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: 1. aspiration pneumonia required intubation 2. cbd injury status post open cholecystectomy major surgical or invasive procedure: : ercp . : successful placement of 8 french external amplatz anchor drain into the distal right hepatic duct with external drainage to the bag. history of present illness: 60m pmh stage 1 bladder cancer s/p radiation rx in , with two years of intermittent ruq pain 6 hours after fatty meals and presumed to be cholecystitis, with partial intermittent cystic duct obstruction confirmed by hida scan. he also had a ruq ultrasound that showed a contracted gallbladder with small stones and a thickened wall. he was scheduled for laparscopic cholecystectomy on , however after 30 minutes of attempting to strip dense adhesions between the gallbladder and the omentum, the procedure was converted to open. a challenging and lengthy dissection ensued, requiring extensive stripping of omental adhesions as well as adhesions between the gallbladder and liver bed. an accessory bile duct was identified and ligated, and clipped again later when it was noted to be leaking. a high ligation near the gallbladder neck was undertaken given the gallbladder neck was edematous and friable, and so it was also oversewn. on , transaminases were noted to be elevated with ast 148, alt 245, tbili 1.4, dbili 0.3. later that day, the patient underwent ercp which showed multiple filling defects in the cbd. a sphincterotomy was performed and several stones were extricated. cholangiogram did not demonstrate filling of the right and left hepatic ducts and subsequently there was extraluminal contrast outside of the cbd and intestine concern for bile leak. during the ercp the patient had an aspiration event, requiring intubation. given concern for possible bile duct injury, the patient was transferred to surgical icu. on presentation the patient was noted to be febrile to 101.9. past medical history: pmh: stage 1 bladder cancer treated in with radiation psh: open cholecystectomy social history: married, former smoker family history: diabetes, cva, htn, melanoma physical exam: on admission: vs: t 101.9, 96, 160/79, 21, 100% on cmv 550x16, peep 5, fio2 60% - general: intubated, sedated - heent: nc, at, ngt with bilious output; et tube in place - cv: rrr, no m/r/g, s1/s2 normal - resp: mechanical breath sounds clear to auscultation, no w/r/r - abdomen: soft, obese, right subcostal incision closed with staples that appears to be healthy (no erythema or discharge) though minimal bruising noted; jp drain with bilious fluid - extremities: warm and well-perfused on discharge: vs: 98.7, 75, 144/76, 12, 96% ra gen: nad cv: rrr, no m/r/g resp: ctab abd: right subcostal incision open to air with steri strips. rlq jp drain to bulb suction and site c/d/i. right flank with ir drain to gravity drainage, site c/d/i. extr: warm, no c/c/e pertinent results: 06:20am blood wbc-8.8 rbc-3.39* hgb-11.1* hct-32.9* mcv-97 mch-32.6* mchc-33.6 rdw-13.8 plt ct-202 06:45am blood glucose-119* urean-10 creat-0.6 na-148* k-3.3 cl-106 hco3-32 angap-13 06:45am blood alt-103* ast-70* alkphos-68 totbili-1.2 06:45am blood calcium-8.2* phos-3.1 mg-2.1 10:17 pm blood culture source: venipuncture #1. **final report ** blood culture, routine (final ): no growth. 3:47 am urine source: catheter. **final report ** urine culture (final ): no growth. abd cta: impression: 1. multifocal aspiration in the lower lungs. 2. post-cholecystectomy changes with drain and surrounding stranding without focal fluid collection to suggest biliary leak or hematoma; however the right hepatic artery is not well seen and interruption/occlusion cannot be excluded with slightly decreased right hepatic enhancement on the arterial phase imaging. ercp: impression: evidence of a previous sphincterotomy was noted in the major papilla. cannulation of the biliary duct was successful and deep with a balloon catheter using a free-hand technique. contrast medium was injected resulting in complete opacification of the distal common bile duct. filling of contrast was noted in the distal bile duct. wire could not be passed into the proximal bile duct. common hepatic duct and intrahepatics could not be opacified. this is concerning for complete bile duct transection. there was extravassation of bile consistent with a post operative bile leak. mrcp; impression: 1. examination is limited due to non-breathhold sequence acquisition and no dynamic imaging was performed secondary to same. 2. diffuse fatty deposition within the liver. 3. decompression of the right posterior intrahepatic bile ducts from the ptbd drain. there is, however, intrahepatic dilatation of the right anterior and left intrahepatic biliary tree. the common hepatic duct is not identified throughout its length. the distal common bile duct is nondilated. 4. preferential hyperenhancement noted of the left lobe of the liver which is transient and equilibrates on more delayed phase of imaging. findings most likely reflect the findings on prior cta from , where the right hepatic artery was not identified on that study. brief hospital course: the patient was transferred from osh and admitted to the general surgical service for evaluation. he was admitted in sicu intubated s/t aspiration pneumonia and started empirically on unasyn. on , the patient underwent abdominal cta, which demonstrated post-cholecystectomy changes with drain and surrounding stranding without focal fluid collection to suggest biliary leak or hematoma; the right hepatic artery is not well seen and interruption/occlusion was suspected. on the patient underwent ercp which was concerning for complete bile duct transection with surgical clip. at the same day, patient underwent ptbd drain placement into right posterior intrahepatic bile ducts for decompression. after procedure patient was extubated and kept in sicu for observation, the patient's lfts were stable. on patient underwent mrcp, during which common hepatic duct was not identified throughout its length. the mrcp was limited secondary to non-breathhold sequence acquisition and claustrophobia. on , patient was hemodynamically stable, his respiratory status improved and he was transferred on the floor tolerating clears iv fluids and antibiotics, with a foley catheter, and dilaudid pca for pain control. the patient was hemodynamically stable. neuro: the patient received dilaudid pca on the floor with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. cv: the patient was found to have mild hypertension and was started on metoprolol with good effect. the patient was discharged home on po lopressor 25 mg with instruction to follow up with pcp within next 1-2 weeks. pulmonary: the patient was treated empirically with iv unasyn for possible aspiration pneumonia. on hd # 2, patient was extubated and his supplemental o2 was weaned off on hd # 7. the patient's pulmonary function was continued to improve; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi/gu/fen: on admission, patient's jp drain output was positive for bile leak. ptbd catheter was placed on hd # 2 and has an average daily output around 500-600 cc. the patient's electrolytes were checked daily and repleted when necessary. diet was advanced when appropriate, which was well tolerated. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. the patient's lfts were stable and he was discharged home on regular low fat diet. id: the patient's white blood count and fever curves were closely watched for signs of infection. blood and urine cultures were negative. the patient was treated with unasyn x 7 days for possible aspirational pneumonia. he was discharged home on po ciprofloxacin for empirical treatment of possible cholangitis. endocrine: the patient doesn't have a history of diabetes, however his serum glucose was slightly elevated during hospitalization. the patient advised to follow up with his pcp for additional work up of possible borderline diabetes. hematology: the patient's complete blood count was examined routinely; no transfusions were required. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: asa81, vicodin discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 2. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*80 tablet(s)* refills:*0* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 weeks. disp:*42 tablet(s)* refills:*0* 5. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day for 2 weeks. disp:*14 tablet, er particles/crystals(s)* refills:*0* 6. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). discharge disposition: home with service facility: discharge diagnosis: 1. transection of common hepatic duct with surgical clip . biliary leak s/p open cholecystectomy 3. aspiration pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. . incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. . ptbd care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *if the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. be sure to empty the drain frequently. record the output, if instructed to do so. *wash the area gently with warm, soapy water or 1/2 strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. change daily and as needed. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *you may shower; wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. followup instructions: department: surgical specialties when: friday at 1:15 pm with: , md building: sc clinical ctr campus: east best parking: garage . please follow up with dr. (pcp) in weeks to discuss you blood pressure medication and possible borderline diabetes. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube other percutaneous procedures on biliary tract endoscopic retrograde cholangiopancreatography [ercp] diagnoses: unspecified essential hypertension personal history of tobacco use peritoneal adhesions (postoperative) (postinfection) other acquired absence of organ other isolated or specific phobias personal history of malignant neoplasm of bladder hyperosmolality and/or hypernatremia accidents occurring in residential institution cholangitis obstruction of bile duct personal history of irradiation, presenting hazards to health pain in joint, shoulder region nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] family history of diabetes mellitus other specified misadventures during medical care family history of other cardiovascular diseases acute respiratory failure following trauma and surgery injury to other intra-abdominal organs without mention of open wound into cavity, bile duct and gallbladder injury to hepatic artery perforation of bile duct postprocedural aspiration pneumonia 

Answer: The patient is high likely exposed to