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: lovastatin attending: chief complaint: melena major surgical or invasive procedure: egd history of present illness: mr. is an 80m with hx of atrial fibrillation on coumadin, etoh cirrhosis, prostate cancer, . tia, htn, hld who initially called his pcp today to report an episode of black stools that started last night. he said that when he had a bowel movement it was black and sticky, he then had another black bowel movement this morning so he called his pcp who recommended that he come into clinic. he denies seeing any bright red blood, denies any chest pain, shortness of breath, dizziness or lightheadedness. he does say that since his recent hospitalization when his ppi was discontinued he has had some heart burn symptoms that previously had been well controlled on omeprazole. at his pcp's office he had melanotic stool in the vault, so he was referred into the er. he denies ever having an episode similar to this in the past, he has had episodes of brbpr with clots due to his history of radiation proctitis/colitis which were very different from this episode. in regards to his liver disease, he says that he was told in the past to cut down on his alcohol intake and he quit drinking for a period of time. currently he drinks about black russians per week, and says that his primary care doctor has not mentioned any liver problems to him recently. . in the ed, initial vs were: 98.0, 60, 148/54, 16, 99% on ra. his labs were notable for an inr of 2.5, hct of 26.1 from recent baseline 29-30 in the beginning of . his exam was notable for guaiac positive black stool in the rectal vault, and an ng lavage cleared with 800cc's of saline. hepatology was consulted and recommended reversal of his inr with 2 units of ffp. he was started on octreotide and pantoprazole drips, given 1 unit of blood and was admitted to the micu for further management. vs on transfer: 97.9, 82, 133/52, 18, 98% on ra. . on arrival to the micu, he denied any pain, says that he has not had any further dark bowel movements and denies any current acid reflux symptoms. his only current concern is that he would like to know when he will be getting his procedure. vs on arrival to the micu: 98.5, 83, 120/53, 26, 92% on ra. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: prostate cancer s/p xrt approx atrial fibrillation/flutter tia alcoholic cirrhosis gerd peripheral neuropathy osa on cpap spinal stenosis htn hld h/o shoulder surgery gout diverticulosis osteoporosis social history: lives with wife. past cigar user. no tobacco use. etoh a couple of drinks weekly, not daily. past working. no other drug use. family history: no history of kidney disease physical exam: \admission exam: . general appearance: well nourished, no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: irregularly irregular, no murmurs/rubs/gallops peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: decreased at the bases l>r abdomen: +bs, soft, palpable liver edge extremities: right lower extremity edema: trace, left lower extremity edema: trace skin: warm neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): person, place, time , movement: purposeful, . discharge exam: t 97-98 bp 111-140/60-80 hr 60-80 rr 18 o2 sat 98% ra gen: elederly male in nad, comfortable heent: sclera anicteric, conjunctiva pale, mmm, oropharynx clear, eomi, perrl cv: irregular, normal s1 + s2, no murmurs, rubs, gallops pulm: ctab, no wheezes, rales, ronchi, no increased wob abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, trace pedal edema neuro: a/ox3, no asterexis, cnii-xii intact, non focal pertinent results: admission las: 04:20pm blood wbc-8.3 rbc-2.90* hgb-8.0* hct-26.1* mcv-90 mch-27.5 mchc-30.5* rdw-13.8 plt ct-360 04:20pm blood pt-26.1* ptt-46.3* inr(pt)-2.5* 04:20pm blood glucose-100 urean-33* creat-1.0 na-143 k-4.5 cl-110* hco3-24 angap-14 04:20pm blood alt-18 ast-38 ck(cpk)-53 alkphos-173* totbili-0.4 04:20pm blood albumin-3.1* 03:33am blood afp-4.1 . discharge labs 07:35am blood wbc-5.7 rbc-2.63* hgb-7.4* hct-24.3* mcv-93 mch-28.0 mchc-30.3* rdw-14.7 plt ct-331 07:35am blood pt-22.0* inr(pt)-2.1* 07:35am blood plt ct-331 07:35am blood glucose-92 urean-12 creat-1.1 na-143 k-3.5 cl-113* hco3-22 angap-12 07:35am blood calcium-8.0* phos-3.3 mg-2.1 03:33am blood afp-4.1 . liver u/s : 1. hypoechoic lesion measuring 0.9 x 0.8 cm within the left lobe of the liver. given patient's history of cirrhosis, an mri is recommended for further characterization of this lesion and to exclude malignancy. 2. right pleural effusion. 3. splenomegaly. 4. patent main portal vein. 5. no ascites. . cxr : interval development of mild pulmonary edema with stable small bilateral pleural effusions. . egd : ulcer in the lower third of the esophagus no evidence of esophageal varices or active bleeding blood in the antrum no evidence of gastric varices, portal gastropathy, ulcers or active bleeding ulcers in the duodenum blood in the first part of the duodenum and second part of the duodenum no evidence of duodenal varices polyps in the fundus otherwise normal egd to third part of the duodenum . ct abdomen (): 1. new small bilateral pleural effusions when compared to chest ct from . 2. cirrhotic liver with sequelae of portal hypertension including splenomegaly and trace of perihepatic ascites with no evidence for intra-abdominal varices. 3. hypoenhancing lesion adjacent and posterior to the intrahepatic ivc at the dome of the liver with imaging characteristics consistent with w hemangioma. no lesion identified to correlate to that seen within the left lobe of the liver on prior ultrasound of , but most likely represents a regenerative nodule. no liver lesion seen concerning for hcc. brief hospital course: primary reason for admission: mr. is an 80 y/o m with a history of alcoholic cirrhosis, gerd with recent discontinuation of his ppi, atrial fibrillation on coumadin who presents with melanotic stools and a three point hct drop over the past two weeks. . active problems: . # gi bleed: melanotic stool and positive ng lavage both consistent with upper source of bleeding. hct was 26.1 on admission and remained stable 25-26 after 1u prbc. he also received 2 u ffp and iv vitamin k to reverse his coagulopathy. ruq u/s with dopplers was done which ruled out portal vein thrombosis. he was started on octreotide and pantoprazole drips. gi was consulted and he underwent egd on which showed ulcer in the lower third of the esophagus, as well as ulcers in the deuodenum. there was no evidence of varicies. aspirin was held throughout his course ulcers. his coumadin was initially held, but was restarted prior to discharge given history of cva off anticoagulation. there was no evidence of recurrent bleeding and on the day of d/c, inr was 2.1 and his hct had remained stable. bm the day of discharge was brown without brb or melena. pt was educated to monitor for any signs of rebleeding and is scheduled to get follow up labs in 2-3days. . # alcoholic cirrhosis: per patient his pcp has not mentioned any liver dysfunction concerns recently, liver architecture on ruq u/s was consistent with cirrhosis, no evidence of synthetic dysfunction, and no varcies on egd. he declined referral to the liver center and would prefer to follow up with his pcp. . # hypoechoic liver lesion: noted on ruq u/s. was 0.9 x 0.8 cm within the left lobe of the liver. given patient's history of cirrhosis, an mri was recommended for further characterization to exclude malignancy. however, mri could not be performed due to penile implant, and ct abdomen was performed instead. ct findings showed likely hemangioma, but lesion noted on ultrasound was not seen on ct, thought possibly due to a regenerative nodule. his afp was reassuring at 4.1 and there was nothing concerning for hcc seen on ct. . # atrial fibrillation: patient with a chads2 score of 4, on coumadin for anticoagulation at home. inr was reversed as above. at the time of d/c his inr was 2.1; he was sent home on 1mg warfarin daiily with instructions to have his inr checked during his pcp f/u appointment. his home metoprolol was initially held in the setting of gi bleed and restarted prior to discharge. . # doe/pleural effusions: pt complained of mild doe, most recent cxr with moderate effusions, echo on last admission with normal systolic function and no evidence of diastolic dysfunction. repeat cxr on this admission showed some increased pulmonary edema and was given lasix with improvement in his symptoms . # hypertension: initially held home antihypertensive regimen of losartan 50mg daily, nifedipine 30mg daily and metoprolol tartrate 25mg in the setting of his gi bleed. medications were restarted prior to d/c, though his nifedipine was held as his bp was well controlled without it. pcp notified of medication changes. . chronic problems: . # hyperlipidemia: - cont simvastatin 20mg daily . # lower extremity edema: since his recent hospitalization he has been started on low dose lasix which was initially held given his bleed. this was restarted prior to discahrgve. . # peripheral neuropathy: - cont home gabapentin . # osa on cpap: - used autoset cpap while in house . transitional issues: -pt needs close follow up of inr and hct to ensure stability given recent bleed and known ulcers. medications on admission: - betamethasone valerate 0.1 % cream - vitamin d2 50,000 unit once a week. - gabapentin 300 mg tid and at bedtime - warfarin 2 mg daily at 4 pm - metoprolol tartrate 25 mg - nifedipine extended release 30 mg once a day. - losartan 50 mg daily - aspirin 81 mg daily - calcium 1000mg once a day. - multivitamin one tablet once a day. - flaxseed oil 1,000 mg once a day. - lasix 20mg prn lower extremity edema - simvastatin 20mg daily discharge medications: 1. vitamin d2 50,000 unit capsule sig: one (1) capsule po once a week for 6 weeks. 2. gabapentin 300 mg capsule sig: one (1) capsule po tid and at bedtime. 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. losartan 50 mg tablet sig: one (1) tablet po once a day. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. calcium 500 500 mg calcium (1,250 mg) tablet sig: two (2) tablet po once a day. 7. multivitamin tablet sig: one (1) tablet po once a day. 8. flaxseed oil 1,000 mg capsule sig: one (1) capsule po once a day. 9. furosemide 20 mg tablet sig: one (1) tablet po prn as needed for leg swelling for 1 doses. 10. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 11. warfarin 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary diagnosis: peptic ulcer disease secondary diagnosis: cirrhosis htn discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , it was a pleasure taking care of you at . you were admitted for a gastrointestinal bleed. you had an endoscopy, which showed ulcers in your esophagus and duodenum. for this, you were treated with medications. we feel you are now safe to return home. you also were found to have a mass in your liver. for this, you had a ct scan, which showed no evidence of cancer. however, you should see a specialist for ongoing management of your liver disease. at your next appointment with dr. , you can arrange for hepatology follow up. the following changes were made to your medications stop aspirin start pantoprazole decreased warfarin to 1mg by mouth once a day stop nifedipine; your primary care phyician can restart this medication if your blood pressure is high followup instructions: name: , m. location: address: , , phone: appt: thursday, at 10:45am procedure: other endoscopy of small intestine diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified pleural effusion unspecified essential hypertension acute posthemorrhagic anemia alcoholic cirrhosis of liver gout, unspecified personal history of malignant neoplasm of prostate atrial flutter other and unspecified hyperlipidemia osteoporosis, unspecified long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction unspecified hereditary and idiopathic peripheral neuropathy unspecified disorder of liver ulcer of esophagus without bleeding 

Answer: The patient is high likely exposed to