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: nsaids attending: chief complaint: gi bleeding major surgical or invasive procedure: exploratory laparotomy with small-bowel resection and primary anastomosis. history of present illness: 48 year old female with a history of recurrent gi bleeds felt to be secondary to nsaid induced ulceration who presents with increased fatigue and shortness of breath, found to be anemic. ms. was hospitalized in for melena and acute anemia with profound drop in hematocrit to 21 from unclear baseline. her presentation was in the setting of recent prescription of meloxicam for lateral epicondylitis. an egd performed during that admission did not reveal a source of bleeding, and a capsule study was attempted but terminated early secondary to equipment malfunction. she also had a gi bleed in , thought to be secondary to nsaids. egd/ at that time also did see a source of active bleeding, but noted a schatzki ring in distal esophagus and diverticuli in sigmoid colon. patient was discharged on protonix and iron supplementation. she has not had any nsaids since discharge. she drinks very little alcohol, rarely has an espresso, and usually drinks black tea. she reports that one week prior to admission, she was unable to get a refill of her lansoprazole as her pharmacy ran out of it. she also stopped her iron pills as she was concerned to take them without the ppi. she was able to get lansoprazole again two days prior to admission. she reports that on the thursday prior to admission, she "wasn't feeling good", reporting an upset stomach similar to discomfort with prior gi bleeds. she restarted her iron pills at this time. she notes that over the past two days she has become increasingly fatigued and short of breath with activity. she reports "feeling anemic," as she has in the past when her hematocrit is low. she reports pain in the center of her stomach which is , "small zaps" and like "champagne bubbles." pain is not associated with nausea or vomiting, and she has had a normal appetite. she reports hunger today. she has lost approximately 5lbs in the last several months, mostly during her last hospitalization. she has three bowel movements a day, which is her baseline. she notes dark/black stools since sunday, which are different than her dark stools with iron. she denies bright red blood per rectum. in the ed inital vitals were 99.4 100 123/70 14 97% ra. physical exam was significant for black guaiac positive stool. her labs were significant for hct 18 (discharge hct 31), wbc 11.3, creatinine 0.6. she refused an ng lavage. she was typed and crossed for 4 units. two 18 gauge pivs were placed. she was given 1l ns. gi was notified of her admission. she was started on a protonix gtt. vitals on transfer were significant for bp 132/75 hr 90s. on arrival to the icu, vital signs were t 100.4, hr 105, bp 124/78, rr 16, 100% on ra. patient was comfortable, reporting central stomach pain, no lightheadedness, no chest pain or shortness of breath. first unit of prbcs hanging on arrival. 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 nausea, vomiting, constipation. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: # recurrent gi bleed nsaids with no clear source identified (, )- diverticuli of sigmoid colon and descending colon, schatzki's ring in distal esophagus on egd/colonoscopy in # asthma # seasonal allergies # occasional gerd with spicy foods # dysmenorrhea . past surgical history # s/p breast biopsy in her 20s # s/p l knee synovectomy () social history: married with two children (8 and 11 yo daughters). lives in , ma. she teaches yoga to children and also works in a bakery. tobacco: none alcohol: occasional red wine illicits: negative exercise: 4x/day - walking, biking and yoga family history: no fh of bleeding disorder, colon or gi malignancy or ibd. mother - died young of . father - primary hyperparathyroidism, cardiomyopathy, dm, htn grandparents lived to 90's. siblings- one recently diagnosed with ra, one recently diagnosed with psoriatic arthritis physical exam: admission exam: vitals: t: 100.4 bp: 124/78 p: 105 r: 16 o2: 100% ra general: young female, awake and alert in nad heent: eomi, perrl, 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, grade ii/vi holosytolic murmur best heard at base abdomen: +bs, soft, nontender, nondistended, no hepatosplenomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no edema discharge exam: vitals - t 98.6, hr 69, bp 124/72, r 16, o2 99% general - no acute distress, alert oriented x 3 cardiac - rrr, no mrg, nl s1s2 lungs - cta b/l, no respiratory distress abd - soft, no rebound/guarding, mild paraincisional tenderness, mild distension wound - primary dressing in place over midline incision pertinent results: admission labs: 12:15pm blood wbc-11.3*# rbc-2.01*# hgb-6.1*# hct-18.2*# mcv-90 mch-30.5 mchc-33.7 rdw-13.0 plt ct-249 12:15pm blood neuts-82.3* lymphs-14.1* monos-3.2 eos-0.2 baso-0.2 12:15pm blood glucose-103* urean-22* creat-0.6 na-135 k-3.7 cl-105 hco3-21* angap-13 12:15pm blood ld(ldh)-236 totbili-0.1 12:15pm blood hapto-101 06:20am blood wbc-7.5 rbc-3.05* hgb-9.2* hct-27.6* mcv-91 mch-30.3 mchc-33.4 rdw-14.8 plt ct-382 05:10am blood wbc-13.8* rbc-2.97* hgb-9.0* hct-26.6* mcv-90 mch-30.4 mchc-33.9 rdw-16.4* plt ct-305 12:15pm blood neuts-82.3* lymphs-14.1* monos-3.2 eos-0.2 baso-0.2 06:20am blood plt ct-382 05:06am blood pt-11.3 ptt-24.9* inr(pt)-1.0 12:15pm blood ret aut-2.9 06:20am blood glucose-90 urean-9 creat-0.6 na-138 k-4.2 cl-104 hco3-29 angap-9 05:10am blood glucose-103* urean-8 creat-0.6 na-140 k-4.5 cl-106 hco3-31 angap-8 05:10am blood glucose-103* urean-8 creat-0.7 na-140 k-4.4 cl-107 hco3-28 angap-9 12:15pm blood ld(ldh)-236 totbili-0.1 05:10am blood calcium-8.1* phos-2.8 mg-2.1 10:18am blood calcium-7.5* phos-2.7 mg-1.9 12:15pm blood hapto-101 ct abd/pelvis : impression: 1. enhancing intraluminal and extraluminal bilobed mass within the mid to proximal jejunum, corresponding to the mass observed on endoscopy. no masses are present in the duodenum. numerous lymph nodes within the mesentery, but none are pathologically enlarged. 2. no active bleeding from this jejunal mass or elsewhere in the gi tract. 3. sigmoid diverticulosis without diverticulitis. 4. free fluid in the deep pelvis may be due to a ruptured hemorrhagic cyst in the right adnexa. 5. endoscopy capsule in the cecum. 6. small hiatal hernia. brief hospital course: 46 yo f with history of recurrent gi bleeds presenting with fatigue and anemia. # gib, sb mass: patient has not had any brbpr, hematochezia/coffee ground emesis, however, does report dark black stools (while on iron), which were guaiac positive in the er. high concern for gib. during last admission, no source was located in the upper gi system, however capsule study was not performed. as recent egd was negative and patient has no risk factors for ugib (no nsaid use, infrequent alcohol use), low suspicion for esophageal or gastric source. in addition, colonoscopy in showed only diverticuli, which may be source of bleed but unlikely as they were in sigmoid colon and patient denies any obviously bloody stool. initially planned repeat egd, but patient preferred less invasive study given recent negative egd. therefore, a tagged rbc scan was performed, which showed slow bleed in the distal jejunum/proximal ileum. ir , but felt that given the slow rate of bleed, angiography unlikely to be positive. patient was initially on a protonix drip which was changed to iv bid once the location of the bleed was localized to the small bowel. the acute care surgery service was consulted and she was found to have a bilobed 4.4 x 2.4 cm mass in her jejunum. she was taken to the or on and had an ex-lap and small bowel resection. she was transfused 2 uprbcs pre-operatively for a hct of 20.2. her post-op hematocrit was 27.5. over the next few days, her hct remained stable. her diet was slowly advanced as her bowel function was able to tolerate. she had no further bleeds and was able to be discharged home with appropriate follow-up instructions and warning signs # anemia: normocytic anemia, most likely due to acute/subacute blood loss. as below, source was identified. patient required 2uprbcs at the time of admission and hematocrit responded appropriately. hemolysis labs were negative and reticulocyte count was appropriate. gib workup as below. likely source of bleeding to be the sb mass as described above. post-operatively, she had no bleeding and her hematocrits were stable until discharge. # tachycardia: sinus in nature on ekg. most likely due to anemia. resolved with transfusions and fluid resuscitation. # leukocytosis: likely related to stress reaction and demargination from gib. resolved with time. # asthma: no shortness of breath or wheezing on admission. continued outpatient advair and atrovent. medications on admission: fluticasone-salmeterol 250/50 inh ipratropium 1 capsule inh qid lansoprazole (stopped one week pta) iron discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*25 tablet(s)* refills:*0* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. ipratropium bromide inhalation 4. advair hfa inhalation discharge disposition: home discharge diagnosis: intestinal bleeding with identification of a 4-cm small bowel mass at the level of the jejunum. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you during your stay at . you were admitted to the hospital due to gi bleeding. you were taken to the or where a mass was seen at the level of the jejunum (a part of your small intestine). this mass and part of your small intestine was removed. you were then observed over the next few days to monitor your gi function and your pain. we feel comfortable sending you home at this time. please remember to take it easy over the next few weeks as you are recovering from a major operation and need time to recuperate. general discharge instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please take the prescribed analgesic medications as needed. you may not drive or heavy machinery while taking narcotic analgesic medications. you may also take acetaminophen (tylenol) as directed, but do not exceed 4000 mg in one day. please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. warning signs: please call your doctor or go to the emergency department if: *you experience new chest pain, pressure, squeezing or tightness. *you develop new or worsening cough, shortness of breath, or wheeze. *you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. *your pain is not improving within 12 hours or is not under control within 24 hours. *your pain worsens or changes location. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *you develop any concerning symptoms. followup instructions: please call ( upon discharge to schedule an appointment in the acute care surgery clinic in 2 weeks, or with any questions/concerns. clinic is located in the medical office building, , . procedure: other partial resection of small intestine esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: esophageal reflux acute posthemorrhagic anemia asthma, unspecified type, unspecified disorders of phosphorus metabolism hemorrhage of gastrointestinal tract, unspecified disorders of magnesium metabolism neoplasm of uncertain behavior of connective and other soft tissue 

Answer: The patient is high likely exposed to