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: no known allergies / adverse drug reactions attending: chief complaint: dizziness, weakness, fatigue, nausea, melanotic stool major surgical or invasive procedure: 1. endoscopy 2. catheterization of the celiac trunk history of present illness: 71 year old female with arthritis, osteoporosis, history of duodenal ulcer and recently diagnosed gastric cancer initially treated with chemotherapy c/b nausea/vomiting/lower gi bleed, now presenting with melanotic stool and ten point hematocrit drop. per the patient, she had been in her usual state of health (limited energy, but independent in adls at home) until this morning, when she had three bowel movements with black stool. her stools were of varying consistency, from very hard to very soft. she did not notice any brbpr. she sought medical care and her pcp obtained labs, which were notable for hgb/hct 6.7/20.0, down from 11.3/32.3 when checked in . she may have felt some dizziness with ambulation for the last couple of days, but denied falls, lightheadedness, dyspnea, chest pain, abdominal pain, or hematuria. per ed history, patient endorsed an episode of bloody emesis, but she denied this after arriving to the . . in the ed, initial vs were 97.08, 92, 91/54, 18, 100% ra. exam was notable for pale sclera and skin, and black stool on rectal exam. ecg revealed normal sinus rhythm at 88 bpm, and no ischemic changes. one unit of rbcs were transfused. a pantoprazole bolus of 80 mg, then 8 mg/hr gtt was started. the patient did not tolerate multiple attempts at ng tube placement for lavage. rbc transfusion was started at . foley catheter was placed. gi was consulted, and recommended keeping patient npo for egd in am, and transfusing rbcs for goal hct > 25. . per recent radiation oncology notes, the patient has also had significant short-term memory problems and a 40 lb weight loss since starting chemo. the decision was made to defer raditation treatment or further chemo, since the patient was feeling generally well and her pet scan showed general decrease in size of tumor burden. past medical history: past oncologic history: carcinoma of ge junction, likely gastric - presented in with dysphagia, initial egd showed ulcer in cardia and gastritis but no mass and biopsies then negative for malignancy. initally diagnosed in after presenting with dysphagia. ct showed showed 5 mm rll nodule and ulcerated gastric mass at ge junction. a ct scan of the chest, abdomen, and pelvis was performed on , at . there was a 5 mm lung nodule noted as well as an ulcerated gastric mass within the fundus near the ge junction extending outside the lumen of the stomach measuring 4.5 x 2.8, without adenopathy. eus revealed hypoechoic ill-defined mass and biopsy and cytology was suspicious for signet cell tumor. based these findings, she was initiated on chemo. - she received chemotherapy starting on , one cycle of eof (epirubicin, oxaliplatin, and 5-fu). she was hospitalized for dehydration. second cycle was held and she subsequently received a cycle of eof on . a repeat pet scan was performed, which revealed decreased bilateral hilar and precarinal lymph node fdg uptake. lung nodule was unchanged, decrease in the size and uptake of the gastroesophageal mass. because the patient tolerated chemotherapy so poorly, she elected to discontinue chemotherapy at that time. she has not received any chemotherapy since the end of . she was seen by dr. to discuss surgical options, but thought to be a poor surgical candidate. - lost 40 pounds since diagnosis. she also has significant short-term memory loss since initiating chemotherapy. she was having some nausea related to mucus production; however, her husband has placed her on a complimentary alternative medicine, which is derived from the mushroom growing on the bark of the white , which is obtained from . he feels that this has significantly decreased her mucus production and reduced her vomiting. she was prescribed megace, which she is not taking. she is ambulating without difficulty and her husband says that she is much more alert and does not sleep as much as she did earlier in . other past medical history: - arthritis - per omr, but patient denies - osteoporosis - diagnosed many years ago, was on fosamax, but discontinued this >1yr ago for unclear reasons - hypercholesterolemia - per omr, but patient denies, never been on a statin or other medication - anxiety - duodenal ulcer - gastritis - palpitations social history: married, originally from . she has 2 children, 47 yo and 36yo, who live in the us. denies tobacco or etoh use. family history: mother died of leukemia many years ago. her father died in and she is unaware of any medical problems. two children are healthy. physical exam: on admission: vs: temp:97.7 bp:99/59 hr:83 rr:11 o2sat:100% 3l nc gen: pleasant elderly russian woman, appears chronically ill and weakened, comfortable, nad heent: + conjunctival pallor, perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits resp: cta b/l with good air movement throughout cv: rrr, s1 and s2 wnl, no m/r/g abd: flat, nt/nd, +b/s, soft, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: awake, alert, interactive, oriented to name, place, year, month, but cannot name the date. cn ii-xii intact. 5/5 strength in upper and lower extremities, proximally and distally. no sensory deficits to light touch appreciated rectal: deferred . on discharge: pertinent results: admission labs: 03:52pm lactate-1.1 03:52pm hgb-6.4* calchct-19 03:35pm glucose-130* urea n-20 creat-0.4 sodium-135 potassium-3.7 chloride-105 total co2-23 anion gap-11 03:35pm estgfr-using this 03:35pm ctropnt-<0.01 03:35pm calcium-8.3* phosphate-3.0 magnesium-1.9 03:35pm wbc-13.8*# rbc-2.04*# hgb-6.1*# hct-18.5*# mcv-91 mch-30.0 mchc-33.0 rdw-14.1 03:35pm neuts-83.3* lymphs-13.9* monos-2.3 eos-0.1 basos-0.5 03:35pm plt count-406# 03:35pm pt-13.9* ptt-36.8* inr(pt)-1.2* . discharge labs: . studies: imaging: cxr : impression: no acute intrathoracic process. . mesenteric study : read pending . egd : a large ulcerated friable mass of malignant appearance was found at the gastroesophageal junction. the mass caused a partial obstruction, but the scope traversed the lesion. this was the likely source of bleeding. normal duodenum, normal stomach brief hospital course: 71 y/o f with gastric adenocarcinoma and history of duodenal ulcers, presenting with one day of black stools and dizziness, found to have ten point hematocrit drop from most recent lab work. . # melena/anemia: thought to be upper gib secondary to gastric malignancy versus possible ulcer. patient was started on iv pantoprazole gtt and transfused prbc x 1 unit in the ed, another 2 prbc units were transfused in the icu with appropriate hct rise from 18.5 on admission to 26 post transfusion. she subsequently remained hd stable and had no significant rebleeding per stable hct on follow-up. she underwent bedside egd in the icu which demonstrated a tumor in the ge junction with no signs of active bleeding and was otherwise unremarkable. per the high risk of rebleeding from the tumor she was taken to the ir suite for attempted embolization which was unsuccessful d/t a common origin of the left gastric artery and inferior diaphragmatic arteries off the celiac trunk thus the former could not be embolized in isolation. as patient's hematocrit remained stable heparin were started for dvt prophylaxis. she had a small guaiac positive stool on , but was asymptomatic without a significant drop in hematocrit. she was discharged on protonix 40mg and sucralfate 1gm po qid. she was discharged with instructions and lab slip to repeat a hct within 7 days of discharge. . # gastric ca: she did not tolerate her cycles of chemotherapy well, and was hospitalized each time with nausea/vomiting and bloody diarrhea, thought to be complications from chemo. since , she has been on holiday from either chemo or xrt. surgery notes indicate that she may have metastatic disease which would preclude her from having curative surgical options. although percutaneous feeding tubes may be of some palliative benefit, if within goals of care. she had a pet scan to assess size of gastroesphogeal mass and whether there were metatastases to determine further treatment - palliative radiation in setting of gastric mass bleeding vs. surgery or other treatment. the patient went for pet imaging the afternoon of discharge. patient will continue to follow-up with her primary oncologist, dr. . . # leukocytosis: likely secondary to stress in setting of gib. remained afebrile without localizing symptoms. was 12.2 on day of discharge. . # code status: dni, ok to attempt resuscitation, confirmed with the patient and her husband. . there were no labs pending on the day of discharge. medications on admission: medications per the patient and her husband: none, except for natural supplement ( tree mushroom) for nausea discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for pain: you may buy this over the counter. disp:*60 tablet(s)* refills:*0* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 3. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 4. ondansetron hcl 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*84 tablet(s)* refills:*2* 5. outpatient lab work please have hematocrit checked in 7 days from day of discharge () and have results faxed to your primary care physician. discharge disposition: home discharge diagnosis: primary diagnoses: 1. gastric cancer 2. upper gastrointestinal bleed 3. anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was pleasure taking care of you during this hospitalization. you were admitted because of blood loss from your gastrointestinal tract which was thought to be caused by bleeding from your gastric cancer. you were given blood to make up for your blood loss. you underwent endoscopy which did not demonstrate any active bleeding. you also underwent catheterization with the aim of stopping blood flow to the gastric tumor but this was unfortunately not achieved. your blood counts stabilized. you are being discharged and will need to go straight to have a pet scan. . the following changes were made to your medications: start pantoprazole 40mg tablet, take one tablet twice daily. start sucralfate 1mg by mouth four times daily start acetaminophen 325mg 1-2 tablets every 4-6hours as needed for pain start ondansetron 8mg tablet by mouth every 8 hours as needed for nausea **it is important that you not take ibuprofen, aleve, or aspirin, as these can cause bleeding. followup instructions: ***you will need a blood test to check your hematocrit within 7 days of your discharge and hyave results faxed to dr. at . . name: , md specialty: internal medicine when: wednesday at 11:40am location: address: , , phone: . name: , md specialty: hematology oncology when: thursday at 10am location: address: , , phone: md procedure: other endoscopy of small intestine arteriography of other intra-abdominal arteries diagnoses: pure hypercholesterolemia iron deficiency anemia secondary to blood loss (chronic) anxiety state, unspecified loss of weight osteoporosis, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified malignant neoplasm of cardia memory loss gastrointestinal vessel anomaly chronic or unspecified gastric ulcer with hemorrhage, with obstruction 

Answer: The patient is high likely exposed to