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: history of present illness: this is an 87-year-old female with a past medical history significant for superficial antral ulcers in , hypertension and pes recently started on anticoagulation who presents with melanotic stools. significantly, the patient had recently been admitted to from to with shortness of breath and was found to have bilateral pe's on cta. studies at that time were negative. the patient was started on coumadin for anticoagulation. the patient was doing well until two days prior to this admission when she noted that she was more short of breath and fatigued. then one day prior to admission, the patient noted dark black tarry stools. the patient denied any new abdominal pain, nausea, vomiting, fevers, and chills. she denies alcohol use. no headaches. negative review of systems for weight loss and night sweats. the patient does have recent decrease in appetite. in the emergency room, the patient's blood pressure was 112/58 with a heart rate of 84. her hematocrit was found to be decreased from 37 to 25.7 over the course of four days. inr was therapeutic at 2.5. the patient was transfused one unit of packed red blood cells and received 1 mg of iv vitamin k to reverse her anticoagulation. gastrointestinal was consulted and saw the patient. past medical history: 1. hyperlipidemia. 2. hypertension. 3. osteoarthritis. 4. congestive heart failure. this is primarily diastolic with an ejection fraction of 55 percent. 5. spinal stenosis with cervical radiculopathy. 6. gastritis. 7. peptic ulcer disease. 8. question of a past silent myocardial infarction. medications on admission: 1. aspirin 81 mg p.o. q.d. 2. celebrex 200 mg p.o. b.i.d. 3. coumadin 2 mg p.o. q.d. 4. eye drops. 5. calcium bicarbonate 500 mg p.o. t.i.d. 6. lipitor 10 mg p.o. q.d. 7. multivitamin tab one tab p.o. q.d. 8. zestril 5 mg p.o. q.d. 9. tylenol 500 mg p.o. q. 4 to 6 hours p.r.n. 10. calcitonin nasal spray 200 units inhaled q.d. 11. ocuvite 1 tab p.o. q.d. 12. albuterol inhaler p.r.n. allergies: no known drug allergies. social history: the patient lives at in the independent living section. she states that she functions well on her own and has help with her housework. the patient has not used any tobacco since . she denies alcohol use. family history: the patient's mother died of renal carcinoma. her daughter had breast carcinoma. physical examination: on admission, temperature was 95.6, heart rate 88, blood pressure was 123/60, respiratory rate was 23, oxygen saturation was 95 percent on room air. in general, pleasant elderly lady in no apparent distress, alert and oriented times 3. head, ears, eyes, nose and throat: normocephalic and atraumatic. moist mucus membranes. neck: no jugular venous distention or lymphadenopathy. lungs: bibasilar crackles but clear to auscultation bilaterally. cardiac: regular rate and rhythm. no murmurs, rubs or gallops. abdomen: soft. positive left periumbilical tenderness with question of guarding. no rebound. normal active bowel sounds. extremities: warm, 2 plus dorsalis pedis pulses bilaterally. trace edema bilaterally. neurological: alert and oriented times 3. no focal deficits. breasts: no masses or lymphadenopathy appreciated. laboratory data: on admission, white blood cell count was 10.3, hematocrit was 25.7, down from 37.1 on , platelets 266, inr 2.5. chemistry: sodium 139, potassium 4.2, chloride 103, bicarb 26, bun 72, creatinine 1.1, glucose 126, ck 112, mb 4, troponin 0.13. hospital course: 1. gastrointestinal bleed: the patient has been admitted with melenotic stools in the setting of anticoagulation for bilateral pe's. she was then admitted to the fenard intensive care unit initially for close monitoring. gastrointestinal was consulted. they performed an esophagogastroduodenoscopy on which showed an acute crater 10 mm ulcer in the stomach body containing pigmented material suggestive of recent bleeding and a 10 to 12 mm ulcer with a visible vessel in the stomach body with stigmata of recent bleeding. these were treated with epinephrine injection and bicap electrocautery. successful hemostasis was obtained. over the course of the first day of admission, the patient had recent a total of 3 units of packed red blood cells. despite this transfusion, her hematocrit increased only from 25.7 to 29.9 and then began to slowly turn down. therefore, on , the patient was transfused another 2 units of packed red blood cells with an appropriate increase in her hematocrit to 34.2. on , the patient had her first stool since admission to the hospital which was guaiac positive. on , a repeat esophagogastroduodenoscopy was performed by gastroenterology which revealed 3 crater nonbleeding ulcer ranging in size from 7 mm to 12 mm in the antrum. all three ulcers were a clean base and not bleeding. no ulcer was found in the stomach body and it was thought at that time that the previous report may have noted a mistake in location. no old or fresh blood was seen. the patient's hematocrit remained fairly stable throughout the remainder of admission with her hematocrit on the time of discharge 33.8. throughout the admission, the patient was continued on iv protime pump inhibitor two times daily. she was discharged to home on a protime pump inhibitor. the patient will follow up with gastroenterology for repeat endoscopy in . 1. pulmonary embolisms on anticoagulation: prior to this admission, the patient had recently been admitted to the and found to have bilateral pulmonary embolisms. she was started on anticoagulation with coumadin at that time. on admission, her anticoagulation was reversed in the setting of a gastrointestinal bleed. on , an inferior vena cava filter was successfully placed without complications. the patient will remain off all anticoagulation at this time. 1. diastolic dysfunction: the patient had no active congestive heart failure issues during the admission. her ace inhibitor was held during the admission in the setting of a gastrointestinal bleed and initially unstable hematocrit. it was restarted at the time of discharge. 1. hypertension: the patient's blood pressure was not significantly elevated during admission and her antihypertensives were held in the setting of a gastrointestinal bleed. these were restarted at discharge when her hematocrit had stabilized. 1. osteoarthritis: the patient had pain controlled with tylenol and p.r.n. marcaine while in the hospital. on discharge, she will use scheduled tylenol and follow up in rheumatology clinic. repeated discussions were held regarding the importance of avoiding all nonsteroidal anti- inflammatory drugs given her history of gastrointestinal bleeds. 1. glucose intolerance: the patient has a history of glucose intolerance. this has been followed by her primary care physician. has not been started on any diabetic medications or insulin. she was covered with a regular insulin sliding scale in the hospital and was discharged to home only with a diabetic diet. 1. prophylaxis: ivc filter and pneumoboots. 1. code: dnr/dni. condition on discharge: stable. discharge status: the patient was discharged to home. discharge diagnosis: 1. upper gastrointestinal bleed secondary to gastric ulcers. 2. osteoarthritis. 3. hypertension. 4. past pulmonary embolism. 5. glucose intolerance. discharge medications: 1. albuterol inhaler 2 puffs inhaled q. 4 to 6 hours p.r.n. 2. brimonidine 0.2 percent eye drops, one drop ophthalmic b.i.d. 3. calcitonin nasal spray 200 units one spray nasally q.d. 4. atorvastatin 10 mg p.o. q. h.s. 5. ferrous sulfate 325 mg p.o. q.d. 6. pantoprazole 40 mg p.o. q.d. 7. zestril 5 mg p.o. q.d. 8. multivitamin tab one tab p.o. q.d. follow up plans: 1. the patient will follow up with dr. in the clinic on at 11:45 a.m. 2. the patient will follow up with dr. in the endoscopy suite on at 8:30 a.m. for a repeat endoscopy. 3. the patient will contact her hematologist, dr. to schedule a follow up appointment at her convenience. dr., 12-akk procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine interruption of the vena cava endoscopic control of gastric or duodenal bleeding transfusion of packed cells transfusion of other serum diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction diastolic heart failure, unspecified other pulmonary embolism and infarction 

Answer: The patient is high likely exposed to