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: patient recorded as having no known allergies to drugs attending: chief complaint: rectal bleeding major surgical or invasive procedure: upper endoscopy x 2 colonoscopy history of present illness: 75 yom w/ h/o esophageal cancer s/p chemo and radiation, portal hypertension/cirrhosis etoh w/ h/o variceal blead , recently dx hcc s/p chemoembolisation who presents s/p syncope. pt was on his way to outpt appointment when collapsed; loc ~ 1 min. no head trauma. no witnessed seizure activity. pt transported to ed where hr 80, sbp 70. he was noted to have a melena/brbpr in ed, and pt reported that he had noted several episodes of melena for the last 5 days (unable to quantify exact amount and frequency). he also reported significant nsaid use (ibuprofen 2 tablets qid) in ed initial hct 16.0; pt received 6 u prbc, 3 u ffp, 2 l ns, protonix 40 mg iv x 1, octreotide gtt; f/u hct 14.2. given persistent hypotension, he was started on a dopamine gtt; received levofloxacin 500 mg iv x 1 and metronidazole 500 mg iv x 1. pt had egd in ed which showed no evidence of active bleeding; portal gastropathy, esophageal varices, and small avm in stomach were noted. currently pt is sedated following egd, and further history is obtained from his children. they report that he has had frequent loose bm (~10/day) for the last 10 days and reported mild nausea (although no significant vomiting) and bloating/abdominal distension. no f/c/r. (+) decreased appetite/po intake. in micu, pt received the last 3 units of his total 9 units prbcs, was a total of 12l positive so far over length of stay, had colonscopy that did not reveal a bleeding source though was notable for a diverticulum, polyps in the distal descending colon, angioectasias in the ascending colon, transverse colon and mid-descending colon (thermal therapy), grade 2 internal hemorrhoids. patient's hct remained stable after his initial presentation, though he continues to have melanotic stools. also of note, patient's mental status has waxed and waned over admission, worsened over the last night in the setting of receiving ativan and ambien. required 1:1 sitter while in micu, patient's family says he is somewhat of a "fighter" at baseline, but that he worsened in the last 24h since the above meds were given. has had mild pain controlled with tylenol, low dose given hepatic dysfunction. inr has come down with vit k, ffp. past medical history: 1) esophageal cancer dx - egd: 3 cords grade ii varices in lower 3rd of esophagus; stricture @ 26 cm w/ contact bleeding; eus c/w t3n1mx - egd: - s/p cisplatin and 5fu w/ concurrent radiation therapy completed - no evidence of residual disease by egd -> 2 cords grade ii varices in lower third of esophagus with esophageal stenosis at 23 cm -> bx not c/w cancer; likely represents radiation changes 2) cirrhosis (attributed to etoh) w/ h/o variceal bleed s/p cautery 3) hcc dx - s/p chemoembolization 4) arthritis 5) seasonal allergies social history: h/o heavy etoh use; sober -; resumed etoh; last drink . quit tobacco 35 yrs ago ( ppd 30 yrs). prior fishmarked owner. married and lives w/ wife family history: grandfather died of unknown cancer. brother w/ "heart disease." sister w/ breast ca physical exam: vitals on admit to micu: tc 96.8, pc 80, bpc 119/42, resp 12, 100% nrb vitals on transfer to medicine floor: 63 138/67 14 100% on 2l gen: lying in reclining chair, a+ox3, somnolent but arousable to voice, following commands, nad heent: anicteric, pupils small and minimally responsive, eom slow to react, mmm, op clear with no subungal jaundice, neck supple, +jvd, +hepatojugular reflux, +flushed face chest: rsc portocath c/d/i; lungs with decreased bs at bases b/l c/w small lung volumes, no wheezing, rhonchi or rales cardiac: rrr, no m/r/g abd: obese, markedly distended but soft; liver edge 3 cm below rcm, nabs; no caput genitalia: +scrotal edema ext: no c/c/e, +trace le edema b/l, 1+ dp bilaterally neuro: cn ii-xii intact though pupils minimally reactive; sensation to lt intact throughout, 5/5 strength in ue/le b/l; +asterixis; no tongue fasciculations; linear tp, somnolent but pleasant affect pertinent results: recent labs: 05:41am blood wbc-4.6 rbc-3.03* hgb-9.2* hct-27.6* mcv-91 mch-30.5 mchc-33.4 rdw-18.3* plt ct-151 05:41am blood plt ct-151 05:41am blood glucose-123* urean-11 creat-0.6 na-135 k-3.4 cl-98 hco3-32* angap-8 04:01am blood alt-34 ast-70* ld(ldh)-286* alkphos-198* totbili-1.3 05:41am blood calcium-7.8* phos-2.1*# mg-1.4* 04:01am blood albumin-2.4* calcium-7.4* phos-3.7 mg-1.6 04:01am blood ammonia-<6 11:30am urine color-straw appear-clear sp -1.010 11:30am urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 11:30am urine rbc-0-2 wbc-0-2 bacteri-none yeast-none epi-0-2 06:36pm ascites wbc-8* rbc-1381* polys-27* lymphs-46* monos-11* mesothe-7* macroph-9* 06:36pm ascites albumin-<1.0 04:25am blood wbc-7.4 rbc-3.51* hgb-10.3* hct-30.8* mcv-88 mch-29.4 mchc-33.5 rdw-18.6* plt ct-159 04:25am blood pt-14.2* ptt-30.6 inr(pt)-1.3 04:25am blood glucose-120* urean-24* creat-0.6 na-136 k-3.5 cl-105 hco3-25 angap-10 02:29am blood alt-41* ast-52* alkphos-135* totbili-3.4* 01:06am blood alt-51* ast-68* ld(ldh)-336* alkphos-144* amylase-49 totbili-4.3* dirbili-1.9* indbili-2.4 01:06am blood lipase-49 04:25am blood mg-1.6 02:29am blood calcium-7.5* phos-2.4 01:16pm blood albumin-2.2* 01:06am blood hapto-159 12:30pm blood tsh-6.0* 12:30pm blood t4-4.7 12:30pm blood afp-1187* 01:26am blood freeca-1.07* 09:38pm urine color-yellow appear-clear sp -1.015 09:38pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-5.0 leuks-neg 09:38pm urine rbc-* wbc-0 bacteri-occ yeast-none epi-0-2 09:38pm urine eos-negative 09:38pm urine hours-random creat-67 na-50 micro: urine inpatient no growth sputum inpatient contamination blood culture inpatient no growth blood culture inpatient no growth urine inpatient no growth reports: cxr: 1) interval resolution of the right upper lobe partial atelectasis and/or infiltration. 2) minimal degree of left lower lobe infiltration, unchanged. no evidence of new infiltration or pulmonary congestion. abd ultrasound: findings: four quadrant ultrasound of the abdomen demonstrates a moderate amount of ascites. an appropriate spot within the right lower quadrant of the abdomen was marked for the ordering service, for the purpose of paracentesis. chest, single ap film: history of gi bleed with wheezing. there are low lung volumes. right subclavian cv line has tip located in region of cavoatrial junction. allowing for technique, heart size is within normal limits and there is no evidence for chf. lungs are grossly clear. ecg: sinus rhythm. compared to the previous tracing the rate has slowed slightly. t waves have normalized in the inferior leads. st-t wave abnormalities have normalized in leads v4-v6. t wave inversions remain in leads v2-v3. ct abd/pelv: impression: 1. interval development of a fair amount of fluid within the abdomen and pelvis, which measures hounsfield units consistent with simple fluid or ascites. clinical correlation is requested. low attenuation hemoperitoneum is rarely seen on ct, but there is no sentinel clot sign as described above to indicate bleeding from solid organs. note that it is somewhat atypical for simple ascitic fluid to collect in the right anterior pararenal space and about the cecum and proximal ascending colon. 2. the appearance of the liver parenchyma is unchanged from . 3. there is interval development of small bilateral pleural effusions. gi bleeding study impression: 1) no active bleeding within the bowel. 2) findings to suggest the possibility of a hematoma within the right upper quadrant. this is possibly a nonspecific finding in light of patient's recent chemo embolization. clinical correlation is requested. brief hospital course: 75 yom with h/o esophgeal ca, variceal bleed, hcc s/p recent chemoembolization presents s/p syncopal episode w/brbpr and melena. . gi bleed: felt to be most likely ugib from esoph varices, though egd was not entirely clear as bleeding had stopped. ddx also included pud, gastric avm, portal gastropathy, small bowel neoplasm, diverticular bleed, colonic avm, hematobilia (given recent chemoembolization). colonoscopy, bleeding scan, ct scan of abdomen and egd did not reveal bleeding lesion though egd showed varices that appeared to have bleed sometime recently. hct was fairly stable after receiving 9 units of prbcs and 3 units ffp, though the patient did get one more unit of prbcs after transfer to the medical floor for hct<28. he was continued on iv protonix and octreotide gtt initially, and an attempt was made at banding his varices though this was not successful secondary to an esoph stricture that limited passage of the banding device. he will follow up with dr. on an outpatient basis and will need his hct followed closely after discharge. . wheezing: developed while in the micu after fluid resuscitation, likely from lung compression by ascites + some element of cardiac asthma. he responded well to lasix while in the unit, and was continued on lasix 40mg po qd while on the floor with a goal -1l/day until he became volume contracted. of note, he was 13l positive after agressive resuscitation in micu. his wheezing went away after diuresis and subsequent paracentesis. . arf: cr 5.1 on admit from baseline 0.7 , felt to be primarily prerenal with drop to 0.6 after volume resuscitation. . hypotension: on admit, resolved with ivf, likely secondary to volume depletion in setting of gi bleed. . coagulopathy: may be secondary to vit k deficiency (given poor po intake), decreased synthetic function given hcc and recent chemoembolization, massive transfusion of prbc. cont vit k 5 mg sc x 3 days, gave ffp x 3 while in unit to correct inr to <1.4. . ag acidosis: on admit, likely secondary to increased lactate and prerenal arf from hypoperfusion, resolved with ivf. . altered mental status: developed while in the unit in the setting of ativan, ambien, zyprexa given on one night. it was felt unlikely to be from infection as his wbc count was normal, he had no fever, his ua was negative, his cxr clear, blood cx without growth. all sedating meds were held initially, his mental status cleared, and then low dose (5mg) ambien was used as needed to help him sleep, at the patient's request. . h/o etoh abuse: reportedly no etoh since . gave thiamine and folate. monitored closely for evidence of withdrawal with ativan prn ciwa scale but no evid of withdrawal while in house. . oncology: h/o esophageal cancer, hepatoma; possible multiple pulmonary mets, spinal mets, ileum mets on recent ct (although atypical spread for both esophageal cancer and hepatoma). will need further w/u as outpatient once clinically stabilized. . communication: daughter . code: full code; confirmed w/ hcp (). discussed pt situation at length with daughter on . pt and family are aware of pt's guarded prognosis. per daughter pt has been a "fighter" and states that he is "on his 7th out of 9 lives". also has stated that "every day extra is a gift". he has also made it clear that he does not want extreme measures to be taken if the cause of his demise is irreversible. he is agreeable to intubation and cardioversion only if there is a strong chance of recovery. if it is known that his emobolization procedure is ineffective and there is nothing else that can be done to save his liver the family is comfortable with taking him home and making him comfortable. medications on admission: 1) tylenol prn 2) prilosec 20 mg po daily 3) atenolol 25 mg po daily 4) benadryl 25 mg po qid prn 5) advil tab qid 6) feso4 325 mg po daily 7) zantac 150 mg po bid 8) dilaudid 2 mg po q6h prn 9) aranesp (last dose 3/10) discharge medications: 1. nadolol 20 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 mdi* refills:*2* 5. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*2* 9. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: blood loss anemia hypovolemic shock gi bleed, likely esophageal variceal bleed altered mental status respiratory distress acute renal failure coagulopathy acidosis, anion gap h/o etoh abuse liver failure portal hypertension discharge condition: hemodynamically stable, hct stable at ~30 after 10 units resuscitation, no further melena or brbpr discharge instructions: please continue to take all medications as prescribed and to follow up with your doctors. if you develop bleeding from your mouth or rectum, dark stools, lightheadedness, dizziness, chest pain, shortness of breath, or any other concerning symptoms, go to the nearest emergency room for evaluation. followup instructions: please keep the following appointments: provider: , rn where: hematology/oncology phone: date/time: 12:00 dr. , gastroenterology ( tuesday . , you should also set up an appointment with your primary care doctor in the next week to follow up on the medical issues addressed during this hospitalization. md, procedure: other endoscopy of small intestine percutaneous abdominal drainage esophagogastroduodenoscopy [egd] with closed biopsy endoscopic destruction of other lesion or tissue of large intestine transfusion of packed cells transfusion of other serum infusion of vasopressor agent diagnoses: acidosis acute posthemorrhagic anemia acute kidney failure, unspecified portal hypertension other shock without mention of trauma malignant neoplasm of liver, primary secondary malignant neoplasm of lung esophageal varices with bleeding secondary malignant neoplasm of bone and bone marrow stricture and stenosis of esophagus personal history of malignant neoplasm of esophagus angiodysplasia of intestine (without mention of hemorrhage) secondary malignant neoplasm of small intestine including duodenum 

Answer: The patient is high likely exposed to