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: codeine / penicillins / optiray 160 attending: chief complaint: abdominal pain major surgical or invasive procedure: egd , ir guided embolization of the left gastric artery ct guided drain placement into liver history of present illness: 60 y/o female with gastric bypass in , pud, sent in to ed by pcp for evaluation of epigastric pain x 2 weeks. she states that she has chronic pain near her right upper quadrant, felt to be related to her ulcer disease. 2 weeks ago, she reported that she developed a new pain in her left lower quadrant. she was told his may be diverticulosis, and was treated conservatively and without antibiotics. subsequently, in the past few days, she reports that she developed an acute on chronic pain in the epigastric/ruq region. she had a "popcorn" feeling and never had pain like this before. she presented to pcp and was sent to -. prior to her - admission, she had ct abdomen at hospital without acute process. at , pt had 300cc of hematemesis, and on transfer an additional 3-4 episodes of hematemesis (? 500 cc in total). has had continued hematemesis in route and here. guaiac neg from below brown stool. hct 36.5 (3:30 pm today) to 29 here. of note, she has never had hematemesis before. in the ed, initial vs - 7, 98, 70, 117/64, 24, 100% 2l nc. exam with ruq and epigastric ttp. labs notable for wbc 9.1, hct 29.5, plt 216, normal chem 7. ng tube aspirate with red color gastric fluid. then lavaged with 500 cc, cleared. ekg showing nsr, old lbbb, no ischemic changes. gi was consulted and recommended iv fluids, ppi bolus + gtt, 2units prbcs, transfuse to hct >30, npo for egd in am, and admit to micu. has received 2l ivf ivf. no blood given in ed. past medical history: -systemic lupus erythematosus diagnosed . possible history of cns lupus that per patient gives her ms symptoms of weakness, tingling and memory problems.***clarified this diagnosis with the patient's pcp who stated it was a 'soft call', not really sure she ever had this, more consistent with anxiety and depression. -sjogren's syndrome also for ~15 years, mostly dry eyes and mouth. -fibromyalgia. -tia 6-7 years ago with one day of one-sided weakness. -migraines with frontal headaches and flashing, and severe headaches. -peptic ulcer disease. -s/p gastric bypass 3 years ago with ~220lbs weight loss. used to take vitamins but not currently. -s/p hysterectomy and oophorectomy. -recent diagnosis of b12 deficiency per patient. social history: lives with her husband in . has three children and three grandchildren in the area. she takes care of a 4 grandchildren 4 days a week. she bikes daily. no tobacco, only rare alcohol, no illicit drugs. family history: father died of aplastic anemia at 38, mother smoked and died of lung cancer at 50. 7 siblings, two died of alcoholism, one recently diagnosed with hemochromatosis and one with thryoid disease. physical exam: on discharge: vs: 98.7, 67, 112/64, 18, 99 ra gen: axox3, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvd 6 cm, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: mild epigastric tenderness, pigtail drain in place ruq draining bilious fluid ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. pertinent results: 10:55pm blood wbc-9.1# rbc-3.43* hgb-9.3*# hct-29.5*# mcv-86 mch-27.1 mchc-31.5 rdw-13.9 plt ct-216 02:21am blood hct-27.4* 05:58am blood wbc-6.5 rbc-3.18* hgb-8.8* hct-27.5* mcv-87 mch-27.8 mchc-32.1 rdw-13.9 plt ct-194 10:55pm blood pt-12.8 ptt-22.2 inr(pt)-1.1 10:55pm blood glucose-108* urean-28* creat-0.6 na-140 k-4.4 cl-110* hco3-23 angap-11 10:55pm blood alt-16 ast-20 ld(ldh)-158 alkphos-41 totbili-0.2 05:58am blood lipase-33 hct 31.3 wbc's 7.9 egd: esophagus: normal esophagus. excavated lesions: two superficial non-bleeding ulcers ranging in size from 3 mm to 4 mm were found in the jejunum distal to the anastamosis. a single additional superficial non-bleeding 5 mm ulcer was found on the jejunal side of the anastamosis. an adherent clot was noted initially, but removed with washing, and no high-risk stigmata were noted. however, this is the location from which the subsequent bleeding originated. four injections of epinephrine 1/ (total 10cc) were applied to the area surrounding this ulceration for hemostasis. this resulted in the formation of a large adherent clot that could not be removed, and prevented adequate visualization for further endoscopic therapy. impression: a single cratered ulcer with a visible vessel on the gastric side of the gastro-jejunal anastamosis (endoclip) previous roux-en-y gastric bypass with identification of the gastro-jejunal anastamosis two superficial non-bleeding ulcers in the jejunum a single superficial ulcer on the jejunal side of the gastro-jejunal anastamosis, with active bleeding (injection) otherwise normal egd to jejunum egd: previous roux-en-y gastric bypass with identification of the gastro-jejunal anastamosis all previously-identified ulcers examined closely single clean-based and non-bleeding ulcer on the jejunal side of the anastamosis, with surrounding inflammation and friability three small non-bleeding superficial ulcers on the jejunal side of the anastamosis otherwise normal egd to jejunum ir guided angio of stomach: indication: 60-year-old woman with upper gi bleed. endoscopy revealing bleeding ulcers on both sides of the gastrojejunostomy site which could not be controlled by epinephrine injection and clips. clinicians: dr. , dr. , dr , and dr. . dr. and dr. participated and performed the procedure. moderate conscious sedation was provided by administering 200 mcg of fentanyl and 3.5 mg of versed throughout the total intraservice time of 1 hour 45 minutes, during which the patient's hemodynamic parameters were continuously monitored by a trained radiological nurse. local 1% buffered lidocaine was also used at the arterial access site. procedures: 1. right common femoral arterial access. 2. selective uperior mesenteric arteriogram. 3. selective celiac arteriogram. 4. superselective arteriograms of proper hepatic, gastroduodenal and left gastric arteries. 4. coiling of the left gastric artery. procedure: a written informed consent was obtained explaining the risks and benefits of the procedure. the patient was brought to the angiography suite and placed supine on the imaging table. a pre-procedure timeout and huddle was performed per protocol. the right groin was prepped and draped in the usual sterile fashion. under fluoroscopy and palpatory guidance, the right common femoral artery was accessed using a 19-gauge single wall needle. a 5 french short vascular sheath was then placed over the wire. 5 french glide cobra catheter was used to catheterize the superior mesenteric artery and an arteriogram was performed and recorded digitally. the c2 glide catheter was then used to cannulate the celiac artery,and artreiogram was redcorded, followed by selective catheterization of the splenic artrey to form loop to engage the left gastric artreey. this was not successful, and the catheter was then re-directed into the common hepatic artery for selective arteriogram. more selective arteriography was then performed after advancing the catheter over a wire into the gastroduodenal artery. a waltmans' loop formed inth ehepatic artrey was then succesful at nearly engagaing the left gastric artrey and a better arteriogram of the celiac truck was then recorded. the left gastric artery was difficult to securley cannulate using the 5 french glide catheter and hence it was exchanged for a 5 french sos catheter using which we easily cannulated the left gastric artery. using a combination of transcend microwire and microcatheter, the left gastric artery was cannulated more distally, and diagnostic angiograms were performed. in view of direct visualization of active bleeding during that morning's egd, empiric embolization using two 2 cm x 1 mm coils which were placed in the left gastric artery. a slurry of gelfoam following coil embolization was also performed. the microcatheter was then removed and hand injection was performed through the sos catheter which demonstrated no flow in the vessels that supply the stomach through the left gastric artery. the catheter and the sheath were removed, and firm pressure held at the right groin until complete hemostasis was achieved. findings: 1. there is gaseous distension of large and smal bowel presumably related to just-completed egd. suture line is visible along the lesser curvature of the stomach superiorly. clips are noted at the region of the bariatric gastrojejunostomy site and cholecystectomy site and a three migrated endoclips are seen distally in the bowel. 2. superior mesenteric arteriogram is of suboptimal quality related to both patient breathing and bowel motion and catheter recoil. images demonstrate no evidence of abnormal extravasation or vascular malformations. branches extending up to the gastrojejunal . are visible with no extravasation. 3. celiac arteriogram demonstrating typical branching pattern with a gastrohepatic trunk and tortuous left gastric artery. no extravasation or abnormal vascularity noted. 4. left gastric arteriogram demonstrating no active extravasation or lesion. post-procedure final scout image demonstrating optimal position of the coils. the patient withstood the procedure well except for back pain from the table and had no immediate complication and was shifted to the floor in stable condition. impression: uncomplicated empirical coil and gelfoam embolization of the left gastric artery for known bleeding ulcers at gastrojejunostomy site. the study and the report were reviewed by the staff radiologist. : ct abdomen/pelvis impression: 1. lobulated hypoattenuating non-enhancing abnormality within the lateral segment of the left liver; differential includes an abscess, biloma, or hypoenhancing cystic/necrotic mass lesion. associated moderate left greater than right intrahepatic biliary ductal dilatation. proximal common duct is also dilated to 1 cm. 2. gallbladder is surgically absent. no choledocholithiasis. 3. tiny hypodensities in the periphery of the spleen may represent cysts or hemangiomas; difficult to further characterize. less likely infarcts or abscesses. 4. status post left gastric artery embolization. no acute extravasation. no enhancement of the left gastric artery. normal enhancement of the other branches of the celiac axis and sma. 5. extensive stool retained throughout the colon. 6. status post hysterectomy. 7. 6mm nodule and 8 mm groundglass opacity of the lingula; comparisons can be made to prior exams if they become available. alternatively consider followup to document continued stability. : ct abd/pelvis impression: 1. increase in left hepatic lobe fluid collection. 2. new small fluid collection in anterior abdomen, without evidence of inflammation or infection. 3. cholecystectomy changes, with moderate intrahepatic and common biliary ductal dilation. 4. roux-en-y gastrojejunostomy and left gastric artery embolization. 5. resolving lingular opacity, likely inflammatory or infectious. duplex us liver: 1. completely normal assessment of the liver vasculature and extrahepatic portal system. 2. the collection adjacent to the left lateral segment is largely solid with only minimal cystic areas, likely representing a gel phase clot. this is not amenable to significant catheter drainage. : us liver difficult study due to multiple dressings overlying the anterior abdomen in the region of interest. the right lobe of the liver is unremarkable in appearance. there is a pigtail drain in situ in the left lobe of the liver. this lies in a predominantly solid, hypoechoic area of liver parenchyma. no simple fluid in this area can be identified in this region; however, the previous ultrasound performed prior to the drain insertion had a very similar appearance. overall, the area of abnormal liver parenchyma measures approximately 3.6 x 3.4 x 4 cm. the pigtail drain is in adequate position centrally within this area of abnormal liver parenchyma. no intra-hepatic bile duct dilatation, the common bile duct measures approximately 7 mm, not significantly changed compared to the prior study. brief hospital course: the patient with known peptic ulcer disease presented with with epigastric pain x 2 weeks. at osh she had 500cc of bloody emesis and hct 37 to 29 on arrival to our ed. the patient was made npo, 2 large bore ivs were placed, and protonix gtt started. patient remained normotensive and her repeat hcts were 27.4 and 27.5. gi was consulted and did a bedside egd where they saw a bleeding ulcer that they were unable to clip. the patient was then given 2 units of prbcs and sent down to ir where the left gastric artery was empirically embolized. she remained stable after this with no further evidence of bleeding and her hematocrit remained stable. bariatric surgery was consulted at this point, and she was transferred to dr. service. on hd #3, a repeat egd was done which showed the same jejunal ulcers, non-bleeding. pt was then started on a regular diet and was transferred to the floor in stable condition. she was continued on a high dose ppi and sucralfate. on hd #4, the patient remained hemodynamically stable, but continued to complain of epigastric pain; the wbc increased from 12.9 to 18.3. on hd #5, the wbc further increased to 19.2. she was subsequently pan cultured with negative results. an abdominal/pelvic ct scan did reveal lobulated hypoattenuating non-enhancing abnormality within the lateral segment of the left liver with associated moderate left greater than right intrahepatic biliary ductal dilatation and proximal common duct dilation to 1 cm. this was consistent with infarction of liver segment. at this time interventional radiology placed a drainage catheter into the fluid collection wich drained 100cc of bilious fluid. this was sent for gram stain and culture which was negative for any growth. this catheter was accidentally pulled out while the pt was transferring herself to the bathroom on the same day. a follow-up ct scan was done to evaulate the hepatic fluid collection after the drainage catheter had been removed. this showed an increased size in the collection from the previous study. at the time of the study the pt's wbc count was decreasing and she remained afebrile. a new drainage catheter was then placed which also drained bilious fluid. this was sent for gram stain and culture which was negative for any growth. she was then started on a regular diet which she tolerated well. her drain output initially put out roughly 200cc per day of bilious drainage. this output decreased daily and patients abdominal pain improved. she was transitioned to po antibiotics per consultation with the infectious disease team and antibiotics were then dc'd upon discharge from the hospital due to negative drain cultures. pt remained hemodynamically stable with a rising hematocrit, normal white blood cell count and she remianed afebrile. on an us of the liver was obtained at the request of the hepatobiliary surgical team which showed a decrease in size of the hepatic fluid collection and the pigtail catheter well placed in the center of the collection. on the day of discharged an mrcp was obtained also at the request of the hepatobiliary surgery team. pt will follow up as an outpatient with their service for consultation of possible liver resection at a future date. pt was discharged with pigtail catheter in place with instructions to follow up with dr. , dr. , her pcp as well as her bariatric surgeons from . -h. pylori sent and negative. -nutrition labs sent which were normal as well. . # sle, sjogren's, fibromyalgia: initially all home medications were held but when the patient started taking po she was restarted on her home medications. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: - topiramate 200mg po daily - hydroxychloroquine 200mg po bid - omeprazole 20mg po daily- - sucralfate 1gram po qid discharge medications: 1. topiramate 100 mg tablet sig: two (2) tablet po daily (daily). 2. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 5. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 7. gabapentin 100 mg capsule sig: two (2) capsule po tid (3 times a day). 8. multivitamin,tx-minerals tablet sig: one (1) tablet po bid (2 times a day). 9. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. 10. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 11. oxycodone 5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. disp:*30 tablet(s)* refills:*0* 12. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: jejunal ulcers biloma/liver necrosis discharge condition: stable. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the surgical service for the treatment of a gastro intestinal bleed. 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. 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. followup instructions: dr. () 9:45 am dr. (pcp) at 11:15am please call ( to scheduled an egd in 8 weeks to re-evaulate your ulcers. provider: , md phone: date/time: 3:00 provider: , md phone: date/time: 3:00 procedure: other endoscopy of small intestine other endoscopy of small intestine arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding other irrigation of (naso-)gastric tube percutaneous aspiration of liver percutaneous aspiration of liver diagnoses: systemic lupus erythematosus acute and subacute necrosis of liver other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified disorders of biliary tract personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits myalgia and myositis, unspecified bariatric surgery status personal history of peptic ulcer disease sicca syndrome chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction unspecified disorders of nervous system 

Answer: The patient is high likely exposed to