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: morphine attending: chief complaint: brbpr major surgical or invasive procedure: colonoscopy central venous line placement and removal history of present illness: this is a 64 year-old f with crohn's disease (intact anatomy, maintained on asacol and ciprofloxacin), alcoholic cirrhosis, pud, pancreatic insufficiency, cad on aspirin 325mg and plavix, and chf who presents with brbpr since tuesday am. she awoke on tuesday morning with a large, non-painful, bloody bowel movement (stool mixed with blood as well as blood pouring from her rectum, no clots). she stayed at home because she thought it would resolve spontaneously, but over the course of tuesday () she had 9 more bowel movements. she presented to the ed yesterday (wed, ) where her hct was 27.0 down from 34.8 2 days prior, and proceded to have around more bloody bowel movements. she received 1u prbcs with no increase in her hct, so received 1 additional unit with last hct of 30.8. she has had 4 large bloody bms already today. both the patient and nurse say there was hardly any stool, but mostly blood and blood clots. the medical team has held her plavix (still on full-dose asas) and initially stopped her bb, but she has been tachycardic to 140's and light-headed with movement so they resumed the bb just this afternoon. she also reported dizziness and nausea with this. she denies any hematemesis, chest pain, and altered mental status. she only has 1 piv due to body habitus. . ms. was diagnosed with crohn's disease at age 39 when she presented with abdominal pain, weight loss, and bloody diarrhea. she has been maintained since this time on asacol (and recently ciprofloxacin + asacol) with very few flares and no surgery. she has baseline bm's per day (thought to be due to pancreatic insufficiency) with no systemic symptoms (including fevers, arthralgias, rash, abdominal pain) and had a normal colonscopy in 8/. she did have an episode of gi bleeding similar to this, but lasting only 24 hours. she was not scoped because the bleeding coincided with initiation of aspirin/plavix; bleeding resolved spontaneously. . ros: pt denies fever or chills. no recent weight loss or gain. denied cough, shortness of breath. denied chest pain or tightness, palpitations. no orthopnea. denied nausea, vomiting, diarrhea, or constipation. no dysuria. no sick contacts, no undercooked meat or pets (other than a house cat). past medical history: 1. cad s/p rca w/bms on 2. diastolic chf (recent ef~55%) 3. crohn's disease: h/o pancolitis w/o small bowel involvement; colonoscopy showed no active disease 4. chronic renal failure (cr~1.4 at baseline). 5. dm type ii 6. hypertension 7. h/o idiopathic dilated cmp now resolved 8. peptic ulcer disease. 9. alcoholic cirrhosis. 10. gerd. 11. rheumatoid arthritis. 12. pulmonary embolus in . 13. total right knee replacement with subsequent chronic pain. 14. mal seizure in childhood. 15. cervical disc disease. 16. l5/s1 radiculopathy with anterolisthesis of l4 on l5 on x- ray with emg consistent with mild radiculopathy. social history: patient lives with a disabled son in . she has one other son who is currently incarcerated. she was married but divorced a long time ago. 4 pack year smoking history, quit 6 years ago. drank ~1 pint alcohol/day x 10 years, quit 6 years ago. family history: mom died of colon cancer. father with dm requiring bilateral below the knee amputation. one sister has had cervical cancer(cured) and rheumatoid arthritis. most members of her family have trouble with hypertension. no one else with ibd. physical exam: vitals: t: 98.3 bp: 100/60-120/86 p: 90-108 at rest rr: 20 spo2: 98% ra wt 192 lbs general: cheerful, well-appearing, bed in nad. heent: eomi, sclera anicteric. mmm, op without lesions neck: supple, unable to assess jvd. pulm: crackles to b/t bases cardiac: rrr, nl s1/s2, no murmurs appreciated abdomen: soft, diffusely tender, mild distention. + bs. no rebound or guarding. rectal: brbpr, glove with maroon blood coating glove ext: no edema b/t pertinent results: colonoscopy: internal hemorrhoids, diverticulum in the sigmoid colon additional notes: bleeding likely hemorrhoidal in origin. no blood seen in colon. normal mucosa . ct abd - distended gallbladder. if clinically indicated, this could be further evaluated by ultrasound. nonspecific small amount of free fluid within the pelvis . echo - the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal rv size and function. the pulmonary artery systolic pressures could not be determined as a tricuspid regurgitant jet was not well seen. if clinically indicated, focused views after the injection of agitated saline could help to estimate pa pressures. compared with the prior study (images reviewed) of , the findings are similar. . pertinent labs: hct remained stable and greater than 27. creatinine remained at baseline. brief hospital course: 64yof with stable crohn's disease, pud, cad, and pancreatic insuffiency presented with brbpr, . # brbpr - patient has known crohn's disease and intermittent rlq pain at baseline. she had >5 episodes of bloody diarrhea upon admission to hospital and hct did not increase appropriately to 3 units of prbcs. nasogastric lavage was negative. at that point, the medical team was unable to get adequate venous access and she was transferred to icu for access and closer monitoring. in the micu, she had a r ij cvl placed and remained hemodynamically stable with no frther bloody stools or transfusion needs. she underwent colonocopsy which revealed internal hemorrhoids and diverticuli, but otherwise normal appear colonic mucosa and no obvious source of bleed. she was transferred back to the medical floor and continued to do well. her aspirin, plavix (bms in ), toprol, diovan, lasix were stopped initially in the setting of bleed and for colonoscopy. she was restarted on her aspirin and 2 days later developed one more episode of brbpr. aspirin was held. gi was reconsulted. she then underwent capsule endoscopy study to evaluate for upper gi source of bleed. she tolerated this well and had no further bloody bowel movements. her hct remained stable in the 24-25 range; however, given her cad hisotry, she was transfused one more unit at discharge. by discharge, she was feeling well. -- she was told to stop her aspirin, plavix until she sees dr. in follow-up on -- she was told to stop her diovan and take a decreased dose of toprol (25 mg instead of 100mg) until she sees dr. in on friday . if at that time, bp is higher, she can restart these bp meds. the lasix she only takes when she is above her dry weight. . # crohn's disease - stable disease state as per primary dr. . she continued home regimen of asacol, cipro, and creon. . # cad - she had no chest pain or coronary complaints. her cardiac medications were adjusted as above. . # chf - echos from past showed compromised ef, but has resolved ef in . she was at her goal weight of 192 lbs. she only takes lasix if weight greater than 195 pounds, and she did not receive any while in house. . # dm - insulin-dependant. goal for blood glucoses 80% <150. during bleed, she was npo and lantus was decreased to 30 units with blood sugars in the 130-160 range. by discharge, she had gradually increased her diet, and was instructed to contact her pcp regarding increasing the lantus back to her home regiman of 68 units at night. . # chronic renal failure - at baseline, will trend given fluid changes. . # chronic pain. she continued lidocaine patch, neurontin, and topamax. . # prophylaxis - pneumoboots, no indication for gi prophylaxis . # access - 1piv, rij placed and removed on discharge day # code - full medications on admission: -asacol 1600mg tid -aspirin 325 mg qday -toprol xl 100 mg qday -calcium 500 mg tid with meals -cipro 250 mg po bid -cymbalta 60 mg qday -diovan 80 mg qday -folic acid 1 mg qam -hydroxyzine hcl 25 mg prn itching -lantus 68u at bedtime -lasix 20 mg po qod prn weight >195 lbs. -lidoderm 5%--place patch on affected region for 12 hours at a time -lomotil 2.5 mg-0.025 mg/5 ml-- ml po qid prn diarrhea -neurontin 1600 mg tid -nystatin 100,000 unit/ml--10 ml suspension(s) po qid -oxycodone 2.5 mg po q4-6h prn pain -oxycontin 40 mg po tid -plavix 75 mg po qday -simvastatin 20 mg po qday -topamax 100 mg qday -vitamin d 800 unit qday -creon 4 capsules tidac discharge medications: 1. mesalamine 400 mg tablet, delayed release (e.c.) sig: four (4) tablet, delayed release (e.c.) po tid (3 times a day). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 3. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. topiramate 100 mg tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 10. amylase-lipase-protease 33,200-10,000- 37,500 unit capsule, delayed release(e.c.) sig: four (4) cap po tid w/meals (3 times a day with meals). 11. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime: this dose is less than your usual home dose. as you eat more, please discuss with your pcp to adjust back to original home dose of 68 units at bedtime. 12. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours). 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 14. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 15. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 16. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 17. lasix 20 mg tablet sig: one (1) tablet po as directed: please take one if your weight is greater than 195 pounds. 18. plavix 75 mg tablet sig: one (1) tablet po once a day. tablet(s) 19. vitamin d 400 unit capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: primary: lower gi bleed crohn's disease peptic ulcer disease . secondary: cad hypertension chronic renal insufficiency discharge condition: stable, pain free, hct stable discharge instructions: you had a gi bleed, but the source in unclear. your colonoscopy did not show any source of bleed. you had a capsule study to evaluate your upper gi tract. your blood counts have stabilized. please stop taking your aspirin, plavix, and diovan until you see dr. and dr. . you should take a lower dose of your toprol at 25 mg daily until you see dr. and dr. . you have also been taking lower doses of your lantus. you should slowly go back to your home dose once you start to eat normally. please call you doctor if you have any shortness of breath, bloody stools, black tarry stools, chest pain, palpitations, shortness of breath or any other concerning symptoms. followup instructions: please follow-up with dr. regarding your recent hospitalization. you have an appointment on at 11am . please see on friday to have your blood count and blood pressure checked. you will see dr. at friday at 3:30pm. provider: . phone: date/time: 2:00 provider: . & phone: date/time: 11:30 provider: phone: date/time: 2:00 procedure: venous catheterization, not elsewhere classified colonoscopy transfusion of packed cells other diagnostic procedures on small intestine diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified regional enteritis of unspecified site rheumatoid arthritis personal history of venous thrombosis and embolism hemorrhage of gastrointestinal tract, unspecified knee joint replacement diverticulosis of colon (without mention of hemorrhage) chronic diastolic heart failure other specified diseases of pancreas internal hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to