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 attending: chief complaint: gi bleed major surgical or invasive procedure: endoscopy capsule endoscopy history of present illness: history of present illness: 68yo female s/p recent posterior stroke, on coumadin, here with a gi bleed. she had not feeling well, with shortness of breath on even minimal exertion for the last two days. she thought she was coming down with something because she had decreased appetite. her vna came this morning and found her inr to be very elevated. she had had heartburn but no actual abdominal pain. she had black, formed stools that she attributed to iron pills. no fevers, chills, vomiting, dysuria or chest pain. after her stroke she has residual r sided weakenss, but is living at home. she has not been drinking etoh or taking nsaids. she has lost about 40lbs this year, both intentionally, and during her recent hospitalization. . at hospital, initial vitals were 98.6 102 129.66 100% ra, hct 22, inr 7. got 80mg pantoprazole and gtt started at 8mg/hr. she passed black tarry stools. she developed retrosternal chest pressure getting up to go to the bathroom, so was transferred here. got 2 units of ffp and 1 units prbc during transport to here. . initial vitals in our ed were 97.7 126 122/72 16 99% 2l. initial hct 19, got 2 more units prbcs, with hct up to 27. got 2 units ffp and 10mg iv vitamin k. ng lavage negative. given cipro for gi bleed prophylaxis. ct abdomen showed a bleed in the 4th portion of the duodenum. consulted gi and surgery. an unsuccessful attempt was made at a left groin line. she did not have any further maroon bowel movements. vitals prior to transfer were 112 125/70 21 97% ra. patient had 2 18 gauge ivs and 1 20. two more units of prbc's given prior to transfer. . on the floor, patient has not had chest pressure since about 3pm. she denies abdominal pain, and has not had further melena since arrival the past medical history: - s/p r cerebellar infarct . found to have aortic plaque, started on coumadin - hyperlipidemia. - hypertension. - diabetes mellitus. - atherosclerosis of the lower extremities. - r-sided breast cancer, s/p lumpectomy and chemotherapy . - appendectomy . - cholecystectomy late . - s/p dilatation and curretage c/b respiratory arrest social history: patient lives at home with her husband. she is a retired nurse. she is a former cigarette smoker (quit , smoked for 10 years 1-1.5 packs per day). drinks alcohol on special occassions only. denies recreational drug use. family history: both parents passed away at the ages of 67 and 75 from strokes. physical exam: on admission: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2. ii/vi sem loudest at lusb. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place. r-sided groin line c/d/i ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aaox3, cns intact, strength and sensation grossly nl. pertinent results: on admission: 07:15pm blood wbc-9.1 rbc-2.42*# hgb-6.5*# hct-19.6*# mcv-81* mch-26.8* mchc-33.1 rdw-16.5* plt ct-212 07:15pm blood pt-24.8* ptt-32.6 inr(pt)-2.3* 07:15pm blood glucose-116* urean-44* creat-0.8 na-141 k-4.4 cl-104 hco3-25 angap-16 07:15pm blood alt-15 ast-21 alkphos-62 totbili-0.2 07:15pm blood ctropnt-<0.01 05:00am blood ck-mb-3 ctropnt-<0.01 07:15pm blood calcium-9.3 phos-3.5 mg-1.6 07:19pm blood glucose-100 na-139 k-4.5 cl-102 calhco3-23 . on discharge: 05:40am blood wbc-9.4 rbc-3.70* hgb-10.8* hct-32.3* mcv-87 mch-29.2 mchc-33.4 rdw-15.7* plt ct-199 . imaging: ct abd/pelvis: 1. small area of active bleeding within the fourth portion of the duodenum. 2. no evidence of active lower gi bleeding. 3. diverticulosis without evidence of diverticulitis. findings were discussed with dr. at approximately 10:15 p.m. on via telephone. 4. left adnexal cyst measuring 1.5 x 1.1 cm. further evaluation with pelvic ultrasound is recommended on a non-emergent basis. . egd : esophagus: normal esophagus. stomach: lumen: a small size hiatal hernia was seen. mucosa: erythema and erosion of the mucosa were noted in the stomach body consistent with ng tube trauma. duodenum: mucosa: multiple nodules were seen in the duodenal bulb with overlying abnormal mucosa. these lesions appeared endoscopically consistent with brunner's gland hyperplasia. after the egd scope was passed to the second part of the duodenum a colonoscope was inserted to visualize the distal duodenum to assess the area bleeding that was suggested on ct scan. no blood was seen in the duodenum and no lesion was seen that could account for the bleeding. the enteroscopy portion was limited secondary to patient discomfort. impression: small hiatal hernia erythema and erosion in the stomach body abnormal mucosa in the duodenum likely brunner's gland hyperplasia otherwise normal egd to fourth part of the duodenum recommendations: the findings do not account for the symptoms plan for capsule study after egd patient should have a repeat egd to biopsy nodules seen in duodenal bulb . small bowel enteroscopy : esophagus: normal esophagus. stomach: lumen: a small size hiatal hernia was seen. mucosa: erythema and erosion of the mucosa were noted in the stomach body consistent with ng tube trauma. duodenum: mucosa: multiple nodules were seen in the duodenal bulb with overlying abnormal mucosa. these lesions appeared endoscopically consistent with brunner's gland hyperplasia. jejunum: the endoscopic was advanced into the 4th duodenum / proximal jejunum - detailed exam was not possible due to patient intolerance / discomfort with procedure. no large lesions or blood was noted. . ileum: not examined. impression: small hiatal hernia erythema and erosion in the stomach body suggestive of -gastric tube trauma. abnormal mucosa in the duodenum bulb - likely brunner's gland hyperplasia. no fresh of old blood was noted. limited exam of the third / fourth part of the duodenum - no bleeding lesions were noted. recommendations: no bleeding source localized. f/u with inpatient gi team. further options include capsule study, repeat push enteroscopy with anetheisa or single balloon/spirus enteroscopy. brief hospital course: 68yo female s/p recent cerebellar infarct on coumadin, who presented with a duodenal bleed. . # gi bleed: the patient experienced a significant bleed with a hct drop of approximately 10 points(28->19) in the setting of inr 7. her bleed was initially concerning for a duodenal source given melena and a negative ng lavage, however egd showed no source for bleed. he then underwent cta showing active bleeding within the fourth portion of the duodenum. she received a total of 5 units of prbcs, 2 units of ffp and 10mg iv vitamin k with improvement in her hematocrit and reversal of her inr. her hct remained stable thereafter, and she did not require any additional transfusions. she was treated with iv ppi, which was transitioned to po. she underwent capsule endoscopy showing multiple angioectasias in the small bowel. the gastroenterology consult team did not wish to pursue balloon enteroscopy on this admission, as it was determined that the patient would stop anticoagulation with warfarin. . # chest pressure: the patient complained of chest pressure on admission, concerning for demand ischemia in the setting of severe anemia. she did have transient st depressions related to this demand, but troponins were negative and ecg changes resolved. notably, the patient recently underwent persantine mibi that was normal. on recent admission, patient was to undergo cardiac cath, but this was stopped because she was found to have significant atheromas in her aorta. she was consequently started on aspirin. the aspirin was held during this admission given her gi bleed. after resolution of her bleed, the patient was started on plavix for both coronary protection and secondary stroke prevention. she was continued on lipitor 80 mg daily. . # diabetes: given ct angiogram, metformin was held and pt was covered with hiss. patient was instructed to resume metformin on discharge. . # recent cva: micu team contact her outpatient neurologist to discuss anticoagulation going forward. a decision was made to stop warfarin and start plavix for stroke prevention. the patient was started on plavix in-house without any signs or symptoms of bleeding for > 24 hours. . # glaucoma: alphagan and latonprost were continued. medications on admission: - alphagan 0.1% eye drops - lipitor 80mg qhs - lumigan 0.01% eye drops - aspirin 325mg daily - coumadin 6mg daily - cozaar 12.5mg daily - metoprolol tartrate 50mg - colace 100mg - ferrous sulfate 325mg daily - metformin 1,000mg discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. alphagan p 0.1 % drops sig: one (1) ophthalmic once a day. 3. lumigan 0.01 % drops sig: one (1) ophthalmic once a day. 4. cozaar 25 mg tablet sig: 0.5 tablet po once a day. 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 6. colace 100 mg capsule sig: one (1) capsule po twice a day. 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 9. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 10. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. losartan 25 mg tablet sig: 0.5 tablet po daily (daily). discharge disposition: home discharge diagnosis: duodenal bleed in setting of supratherapeutic inr discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital for a bleed in your small bowel, which we think was related to your very elevated level of coumadin. the capsule endoscopy did show that you have something called arteriovenous malformations, which are blood vessels that have a tendency to bleed in the bowel. we have stopped coumadin, and started plavix, and your blood counts have remained stable. if you have another episode of bleeding on plavix, you may require a procedure called a single balloon enteroscopy. we made the following changes to your home medications: stop coumadin stop aspirin start plavix 75 mg daily start pantoprazole 40 mg twice daily followup instructions: name: , j. location: beacon st family medicine address: , , phone: appointment: wednesday at 2pm department: neurology when: wednesday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: other endoscopy of small intestine central venous catheter placement with guidance diagnoses: abnormal coagulation profile anemia, unspecified coronary atherosclerosis of native coronary artery unspecified essential hypertension atherosclerosis of aorta personal history of malignant neoplasm of breast personal history of tobacco use diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use other specified disorders of stomach and duodenum atherosclerosis of native arteries of the extremities, unspecified subendocardial infarction, subsequent episode of care angiodysplasia of stomach and duodenum with hemorrhage other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to