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: penicillins / codeine attending: chief complaint: tarry black stools major surgical or invasive procedure: egd tips history of present illness: 46 year old woman with etoh/hcv cirrhosis who was recently admitted on with coffee ground emesis and black colored stools. . today the patient called her pcp and reported 3 episodes of jet black diarrhea, which was similar to her prior episode of ugib. she denied hematemesis, but reported diffuse abdominal pain and poor po intake all weekend. the patient denies the use of nsaids, anti-coagulants, iron supplementation or pepto bismol. she has no known history of bleeding disorders. of note since her last discharge she was having loose, brown watery stools. due to her chronic diarrhea, she is always orthostatic. . in the ed the patient's vitals were as follows t 98.3 hr 86, bp 92/66 (bp tends to run chronically low) rr 20 o2sat 96% ra. her stool was grossly guaiac positive. she received 4l of ivf. her hct was 41 (thought to be hemoconcentrated as her entire cell line was up from baseline). she was seen by gi and transferred to the unit for an egd and overnight monitoring. . during her last admission, she required 9u prbcs and aggressive ivf resuscitation. an egd was performed on which showed grade i varices at the lower third of the esophagus, grade 1 esophagitis in the gastroesophageal junction, portal gastropathy, duodenitis in the proximal bulb and large duodenal varix. past medical history: -heavy etoh abuse -hcv -elevated portal pressures with varices and portal gastropathy -chronic le neuropathy -diastolic chf -asthma -depression -osteopenia . psh: -ccy -tah for endometrial hyperplasia social history: lives with husband and 29 y.o son from a previous marriage. heavy etoh abuse in the past, last drink 3 months ago. had "dts" in during years of etoh abuse never admitted for withdrawal symptoms. tobacco 1 ppd x 30 years. no ivdu. family history: father died of mi in 80's. many alcoholics in family. one cousin with celiac sprue. physical exam: vitals: t97.7 hr 77 bp 100/36 r16 o2 99ra gen: caucasian female in nad lying on stretcher heent: mmm dry, poor dentition, oropharynx chest: cta b/l, no gmr cv: nl rate, s1s2, no gmr abd: soft, round, slightly protuberant, +bs, liver 2 finger breadth below costal margin extr: warm, no cce neuro: a & o x 3, strength 5/5 in upper and lower extremity skin: spider angiomata on upper torso pertinent results: labs on admission 11:30am blood wbc-8.3# rbc-4.69 hgb-14.0 hct-41.3 mcv-88 mch-29.7 mchc-33.8 rdw-15.6* plt ct-119*# 11:30am blood neuts-72.5* lymphs-19.9 monos-4.5 eos-2.3 baso-0.9 11:30am blood plt ct-119*# 11:30am blood pt-19.1* ptt-39.6* inr(pt)-1.8* 11:30am blood glucose-113* urean-13 creat-0.7 na-132* k-4.6 cl-96 hco3-24 angap-17 11:30am blood alt-19 ast-48* alkphos-93 amylase-23 totbili-4.1* 11:30am blood ctropnt-<0.01 04:18pm blood hgb-12.8 calchct-38 . tips impression: 1. successful placement of a transjugular intrahepatic portosystemic shunt using three 10-mm bare metallic wallstents extending from a right portal vein to the right hepatic vein. 2. slightly unusual hepatic venous anatomy identified with two separate right hepatic veins which were small in caliber. 3. gradient between the portal vein and ivc pre-tips placement was 13 mmhg. post- tips placement the gradient was 9 mmhg. . . . 05:30am blood wbc-4.6 rbc-3.24* hgb-10.2* hct-28.7* mcv-89 mch-31.5 mchc-35.6* rdw-15.7* plt ct-59* 12:01am blood hct-27.6* 06:22pm blood hct-29.6* 03:03am blood wbc-7.3 rbc-3.37* hgb-10.2* hct-30.2* mcv-90 mch-30.3 mchc-33.9 rdw-15.6* plt ct-77* 11:39pm blood hct-31.5* brief hospital course: 46 f with history of alcohol/hep c cirrhosis, portal hypertension who was recently admitted with an ugib found to have a grade i varices, represents today with black tarry stools similar to her prior presentation. . ddx includes from most likely to least likely bleeding varices (given prior egd), pud, avms, dieulafoy lesion, m-w tears (unlikely given no hx of retching) . 1) upper gi bleed: an egd was performed on hd#1 but was aborted due to the fact that the patient had consumed a while in the ed and was vomiting during the procedure. the patient was aggressively suctioned, but there is a possibility that she may have aspirated. serial hcts were done and remained >30. the patient remained hd stable. she was kept on levo, octreotide and iv ppi. she had a 16 and 18 gauge iv. . an egd was performed the following day with showed a duodenal varix. due to the patient's hx of ugib and the nature of the varix, tips was performed on the same day. there were no complications. doppler u/s was performed the following day which showed the following: . patent tips with flow rates ranging from 84 to 151 cm/sec. patent and appropriate directional flow in the portal vein, hepatic vein, hepatic artery. . she was transferred to the general medical wards following her procedure on , with hct (31->29-27->28). on the morning of discharge, pt was frustrated, and stated that she wanted to leave ama. she was ultimately seen by interventional radiology, who inspected the site of her tips procedure, and by the gi service. she was discharged home with instructions to check her hct and follow-up with her pcp and the gi service within weeks. . . 2) transient episode of hypoxia - during the egd, she vomited up gastric contents and had a transient episode of hypoxia. her o2sats fell to the high 80s. she was placed temporarily on 2l nc and her sats improved to the high 90s. throughout her course the patient had transient desats to high 80s. she reported being asymptomatic. repeat cxr showed moderate right pleural effusion and a small left pleural effusion. consolidation was also present at the bases c/w atelectasis or aspiration. repeat cxr on showed "moderate bilateral pleural effusions and pulmonary vascular congestion, which developed between and have decreased substantially, there is no interstitial edema, and consolidation in the left lower lobe, probably atelectasis has improved." she was discharged home without further treatment, as she declined to go home with oxygen. . . 3) thrombocytopenia: on admission patient's plts were 119. this is around baseline. of note on last admission plts fell to 48k. this was attributed to octreotide and chronic hypersplenism. low platelets may also be a reflection of liver disease and low thrombopoietin. . 4) cirrhotic liver disease patient reports that she drank for over 30 years. she also has a history of hep c (vl 600-700,000 copies/ml detected.) her coagulopathy (inr 1.8) liver disease. . she is on nadolol, furosemide and spironolactone at home but this has been held in the setting of her gib. elevated lfts to chronic liver disease. will monitor. she has no localizing abd pain on exam. . 6) neuropathy continue neurontin. . 7) hypothyroidism continue levoxyl. . 9.) fen: npo for egd, following procedure gluten free diet given celiac disease. hyponatremia prob to poor po intake. . 10.) prophy: on ppi, pneumoboots, no sc heparin given gib and inr>1.8 . 11.) code status: full code . pt was discharged home on , with stable hct (28's). she continued to require o2 to maintain o2 sats in the 90s, however she refused to take home o2, and denied any symptoms of sob with o2 sats in the 80s on ra. she was instructed to follow-up with the gi service and her primary care physician 2-4 weeks, and specifically to have her hematocrit checked before following up with her pcp. medications on admission: levothyroxine 50 mcg neurontin 900 protonix 40 nadolol 20 lasix 40 albuterol atrovent niacin 250 trental 400 tid kcl 80 meq pyridoxine spirinolactone 25 thiamine discharge medications: 1. gabapentin 400 mg capsule sig: two (2) capsule po q8h (every 8 hours). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 4. phytonadione 5 mg tablet sig: two (2) tablet po once (once) for 1 doses. 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. niacin 250 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). 7. levofloxacin 500 mg tablet sig: one (1) tablet po once a day: for sbp prophylaxis. . :*30 tablet(s)* refills:*2* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. :*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. trental 400 mg tablet sustained release sig: one (1) tablet sustained release po three times a day. 10. pyridoxine 25 mg tablet sig: one (1) tablet po qd prn: take as needed for nausea. . discharge disposition: home discharge diagnosis: gi bleeding from duodenal varices secondary to portal hypertension. discharge condition: stable. discharge instructions: please continue to take all of your medications as prescribed. if you experience any worsening symptoms such as vomitting blood, dark tarry stools, light-headedness, chest pain, shortness of breath, abdominal pain or distension, please contact your primary care provider or the emergency department. followup instructions: please follow-up with your primary care provider weeks. please also follow-up with your dr. , please have your cbc drawn prior to seeing dr. . procedure: other endoscopy of small intestine injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol alcoholic cirrhosis of liver portal hypertension unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma asthma, unspecified type, unspecified depressive disorder, not elsewhere classified pulmonary collapse mononeuritis of lower limb, unspecified blood in stool celiac disease varices of other sites other specified disorders of stomach and duodenum surgical or other procedure not carried out because of contraindication diastolic heart failure, unspecified other and unspecified alcohol dependence, unspecified disorder of bone and cartilage, unspecified esophageal varices without mention of bleeding 

Answer: The patient is high likely exposed to