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: coffee ground emesis major surgical or invasive procedure: upper endoscopy history of present illness: 89 year old female with history of htn and gastric ulcers presents with nausea, vomiting, and coffee-ground emesis >10 episodes since last night. pt developed acute onset nausea/vomiting last night around 11pm, and after 2-3 episodes of vomiting developed coffee-ground emesis. symptoms did not improve overnight, so she came in to the ed for evaluation today. she denies any fevers, chills, chest pain, dyspnea, lightheadedness, dizziness, abdominal pain or changes in bowel habits, melena, or hematochezia. she takes aspirin 81 mg every other day, but denies any recent nsaid or etoh use. she has otherwise has been feeling well without problem. previous history of upper gi bleeding. has had an upper endoscopy previously, in , for anemia, which showed multiple small shallow gastric antral ulcers without bleeding, and she did not have any follow-up egd after that. she has no history of liver disease. . in the ed, initial vs were: 99, 83, 147/83, 18, 97%. patient was noted to have a hematocrit of 43, bun 24, lipase 74. ngt was placed with immediate return of ~1.5l coffee grounds. after lavage with 1 l of ns, return was still pink. found to be guaiac negative. she otherwise feels well, and her nausea has been relieved by the ng tube placement. gi evaluated patient in the ed, would like to perform egd tonight. she received 1 l of fluids, reglan, and zofran. prior to transfer, her vitals were: 92, 129/86, 16, 97% ra past medical history: hypertension osteopenia h/o gastric ulcers - no active gi bleeds, seen in egd in . also had colonoscopy at that time h/o pe - treated with coumadin, not currently taking s/p hysterectomy s/p elbow surgery social history: former salesperson. lives at home. denies etoh, tobacco or illicits. family history: no known gi or liver disease physical exam: admission exam: vitals: t:98.9 bp: p:90 rr:18 o2:96% heent: nc/at, sclerae anicteric, dry mm neck: supple, no lad or thyromegaly lungs: cta heart: rrr, nl s1-s2, no mrg abdomen: +bs, soft/nt/nd, no hsm rectal: guaiac negative per ed extrem: wwp, no c/c/e discharge exam: vitals: t99.5 bp144/84 p78 r18 94%ra. heent: nc/at, sclerae anicteric, op clear, mmm, eomi, perrla neck: supple, no lad or thyromegaly lungs: cta bilaterally without rales, rhonchi, or wheezes heart: rrr, nl s1-s2, +2/6 sem at the second rics, no radiation abdomen: +bs, soft/nt/nd, no hsm rectal: guaiac negative per ed extrem: wwp, no c/c/e 2+ dp pt pulses pertinent results: admission labs: 02:40pm pt-12.1 ptt-23.3 inr(pt)-1.0 02:40pm plt count-227 02:40pm neuts-87.1* lymphs-10.3* monos-2.0 eos-0.3 basos-0.3 02:40pm wbc-9.9# rbc-5.10 hgb-15.4 hct-43.8 mcv-86 mch-30.2 mchc-35.2* rdw-13.4 02:40pm lipase-74* 02:40pm alt(sgpt)-17 ast(sgot)-23 alk phos-103 tot bili-1.3 02:40pm estgfr-using this 02:40pm glucose-164* urea n-24* creat-1.1 sodium-145 potassium-3.6 chloride-102 total co2-29 anion gap-18 05:05pm urine rbc-* wbc-0-2 bacteria-few yeast-none epi-0-2 05:05pm urine blood-tr nitrite-neg protein-75 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 05:05pm urine color-yellow appear-clear sp -1.022 09:20pm hct-37.7 discharge labs: 05:25am blood wbc-4.3 rbc-3.91* hgb-11.6* hct-33.1* mcv-85 mch-29.6 mchc-35.0 rdw-13.0 plt ct-150 05:25am blood glucose-98 urean-7 creat-0.9 na-142 k-3.2* cl-106 hco3-28 angap-11 05:25am blood calcium-8.5 phos-3.1 mg-1.7 egd : diffuse esophagitis with patches of black discoloration and overlying exudate suggestive of necrosis was noted throughout the esophagus. an area of heaped-up and friable mucosa with a central eschar but no obvious ulceration was noted in the fundus. this lesion may be malignant but could also represent severe localized inflammation. there was a significant amount of retained food in the fundus but no fresh or old blood. the stomach appeared deformed such that the scope repeatedly retroflexed upon attempts to reach the antrum. given the concern for acute esophageal necrosis and retained food in the stomach, the decision was made to abort the procedure. . kub : a hiatus hernia is present and gas is seen within the herniated stomach. no evidence of dilated bowel is otherwise seen. no evidence of gastric volvulus. elsewhere the bowel gas is normal. degenerative changes are noted within the lumbar spine. . ct abdomen : 1. herniation of the stomach into the thoracic cavity; somewhat it takes a tortuous course within the thorax but does not exhibit signs of volvulus. 2. hepatic cysts. 3. small bilateral pleural effusions with atelectasis. 4. sigmoid diverticulosis without evidence of diverticulitis. . cxr nasogastric tube tip within the stomach. large hiatal hernia with adjacent atelectasis. no free air under the diaphragms. brief hospital course: ms. is an 89 f with history of htn and gastric ulcers who presented with coffee-ground emesis in the setting of nausea, and was found on egd to have a black esophagus and inability to pass the scope distally secondary to a significant hiatal hernia. active issues: 1. upper gi bleed: an ng tube was placed in the ed with immediate return of ~1.5l coffee grounds initially, without clearing on lavage with 1l ns. she was admitted to the micu overnight and started on iv ppi. her hematocrit remained stable in the mid 30s. she underwent egd the following morning, which showed diffuse esophagitis with patches of black discoloration and overlying exudate suggestive of necrosis, as well as an area of heaped-up and friable mucosa with a central eschar in the fundus. the scope could not be easily advanced beyond the antrum. a gastric volvulus was suspected, though was not detected on follow up ct abdomen the following day. rather, a large hiatal hernia was seen with much of the stomach taking a tortuous course through the thorax. general surgery was involved, and at that time, the patient had decided against a surgical intervention due to high perioperative risk of mortality given her age. she was transferred to the medical floor where she was continued on ppi and sucralfate. per surgery recommendation, we advanced her diet slowly to assess for functional signs of obstruction. she tolerated advancement of her diet without nausea, vomiting, or abdominal pain. while a definitive diagnosis of her blackened esophageal mucosa was not obtained, it was felt to be possibly hemorrhagic from her severe hiatal hernia causing intermittent volvulus or obstruction. the minimally-invasive surgery team was consulted as the patient became more amenable to intervention, and felt that a correction of the hiatal hernia would be non-emergent though appropriately managed in the outpatient setting after undergoing repeat egd to definitively establish a diagnosis of her friable fundus mucosa and eschar via biopsy. she was tolerating a regular diet at the time of discharge and had gi and surgery followup in place. she was continued on her po ppi, sucralfate, and was instructed to stop aspirin. 2. hypertension: her antihypertensives were initially held given concern for upper gi bleed. she was discharged on her metoprolol and lisinopril. pending labs at discharge: none transitional care issues: - will need repeat egd as an outpatient to establish diagnosis of esophageal and gastric abnormalities - will need to follow up with dr. following repeat egd. patient was given the office phone number. medications on admission: carvedilol cr 80 mg daily lisinopril 40 mg daily aspirin 81 mg every other day discharge medications: 1. sucralfate 100 mg/ml suspension sig: ml po four times a day. disp:*qs bottle* refills:*2* 2. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 3. 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* 4. carvedilol phosphate 80 mg cap, multiphasic release 24 hr sig: one (1) cap, multiphasic release 24 hr po once a day. discharge disposition: home discharge diagnosis: 1. paraesophageal hiatal hernia 2. hematemesis 3. black esophagus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital after vomiting blood. you underwent an endoscopy which revealed likely dark bleeding and poor blood flow to the esophagus, and a mass-like object in your stomach which may represent a compression of the stomach by a hiatal hernia. this means that part of the stomach is extending up into the chest through the diaphragm. you were evaluated by the surgery team, who feels that you will eventually need surgical repair, but you will need to have another endoscopy prior to this procedure as an outpatient. we slowly allowed you to eat more substantial foods, which you were able to tolerate well. the following changes were made to your medications: 1. start pantoprazole 40mg twice a day until instructed to stop 2. start sucralfate 1 gram four times a day until instructed to stop. do not take at the same time as your pantoprazole, as it will decrease its effectiveness. try to take it 1-2 hours apart. 3. stop aspirin and all other "non steroidal anti-inflammatory drugs" like ibuprofen and naproxen. please continue all other medications as previously prescribed. it was a true pleasure working with you, ms. . followup instructions: you have the following appointments to see your pcp and gi specialist: department: bidhc when: monday at 11:00 am with: address: 545a , department: div. of gastroenterology when: wednesday at 1 pm with: , md building: ra (/ complex) campus: east best parking: main garage please call dr. after you meet with your gi specialist and have a repeat endoscopy to discuss the surgical repair of your hernia. his office can be reached at . md procedure: other endoscopy of small intestine diagnoses: unspecified essential hypertension acute posthemorrhagic anemia diaphragmatic hernia without mention of obstruction or gangrene fever, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage disorder of bone and cartilage, unspecified esophageal hemorrhage 

Answer: The patient is high likely exposed to