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: melena major surgical or invasive procedure: egd history of present illness: 44m w/ hx of hep b without known cirrhosis, smv thrombus on coumadin presents with hematemesis and melena. per the pt's wife, the pt had been having dark stools and fatigue for a few days. on the day of admission he felt dizzy in the morning and later began vomiting blood. he denied fevers, chills, previous abdominal pain, hx of ulcers or prior gi bleed. . in the ed the pt was found to be hypotension sbp as low as 65. he had a hct 32 down from 46 in . the pt was ng lavaged 1l without clearing of bright red blood. he was started on pantoprazole and octreotide gtts, transfused 5l ns, 1u prbc through the rapid infuser, 2u ffp, and 10g vitamin k. gi was consulted and the pt was intubated in anticipation of endoscopy. . on the floor the pt was intubated and sedated. his vs 96.6 155/96 110 23. he underwent immediate endoscopy showing multiple of esophageal varices, multiple fundal varices, clot by the fundal varices, but no active bleeding. no intervention was done at that time. the pt had a repeat hct of 28.4 and 1u prbc was transfused. . review of systems: pt intubated, unable to elicit. past medical history: sigmoid diverticulitis asthma hep b without hx of e/o cirrhosis smv thrombus on coumadin social history: no tobacco, no etoh. works as an it manager. family history: father: deceased 72yo -- lung cancer sister: + peri-menopausal blood clots per wife, multiple family members with death in the 40s-50s stroke per wife, possible family history of antithrombin 3 deficiency physical exam: admission pe: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, 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 discharge pe: vs: tc 100.8/tm 101.9 111/72 (95-126/55-72) 110 (72-110) 20 96 ra gen: alert and appropriate, pleasant gentleman, nad, interactive and answering questions. aao3 without asterixes heent: mmm, no anicteric sclerae neck: no jvp cv: rrr, s1, s2 no murmurs/rubs/gallops lungs: bibasilar inspiratory crackles, r>>l, improved from yesterday abdomen: distended, soft, nontender, bs+ extremities: 2+ pulses, no le edema neuro: aaox3, no asterisix on exam pertinent results: admission labs: 09:40pm blood wbc-11.0# rbc-3.84*# hgb-11.5*# hct-32.7*# mcv-85 mch-30.0 mchc-35.2* rdw-14.8 plt ct-195 12:32am blood wbc-7.0 rbc-3.19* hgb-9.4* hct-28.4* mcv-89 mch-29.4 mchc-33.0 rdw-14.7 plt ct-110* 04:28am blood wbc-6.8 rbc-3.31* hgb-10.1* hct-28.8* mcv-87 mch-30.3 mchc-34.9 rdw-14.7 plt ct-103* 10:17am blood wbc-7.5 rbc-3.76* hgb-11.4* hct-32.2* mcv-86 mch-30.4 mchc-35.6* rdw-15.3 plt ct-103* 04:35pm blood wbc-6.0 rbc-3.47* hgb-10.4* hct-30.8* mcv-89 mch-29.9 mchc-33.7 rdw-15.4 plt ct-105* 04:13am blood wbc-7.5 rbc-3.66* hgb-11.0* hct-32.6* mcv-89 mch-30.1 mchc-33.8 rdw-15.2 plt ct-87* 09:40pm blood glucose-137* urean-30* creat-0.8 na-145 k-3.6 cl-111* hco3-26 angap-12 12:32am blood glucose-133* urean-23* creat-0.6 na-148* k-4.0 cl-119* hco3-23 angap-10 04:28am blood glucose-112* urean-21* creat-0.7 na-150* k-4.1 cl-117* hco3-26 angap-11 10:18pm blood na-144 k-3.2* cl-111* 04:13am blood glucose-109* urean-20 creat-1.0 na-144 k-4.0 cl-111* hco3-27 angap-10 12:32am blood pt-14.3* ptt-27.0 inr(pt)-1.2* 04:28am blood pt-13.9* ptt-26.8 inr(pt)-1.2* 04:13am blood pt-14.4* ptt-37.1* inr(pt)-1.2* 09:40pm blood alt-22 ast-24 alkphos-49 totbili-1.1 04:28am blood alt-21 ast-29 ld(ldh)-204 alkphos-44 totbili-1.0 06:05am blood alt-17 ast-33 05:50am blood alt-17 ast-28 alkphos-51 totbili-2.3* 09:40pm blood calcium-8.8 phos-3.6 mg-2.1 12:32am blood calcium-6.9* phos-2.4* mg-1.8 04:28am blood albumin-3.4* calcium-7.0* phos-3.3 mg-1.9 04:28am blood afp-2.4 discharge labs: 05:50am blood wbc-8.9 rbc-3.44* hgb-10.2* hct-29.7* mcv-86 mch-29.7 mchc-34.4 rdw-14.4 plt ct-74* 05:00am blood wbc-7.3 rbc-3.57* hgb-10.7* hct-30.8* mcv-86 mch-29.9 mchc-34.7 rdw-14.2 plt ct-87* 06:25am blood wbc-6.6 rbc-3.61* hgb-10.8* hct-31.2* mcv-87 mch-30.0 mchc-34.7 rdw-14.1 plt ct-105* 06:15am blood wbc-5.7 rbc-3.43* hgb-10.2* hct-29.4* mcv-86 mch-29.6 mchc-34.5 rdw-14.0 plt ct-142* 06:05am blood wbc-5.9 rbc-3.38* hgb-10.1* hct-29.4* mcv-87 mch-30.0 mchc-34.5 rdw-14.6 plt ct-141* 07:20am blood wbc-6.0 rbc-3.25* hgb-9.6* hct-27.9* mcv-86 mch-29.6 mchc-34.4 rdw-14.7 plt ct-167 06:25am blood pt-13.3 inr(pt)-1.1 06:15am blood pt-13.6* inr(pt)-1.2* 06:05am blood pt-14.1* ptt-27.7 inr(pt)-1.2* 07:20am blood pt-14.3* inr(pt)-1.2* 05:00am blood glucose-115* urean-16 creat-0.7 na-138 k-3.3 cl-101 hco3-27 angap-13 06:25am blood glucose-103* urean-13 creat-0.8 na-138 k-3.2* cl-101 hco3-28 angap-12 06:15am blood glucose-101* urean-9 creat-0.7 na-137 k-3.4 cl-102 hco3-26 angap-12 06:05am blood glucose-99 urean-12 creat-0.8 na-136 k-3.3 cl-102 hco3-25 angap-12 07:20am blood glucose-106* urean-8 creat-0.7 na-137 k-3.0* cl-103 hco3-25 angap-12 05:00am blood alt-39 ast-36 alkphos-121 totbili-2.7* 06:25am blood alt-45* ast-41* alkphos-138* totbili-3.3* 06:15am blood alt-63* ast-77* alkphos-175* totbili-2.9* 06:05am blood alt-104* ast-109* alkphos-227* totbili-2.1* 07:20am blood alt-135* ast-118* alkphos-292* totbili-1.8* 05:00am blood albumin-3.2* calcium-7.7* phos-1.4* mg-2.1 06:25am blood albumin-3.2* calcium-7.7* phos-2.1* mg-2.2 06:15am blood albumin-2.9* calcium-7.7* phos-2.6* mg-2.2 06:05am blood albumin-3.0* calcium-7.9* phos-3.4 mg-2.1 07:20am blood albumin-2.6* calcium-7.5* phos-3.3 mg-2.1 06:15am blood liver fibrosis panel-pnd 06:05am blood hepatitis delta antibody-pnd . egd 10/6 esophagus: protruding lesions 3 cords of grade iii varices were seen in the middle third of the esophagus and lower third of the esophagus. the varices were not bleeding. there was no stigmata of recent bleeding. stomach: mucosa: diffuse continuous granularity, friability, erythema and congestion of the mucosa with no bleeding were noted in the whole stomach. these findings are compatible with portal hypertensive gastropathy. protruding lesions protuding varices, with stigmata of recent bleeding were seen in the fundus. there was no active bleeding. the varices were not injected or banded given high risk location, lack of ongoing bleeding and need for further assessment of abdominal vasculature in order to determine appropriate further plan of care. duodenum: mucosa: diffuse continuous granularity, friability, erythema and congestion of the mucosa with contact bleeding were noted in the whole examined duodenum compatible with hypertensive duodenopathy. impression: varices at the middle third of the esophagus and lower third of the esophagus granularity, friability, erythema and congestion in the whole stomach compatible with portal hypertensive gastropathy varices at the fundus granularity, friability, erythema and congestion in the whole examined duodenum compatible with hypertensive duodenopathy otherwise normal egd to third part of the duodenum . mrv 1. significant cavernous transformation of the portal vein with collateralization of blood flow. in addition to a chronic superior mesenteric vein thrombosis, there are new splenorenal shunt and splenic vein thromboses, which appear to extend beyond the portion of demonstrated fibrin glue seen on chest radiograph. this may be indicative of bland thrombus developing on top of embolized fibrin glue. given patient's inability to breath-hold during exam, the abdominal vasculature is not fully evaluated; a ct abdomen and pelvis is recommended to further characterize the thromboembolic disease. 2. nonenhancing peripheral pulmonary parenchymal abnormality in right lower , be related to known fibrin pulmonary embolus, though pulmonary infarct or possibly superimposed infection cannot be excluded. consider chest cta to further evaluate. 3. moderate ascites. 4. stable splenic hemangioma. cta torso: impression: 1. pulmonary abnormality seen on mr, likely corresponds to fibrin glue. 2. persistent portal vein, superior mesenteric vein, and splenic vein thromboses with large thrombosed left upper quadrant varices and cavernous transformation of the portal vein. brief hospital course: 44m with hx hbv without e/o cirrhosis, smv thrombus on coumadin, inr of 1.2 p/w hematemesis and melena. . # ugib: the pt presented with hematemeis and melena xseveral days, found to be hypotensive with hct decrease from 46-->32-->28 despite 1u prbc. gi performed endoscopy demonstrating multiple esophageal and gastric varices, clot, but no active bleed. no intervention was done at the time. unclear the etiology of these varices, however concerning for mesenteric thromboses. active type and screen maintained. patient received 2u ffp, vitamin k 10mg, and transfused a total of 3prbc. continued on ppi and octreotide gtt. patient adminstered ctx 1gm qd x5days. patient underwent banding and fibrin glue administeration with stabilization of bleed. after the procedure, the patient was stable and did not rebleed. he was transferred to the floor were his crits and vital signs all remained stable. the patient was started on nadolol, sucralfate, and omeprazole. . # hep b liver disease: the patient is a chronic, inactive hep b carrier. he has no known history of cirrhosis. it is likely that his varices are not due to any cirrhosis, but rather from portal hypertension to his thrombi. a hep b viral load was not significantly increased from prior. however, his lfts were continuing to increase during the admission, and there was still some concern about reactivation of his hep b. he underwent a liver biopsy, results are still pending. he also was instructed to get a repeat hep b viral load two weeks after discharge. . # glue emboli: the patient had a fibrin glue injection into his gastric varix and after the procedure he started to develop fevers. a chest xray was done and teh patient was found to have glue emboli throughout his lungs. initially it was thought that his fevers were due to the glue emboli. however, because the patient continued to spike, and also started complaining of a new productive cough, he was initially placed on levofloxacin for pneumonia coverage, which was then switched to vanc/cefepime to cover for hap/vap. the patient continued to spike through these antibiotics, and on mrv/cta torso, a rll infarct was visualized that was secondary to the fibrin glue emboli. it is likely that this infarcted area accounted for his fevers. the patient also had an oxygen requirement when he was first discharged from the unit; he was slowly weaned off the o2 and was satting well on ra. we did not discharge the patient on any antibiotics. . # smv thrombus: the pt has a hx of smv thrombus in , reportedly on coumadin since, however unclear who is following inrs. pt presents with subtherapeutic inr. all anticoagulation was stopped given his ugib. in order to better visualize his vasculature an mrv and then a cta torso were done. the patient was found to have persistent portal vein, superior mesenteric vein, and splenic vein thromboses with large thrombosed left upper quadrant varices and cavernous transformation of the portal vein. as per the patient's wife, there is a family history of antithrombin three deficiency; the patient has yet to be worked up for this. he was set up to see hematology as an outpatient. he was not discharged on any anticoagulation given his recent ugib. . # increasing lfts: on admission, the patient's lfts were normal, however, during the course of his admission, everything started trending up. because of this trend, the patient underwent a transjugular liver biopsy. the etiology of this trend is unclear; a hep b viral load was not significantly increased from priors. the patient was instructed to recheck his hbv viral load two weeks after discharge. a delta antibody and a fibrosis panel are still pending. the patient has follow up in the liver clinic. . # asthma: the patient was given albuterol prn . transitional issues: . # outpatient hypercoaguability workup: as per the patient's wife, he has a family history of antithrombin three deficiency. he was not discharged on anticoagulation given his recent gi bleed, but he has significant thrombi as per mrv and cta torso. in order to be tested for antithrombin deficiency, the patient needs to be off anticoagulation. he has outpatient follow up with hematology for further workup. . # fibrosis panel and hep delta ab: both of these tests are still pending. . # rll infarct/fevers: the patient was spiking fevers, most likely from an area of infarct in his rll. please follow up in clinic to make sure the patient is still not febrile. . # transjugular liver biopsy: the results of the biopsy are still pending. . # outpatient labs: the patient was instructed to get outpatient labs done, including inr, cbc, lytes, and a hep b viral load, and fax them to the liver center. medications on admission: coumadin 3 mg daily albuterol prn discharge medications: 1. outpatient lab work please draw cbc, lft, pt, ptt, inr on monday and fax results to dr. at ( 2. outpatient lab work please draw cbc, lft, pt, ptt, inr, and hbv viral load on monday and fax results to dr. at ( 3. outpatient lab work please draw cbc, lft, pt, ptt, inr on monday and fax results to dr. at ( 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain: please do not take more than 2 grams total daily ( milligrams). 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 6. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 7. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: upper gastrointestinal bleed hepatitis b history of superior mesenteric vein thrombus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you were vomiting blood; you were very unstable and you initally went to the intensive care unit. while you were there, they did an upper endoscopy and we found that you had bleeding blood vessels in your esophagus and stomach. two of these in the esophagus were banded to stop the bleeding, and the one in the stomach was injected with glue to stop the bleeding. . after the procedure, you did not have any recurrence of bleeding. however, we think that some of the glue that was injected got into your lungs, and caused a small portion of your lung to have decreased blood flow. because of this decreased blood flow, some of your lung cells died. we think that this is why you have been having fevers since the procedure. we initially thought that you had a pneumonia, and gave you antibiotics. however, your fevers have persisted through the antibiotics, which is why we think that the fevers are related to the lung infarct instead. these fevers should gradually resolve on their own; it is important that you follow up with your primary care doctor. . you liver enzymes were also increasing while you were in the hospital. because of this, we also did a liver biopsy to find out what is going on inside of your liver. these results are still not back yet and it is very important that you follow up with the liver center and with your primary care doctor, dr. . . we also did another two imaging tests so we could take a better look at your blood vessels; many of your blood vessels in your abdomen have blood clots. we are not sure why you have these blood clots. we have an appointment for you to see the hematologits (the blood doctors) as an outpatient so they can do a work up for some family conditions that may increase your risks of blood clots. . we made the following changes to your medications: stop coumadin (until you talk to the hematologist) start nadolol 20 mg by mouth daily start sucralfate 1 gram by mouth four times per day start omeprazole 40 mg by mouth twice daily if you are experiencing any shortness of breath, chest pain, trouble breathing, vomit blood, have black stools, notice blood in your stool, develop any fevers/chills or just feel unwell; please call your doctor and go to the er. followup instructions: name: , address: ,ste 8a, , phone: appt: friday, at 10:15am . department: hematology/oncology when: friday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage . department: liver center when: wednesday at 4:20 pm with: , md building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine insertion of endotracheal tube closed (percutaneous) [needle] biopsy of liver endoscopic control of gastric or duodenal bleeding endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: acute posthemorrhagic anemia portal hypertension asthma, unspecified type, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants iatrogenic pulmonary embolism and infarction personal history of venous thrombosis and embolism hemorrhage of gastrointestinal tract, unspecified hypovolemia varices of other sites esophageal varices in diseases classified elsewhere, without mention of bleeding accidents occurring in residential institution chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta physical restraints status 

Answer: The patient is high likely exposed to