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: history of present illness: this 84-year-old female with a history of diverticula, crest and irritable bowel syndrome presented to the emergency room with a chief complaint of epigastric pain, lightheadedness, nausea without emesis and dark stools. she denied chest pain, shortness of breath, cough, fevers, chills and night sweats. in the emergency room she was found to have a blood pressure of 130/palp with a heart rate of 72. one hour later this was 119/39 with a pulse of 100. she had heme positive stool and hematocrit was found to be 16.6. the patient therefore had an emergent egd in the gi unit. no nasogastric lavage was performed. past medical history: the patient has sjogren's with sicca syndrome and presumed crest with a history of dysphagia and dyspepsia. the patient's primary gastroenterologist is dr. . patient has a history of hypertension, hypothyroidism, irritable bowel syndrome with chronic diarrhea, raynaud's, history of tah, cholecystectomy and pericholecystectomy hernia repair, copd and bronchiectasis, right bronchial sclerosis and sjogren's, history of bladder stretchings, negative mrcp except for some liver cysts, diverticula on colonoscopy with possibility of crohn's noted. social history: the patient smoked some tobacco in the past but it was a small amount. she drinks no alcohol. family history: crohn's disease. allergies: penicillin, bactrim and sulfa. medications: norvasc 10 mg q d, atenolol 50 mg q d, levoxyl 1.25 mg q d, dyazide 37.5/25 q d, serax prn, occasional nsaids, premarin .625 mg q d and aspirin. physical examination: temperature 97, blood pressure 95/69, respiratory rate 14, satting 100% on two liters. the patient was alert and oriented times three, she was fully conversant and awake, interactive and appropriate. she was in no acute distress. conjunctiva were pale. she had dry mucus membranes. she was normocephalic, atraumatic, extraocular movements intact, pupils were equal, round and reactive to light. there was no jvd. neck was supple. tms were normal. there was no lymphadenopathy of the neck, faint bibasilar crackles were heard on lung exam. the patient was tachycardic with a normal s1 and s2 with 2/6 systolic ejection murmur radiating to the axilla. abdomen was soft and non distended with normal bowel sounds, was mildly tender to deep palpation. extremities without clubbing, cyanosis or edema. fingers were cool as were the toes but she had 1+ pulses times four. cranial nerves ii through xii were intact. motor was 5/5 strength globally, symmetric. deep tendon reflexes were 2+ globally and were symmetric. laboratory data: white count 12.8, hematocrit 16.6, platelet count 282,000, mcv 89. chem 7, sodium 140, potassium 4.8, chloride 105, co2 21, bun 53 with a baseline of 10, creatinine .9, glucose 98, anion gap 14, esr 60, alt 52, ast 84, alkaline phosphatase 313, thyroid peroxidase antibody and endomesial antibodies were positive. note was made of prior alkaline phosphatase elevations as well as a ggt of 469 and a lipase of 199. tsh was 6.4. was positive at greater than 1:1280. gastrin was normal in 9-00 at 92. ekg showed normal sinus rhythm at 100, left axis deviation, intervals were 184/74/422. there was a small t wave inversion in 1 and avl, question of left anterior fascicular block, small st deviation similar to prior on . ct done for abdominal pain showed emphysema, no acute cardiopulmonary disease, hypoattenuation of liver and fibrotic lung changes. hospital course: 1. gi and cardiovascular: on the patient presented with malaise, epigastric pain, nausea for three days, lightheadedness, black stools and was found to have a hematocrit of 15.6 from a baseline of 43 and bun of 53. the patient was admitted to the micu. two peripheral ivs were placed, fluids and blood was applied, protonix was begun iv. emergent egd was performed that showed a stomach full of blood, a probable avm which was treated with electrocautery. the patient ruled out for mi because she had inferolateral ekg changes with st depression which later resolved after a blood transfusion. she had relative hypotension given her history of hypertension. on the 7th she was evaluated by surgery and told that operation for her bleed would be high risk and high morbidity and would involve partial gastrectomy so she declined the operation. a groin line was placed. on the 8th a repeat egd was similar to the first with large amounts of blood and the patient was taken to interventional radiology where she had her left gastric artery embolized. no further ir options were available after this procedure. in total the patient received 11 units of blood, ending on the 8th and hematocrits through the 10th were approximately 40 and stable. vascular access was initiated during the stay and on transfer to the floor , the patient had only one pid. groin line was removed on the 8th because of fever and stool contamination and on the 9th the triple lumen was removed because the patient felt she had no definitive options if she did have a massive bleed. the patient was made dnr, dni at her request and plans were to make her comfort care if she had a large recurrent bleed, although she later indicated that short-term central line would be acceptable. on transfer to the floor her issues were mild sinus tachycardia thought to be due to beta blocker withdrawal since it persisted through blood and volume repletion. a repeat egd was performed since the patient's lesion was never well visualized with all the blood in her stomach. this showed only gastritis with friability and the same findings in the duodenum. beta blocker was increased to treat her hypertension and tachycardia but with caution since she was at risk for rebleed. diarrhea was noted and c. diff and fecal leukocytes were checked and were negative. this was then attributed to melena and it trailed off when she had stable hematocrit. on the 12th the patient was noted to have a decreased hematocrit which declined from 42 to 32.8 with an apparent rebleed with increased melena post egd. it remained stable thereafter through the 15th at 33.5. simethicone was given for gassy distension and ambulation was encouraged to decrease this as well. 2. fluids, electrolytes & nutrition: lytes especially potassium and phosphorus were repleted. 3. endocrine: synthroid was continued for hypothyroidism and it increased to 150 since her tsh was high. this needs to be followed up with a repeat tsh. 4. pulmonary: with her persistent tachycardia on bvl replacement, concern for pe rose and a chest x-ray which showed a right upper lobe process thought to be early pneumonia was performed. ct angio was then done on the 12th which showed no pe but a large right upper lobe consolidation and left upper lobe and left lower lobe consolidations adjacent to an effusion as well. she was therefore treated for multifocal pna thought to be related to possible aspiration at the time of her egd with levofloxacin and flagyl with resultant decrease in white blood count. nebs were provided for wheezing, most likely related to copd. 5. the patient was seen for question of aspiration and it was felt her meds should be crushed and administered in apple sauce and that soft moist solids and liquids would serve her best but she was not a major aspiration risk. 6. id: as per pulmonary, patient also had a positive urinalysis and a culture showing 1,000 to 100,000 proteus and pseudomonas but since transferring to the floor, the patient complained of no urinary discomfort so this was not treated. repeat urinalysis showed no uti. the patient was followed by physical therapy and assisted with ambulation. 7. patient's crest and sjogren's were treated with solutions to mouth and eyes as per her routine. calcium channel blocker for question esophageal spasm was held given the risk of re-bleed and hypotension. 8. renal: patient's creatinine clearance was estimated at slightly more than 50 cc per minute and was stable throughout. discharge medications: protonix 40 mg , simethicone 80-125 mg qid prn, serax 10 mg po prn, trazodone 25 mg po prn insomnia, metoprolol 50 mg po tid, synthroid 150 mcg q d, colace 100 mg po bid, milk of magnesia prn. patient's own mouth rinses and eyedrops were sicca syndrome. levofloxacin 500 mg po q d through , flagyl 500 mg po tid through . discharge condition: stable. follow-up: to arrange with dr. of gastroenterology and the patient's primary care physician, . . discharge diagnosis: as per hpi plus: 1. gi bleed secondary to gastritis and avm (arteriovenous malformation). dr., j. 12-424 dictated by: medquist36 procedure: other endoscopy of small intestine other endoscopy of small intestine other endoscopy of small intestine other endoscopy of small intestine injection or infusion of other therapeutic or prophylactic substance endoscopic control of gastric or duodenal bleeding transfusion of packed cells diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified cachexia unspecified gastritis and gastroduodenitis, with hemorrhage bronchiectasis without acute exacerbation angiodysplasia of stomach and duodenum with hemorrhage sicca syndrome systemic sclerosis 

Answer: The patient is high likely exposed to