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: ruq pain major surgical or invasive procedure: central line placement ercp history of present illness: 44yo f w/ pmhx significant for etoh abuse, pancreatitis, known cholethiasis presented to the ed with 3 days of ruq pain. this ruq pain was not relieved with tylenol and motrin. the pain starts in the ruq and radiates to the midaxillary line or to her back. the pain has been so severe that she has not had an appetite and has not been able to sleep well. when she does eat, she has noticed that there are times when her abdominal pain is worse. she reports nausea and vomitting. she also reports weakness and chills, but denies fevers. she reports diarrhea over the past couple of days as well as dark stools but not melena. she denies hematochezia. she reports defuse itching that started today. . in the ed, initial vs were: t 97.0 p 98 bp 94/58 r 15 o2 sat 100% ra. the patient was started on unasyn 3mg iv times 1 and given morphine 2mg iv x3, and zofran 4mg iv. surgery also saw the patient while she was in the ed recommended that the patient have urgent ercp to relieve cbd obstruction and to have a cholecystectomy once her cholangitis resolves during this hospitalization. because of persisently low bps, the patient was bolused for a total of 5l of ns. despite volume resuscitation, the patient's sbp remained in the 80s. a lij was placed in the ed and placement confirmed with cxr. the patient was subsequently started on levophed at 0.03mcg/kg/min. of note, vancomycin was also started in the ed and prior to transfer she recieved 1mg iv dilaudid. . when the patient arrived to the unit, vs were: t 96.5 hr 119 bp 99/65 rr 19 o2 sat 97% ra. the patient is conversant and able to provide her history. levophed was set at 0.3mcg/kg/hr. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies constipation, . denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: past medical history: -asthma -h/o seizures past surgical history: -cesarian sectionx2 -s/p tonsillectomy social history: - tobacco: 4 cigarettes/day - alcohol: denies use for 2-3 years - illicits: denies. family history: no family history of biliary disease. mother with htn, asthma, and arthritis. physical exam: admitting physical exam: general: alert, oriented, no acute distress heent: sclera icteric. mmm. oropharynx without erythema or exudate. neck: supple. jvp not elevated. no lad. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardia +. normal s1 + s2. no murmurs, rubs, gallops. abdomen: normal, active bs+. soft, non-distended. no tenderness to palpation over ruq. no rebound tenderness or guarding. no organomegaly. no sign. gu: foley in place. skin: jaundiced appearance. ext: wwp. 2+ dps. no clubbing, cyanosis or pitting edema. pertinent results: admission labs: 11:05pm pt-15.6* ptt-27.5 inr(pt)-1.4* 11:05pm plt count-309 11:05pm neuts-89.5* lymphs-8.4* monos-1.3* eos-0.5 basos-0.3 11:05pm wbc-10.6 rbc-3.23* hgb-9.8* hct-27.9* mcv-86 mch-30.3 mchc-35.1* rdw-19.3* 11:05pm asa-neg acetmnphn-12 bnzodzpn-neg barbitrt-neg tricyclic-neg 11:05pm albumin-3.9 11:05pm lipase-153* 11:05pm alt(sgpt)-462* ast(sgot)-1703* alk phos-1489* tot bili-3.6* 11:05pm estgfr-using this 11:05pm glucose-151* urea n-23* creat-1.5* sodium-134 potassium-2.5* chloride-97 total co2-18* anion gap-22* 11:12pm lactate-2.1* 01:54am urine mucous-rare 01:54am urine granular-1* hyaline-5* cell-0 01:54am urine rbc-0 wbc-23* bacteria-few yeast-none epi-1 01:54am urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-tr 01:54am urine color-yellow appear-hazy sp -1.011 urine cultures negative x 2. cta abd w and w/o contrast: impression: decompressed biliary tree following placement of plastic stent. persistent pancreatic duct dilatation. ill-defined hypoenhancing area in the pancreatic head is nonspecific and may relate to an area of focal pancreatitis; however, a focal mass lesion cannot be excluded. there are a number of peripancreatic lymph nodes which are enlarged as described above. normal appearance of the kidneys and adrenal glands. correlation with outside imaging would be of benefit to evaluate for interval change. a low-attenuation predominantly cystic lesion in the pancreatic tail likely represents a small pseudocyst. the lesion appears to indent the stomach. : us abd: impression: 1. heterogeneous liver parenchyma in keeping with fatty infiltration. 2. patent hepatic vasculature. 3. satisfactory position of the cbd stent with air in the cbd and left-sided biliary duct system. 4. there is persitent irregular eccentric gall bladder wall thickening measuring 1.4 cm maximally. 5. pancreatic duct dilatation as described. cxr: mild lower lobe atelectasis. ercp impression: a stricture was seen at the distal common bile duct. a sphincterotomy was performed. balloon sweep was peformed without extraction of stones or sludge. a 7cm by 10fr plastic stent biliary stent was placed successfully. a single 2 cm stricture was seen in the distal pancreatic duct cbd and pd stricture most likely secondary to pancreatic mass vs. chronic pancreatitis. brief hospital course: micu course:44yo f w/ pmhx significant for etoh abuse, pancreatitis, known cholethiasis presented to the ed with 3 days of ruq pain and hypotension. #hypotension: pressures unresponsive to saline boluses in ed. she had a central line placed in the ed and was started on levophed in the ed with normotensive pressures in the unit. the patient's hypotension was thought to be multifactorial in etiology in part due to sepsis with her biliary tree being a likely source of infection and poor oral intake in the days prior to admission. on admission, patient had a lactate of 2. she was weaned from pressors as tolerated, with a goal of keeping maps >65 and bolusing with ns prn to maintain cvps between 8 and 12. antibiotics were started in the ed and continued through the patient's in the . since being off pressors, the patient's bps were maintained without fluid boluses. . #ruq pain: ruq u/s showing dilated pancreatic duct and a heterogeneous pancreas as well as cholelithasis and elevated lfts were suggestive of an obstructing process. the differential for the patient's ruq pain upon admission included pancreatits versus cholecystitis versus ascending cholangitis. she was seen by surgery in the ed who recommended ercp and cholecystectomy later during the hospitalization. ercp was performed and showed pancreatic/cbd strictures c/w malignancy vs chronic pancreatitis. the patient also had a biliary stent placed. given the concern for malignancy, the patient had an abdominal ct done, which showed 2.4x2.0 cm (3a:38) cystic structure arising from the panc tail could reflect pancreatic pseudocyst (given h/o etoh pancreatitis) vs. cystic pancreatic neoplasm. no definite pancreatic head mass though artifact from cbd stent limits assessment. panc duct is dilated as on recent ercp. irregularity also seen in pancreatic tail (3a:46) of uncertain significance. fatty liver. heterogeneous perfusion in the liver is noted with multiple, non mass like sites of early arterial enhancement. enlarged celiac and portocaval nodes. gastrosplenic varicies noted. general surgery and pancreaticobiliary surgery service were aware of the patient wanted the patient to be kept npo and antibiotics continued. they suspected the cbd stricture might be due to chronic pancreatitis, which is more probable due to past and possibly current etoh intake and pancreatic cyst on cta. the patient will need repeat ercp in 6 weeks for stent exchange. . #transaminitis: ast:alt ratio >2:1, suggestive of alcholism. elevated alp suggests a biliary blockage which is consistent with findings on ruq u/s. lfts were trended through her stay in the . alp and total bilirubin improved after ercp, but the patient's ast and alt continued to rise. there was concern that the acutely elevated ast and alt represented some other hepatic insult beyond those caused by the biliary tree obstruction. hepatitis serologies and hiv were sent. the results of these studies are pending upon discharge from . . #: on admission, patient's scr 1.5, baseline unknown. thought to be most likely prerenal, secondary to sepsis and poor po intake given patient's 3-day h/o abdominal pain. with ivfs the patient's scr improved to <1.0. . #anion-gap metabolic acidosis: patient initially presented with an anion gap of 19, with elevated lactate 2.1. patient's hypotension may have led to organ ischemia is suggestive by elevated scr. elevated lactate may be due in part to patient's underlying h/o etoh abuse impaired hepatic gluconeogensis. anion gap was followed and resolved. lactate normalized in the . . #uti: on admission, there was concern for uti given the results of ua. urine culture was drawn and was pending when patient left the . patient was on unasyn, s/p 1 dose vancomycin in ed. . #anemia: microcytic w/ mcv 86, suggestive of fe deficiency anemia versus anemia of chronic disease. . #asthma: home albuterol and fluticasone were continued through her admission in the . . #alcohol history: patient with a known history of etoh abuse. no level drawn in ed and there were no signs of intoxication when the patient was admitted during her stay in the . patient was monitored for signs of withdrawal. she did not need to be placed on ciwa scale while in the . floor course: the patient was trasnferred to the floor on . her abdominal pain improved and her transaminitis improved. iv narcotics were discontinued and her pain was treated with oxycodone. her diet was advanced. a liver consult was obtained for her transaminitis. they recommended checking , antibody ceruloplasmin and immunoglobulins for other causes of acute heptatitis which are pending. hepatitis serologies for hep a, b, and c were negative. hiv was also negative. repeat us showed satisfactory position of the cbd stent as well as patent hepatic vasculature. she was counseled extensively by me as well as gastroenterology about the need to follow up for repeat imaging for further eval of a pancreatic mass vs chronic pancreatitis. she understands that she should also follow up in the liver clinic. she will follow up with her pcp and will also need further evaluation of cholecystectomy as an outpatient. (dr. from surgery saw her during her hospital course.) she was transitioned from unasyn to augmentin at discharge to complete a week of antibiotic coverage. blood and urine cultures all showed no growth. she was discharged in stable condition with follow up. medications on admission: albuterol inhaler flovent 2 puffs inh discharge medications: 1. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 2. oxycodone 5 mg capsule sig: capsules po every four (4) hours as needed for pain. disp:*30 capsule(s)* refills:*0* 3. augmentin 875-125 mg tablet sig: one (1) tablet po twice a day. disp:*5 tablet(s)* refills:*0* 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every four (4) hours as needed for shortness of breath or wheezing. discharge disposition: home discharge diagnosis: cholangitis discharge condition: stable, tolerating regular diet, normal mental status, ambulating discharge instructions: you were treated for cholangitis. you underwent ercp. we are concerned that you may have a pancreatic mass vs chronic pancreatitis causing strictures. you must follow up with dr. for stent replacement and for further imaging. you should also follow up in the liver clinic as you had evidence of significant liver injury. you should also follow up with your pcp this week as well. you should also take the antibiotics as prescribed. followup instructions: you should call your pcp to schedule an appointment this week. you should also call the liver clinic tomorrow morning (monday, ) to schedule an appointment. their phone number is . the following appointments were already scheduled for you. department: gastroenterology when: wednesday at 10:00 am with: , md building: ra (/ complex) campus: east best parking: main garage department: endo suites when: thursday at 9:00 am department: digestive disease center when: thursday at 9:00 am with: , md building: building (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: acidosis anemia, unspecified urinary tract infection, site not specified acute and subacute necrosis of liver acute kidney failure, unspecified unspecified septicemia severe sepsis asthma, unspecified type, unspecified alcohol abuse, unspecified hypopotassemia septic shock calculus of gallbladder without mention of cholecystitis, without mention of obstruction chronic pancreatitis cholangitis obstruction of bile duct cyst and pseudocyst of pancreas 

Answer: The patient is high likely exposed to