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: painless jaundice major surgical or invasive procedure: : 1. exploratory laparotomy with primary duodenorrhaphy. 2. palliative gastrojejunostomy. 3. wedge liver biopsy--metastatic disease suspected. 4. cholecystojejunostomy biliary bypass. 5. omental flap closure duodenal perforation. history of present illness: mrs. is an 84-year-old woman who has apparent metastatic breast cancer to the bone and perhaps the abdomen who has developed full malignant obstructive jaundice. dr. attempted to resolve this as minimally invasively as possible by endoscopic means to provide her palliation. unfortunately, during that procedure an apparent duodenal perforation occurred in the tenuous duodenal tissue and was immediately recognized. she was then brought emergently to the operating room for the procedures listed below. past medical history: breast ca (mets to liver, bone, lungs), hiatal hernia physical exam: exam on discharge: gen: aox3, nad, cooperative, engaging, responsive heent: no lad, no aparrent jaundice, no evidence for thyromegaly cv: no overt m/r/g, regular rate pulm: ctab abd: soft, incision is c/d/i, ext: normal strength, sensation pertinent results: 05:20am blood wbc-7.7 rbc-3.22* hgb-8.7* hct-27.3* mcv-85 mch-27.1 mchc-32.0 rdw-17.7* plt ct-356 04:40am blood wbc-9.4 rbc-3.20* hgb-8.8* hct-27.4* mcv-86 mch-27.6 mchc-32.2 rdw-18.0* plt ct-342 09:37pm blood wbc-11.8* rbc-4.02* hgb-11.2* hct-34.9* mcv-87 mch-27.9 mchc-32.2 rdw-17.0* plt ct-316 02:54am blood wbc-13.7* rbc-3.63* hgb-9.9* hct-31.2* mcv-86 mch-27.2 mchc-31.7 rdw-17.5* plt ct-305 07:15pm blood pt-15.2* ptt-78.5* inr(pt)-1.3* 07:15pm blood plt ct-219 02:29am blood pt-12.4 ptt-31.3 inr(pt)-1.1 05:20am blood plt ct-356 09:37pm blood glucose-153* urean-6 creat-0.6 na-136 k-3.9 cl-104 hco3-24 angap-12 03:51am blood glucose-116* urean-5* creat-0.6 na-137 k-4.0 cl-107 hco3-24 angap-10 02:54am blood alt-146* ast-133* alkphos-331* amylase-43 totbili-9.8* dirbili-7.8* indbili-2.0 03:51am blood alt-61* ast-51* alkphos-231* totbili-2.8* 02:54am blood albumin-2.4* calcium-7.3* phos-3.0 mg-2.7* 03:51am blood calcium-7.0* phos-2.4* mg-2.0 05:20am blood lipase-93* ________________________________________________________________ operative report , p. signed electronically by , on wed 10:57 am name: , i unit no: service: date: surgeon: , md 2365 first surgical assistant: , m.d. preoperative diagnosis: 1. endoscopy-related duodenal perforation. 2. peritonitis. 3. metastatic breast cancer. 4. malignant obstructive jaundice. postoperative diagnosis: 1. endoscopy-related duodenal perforation. 2. peritonitis. 3. metastatic breast cancer. 4. malignant obstructive jaundice. operative procedure: 1. exploratory laparotomy with primary duodenorrhaphy. 2. palliative gastrojejunostomy. 3. wedge liver biopsy--metastatic disease suspected. 4. cholecystojejunostomy biliary bypass. 5. omental flap closure duodenal perforation. anesthesia: general endotracheal. sponge and needle counts: correct. estimated blood loss: 500 cc. indications for operation: mrs. is an 84-year-old woman who has apparent metastatic breast cancer to the bone and perhaps the abdomen who has developed full malignant obstructive jaundice. dr. attempted to resolve this as minimally invasively as possible by endoscopic means to provide her palliation. unfortunately, during that procedure an apparent duodenal perforation occurred in the tenuous duodenal tissue and was immediately recognized. dr. noticed and identified this and immediately called me hoping for operative treatment. prior to the operation, dr. , my chief resident on my behalf, as i became available, spoke by telephone with the patient's son in who provided informed consent for us to proceed. this was an emergency operation in a very high risk patient with malignant obstructive jaundice, probably very poor nutrition and would have high risk but was absolutely necessary that we proceed given that she had a free intestinal perforation in her abdomen. operative procedure: following satisfactory induction of general endotracheal anesthesia, the abdomen was widely prepped with betadine and sterile drapes were placed. after a suitable team time out, identifying the patient and the planned operative procedure, we entered the abdomen through an upper midline incision. there was not really a lot of soilage in the upper abdomen, although there was some free- fluid which was cultured. we explored the upper abdomen and specifically went over the duodenum where we found a 1.3 cm fresh perforation just about the size of an endoscope actually in the anterolateral aspect of the second portion of the duodenum. it was leaking bile and enteric fluid. this was all aspirated around and cleared up with irrigation. i now went ahead and explored this area more to find sclerotic, most likely tumor metastasis in and around the duodenum and the head of the pancreas which were not biopsied at this location. i used two techniques to close the duodenal perforation. first, a primary duodenorrhaphy was provided well by multiple interrupted 3-0 silk sutures, reapproximating full closure of the duodenal perforation. this combined with the degree of constriction of the duodenum would measurably decrease luminal patency and so she would need something more because of a partial gastric outlet obstruction. this will follow in the description of the gastrojejunostomy. the second approach was mobilizing omentum at the superior aspect of the transverse colon and then bringing this up such that it overlay on top of the duodenorrhaphy, at which point it was sutured down for additional sealing effect. we next excised with a wedge liver biopsy a lesion near the gallbladder bed which was almost certainly a metastasis. this was for staging and documentation of lymphatic metastatic disease. this bled terribly unfortunately, probably requiring 200-300 cc blood loss before i could finally get this bleeding stopped with high-voltage cautery and mattress sutures of chromic. a small amount of bile was leaking from this small 1 cm peripheral wedge biopsy site. a drain would subsequently be placed over this. it seemed to settle down as the operation continued. we next performed a palliative gastrojejunostomy. the greater curvature of the stomach was cleaned off of some of the blood vessels in the dependent location. the jejunum 20 cm distal to the ligament of treitz was brought up in a retrocolic manner and a side-to-side stapled gastrojejunostomy anastomosis constructed smoothly. it was secured at the end with silk sutures to protect the staple line. the mesentery of the transverse mesocolon was sutured around it to prevent internal hernia. the final procedure now was to establish biliary bypass of some degree for palliation. she had a distended courvoisier gallbladder and so i thought that this would be a suitable and safe conduit for extrahepatic biliary ductal bypass. about 50 cm below the gastrojejunostomy i brought up a lazy loop of jejunum to the fundus of the gallbladder where a two-layer hand-sewn silk and vicryl side- to-side cholecystojejunostomy anastomosis of 1 cm wide patency was achieved. this would provide a decompressive route for her obstructive biliary system. the patient was generally stable during the operation, although she did suffer 500 cc of blood loss but not any significant hemodynamic trouble. she was profoundly icteric at the beginning of the operation without preoperative labs but i would estimate her bilirubin was at least 11 or 12. this, i am sure, affected her blood clotting capabilities. we now irrigated and washed out the upper abdomen and then placed a 19 french drain up in the right upper quadrant near the liver biopsy site and the cholecystojejunostomy anastomosis and the duodenorrhaphy to drain those three perilous areas. so in this emergency operation i was able to control the duodenal perforation itself but also, i hope, provide some effective palliation for her should she recover from this emergency aggressive but necessary operation. she was taken to the intensive care unit in guarded condition. as her attending operating surgeon, i was present for her entire operation and i performed all of its components. , _ ________________________________________________________________ pathology diagnosis: liver, wedge biopsy: metastatic poorly-differentiated adenocarcinoma consistent with breast origin, see note. note: the tumor cells are positive for cytokeratin 7 and estrogen receptor and focally positive for gross cystic disease fluid protein. the cells are negative for cytokeratin 20 and mammaglobin. the histologic features and immunophenotype are consistent with a breast origin. brief hospital course: : the patient had second ercp attempted at (first was at osh) which was complicated by duodenal perforation with a ct showing free peritoneal air. the patient was brought to the icu and subsequently transferred to the operating room for emergent repair. postoperatively she was brought to the icu for monitoring still intubated. she was started on unasyn immediately. : patient was transferred to the for more definitive management in the t/sicu. she required 3l of ns boluses for hypotension and low uop : the patient was extubated and stable with normal uop and normal pressures : she was transferred from the unit to the floor : ngt discontinued, stable and minimal complaints : slight nausea, self regulating on clears : tolerating normal diet, jp discontinued, clear to d/c home by pt with home pt : small stitch applied to jp drain site for drainage; stopped unasyn, afebrile discharge medications: 1. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. oxycodone 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. disp:*20 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: pancreatic duct stricture, endoscopy related duodenal perforation, peritonitis, malignant obstructive jaundice, metastatic breast cancer discharge condition: stable discharge instructions: incision care: keep clean and dry. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to ambulate several times per day. * no heavy ( lbs) until your follow up appointment. followup instructions: please call dr. office to schedule a follow up appointment for 2-3 weeks. ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube other gastroenterostomy without gastrectomy open biopsy of liver anastomosis of gallbladder to intestine suture of laceration of duodenum diagnoses: other iatrogenic hypotension malignant neoplasm of liver, secondary iron deficiency anemia secondary to blood loss (chronic) accidental puncture or laceration during a procedure, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene secondary malignant neoplasm of lung obstruction of bile duct secondary malignant neoplasm of bone and bone marrow secondary malignant neoplasm of other digestive organs and spleen accidental cut, puncture, perforation or hemorrhage during endoscopic examination malignant neoplasm of breast (female), unspecified choleperitonitis 

Answer: The patient is high likely exposed to