks. 2. oxycodone 5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. disp:*40 tablet(s)* refills:*0* 3. aspirin 81 mg tablet sig: one (1) tablet po once a day. 4. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation 1 inhalation (). 5. metoclopramide 10 mg tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day: if not formulary, may substitute with omeprazole 1 cap po bid (#60, 11 rf). disp:*60 tablet, delayed release (e.c.)(s)* refills:*11* 7. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*0* 8. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation: over-the-counter. 9. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation four times a day as needed for shortness of breath or wheezing. disp:*1 hfa* refills:*1* discharge disposition: home with service facility: discharge diagnosis: 1. ampullary adenocarcinoma metastatic to common hepatic arterial lymph node. 2. mild cholecystitis 3. copd discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, but will need to cover your incision with an occlussive wrap, such as saran wrap until it is completely healed over. *if you have staples, they will be removed at your follow-up *the vna nurse will show you how to care for the incisional wound. followup instructions: provider: , specialties cc-3 (nhb) phone:. location: , , , . please call for the date and time of your follow-up appointment. . please call ( to arrange a follow-up appointment with dr. (pcp) in weeks. procedure: other bronchoscopy injection or infusion of other therapeutic or prophylactic substance cholecystectomy other gastroenterostomy without gastrectomy biopsy of lymphatic structure anastomosis of hepatic duct to gastrointestinal tract diagnoses: tobacco use disorder unspecified essential hypertension chronic airway obstruction, not elsewhere classified alcohol abuse, unspecified other and unspecified hyperlipidemia right bundle branch block malignant neoplasm of ampulla of vater unspecified gastritis and gastroduodenitis, without mention of hemorrhage acute pancreatitis secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes other respiratory abnormalities chronic cholecystitis other sedatives and hypnotics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to