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: aspirin / nexium attending: chief complaint: gi bleed, altered mental status major surgical or invasive procedure: none history of present illness: 75 yo m with cirrhosis nash and likely etoh use c/b portal hypertension, gastric varices, recurrent ugib requires tips placement in and revision in , encephalopathy, and other medical issues, now transferred from for fresh hemetemesis and coffee ground on ng lavage. per patient's wife, he was at his usual state of health until . he woke up feeling unwell, and his wife saw him sitting at the edge of the bed with a wastebasket that had about 2 cups of red-brown blood. she flushed it, and he dry-heaved and vomited up another cup of blood. he was taken to . according to the wife, patient was a&ox3. she firmly stated that he has not touched alcohol since . per dr. at , patinet was admitted to the icu on with hematemesis. exam was notable for clear lungs, mild tachycardia, asterixis, alert, and awake. his initial hgb was 10.9 but then subsequently dropped to 8.8. it was reported that his hemodynamics were stable. he received 2 units of prbc and 2 units of ffp. he was started on octreotide and protonix gtt. he was also given 5 mg po vitamin k daily. patient was apparently alert and oriented at the time of the admission. he became agitated (pulled out iv & punched a nurse) and hallucinated overnight and received iv ativan (3 mg) and ? haldol for concern of etoh withdrawal although patient and his wife denied etoh ingestion. on the day of transfer, patient underwent egd with banding. per verbal report, it seemd that he had gastric varices that was no longer actively bleeding. he received another unit of prbc for hgb of 9.1 and 2 more ffp. he was thought to be more sedated, possibly from hepatic encephalopathy and medication (lorazepam), only arousable to painful stimuli. dr. stated that patient's vs were stable at the time of transfer and did not think patient would require intubation. he was continued on lactulose and rifaximin. he was also given ceftriaxone prophylactically given the gib. vs upon transfer were 98.6f, pulse 69, resp 14, bp 136/85, o2sat 100%. wife wants him to receive the remaining of his care here at . on arrival to the micu, patient's vs were 97.7f, 74, sbp 137, rr 22, o2sat 96% ra. patient mumbled. review of systems: (+) per hpi (-) unable to obtain past medical history: - cirrhosis nash and likely etoh c/b portal hypertension, varices, encephalopathy - h/o etoh abuse - h/o recurrent variceal bleeds s/p tips placement in and tips revision - gastric varices - diverticulosis - gerd - barrett's esophagus - h/o rheumatic fever - h/o thrombocytopenia - cataracts, s/p bilateral cataract surgeries, last one was 2 weeks ago - h/o right humerus fx, s/p reverse shoulder surgery in - cad (per omr, but wife is not aware of this) social history: - ex-smoker, quit in , ~ 37.5 pack year - h/o heavy etoh, quit - part time plumber - lives with wife - 2 adult children - no illicit drug use family history: - no family history of cad, dm, cancer - no family history of liver disease - mother died of old age - father died of lung disease physical exam: admission exam general: lethargic, oriented to self, does not appear to be in acute distress heent: sclera anicteric, mucous membrane dry, op clear, neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation anteriorly bilaterally, no wheezes, rales, ronchi abdomen: soft, mildly distended, non-tender, no rebound or guarding gu: + foley, yellow urine rectal: dark tarry liquid stool ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. trace edema neuro: perrla, eomi, oriented to self, but not oriented to place or time, + asterixis, move all 4 extremities, gait deferred. . exam: vs: t 98 bp 100-120/40-50s hr 70s rr 18 o2 100 ra general: well appearing, nad, aox3. heent: sclera icterus noted. mmm. cardiac: rrr with m/r/g noted lungs: lungs clear b/l without wheeze. abdomen: soft, mildly distended, no tenderness to palpation. (-) hsm. extremities: mild edema b/l. warm and well perfused, no clubbing or cyanosis. neurology: no asterixis, mild tremor pertinent results: admission labs 10:02pm blood wbc-10.2 rbc-3.45* hgb-10.6* hct-32.3* mcv-94 mch-30.7 mchc-32.7 rdw-14.9 plt ct-110* 10:02pm blood pt-14.4* ptt-32.0 inr(pt)-1.3* 10:02pm blood glucose-158* urean-30* creat-0.8 na-146* k-4.4 cl-115* hco3-24 angap-11 10:02pm blood alt-18 ast-34 ld(ldh)-232 alkphos-64 totbili-1.9* 10:02pm blood albumin-3.3* calcium-8.3* phos-2.4* mg-2.1 . urine studies 10:02pm urine color-yellow appear-clear sp -1.018 10:02pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 10:02pm urine rbc-67* wbc-16* bacteri-few yeast-none epi-0 renalep-<1 . microbiology urine culture (final ): no growth. blood culture- pending . imaging cxr heart size is upper limits of normal. there is tortuosity of the thoracic aorta. the lungs are relatively clear without signs for overt pulmonary edema or focal consolidation. no pneumothoraces are identified. . abdominal us limited study as above with patent tips, main portal vein and left portal vein. . tips study : 1. mild-to-moderate focal stenosis was demonstrated at the distal shunt-hepatic vein junction. this was confirmed with the pressure jump across the area of stenosis. 2. angioplasty was performed with a 10 mm x 4 cm balloon. 3. post-angioplasty venogram did not demonstrate the area of stenosis. the gradient had also normalized across the area of interest. 4. pre-angioplasty portosystemic gradient was 8 mmhg and post-angioplasty portosystemic gradient was 7 mmhg. mri abdomen w/ and w/o contrast: 1. patent portal vein, tips and splenic vein. 2. non-occlusive thrombus in the smv, slightly more extensive than on the mri. 3. no large concerning hepatic lesion although assessment is limited by non-breath-hold technique. egd : normal mucosa in the esophagus (no varices noted) normal mucosa in the duodenum abnormal vascularity and mosaic appearance in the body and fundus compatible with mild portal hypertensive gastropathy erythema and petechiae in the antrum compatible with moderate gave food in the stomach small gastric varices with prior bands in place a focal area of erythema in the body which may be from prior ng tube trauma otherwise normal egd to third part of the duodenum . labs on : 10:00am blood wbc-3.2*# rbc-2.96* hgb-9.4* hct-28.4* mcv-96 mch-32.0 mchc-33.3 rdw-15.3 plt ct-63* 10:00am blood pt-15.1* ptt-31.4 inr(pt)-1.4* 10:00am blood glucose-118* urean-5* creat-0.8 na-141 k-4.2 cl-111* hco3-24 angap-10 10:00am blood alt-18 ast-32 alkphos-73 totbili-1.1 10:00am blood calcium-7.4* phos-2.6* mg-1.8 brief hospital course: 75 yo m with cirrhosis nash and possibly history of heavy etoh use c/b portal hypertension, gastric varices, recurrent ugib requires tips placement in and revision in , encephalopathy, and other medical issues, transferred to micu from for upper gi bleed and delirium. # ugib. most likely gastric varices given his history of variceal bleeding, though also could be secondary to gastric angioectasias. unclear what the precipitant was given this occurred quite suddenly. per wife, he was taking all of his medications as prescribed and that he has not had any alcohol since . ruq us showed patent tips. patient underwent egd at osh with banding of non bleeding gastric varicies. patient received a total of 3 u prbc and 4 of ffp at osh. on arrival to micu he was continued on an octreotide drip and iv ppi. his home nadolol was initially held. he was further started on ceftriaxone for sbp prophylaxis. hepatology was consulted and recommended starting carafate. hct remained stable and he was transferred to the liver service. on the hepatology floor, ruq us demonstrated patent tips, but still had concern for malfunction of tips given the bleed. pt had mri to evaluate for portal or sma thrombus, which was negative. tips study completed which demonstrated focal stenosis at distal shunt-hepatic vein junction. an angioplasty was performed and the pressure gradient was reduced from 8mmhg to 7mmhg. a post-procedure venogram did not show the area of stenosis. of note, hct trended down very slowly from 30 to ~26 while on the floor, did not suspect bleed, but will have labs re-checked on . # encephalopathy, nos. based on history, patient initially was alert and oriented at the time of initial admission to osh. his mental status deteriorated in the setting of ugib and possibly result of benzodiazepine +/- antipsychotics. it is not clear if he received antipsychotics based on osh record. it is also unclear how frequently he was receiving lactulose for his underlying hepatic encephalopathy. infectious work-up including cxr,ua, and blood cultures were negative for infection. he was continued on lactulose and rifaxamin. sedating medications were avoided. ms improved. the patient did not exhibit signs or symptoms of withdrawal. # cirrhosis nash/etoh. appears to be compensated based on recent labs. meld score per osh labs was 15 on arrival. his home spironolactone and lasix were held in the setting of a mildly elevated cr but re-started on . # cataract, s/p surgery 2 weeks ago. he was continued on his home eyedrops. transitional issues - will f/u in liver clinic - will have labs checked on and faxed to liver clinic (particularly cbc) - patient was full code throughout this admission medications on admission: home medications: per wife - 550 mg po bid - omeprazole 20 mg - magnesium oxide 250 mg - aldactone 25 mg qd (down from since last hepatology visit) - lasix 40 mg daily - lactulose 2 tablespoons - iron 240 mg - a medication for the bones- "osteo---" daily - ? neo-poly-dex eye drops 1 drop in right eye qid - ? ketorolac 1 drop in right eye qid medications upon transfer: - folic acid 1 mg daily - ketorolac 0.5% ophth solution right eye, qid - lactulose 20 g tid - mvi daily - nadolol 20 mg daily - neomy/polymyx/dexam ophth susp right eye, qid - octreotide 25 mcg/hr gtt - protonix 40 mg daily - phytonadione 5 mg daily - rifaximin 550 mg - thiamine 100 mg daily - ceftriaxone 1 g daily - ativan 1-2 mg iv q2-4hr prn for agitation - ns 75 ml/hr medications: 1. outpatient lab work please check chem10, cbc, lfts, coags and fax to: liver transplant clinic 2. rifaximin 550 mg po bid 3. nadolol 20 mg po daily pls hold for sbp<100 or hr<60 4. lactulose 30 ml po tid 5. ferrous sulfate 240 mg po daily 6. furosemide 40 mg po daily 7. spironolactone 25 mg po daily 8. magnesium oxide 250 mg po bid 9. omeprazole 40 mg po bid rx *omeprazole 40 mg 1 capsule(s) by mouth twice a day disp #*60 capsule refills:*0 disposition: home diagnosis: gastric variceal bleed hepatic encephalopathy tips occlusion condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. instructions: dear mr. , you were admitted to another hospital initially because you were having a lot of bleeding from some blood vessels in your stomach. there, the bleeding was stopped and you were transferred to medical center. here, you did not have any more bleeding. you had another endoscopy which confirmed you did not have any bleeding. we were concerned that your tips was not open. an mri and ultrasound were normal. you then had a dedicated tips study which did show a narrowing which was dilated successfully. we have made sure your kidney function was normal after the procedure. you were a bit confused initially during the admission. please make sure to take your lactulose regularly, goal of bowel movements daily. your blood counts were a little bit low, so we would like you to have them checked after the weekend. we have made the following changes to your medications: - increase omeprazole to 40mg twice per day - increase lactulose to 30ml 3 times per day, goal of bowel movements daily on , please call dr. office to schedule a follow up appointment at in the next 1-2 weeks. please have your labs checked on , and faxed to the liver clinic. prescription included below. followup instructions: department: radiology when: thursday at 10:00 am with: ultrasound building: cc campus: west best parking: garage department: liver center when: thursday at 11:00 am with: , md building: lm campus: west best parking: garage procedure: other endoscopy of small intestine other revision of vascular procedure phlebography of other intra-abdominal veins using contrast material central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified alcoholic cirrhosis of liver portal hypertension other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other vascular device, implant, and graft hepatic encephalopathy varices of other sites hyperosmolality and/or hypernatremia other and unspecified alcohol dependence, unspecified other chronic nonalcoholic liver disease angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to