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: patient recorded as having no known allergies to drugs attending: chief complaint: newly-diagnosed adenocarcinoma of the proximal stomach. major surgical or invasive procedure: total gastrectomy with roux-en-y esophagojejunostomy, regional lymphadenectomy, jejunostomy tube placement, egd history of present illness: the patient was initially referred to dr. , who has asked me to see him as i am now doing much of the gastric cancer surgery at our institution. the patient is a previously healthy 76 year-old indian gentleman who reports an at least 6 month history of upper abdominal discomfort and loss of appetite. he recently moved here from , where he was noted to be anemic several months ago. he was advised to undergo a colonoscopy, but that was deferred as he was moving to the area. at the urging of his son, he presented to you and you performed initially a colonoscopy, which was reportedly normal. you then did an upper endoscopy on and there was apparently a large, irregular, ulcerating lesion in the upper stomach, which upon biopsy was consistent with a moderately to poorly differentiated invasive adenocarcinoma. the patient denies abdominal pain or any increase in the girth of his abdomen. he does admit to a 5-pound weight loss over the last several months. he has had no nausea or vomiting and tolerates food without difficulty. in addition, he denies any black tarry stools or frank blood in his bowel movements. he has been relatively fatigued and this has been attributed to his anemia. he has not received a blood transfusion and is currently taking iron supplements. a diagnostic laparoscopy was done on , with biopsies of anterior wall of the stomach and left lateral segment of the liver, and peritoneal washings for cytology. the staging was negative for any other evidence of intraperitoneal disease. past medical history: htn, hyperlipidemia, adenoca stomach, h/o tuberculosis (treated) social history: the patient has never smoked and only occasionally drinks alcohol. he is a retired office worker and lives in , . family history: unremarkable for history of cancers. physical exam: blood pressure 124/58, pulse 65. in general, this is a thin appearing indian gentleman who is a pleasant. sclerae are anicteric. neck and supraclavicular fossae are supple without lymphadenopathy. lungs are clear to auscultation bilaterally. heart is regular rate and rhythm. abdomen is soft and nondistended without palpable mass or evidence of ascites. extremities show no edema. pertinent results: 01:25pm blood wbc-7.7 rbc-2.78* hgb-8.5* hct-25.4* mcv-91 mch-30.7 mchc-33.7 rdw-17.0* plt ct-337 05:17am blood wbc-10.5 rbc-3.14* hgb-9.5* hct-27.5* mcv-88 mch-30.1 mchc-34.3 rdw-17.7* plt ct-267 01:25pm blood glucose-133* urean-12 creat-0.8 na-139 k-3.7 cl-110* hco3-24 angap-9 05:17am blood glucose-95 urean-19 creat-0.8 na-134 k-3.7 cl-102 hco3-26 angap-10 05:17am blood calcium-7.5* phos-1.9* mg-1.9 pathology examination name birthdate age sex pathology # , 76 male report to: dr. gross description by: dr. /cofc specimen submitted: total gastrectomy, jejunum, and esophagus donut. procedure date tissue received report date diagnosed by dr. . /vf previous biopsies: consult slides referred to dr. . . liver bx & stomach bx. diagnosis: i. stomach, total gastrectomy (a-z): 1. adenocarcinoma of the mid-portion, see synoptic report. 2. chronic inactive antral gastritis and duodenitis. 3. peritoneal fibrous adhesions with small fragment of skeletal muscle. 4. there is esophageal mucosa at the proximal and duodenal mucosa at the distal margin. ii. jejunum donut (aa): small intestinal fragment, no malignancy identified. iii. esophagus donut (a,b): esophageal fragment, no malignancy identified. stomach: resection synopsis macroscopic specimen type: total gastrectomy. tumor site: upper antrum. tumor configuration: ulcerating. tumor size greatest dimension: 5.8 cm. additional dimensions: 4.5 cm x 2.0 cm. microscopic histologic type: adenocarcinoma, intestinal type. histologic grade: moderately differentiated. primary tumor: pt2b: tumor invades subserosa. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 14. number involved: 0. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma. distal margin: uninvolved by invasive carcinoma. omental (radial) margins lesser omental margin: uninvolved by invasive carcinoma. greater omental margin: uninvolved by invasive carcinoma. distance from closest margin: 14 mm. specified margin: lesser omentum. lymphatic (small vessel) invasion: absent. venous (large vessel) invasion: absent. perineural invasion: absent. esophagus 9:38 am esophagus reason: please evaluate for anastamotic leak contrast: conray medical condition: 76 year old s/p esophagogastrectomy, please do swallow study to evaluate for anastamotic leak. reason for this examination: please evaluate for anastamotic leak indication: 76-year-old man with a history of gastric cancer status post gastrectomy with roux-en-y esophagojejunostomy. please evaluate for anastomotic leak. findings: scout view demonstrated no free air under the diaphragm. a jejunostomy tube overlies the left upper quadrant. midline skin staples are still seen. there is a small left-sided pleural effusion. conray followed by thin barium was used in this study. contrast flows freely and promptly through the esophagus through the anastomosis and into the jejunum. there is no evidence of contrast leak. there is mild thickening of the jejunal folds near the anastamosis, suggesting mild edema. the loops of small bowel are not dilated and contrast flows freely into the distal small bowel. impression: no evidence of anastomotic leak. brief hospital course: she was admitted on for a total gastrectomy and roux-en-y stapled esophagojejunostomy. he tolerated the procedure well and post-operatively he was stable. he had no complications during his post-op period. abd: he had an incision that was c,d,i. he had a feeding j-tube to gravity. his abdomen was nondistended and soft. the drain was removed pod 9. his staples were removed and steri strips applied on pod 9. . gi: he was npo with a ngt. he was started on j-tube feedings on pod 2. the ngt was d/c'd pod 3. he remained npo for 5 days. he had a swallow study to assess for a anastomotic leak on pod 8. the study showed no evidence of anastomotic leak. he was started on clears on after said study and advanced to fulls. he will be discharge on a full liquid diet and tube feedings (3/4 strength impact) at 90 cc/hr. . heme: he received 1 unit of prbc for a hct of 25 and his hct rose to 32.9 post transfusion. . id: he was started on cefazolin and flagyl perioperatively. these were discontinued post-op. . pain: he had an epidural for pain control. pod 0, in the pacu, he had episodes of apnea and very sleepy, most likely due to anesthesia. the epidural was turned down. the epidural was d/c'd on pod 4. he was then well controlled with a pca and eventually switched to roxicet elixir. . renal: pod 3, he required a 250cc bolus for low urine output. he responded well to the fluids. . pulm: he had faint crackles at the bases. he required oxygen by nasal cannula for 3 days. his respiratory status improved with is, deep breathing, and ambulation. . activity: he was weak and deconditioned. we encouraged ambulation. he was safe to go home. medications on admission: iron, laxative discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed for 1 months. disp:*50 ml(s)* refills:*0* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: gastric cancer discharge condition: good discharge instructions: * increasing pain * fever (>101.5 f) * inability to eat or persistent vomiting * inability to pass gas or stool * increasing shortness of breath * chest pain please resume all of your regular medications and take any new meds as ordered. continue to ambulate several times per day. you will continue with tubefeedings at 90cc/hr (3/4 strength impact) flush your j-tube with 30cc water 3x/day. full liquid diet. followup instructions: please follow-up with dr. in 1 week. call ( to schdule an appointment. procedure: other total gastrectomy other enterostomy enteral infusion of concentrated nutritional substances division or crushing of other cranial and peripheral nerves regional lymph node excision transfusion of packed cells diagnoses: unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) other and unspecified hyperlipidemia malignant neoplasm of pyloric antrum 

Answer: The patient is high likely exposed to