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: no known allergies / adverse drug reactions attending: chief complaint: transferred to for ercp to evaluate for question of blockage major surgical or invasive procedure: ercp with sphincterotomy and removal of small stone history of present illness: patient is a 67 yo f with a past medical history of aortic stenosis, dmii as well as symptomatic cholelithiasis who was admitted to hospital for elective cholecystectomy. she underwent laproscopic cholecystectomy with cholangiogram on . intraop cholangiogram was concerning for blockage as no contrast was seen to reach the duodenum, and the cystic duct was large with sludge. post-operatively, she was hypotensive with systolic blood pressure in the 80s and received 1 l ivf and then continued to receive lr at 100 cc/ hr for maintainence fluid. she was transferred to for ercp to evaluate for question of blockage. past medical history: - hypertension - moderate aortic stenosis - hyperlipidemia - diabetes mellitus type ii - history of paroxysmal supraventricular tachycardia - biliary colic s/p lap ccy - s/p lap bso with loa in - s/p right ankle/heel surgery social history: married with three children. former 1 ppd smoker, quit 8 years ago. rare etoh. family history: father d. in his late 40s suddenly, ? cva. mother d. age 82 with alzheimer's dementia. physical exam: vitals: t: 101.1 bp: 123/49 p: 100 r: 22 o2: 94% on 4l nc general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp elevated to 5 cm above clavicle at 60 degrees lungs: diminished bs at bases, otherwise no wheezes, rales, rhonchi cv: regular rate and rhythm, holosystolic murmur heard best at lusb abdomen: hypoactive bs, sl distended, laproscopic surgical scars clean dry, intact, mild ttp, no rebound, guarding gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam vss gen: patient lying comfortably in bed nad a+ox3 heent: mmm oropharynx clear neck: supple no thyromegaly cv: rrr no m/r/g resp: ctab no w/r/r abd: soft nt nd bs+ extr: no le edema good pedal pulses bilaterally derm: no rashes, ulcers or petechiae. erythema noted over the left forearm near previous iv site neuro: cn 2-12 grossly intact non-focal psych: normal affect and mood pertinent results: cbc 06:21pm blood wbc-11.9* rbc-4.07* hgb-11.5* hct-35.4* mcv-87 mch-28.4 mchc-32.6 rdw-14.5 plt ct-168 04:02am blood wbc-8.1 rbc-3.83* hgb-11.0* hct-33.5* mcv-87 mch-28.7 mchc-32.9 rdw-14.0 plt ct-159 coags 06:21pm blood pt-13.7* ptt-29.9 inr(pt)-1.3* chemistry 06:21pm blood glucose-101* urean-9 creat-1.0 na-137 k-3.8 cl-103 hco3-24 angap-14 04:02am blood glucose-101* urean-9 creat-1.0 na-141 k-4.1 cl-106 hco3-27 angap-12 06:21pm blood alt-329* ast-233* alkphos-208* totbili-1.0 04:02am blood alt-255* ast-141* ld(ldh)-171 alkphos-184* totbili-0.7 06:21pm blood calcium-8.6 phos-2.5* mg-2.0 04:02am blood calcium-8.3* phos-3.4 mg-2.2 cxr: impression: cardiac enlargement and pulmonary congestion clearly more marked than it was seven years ago. findings are compatible with chf, if this is related to fluid overload is a clinical question to be answered. echo: the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is at least 15 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef 70-75%). the estimated cardiac index is high (>4.0l/min/m2). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are moderately thickened (cannot determine #). there is moderate to severe aortic valve stenosis (valve area 0.9 cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a prominent fat pad. impression: moderate to severe aortic stenosis. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. ercp: impression: normal major papilla cannulation of the biliary duct was successful and deep after a guidewire was placed a small stone was noted at the distal cbd. otherwise, normal biliary tree a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. the stone was extracted successfully using a balloon discharge labs: 06:45am blood wbc-7.4 rbc-4.04* hgb-11.1* hct-35.6* mcv-88 mch-27.4 mchc-31.2 rdw-14.4 plt ct-215 06:45am blood glucose-104* urean-12 creat-0.8 na-142 k-4.0 cl-105 hco3-29 angap-12 06:45am blood alt-117* ast-29 alkphos-194* totbili-0.4 brief hospital course: patient is a 67 yo female with pmh of aortic stenosis, dmii as well as symptomatic cholelithiasis who was admitted to hospital for elective cholecystectomy now transferred to for ercp after intraop cholangiogram showed question of obstruction . #s/p cholecystectomy and cbd obstruction: the patient underwent elective cholecystectomy for ~1 year of symptomatic cholelithiasis at hospital and intraopperative cholangiogram showed question of cbd obstruction so she was referred to for ercp. this was initially deferred due to her respiratory distress and hypoxia. after the patient was diuresed she was taken for ercp on hd#2. she had sphincterotomy with balloon extraction of a small stone. the procedure was otherwise uncomplicated. she was given dilaudid for pain control. she was kept npo overnight and started on clears, which she tolerated well the next morning and her diet should be advanced as tolerated. she was started on unasyn/cipro because of fevers, although the fever was thought to be related to recent ccy as she had no abd pain or acute signs of infection. abx were changed to cipro after ercp and continued for a 5 day course. . #acute diastolic chf/aortic stenosis: on arrival to , the patient was dyspneic, hypoxic to 88% on 3l nc but otherwise hemodyamically stable. she remained hypoxic to 90% on 6l nc. a cxr was performed and showed mild pulmonary edema and pleural effusions. she received 20 mg iv furosemide in the pacu and was transferred to the icu where she was diuresed with improvement in her symptoms. her hypoxia was felt to be from pulmonary edema in the setting of aortic stenosis with previous iv fluid resuscitation at osh to treat her hypotension. she did have an echocardiogram that showed ef 70%, aortic valve area of 0.8 cm2 with peak gradient 58mmhg. after diuresis she was discharged on ra. she will continue her betablocker/acei on discharge and was given lasix 20mg po to use prn for sob or le swelling. . # superficial thrombophlebitis/cellultis: pt developed this initially on her left forearm on at osh. she subsequently developed it on another area in her l forearm during icu stay. she has some mild erythema of the l forearm with tenderness to palpation. this should be monitored for signs of developing infection. on day of discharge her eyrthema and pain was slightly worse. she was discharged with 5 day course of keflex #dm ii: the patient's home dose of metformin was held and she was maintained on an insulin sliding scale. she should restart her regular diabetes regimen upon discharge home. #hypertension: the patient was normotensive. her home atenolol and lisinopril were held given her recent hypotension. she will eventually need to be restarted on these medications. hypothyroidism: the patient was continued on her home dose levothroxine. . #hyperlipidemia: the patient's simvastatin was held but should be restarted. transition issues 1. patient to follow up with pcp in one week 2. she will continue taking antibiotics(cipro for gi coverage, keflex for cellulitis) for 5 days after discharge 3. patient will follow up with her surgeon for post op check after ccy medications on admission: home medications: - ergocalciferol 50,000 units po qmonth - vitamin b complex po daily - fish oil 2 grams po daily - aspirin 81 mg po daily - atenolol 25 mg po daily - metformin 500 mg po daily - levoxyl 0.1 mg po daily - simvastatin 20 mg po daily - lisinopril 10 mg po daily . transfer medications: - ciprofloxacin 400 mg iv q12 hours - unasyn 3 grams iv q6 hours - protonix 40 mg iv q12 hours - morphine 2-4 mg iv prn - zofran 4 grams iv prn - aspirin 81 mg po daily - atenolol 25 mg po daily - b complex with vitamin c po daily - ergocalciferol 50,000 units po monthly - fish oil 2 grams po daily - levoxyl 0.1 mg po daily - lisinopril 10 mg po daily - metoprolol 2.5 mg iv q8 hours - metformin 250 mg po daily - simvastatin 20 mg po daily discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. atenolol 25 mg tablet sig: one (1) tablet po once a day. 3. metformin 500 mg tablet sig: one (1) tablet po twice a day. 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*10 tablet(s)* refills:*0* 5. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 6. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day: restart aspirin on . 7. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 8. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a day. 9. fish oil 1,000 mg capsule sig: two (2) capsule po once a day. 10. vit b complex 100 combo no.2 100 mg tablet extended release sig: one (1) tablet extended release po once a day. 11. keflex 500 mg capsule sig: one (1) capsule po every six (6) hours for 5 days. disp:*20 capsule(s)* refills:*0* 12. lasix 20 mg tablet sig: one (1) tablet po once a day as needed for shortness of breath or wheezing: use if you have shortness of breath or increased swelling in your legs. disp:*5 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: choledocolithiasis status post cholecystectomy aortic stenosis acute diastolic chf superficial thrombophlebitis/cellulitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred to to have an ercp to remove a stone from your bile duct. when you arrived, you were found to have difficulty breathing which we think was because of your aortic stenosis. you were given medications to get rid of fluid and you began to breath better. you went for your ercp and were found to have a stone in your common bile duct. you had a small slit cut in your bile duct in order to have the stone removed. you did well during the procedure. the following changes have been made to your medications: 1. ciprofloxacin(antibiotic for your abd) for 5 days 2. keflex(antibiotic for your arm for 5 days 3. lasix 10mg(water pill) if you have worsening shortness of breath or swelling in your legs 4. hold your aspirin until . do not use ibuprofen, naproxen, advil, aleve for 5 days. followup instructions: please call your primary care physician, . , at and make a follow up appointment in days. please call your surgeon and make a follow up appointment for this week. procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism aortic valve disorders other and unspecified hyperlipidemia cellulitis and abscess of upper arm and forearm obesity, unspecified acute diastolic heart failure phlebitis and thrombophlebitis of superficial veins of upper extremities calculus of gallbladder and bile duct without cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to