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: mesalamine / aminosalicylic acid / aspirin / lactose / codeine attending: chief complaint: hematemesis major surgical or invasive procedure: ercp with banding of gastric varices and replacement of stent in common bile duct history of present illness: 48m with history of depression, hcv, and etoh cirrhosis who initially presented to an osh on with coffee ground emesis. patient admitted in and of this year to osh with encephalopathy and cellulitis. recent admitted to osh from with hepatic encephalopathy, with course c/b etoh withdrawal/dts requiring intubation and lorazepam drip. patient discharged to rehab on . reports he was feeling well, but several days later developed nausea and vomited dark, coffee ground material. some epigastric pain, but no fevers or chills. has had dark colored stools. was brought to on for evaluation. at , had large volume coffee ground emesis on day of presentation. patient started on ppi gtt, octreotide gtt and admitted to icu with gi consulted. inr 1.4. received ffp and vitamin k. on , underwent egd that showed varices, but no evidence or stigmata of recent bleeding. no bands were placed as patient was difficult to sedate. during course of admission, his hct trended down from 30 to 20. received 3 units prbcs in addition to the ffp. underwent repeat egd on , during which he was noted to have oozing of blood around a previously placed ampullary stent. did remain hemodynamically stable. also had ct abd that showed dilatation of the cbd, intrahepatic, and gallbladder ducts. only a minimal amount of ascites was noted. he was transferred to for ercp and stent removal, as well as further evaluation of his bleeding and ductal obstruction. on arrival to the micu, patient's vs stable. patient reports n/v have resolved, and he denies any abdominal pain. reports chronic pain in his bilateral legs secondary to neuropathy, exacerbated by recent ambulance ride. of note, he had an ampullary stent placed one year ago at for a possible distal stricture. no sphincteromtomy performed due to high inr at time. patient did not follow-up to have stent removed. review of systems: (+) per hpi. reports 25-30 pound weight loss. has chronic bilateral lower extremity pain due to neuropathy. last bm 2 days ago. occasional non-productive cough. (-) denies fever, chills, sweats, headache, shortness of breath, chest pain or discomfort, abdominal pain, diarrhea, dysuria, frequency, or urgency. no rashes or skin changes. past medical history: etoh abuse (history of dts, withdrawal) hcv (vl negative ) cirrhosis (presumably secondary to etoh) history of alcoholic hepatitis depression peripheral neuropathy history of opiate abuse ulcerative colitis diazepam overdose social history: lives alone, though was in rehab prior to admission. fiance recently passed away. history of etoh abuse, though no use over past several weeks. smokes ppd. history of marijuana use in past, though denies recent use. no history of ivdu. has tattoos. family history: no history of liver disease. physical exam: admission exam: vitals: 97.7 90 124/90 12 97% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, pupils mildly asymmetric with right more constricted but bilaterally reactive to light and accomodation. neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, grade 2/6 systolic murmur at right sternal border, no rubs or gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: tense with mild distention, not tympanic, bowel sounds present, hepatomegaly, no splenomegaly appreciated, bowel sounds present, negative for fluid wave or shifting dullness, mild tenderness to deep palpation in central epigastric region, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, 1+ pitting edema in bilateral lower extremities to ankles, no clubbing or cyanosis skin: no palmar erythema or spider angiomas, tattoo on right upper extremity. neuro: cnii-xii intact, 5/5 strength upper/lower extremities, decreased sensation and proprioception in feet with tenderness to gentle palpation,grossly normal sensation otherwise, 2+ reflexes bilaterally, gait deferred, no asterixis. discharge exam: 98.1, 93/73, 89, 96ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, pupils mildly asymmetric with right more constricted but bilaterally reactive to light and accomodation. neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, grade 2/6 systolic murmur at right sternal border, no rubs or gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: tense with mild distention, not tympanic, bowel sounds present, hepatomegaly, no splenomegaly appreciated, bowel sounds present, negative for fluid wave or shifting dullness, mild tenderness to deep palpation in central epigastric region, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, 1+ pitting edema in bilateral lower extremities to ankles, no clubbing or cyanosis skin: no palmar erythema or spider angiomas, tattoo on right upper extremity. neuro: cnii-xii intact, 5/5 strength upper/lower extremities, decreased sensation and proprioception in feet with tenderness to gentle palpation,grossly normal sensation otherwise, 2+ reflexes bilaterally, gait deferred, no asterixis. pertinent results: admission labs: 02:26pm blood wbc-8.6# rbc-3.16* hgb-9.9* hct-28.8* mcv-91# mch-31.4# mchc-34.5 rdw-16.5* plt ct-104* 02:26pm blood neuts-82.7* lymphs-8.1* monos-4.4 eos-4.3* baso-0.6 02:26pm blood pt-14.3* ptt-39.9* inr(pt)-1.3* 02:26pm blood glucose-97 urean-12 creat-0.8 na-135 k-3.7 cl-102 hco3-27 angap-10 02:26pm blood alt-20 ast-38 alkphos-111 totbili-1.7* 02:26pm blood albumin-3.4* calcium-9.2 phos-3.3 mg-1.2* discharge labs: 01:29am blood calcium-8.6 phos-3.5 mg-1.2* 01:29am blood alt-17 ast-33 alkphos-108 01:29am blood glucose-129* urean-11 creat-0.7 na-134 k-3.8 cl-102 hco3-25 angap-11 01:29am blood pt-17.1* ptt-44.9* inr(pt)-1.6* 01:29am blood neuts-80.1* lymphs-9.7* monos-4.7 eos-5.0* baso-0.6 01:29am blood wbc-7.9 rbc-2.98* hgb-9.1* hct-26.9* mcv-90 mch-30.7 mchc-34.0 rdw-16.5* plt ct-92* microbiology: blood cultures 8/30 x2: pending, no growth to date at time of discharge imaging: ercp : the cbd was diffusely dilated to about 16 mm up to the ampulla. the findings were suggestive of papillary stenosis. given that the pt had presented with gi bleeding, a sphincterotomy was not performed. instead, a 10f x 7 cm plastic stent was placed successfully in the cbd with good drainage of bile. impression: previously placed biliary stent removed with snare. diffuse dilation of cbd to about 16 mm upto the ampulla, suggestive of papillary stenosis. given that the pt had presented with gi bleeding, a sphincterotomy was not performed. instead, a 10f x 7 cm plastic stent was placed successfully in the cbd with good drainage of bile egd : findings: esophagus: protruding lesions 5 cords of grade ii varices were seen in the lower third of the esophagus. no active bleeding seen. all 5 cords of varices were banded successfully. total 6 bands were placed. stomach: other portal hypertensive gastropathy was visualized in the body of the stomach duodenum: normal duodenum. impression: varices at the lower third of the esophagus banded successfully. portal hypertensive gastropathy was visualized in the body of the stomach. otherwise normal egd to third part of the duodenum. brief hospital course: 48m with history of etoh abuse, hcv, cirrhosis with grade 2 varices, recent hospitalizations for encephalopathy and c/b etoh withdrawal, transferred to for ercp after presenting to with coffee ground emesis, where he was found to have acute blood loss anemia and oozing at the site of a previously placed stent in the ampulla. now s/p repeat egd/ercp at , where stent was replaced and patient underwent banding of gastric varices. # upper gi bleed: differential diagnosis includes variceal bleed, bleeding secondary to portal hypertensive gastropathy, oozing at site of prior ampullary stent. no evidence of pud on egd. also no evidence of recent variceal bleeding, though patient underwent variceal banding by gi during egd . patient transfused 3 units prbcs at osh prior to transfer, but has remained hemodynamically stable with hct now stable. did not require transfusion at . stent has since been replaced, and per gi no evidence of active bleeding at time of procedure today. pt continued on ppi gtt, octreotide gtt. given history of cirrhosis, continued antibiotics with cipro 400 mg iv bid o be continued on transfer back to . diet advanced to clear liquids after ercp procedure. monitored overnight and hct remained stable at 29. advanced to full diet in am. stable for transfer to floor unit, no icu requirement. gi recommended d/c octreotide ggt and switch pantoprazole to 40mg po bid. # papillary stensosis: findings on ercp suggestive of papillary stenosis (cbd was diffusely dilated to about 16 mm up to the ampulla). per gi, no sphincterotomy performed given recent gi bleeding. plastic stent was removed and re-placed in cbd with good drainage of bile per report. he will need repeat ercp in 1 month for stent pull and sphincterotomy. # etoh/cirrhosis: has been c/b encephalopathy in past. currently no evidence of decompensation, with clear mental status, normal renal function, and no evidence of ascites on exam. also no evidence of variceal bleeding on recent egds. of note, ultrasound last year comments on echogenic focus in the right lower lobe of the liver, for which mri was recommended. given history of recent weight loss, have some concern for hcc. continued lactulose, rifaximin. continued lasix and spironolactone. will need further work-up for echogenic focus in liver if not already done; needs mri. # etoh abuse: recent admission at osh c/b acute etoh withdrawal requiring intubation and lorazepam drip. no signs of withdrawal this admission, as patient has been off etoh for several weeks. continued thiamine, folic acid and started mvi. # neuropathy: likely secondary to etoh. continued pain control with oxycodone. # depression: continued citalopram 40 mg daily. continued trazodone 100 mg hs prn insomnia. transitional issues: -blood cultures pending at time of discharge -will need repeat ercp in 1 month to remove stent and perform sphincterotomy -if not previously done, needs mri to evaluate 0.5 cm echogenic lesion in right lower lobe of the liver seen on ultrasound -patient's code status was full code this admission medications on admission: preadmission medications listed are correct and complete. information was obtained from transfer paperwork. 1. oxycodone (immediate release) 15 mg po q4h:prn pain 2. trazodone 50 mg po hs:prn home med 3. ciprofloxacin 400 mg iv q12h 4. citalopram 40 mg po daily start: in am 5. furosemide 40 mg po daily start: in am 6. lactulose 20 ml po tid 7. octreotide acetate 10 mcg/hr iv drip infusion 8. rifaximin 550 mg po bid 9. spironolactone 100 mg po daily start: in am discharge medications: 1. citalopram 40 mg po daily 2. furosemide 40 mg po daily 3. lactulose 20 ml po tid 4. oxycodone (immediate release) 15 mg po q6h:prn pain 5. rifaximin 550 mg po bid 6. spironolactone 100 mg po daily 7. trazodone 50 mg po hs:prn home med 8. docusate sodium (liquid) 100 mg po bid 9. heparin 5000 unit sc tid 10. pantoprazole 40 mg po q12h 11. senna 1 tab po bid:prn constipation 12. ciprofloxacin hcl 500 mg po q12h discharge disposition: extended care discharge diagnosis: primary: upper gastrointestinal bleeding, papillary stenosis secondary: cirrhosis, alcohol abuse, acute blood loss anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking care of you during your stay at . you were transferred here for a procedure called an ercp, in which the gastroenterology doctors used a to look in your esophagus, stomach, and small intestine to determine where you might be bleeding. they removed a stent from your bile duct and placed a new stent. they did not see any bleeding. they also saw some dilated blood vessels called varices, which they placed clips on to help prevent them from bleeding. you tolerated these procedures well and remained stable overnight. you are now stable for transfer back to . it is very important that your follow-up with the ercp doctors 1 month. you will need a repeat ercp so that they can remove this new stent. followup instructions: please follow-up with your pcp . within 1 week of your discharge from rehab. please follow-up with ercp within 1 month, so that they can remove your stent. procedure: endoscopic excision or destruction of lesion or tissue of esophagus endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: other chronic pain abnormal coagulation profile tobacco use disorder acute posthemorrhagic anemia alcoholic cirrhosis of liver portal hypertension unspecified viral hepatitis c without hepatic coma depressive disorder, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication due to other implant and internal device, not elsewhere classified hematemesis alcoholic polyneuropathy ulcerative colitis, unspecified other specified disorders of stomach and duodenum obstruction of bile duct other and unspecified alcohol dependence, continuous hemorrhage, unspecified other specified disorders of liver esophageal varices without mention of bleeding opioid abuse, in remission cannabis abuse, in remission 

Answer: The patient is high likely exposed to