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: oxycontin attending: chief complaint: hypotension in setting of ativan administration major surgical or invasive procedure: diagnostic paracentesis history of present illness: mr. is a 54 year old gentlamen with etoh cirrhosis complicated by ascites and encephalopathy admitted for transient hypotension. the patient was scheduled for outpatient mri liver today, for which he was prescribed 0.5 mg po ativan taken 1 hour prior to arrival. while awaiting mri in the waiting room, the patient became dizzy and states that he "couldn't see" and that he "lost focus." at that time, he lay down on the floor and was noted to have an sbp 70s from a baseline sbp 90-100s. he received 1l ivf, and was transferred to the ed for further evaluation. of note, the patient reports that he last ate at 8 am this morning, with his meal consisting of a bowl of cereal. he does report that he had assocaited nausea, but denies any cp, f/c/s, ha, diaphoresis, palpitations, orthopnea, pnd, le swelling, pain in his legs. he does report chronic diarrhea since starting lactulose. of note, the patient was admitted to county hospital ( ri) from for hepatic encephalopathy, during which he was treated with lactulose and had a large volume paracentesis. in addition, the patient underwent rhc on with 21 mmhg. . in the ed, initial vs 98.0 74 92/58 16 100%ra. he received 1 l ns, had a negative cxr, with labs notable for hyponatremia to 118 and creatinine 2.9, with only prior creatinine 2.6 on . he had a diagnostic paracentesis that was negative for sbp, and was admitted to the micu at the request of liver. . currently, the patient is resting comfortably. he does state on ros that he has had worsening sob over the past 3 days such that he is unable to walk 20 feet without feeling fatigued. past medical history: 1. etoh cirrhosis complicated by diuretic refractory ascites and encephalopathy currently undergoing transplant eval. reports having large volume paracentesis q2wks since . 2. etoh abuse 3. acute kidney injury. 4. hypertension. social history: he denies a history of intravenous drug use. he has a 25- pack year history of tobacco use quitting 15 years ago. he has a history of extensive alcohol use in the past quitting 7 months ago (etoh - last drink ). he is married and has 2 daughters ages 24 and 28. family history: a grandparent had alcoholism. his mother died at age 75 and his father at age 77. there is a history of diabetes and colon cancer in the family. physical exam: on admission: vs - temp 97.3f, 100/63 bp , 90hr , 18r , o2-sat 98% ra general - well-appearing man in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - obese, no fluid waves, soft, nabs, soft/nt/nd, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact pertinent results: on admission: 08:00pm ascites glucose-125 ld(ldh)-37 albumin-less than 08:00pm ascites wbc-240* rbc-670* polys-10* lymphs-55* monos-28* eos-1* mesotheli-1* macrophag-5* 04:20pm glucose-99 urea n-77* creat-2.9* sodium-118* potassium-4.3 chloride-89* total co2-19* anion gap-14 04:20pm alt(sgpt)-83* ast(sgot)-144* ld(ldh)-235 tot bili-2.0* 04:20pm lipase-182* 04:20pm albumin-1.8* 04:20pm wbc-8.4 rbc-3.09* hgb-11.1* hct-31.9* mcv-103* mch-35.9* mchc-34.8 rdw-14.0 04:20pm plt count-130* 04:20pm plt count-130* 03:04pm creat-2.9* 03:04pm estgfr-using this . cxr: findings: frontal and lateral views of the chest are obtained. blunting of the right posterior costophrenic angles raises concern for small pleural effusion. minimal left mid-to-lower lung atelectasis is noted. no discrete focal consolidation is seen. the cardiac and mediastinal silhouettes are unremarkable. impression: small right pleural effusion. mild left base atelectasis. . echo: no atrial septal defect is seen by 2d or color doppler but a patent foramen ovale is suggested with premature appearance of saline contrast in the left heart with cough. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the estimated pulmonary artery systolic pressure is normal. there is a small to moderate sized pericardial effusion around the right atrium. there is a prominent pleural effusion. impression: patent foramen ovale. loculated pericardial effusion suggestive of a pericardial cyst. . renal u/s: impression: 1. technically limited study, however patent bilateral main renal arteries and veins. 2. large amount of ascites. . mri/mrv: impression: non-obstructive infrarenal partial thrombus in ivc, without extension beyond the bifurcation. . lenis: negative for dvt . egd: esophagus: protruding lesions 1 cords of grade i varices were seen in the gastroesophageal junction. the varices were not bleeding. stomach: contents: food was found in the stomach mucosa: diffuse erythema, congestion and mosaic appearance of the mucosa with no bleeding were noted in the stomach. these findings are compatible with portal gastropathy. . on discharge: 04:50am blood wbc-5.3 rbc-2.50* hgb-9.1* hct-25.9* mcv-104* mch-36.2* mchc-35.0 rdw-13.9 plt ct-112* 04:50am blood pt-17.1* ptt-97.3* inr(pt)-1.5* 04:50am blood glucose-105* urean-58* creat-2.4* na-132* k-4.0 cl-100 hco3-21* angap-15 04:50am blood alt-28 ast-57* alkphos-241* totbili-1.7* 08:00pm ascites wbc-240* rbc-670* polys-10* lymphs-55* monos-28* eos-1* mesothe-1* macroph-5* . meld = 19 brief hospital course: mr. is a 54 year old gentleman with etoh cirrhosis complicated by refractory ascites and encephalopathy admitted for transient hypotension. . # hypotension: the patient became hypotensive after taking ativan prior to receiving his outpatient mri for hcc screening. he was briefly dizzy but that felt normal within minutes. he was transported to the ed where he was given ns boluses. he was then admitted to the icu overnight for observation. blood pressures remained stable with sbp in the 80s-90s overnight. the patient was then transferred to the floor where orthostatics were neagative. the patient was asymptomatic with systolics in the 80s-90s. . # hyponatremia: na was 118 on admission. the patient reported having been drinking lots of fluid because he was told it would help his kidneys. he was placed on salt restriction and 1500 - 2l fluid restriction. his sodium gradually improved and was 132 on the day of discharge. he was taught about the importance of salt-restriction in his diet. urine osm/na showed perceived decreased effective circulating volume secondary to cirrhosis. . # prolonged pr: new 1st degree avb compared to prior ecg. he was kept briefly on telemetry without events. . # acute on chronic renal failure: creatinine was 2.9 on admission; past labs revealed a cr of 2.6 on . the patient reported having frequent large volume paracenteses without the administration of albumin. he also reported that he thought his creatinine was usually ~2. he was briefly treated for hepatorenal syndrome (with albumin, octreotide, and midodrine) without much improvement in his creatinine. he had normal urine output. on discharge, cr was 2.4. he was scheduled to see nephrology for consultation for possible renal transplant in addition to liver transplant. . # etoh cirrhosis c/b portal hypertension with ascites and recent admission at osh for hepatic encephalopathy: the patient's transplant evaluation was completed with echo, mri, and egd. egd showed grade i varices and portal hypertensive gastropathy. he was presented to the transplant committee and was listed for transplant. unfortunately, the mri showed an incidental ivc thrombus (see below). he was also scheduled for renal follow-up for possible renal transplant listing. rifaximin and lactulose were continued on discharge. a diagnostic paracentesis on admission was negative for sbp. . # ivf thrombus: infrarenal, non-occlusive thrombus was seen on mri. occupying 30% vessel. likely a result of cirrhosis and decreased anticoagulant proteins. heparin gtt was initially started and was continued for 3 days. coumadin was started. inr was 1.5 on discharge with plans for repeat inr check in 2 days at pcp . goal inr 2-2.5 with anticoagulation for at least 6 weeks. . # etoh abuse: patient reports his last drink was in . he was scheduled to begin substance relapse prevention program at kodak shortly after discharge. . transitional issues: - sodium monitoring - renal function monitoring, possible listing for renal/liver transplant - anticoagulation for ivc thrombus - substance relapse prevention medications on admission: rifaxamin 550 mg dexilant 60 mg daily ciprofloxacin 250 mg daily vicodin prn vitamin d 50,000 units weekly discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain or fever: do not exceed 2g in 24 hours (caution: as vicodin contains acetaminophen). 2. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 6. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a week. 7. dexilant 60 mg cap, delayed rel., multiphasic sig: one (1) cap, delayed rel., multiphasic po once a day. 8. vicodin 5-500 mg tablet oral 9. warfarin 1 mg tablet sig: five (5) tablet po once a day: daily at 4pm; requires frequent monitoring of inr; goal inr 2-2.5. disp:*150 tablet(s)* refills:*2* 10. outpatient lab work please draw inr on and provide results to dr. (ph: ). patient should have twice weekly inrs with goal 2-2.5. 11. lactulose 10 gram/15 ml solution sig: 15-30 ml po three times a day: please titrate to soft bowel movements per day. disp:*1 bottle* refills:*2* discharge disposition: home discharge diagnosis: primary: hypotension inferior vena cava thrombus cirrhosis - alcoholic acute vs. chronic kidney disease . secondary: gerd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure caring for you at the . you were admitted after you became hypotensive prior to your mri. we completed your liver transplant evaluation and you were presented to the transplant committee. dr. would also like for you to see a transplant nephrologist to be evaluated for a possible kidney transplant as your kidney function is abnormal. we incidentally discovered a small thrombus in your inferior vena cava for which you will need to be anticoagulated for at least 6 weeks. coumadin requires very close monitoring with twice weekly inrs - your goal inr is 2-2.5. . we made the following changes to your medications: we started coumadin (warfarin) 5 mg per day; you will need to have your inr checked twice per week - first check this thursday on . we continued lactulose, which you should use to titrate to soft bowel movements per day . we called dr. office and he is willing to manage your coumadin. . your follow-up information is listed below. followup instructions: department: transplant center when: friday at 9:20 am with: , md building: lm campus: west best parking: garage department: echo lab when: friday at 1 pm with: echocardiogram building: gz building (felbeerg/ complex) campus: east best parking: main garage department: endo suites when: thursday at 9:00 am md procedure: other endoscopy of small intestine percutaneous abdominal drainage diagnoses: other iatrogenic hypotension alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission portal hypertension personal history of tobacco use chronic kidney disease, unspecified ostium secundum type atrial septal defect esophageal varices in diseases classified elsewhere, without mention of bleeding other venous embolism and thrombosis of inferior vena cava esophageal varices without mention of bleeding benzodiazepine-based tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to