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: melena major surgical or invasive procedure: egd with banding of esophageal varices . history of present illness: mr. is a 63-year-old gentleman with hep-c cirrhosis and multifocal hcc. about 3 years ago, he underwent treatment with pegylated interferon and ribavirin for 6 months, and did not respond to it. he had to reduce his dose at 4-1/2 months secondary to anemia, and he was told he had genotype 2. he is status post a right lobe tace on followed by rfa to a segment ii/iii lesion on . a left lobe tace was subsequently performed on for residual disease. the patient has portal vein infiltration from his hcc and known portal hypertension evidenced by grade i esophageal varices seen on recent egd. the patient was in his normal state of health until saturday when he had increasing pain in his midepigastric area. he described the pain as sharp, radiated to the back, and was worse with deep breaths, and with laying on his left side. he had some relief with dilaudid, but he says that the pain was worse and different than his normal ruq pain. the pain was not associated with eating, nor did he describe it as reflux pain. the patient says that the pain continued until sunday when he felt a "popping" sensation in the same distribution as the pain. he said that the pain actually improved then, but then on monday he developed dark, black, tarry stool. the patient continued to have black, tarry, large quantity stools on wednesday, but then the patient's stools returned to a brown color. the patient denied hematemesis, nausea, reflux, brbpr, lightheadedness, dizziness, orthostasis. he does take intermittent ibuprofen. he is not on prophylactic nadalol or propranolol. the patient was admitted directly from clinic to the micu for urgent egd for possible variceal bleed. on arrival to the micu, the patient was afebrile with normal bp, hr. past medical history: past oncologic history: mr. is a 63-year-old man with cirrhosis who was found to have multiple liver lesions suspicious for hcc on screening ultrasound . mri demonstrated a cirrhotic liver with a 4.2 cm mass in segment ii and a bilobed 5.5 cm mass in segment viii. he underwent tace to the right lobe of the liver on . his post tace course was notable for fever, significant and prolonged ruq pain, mild nausea, urinary retention and constipation in the setting of narcotics to treat his pain. on , he started on a clinical trial 08-256 involving rfa plus or minus sorafenib. the patient underwent rfa to a segment ii/iii lesion on . he also underwent ct/ultrasound-guided biopsy at that time. imaging was notable for a previously noted right adrenal nodule which was shown to have increased in size to 25 x 15 mm, suspicious for metastasis. notation was also made of interval increase in size of remaining foci of arterial enhancing lesions within the liver. these findings were reviewed in tace imaging conference and it was recommmended that the patient undergo tace. following tace, the patient will be set up for bx and rfa of his adrenal nodule. consideration will be given to sorafenib in the near future. he received his first tace to the left lobe and to two targeted branches to the segment 4 in the right lobe and the hepatic dome. he had discomfort at the end of the procedure (he has previously had epigastric and left shoulder pain related to his rf and ruq and right shoulder pain from his tace - both of these might be expected post-procedure). he got versed/fentanyl for moderate sedation, toradol during the case, and had significant nausea at the end of the procedure for which he got additional zofran and a dose of haldol. the procedure itself went well. he received diludid pca complicated by constipation and nausea. pmhx: - gallstones, s/p cholecystectomy in early complicated by a collapsed lung and "nicked" diaphragm. - hx of iv drug abuse - cirrhosis (bx performed during cholecystectomy in early b/c of abnormal liver findings) presumed hep c 3a, viral load > 1 million . complicated by 'fogginess' and difficulty multi-tasking improved on rifaxamin after trial of lactulose. treated with interferon x 4 doses in without response. hiv negative. - kidney stones as per pt report - hepbsab + but hbsag negative. - hep c 3a positive, viral load > 1 million social history: (as per previous notes). married. lives with wife and adult daughter and young grandson. smokes pack/day. smoked 25+ pack year. sober x 25 years. prior heavy drinker. worked as contractor/carpenter on until . quit iv drug use at age 49. family history: father with cad. dm in his sister and grandparents. physical exam: on admission: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, ttp in ruq, minimal mid-epigastric tenderness, hepatomegaly, splenomegaly, no ascites appreciated gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact at discharge: vs: 97.4, hr 55 (50s - 80s), bp 116/66, rr 18, 96% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, wheezes on the right side, rales, ronchi abdomen: soft, distended, ttp in ruq, minimal mid-epigastric tenderness, hepatomegaly, splenomegaly, no ascites appreciated gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact pertinent results: admission labs: 08:49pm glucose-96 urea n-14 creat-0.7 sodium-134 potassium-5.1 chloride-103 total co2-23 anion gap-13 08:49pm alt(sgpt)-99* ast(sgot)-140* alk phos-159* amylase-88 tot bili-1.1 08:49pm lipase-14 08:49pm albumin-3.3* calcium-8.7 phosphate-4.1# magnesium-1.8 08:49pm neuts-68.2 lymphs-19.5 monos-8.0 eos-3.0 basos-1.3 08:49pm neuts-68.2 lymphs-19.5 monos-8.0 eos-3.0 basos-1.3 08:49pm plt count-101* 08:49pm pt-13.4* ptt-25.1 inr(pt)-1.2* 12:10pm urea n-14 creat-0.7 sodium-137 potassium-4.2 chloride-103 total co2-27 anion gap-11 12:10pm estgfr-using this 12:10pm wbc-6.6 rbc-3.98* hgb-13.5* hct-36.8* mcv-92 mch-34.0* mchc-36.8* rdw-13.6 12:10pm wbc-6.6 rbc-3.98* hgb-13.5* hct-36.8* mcv-92 mch-34.0* mchc-36.8* rdw-13.6 12:10pm plt count-103* 12:10pm gran ct-4830 discharge labs: 07:25am blood wbc-5.0 rbc-3.58* hgb-11.7* hct-33.1* mcv-93 mch-32.6* mchc-35.3* rdw-13.2 plt ct-106* 07:25am blood pt-14.2* ptt-30.0 inr(pt)-1.3* 07:25am blood glucose-98 urean-10 creat-0.6 na-136 k-4.2 cl-103 hco3-28 angap-9 07:25am blood calcium-8.3* phos-2.7 mg-1.8 egd: esophagus: protruding lesions cords of grade varices were seen in the lower third of the esophagous. none of the varices were bleeding. 3 were successfully placed. stomach: mucosa: severe diffuse portal hypertensive gastropathy was noted through the stomach. no gastric varices were seen. no evidence of any active bleeding in the stomach. duodenum: normal duodenum. impression: esophageal varices abnormal mucosa in the stomach otherwise normal egd to third part of the duodenum recommendations: follow up with the inpatient liver team continue the octreotide drip additional notes: the attending was present for the entire procedure. final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology brief hospital course: assessment/plan: this is a 63 yo m with hep c cirrhosis c/b hcc invading the portal vein s/p tace and rfa who presents from clinic with evidence of recent upper gib concerning for variceal bleed. active issues: 1. upper gi bleed: patient was admitted to the micu given concern for variceal bleeding and was taken urgently for egd, which demonstrated cords of grade ii-iii varices in his lower esophagus. three were successfully deployed. he did not require any blood transfusions. his hct remained stable throughout hospitalization. he was initially kept on iv ppi and octreotide drip. he did well and was transitioned to a po ppi and nadolol. he was also discharged on two weeks of a sucralfate slurry and a soft diet for one week. 2. intubation: the patient required intubation to complete egd. the patient was intubated with ett without any complications and he was kept intubated overnight due to high dose of analgesics he got during procedure. he was extubated without event and was called out of micu. patient did not require any further oxygen. 3. cirrhosis: the patient has hep c cirrhosis c/b varices and ? encephalopathy in the past. he was continued on lactulose and started on ceftriaxone. he was discharged home on ciprofloxacin 500 mg twice a day to complete a seven day course and will take ciprofloxacin 250 mg daily thereafter for prophylaxis. 4. hcc: patient will continue treatment as per outpatient providers. chronic/inactive issues: 1. insomnia: continued home dose lorazepam. transitional issues: 1. patient will have cbc checked as outpatient. will follow-up with pcp. 2. hcc: has follow-up scheduled with oncology. medications on admission: hydromorphone - 2 mg tablet - one tablet(s) by mouth every 6 hrs as needed as needed for pain lactulose - (prescribed by other provider) - 10 gram/15 ml solution - 5 ml by mouth once a day lorazepam - 0.5 mg tablet - tablet(s) by mouth q4-6 as needed for nausea, insomnia, or anxiety ranitidine hcl - (prescribed by other provider) - 150 mg tablet - one tablet(s) by mouth once day as needed for prn sorafenib - 200 mg tablet - 2 tablet(s) by mouth twice a day tiotropium bromide - 18 mcg capsule, w/inhalation device - 18 mcg inhalations via 2 inhalations daily discharge medications: 1. hydromorphone 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 2. lactulose 10 gram/15 ml syrup sig: ten (10) ml po twice a day: please titrate to 2 - 3 bowel movements per day. . disp:*qs 1 month ml* refills:*2* 3. lorazepam 0.5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for anxiety, insomnia, or nausea. 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: two (2) inh inhalation once a day. 5. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po twice a day for 4 days. disp:*8 tablet(s)* refills:*0* 8. ciprofloxacin 250 mg tablet sig: one (1) tablet po once a day: after you complete course of 500 mg . start once days in 4 days. . disp:*30 tablet(s)* refills:*2* 9. sucralfate 100 mg/ml suspension sig: one (1) gram po four times a day for 14 days. disp:*qs 14 days ml* refills:*0* 10. outpatient lab work please check cbc fax results to: dr. phone: , fax: discharge disposition: home discharge diagnosis: primary: upper gastrointestinal bleed, esophageal varices secondary: hepatocellular carcinoma, hepatitis c cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to participate in your care mr. . you were admitted to the hospital for an egd because of concern you are bleeding in your gi tract. you had a procedure called an egd - we found that you had large veins in your esophagus called varices. the liver doctors around your varices so that they would not bleed. please make the following changes to your medications: 1. start nadolol 20 mg daily 2. start ciprofloxacin 500 mg daily for 4 days. when you complete the 4 day course, you will take 250 mg daily thereafter. 3. start protonix 40 mg 4. start sucralfate 1 mg by mouth four times a day for 2 weeks 5. increase lactulose - 2 - 3 doses per day, titrate to 2 - 3 bowel movements per day please see below for your follow-up appointments. followup instructions: please call to make an appointment with your primary care doctor this week. you need to have your blood count checked (cbc) this week. please call to make an appointment with dr. within the next several weeks. department: radiology care unit when: tuesday at 9:30 am building: de building ( complex) campus: west best parking: garage department: radiology when: tuesday at 11:00 am with: cat scan building: cc clinical center campus: west best parking: garage department: hematology/oncology when: wednesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver portal hypertension other chronic pulmonary heart diseases secondary malignant neoplasm of other specified sites malignant neoplasm of liver, primary esophageal varices in diseases classified elsewhere, with bleeding other specified disorders of stomach and duodenum other and unspecified alcohol dependence, unspecified insomnia, unspecified 

Answer: The patient is high likely exposed to