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: hyponatremia major surgical or invasive procedure: ultrasound guided biopsy of hepatic mass history of present illness: 73m w/ pmh of chf (ef 20% per osh records), diabetes (on insulin), and recent diagnosis of pancreatic tail mass was transfered from osh for hyponatremia. pt reports he was in his usual state of health until ~1mo ago when he had decreased appetite in the setting of many upsetting life issues, with some nausea and vomiting. ovre the past week he reports weight gain with increasing abdominal girth but denies orthopnea, pnd or worsening doe. he reports worsening fatigue with inability to continue his usual. he reports difficulty urinating but denies any changes in color or dysuria urinating. he reports overall not feeling well and went to his pcp where he was found to have hyponatremia and was called and told to go to the hospital. he went to lawrenece general where he had labs that were notable for a na of 116, wbc of 14.8, amalyse was 41, and digoxin level of 0.7. he received benadryl, zofran and ns at 250cc/hr. in the ed, initial vs were: 20:05 2 100.4 80 94/59 18 98% ra. his ua was bland, lactate 1.3. cxr showed possible rll infiltrate and cardiomegaly per my read. he was given vanc and ceftriaxone and admitted to the micu for hypotension and hyponatremia. her vs on transfer were 99.5 75 98/53 18 97%. on arrival to the micu, the patient had no complaints. he reports no nausea or vomting. he reports having decreased po intake over the past week, and that he has been tdrinking 15 bottles of water or more per day since he gardens outside in the heat. past medical history: dm2 heart failure (ef 20%) pafib hx alcohol abuse pancreatic tail mass (not further characterized) social history: lives with his wife. originally from and then . remote history of alcohol abuse (not since ) family history: nc physical exam: admission exam: general: alert and oriented x 3, sitting up on the edge of the bed comfortably, ill appearing, in nad. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: rrr, distant heart sounds 2/6 systolic murmur appreciated at the lsb. lungs: decreased breath sounds bilaterallys, but no appreciable crackles. abdomen: soft, markedly protuberant. 6inch fluid shift . no palpable masses. tender to palpation in lower abdomen. normoactive bowel sounds. no palpable masses. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. 1+ pitting edema bilaterally, multiple scabbed over areas neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: 98.2 102/46 74 18 99%ra gen alert, no acute distress neck supple, no jvd, no lad pulm good aeration, bibasilar rales (much improved since acceptance from icu) cv rrr, normal s1/s2, no murmur heard today abd soft, mildly distended ext wwp, 2+ pedal edema b/l (much improved since accept from icu) pertinent results: admission labs: 08:25pm blood wbc-15.6* rbc-3.50* hgb-9.7* hct-29.9* mcv-85 mch-27.8 mchc-32.5 rdw-12.1 plt ct-252 08:25pm blood neuts-83.3* lymphs-5.5* monos-9.0 eos-2.0 baso-0.2 03:53am blood pt-15.8* ptt-28.4 inr(pt)-1.5* 08:25pm blood glucose-84 urean-33* creat-1.2 na-119* k-5.0 cl-85* hco3-26 angap-13 08:25pm blood alt-23 ast-24 alkphos-152* totbili-0.9 08:25pm blood albumin-3.3* calcium-7.8* phos-2.7 mg-2.1 08:25pm blood osmolal-251* 04:09am blood digoxin-pnd 08:35pm blood lactate-1.3 10:20pm urine color-straw appear-clear sp -1.008 10:20pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 12:51am urine hours-random urean-613 creat-45 na-less than k-29 cl-less than 12:51am urine osmolal-311 ascites studies: 01:07pm ascites wbc-1150* rbc-* polys-43* lymphs-44* monos-10* mesothe-3* 01:07pm ascites totpro-3.3 glucose-119 creat-0.9 ld(ldh)-90 amylase-13 totbili-0.5 albumin-2.2 micro: 1:07 pm peritoneal fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): no mycobacteria isolated. legoniella antigen negative urine culture negative (x1) blood culture negative (x2) discharge labs: 07:20am blood wbc-14.9* rbc-3.64* hgb-10.5* hct-31.7* mcv-87 mch-28.7 mchc-33.0 rdw-12.2 plt ct-275 07:20am blood plt ct-275 07:20am blood glucose-148* urean-17 creat-1.1 na-129* k-3.9 cl-89* hco3-31 angap-13 07:20am blood calcium-8.1* phos-2.9 mg-2.1 brief hospital course: mr. is a 73 yo m w/ pmh of diabetes on inuslin, chf with ef of 20% who was found to have new onset hyponatremia in the setting of worsening ascites and newly diagnosed pancreatic mass with hepatic spread. active issues: #hyponatremia- the patient was transferred to the micu for management of his hyponatremia to 119 which was symptomatic with some confusion, but no obtundation or seizures. he was originally fluid resuscitated given his low blood pressures and appearance of intravascular depletion, and when his na did not respond to this he was switched to diureses after it was found that he was 10 lbs over his baseline weight. his sodium improved to 121 at the time of transfer to the floor after being fluid restricted to 1.5l and given 40 iv lasix. his diuresis was continued in the micu until he could be transferred to the floor (notably, his mental status was at baseline when he was sent to the floor). his sodium steadily climbed to the mid and high 120s, but on resumption of his home po furosemide, his sodium declined from the high to mid 120s. given the suspicion of poor absorption from gut edema, the patient was switched to a po dose of torsemide (40mg) equivalent to his former po lasix dose (80mg). he responded very well to this and his sodium increased promptly. it was 129 at the time of discharge. of note, multiple urine electrolyte studies were used to guide diuresis and the patient was never terribly sodium avid, even with extensive diuresis. #ascites- the patient had new onset ascites on exam. he denied abdominal pain. he underwent a diagnostic paracentesis which was obtained and was a bloody tap. neither his clinical picture nor his paracentesis results were consistent with spontaneous bacterial peritonitis. his ascites did decrease with diuresis, as did his pedal edema. given that the patient had no evidence of acute cardiac decompensation due to intrinsic disease, medication noncompliance, or dietary indiscretion, it was thought that this was largely due to the patient's intra-abdominal neoplasm. #pancreatic mass- this was noted on imaging from outside hospital and he was found to have a pancreatic tail mass. multiple hepatic nodules were found as well. the patient received further workup while at . an ultrasound of his liver was done with subsequent biopsy of an identified mass. cytology showed malignant cells consistent with a poorly differeniated carcinoma. a core biopsy taken from the same nodule was consistent with adenocarcinoma. serum ca-19-9 was 1246 and cea was 8.1. #leukocytosis- patient had elevated white blood cell count and was found to meet sirs crieria so he was started on broad spectrum antibiotics which were stopped after transfer to the icu, stabilization of vitals, and an unproductive search for source of infection. # anxiety: the patient was very anxious during his hospital stay. he did speak extensively with our social worker about end of life issues. he stated on numerous occasions that he was coming to terms with dying, but that his wife's anxiety was the primary factor in his anxiety. #chf- he has a history of paroxysmal afib with a known lbbb and ef of 20%. he was not orthopneic or having pnd on exam. he was 10 lbs heavier on admission than his dry weight(224) and was subsequently diuresed. please see "hyponatremia" above. inactive issues: #anemia- his baseline hct is 31 and this is where he was on admission and no further workup was pursued. #diabetes- patient is on large doses of lantus at home 42u qhs, and his blood sugars while in the micu were low without his home dose of glargine so he was continued on a sliding scale. his blood sugars were well controlled while in house. # hyperlipidemia: no events in house. transitional issues: # hyponatremia: the patient was discharged with a prescription for a blood draw to be done on the following day to follow his sodium. dr. fax number was included on the prescription so that the results could be faxed to her office. the patient was also sent home with vna services. # pancreatic mass: the work-up as described above will be faxed to drs. and along with this discharge summary. # anxiety: suggest extensive family counseling re: coping to increase quality of life for the patient. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. digoxin 0.125 mg po daily 2. carvedilol 25 mg po bid hold for sbp<100 or hr<60 3. potassium chloride (powder) dose is unknown po daily written as 2u once a day 4. lipitor 20 mg po daily 5. lisinopril 5 mg po daily hold for sbp<100 or hr<60 6. furosemide 80 mg po daily hold for sbp<100 or hr<60 7. glargine 42 units bedtime insulin sc sliding scale using novolog insulin 8. sertraline 100 mg po daily 9. alprazolam 0.5 mg po tid:prn anxiety 10. aspirin 81 mg po daily 11. vitamin d 400 unit po daily 12. vitamin e 400 unit po daily 13. fish oil (omega 3) 1200 mg po daily 14. co q-10 *nf* (coenzyme q10;<br>coenzyme q10-vitamin e) 200 mg oral daily 15. diphenhydramine 25 mg po q6h:prn itchiness discharge medications: 1. alprazolam 0.5 mg po tid:prn anxiety 2. carvedilol 25 mg po bid hold for sbp<100 or hr<60 3. digoxin 0.125 mg po daily 4. lipitor 20 mg po daily 5. sertraline 100 mg po daily 6. vitamin d 400 unit po daily 7. vitamin e 400 unit po daily 8. artificial tears 1-2 drop both eyes prn eye drops rx *artificial tear (hypromellose) 0.3 % 1-2 drops once a day disp #*1 bottle refills:*0 9. torsemide 40 mg po daily sbp < 90 rx *torsemide 20 mg 2 tablet(s) by mouth qday disp #*60 tablet refills:*0 10. aspirin 81 mg po daily 11. co q-10 *nf* (coenzyme q10;<br>coenzyme q10-vitamin e) 200 mg oral daily 12. fish oil (omega 3) 1200 mg po daily 13. lisinopril 5 mg po daily hold for sbp<100 or hr<60 14. outpatient lab work chem 10 (na, cl, k, hco3, bun, cr, glucose, mg, p, ca) panel on , and have results faxed to pcp at 15. glargine 20 units dinner insulin sc sliding scale using novolog insulin discharge disposition: home with service facility: , discharge diagnosis: primary diagnoses: hyponatremia lung, liver and pancreas masses discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you while you were hospitalized at the . as you recall, you were transferred to the for a dangerously low sodium level. we found that you had a great deal of excess fluid in your body, which likely was contributing to your low sodium level. your sodium level improved when we removed some fluid from your body. we also discovered masses in your liver and your lungs, in addition to the one known to be in your pancreas. unfortunately, this is very suspicious for a malignancy. we were able to perform a biopsy of one of your liver lesions. the pathology of this lesion should be very informative. the following changes to your medication have been made: stop furosemide (lasix) start torsemide 40mg daily you should also have your blood drawn on monday at your doctor's office or at a commercial phlebotomist and have the results faxed to your pcp's office. you will be discharged with a prescription to have this done. followup instructions: name: ,suetta m. location: medical associates address: , , phone: please call dr. office to be seen within 1 week of your discharge from the hospital. let them know it is a post hospitalization visit. please discuss the results of your biopsy with dr. at this visit. name: , md specialty: hematology/oncology when: thursday at 1:30pm location: hematology/oncology address: , ste#301, , phone: md procedure: closed (percutaneous) [needle] biopsy of liver percutaneous abdominal drainage diagnoses: malignant neoplasm of liver, secondary congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia hyposmolality and/or hyponatremia atrial fibrillation sepsis other and unspecified hyperlipidemia anxiety state, unspecified long-term (current) use of insulin chronic systolic heart failure other ascites secondary malignant neoplasm of lung leukocytosis, unspecified other specified diseases of pancreas anemia in neoplastic disease malignant neoplasm of tail of pancreas 

Answer: The patient is high likely exposed to