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: fatigue and abdominal pain major surgical or invasive procedure: egd history of present illness: 74 yom w/ a h/o etoh related cirrhosis presents with coffee ground emesis (few episodes) and black stools x 3 weeks. he had been taking 6 asa per day for a few weeks. he also has not been taking his nexium for the past 3 weeks. the patient went to where his hct was found to be 18, he was then transferred to . prior to transfer he was given protonix 40 mg ivx1, and morphine 2 mg ivx1. in addition the patient complains of fatigue, nausea, and abdominal pain for the past 2-3 weeks. in the ed, initial vs: t 96.9 hr 95 bp 125/67 rr 22 o2 sat: 96% on ra. he rec'd 1 uprbc in the er. he was guaiac +, dark stool. ng lavage negative. he rec'd 2 liters of fluid. he was given 40mg iv protonix (in addition to the 40mg iv protonix). he was started on an octreotide drip after a bolus. bp 122/56 hr 93 100% on 3l rr 12. past medical history: copd cirrhosis (gi f/u @ ) gastric pud 10 years ago variceal bleed in past (10 years ago) h/o gi bleed htn etoh abuse copd dm c/b neuropathy djd oa anemia social history: h/o etoh abuse. no etoh recently (x10 years) w/ the exception of "sneaking" some etoh recently. family history: non contributory physical exam: vitals - t: 96.6 bp: 122/57 hr: 96 rr: 12 02 sat: 96% 2l general: oriented x1, sleeping but arousable heent: perrl, no scleral icterus, dry mm cardiac: tachy, regular, no murmurs rubs or gallops lung: clear bilaterally abdomen: + bs, soft, nt, no hsm, dull to percussion bilaterally in flanks ext: wwp, 1+ pedal edema, no c/c neuro: no asterxis pertinent results: 09:24am blood hct-23.7* 02:47am blood wbc-5.7 rbc-2.58* hgb-7.8*# hct-24.0* mcv-93 mch-30.2 mchc-32.4 rdw-18.1* plt ct-213 12:53pm blood wbc-7.0 rbc-2.08*# hgb-6.1*# hct-20.1*# mcv-97# mch-29.1 mchc-30.2* rdw-18.9* plt ct-201 02:47am blood neuts-83.3* bands-0 lymphs-8.9* monos-6.7 eos-0.7 baso-0.5 02:47am blood pt-17.3* ptt-32.9 inr(pt)-1.5* 12:53pm blood pt-17.4* ptt-32.0 inr(pt)-1.6* 02:47am blood glucose-42* urean-28* creat-0.8 na-145 k-3.4 cl-112* hco3-20* angap-16 12:53pm blood glucose-147* urean-33* creat-0.9 na-143 k-3.9 cl-106 hco3-23 angap-18 02:47am blood alt-82* ast-175* alkphos-103 totbili-3.1* dirbili-1.2* indbili-1.9 12:53pm blood alt-100* ast-248* alkphos-121* totbili-1.4 02:47am blood albumin-2.6* calcium-7.6* phos-2.2* mg-1.6 12:53pm blood albumin-2.9* calcium-8.7 phos-2.7 mg-1.8 12:53pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 12:53pm blood afp-153.2* 12:53pm blood lipase-24 ggt-550* 12:53pm blood hbsag-negative hbsab-negative hav ab-positive igm hbc-negative 12:53pm blood ttg-iga-21* 12:53pm blood hcv ab-positive* 05:30am blood wbc-3.4* rbc-3.11* hgb-9.2* hct-29.0* mcv-93 mch-29.4 mchc-31.5 rdw-18.0* plt ct-213 05:30am blood glucose-110* urean-22* creat-0.8 na-141 k-4.0 cl-108 hco3-22 angap-15 06:55am blood ret aut-1.9 05:30am blood glucose-110* urean-22* creat-0.8 na-141 k-4.0 cl-108 hco3-22 angap-15 05:30am blood alt-55* ast-84* alkphos-97 totbili-2.6* 05:30am blood albumin-2.9* calcium-8.2* phos-2.4* mg-1.8 egd : varices at the lower third of the esophagus and gastroesophageal junction ulcers in the antrum three non bleeding avm's found in the stomach erythema, congestion, abnormal vascularity and mosaic appearance in the whole stomach compatible with portal hypertensive gastropathy villous blunting noting diffusely in first and second portion of the duodenum varices at the fundus otherwise normal egd to second part of the duodenum ruq ultrasound: 1. cirrhotic shrunken liver, with a mass in the right lobe, which is worrisome for the presence of hcc. recommend a multi-phasic ct or mri of the liver to further evaluate the mass in the right lobe. 2. the main portal vein, right and left portal vein are patent with hepatopetal flow. 3. there is extensive ascites and splenomegaly in keeping with portal hypertension. 4. the right hepatic vein is not visualized. brief hospital course: upper gi bleed: given his symptoms of coffee ground emesis, dark stool and low hematocrit, the patient was assumed to have suffered an upper gi . he underwent an upper endoscopy in the medical icu which revealed no active bleeding but multiple sources including grade ii varicies, avms and peptic ulcer disease. the patient was started on an octreotide and protonix drip initially; eventually the octreotide was discontinued and the protonix changed to oral dosing. the patient was instructed to avoid nsaids, asa, and etoh. he was transfused 2 units of prbcs and his hematocrit rose to the upper 20s and was stable. liver cirrhosis: the patient has known alcoholic cirrhosis as per hpi. during this admission, he was started on spironolactone, lactulose, and nadolol for his cirrhosis/varices, ciprofloxacin for sbp prophylaxis, and folic acid and thiamine for nutritional deficits, but he refused to take most of these medications during his stay. after discussion with his wife, we will prescribe these medications at transfer with the intent for patient to take prescriptions with him when departing rehab. his wife understands the the priority order (if patient wishes to limit number of medications) is lactulose > nadolol > spironolactone > cipro/folic acid/thiamine. he will continue to take nexium as before. hepatic mass: this is likely hcc based on ultrasound findings, and his afp was markedly elevated. this finding was discussed at length with dr. (hepatology attending), the patient and his wife, and a decision was reached to pursue no further work-up or treatment for this mass. in addition, the patient has elected to change his code status to dnr/dni. pain control: the patient was reportedly taking aspiring per day prior to admission, which may have caused or exacerbated his upper gi bleed. he has been on tramadol 50 mg po tid at home as well as percocet, which seem effective for his pain and are safer than nsaids or aspirin. his total acetominophen intake should be limited to 2 g daily given his liver disease. additional narcotic medication may be required in this patient with likely cancer in the future. diabetes mellitus: per the patient's wife, he was taken off of insulin in of this year, and since then has largely refused to allow her to check his fingersticks. during this admission, he was placed on a humalog sliding scale with blood sugars ranging in the 100s (range 145-202 on the day prior to discharge). given the relatively low sugars and the patient's preference to stay off of insulin, we are not continuing his fingersticks or humalog sliding scale at discharge. other care: also, patient was discharged with foley catheter in place. as soon as possible, please remove foley and do voiding trial. medications on admission: nexium 40 mg po daily percocet prn (patient has taken 9 tabs since ) tramadol 50 mg po tid prn (patient typically takes tid) ambien 10 mg po qhs prn insomnia asa prn (up to 6-8 tablets per day, per his wife) supplement discharge medications: 1. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 2. ciprofloxacin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 4 days. 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): hold for > 3 bowel movements per day. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. tramadol 50 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain: ok for patient to take this medication 3 times daily at times of his choice. 8. nadolol 20 mg tablet sig: two (2) tablet po daily (daily). 9. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). 10. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). 11. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain: please do not drive or operate machinery while taking this medication. please keep your total daily acetominophen use to less than mg daily (325 mg per percocet tablet). 13. (ferrous sulfate) 325 mg (65 mg ) tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: - upper gastrointestinal bleed (source unknown - esophageal varices vs. ulcer vs. avm) - alcoholic cirrhosis of the liver - liver mass (probable hepatocellular carcinoma) - esophageal varices - ulcers in antrum secondary: - diabetes mellitus type ii (diet-controlled) - copd discharge condition: mental status:confused - sometimes (at the time of discharge, patient is coherent, but had episodes of confusion throughout this admission) level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) - this is his baseline; he is currently deconditioned and only able to walk very short distances discharge instructions: you were transferred to with weakness, fatigue, dark stool, and a low hematocrit (red blood level). you were admitted to the intensive care unit and you underwent an upper endoscopy procedure. this showed esophageal varices (distended veins), ulcers in the stomach, and some arteriovenous (vascular) malformations, but there was no active bleeding seen. you received 2 units of packed red blood cells and your hematocrit (blood level) improved and remained stable. you were re-introduced to a regular diet, and you appeared much improved. however, because you are still very weak and it will be difficult for your wife to care for you alone at home, you will be discharged to a rehab facility where you can focus on re-gaining your strength. while you were here, an imaging study of your liver showed a new liver mass. this most likely represents a type of liver cancer called hepatocellular carcinoma. you discussed this finding with dr. and your wife, and a decision was made not to pursue further work-up or treatment for the mass at this time. we have made the following changes to your medication regimen: - stop taking aspirin and do not take any other over-the-counter nsaids (non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen). these medications could cause a life-threatening bleed given the findings on your endoscopy study. - continue taking percocet as needed for pain. please keep your total acetominophen (tylenol) level to < mg (2 g) per day. each percocet contains 325 mg of acetominophen. - begin taking acetaminophen (tylenol) for pain not controlled by the tramadol and percocet you already use, up to mg (2 g) a day as above. note that each percocet tablet contains 325 mg of acetaminophen that must be counted toward the total daily dose. it is important that you not take more acetominophen than this as it may worsen your liver disease. - begin taking lactulose 30 ml by mouth three times daily (unless having more than 3 bowel movements daily; then scale back). this medication will help to keep your mind clear by preventing confusion caused by liver disease. this is the most important medication for you to take as prescribed. - begin taking nadolol 40 mg by mouth daily. this medication will help to prevent bleeding complications from esophageal varices. this is the second most important medication for you to take as prescribed. - begin taking spironolactone 100 mg by mouth daily. this medication will prevent complications from fluid build-up caused by your liver disease. this is the third most important medication for you to take as prescribed. - begin taking ciprofloxacin 500 mg by mouth daily. this medication will help to prevent abdominal infections caused by your liver disease. - begin taking folic acid 1 mg by mouth daily - begin taking thiamine 100 mg by mouth daily if you have to prioritize your medications, the most important ones by order are 1. lactulose 2. nadolol 3. spironolactone followup instructions: please follow up with your primary care doctor as below. you do not require specific liver clinic follow up at this time. if you are unwilling or unable to make these appointments, please call ahead to cancel. provider: , md phone: date/time: tuesday 11:00 am provider: , md phone: date/time: 10:00 am procedure: other endoscopy of small intestine diagnoses: unspecified essential hypertension alcoholic cirrhosis of liver iron deficiency anemia secondary to blood loss (chronic) portal hypertension chronic airway obstruction, not elsewhere classified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes cachexia chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction celiac disease other ascites esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy hemorrhage of gastrointestinal tract, unspecified other specified disorders of stomach and duodenum angiodysplasia of stomach and duodenum with hemorrhage alcohol abuse, episodic 

Answer: The patient is high likely exposed to