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: syncope, chills, nausea, vomiting, diarrhea major surgical or invasive procedure: - arterial line placement history of present illness: 75 yo m with metastatic gallbladder cancer on gemzar/cisplatinum (last dose ), bladder cancer s/p cystectomy, recent admissions for partial sbo ( - ) and for biliary obstruction ( - ) now presenting with hypotension, nausea, vomiting. . the patient was admitted /12 following ercp, performed due to biliary obstruction. during the ercp, diffuse ulceration was noted in the distal esophagus, at the ge junction, and in the body of the stomach. cannulation of the biliary duct was initially difficult but was successful and deep after placement of a 5 mm x 5 fr pancreatic stent. a 12 mm long segment of severe narrowing was noted at the level of the hilum consistent with a stricture. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. a wallflex tm biliary rx uncovered 8 mm x 80 mm stent (ref: 7062, lot: ) was placed successfully. the pancratic stent was removed after placement of the metal stent. . ercp was complicated by nausea, vomiting, and elevated lipase. the patient was treated with bowel rest and iv fluids, and his diet was advanced prior to discharge on . hospital course was also notable for new diagnosis of bilateral dvts for which patient was started on lovenox treatment. . yesterday, the patient developed weakness, nausea, and vomiting. he estimates that he had 10 episodes of non-bloody emesis. he also had some black diarrhea overnight last night. then, at 3 a.m., the patient awoke with nausea and vomiting. he spent the next couple of hours sitting on a couch, during which time he experienced shaking chills and also syncopized for a couple of minutes. he regained consciousness and his family helped him to the toilet, at which point he had no bm had more syncope, and his family called ems. when ems arrived, initial bp was 70s/40s. . the patient also complains of cough and the sensation fo being unable to take a deep breath, which started during his recent admission. he has had hiccups for several weeks now, and has been taking baclofen twice daily for this. . in the ed, initial vitals signs were t 98.4 bp 73/37 hr 122 rr 16 sat 93%. exam was significant for aox2, course breath sounds bilaterally. patient was bolused with ivf. labs were notable for wbc 6.9 (73n, 15bands), hct 34 (27 at discharge), platelets 1000 (588 at discharge), cr 1.4 (0.7 at discharge), alt 16, ast 15, ap 675 (627 at discharge), tbili 2.5 (2.2 at discharge), lactate 5.1, ua w 83 wbcs, positive nitrites, few bacteria. cxr demonstrated new l basilar infiltrate and bilateral pleural effusion. patient was started on vanco/cefepime for presumed hcap. lij was placed for fluid resuscitation. patient remained hypotensive in sbp 80s, requiring initiation of levophed. ed course otherwise notable for patient reporting abdominal pain. ct abd/pelvis demonstrated known tumor, mildly distended stomach, with some fluid in the lower esophagus, could relate to partial gastric antral obstruction in the presence of symptoms. ct abd/pelvis also showed pleural effusion, ascites, improved left hydronephrosis. repeat lactate returned 2.1. at time of transfer, patient had received 4l ivf and had a lij and two peripheral 18 gauge ivs. vital signs on transfer were 98.5 hr119 bp85/50, rr34 98%3l. . on arrival to the icu, the patient complained of heartburn and abdominal bloating. his nausea had resolved. he had the sensation of needing to defecate. however, he did not pass any stool. . review of systems: no fever. +chills. +cough and dyspnea. no chest pain. +syncope. +abdominal discomfort and bloating, increased from baseline. urine has been darker than usual. has urinary ostomy. +hiccups. no rash. no focal weakness. +chronic bilateral toe tingling l>r. no visual changes. past medical history: oncology history - - cystoprostatectomy by dr. revealed bladder tcc invading the lamina propria involving intravesicular portion of the left ureter - - resection for local recurrence. - - ct abdomen w hypodense liver lesion and mesenteric band-like nodularity in the right upper quadrant concerning for peritoneal carcinomatosis, pleural thickening along the ascending colon. - - colonoscopy w severe narrowing at the hepatic flexure extrinsic compression, ct torso and mrcp demonstrated regular hypoenhancing mass centered within the gallbladder fossa and infiltrating portions of the right and left hepatic lobes, extending to hepatic flexure most c/w gallbladder cancer, also w loss of intervening fat plane between the extension of the tumor out of the liver and the hepatic flexure and duodenal bulb, intrahepatic bile duct dilation, extrinsic compression of the hepatic duct, and enhancing soft tissue nodules in the greater omentum consistent with peritoneal carcinomatosis. - - ct-guided liver biopsy carcinoma with clear cell features diffusely positive for cytokeratin cocktail and cytokeratin 7 and negative for hep par 1 packs 2 ttf-1, cytokeratin 20 and p63 most compatible with a tumor of biliary pancreatic or upper gastrointestinal origin - - kub partial small-bowel obstruction - - gemzar/cisplatin started - - presentation w abd pain and elevated bilirubin, ercp w 12mm long segment of severe narrowing, sphincterotomy and placement of wallflex tm biliary rx uncovered stent . past medical history - metastatic gallbladder cancer - recurrent bladder ca s/p primary resection (), penile/urethral metastatsis resection () - htn - hld - lvh w mild lvot obstruction and mildly dilated thoracic aorta - h/o cystectomy - h/o resection penile recurrence social history: lives with wife in . emigrated from remotely. retired engineer. quit tobacco 20+ years ago, 36 pack years. denies etoh, denies illicits. family history: father with bladder cancer. mother with either cva or mi. physical exam: admission exam: . general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, lij in place lungs: coarse breath sounds bilaterally cv: tachycardic, regular, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, diffusely tender, especially in ruq, very quiet bowel sounds, +guarding in ruq, urinary ostomy bag in place with yellow urine. ext: warm, well perfused, 2+ pulses, 3+ bilateral lower extremity edema neuro: cn ii-xii intact. moving all extremities . discharge exam: . pertinent results: admission labs: . 07:30am blood wbc-6.9# rbc-5.02 hgb-11.3* hct-34.4* mcv-69* mch-22.5* mchc-32.8 rdw-17.1* plt ct-1000*# 07:30am blood hypochr-1+ anisocy-1+ poiklo-2+ macrocy-normal microcy-1+ polychr-normal ovalocy-2+ acantho-2+ ellipto-2+ 07:30am blood pt-15.2* ptt-28.1 inr(pt)-1.4* 07:30am blood glucose-110* urean-23* creat-1.4* na-136 k-4.1 cl-97 hco3-23 angap-20 07:30am blood alt-16 ast-15 alkphos-675* totbili-2.5* 07:30am blood probnp-1532* 07:30am blood ctropnt-<0.01 12:44pm blood ck-mb-1 ctropnt-<0.01 05:17pm blood ck-mb-1 ctropnt-<0.01 07:30am blood albumin-2.6* 07:49am blood lactate-5.1* 01:05pm blood freeca-1.03* . microbiology: . urine culture - pending blood culture (x 2) - pending mrsa screen - pending . imaging studies: . chest (portable ap) - slight prominence of the hila, could be due to vascular engorgement. bibasilar opacities could represent atelectasis, aspiration, or infection in the appropriate clinical setting. . ct abd & pelvis w/o con - moderate-sized right and a small left pleural effusion, with bibasilar compressive atelectasis. patchy opacities in the left lower lobe, concerning for acute infection/aspiration. known infiltrating gallbladder fossa mass, allowing for differences in technique is similar to the prior study. infiltration of the gastric antrum and ascending colon, with resultant gastric outlet obstruction. moderate-to-large volume ascites, consistent with worsening omental metastatic disease, which is suboptimally assessed in this non-contrast study. additional hypodense liver lesion, likely cysts. lack of air within the biliary stent and left lobe of liver suggests stent occlusion. interval improvement in the previously noted left hydroureteronephrosis in this patient status post urinary diversion and ileal conduit. . duplex dopp abd/pel por and liver or gallbladder us - please note, patient had difficulty remaining in left lateral decubitus after obtaining only sagittal images, at which point the decision was made to transfer to the right lateral decubitus position. after obtaining left-sided images, patient was able to again return to left lateral decubitus position, at which point the right-sided transverse images were acquired. the right kidney measures 11.5 cm. the left kidney measures 10 cm. there is no evidence of hydronephrosis, stones, or masses. patient is status post urinary diversion and ileal conduit. no bladder assessment performed. significant ascites idenitifed throughout the abdomen. brief hospital course: impression: 75m with pmh significant for metastatic gallbladder carcinoma, bladder carcinoma (s/p primary resection with ileal conduit formation), hypertension and hyperlipidemia with recent hospitalization for ercp in the setting of biliary stricture with metal stent deployment complicated by post-procedural pancreatitis and evidence of dvts who now presents with nausea, emesis and hypotension concerning for septic shock requiring pressor support with evolving pneumonia, acute renal insufficiency and hyperbilirubinemia. given worsening clinical status despite aggressive resuscitation and pressors, patient was transitioned to comfort measures only and expired on . . # acute hypoxic respiratory failure - following volume resuscitation needs given his septic shock, the patient developed worsening respiratory concerns and hypoxia with an increased oxygen requirement. his cxr imaging demonstrated marked pleural effusions. after discussion with the family, it was clarified that he would not want to be intubated, thus he was made comfortable on supportive oxygen. . # shock - presented with hypotension and evidence of volume depletion with leukocytosis and bandemia in the setting of metastatic gallbladder carcinoma, with acute renal insufficiency and hyperbilirubinemia. shock appears distributive or vasodilatory in the setting of sepsis. possible sources of infection include: biliary obstruction or stent obstruction with gram negative or anaerobic enteric seeding vs. aspiration pneumonitis (ct imaging showed lll opacification) or pneumonia vs. urinary tract infection. patient was empirically antibiosed with vancomycin, levofloxacin and zosyn. lactate 5.1 on admission, trending downward with iv fluid resuscitation. following aggressive volume resuscitation, his hypotension and tachycardia improved and his pressor support was weaned. his serial lactate and central venous oxygen saturations improved with broad spectrum antibiotics - vancomycin, levofloxacin and zosyn (started ). acs surgery had been consulted given his evidence of delayed emptying and possible gastric obstruction with known biliary obstruction and felt no surgical intervention was feasible. they recommended palliation with possible duodental stent placement in discussion with the gastroenterology team based on his imaging findings. his imaging showed evidence of gastric antral obstruction. given his overall poor prognosis, the family opted to enagage comfort measures only and a dilaudid infusion was started. . # nausea, emesis and gastric outlet obstruction - ct imaging revealed tumor that extends to the gastric antrum and hepatic flexure with mildly distended stomach and some fluid in the lower esophagus; possibly related to partial gastric antral obstruction vs. delayed transit and slow emptying given his nausea and bilious emesis concerns. ngt remains in place. evidence of tumor causing obstruction without definable surgical options - would likely require palliative stenting. ercp 2-days prior allowed passage of endoscope to the level of the duodenum for biliary stenting, now with evidence of on-going obstruction. acs surgery had been consulted given his evidence of delayed emptying and possible gastric obstruction with known biliary obstruction and felt no surgical intervention was feasible. ercp team was also notified. given his overall poor prognosis, the family opted to enagage comfort measures only and a dilaudid infusion was started. . # acute renal insufficiency - patient presents with baseline creatinine of 0.7-0.9 now with admission creatinine of 1.4 in the setting of septic shock, hypotension and low urine output. this likely represents poor forward flow and hypoperfusion with pre-renal azotemia in the setting of vasodilation and sepsis physiology generating hypotension. atn certainly could have developed in the this time frame. following fluid resuscitation, his creatinine continued to worsen. . # ascites - likely malignant in the setting of know gallbladder carcinoma with metastatic involvement. now with septic shock picture in the setting of multiple sources of infection. his ruq ultrasound showed concern for no pneumobilia with possble obstruction at the level of his biliary stent. . # metastatic gallbladder carcinoma, bladder cancer - metastatic gallbladder carcinoma currently receiving gemzar/cisplatinum. bladder carcinoma treated with primary resection and cystectomy with ileal conduit. his outpatient oncologist was notified of the admission and discussed with the family the overall very poor prognosis. comfort measures were employed following that discussion. . # deep venous thromboses - dvt in both posterior tibial veins on the right and one posterior tibial vein on the left in 2/29. heparin gtt started this admission (switched from lovenox given renal dysfunction). he was maintained on a heparin gtt until comfort measures were established. . # hypertension - hypotensive in the setting of sepsis, as noted above. holding metoprolol, verapamil, lisinopril. . medications on admission: medications (per recent discharge summary) - enoxaparin 70mg q12hrs - metoprolol succinate 50mg daily - verapamil 120mg extended release daily - docusate sodium 100mg - senna - polyethylene glycol daily - oxycodone 5mg q6hrs prn - omeprazole 20mg daily - lisinopril 20mg daily - baclofen 10mg prn hiccups discharge medications: none discharge disposition: expired discharge diagnosis: septic shock and metastatic gallbladder cancer discharge condition: expired discharge instructions: patient expired on . followup instructions: none procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension unspecified septicemia severe sepsis other and unspecified hyperlipidemia acute respiratory failure septic shock personal history of malignant neoplasm of bladder hydronephrosis obstruction of bile duct jaundice, unspecified, not of newborn acute venous embolism and thrombosis of deep vessels of distal lower extremity malignant neoplasm of gallbladder acquired hypertrophic pyloric stenosis malignant ascites 

Answer: The patient is high likely exposed to