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: penicillins attending: chief complaint: hematobillia, acute blood loss anemia, alcohol withdrawal major surgical or invasive procedure: ercp x 2 mesenteric angio x 2 pseudoaneurysm coil embolized history of present illness: 44 year old male with history of duodenal mass and chronic idiopathic gi bleeding transferred urgently from for workup of hematobillia. the patient has had multiple egd's for workup of his duodenal mass and bleeding, which so far have been unrevealing. his last egd prior to this admission was on which apparently demonstrated blood in the duodenum with possible hematobillia as well as gastritis and the duodenal mass. a biopsy of the mass was negative for a diagnosis. a colonoscopy in was also negative for pathology. he presented to 1 day prior to admission with complaints of nausea, vomiting, abdominal pain and melena. prior to this admission he was seen on multiple occasions at hospitals for acute alchol intoxication as well as similar complaints. he reports the pain, as always is dull and aching. this was associated with nausea, vomiting for the 5 days prior to admission accompanied by anorexia. the patient states, that despite the nausea and vomitting he continued to drink with last drink 2 days prior to admission with about 4 beers. he was transfused 3 units of prbc at . he states his vomit was non-bloody but he did have hematochezia and melena in stool. at an egd was performed by dr. on /8 which again demonstrated a duodenal mass. there was no bleeding however seen from that mass, but of great concern, he was noted to have hematobilia with frank blood pouring out of his bile duct. he was transferred for urgent ercp consultation. past medical history: chronic idiopathic gi bleeding alcohol dependence with withdrawal induced seizures duodenal mass (3-4 cm in size, normal mucosa, stable on ct scan for the last 3 years) chronic pancreatitis type 2 diabetes benign hypertension diverticulosis psoriasis depression social history: - tob, drinks 12 packs of beer a day, lives with girl friend family history: non-contributory physical exam: ros: gen: - fevers, - chills, - weight loss eyes: - photophobia, - visual changes heent: - oral/gum bleeding cardiac: - chest pain, - palpitations, - edema gi: + nausea, + vomitting, - diarhea, + abdominal pain, - constipation, + hematochezia, + melena pulm: - dyspnea, - cough, - hemoptysis heme: + bleeding, - lymphadenopathy gu: - dysuria, - hematuria, - incontinence skin: - rash endo: - heat/cold intolerance msk: - myalgia, - arthralgia, - back pain neuro: - numbness, - weakness, - vertigo, - headache physical exam: vss: 99, 146/86, 106, 97% gen: nad pain: heent: eomi, mmm, - op lesions pul: cta b/l cor: rrr, s1/s2, - mrg abd: diffuse tenderness, nd, +bs, - cvat, - rebound/guarding, gauiac (+) ext: - cce neuro: caox3, non-focal, tremulous, anxious pertinent results: 08:10am blood wbc-9.1 rbc-3.74* hgb-11.2* hct-32.6* mcv-87 mch-29.9 mchc-34.3 rdw-15.3 plt ct-161 09:00pm blood wbc-7.5 rbc-3.98* hgb-11.5* hct-34.2* mcv-86 mch-28.9 mchc-33.6 rdw-14.9 plt ct-165 08:10am blood pt-13.2 ptt-29.5 inr(pt)-1.1 08:10am blood glucose-180* urean-9 creat-0.7 na-133 k-4.2 cl-97 hco3-20* angap-20 09:00pm blood glucose-138* urean-9 creat-0.6 na-134 k-3.8 cl-98 hco3-22 angap-18 08:10am blood alt-22 ast-27 ld(ldh)-154 alkphos-85 amylase-62 totbili-0.5 09:00pm blood alt-25 ast-36 ld(ldh)-146 alkphos-88 amylase-57 totbili-1.2 08:10am blood lipase-56 09:00pm blood lipase-35 08:10am blood albumin-4.2 calcium-8.3* phos-2.5* mg-1.7 09:00pm blood albumin-4.1 calcium-8.7 phos-2.3* mg-1.7 ercp : findings: other there was no evidence of esophageal varices. stomach: limited exam of the stomach was normal protruding lesions a sub-mucosal non-bleeding 4cm mass was found at the duodenal bulb. the mass caused a partial obstruction. the scope traversed the lesion. there was a 8 mm ulceration on the mass that was not bleeding. major papilla: blood was seen coming from the major papilla at the level of the pancreatic orifice. these findings are consistent with hemosuccus pancreaticus. minor papilla: blood was seen coming from the minor papilla. cannulation: cannulation of the pancreatic duct was successful and superficial with a sphincterotome using a free-hand technique. contrast medium was injected resulting in partial opacification. a 0.035in in diameter and 260cm in length straight tip glidewire was placed. pancreas: an irregular stricture that was 8mm long was seen at the main pancreatic duct. these findings are compatible with chronic pancreatitis. impression: there was no evidence of esophageal or gastric varices. mass in the duodenal bulb blood seen coming from the major and the minor papilla. the blood from the major papilla appeared to be coming from the pancreatic orifice. there were multiple calcifications seen in the pancreas. an irregular stricture that was 8mm long was seen at the main pancreatic duct. this is compatible with chronic pancreatitis secondary to alcohol abuse . ercp minor papilla: blood was seen in the minor papilla consistent with hemosuccus pancreaticus. impression: hemosuccus pancreaticus in the minor papilla 3 cm submucosal duodenum bulb mass causing partial obstruction ng tube was placed post endoscopy and confirmed with auscultation recommendations: angiography to identify the source of bleeding follow h/h eus to assess the lesion within the duodenum bulb according to angiographic evaluation . radiology report cta abd w&w/o c & recons study date of 4:34 pm impression: 1. findings consistent with acute on chronic pancreatitis. the pancreatic duct is dilated up to approximately 1.7 cm in the pancreatic neck consistent with the patient's provided history of pancreatic stricture. no evidence of pseudoaneurysm, splenic vein thrombosis or gallbladder hemorrhage. 2. mild tree in opacities are noted in the left lower lobe. these findings may be seen with bronchopneumonia or aspiration. . radiology report messenertic study date of 8:38 am preliminary report !! pfi !! uncomplicated mesenteric angiogram demonstrating aberrant vasculature including the following: 1. splenic artery arising from the abdominal aorta directly. 2. hepatic artery (common) and sma showing a common trunk from the aorta. the gda arises from the mid hepatic artery heading cephalad and lies parallel to the artery (hepatic). superior pancreatic artery arising from the gda. 3. pipd arising from a short trunk off of the sma that is tortuous. of note, small pseudoaneurysm was seen arising from the pipd. however, given the tortuosity of the vasculature we could not cannulate this vessel thus cannot treat the false aneurysm. in light of the contrast given it was decided to repeat the examination at a later date given the patient's hemodynamic stability. . radiology report messenertic study date of 9:32 am preliminary report !! pfi !! 1. mesenteric angiogram again demonstrating aberrant vasculature with a replaced common hepatic artery arising from a common trunk off of the abdominal aorta with the sma as well as a solitary splenic artery arising in the expected region of the celiac trunk. again, a 9.3 x 5.0 mm pseudoaneurysm was identified within the distribution of the anterior superior pancreaticoduodenal artery. 2. cannulation of diseased vessel with coil embolization and thrombin injection of pseudoaneurysm as well as coil embolization of diseased anterior superior pancreaticoduodenal artery. prior to embolization, note was made of contrast extending from the pseudoaneurysm in to the presumed pancreatic duct and then in to the duodenum consistent with the patient's history. 3. completion angiogram demonstrating no direct blood flow to the pseudoaneurysm. . complete blood count hct 07:15am 29.3* . brief hospital course: 1. acute blood loss anemia due to gi bleeding due to pancreatic hemorage causing hematobillia - urgent ercp consultation - egd/ercp today - type & screen through - iv hydration - npo - pain control - antiemetics - ppi, will ask gi about stopping sucralafate - given ercp results, will obtain cta-p and contact ir about coil/embolization - concern for varix vs. pseudoaneurysmal bleed - given concern of uncontrollable bleeding, despite currently hemodynamically stable, in discussion with dr. of surgery, we will transfer him to surgery after the cta-p on the , given availability of an urgent or if needed. 2. alcohol withdrawal, substance dependence - alcohol - patient in active withdrawal. he was monitored closely and had a ciwa scale. - increase valium to 10mg, and change interval to q2h - social work consultation - thiamine, folate, mvi 3. type 2 diabetes uncontrolled without complications - hold glyburide and metformin while npo - hiss - careful monitoring of blood glucose 4. benign hypertension - lisinopril - metoprolol 5. depression - topamax, venlafexine ===================================================== he was transferred to the surgery service and was in the icu for monitoring of dts and possible hemodynamic decompensation. the following procedures were performed: cta ct abd: acute-on-chronic pancreatitis with the pancreatic duct measuring up to approximately 1.7 cm in the pancreatic neck/proximal body. no evidence of intra- or extra-hepatic bile duct dilation. the gallbladder appears normal without intraluminal hyper-attenuation to suggest hemorrhage or blood clot. no evidence of pseudoaneurysm. portal venous system is patent. ercp: no evidence esoph/ varices, mass in the duodenal bulb, irreg stricture 8mm long at the main pancreatic duct ercp: hemosuccus pancreaticus in the minor papilla; submucosal mass in the duodenal bulb; otherwise normal ercp to third part of the duodenum. mesenteric angio: no definite bleeding source id'd. variant anatomy. will bring back for left brachial approach. mesenteric angio: pseudoaneurysm coil embolized (5th order branches) thrombin also injected. need to check groin. if he rebleeds, probalbly from the vessels distal to the neck (we could not get to them) cv: he was tachycardic, related to relative hypovolemia and . this resolved eventually and he was cv and hemodynamically stable. heme: his hct was monitored closely and he received transfusions as necessary for acute blood loss anemia. his inr was elevated and he received ffp as necessary prior to his angio procedures. following his angio on his hct was stable at 25.6. endo: once tolerating a diet, his home meds, including metformin and glyburide were restarted for diabetes. he will continue with his normal blood glucose monitoring and regimine at home. fen: his diet was advanced following embolization and he was tolerating food. social: he is agreeable to rehab next week. medications on admission: lisinopril 10mg daily glyburide 6mg topamax 25mg pepcid 20mg metformin 1000mg lopressor 25mg thiamine 100mg daily folate 1mg daily venlafaxine 75mg daily sucralfate 1gram qid vitamin d iu daily lunesta 2mg qhs mvi 1 tab daily discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. pepcid 20 mg tablet sig: one (1) tablet po once a day. 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 6. venlafaxine 75 mg tablet sig: one (1) tablet po bid (2 times a day). 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 8. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 9. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). 10. topiramate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* discharge disposition: home discharge diagnosis: etoh withdrawl hemobilia / gi bleed / acute blood loss anemia duodenal mass and stricture in head of pancreas hemosuccus pancreaticus in the minor papilla pseudoaneurysm tachycardia discharge condition: good discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in 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. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * take all new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to increase activity daily * no heavy lifting (> lbs) for 6 weeks. * you may shower and wash. no tub baths or swimming. * no alcohol followup instructions: follow-up with gi for a repeat ercp on tuesday . arrive at 1:00pm to . please follow-up with dr. in 3 weeks. call to schedule an appointment. follow-up with dr. from gi on at 11:00 at . call ( with questions or concerns. procedure: injection or infusion of other therapeutic or prophylactic substance arteriography of other intra-abdominal arteries transfusion of packed cells endoscopic retrograde cholangiopancreatography [ercp] diagnoses: unspecified essential hypertension acute posthemorrhagic anemia depressive disorder, not elsewhere classified other specified disorders of biliary tract diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hypovolemia chronic pancreatitis other psoriasis diverticulosis of colon (without mention of hemorrhage) acute pancreatitis other specified diseases of pancreas alcohol withdrawal delirium acute alcoholic intoxication in alcoholism, continuous aneurysm of other visceral artery other obstruction of duodenum 

Answer: The patient is high likely exposed to