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: topiramate / aripiprazole / shellfish / bee pollen attending: chief complaint: gib major surgical or invasive procedure: egd without intervention diagnostic/therapeutic paracentesis diagnostic/therapeutic paracentesis diagnostic paracentesis diagnostic/therapeutic paracentesis egd with dobhoff placement with sedation diagnostic/therapeutic paracentesis history of present illness: ms. is a 43f with a history of alcoholic cirrhosis s/p tips 6 weeks ago (gradient 17->10), active alcoholism, and recect ugib attributed to duodenal varix who was discharged after ir guided embolization of a sentinel bleed from a duodenal varix. during her most recent admission the pt was tachycardic, hypotensive and required multiple blood transfusions and underwent egd that showed only mild portal gastropathy and colonoscopy that showed a large volume of blood in the colon and grade 1 external/internal hemorrhoids. she subsequently underwent cta that showed duodenal varicies that were embolized. following this, patient was in her normal state of health until she started having brbpr as well as light-headedness and presented to osh where she had a crit of 18.8 blood of 279. she was also found to be hypotensive to as low as 80/44 but was said to be mentating well. she was given 1 unit of ffp, 1 unit of prbc's, started on an octreotide drip, and given 1 dose of 40mg iv pantoprazole and was transferred to for further evaluation and management. . in the ed, initial vs were: 98.9 118 84/55 12 100% ra she was noted to have brbpr on rectal exam as well as dark blood from her vagina, pelvic exam was significant for dark red blood from her cervical os, she was dosed with iv 2gram ceftriaxone, continued on her octreotide drip, and had blood from osh hanging. her crit was 22.3 (baseline mid 20's), plt ct of 44 (fluctuates between 40's and low 120's), lactate of 2.5, serum of 164, cr of 0.7. prior to transfer to the micu her bp was 98/54. on arrival to the micu, patient is alert and confirms the above history. she states that she had the sudden onset of brbpr along with the feeling of generalized weakness. she denies significant abdominal pain although described mild abdominal discomfort such as hunger cramps. no n/v/d, no hematemesis, states she has had a few recent falls related to her generalized weakness and perhaps her intake. she denies loc but did hit her nose on her coffee table and had a minor nose bleed. otherwise describes no blood in her urine but has had small amounts of dark blood from her vagina but states that she hasn??????t had an ordinary period in over a year. she denies fevers, chills, cp, sob, focal numbness, weakness, or tingling. past medical history: - alcoholic cirrhosis s/p tips - s/p cholecystectomy - gastroesophageal reflux disease - bipolar disorder - htn - depression/anxiety - recent burns to both hands (housefire) s/p skin grafting from r thigh social history: she lives with her husband and 2 children, ages 16 and 17. smokes 1 pack every few weeks. used to be an accountant. describes a few beers daily. denies other drug use. family history: non-contributory physical exam: admission physical exam: general: alert, oriented, no acute distress although appears uncomfortable heent: moderately icteric sclerae, dry mm, oropharynx clear, eomi, perrl, no sinus tenderness neck: supple, jvp not elevated, no lad cv: rapid rate and regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley with icteric urine ext: warm, well perfused, 2+ pulses, trace ble edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally . discharge physical exam: vs 97.6 (99.7) 117/74 (110-122/66-79) 113 (103-131) 20 97ra (97-99ra) i/o: po 1500 + tf 1075 / uop 1250 + bmx6 general: appears older than stated age, nad, comfortable in bed heent: sclera anicteric. perrl, eomi. neck: supple with low jvp cardiac: tachycardic, sem at rusb. +s4. lungs: unlabored breathing, poor air movement. decreased breath sounds at right lung base to halfway up lungfields, with bibasilar crackles. abdomen: less distended and slightly tighter. soft, non-tender. extremities: warm and well perfused, trace edema pertinent results: admission labs: 11:00am wbc-3.4* rbc-2.48* hgb-7.3* hct-22.3* mcv-90 mch-29.5 mchc-32.9 rdw-19.0* 11:00am neuts-83.5* bands-0 lymphs-7.9* monos-7.4 eos-0.7 basos-0.6 11:00am plt count-44* 11:00am glucose-167* urea n-26* creat-0.7 sodium-126* potassium-3.5 chloride-94* total co2-23 anion gap-13 11:00am alt(sgpt)-27 ast(sgot)-67* alk phos-112* tot bili-6.3* 11:00am albumin-2.2* calcium-6.9* phosphate-3.1 magnesium-1.3* 11:00am asa-neg ethanol-164* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:00am pt-18.7* ptt-36.8* inr(pt)-1.8* 11:00am fibrinoge-113* 07:02pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-mod urobilngn-2* ph-6.0 leuk-neg 07:02pm urine rbc-<1 wbc-14* bacteria-none yeast-none epi-1 11:15am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg . discharge labs: 05:45am blood wbc-10.5 rbc-2.56* hgb-7.8* hct-25.3* mcv-99* mch-30.3 mchc-30.7* rdw-21.9* plt ct-94* 05:45am blood pt-31.1* ptt-44.9* inr(pt)-3.0* 05:45am blood glucose-123* urean-15 creat-0.7 na-137 k-4.2 cl-104 hco3-25 angap-12 05:45am blood alt-10 ast-30 alkphos-95 totbili-3.7* 05:45am blood calcium-8.1* phos-1.9* mg-1.5* . microbiology: blood cultures x2: no growth urine culture: no growth urine culture: no growth blood cultures x2: no growth blood cultures x2: no growth stool c. diff pcr: positive stool bacterial culture: no growth peritoneal fluid gram stain and culture: no growth peritoneal fluid gram stain and culture: no growth blood culture: no growth urine culture: yeast urine culture: no growth blood cultures x2: no growth to date peritoneal fluid gram stain and culture: no growth peritoneal fluid gram stain and culture: no growth peritoneal fluid gram stain and culture: no growth . . imaging: ruq us findings: the liver is diffusely echogenic, consistent with chronic liver disease. there is a simple hepatic cyst in the left lobe measuring 2.5 cm. the spleen is enlarged measuring 15 cm. there is no ascites. color flow and pulse wave doppler: the tips shunt is widely patent with wall-to-wall flow throughout. the flow velocities in the proximal, mid and distal portion of the tips shunt are 55.1, 180, and 116 cm/sec respectively. these velocities previously were 133, 157 and 105 cm/sec respectively. the main portal vein has normal hepatopetal flow. there is stable, expected reversal of flow within the left portal vein. the right portal vein is patent. the hepatic veins are patent. impression: patent tips shunt with wall-to-wall flow throughout. . cxr: findings: endotracheal tube ends approximately 6.3 cm from the carina, just above the level of medial heads of the clavicles. consider advancing the et tube by another 2.5 cm for a better seating. bilateral lungs are remarkable for mild pulmonary vascular congestion, prominent bilateral hila and azygos vein which is likely from volume overload, given clinical setting. heart size is top normal. no pneumothorax or pleural effusion. . abd ct: ct abdomen: there are small bilateral pleural effusions with adjacent compressive atelectasis and lingular atelectasis. no pericardial effusion. an echogenic focus at the hepatic dome (2b:97) is incompletely imaged and apparently new from , too small to characterize. the liver is shrunken and nodular, compatible with known cirrhosis. a 2.1 cm hypodensity in the left hepatic lobe is a cyst seen on prior ultrasounds. a tips shunt is in place. the patency cannot be assessed on this study, but it is patent on ultrasound . the gallbladder is absent. the spleen is enlarged to 13.8 cm. the pancreas and bilateral adrenal glands are normal. the kidneys enhance symmetrically and excrete contrast promptly without hydronephrosis. a gastric diverticulum at the posterior stomach (2a:18) is unchanged. high-density material in the duodenum is likely related to coiling of duodenal varices, performed . the small bowel is normal in course and caliber without obstruction. there is large bowel wall thickening, predominantly in the right colon with a large amount of adjacent stranding, increased from . the findings are concerning for colitis, probably infectious or inflammatory, less likely ischemic given the distribution. there is a small amount of perihepatic fluid. there is no free air. the aorta is of normal caliber throughout. the main portal vein, splenic vein, and proximal smv are patent. extensive portosystemic shunts are again seen. the aorta is of normal caliber throughout. no pathologically enlarged mesenteric or retroperitoneal lymph nodes are identified. ct pelvis: the rectum and sigmoid colon are normal. the bladder is normal, with a foley catheter in place. the uterus is normal. a small amount of free fluid in the cul-de-sac is probably tracking down from the abdomen. there is no pelvic or inguinal lymphadenopathy. bone windows: no bone finding suspicious for infection or malignancy is seen. impression: 1. findings concerning for colitis, likely infectious or inflammatory, less likely ischemic given the distribution. 2. cirrhosis with stigmata of portal hypertension including ascites, extensive portosystemic collaterals. a tips shunt is in place. . egd findings: esophagus: protruding lesions 1 cords of grade i varices were seen in the lower third of the esophagus. stomach: mucosa: diffuse erythema and congestion of the mucosa were noted in the stomach. these findings are compatible with portal hypertensive gastropathy. other no active bleeding. duodenum: protruding lesions non bleeding varices were seen in the first part of the duodenum. impression: varices at the lower third of the esophagus no active bleeding. erythema and congestion in the stomach compatible with portal hypertensive gastropathy varices at the first part of the duodenum otherwise normal egd to second part of the duodenum recommendations: ppi octreotide drip keep hct above 25 duplex for tips patency if rebleeds, would get ir evaluation for tips pressure gradient measurement and angioplasty if elevated gradient . cxr pa/lat: pa and lateral chest radiographs demonstrate opacification of the left lower lobe with air bronchograms. the patient has been entubated. there is also bibasilar atelectasis. the heart size is mildly enlarged. prominence of the azygos vein and pulmonary vasculature is unchanged from . impression: likely left lower lobe pneumonia. . cxr portable: left picc terminates in the mid superior vena cava. the cardiac silhouette is enlarged and accompanied by increased vascular pedicle width, increased pulmonary vascular congestion, and bilateral perihilar haziness suggestive of edema. additionally, there persist opacities within the right middle and right lower lobes suggestive of atelectasis. previously reported left lower lobe opacities have slightly improved and could be due to either atelectasis or improving infection. . ekg: sinus rhythm. prominent qrs voltage but does not meet criteria for left ventricular hypertrophy. since the previous tracing of the rate is slower. otherwise, probably unchanged. . abdominal ultrasound ascites search: a limited examination of the four quadrants of the abdomen was performed. a moderate amount of ascites is seen and a mark was made at the right lower quadrant for a paracentesis to be performed by the clinical staff. impression: moderate ascites. the right lower quadrant was marked for a paracentesis to be performed by the clinical staff. . portable abdominal x-ray: a single supine frontal view of the abdomen demonstrates a non-specific bowel gas pattern with gas in non-dilated loops of small bowel and large bowel. a tips shunt is in place in the right upper quadrant of the abdomen. surgical clips adjacent to the tips shunt are consistent with prior cholecystectomy. evaluation for a small amount of free air is limited due to supine positioning; however, there is no evidence of a large amount of free intraperitoneal air. generalized increased opacification of the abdomen is consistent with ascites. no portal venous gas is appreciated. impression: non-specific bowel gas pattern without evidence of obstruction or ileus. no free air detected; however, a left lateral decubitus film, upright film or ct would be more sensitive for a small amount of free intraperitoneal air. . portable chest x-ray: single supine view was submitted for review, this limits the evaluation of free air. there are low lung volumes. cardiac size is top normal. left picc tip is in the mid svc. there is no pneumothorax. if any, there is a small right pleural effusion. bibasilar atelectases, larger on the right side. streaky atelectases are also present in the left upper lobe. there is mild vascular congestion. tips projects in the right upper quadrant. . ct abd/pelvis w/o contrast: 1. resolution of colonic wall thickening, which was compatible with colitis. 2. slight increase in ascites, however likely due to fluid overload given interval development of anasarca and increased stranding of the intra-abdominal fat. 3. no intra-abdominal abscess. 4. bibasilar atelectasis, wedge-shaped volume loss at right lung base may indicate a small infiltrate. 5. chronic findings including tips shunt (cannot assess patency due to lack of contrast), large gastric diverticulum, multiple secondary findings indication of cirrhosis and portal hypertension. . ir-guided diagnostic/therapeutic paracentesis: uneventful diagnostic and therapeutic ultrasound-guided paracentesis yielding 2.35 liters of yellow ascitic fluid. . portable abdominal x-ray: in comparison with the study of , there is again generalized haziness of the abdomen consistent with extensive peritoneal fluid. a tips shunt is in place. there is dilatation of gas-filled loops of small bowel that appear to be out of proportion to the large bowel gas. this raises the possibility of a partial or early small-bowel obstruction. if this is a serious clinical concern, ct would be the next imaging procedure. although there is no definite free intraperitoneal gas, though this also could be evaluated on ct. . ct abd w/o contrast: 1. cirrhotic liver with evidence of portal hypertension with splenomegaly, increased ascites, and extensive varices. 2. bilateral small pleural effusions with overlying atelectasis. 3. stable appearance of large gastric diverticulum. 4. stable left paraaortic lymph node. . ekg: sinus tachycardia. consider left ventricular hypertrophy by voltage. st-t wave abnormalities of strain and/or ischemia. since the previous tracing of the rate is faster. st-t wave abnormalities are more prominent. . ct head w/o contrast: no evidence of hemorrhage or infarction. prominent ventricles and sulci for age. . ekg: sinus tachycardia. since the previous tracing st segment depressions may be less prominent. t wave abnormalities persist. . ir-guided diagnostic/therapeutic paracentesis: ultrasound-guided therapeutic and diagnostic paracentesis with removal of 2 l of straw-colored fluid. . egd: a 10f nasojejunal feeding tube was placed in a standard fashion. the tube was subsequently bridled. no complication occured. the estimated blood loss was 2 cc. otherwise normal egd to third part of the duodenum. dobhoff is okay to use. . cxr pa/lat: persistent lower lung volume. mild cardiomegaly is accentuated by low lung volumes. pulmonary edema has improved, now mild. large right lower opacity is a combination of pleural effusion and atelectasis. this has improved from prior study. the lower lung atelectasis has improved. there is no pneumothorax or pleural effusion. left picc tip is in the upper-to-mid svc. ng tube is out of view below the diaphragm. of note, the opacity in the right lower lobe could be due to atelectasis but superimposed infection cannot be excluded in the appropriate clinic setting. . abdominal ultrasound: large amount of loculated ascites is seen in the abdomen. . ir-guided paracentesis: ultrasound-guided therapeutic and diagnostic paracentesis with removal of 3l of blood tinged ascitic fluid. . cxr (portable): left-sided picc line overlies mid/distal svc. an ng-type tube extends beneath the diaphragm beyond the inferior edge of the film, likely extending into the duodenum. cardiomediastinal prominence, right effusion, underlying right base collapse and/or consolidation, and diffuse increased vascular markings are grossly unchanged. . lle ultrasound with doppler: no dvt in the left lower extremity. brief hospital course: ms. is a 43 year old lady with a hx of alcoholic cirrhosis s/p tips 6 weeks prior to presentation, active alcoholism, and recent duodenal varix bleed s/p ir guided embolization, who was admitted with brbpr and relative hypotension, from a presumed upper gi bleed; she then developed c. diff colitis, healthcare associated pneumonia and sbp. hospital course was also complicated by hyponatremia, a fall without loss of consciousness, and tachycardia. . . active issues: # upper gi bleed: patient presented with hematochezia c/b hypotension: patient with prior history of gastrointestinal bleeding from varices s/p ir-guided embolization () and egd with injection of glue to duodenal varix in third part of duodenum () now presenting with brbpr and relative hypotension. hematocrit was 18 at osh and she received 2 units prbcs prior to transfer to . here she received two more units of prbcs. she was started on octreotide, pantoprazole and ceftriaxone. she underwent liver us which showed a patent tips. she then underwent egd without clear source of bleeding. for the rest of hospitalization, her hematocrit remained stable ~25. . # colitis: while in the micu, the patient had low grade fevers and reent history of gastrenteritis-like illness. she complained of severe abdominal pain, so a ct scan was obtained, showing possible colitis. her ceftriaxone was switched to ciprofloxacin and flagyl was also started for treatment of presumptive infectious colitis. soon after transfer to the floor, the patient developed severe diarrhea, with stool sample positive for c. diff. ciprofloxacin was discontinued. she was treated with vancomycin po and flagyl iv for the rest of her hospital course. even though the patient was counseled that opioids put her at risk for developing toxic megacolon and could lead to severe complications including death, she preferred receiving low-dose opioids for pain control; these were tapered off. on , she developed increasing abdominal distention with no bowel movements overnight; x-ray and ct imaging were negative for toxic megacolon. the patient's diarrhea and abdominal pain improved. stool studies for other infectious etiologies were negative. the patient will need to continue vancomycin for a 4-week-long tapered course. . # hcap: on arrival to the floor from the micu, patient was noted to have shortness of breath and chest discomfort, along with a leukocytosis. cxr revealed a left lower lobe pneumonia. she was treated with cefepime iv and vancomycin iv for healthcare associated pneumonia. dyspnea improved. . # spontaneous bacterial peritonitis: after transfer from micu to the floor, patient developed increasing leukocytosis along with worsening abdominal distention and pain. she underwent diagnostic paracentesis on that was consistent with sbp. she continued cefepime and flagyl iv, which had been started for her hcap and c. diff, respectively. when repeat diagnostic/therapeutic tap on showed worsening wbc count in ascitic fluid, there was concern for translocation of bacteria from the gut or from perforation. abdominal ct from did not show obvious perforation or free air and did show an improving colitis. she was transferred back to the micu for closer observation and management. in the micu, fluconazole for coverage of fungal infection of ascites was added to her antimicrobial regimen. transplant surgery was consulted who felt this was not a perforation, and did not need surgical intervention. patient was watched in icu until with improvement of her abdominal exam. she was then transferred back to the floor. she underwent three more paracenteses, which showed signs of improving infection with resolving ascitic leukocytosis. abdominal pain improved. . # hyponatremia: patient has a history of hyponatremia related to her cirrhosis. she presented with sodium of 126, which trended down and nadired at 120. on presentation, she also had low plasma osm of 254 and appeared to be total body fluid overloaded. she was place on fluid restriction, but did not want to adhere to a low sodium diet. with reinstitution of her diuretics and fluid restriction, sodium increased to the 130s and remained stable. . # : patient's cr trended up to peak at 4.5 during her hospital stay from 0.7 on admisison. etiology was prerenal azotemia, but there was also concern for hepatorenal syndrome. patient was aggressively volume resuscitated with albumin and her cr decreased to 0.7, where it stabilized. . # tachycardia: on the day prior to discharge, patient developed sinus tachycardia, along with a sensation of shortness of breath. the rest of her physical exam was significant for volume overload. cxr showed pulmonary edema. ekg was consistent with sinus tachycardia, and lle u/s showed no evidence of dvt. she was diuresed with iv lasix, and her tachycardia and dyspnea resolved. there was also a high component of anxiety in her symptoms. . . chronic issues: # alcoholic cirrhosis: patient with chronic cirrhosis secondary to alcohol ongoing alcohol abuse s/p tips with significant esophageal and duodenal varices. no prior hx of esophageal variceal bleed. meld at discharge was 21. she continued lactulose and rifaximin. she was counseled extensively regarding necessity of a relapse prevention to maintain and document sobriety after discharge in order to be considered a transplant candidate. while in house, a dobhoff was placed and tube feeds started for supplemental nutrition. . # active alcoholism: patient with level of 274 at osh. she was placed on ciwa scale though she did not require benzodiazepines during this admission. as above, she was counseled extensively regarding need to maintain sobriety for overall health and transplant consideration. . # uterine bleeding: patient with low volume dark blood from her cervical os per ed pelvic exam. per ed, patient is otherwise amenorrheic so they have raised concern for possible dic. since hospitalization no further bleeding from vagina. pelvic ultrasound should be considered for further evaluation as an outpatient. . . transitional issues: # patient should continue vancomycin po for four weeks, tapered as described. # commitment to a relapse prevention program, and documented sobriety for three months is necessary for patient to be considered a transplant candidate. this was discussed extensively with the patient, her husband, and her . # please consider pelvic ultrasound for further evaluation of uterine bleeding as an outpatient. # picc was left in place per request of rehab facility. pt is currently not on any iv medications. it should be removed as soon as possible to reduce risk of line infection. # pt has foley catheter in place currently. a voiding trial can be attempted as pt gains strength to use a bedside commode/bathroom. # code: full # hcp: husband medications on admission: - furosemide 60 mg po daily - lactulose 10 gram/15 ml - 30 ml po qid - rifaximin 550 mg po bid - folic acid 1 mg po daily - thiamine hcl 100 mg po daily - multivitamin po daily - spironolactone 150 mg po bid - omeprazole 40 mg po daily - lorazepam 0.5 mg po q8h prn anxiety discharge medications: 1. furosemide 20 mg tablet sig: three (3) tablet po once a day. 2. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po three times a day: titrate to bms per day. 3. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. multivitamin tablet sig: one (1) tablet po once a day. 7. spironolactone 50 mg tablet sig: three (3) tablet po once a day. 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for severe anxiety. 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). 11. vancomycin 125 mg capsule sig: one (1) capsule po see taper: -1 tab qid for 7 days () -1 tab for 7 days () -1 tab daily for 7 days () -1 tab every other day for 7 days () -1 tab every 3 days for 14 days (). disp:*62 capsule(s)* refills:*0* 12. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 13. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 14. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). discharge disposition: extended care facility: rehab unit at - discharge diagnosis: primary diagnosis: upper gi bleed . secondary diagnoses: healthcare associated pneumonia severe c. diff colitis spontaneous bacterial peritonitis cirrhosis 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: dear ms. , it was a pleasure to participate in your care here at . you were admitted with an upper gi bleed, which stablized. you then developed several infections, including a pneumonia, colitis and spontaneous bacterial peritonitis. all these infections were treated with appropriate antibiotics. you improved clinically and were then discharged to a rehab facility so that you can continue to regain your strength. please make the following changes to your medications: start vancomycin by mouth: 125 mg by mouth four times per day for 7 days () 125 mg by mouth twice daily for 7 days () 125 mg by mouth once daily for once 7 days (-/12) 125 mg by mouth every other day for 7 days () 125 mg by mouth every 3 days for 14 days () continue to take all of your other medications as prescribed. please see below for your follow-up appointments. followup instructions: department: liver center when: friday at 10:00 am with: building: lm campus: west best parking: garage department: liver center when: friday at 3:20 pm with: , md building: lm campus: west best parking: garage procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage insertion of (naso-)intestinal tube diagnoses: pneumonia, organism unspecified esophageal reflux alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia portal hypertension hypopotassemia other specified cardiac dysrhythmias intestinal infection due to clostridium difficile other ascites hemorrhage of gastrointestinal tract, unspecified other specified disorders of stomach and duodenum other and unspecified alcohol dependence, continuous jaundice, unspecified, not of newborn spontaneous bacterial peritonitis esophageal varices without mention of bleeding other fluid overload unspecified disorders of menstruation and other abnormal bleeding from female genital tract 

Answer: The patient is high likely exposed to