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: heparin agents attending: chief complaint: brbpr/colon tumor major surgical or invasive procedure: cardiac catheterization left hemicolectomy with primary anastomosis. history of present illness: 88m with history of atrial fibrillation on coumadin, chf, distant history of peptic ulcer disease, severe as (found during admission) transferred from for brbpr found to have sigmoid tumor. presented on with complaint of painless brbpr x 3 days with generalized malaise, no n/v/d. in the ed there, bp 86/60, hr 76, inr 2.6. ng lavage with no bloody return. he was admitted to the icu for further management. hospital course consisted of gi bleed work up with positive tagged rbc scan localizing to sigmoid colon. colonscopy this am showed circumferential, ulcerated, hemorrhagic mass measuring 6 cm in length with extensive diverticulosis. no active bleeding was seen. he recieved 7 units prbcs and 9 units ffp during his hospitalization, hct nadir of 19.6 in am of during prep. recieved 1 unit prbcs on transfer. . on arrival patient is cold and thirsty. denies chest pain, shortness of breath, cough, palpitations, dizzyness or syncope, abdominal pain, nausea, vomiting, diarrhea, dysuria, headache. no recent weight loss. appetite has been good. past medical history: atrial fibrillation on anticoagulation arthritis peptic ulcer disease hypertension chf bph as social history: continues to work 7 days a week at a bowling alley, balancing books. - tobacco: none - alcohol: rare - illicits: none family history: no history of colon or other cancer. physical exam: adm pe: vitals: t: 96.5 bp: 134/83 p: 99 r: 13 o2: 100%ra general: alert, oriented, no acute distress heent: sclera anicteric, mildly dry mucous membranes, oropharynx clear, no thrush, neck: supple, jvp not elevated, no lad lungs: occasional crackle at base, otherwise clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular rhythm, regular rate, normal s1 + s2, harsh systolic murmur best heard at lusb radiates to bilateral carotids and clavicle. no rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. hand joints with ulnar deviation of pip joints and marked chronic swelling. pertinent results: adm labs: 09:10pm blood wbc-6.0 rbc-3.16* hgb-9.7* hct-27.7* mcv-88 mch-30.6 mchc-34.9 rdw-15.1 plt ct-123* 09:10pm blood neuts-72.6* lymphs-20.2 monos-5.4 eos-1.3 baso-0.5 09:10pm blood pt-16.1* ptt-28.8 inr(pt)-1.4* 09:10pm blood plt ct-123* 09:10pm blood glucose-144* urean-20 creat-0.8 na-145 k-4.1 cl-105 hco3-27 angap-17 09:10pm blood alt-17 ast-26 alkphos-51 totbili-1.4 09:10pm blood albumin-3.5 calcium-8.3* phos-4.8* mg-1.9 09:28pm blood type- ph-7.34* comment-green top 09:28pm blood lactate-2.3* 09:28pm blood freeca-0.66* ekg: atrial fibrillation 91. na/qrs 110. e/o lvh by voltage criteria. no st or tw changes noted, poor baseline. no q waves. echo: biatrial enlargement. normal left ventricular cavity size with moderate left ventricular hypertrophy and mildly depressed global left ventricular systolic function. critical aortic stenosis with mild aortic regurgitation. mild to moderate mitral regurgitation. at least moderate tricuspid regurgitation in the setting of moderate to severe pulmonary artery systolic hypertension. : ct chest: impression: 1. likely extravasation of iv contrast material into the sigmoid colon from a colonic diverticulum, accounting for the patient's bright red blood per rectum. 2. concentric wall thickening within the distal descending colon could relate to the stated history of a colonic mass. alternatively, this wall thickening could be the result of normal peristalsis. recommend correlation with the colonoscopy report. 3. slight wall thickening with intraluminal fluid involving the rectum and distal sigmoid colon is most consistent with proctocolitis. 4. bibasilar septal thickening could be secondary to mild pulmonary edema or mild fibrosis. 5. moderate bilateral pleural effusions. 7. small splenic hypodensities, too small to characterize. similarly, multiple small bilateral renal lesions are too small to characterize, although these lesions are likely simple cysts. 8. marked atherosclerosis with moderate stenosis of the sma origin. 9. enlarged right axillary lymph node, measuring 11 mm. colon and rectum: resection synopsis (includes transanal disk excision of rectal neoplasms) macroscopic specimen type: left hemicolectomy. specimen size: greatest dimension: 46.5 cm. additional dimensions: 5.5 cm x 3.6 cm. tumor site: left (descending) colon. tumor configuration: ulcerating. tumor size:greatest dimension: 4.0 cm. macroscopic tumor perforation: not identified. microscopic histologic type: adenocarcinoma. histologic grade: low-grade (well or moderately differentiated). extent of invasion primary tumor: pt3: tumor invades through the muscularis propria into the subserosa or the nonperitonealized pericolic or perirectal soft tissues. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 25. number involved: 0. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma: distance of tumor from closest margin: 210 mm. distal margin: uninvolved by invasive carcinoma: distance of tumor from closest margin: 320 mm. circumferential (radial) margin: uninvolved by invasive carcinoma: distance of tumor from closest margin: 65 mm. treatment effect: no prior treatment. lymphatic small vessel invasion: absent. venous (large vessel) invasion: absent. perineural invasion: absent. tumor deposits (discontinuous extramural extension): not identified. additional pathologic findings: diverticular disease. clinical: left colon. gross: the specimen is received fresh in two parts, each labeled with the patient's name, ", " and the medical record number. part 1 is additionally labeled "left colon, 2 stitches = splenic flexure, one stitch = rectosigmoid, one long stitch = inferior mesenteric pedicle". it consists of a segment of colon that measures 52 cm in length and up to 5.5 cm in diameter. a portion of mesentery is attached to the colon that measures 46.5 x 5.5 x 3.6 cm. the surgeon has designated two stitches as the splenic flexure, one stitch as the rectosigmoid, and a long stitch designating the inferior mesenteric pedicle. the mesentery is unremarkable. the serosa of the bowel is smooth and unremarkable. a palpable mass is present within the bowel. the serosa overlying the mass is inked black. the specimen is opened along the antimesenteric surface to reveal a fungating ulcerated mass within the lumen that measures 4 x 3 cm. this mass is located 21 cm from the splenic flexure surgical margin, 32 cm from the rectosigmoid surgical margin, and 6.5 cm from the cut mesenteric margin. serial slices show that the tumor does appear to invade the muscularis propria and mesentery and is 1.5 cm deep. no perforation is present. there is a tan mucosal polyp measuring 0.5 x 0.3 x 0.2 cm, located 19 cm from the rectosigmoid surgical margin. additionally, multiple diverticula are present throughout the colon. two diverticula with hypertrophical bowel wall adjacent to them are located 15 cm from the splenic flexure margin. the remainder of the mucosa is tan and unremarkable. within the mesentery, lymph nodes are identified. the specimen is represented as follows: a = the polyp which has been shaved from the mucosal surface, b-e = representative sections of tumor (full thickness), with b and d containing the deepest point of invasion, f = diverticula located 15 cm from the splenic flexure surgical margin, g = two additional representative diverticula, h = unremarkable bowel wall, i = possible lymph nodes at the inferior mesenteric pedicle, j = surgical margin at the splenic flexure, k = surgical margin at the rectosigmoid, l-t = lymph nodes. part 2 is additionally labeled "inferior mesenteric artery node." it consists of a lymph node and attached peri lymph node fat measuring 1.5 x 0.5 x 0.3 cm. the lymph node is bisected and entirely submitted in cassette u, along with the perilymph node fat. ct abd/pelvis: impression: 1. free air is seen in a reasonable amount five days after surgery. 2. free peritoneal fluid is observed. while the largest pocket is located in proximity to the anastomotic site; the absence of air in this fluid and the fact that the fluid is low in density make a leak less likely, although this cannot be entirely excluded. ct abd/pelvis impression: 1. no findings to suggest anastomotic leak. however, oral contrast has not yet progressed to the colon, limiting evaluation. if further evaluation is required, a delayed study of the pelvis only could be performed. 2. small amount of ascites, stable since the prior study. 3. stable size of bilateral moderate-sized pleural effusions. 4. diffuse anasarca. bilat le ultrasound impression: non-occlusive thrombus in the right common femoral vein entering from the right greater saphenous vein. flow is visualized throughout the left lower extremity. kub impression: in comparison to yesterday's abdominal x-ray, some passage of contrast. there are also dilated loops of bowel representative of an ileus. 06:20am blood wbc-11.1* rbc-3.36* hgb-10.1* hct-30.0* mcv-89 mch-30.1 mchc-33.6 rdw-16.7* plt ct-269 01:40pm blood pt-16.7* inr(pt)-1.5* 06:20am blood glucose-112* urean-14 creat-0.8 na-140 k-4.0 cl-105 hco3-30 angap-9 brief hospital course: pcp: /han office, ( micu course: 88m transfer from osh with history of atrial fibrillation admitted with lower gi bleed requiring multiple blood transfusions, found to have sigmoid mass concerning for adenocarcinoma and new diagnosis severe as. . # lower gi bleed - hemorrhagic mass seen at osh on colonoscopy, not actively bleeding that appeared consistent with adenocarcinoma (biopsies pending....). received multiple transfusions at the osh. while in the micu, me was transfused as needed to maintain a hematocrit goal of 25 (given concerns for heart stress related to his aortic stenosis). surgery and cardiology were consulted, and the patient was sent for valvuloplasty in order to prepare him for colon resection . # as - presumed new diagnosis, critical. his as was felt to be too severe to make him a good candidate for surgery, so the decision was made for valvuloplasty followed by resection. he was asymptomatic while in the micu under careful observation. . # atrial fibrillation - currently in atrial fibrillation on ekg. his coumadin was held given concerns for gi bleeding, inr 1.4 on admission. his rate was well controlled throughout admission and he was monitored on telemetry. . # h/o chf - patient exhibited no signs of volume overload while admitted to the micu. his ace-i and metoprolol were held given gi bleed. # hypocalcemia - ionized ca 0.66 on admission, likely due to multiple transfusions at the outside hospital. he received calcium gluconate 4g with subsequent improvement. his levels were closely monitored throughout admission, and were repleted as necessary. # arthritis - tylenol prn pain, remained stable throughout admission. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ mr. care was transferred to the acute care team on when he was taken urgently to the or for left hemicolectomy with primary anastomosis; biopsies were obtained of the mass in his sigmoid. postoperatively he was returned to intubated, paralyzed, and on neo drip which was able to be weaned off. he was extubated and noted with low uop < 20 and was given a 500 cc bolus. he was also noted with tachycardia and was given extra metoprolol. cardiology was consulted who recommended diuresis and continuing beta blockade. once stabilized he was transferred to the regular floor. once on the floor bowel function was very slow to return. over the course of several days he was slowly advanced from sips to clears and then to a regular diet. on he was noted with episode of unresponsiveness and hypotension; there was concern for anastomosis leak. a ct scan of his abdomen and pelvis was done and no leak was identified. he subsequently was noted with several more trigger events over the course of 3 days with hypotension, tachycardia and desaturation. he required intermittent iv fluid bolus' with normal saline for which he adequately responded. following the 3rd trigger event there was concern again for anastomosis leak and he underwent ct imaging of his abdomen which did not show any leaking; it did however show a possible stricture at the anastomosis. a kub with contrast was ordered to determine if the contrast went all the way through this area results revealed some passage of contrast and dilated loops of bowel representative of an ileus. on he was noted with a plt drop down to 53 - his admission plts were 123. his subcutaneous heparin was stopped and a hit panel was sent which came back positive. argatroban was started and adjusted per his ptt. cardiology was re-consulted and his lasix was recommended to be stopped while continuing his beta blockade. he was also given additional 250 ml ns fluid bolus following his lasix being stopped. cardioversion was also being recommended but at the time was being deferred as an outpatient. his coumadin was also recommended to be started with parameters for adjusting and eventually stopping the argatroban. the argatroban drip was eventually stopped and he was given 5mg coumadin; initial dose on for several doses, his inr was 1.5 on . goal inr . he was noted with hematuria on requiring that a foley be replaced for irrigation and monitoring purposes - this did resolve; his hematocrit remained stable with 30 being the last value on . the foley was removed and he was able to void. his hypotensive episodes did resolve and there were no more trigger events. he was however noted with significant scrotal edema and his le edema had increased. cardiology was re-consulted and recommended lasix 40 mg every other day; they further noted that his albumin was likely contributing to his edema as well. heme/onc was consulted for follow up as an outpatient to discuss with patient if treatment options indicated. the necessary ct scans were already done prior as part of his workup and it was requested to send a cea as baseline. physical and occupational therapy evaluations concluded that he would require acute rehab after his hospital stay. the screening process was initiated by case management. medications on admission: medications (home): patient unable to remember but include coumadin and metoprolol. . medications (on transfer from osh): sodium chloride potassium chloride po prn calcium gluconate prn discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po daily (daily). 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 4. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 5. lasix 40 mg tablet sig: one (1) tablet po every other day. 6. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: dose daily based on inr goal of . discharge disposition: extended care facility: hospital - discharge diagnosis: 1. bleeding sigmoid adenocarcinoma 2. right common femoral dvt - non occlussive 3. uti 4. post op ileus 5. rapid atrial fibrillation 6. heparin induced thrombocytopenia 7. acute on chronic heart failure (left ventricular systolic function is mildly depressed lvef= 45-50 %) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admited to the hospital because of bleeding from your gastrointestinal tract requiring an operation. it was also noted during your operation that there was a mass concerning for cancer in your colon. the biopsy results did revela that it was a cancerous tumor which was discussed with you by dr. during your hospital stay. you will be followed as an outpatient with hematology/oncology after you are discharged from the hospital. it is also being recommended by dr. that you see a cardiac surgeon to discuss your aortic stenosis. you may resume your home medications as prescribed. you are being discharged on medications to treat the pain from your operation. these medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. you must refrain from such activities while taking these medications. please call your doctor or return to the emergency room if you have any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. activity: no heavy lifting of items pounds for 6 weeks. you may resume moderate exercise at your discretion, no abdominal exercises. wound care: you may shower, no tub baths or swimming. if there is clear drainage from your incisions, cover with clean, dry gauze. please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: follow up in weeks in acute care clinic. upon discharge please call for an appointment. follow up in the hematology/ clinic with & tel number (. your appointment is being scheduled for @ 9:30 a.m. location on . follow up with urology for the recent blood in your urine; call for an appointment to be seen in weeks. follow up with dr. , cardiac surgery in weeks for discussion surrounding possible surgery for your heart valve, please call ( for an appointment. follow up with your primary care doctor in weks for a general physical. you will need to call for an appointment. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters intraoperative cardiac pacemaker open and other left hemicolectomy large-to-large intestinal anastomosis percutaneous balloon valvuloplasty diagnoses: other iatrogenic hypotension hypocalcemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation hematoma complicating a procedure aortic valve disorders hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure paralytic ileus rheumatoid arthritis gross hematuria acute venous embolism and thrombosis of deep vessels of proximal lower extremity hemorrhage of gastrointestinal tract, unspecified acute on chronic systolic heart failure tachycardia, unspecified diverticulosis of colon (without mention of hemorrhage) heparin-induced thrombocytopenia (hit) malignant neoplasm of descending colon 

Answer: The patient is high likely exposed to