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: r-sided flank pain major surgical or invasive procedure: exchange of the right and left nephrostomy tubes history of present illness: in brief, the patient is a 52 f h/o metastatic colon ca recently place on hospice care and s/p bilateral nephrostomy tube placement. she presented to the ed on with acute onset of r sided flank pain, associated with nausea and nonbloody vomiting on the evening of . no fever, cp, sob. on arrival to the ed, t 98, hr 100, 160/117, 16, 95%ra. exam revealed diffusely tender abdomen without any peritoneal sign. wbc 20, cr 1.9 (baseline 0.8), lactate 4.3. non-contrast abdominal ct revealed r-sided hydronephrosis with fat stranding. she received ceftriaxone, vancomycin, and pip-tazo. after 3l of ns, her lactate went down to 3.7, and her hr down to 80s. ir replaced nephrostomy tubes on both sides. she was admitted to the micu. she received ivf but never received vasopressors. her lactate trended down. her urine output improved. she had both nephrostomy tubes placed with good effect. her creatinine peaked at 1.9, is now 1.4. she is now transferred to the floor. ms. feels much better. she has chronic constipation and abdominal discomfort, but takes no narcotics. her r flank is still slightly painful, but improved. she is still somewhat nauseated. review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied diarrhea, constipation. no recent change in bowel or bladder habits. denied arthralgias or myalgias. past medical history: oncologic history: she initially presented on to the emergency department with abdominal pain and pelvic pain. she said at that time the pain was predominantly in her lower pelvic area. on a ct scan on , she had a large pelvic mass measuring 14 x 8 x 8 cm. she underwent a tahbso and ileocolectomy on . on frozen section, it was found that the tumor was most consistent with a colonic primary. on final pathology, it was found to be a 7-cm colon cancer, which was a pt3 n2 m1 with metastases to the ovary. she was discharged from that admission on . she had a port placed on . she started on capecitabine, oxaliplatin on . of note, she is k-ras mutation positive for the gly-12 . ms. was admitted on due to abdominal pain and was found to be in acute renal failure. based on this, she had bilateral nephrostomy tube placement performed at that time. of note, on her ct on , she had evidence of disease progression. she completed three cycles of capecitabine and oxaliplatin. she had evidence of ct progression on a scan performed on . based upon that, we changed her to irinotecan alone, which she received for one cycle. she ended up having another ct performed on to evaluate hydronephrosis which showed further disease progression. as her disease continued to progress despite chemotherapy, she started receiving hospice care in . pmh: stage iv colon ca h/o hydronephrosis s/p nephrostomy tube placement asthma social history: the patient is currently on home hospice. she currently lives in with her longterm boyfriend. the patient has 3 children. she previously was employed as a case manager at house working with patients with addictions. tobacco: smokes a "few cigarettes" intermittently, 20-30 pack years. etoh: none. illicits: none family history: mother: physical exam: vitals: t: 98.4 bp: 130/86 p: 94 r: 18 o2: 98% on ra general: thin, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: mildly diffusely tender, firm r-sided mass, bowel sounds present, no rebound tenderness or guarding flank: bilateral nephrostomy tubes in placed. l draining clear urine, r draining pink urine. r-sided flank pain to percussion, l non-tender ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 10:40am glucose-146* urea n-19 creat-1.9*# sodium-142 potassium-3.1* chloride-92* total co2-26 anion gap-27* 10:40am wbc-20.0*# rbc-4.85 hgb-14.0 hct-42.1 mcv-87 mch-28.9 mchc-33.3 rdw-16.6* 10:40am neuts-85.8* lymphs-8.5* monos-4.8 eos-0.5 basos-0.3 10:40am plt count-751* 12:12pm lactate-4.3* 01:40pm lactate-3.7* 03:21pm lactate 2.4* 05:08am lactate 2.4* discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:50am 9.3 3.69* 11.0* 32.7* 89 29.9 33.7 17.2* 562* renal & glucose glucose urean creat na k cl hco3 05:50am 109* 5* 0.7 139 3.6 103 26 micro: bcx x2: ngtd ucx: yeast images: abd ct abd/pelvis (): 1. no evidence of free air. no evidence of bowel obstruction. free fluid in the abdomen. please note that evaluation is limited due to lack of iv and oral contrast. 2. evidence of significant hydronephrosis and hydroureter on the right, with significant fat stranding and areas of fluid attenuation which could suggest urinoma. findings are concerning for nonfunctioning right nephrostomy tube. 3. innumerable hepatic and splenic lesions, with similar appearance compared to prior study consistent with metastatic disease. peritoneal carcinomatosis with multiple mesenteric and peritoneal soft tissue implants. 4. cholelithiasis with possible gallbladder adenomyomatosis. cxr (): vague lucency in the right upper abdomen may represent interposed bowel or gas related to nephrostomy tubes, but free air or gas in a collection cannot be excluded. ct may be helpful for further evaluation depending on level of clinical concern. bilateral nephrostomy tube change (): impression: 1. successful exchange of bilateral indwelling nephrostomy catheters with new 8 french flexima nephrostomy catheter. 2. moderate-to-severe right-sided hydronephrosis. antegrade urography(): impression: 1. right-sided percutaneous nephrostomy tube patent and in correct position within the renal pelvis. 2. possible obstruction within the tube/bag which was exchanged. the patient was also educated regarding nephrostomy tube flushes b.i.d. kub (): impression: nonspecific bowel gas pattern with air seen throughout the large and small bowel. brief hospital course: 52 yo female with metastatic colon ca s/p b/l nephrostomy tube placement admittd with right-sided flank pain, n/v, found to have severe r-sided hydronephrosis, s/p b/l nephrostomy replacement. # hydronephrosis: the patient's arf resolved with nephrostomy tube change. her left nephrostomy tube consistently put out good urine output, however her right nephrostomy tube had low output intermittently. ir evaluated it several times and brought her back for a urogram, however the tube appeared to be in the correct position. they recommended twice daily flushing of the tube to maintain patency. urine culture only grew out yeast which is likely due to colonization. she was initally treated with 4 days of ceftriaxone due for high suscipicion of hydronephrosis. this was changed to cefpodoxime and she was discharged to complete a 10 day course as an outpatient. # n/v/constipation: the patient had over a week of constipation on admission. she was treated with colace, senna, lactulose, and a dulcolax suppository and eventually had several bowel movements. she continued to experience nausea and vomiting, but reported that it was her baseline and felt she could keep up with oral intake adequately at home. her nausea was treated with zofran, compazine, and ativan prn. # lactic acidosis: her lactic acidosis (4.3 on admission) was likely secondary to dehydration and trended down with ivf. # metastatic colon ca: patient was supposed to have started hospice prior to admission to the hospital, however before discharge she decided she did not want enroll in hospice at this time. her pain was controlled with percocet prn. she will follow up with dr. on . # asthma: asymptomatic during this admission. she was continued on her albuterol prn. # code: dnr/dni medications on admission: albuterol inh fluticasone inh ondansetron prn oxycodone-acetaminophen prn polyethylene glycol prn kcl 40 meq qday prochlorperazine prn docusate senna discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: puff inhalation every four (4) hours as needed for shortness of breath or wheezing. 2. fluticasone 220 mcg/actuation aerosol sig: two (2) puff inhalation twice a day. 3. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*30 tablet(s)* refills:*0* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: two (2) tablet po at bedtime as needed for constipation. 6. polyethylene glycol 3350 17 gram (100 %) powder in packet sig: one (1) packet po once a day. 7. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. disp:*30 tablet(s)* refills:*2* 8. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. disp:*1 bottle* refills:*2* 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day. 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. disp:*25 suppositories* refills:*2* 12. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day for 10 days. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary - obstruction of the right nephrostomy tube resulting in hydronephrosis probable pylenephritis constipation secondary - metastatic colon carcinoma asthma discharge condition: stable, consistent output from both the right and left nephrostomy tubes. continues to have what she reports is her baseline occasional nausea and vomiting. discharge instructions: you were admitted to the hospital due to back pain, nausea and vomiting. you were found to have a blockage of your right nephrostomy tube which was causing your back pain. you were treated with antibiotics for possible infection. interventional radiology changed your nephrostomy tubes with some resolution of your symptoms. your right nephrostomy tube continues to intermittently become clogged, however with regular flushing of the tube it is now draining consistently. - you should flush your nephrostomy tubes at least twice a day as instructed. medication changes: 1. you will need to complete 10 more days of antibiotics: cefpodoxime 200 mg twice daily. 2. if you become constipated you can take 30 ml of lactulose as needed or a dulcolax suppository as needed. you should continue to take colace, miralax, and senna regularly. 3. for pain you can take 1-2 tablets of percocet every 4 hours as needed. 4. for nausea you can continue to take your home regimen of compazine 10 mg every 6 hours as needed in addition to 8 mg of zofran every 8 hours as needed. continue your outpatient medications as prescribed. you were set up for hospice at home but have declined this for now. you have the numbers to call to set this up when you are ready. call your doctor if you experience fevers, chills, shortness of breath, chest pain, recurrent flank pain, decreased output from your nephrostomy tubes, or other worrisome symptoms. followup instructions: please keep your previously scheduled appointments: provider: , md phone: date/time: 3:00 provider: . phone: date/time: 3:00 provider: ,one date/time: 7:30 md, procedure: replacement of nephrostomy tube replacement of nephrostomy tube diagnoses: acidosis acute kidney failure, unspecified asthma, unspecified type, unspecified other constipation hydronephrosis secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of other specified sites of large intestine pyelonephritis, unspecified other ureteric obstruction secondary malignant neoplasm of ovary 

Answer: The patient is high likely exposed to