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: recurrent gastrointestinal bleeding. major surgical or invasive procedure: egd/colonoscopy interventional radiology duodenal artery embolization history of present illness: mr. is a 74m with hx of copd, dchf, htn, recent admission to for gi bleed, transfered from after being admitted again for rectal bleeding. patient reported episodes of loose bowel movements mixed with blood around 2pm on . he reports a toilet bowl full of bright red blood that day, then two large melenotic stools the following day, . he denied any chest pain, shortness of breath, doe, symptoms of orthostasis or presyncope. at osh, he was started on protonix drip and seen by gastroenterology. his hct dropped to 26 (from 31), so he was transfused 1u prbcs, after which his hct bumped appropriatedly to 29. egd both last month showed a visible pulsatile vessel in duodenum with no ulcer, which underwent successful epinephrine injection and endo clip, and appeared to be at high risk for rebleed. during this hospitalization, patient underwent repeat egd on which again showed pulsatile vessel with small clot on it, felt to be arterial, no evidence of active bleeding, and it again responded to epinephrine injection and was clipped with no further bleeding. there was discussion with gastroenterology about potential surgical treatment. when he was admitted last month, he did admit to some lightheadedness and had noted both melena and hematochezia. currently, patient feels well without complaints. he has not had a bowel movement in 2 days. ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, dysuria, hematuria. past medical history: copd, continued tobacco use chronic dchf hypertension hyperlipidemia gerd, doudenitis, gastritis - h. pylori s/p treatment - hx schatzki ring - hx of recent hospitalization for gi bleeding osteoarthritis prostate cancer s/p prostatectomy social history: married. retired. tobacco: smokes a few cigarettes/day. denies hx of etoh abuse. family history: father died in 90s. mother died at age 74 due to aneurysm rupture physical exam: on admission: vitals - 98.2 157/80 66 18 99%ra general: alert, oriented x3, pleasant, no acute distress, well appearing heent: dry mucus membranes, pink conjunctivae (just mildly pale), no scleral icterus cardiac: reg rhythm, normal rate but muffled heart sounds lung: clear to auscultation bilaterally abdomen: soft, mildly distended, nontender ext: no peripheral edema neuro: cn iii-, -xii intact (cannot hear finger rub on either side) psych: listens and responds to questions appropriately, pleasant on discharge: exam is stable and unchanged from discharge. pertinent results: labs on admission: 10:40pm blood wbc-9.5 rbc-3.62* hgb-10.6* hct-32.4* mcv-90 mch-29.2 mchc-32.6 rdw-15.0 plt ct-237 10:40pm blood pt-11.7 ptt-29.2 inr(pt)-1.1 10:40pm blood glucose-87 urean-12 creat-1.0 na-140 k-3.8 cl-105 hco3-24 angap-15 10:40pm blood calcium-8.7 phos-3.1 mg-1.8 imaging & studies: egd : impression: schatzki's ring nodularity and congestion in the stomach compatible with gastritis a 2-3mm visible vessel was seen in the duodenal bulb. gold probe was applied for thermal therapy. the lesion then began to bleed in a pulsatile manner. the lesion was injected with 8ccs of epinephrine. an endoclip was applied in an attempt to achieve hemostasis. there was residual oozing of bright red blood around the area of the clip with poor visualization. with 2 additional ccs of epinephrine the bleeding subsided. there was no clear location in which to place an additional clip. angioectasias in the duodenal bulb otherwise normal egd to third part of the duodenum ir embolization imaging: 1. no evidence of active arterial extravasation from the gastroduodenal artery or its branches on dsa arteriogram of the gastroduodenal artery. 2. successful retrograde coil embolization of the gastroduodenal artery, resulting in occlusion/flow stasis. post line placement: r picc in mid-svc labs on discharge: 05:46am blood hct-28.3* brief hospital course: this is the brief hospital course of a 74 year-old male with chronic obstructive pulmonary disease, chronic diastolic heart failure, hypertension, and recurrent gi bleeds who was admitted this hospitalization from following a gi bleed. over the course of the first two hospital days at , the patient did not have any bowel movements. on hd #3, he was noted to have 2 frankly melanotic bowel movements. gi was consulted and a plan was established to perform an egd and colonoscopy the following day, . during the procedure, the patient began to demonstrate pulsatile bleeding from his presumed duodenal artery that was not responsive to cauterization, epinephrine injection, or clipping. the patient was transferred to the micu on hd #4 () for closer monitoring with plans to undergo ir embolization of the bleeding artery at the next possible time. picc line was placed for better iv access. he successfully underwent ir-guided retrograde coil embolization of the greater duodenal artery on hd #5 (). after this his hct remained stable around 28-29, and he remained hemodynamically stable with no further episodes of bleeding until his transfer back to the floor on , hd #6. he was kept overnight (to abide by 72 hour inpatient regulations following active gi bleed) until , hd #7, when he was discharged home in good condition, with no evidence of active bleeding. the patient's home ppi dose was increased to 40mg twice daily. he was given stool softeners to be taken at home as needed. he will follow up with his primary gastroenterologist, who was informed of this course by the inpatient gi team. additionally, ivs placed at in the patient's right arm as well as one on the left arm were infiltrated on his arrival to . hot packs were used to alleviate pain and sweliing. on the day of discharge, these were resolved. inactive issues this admission: # copd - duonebulizers were given prn # hypertension - home amlodipine and atenolol were held as patient was normotensive while in house, did not discharge on either medication, will follow-up with pcp for restart # hyperlipidemia - continued home simvastatin 20mg qday # tobacco use - encouraged smoking cessation and offered nicotine patch prescription the patient was informed that he should still have a screening colonoscopy performed as part of his regular health maintenance in the near future as the studies done this admission were not adequate for this screening. transitional issues: -amlodipine and atenolol were held at discharge. -patient will need screening colonoscopy in the future as he has not had this. medications on admission: multivitamin simvastatin 20mg omeprazole 20mg atenolol 50mg daily norvasc 10mg daily discharge medications: 1. omeprazole 20 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po twice a day. disp:*120 tablet, delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 3. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*0* 4. multivitamin tablet sig: one (1) tablet po once a day. 5. simvastatin 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary: upper gastrointestinal bleed discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred from another hospital because of a repeat upper gastrointestinal bleed. here, you were observed and underwent an endoscopy where you were found to have a visible vessel that bled, so you were transferred to the medical icu and underwent interventional radiology-guided embolization of a blood vessel to stop the bleeding. now you have been stable for 3 days without any further episodes so you are being discharged home with plans to follow up with your gastroenterologist and your primary care doctor. we made the following changes to your medications: -increased omeprazole to 40mg twice a day -started colace and senna for constipation prevention -hold norvasc and atenolol as blood pressure has been controlled in the hospital, your pcp may restart these medication at your follow-up appointment on . followup instructions: primary care name: , np (works with dr ) location: - primary care address: , , phone: appt: at 3pm ***note: we asked your to hold norvasc and atenolol as your blood pressure has been controlled in the hospital, but please discuss this at your pcp visit because your pcp may restart these medication at your follow-up appointment on .*** gastroenterology name: , location: digestive disease associates address: , , phone: appt: pending, if you do not hear about appt by friday @ noon, call. ***please note that you should have a colonoscopy for routine colon cancer screening.*** procedure: venous catheterization, not elsewhere classified endoscopic excision or destruction of lesion or tissue of esophagus arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding diagnoses: tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of prostate other and unspecified hyperlipidemia hemorrhage of gastrointestinal tract, unspecified chronic diastolic heart failure tracheoesophageal fistula, esophageal atresia and stenosis other specified counseling 

Answer: The patient is high likely exposed to