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 / indocin / flexeril / amoxicillin / darvocet a500 attending: chief complaint: abdominal pain, weight loss major surgical or invasive procedure: egd with biopsy laparoscopic cholecystectomy history of present illness: 89 yo f with h/o cholangitis (), gerd, constipation who presented to hospital after vna found her at home with low bp, decreased po intake and generally not feeling well. she reports that over the last few months, she has experienced anoreixa and a feeling of early satiety after just a few mouthfuls of food and she reports 50lb wt loss over several years. over the last few days, she has had abdominal pain, particularly in the epigastric area. no fevers, chills. she describes the pain as achy and notes that it radiates to the back. she had also had some vomiting last week. upon presentation to hospital, she had a ruq u/s which revealed pneumobilia and she had mildly elevated lfts. she was given levofloxacin and metronidazole for ? cholangitis and she was transferred for consideration of ercp. past medical history: gerd constipation hypothyroidism hyperlipidemia htn hypothyroidism back pain oa traumatic sdh seizure disorder glaucoma h/o r total hip replacement h/o c-section dementia social history: she lives with her son on , states that she is divorced. no alcohol or tobacco. used to work doing stitching. family history: mother had problem with "dilated stomach" physical exam: t 97 p 60 bp 150/60 rr 18 o2sat 100% ra general: pleasant, non-toxic, mentating clearly eyes: nc/at, perrl, eomi, no scleral icterus noted ears/nose/mouth/throat: mmm, no lesions noted in op, dentures neck: supple, respiratory: lungs cta bilaterally without r/r/w cardiovascular: reg s1s2, syst murmur at rusb gastrointestinal: soft, +bowel sounds, trochar incisions cdi genitourinary: no flank tenderness skin: no rashes or lesions noted. no pressure ulcer extremities: 1+ edema bilaterally, warm lymphatics/heme/immun: no cervical, supraclavicular lymphadenopathy noted. neurologic: -mental status: alert, oriented to place, person. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout. psychiatric: pleasant and interactive pertinent results: 08:52pm wbc-3.4* rbc-3.67* hgb-10.8* hct-33.6* mcv-91 mch-29.4# mchc-32.1 rdw-13.5 08:52pm neuts-60.8 lymphs-29.7 monos-7.0 eos-2.1 basos-0.4 08:52pm plt count-196 08:52pm glucose-66* urea n-40* creat-1.6* sodium-142 potassium-3.6 chloride-107 total co2-22 anion gap-17 08:52pm alt(sgpt)-43* ast(sgot)-54* alk phos-145* tot bili-1.0 08:52pm lipase-80* 08:52pm albumin-3.6 calcium-9.2 phosphate-3.6 magnesium-1.6 hospital abd ct and ruq us: (uploaded) distended gallbladder, pneumobilia, cbd 8mm, small gb stones/sludge . ................................ 06:35am blood wbc-3.4* rbc-3.28* hgb-10.2* hct-30.4* mcv-93 mch-31.0 mchc-33.4 rdw-14.0 plt ct-147* 06:50am blood wbc-2.9* rbc-3.18* hgb-10.0* hct-29.3* mcv-92 mch-31.4 mchc-34.1 rdw-14.0 plt ct-176 06:30am blood wbc-3.7* rbc-3.64* hgb-11.0* hct-33.3* mcv-92 mch-30.3 mchc-33.1 rdw-14.0 plt ct-168 08:52pm blood wbc-3.4* rbc-3.67* hgb-10.8* hct-33.6* mcv-91 mch-29.4# mchc-32.1 rdw-13.5 plt ct-196 08:52pm blood neuts-60.8 lymphs-29.7 monos-7.0 eos-2.1 baso-0.4 08:52pm blood neuts-60.8 lymphs-29.7 monos-7.0 eos-2.1 baso-0.4 06:35am blood plt ct-147* 06:50am blood plt ct-176 06:30am blood plt ct-168 06:35am blood glucose-143* urean-12 creat-1.1 na-140 k-3.0* cl-111* hco3-24 angap-8 06:50am blood glucose-153* urean-23* creat-1.3* na-141 k-3.3 cl-110* hco3-25 angap-9 06:30am blood glucose-53* urean-36* creat-1.6* na-143 k-3.5 cl-106 hco3-21* angap-20 08:52pm blood glucose-66* urean-40* creat-1.6* na-142 k-3.6 cl-107 hco3-22 angap-17 06:35am blood alt-27 ast-25 alkphos-123* totbili-0.5 06:50am blood alt-28 ast-30 alkphos-129* totbili-0.5 06:30am blood alt-41* ast-44* ck(cpk)-16* alkphos-145* totbili-0.9 08:52pm blood alt-43* ast-54* alkphos-145* totbili-1.0 06:50am blood lipase-55 06:30am blood lipase-66* 08:52pm blood lipase-80* 06:30am blood ck-mb-2 ctropnt-<0.01 06:30am blood caltibc-286 ferritn-74 trf-220 06:30am blood tsh-0.15* 06:50am blood free t4-1.2 01:43pm blood lactate-0.8 . mrcp : impression: 1. significant gallbladder wall distention with some focal intramural fluid noted within the wall. however, there is no diffuse gallbladder wall thickening or mucosal hyperenhancement. no evidence for gallstones or layering sludge within the gallbladder. 2. central intrahepatic and extrahepatic biliary dilatation with evidence for pneumobilia in keeping with ercp, but no evidence for choledocholithiasis or cholangitis. 3. multiple bilateral punctate hemorrhagic / proteinaceous and simple cysts noted in the kidneys as described. 3. atrophic uterus; however, the endometrial stripe thickness is distended measuring 8 mm. moderate amount of free fluid is also noted within the pelvis. this is incompletely evaluated on this mri and further evaluation with pelvic ultrasound is recommended. . egd : impression: normal mucosa in the esophagus atrophy in the stomach (biopsy) normal mucosa in the duodenum (biopsy) duodenal deformity recommendations: follow-up biopsy results final diagnoses are listed in the impression section above. estimated blood loss <5 cc follow up with gi consult team . gi biopsy:1. stomach, antrum, biopsy (a): mild chronic inactive gastritis. 2. duodenum, biopsy (b): duodenal mucosa, no diagnostic abnormalities recognized. ct chest: impression: 1. bilateral small pleural effusions. 2. subpleural fibrotic changes, which may be due to an interstitial lung disease process such as nsip. a dedicated hrct of the chest should be performed to further evaluate. enlarged lymph nodes in the mediastinum and hilum could be due to this interstitial lung disease pattern. 3. stable appearance to the upper abdomen; however, with mild increased fluid adjacent to the gallbladder. an ultrasound is recommended for further evaluation. 4. stable pneumobilia. 5. wedge shaped area of enhancement within the right hepatic lobe without significant associated biliary dilatation. this could represent cholangitis versus possibly a perfusion abnormality. clinically correlate. enlarged periportal lymph nodes. findings would best be evaluated on mri or a multiphasic ct. 5. stable renal cysts. us of ruq impression: mild gallbladder wall thickening, small amount of pericholecystic fluid, and layering sludge without son sign. these findings are inconclusive, acute cholecystitis cannot be excluded. hida scan is recommended. hida scan: impression: 1. no evidence of acute cholecystitis 2. filling of the gallbladder was initially equivocal, prompting morphine administration which assisted in confirming gallbladder filling, though precludes evaluation of gallbladder ejection fraction. ct head: impression: no acute intracranial findings. sensitivity for acute hemorrhage is somewhat limited by the contrast-enhanced study. atrophy and small vessel microvascular changes. brief hospital course: pt is an 89 y.o female with h.o gerd, cholangitis, hypothyroidism, constipation, htn, hl, seizure disorder who was transferred from osh for evaluation of abdominal pain, nausea, weight loss. . #acute pancreatitis-unclear etiology. pt with h.o cholangitis in the past. imaging at osh per report showed "distended gb, pneumobilia, cbd 8mm, small cb stones/sludge". there was consideration of gallstone pancreatitis and pt was transferred for ercp. however, ercp team did not feel that an ercp was indicated as pt did not have an elevated bilirubin or signficant transaminitis. no fever or leukocytosis suggestive of cholangitis. pt was initially given bowel rest and iv fluids. general gi was consulted, see below. mrcp was performed that was not suggestive of bile duct stones. pt underwent ct of the chest and head as screening for malignancy and was found to have the findings above including ? of fluid around the gallbladder prompting recommendation for u/s of the rt. upper quadrant (avove) prompting recommendation for hida scan (above). ultimately, it was felt clinically that the pt. did not have evidence of acute cholecystitis or cholangitis, and diet was advanced and pt. was prescribed an empiric course of 10 days of antibiotics as she had initially been on them and appeared clinically well so it was felt prudent to complete the initially indended course of antibiotics. ultimately, gi team recommended consideration of elective cholecystectomy as an outpatient, however, the pt. and her son asked if surgery would re-evaluate for the appropriateness of performing this while pt is hospitalized (this hospitalization), so surgery team was asked to re-evaluate. on hd 8 it was decided to proceed with elective laparoscopic cholecystectomy. the procedure was uncomplicated but the paitent was hypoxic and unresponsive in the pacu postoperatively. she was reintubated and was briefly on pressors on pod 0-1. she stabalized on the evening of pod 1 and was able to be extubated. she did not require any further pressors. her diet was advanced and she was prepared for dischage to a rehabilitaion center on pod 2. #abdominal pain- pt with history of anorexia, nausea, weight loss, abdominal pain. etiology has been unclear, but it appears that patient has undergone a significant work up in the outpatient setting with ct scan, mri, egd, colonoscopy. the common factor in all the imaging has been a distended gallbladder without evidence for acute cholecystitis or cholelithiasis. pt did have a mild lipase elevation and there was some consideration of gallstone induced pancreatitis. pt had pneumobilia on imaging, with last ercp , but no fever to suggest acute cholangitis. pt was initially given empiric cipro and flagyl,. and this was continued for empiric 10 day course as written above. gi was consulted who recommeded egd, which was performed and showed muld gastritis on biopsy (pts nsaid stopped, ppi continued), and a "duodenal abnormality"-unclear clinical signficance. mrcp also reconfirmed distended gallbladder this admission without overt evidence for mass or stones. in the end, it may be that markedly distended gallbladder is the cause of patient's symptoms and she should continue to consider ccy and follow up with surgery as an outpatient if the surgery team does not feel it is indicated to remove the gall bladder during this hospitalization... . #chronic constipation-unclear etiology in combination with weight loss is concerning. last colonoscopy with melanosis coli of the right colon. stools were ordered for guaiac and there was some quaiac positivity with brown stools - the hct remained stable, however, and the pt. remained hemodynamically stable without overt bleeding. the occult bleeding may be due to the gastritis, biopsies, or melanosis. outpatient repeat colonoscopy should be reconsidered if hct falling. repeat cbc check recommended via pcp office for one week from dischage (see below). #weight loss-unclear etiology. pt reports 50lb weight loss over last few years. +current anorexia; this is likely related to the abdominal issues above, however, ct of the head and chest were done to evaluate for malignancy and the results are above. tsh was found to be very low, but free t4 was appropriate. . . #anemia-normocytic. hct stable in mid 30's. stools guaiac positive as above, but pt. hemodynamically stable and hct stable without overt bleeding. nsaid stopped given gastritis on egd, and ppi continued. will need ongoing evaluation and monitoring as an outpatient via her primary md. . #hypothyroidism-continued home levothyroxine, tfts as above. . #htn, stable . #dementia-continued aricept . #seizure disorder-does not appear to be on any meds at baseline. this was confirmed by her outpatient neurologist. tsicu course - : admitted to tsicu (remains in pacu). attempted trial of cpap however pt with poor tidal volumes and inspiratory effort, therefore remained intubated overnight. phenylephrine started 4am for continued low bp despite albumin bolus. : ruled out for mi, extubated, echo optained revealing an ef 80%. her diet was advancved, her pain was controlled and she was screened for rehab. she will be discharged to rehab straight from the icu as there were no hospital beds on the regular surgical floor. medications on admission: levothyroxine 88mcg daily dorzolamide gtt sulindac 200mg fluoxetine 10mg daily furosemide 40mg daily senna daily atenolol 12.5 mg daily omeprazole 20mg aricept 10mg daily claritin 10mg daily fluticasone nasal spray discharge medications: 1. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 2. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day). 3. fluoxetine 10 mg capsule sig: one (1) capsule po daily (daily). 4. donepezil 10 mg tablet sig: one (1) tablet po hs (at bedtime). 5. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 6. senna 8.6 mg tablet sig: one (1) tablet po daily (daily). 7. claritin 10 mg tablet sig: one (1) tablet po once a day. 8. atenolol 25 mg tablet sig: tablet po once a day. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. capsule, delayed release(e.c.)(s) 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 11. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 5 days. disp:*15 tablet(s)* refills:*0* 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 13. oxycodone 5 mg capsule sig: one (1) capsule po every hours as needed for pain for 3 weeks. disp:*40 capsule(s)* refills:*0* discharge disposition: extended care facility: cape code nursing & rehabilitation center - discharge diagnosis: enlarged gallbladder nausea anorexia constipation abdominal pain acute renal failure weight loss occult gi bleeding (mild, stable hematorcrit, gastritis found on egd currently being treated with a ppi). . chronic .... htn hypothyroidism seizure disorder dementia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted for further evaluation of abdominal pain, nausea, an decreased appetite. for this, you were evaluated by surgery and by the gastroenterology team who performed an endoscopy that did not show ulcers, but did show an abnormality in your small intestine. a biopsy of this area revealed gastritis (inflammation) for which we have prescribed an acid - suppressing medication. in addition, you had an mri of your abdomen that showed a very enlarged gallbladder, but after multiple imaging tests, it does not appear to be infected. this may be what was causing your symptoms. your gallbladder was removed during this admission and you are now ready to go to rehabilitation. take all medications as prescribed. please follow up as instructed below. the abnormality in your small bowel, below your stomach, may be causing an intermittant partial obstruction to your bowels explaining why you feel full after small meals, and why you occasionally have pain and nausea. i have recommended that you eat frequent, small, meals in order to minimize these symptoms while maintaining adequate caloric intake. you were noted to have some blood in your bowel movements. this was not seen overtly, but was measured in a chemical test. this most likely is coming from the inflammation in you stomach mentioned above. you should stop taking sulindac which be causing this inflammation and bleeding. your blood counts have remained stable despite this, but you should have your cell stable within one week of leaving the hospital (see below). you should also have routine screening colonoscopy done as indicated if you have not done so already - this can be arranged through your primary md. . medication changes: stop sulindac; zofran as needed for nausea. 5 days of antibiotics as prescribed below (ciprofloxacin and metronidazole). . please take all of your medications as prescribed and follow up with the appointments below. followup instructions: please call your pcp . at and arrange follow up for within one week of discharge to discuss your hospitalization and to have your cell counts (cbc) checked, and to ensure appopriate follow up with screening colonoscopy if this is not currently up to date. dr. of gastroenterology (office phone: () will be calling you to arrange a follow up appointment here for ongoing discussion of your abdominal condition. if you have not heard from him in a week or so, call at the above number to confirm. please follow up with the clinic in weeks. please call dr. office for an appointment at ( md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours laparoscopic cholecystectomy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acidosis other iatrogenic hypotension anemia, unspecified esophageal reflux unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism depressive disorder, not elsewhere classified constipation, unspecified other and unspecified hyperlipidemia loss of weight epilepsy, unspecified, without mention of intractable epilepsy other ascites hypoxemia removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation hip joint replacement atrophic gastritis, without mention of hemorrhage other late effects of cerebrovascular disease, facial weakness other specified disorders of gallbladder body mass index between 19-24, adult 

Answer: The patient is high likely exposed to