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: amphotericin b attending: chief complaint: transfer from bombay with fevers, perihepatic fluid collection, acute pancreatitis, line sepsis, pleural effusions, and bile leak major surgical or invasive procedure: - 1. exploration of retroperitoneal area. 2. drainage of retroperitoneal and intra-abdominal abscesses - flank approach. - 1. bronchoscopy. 2. left pleuroscopy with pleural drainage and pleural biopsy. - 1. extended right colectomy with end ileostomy and mucous fistula. 2. drainage of liver abscess. 3. peripancreatic necrosectomy 4. drainage of retroperitoneal abscess. 5. feeding jejunostomy tube placement. ercp with biliary stent removal history of present illness: the patient is a 54-year-old man with a protracted course of intra-abdominal complications following a liver resection in bombay on for an intrahepatic cholangiocarcinoma (t2n0m0). he was discharged home on postoperative day nine, then re-admitted on postoperative day eleven for fever and perihepatic fluid collection, which was subsequently drained by a pigtail catheter (cultures positive for klebsiella, mrsa, and citrobacter). he was discharged on postoperative day fifteen, then readmitted postoperative day nineteen for an mrcp, which showed no biliary leak. a stent was placed by ercp on postoperative day twenty one for biliary drainage and a pigtail catheter was again placed to drain his perihepatic collection. following his ercp, he developed acute pancreatitis. his pancreatitis and fluid collection improved with conservative management and iv antibiotics. on however, he developed line sepsis. he later developed a right pleural effusion which was drained multiple times with different sized chest tubes. he continued to spike fevers and his white blood cell count remained elevated over 18. a ct scan on showed that his right retrocolic collection was spreading. he was subsequently transferred to the sicu on . past medical history: hypertension social history: noncontributory family history: noncontributory physical exam: vitals: 98.6, 105, 166/89, 27, 99% general: fatigued, no acute distress heent: normocephalic/atraumatic, pupils equal round and reactive to light, extraoccular movements in tact lungs: clear to ascultation bilaterally, serous straw-colored drainage from chest tube site on the right heart: tachycardic, regular rhythum, normal s1s2 abdomen: soft, distended, slightly tender especailly in the right flank, right flank induration, bowel sounds positive drains: right hepatic pigtail, right chest tube pertinent results: 10:29pm blood freeca-1.17 10:23am blood freeca-0.94* 12:41am blood freeca-1.35* 05:20pm blood freeca-1.18 03:13am blood freeca-1.22 09:17pm blood freeca-1.05* 02:55pm blood freeca-1.11* 06:00pm blood freeca-1.11* 09:53pm blood freeca-1.06* 02:01pm blood freeca-1.18 10:29pm blood o2 sat-94 03:41pm blood hgb-10.8* calchct-32 o2 sat-97 11:41am blood hgb-9.2* calchct-28 12:00pm blood hgb-9.7* calchct-29 08:39pm blood hgb-11.7* calchct-35 o2 sat-80 10:27pm blood o2 sat-97 05:03pm blood hgb-11.3* calchct-34 10:04am blood o2 sat-98 06:00pm blood o2 sat-98 05:44pm blood o2 sat-96 10:29pm blood lactate-1.1 08:22am blood glucose-115* lactate-1.9 na-129* k-2.6* cl-92* 10:51am blood glucose-136* lactate-3.6* na-134* k-2.6* cl-94* 11:41am blood glucose-132* lactate-6.1* na-131* k-2.7* cl-97* 03:35am blood lactate-3.8* 11:31am blood lactate-4.8* 12:40pm blood lactate-4.3* 03:13am blood lactate-1.5 03:14pm blood k-4.1 05:03pm blood glucose-153* k-3.4* 01:41am blood k-4.3 10:04am blood glucose-110* 05:33am blood glucose-106* lactate-0.7 k-3.3* 05:44pm blood glucose-110* na-134* k-3.1* cl-106 10:29pm blood type-art po2-69* pco2-36 ph-7.46* calhco3-26 base xs-1 03:41pm blood type-art tidal v-736 po2-113* pco2-41 ph-7.42 calhco3-28 base xs-2 intubat-intubated vent-controlled 07:50pm blood type-art po2-96 pco2-51* ph-7.30* calhco3-26 base xs--1 intubat-not intuba 12:54pm blood type-art tidal v-720 fio2-53 po2-167* pco2-30* ph-7.58* calhco3-29 base xs-7 intubat-intubated vent-controlled 01:50pm blood type-art rates-/10 tidal v-720 fio2-45 o2 flow-1 po2-196* pco2-35 ph-7.54* calhco3-31* base xs-7 intubat-intubated vent-controlled 05:04pm blood type-art po2-153* pco2-61* ph-7.35 calhco3-35* base xs-6 intubat-intubated 09:12pm blood type-art po2-148* pco2-45 ph-7.45 calhco3-32* base xs-7 12:41am blood type-art po2-101 pco2-45 ph-7.39 calhco3-28 base xs-1 11:31am blood po2-142* pco2-48* ph-7.36 calhco3-28 base xs-1 05:20pm blood type-art po2-114* pco2-50* ph-7.35 calhco3-29 base xs-1 10:38pm blood type-mix 12:28am blood type-art po2-111* pco2-42 ph-7.36 calhco3-25 base xs--1 02:30am blood type-art po2-143* pco2-44 ph-7.38 calhco3-27 base xs-0 02:41am blood type-art po2-146* pco2-39 ph-7.50* calhco3-31* base xs-7 04:14pm blood type-art po2-141* pco2-49* ph-7.41 calhco3-32* base xs-5 10:48am blood type-art po2-147* pco2-54* ph-7.37 calhco3-32* base xs-4 03:14pm blood type-art po2-167* pco2-49* ph-7.42 calhco3-33* base xs-6 10:51am blood type-art po2-141* pco2-59* ph-7.32* calhco3-32* base xs-2 03:57pm blood type-art po2-116* pco2-51* ph-7.37 calhco3-31* base xs-3 04:52am blood type-art po2-128* pco2-37 ph-7.49* calhco3-29 base xs-5 intubat-intubated 09:39pm blood type-art po2-144* pco2-34* ph-7.52* calhco3-29 base xs-5 03:23am blood type-art po2-141* pco2-38 ph-7.43 calhco3-26 base xs-1 02:55pm blood type-art po2-175* pco2-36 ph-7.41 calhco3-24 base xs-0 03:37am blood type-art po2-152* pco2-36 ph-7.42 calhco3-24 base xs-0 09:25pm blood type-art po2-145* pco2-37 ph-7.42 calhco3-25 base xs-0 intubat-intubated 05:33am blood type-art po2-120* pco2-42 ph-7.39 calhco3-26 base xs-0 12:40pm blood type-art po2-103 pco2-49* ph-7.41 calhco3-32* base xs-4 06:00pm blood type-art po2-127* pco2-57* ph-7.39 calhco3-36* base xs-8 08:43am blood type-art po2-141* pco2-44 ph-7.46* calhco3-32* base xs-7 intubat-intubated 02:08pm blood type-art po2-102 pco2-44 ph-7.46* calhco3-32* base xs-6 04:20pm blood ph-7.43 comment-green top 02:46pm blood type-art po2-106* pco2-47* ph-7.46* calhco3-34* base xs-8 11:20am blood type-art po2-61* pco2-43 ph-7.47* calhco3-32* base xs-6 03:58am blood type-art po2-69* pco2-38 ph-7.48* calhco3-29 base xs-4 01:34pm blood type-art po2-150* pco2-30* ph-7.46* calhco3-22 base xs-0 02:01pm blood type-art po2-164* pco2-37 ph-7.45 calhco3-27 base xs-2 09:32am blood vanco-9.7* 05:52am blood vanco-9.8* 09:09am blood cortsol-5.5 10:10am blood cortsol-5.6 09:19pm blood tsh-1.9 07:30am blood tsh-3.6 06:00am blood ammonia-46 09:19pm blood triglyc-207* 02:28am blood triglyc-213* 09:19pm blood caltibc-170* ferritn-> trf-131* 04:19am blood caltibc-143 ferritn-greater th trf-110* 09:19pm blood albumin-2.7* calcium-7.9* phos-2.4* mg-1.9 iron-25* 05:00am blood albumin-2.4* calcium-7.8* phos-3.0 mg-1.9 05:32pm blood calcium-7.8* phos-2.5* mg-1.6 02:41am blood albumin-2.2* calcium-7.1* phos-2.0* mg-1.7 04:34am blood albumin-2.4* calcium-7.6* phos-1.6* mg-1.8 04:01am blood calcium-7.7* phos-2.4* mg-1.7 01:59am blood calcium-7.3* phos-2.6* mg-1.8 05:54am blood calcium-7.5* phos-1.8* mg-1.6 05:15am blood calcium-7.5* phos-1.8* mg-1.7 08:50am blood calcium-8.0* phos-1.7* 05:05am blood albumin-2.5* calcium-7.8* phos-1.5* mg-1.8 09:32am blood calcium-7.4* phos-2.4* mg-1.6 06:00am blood albumin-1.9* calcium-7.2* phos-2.2* mg-1.9 04:59am blood albumin-2.4* calcium-7.6* phos-1.5* mg-1.7 03:18am blood calcium-8.6 phos-3.2 mg-2.1 07:30am blood albumin-1.6* calcium-8.2* phos-3.1 mg-1.8 02:10am blood albumin-1.5* calcium-8.0* phos-3.2 mg-2.1 11:57am blood albumin-1.6* calcium-7.8* phos-3.3 mg-1.9 02:28pm blood mg-2.3 02:28am blood albumin-1.6* calcium-8.3* phos-4.1 mg-2.2 03:27am blood calcium-7.9* phos-3.2# mg-1.8 11:30am blood mg-1.9 10:39pm blood calcium-6.9* mg-1.7 04:16am blood calcium-7.4* phos-2.1* mg-2.0 09:13pm blood calcium-7.0* mg-1.8 04:59am blood albumin-1.6* calcium-7.5* phos-2.3* mg-1.9 02:27pm blood calcium-6.8* phos-2.4* mg-1.7 08:49pm blood calcium-6.8* phos-2.5* mg-1.9 10:49pm blood calcium-6.8* mg-1.6 11:55pm blood calcium-7.0* phos-1.9* mg-1.5* 04:31am blood calcium-7.0* phos-1.8* mg-1.7 10:13am blood mg-1.5* 04:09am blood albumin-2.1* calcium-7.4* phos-2.4* mg-1.8 03:08am blood calcium-7.8* phos-2.5* mg-1.7 02:18am blood calcium-7.8* mg-1.6 01:17pm blood calcium-7.8* mg-1.7 03:34am blood calcium-7.7* mg-1.7 03:30am blood calcium-7.9* mg-1.5* 10:30am blood calcium-8.0* mg-1.5* 02:27pm blood ck-mb-notdone ctropnt-0.01 08:49pm blood ctropnt-<0.01 09:19pm blood lipase-98* 05:00am blood lipase-83* 01:30am blood lipase-55 08:41pm blood lipase-8 02:10am blood lipase-6 04:16am blood lipase-135* 04:19am blood lipase-382* 02:27pm blood lipase-194* 03:30am blood lipase-188* 01:38pm blood lipase-71* ggt-448* 09:19pm blood alt-35 ast-65* ld(ldh)-517* alkphos-900* amylase-36 totbili-1.6* dirbili-0.6* indbili-1.0 05:00am blood alt-26 ast-39 alkphos-748* amylase-34 totbili-1.5 dirbili-0.8* indbili-0.7 05:32pm blood alt-33 ast-56* alkphos-790* amylase-35 totbili-1.5 02:41am blood alt-26 ast-39 ld(ldh)-212 alkphos-457* amylase-26 totbili-1.5 01:30am blood alt-22 ast-31 ld(ldh)-224 alkphos-402* amylase-23 totbili-1.5 04:34am blood alt-22 ast-34 ld(ldh)-264* alkphos-415* amylase-23 totbili-1.6* 04:01am blood alt-18 ast-28 alkphos-379* totbili-1.4 04:01am blood alt-17 ast-25 alkphos-401* totbili-1.3 01:59am blood alt-13 ast-21 alkphos-329* totbili-1.1 04:59am blood alt-18 ast-32 alkphos-352* amylase-12 totbili-0.6 03:15pm blood alt-11 ast-20 alkphos-89 amylase-23 totbili-2.3* 03:18am blood alt-12 ast-23 alkphos-82 amylase-21 07:30am blood alt-8 ast-19 alkphos-79 totbili-0.7 02:28am blood alt-8 ast-15 alkphos-243* amylase-8 totbili-0.7 02:47am blood alt-15 ast-36 alkphos-563* amylase-13 totbili-0.7 03:27am blood alt-42* ast-65* alkphos-642* totbili-0.9 03:08am blood alt-35 ast-48* alkphos-391* amylase-74 totbili-1.4 02:27pm blood alt-45* ast-68* ck(cpk)-10* amylase-54 totbili-1.3 08:49pm blood ck(cpk)-9* 03:17am blood alt-34 ast-35 alkphos-673* totbili-0.9 04:09am blood alt-29 ast-29 alkphos-719* amylase-25 totbili-0.9 01:38pm blood alt-27 ast-33 alkphos-763* amylase-32 totbili-0.6 09:19pm blood glucose-104 urean-9 creat-0.6 na-136 k-4.5 cl-101 hco3-24 angap-16 05:00am blood glucose-96 urean-8 creat-0.6 na-137 k-3.5 cl-104 hco3-26 angap-11 05:32pm blood glucose-101 urean-9 creat-0.6 na-135 k-3.5 cl-102 hco3-23 angap-14 02:11am blood glucose-78 urean-9 creat-0.6 na-135 k-3.2* cl-102 hco3-25 angap-11 02:41am blood glucose-119* urean-7 creat-0.6 na-132* k-2.9* cl-98 hco3-28 angap-9 01:30am blood glucose-98 urean-7 creat-0.5 na-134 k-3.3 cl-98 hco3-28 angap-11 04:34am blood glucose-84 urean-7 creat-0.5 na-134 k-3.5 cl-96 hco3-31 angap-11 04:01am blood glucose-85 urean-5* creat-0.5 na-133 k-3.3 cl-97 hco3-30 angap-9 03:02pm blood glucose-92 urean-5* creat-0.7 na-134 k-4.1 cl-99 hco3-29 angap-10 01:59am blood glucose-106* urean-5* creat-0.6 na-136 k-3.5 cl-101 hco3-28 angap-11 06:00am blood glucose-103 urean-7 creat-0.5 na-135 k-3.3 cl-96 hco3-31 angap-11 05:15am blood glucose-124* urean-8 creat-0.6 na-131* k-3.1* cl-94* hco3-31 angap-9 08:50am blood glucose-102 urean-7 creat-0.6 na-132* k-3.9 cl-95* hco3-30 angap-11 06:10am blood k-3.3 05:05am blood glucose-102 urean-4* creat-0.5 na-130* k-3.7 cl-95* hco3-25 angap-14 09:32am blood glucose-116* urean-6 creat-0.6 na-128* k-3.5 cl-96 hco3-26 angap-10 06:15am blood glucose-104 urean-5* creat-0.5 na-131* k-3.8 cl-98 hco3-26 angap-11 09:00pm blood glucose-124* urean-5* creat-0.5 na-131* k-3.9 cl-96 hco3-25 angap-14 04:59am blood glucose-108* urean-6 creat-0.5 na-136 k-2.9* cl-93* hco3-36* angap-10 06:00am blood glucose-83 urean-8 creat-0.6 na-136 k-2.8* cl-92* hco3-37* angap-10 03:15pm blood glucose-89 urean-7 creat-0.5 na-140 k-2.5* cl-99 hco3-29 angap-15 08:41pm blood glucose-82 urean-8 creat-0.4* na-138 k-3.2* cl-102 hco3-29 angap-10 11:09am blood glucose-144* urean-9 creat-0.6 na-134 k-3.7 cl-101 hco3-25 angap-12 05:22pm blood glucose-104 urean-9 creat-0.7 na-135 k-4.3 cl-103 hco3-23 angap-13 10:20pm blood glucose-160* urean-10 creat-0.7 na-133 k-4.2 cl-100 hco3-24 angap-13 11:57am blood glucose-159* urean-10 creat-0.6 na-132* k-3.8 cl-101 hco3-23 angap-12 11:57am blood glucose-138* urean-11 creat-0.6 na-135 k-4.0 cl-101 hco3-28 angap-10 01:57am blood glucose-132* urean-12 creat-0.6 na-137 k-3.7 cl-102 hco3-28 angap-11 04:06pm blood glucose-127* urean-18 creat-0.6 k-4.6 02:47am blood glucose-163* urean-20 creat-0.6 na-144 k-3.9 cl-107 hco3-32 angap-9 03:27am blood glucose-142* urean-25* creat-0.5 na-145 k-3.5 cl-110* hco3-31 angap-8 11:30am blood urean-25* creat-0.4* k-3.5 03:01pm blood glucose-145* k-3.5 04:16am blood glucose-90 urean-23* creat-0.5 na-139 k-3.7 cl-106 hco3-29 angap-8 12:21pm blood k-3.5 04:19am blood glucose-131* urean-18 creat-0.4* na-137 k-3.9 cl-106 hco3-27 angap-8 02:48pm blood glucose-122* urean-18 creat-0.4* k-4.4 cl-107 hco3-24 03:08am blood glucose-114* urean-19 creat-0.4* na-135 k-4.1 cl-106 hco3-23 angap-10 02:27pm blood glucose-119* urean-21* creat-0.5 na-134 k-4.0 cl-106 hco3-24 angap-8 08:49pm blood glucose-105 urean-20 creat-0.4* na-136 k-3.9 cl-107 hco3-23 angap-10 03:02pm blood glucose-119* urean-16 creat-0.4* na-135 k-3.6 cl-103 hco3-23 angap-13 02:42am blood glucose-106* urean-14 creat-0.3* na-134 k-3.9 cl-103 hco3-25 angap-10 03:58pm blood glucose-87 urean-12 creat-0.3* na-134 k-4.5 cl-101 hco3-27 angap-11 11:55pm blood glucose-95 urean-11 creat-0.3* na-134 k-3.7 cl-101 hco3-27 angap-10 03:17am blood glucose-107* urean-13 creat-0.4* na-135 k-3.7 cl-96 hco3-31 angap-12 10:13am blood glucose-139* k-4.0 09:00pm blood k-4.3 03:37am blood glucose-126* urean-12 creat-0.4* na-132* k-4.0 cl-98 hco3-28 angap-10 01:17pm blood k-5.0 01:38pm blood glucose-134* urean-13 creat-0.4* na-134 k-3.9 cl-100 hco3-27 angap-11 05:47pm blood na-132* k-4.3 cl-100 03:49am blood urean-14 creat-0.4* k-3.9 10:30am blood k-4.1 10:45am blood fibrino-340 12:00pm blood fibrino-208 01:31pm blood fibrino-189 11:09am blood fibrino-266 05:22pm blood fibrino-285 02:10am blood fibrino-334 09:19pm blood pt-14.4* ptt-24.2 inr(pt)-1.4 05:00am blood pt-14.9* ptt-27.1 inr(pt)-1.5 02:41am blood pt-14.3* ptt-32.2 inr(pt)-1.4 01:30am blood pt-13.6* ptt-29.4 inr(pt)-1.2 01:30am blood plt ct-381 04:34am blood plt ct-480* 04:01am blood plt ct-392 01:59am blood plt ct-349 05:30am blood plt ct-366 05:15am blood plt ct-334 05:05am blood plt ct-344 09:45am blood pt-15.0* ptt-30.0 inr(pt)-1.5 07:48pm blood plt ct-322 08:35am blood plt ct-282 06:15am blood plt ct-267 11:00am blood pt-14.0* ptt-26.6 inr(pt)-1.3 10:45am blood pt-14.0* ptt-30.5 inr(pt)-1.3 10:45am blood plt ct-124* 11:35am blood pt-14.5* ptt-32.6 inr(pt)-1.4 11:35am blood plt ct-103* 01:31pm blood pt-13.9* ptt-30.6 inr(pt)-1.3 01:31pm blood plt ct-85* 03:15pm blood pt-13.8* ptt-31.0 inr(pt)-1.3 12:31am blood pt-15.1* ptt-38.4* inr(pt)-1.5 12:31am blood plt ct-88* 03:18am blood pt-14.4* ptt-32.8 inr(pt)-1.4 11:09am blood plt ct-129* 05:22pm blood pt-15.2* ptt-35.0 inr(pt)-1.5 05:22pm blood plt ct-125* 10:20pm blood ptt-37.6* 11:57am blood pt-15.3* ptt-39.8* inr(pt)-1.6 11:57am blood plt ct-95* 02:28am blood plt ct-100* 04:06pm blood pt-14.0* ptt-32.4 inr(pt)-1.3 02:47am blood plt ct-125* 03:27am blood pt-14.0* ptt-26.2 inr(pt)-1.3 04:16am blood pt-15.3* ptt-28.3 inr(pt)-1.6 04:16am blood plt ct-137* 03:08am blood pt-13.9* ptt-29.4 inr(pt)-1.3 03:08am blood plt ct-192 03:30am blood plt ct-196 02:42am blood pt-14.0* ptt-28.5 inr(pt)-1.3 03:17am blood pt-14.2* ptt-28.0 inr(pt)-1.4 03:17am blood plt ct-290 01:38pm blood plt ct-278 03:49am blood plt ct-318 09:19pm blood hypochr-1+ anisocy-normal poiklo-1+ macrocy-normal microcy-occasional polychr-normal target-1+ envelop-1+ 04:59am blood hypochr-1+ anisocy-normal poiklo-occasional macrocy-normal microcy-normal polychr-occasional schisto-occasional 03:30am blood poiklo-1+ 09:19pm blood neuts-90.0* bands-0 lymphs-8.3* monos-1.5* eos-0.1 baso-0.1 05:05am blood neuts-80.2* lymphs-13.8* monos-4.9 eos-1.0 baso-0.1 04:59am blood neuts-83* bands-2 lymphs-7* monos-4 eos-3 baso-0 atyps-1* metas-0 myelos-0 03:27am blood neuts-84.5* lymphs-9.5* monos-5.9 eos-0 baso-0.1 02:27pm blood neuts-89* bands-6* lymphs-2* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 03:30am blood neuts-86.8* lymphs-7.0* monos-3.9 eos-2.1 baso-0.2 04:09am blood neuts-80.6* lymphs-12.1* monos-5.1 eos-2.0 baso-0.2 05:00am blood wbc-16.7* rbc-4.03* hgb-10.6* hct-32.4* mcv-80* mch-26.2* mchc-32.6 rdw-17.1* plt ct-321 05:32pm blood wbc-23.6* rbc-4.01* hgb-10.6* hct-32.9* mcv-82 mch-26.3* mchc-32.1 rdw-17.0* plt ct-352 02:11am blood wbc-26.7* rbc-3.98* hgb-10.5* hct-32.1* mcv-81* mch-26.5* mchc-32.8 rdw-17.0* plt ct-348 02:41am blood wbc-21.8* rbc-3.61* hgb-9.4* hct-29.0* mcv-80* mch-26.1* mchc-32.5 rdw-17.4* plt ct-347 09:32am blood hct-32.9* 01:30am blood wbc-20.9* rbc-3.80* hgb-10.1* hct-30.5* mcv-80* mch-26.5* mchc-32.9 rdw-17.2* plt ct-381 04:34am blood wbc-18.2* rbc-3.74* hgb-9.8* hct-29.8* mcv-80* mch-26.2* mchc-32.9 rdw-17.2* plt ct-480* 04:01am blood wbc-22.8* rbc-3.83* hgb-10.1* hct-31.4* mcv-82 mch-26.3* mchc-32.1 rdw-17.1* plt ct-445* 04:01am blood wbc-21.2* rbc-3.44* hgb-8.9* hct-28.4* mcv-83 mch-25.9* mchc-31.3 rdw-17.4* plt ct-392 06:00am blood wbc-19.7* rbc-3.32* hgb-9.0* hct-27.2* mcv-82 mch-27.1 mchc-33.1 rdw-16.0* plt ct-351 05:15am blood wbc-14.8* rbc-3.11* hgb-8.4* hct-25.8* mcv-83 mch-27.0 mchc-32.5 rdw-16.2* plt ct-334 11:35am blood wbc-16.4* rbc-3.09* hgb-8.2* hct-25.3* mcv-82 mch-26.4* mchc-32.2 rdw-15.9* plt ct-342 05:23am blood wbc-15.2* rbc-3.15* hgb-8.2* hct-26.2* mcv-83 mch-26.0* mchc-31.2 rdw-16.1* plt ct-364 09:32am blood wbc-13.2* rbc-2.87* hgb-7.9* hct-24.0* mcv-84 mch-27.7 mchc-33.0 rdw-16.8* plt ct-350 06:15am blood wbc-13.0* rbc-3.33* hgb-9.1* hct-28.9* mcv-87 mch-27.3 mchc-31.5 rdw-16.3* plt ct-343 09:00pm blood wbc-11.9* rbc-3.46* hgb-9.5* hct-29.8* mcv-86 mch-27.5 mchc-32.0 rdw-16.3* plt ct-347 06:15am blood wbc-12.5* rbc-3.02* hgb-8.3* hct-25.9* mcv-86 mch-27.7 mchc-32.3 rdw-17.1* plt ct-267 06:00am blood wbc-9.4 rbc-3.30* hgb-9.3* hct-28.5* mcv-86 mch-28.1 mchc-32.5 rdw-16.7* plt ct-247 10:32am blood wbc-12.4* rbc-3.76* hgb-10.7* hct-32.2* mcv-86 mch-28.4 mchc-33.1 rdw-16.2* plt ct-202 03:15pm blood wbc-11.2* rbc-3.87* hgb-11.7* hct-32.3* mcv-84 mch-30.1 mchc-36.1* rdw-15.1 plt ct-136*# 08:41pm blood wbc-15.3* rbc-3.65* hgb-10.9* hct-30.6* mcv-84 mch-29.7 mchc-35.5* rdw-15.3 plt ct-119* 10:20pm blood wbc-28.9* rbc-3.74* hgb-11.2* hct-32.8* mcv-88 mch-29.8 mchc-34.1 rdw-16.3* plt ct-124* 02:10am blood wbc-31.0* rbc-3.86* hgb-11.5* hct-33.5* mcv-87 mch-29.9 mchc-34.5 rdw-16.2* plt ct-130* 11:57am blood wbc-27.3* rbc-3.53* hgb-10.9* hct-30.9* mcv-88 mch-30.8 mchc-35.2* rdw-16.2* plt ct-96* 02:47am blood wbc-11.5* rbc-3.49* hgb-10.2* hct-32.2* mcv-92 mch-29.1 mchc-31.6 rdw-15.9* plt ct-125* 03:27am blood wbc-9.4 rbc-3.50* hgb-10.3* hct-32.7* mcv-93 mch-29.4 mchc-31.4 rdw-15.7* plt ct-117* 04:24am blood wbc-8.7 rbc-3.35* hgb-9.9* hct-31.7* mcv-95 mch-29.6 mchc-31.3 rdw-15.8* plt ct-130* 04:16am blood wbc-13.2* rbc-3.40* hgb-10.2* hct-31.9* mcv-94 mch-30.0 mchc-32.0 rdw-15.9* plt ct-137* 04:19am blood wbc-16.4* rbc-3.27* hgb-9.8* hct-29.9* mcv-91 mch-29.9 mchc-32.7 rdw-15.9* plt ct-138* 04:59am blood wbc-17.0* rbc-2.79* hgb-8.4* hct-25.8* mcv-92 mch-30.3 mchc-32.7 rdw-16.3* plt ct-166 08:49pm blood wbc-16.2* rbc-2.98* hgb-9.1* hct-27.2* mcv-91 mch-30.4 mchc-33.3 rdw-15.8* plt ct-187 03:30am blood wbc-15.4* rbc-3.21* hgb-9.9* hct-29.7* mcv-92 mch-30.7 mchc-33.3 rdw-15.7* plt ct-196 02:42am blood wbc-17.8* rbc-3.00* hgb-9.1* hct-27.7* mcv-92 mch-30.5 mchc-33.0 rdw-15.6* plt ct-232 06:03pm blood wbc-15.8* rbc-3.02* hgb-9.1* hct-27.8* mcv-92 mch-30.2 mchc-32.7 rdw-15.1 plt ct-303 03:17am blood wbc-13.9* rbc-2.89* hgb-8.6* hct-26.7* mcv-92 mch-29.9 mchc-32.4 rdw-15.0 plt ct-290 04:09am blood wbc-14.0* rbc-3.35* hgb-10.1* hct-30.3* mcv-91 mch-30.1 mchc-33.3 rdw-15.6* plt ct-301 01:38pm blood wbc-13.3* rbc-3.53* hgb-10.4* hct-32.1* mcv-91 mch- 29.5 mchc-32.4 rdw-14.8 plt ct-278 ct a/p - gross intraabdominal inflammatory changes as described above. the appearances are more suggestive of gross inflammatory change possibly with areas of fat necrosis than fluid collection which is amenable to percutaneous drainage. proximity to the upper right colon would raise the possibility at least of prior colonic injury. a delayed ct scan could be obtain to evaluate the right colon with oral contrast. 2. low-density area in the lateral subcapsular aspect of the previous resection with no residual fluid attenuating biloma in the region of the pigtail catheter. 3. there are small bibasilar pleural effusions. the right chest drain lies above the remaining fluid. 4. number of subcentimeter hypodensities in the liver which are indeterminate. ct a/p - interval reduction in size of the component of the collection recently drained in the right posterolateral retroperitoneum and subcutaneous tissues. 2. there persists multiloculated low density collections/phlegmon in the inferior midline retroperitoneum, left posterior inferior retroperitoneum and superior left pelvis.the largest collection in the right upper quadrant extends anteroinferiorly from the region of the pancreatic head. this collection contains several air locules which may be due to communication with recently drained component or possibly sepsis. 3. small amount of intra-abdominal ascites, slightly larger in the interval. 4. small bibasilar pleural effusions and minor bibasilar atelectasis, unchanged. ct a/p -mild interval reduction in size of the multiloculated collections within the mesentry and retroperitoneum as described. 2. two dominant areas that may be amenable to additional percutaneous drainage, one located in the right upper quadrant just inferior to the pancreatic head and the other, a fluid attenuating locule measuring up to 5 cm in the left retroperitoneum anterior to the site of recent pigtail catheter insertion. 3. bibasilar lung effusion and posterior basilar atelectasis unchanged. mild interval reduction in the amount of intraabdominal ascites cta - 1) study limited by suboptimal contrast bolus but there is no major central pulmonary embolism. 2) small, new left-sided pneumothorax. phoned to dr. . 3) bilateral pleural effusions/atelectasis, slightly increased compared to the prior study. 4) pigtail catheter in the area of the hepatic resection with surrounding inflammatory changes is not significantly changed. cytology reportshighly atypical cells present suspicious for malignancy hepatic us - no evidence of a hepatic fluid collection. 2. echogenic liver suggestive of fatty infiltration. more advanced liver disesase and other types of liver disease, including cirrhosis/fibrosis, cannot be excluded by ultrasound in the presence of fatty infiltration. 3. moderate ascites ct a/p - . persistent complex collection in the right upper quadrant posteriorly just inferior to the pancreatic head that has not been drained by the previously inserted right percutaneous catheter. following discussion with dr. , this collection was subsequently drained with a percutaneous catheter. 2. the other components of these collections more inferiorly in the right posterior abdomen, midline retroperitoneum, and superior left pelvis are stable in the interval. no residual collection adjacent to the left lower abdominal catheter tip, this was subsequently removed. 3. moderate amount of intra-abdominal ascites. 4. moderate left basal pleural effusion and some atelectasis of the dependent left lower lobe. a small right basal pleural effusion ct a/p - modest interval decrease in size of infrapancreatic collection following percutaneous catheter placement. otherwise, unchanged appearance of multiple intraabdominal fluid collections. 2. unchanged mild-to-moderate ascites. 3. persistent moderate bilateral pleural effusions, left greater than right, with compressive atelectasis of the left lower lobe left pleural tissue-fibroadipose tissue and fibrous connective tissue with focal chronic inflammation and fibroblastic proliferation. 2. unremarkable skeletal muscle. 3. no evidence of malignancy ct a/p-no evidence of pulmonary embolism. 2. moderate-sized left-sided pneumothorax. 3. significant change in the complex collection in the right upper quadrant posteriorly just inferior to the pancreatic head as well as the surgical site of hepatic resection. 4. interval increase in the amount of ascites. 5. stable small bilateral pleural effusions. ct a/p -three pigtail catheters and a penrose drain within four stable-appearing abscess collections, as described above. 2. injection of the inferiormost drain demonstrates communication with the right colon. this catheter is in very close proximity to the bowel wall and may or may not perforate the colonic wall itself. 3. interval increase in the size of the subcutaneous abscess located between the middle and inferior pigtail catheter entry sites. 4. large amount of free fluid, unchanged from prior exam fluroscopy abd - filling of the ascending colon upon injection of the inferior pigtail catheter. this catheter is in very close proximity to the ascending colon. it cannot be determined if this catheter has actually perforated the colonic wall. 2. no filling of the superficial abscess collection to suggest communication the peritoneal abscesses. 3. injection of the middle and superior pigtail catheters demonstrating the peritoneal abscess collections seen on ct scan ct a/p - catheter exchange and repositioning into the right lateral subdiaphragmatic/perihepatic collection. there is now 12 french catheter in situ and aspiration yielded 25 cc of purulent material. 2. paracentesis drained 2500 ml of serous ascites path - ileocolectomy and colon segment (a-q): 1. organizing fat necrosis and hemorrhage, around the cecum and separate segment of colon. the ileal segment colonic mucosa are free of disease. there is no tumor. ii. necrotic abdominal tissue (r): 1. necrotic tissue. 2. no tumor. ruq us - limited study. no evidence of biliary ductal dilatation ct a/p - new bilateral pleural effusions with adjacent atelectasis. 2. resolution of the right subcutaneous abscess and collection in the bed. decrease in the amount of the free fluid within the abdomen. 3. overall decrease in the collection in the mesentery and left pelvis. decrease in size in the subcutaneous left collection. 4. no new collections were seen us le - no evidence for deep vein thrombosis. ct a/p - stable residual small collections/inflammatory phlegmon in the right posterior retroperitoneum and left posteroinferior retroperitoneum as described. one of the small left posterior pelvic collections is smaller in the interval. no new collections are demonstrated. surgically placed catheter remain in good position. 2. biloma drain in good position. a small (2.5 cm) lentiform hypodensity adjacent to the catheter tip. 3. small amount of residual intra-abdominal ascites. 4. open midline laparotomy wound without associated collection on ct. 5.small bibasilar effusions with associated dependent atelectasis ct a/p - overall interval improvement compared to recent study of , including almost complete resolution of intraabdominal ascites and improvement at the lung bases. 2. some residual phlegmon located mainly in the right posterior retroperitoneum, lower preaortic and left posterior inferior retroperitoneal regions is mostly stable compared to the prior ct. small (4 x 2 cm) fluid- attenuating locule in the right upper quadrant at the site of previous drain tip. 3. small bibasilar pleural effusions and minor atelectasis in the dependent lung bases. - bile duct stent was negative for malignant cells ercp - a fistulotomy site was noted above the orifice of major papilla. 2. the biliary stent was noted to have migrated into the bile duct. 3. the common bile duct, common hepatic duct, residual intrahepatic ducts were filled with contrast and appeared normal. the course and caliber of the structures are normal with no evidence of extrinsic compression, no ductal abnormalities, no leak, and no filling defects. 4. the biliary stent could not be removed on balloon sweep of the bile duct. therefore, a sohendra stent remover was used to retrieve the migrated biliary stent from the bile duct into the duodenum. a snare was used to remove the biliary stent kub- no evidence of free air or retroperitoneal air ct a/p - minor residual localised fluid-attenuating collection (likely small biloma measuring less than 3.1 cm ap x 1.4 cm transverse) at the hepatic resection site/ pigtail site (most of which was even present pre- removal. 2. small residual hypoattenuating collections and associated phlegmon in the retroperitoneum are stable. 3. minor bibasilar pleural effusion and bibasilar posterior atelectasis. minimal ascitic fluid in the right upper quadrant brief hospital course: the patient was admiited to the sicu on as a transfer from bombay. he presented with a right chest tube draining a pleural effusion. he had a right pigtail catheter draining a biliary leak in his abdomen. he was started on meropenem, vancomycin, and caspofungin empirically. a ct scan on hospital day two demonstrated findings more suggestive of gross inflammatory change (possibly with areas of fat necrosis) than a fluid collection which is amenable to percutaneous drainage. the proximity to the upper right colon raised the possibility at least of prior colonic injury. it also showed a low-density area in the lateral subcapsular aspect of the previous resection with no residual fluid attenuating previous biloma in the region of the pigtail catheter. in additon, there were small bibasilar pleural effusions. that day, he underwent an exploration of the retroperitoneal area with drainage of retroperitoneal and intra-abdominal abscesses via a flank approach. this operation was performed by dr. . the objective of this operation was to determine whether or not we could maximize drainage out through the flank and whether or not we could get further control of the retroperitoneal sepsis. the patient suffered no overt blood loss during the procedure and was taken back directly to the surgical intensive care unit stable. his chest tube was removed in the operating room. the patient spiked a fever to 102.5 on postoperative day one. tube feeds were started. tube feeds were held postoperative day three due to postoperative ileus. he was started on zosyn for pseudomonas which grew from his abscess culture. meropenem was discontinued. a ct on postoperative day four showed interval reduction in size of the component of the collection recently drained in the right posterolateral retroperitoneum and subcutaneous tissues. however, there were persistent multiloculated low density collections/phlegmon in the inferior midline retroperitoneum, left posterior inferior retroperitoneum and superior left pelvis. the largest collection in the right upper quadrant extends anteroinferiorly from the region of the pancreatic head. this collection contains several air locules which may be due to communication with recently drained component or possibly sepsis. following those results, a percutaneous pigtail catheter was inserted into the largest collection in the right upper quadrant (12 french) and 10 french pigtail catheter was inserted into the posterior left retroperitoneal collection. samples sent for culture. on postoperative day five, tube feeds were resumed. he tolerated clears. a ct scan from postoperative day seven demonstrated a mild interval reduction in size of the multiloculated collections within the mesentry and retroperitoneum. it also showed two dominant areas that may be amenable to additional percutaneous drainage, one located in the right upper quadrant just inferior to the pancreatic head and the other, and a fluid attenuating locule measuring up to 5 cm in the left retroperitoneum anterior to the site of recent pigtail catheter insertion. in addition, it showed bibasilar lung effusion and posterior basilar atelectasis unchanged. mild interval reduction in the amount of intraabdominal ascites. he then had ct guided drainage of his left lower retroperitonela collection. on postoperative day eight, one of his drains "fell out." vancomycin was discontinued. he was transferred to the floor. on postoperative day nine, a ct ruled out a pulmonary embolism, however there were bilateral pleural effusions/atelectasis, slightly increased compared to the prior study. on postoperative day ten, he was transfused one unit of rbcs for anemia of chronic disease. a ct scan from postoperative day eleven showed that the intra-abdominal and retroperitoneal collections were marginally smaller in the interval. the collection from the lower left retroperitoneal area from which the drainage catheter has displaced is smaller compared to previous imaging. there was a recurring biloma in the right subdiaphragmatic space, moderate left basal pleural effusion which has enlarged in the interval, and a mderate amount of intra-abdominal ascites, unchanged. in addition, under the supervision of the thoracic surgery service, using ct-fluoroscopic guidance and a right lateral intercostal approach, a 22- gauge chiba needle was advanced into the collection in the right subdiaphragmatic space. aspiration yielded yellow bile, a sample of which has been sent for biochemical and microbiological analysis. using a coaxial technique parallel to this needle, a 10 french multipurpose pigtail catheter was inserted into the collection. tip placement was confirmed by ct and initial aspiration yielded 30 cc of bile. following this, 250 ml of serous ascites was drained from the ascitic fluid along the left flank following aseptic technique and local analgesia. sample of the ascites was also sent for microbiological culture. postoperative day fourteen, the patient toleated a regular diet. he was febrile to 102.3. an ultrasound showed no evidence of a hepatic fluid collection, and an echogenic liver suggestive of fatty infiltration. more advanced liver disesase and other types of liver disease, including cirrhosis/fibrosis, could not be excluded by ultrasound in the presence of fatty infiltration. on postoperative day fifteen, his central venous line was changed over a wire. tube feeds continued to run. linezolid was started for vre in his abscess. caspofungin was discontinued. he complained of spigastric discomfort and dysphagia, so nasogastric suction was resumed. his diet was resumed postoperative day sixteen. lasix was started for peripheral edema on postoperative dy seventeen. his ng tube was removed on postoperative day eighteen. a ct scan from postoperative day nineteen showed a persistent complex collection in the right upper quadrant posteriorly just inferior to the pancreatic head that has not been drained by the previously inserted right percutaneous catheter. following discussion with dr. , this collection was subsequently drained with a percutaneous catheter (using ct fluoroscopic guidance, a 22-gauge chiba needle was advanced into the remaining collection in the posterior right upper quadrant collection using a right lateral approach. this collection is located just cranial to the one previously drained percutaneously just inferiorly. initial aspiration yielded purulent material, a sample of which is being sent for analysis. using coaxial technique, a 10 french multipurpose pigtail catheter was advanced into this collection. the formed tip was confirmed within the collection. initial aspiration yielded 30 cc of purulent material. the abscess cavity was irrigated with sterile saline). the other components of these collections more inferiorly in the right posterior abdomen, midline retroperitoneum, and superior left pelvis were stable in the interval. no residual collection adjacent to the left lower abdominal catheter tip, this was subsequently removed. there was a moderate amount of intra-abdominal ascites, along with moderate left basal pleural effusion and some atelectasis of the dependent left lower lobe, and a small right basal pleural effusion. on postoperative day twenty two, a ct scan showed modest interval decrease in size of infrapancreatic collection following percutaneous catheter placement. otherwise, unchanged appearance of multiple intraabdominal fluid collections and persistent moderate bilateral pleural effusions, left greater than right, with compressive atelectasis of the left lower lobe. on postoperative day twenty five, dr. performed a bonchoscopy and left pleuroscopy with pleural drainage and pleural biopsy. the biopsy was negative for malignancy. a left subclavian line was placed. on postoperative day 26/1, a ct scan showed no evidence of pulmonary embolism, moderate-sized left-sided pneumothorax, significant change in the complex collection in the right upper quadrant posteriorly just inferior to the pancreatic head as well as the surgical site of hepatic resection, interval increase in the amount of ascites, and stable small bilateral pleural effusions. on postoperative day 30/5, an abdominal son with fluoroscopy showed filling of the ascending colon upon injection of the inferior pigtail catheter. it could not be determined if this catheter has actually perforated the colonic wall. there was no filling of the superficial abscess collection to suggest communication the peritoneal abscesses. there was injection of the middle and superior pigtail catheters demonstrating the peritoneal abscess collections seen on ct scan. a ct scan from that same day showed three pigtail catheters and a penrose drain within four stable-appearing abscess collections. injection of the inferiormost drain demonstrates communication with the right colon. this catheter is in very close proximity to the bowel wall and may or may not perforate the colonic wall itself. there was an interval increase in the size of the subcutaneous abscess located between the middle and inferior pigtail catheter entry sites. there was also a large amount of free fluid, unchanged from prior exam. on postoperative day 31/6, there was successful therapeutic paracentesis of approximately 1.6 liters of ascites. on postoperative day 32/7, the icu team performed a ct guided catheter exchange and repositioning into the right lateral subdiaphragmatic/perihepatic collection. a new 12 french catheter was placed in situ and aspiration yielded 25 cc of purulent material. paracentesis drained 2500 ml of serous ascites. in addition, there was successful placement of a post-pyloric feeding tube and tube feeds were started. this tube fell out and was successfully replaced on postoperative day 35/10. on postoperative day 36/11, the following operations were performed by dr. : 1. extended right colectomy with end ileostomy and mucous fistula. 2. drainage of liver abscess. 3. peripancreatic necrosectomy 4. drainage of retroperitoneal abscess. 5. feeding jejunostomy tube placement. this operation was performed because we did not have sufficient control of this sources of sepsis. tis operation was well tolerated. on postoperative day two, an echocardiogram showed a dilated left atrium, with overall left normal left ventricular systolic function (lvef 50-55%). an ultrasound from postoperative day six showed no evidence of biliary ductal dilatation. to update the patient's icu condition, on postoperative day seven (), the patient was sedated on lorazepam with fentanyl for pain. clonidine was added. he did not require pressors and in fact he was on metoprolol for control of tachycardia. he was intubated on pressure support. he was tolerating tube feeds. his tpn was being weaned. lasix was used to get the patient two liters negative. he was on meropenem (18), linezolid (27), ceftazidime (8), and caspofungin (1). his temperature was 103 despite these antibiotics. his white blood cell count was 13.2. ceftazidime was stopped and aztreonam was started on postoperative day eight. a ct scan from postoperative day nine demonstrated new bilateral pleural effusions with adjacent atelectasis, resolution of the right subcutaneous abscess and collection, decrease in the amount of the free fluid within the abdomen, overall decrease in the collection in the mesentery and left pelvis, and decrease in size in the subcutaneous left collection. his tpn was stopped postoperative day ten. his central venous line was changed over a wire. on postoperative day thirteen, caspofungin was discontinued. meropenem was changed to imipenem. he was extubated on postoperative day fifteen. a swallow evaluation on postoperative day sixteen suggested advancing diet to oral liquids, which we did and which was tolerated by the patient, although his intake was minimal. aztreonam was discontinued. his abdominal wound was debrided at the bedside by dr. on postoperative day seventeen. tube feeds were running at goal on postoperative day eighteen. his lasix drip was weaned. on postoperative day twenty, his left arterial line was changed over a wire. lasix was stopped postoperative day twenty four. his foley was discontinued. he was transferred to the floor in good condition (afebrile with stable vital signs). linezolid was discontinued on postoperative day twenty five. his wound was debrided at the bedisde by dr. . on pod61/26 patient had tube feeds cycled, to encourage po intake during the day. calorie counts were instituted by nutrition to follow the patient's nutritional intake on a daily basis. patient continued on imipenem as long as drains were still in the patient, with ns wet to dry wound care for his abdominal wound that continued to granulate inward. the patient remained afebrile during the next several days of hospitalization, as his tube feed nutrition was optimized, po intake encouraged, and wet-to-dry dressing changes for the abdominal wound continued. imipenem was discontinued on pod 69/34, and physical therapy began to work with the patient during this time to improve his mobility and regain strength and endurance. on pod 73/38, patient had wound vac placed on abdominal wound to speed granulation and epithelialization of wound. the vac appeared to be operating appropriately, until drainage consistent with that of the patient's jp site was noticed to drain from the right lateral flap of the abdominal wound, and the decision was made to discontinue its usage, and ns dressing changes were resumed. out of concern for the drainage, a ct was obtained that showed a questionable fistulous collection between the ruq jp site and the skin, though overall the ct scan showed interval improvement in ascites and fluid collections. the patient continued aforementioned hospital course with decreased tf as po intake improved, and noted improvement in drainage from right lateral wound edge, while remaining afebrile. the last jp began to be removd on , as it was advanced from insertion site 4 inches. patient discharge planning discussions were initiated, and it was determined that the patient would be discharged to a fellow physicians home, where the patient would care for much of his own dressings. the jp was again advanced on pod 84/49, where it was also determined that the patients biliary stent placed in would need to be removed prior to patient's discharge from this hospital. ercp was consulted, and on pod 86/51, patient underwent ercp with biliary stent removal by dr. . the patient had some pain following the procedure that was well-controlled by a single sc injection of dilaudid without further complications. the patient did have a febrile episode to 101.7 on pod 87/52 for which patient was started back on imipenem. a repeat ct scan was obtained on which was negative for acute processes, and showed interval improvement from the scan on . imipenem was discontinued on and patient persisted with low-grade fevers into . patient was discharged on and will follow up with dr. . discharge medications: 1. 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* 2. metoprolol tartrate 25 mg tablet sig: 2.5 tablets po bid (2 times a day). disp:*150 tablet(s)* refills:*2* 3. hydromorphone 2 mg tablet sig: 1-2 tablets po q3-4h (every 3 to 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 4. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*2* 5. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 2 weeks. disp:*14 tablet(s)* refills:*0* 6. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 2 weeks. disp:*42 tablet(s)* refills:*0* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*1* 9. lorazepam 0.5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 10. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. multivitamin capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 12. polyvinyl alcohol 1.4 % drops sig: two (2) ophthalmic twice a day: 2 drops to affected eye prn . disp:*2 bottles* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: intrahepatic cholangiocarcinoma discharge condition: stable discharge instructions: please return to hospital er for fever greater than 101.4, for increasing abdominal pain, worsening nausea/vomiting, inability to maintain po intake, or signs of wound infection: increasing redness, swelling, tenderness, warmth, or purulent drainage followup instructions: please follow up with dr. in 2 weeks. please call to schedule an appointment. procedure: parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage temporary ileostomy other pleural biopsy excision or destruction of peritoneal tissue other lysis of peritoneal adhesions open and other right hemicolectomy removal of t-tube, other bile duct tube, or liver tube other laparotomy endoscopic retrograde cholangiopancreatography [ercp] retroperitoneal fistulogram injection or infusion of oxazolidinone class of antibiotics diagnoses: other postoperative infection cellulitis and abscess of trunk unspecified pleural effusion acute posthemorrhagic anemia unspecified septicemia severe sepsis peritoneal adhesions (postoperative) (postinfection) septic shock abscess of liver paralytic ileus other specified disorders of biliary tract personal history of malignant neoplasm of other gastrointestinal tract peritoneal abscess acute pancreatitis 

Answer: The patient is high likely exposed to