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: patient recorded as having no known allergies to drugs attending: chief complaint: hematemesis major surgical or invasive procedure: egd and variceal banding history of present illness: micu admission: 64yof with multifocal hepatocellular carcinoma secondary to hepb cirrhosis, s/p rfa (clinical trial 08-256) of right liver lesions, but persistence of left liver lesions, now s/p tace treatment with doxorubicin on , presented to the ed and was womiting blood, with repeat of this while in triage. she was admitted to micu for an emergent upper endoscopy. vomitted brb at home and vomited brb here 100cc. called for emergency release blood, hx of varices, getting pantoprazole, octreotide, blood. has 2 18g and a 16g piv. called for 2u prbcs and 2u ffp. t/c sent for 4 units. . floor transfer: for full hpi please see micu admission note. in summary, ms. is a 64 year old female w/ hbv cirrhosis c/b varices, multifocal hcc s/p rfa (clinical trial 08-256) of right liver lesions, but persistence of left liver lesions, now s/p tace treatment with doxorubicin on who initially presented w/ hematemesis and transferred to micu for egd. she was treated w/ iv ppi and octreotide. she was intubated for egd () that was notable for grade iii - iv esophageal varices s/p banding. patient was successfully extubated, and switched to po ppi, and is also on cipro. she has received a total of 3u prbc. her lamivudine was changed to tenofovir. currently, pt does not complain of any pain. she reports feeling tired. has had no bowel movements since admission. no abd pain or cough. past medical history: past oncologic history: - hepatitis b, diagnosed in nigera , when she presented with ascites, has been on lamivudine since. - moved to the us and ultrasound at demonstrated two lesions in the liver concerning for hcc. - mri showed a 5.6 x 4.3 cm lesion in segment vi that demonstrated arterial enhancement and contrast washout and a 3.0 x 2.3 cm lesion in segment iii, also with arterial enhancement and contrast washout. another 1.8x2.5 cm lesion was seen at the dome of the liver suspicious for hepatoma as well as other smaller lesions suspicious for hepatoma. - referred to for evaluation in the liver center and was found to have an afp of 9508 ng/ml. - enrolled in clinical trial 08-256 and underwent radiofrequency ablation on with some ruq pain after that resolved, with adequate treatment of r sided lesions - transarterial chemoembolization to treat the left sided lesions. . other past medical history: 1. history of hepatitis b cirrhosis, diagnosed 05/. 2. advanced multifocal hepatocellular carcinoma 3. hypertension. 4. chronic peripheral paresthesias. her daughter states this started decades ago before she was born and resulted from a trip in where she had to stand in the for 2-3 days (?) 5. multinodular thyroid gland seen on ultrasound with dominant right lobe nodule amenable for ultrasound-guided biopsy, likely after tx for hcc, per heme onc notes social history: originally from and has been living in united states with her daughter and her daughter's family since . she denies any history of tobacco, alcohol, or illicit drug use. first language is yoruba. patient speaks english. family history: no family history of malignancy. physical exam: vs - temp 99.8f, bp 107/61, hr 73, r 18, o2-sat 100% ra general - well-appearing woman in nad heent - nc/at, perrla, eomi, sclerae anicteric neck - supple, thryromegaly w/out nodules, + cervical lad lungs - poor respiratory effort and poor air entry to lower lobes, mild crackles bibasilarly heart - pmi non-displaced, rrr, holosystolic murmur at rusb abdomen - soft, slightly distended, bs+, nt, no hepatomagelay extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - awake pertinent results: 05:25am blood wbc-3.0* rbc-3.32* hgb-10.3* hct-29.7* mcv-89 mch-30.9 mchc-34.6 rdw-17.3* plt ct-pnd 05:10am blood wbc-3.5* rbc-3.33* hgb-10.2* hct-29.9* mcv-90 mch-30.6 mchc-34.1 rdw-17.1* plt ct-56* 07:05am blood wbc-4.0 rbc-3.40* hgb-10.5* hct-30.2* mcv-89 mch-30.8 mchc-34.6 rdw-18.0* plt ct-44* 05:22am blood wbc-2.9* rbc-3.33* hgb-10.3* hct-29.7* mcv-89 mch-30.8 mchc-34.5 rdw-17.6* plt ct-44* 04:12am blood wbc-6.0 rbc-3.05* hgb-9.6* hct-27.5* mcv-90 mch-31.6 mchc-34.9 rdw-15.2 plt ct-49*# 01:25am blood wbc-8.8# rbc-3.42* hgb-11.2* hct-32.0* mcv-94 mch-32.7* mchc-34.9 rdw-15.0 plt ct-111* 10:50am blood neuts-80.6* lymphs-11.8* monos-4.2 eos-2.9 baso-0.4 01:25am blood neuts-71* bands-0 lymphs-23 monos-3 eos-3 baso-0 atyps-0 metas-0 myelos-0 05:25am blood pt-18.3* inr(pt)-1.7* 01:25am blood pt-19.0* ptt-30.3 inr(pt)-1.7* 05:25am blood glucose-77 urean-10 creat-0.7 na-139 k-3.5 cl-108 hco3-27 angap-8 05:10am blood glucose-89 urean-12 creat-0.8 na-141 k-3.4 cl-110* hco3-26 angap-8 07:05am blood glucose-78 urean-15 creat-0.9 na-134 k-3.6 cl-105 hco3-26 angap-7* 01:25am blood glucose-126* urean-25* creat-0.8 na-137 k-6.5* cl-106 hco3-21* angap-17 01:25am blood alt-42* ast-135* alkphos-81 totbili-1.7* 04:22am blood totbili-1.8* 01:25am blood lipase-77* 05:25am blood calcium-7.5* phos-2.4* mg-2.2 01:25am blood albumin-3.4* calcium-8.7 phos-2.9 mg-1.9 04:12am blood calcium-8.3* phos-2.8 mg-1.7 07:05am blood afp-* . . cxr - no acute intrathoracic abnormality. . egd: continue octreotide gtt for 48 hours. cipro 250 mg x 5 days continue ppi gtt for 48 hours total, then switch to oral. consider sorafenib for unresectable hcc. recommend oncology consult. patient will need further variceal banding as outpatient. okay to extubate. clear liquids for next 24 hours. then soft diet after. carafate slurry 1g po qid for 5 days. brief hospital course: is a 64-year-old woman with advanced multifocal hepatocellular carcinoma occurring in the setting of hepatitis b cirrhosis, s/p rfa p/w hematemesis from esophageal varices, s/p banding on this admission. . # esophageal varices- p/w hematemesis and melena, egd showed varices in the middle third of esophagus, s/p banding in 4 places on . pt was transferred from micu the day following banding and was hemodynamically stable throughout. bps were sbp 110s-120s throughout admission. hct was stable around 28-30 and she did not require any blood transfusions. she completed 72-hr course of octreotide, had iv ppi, 5 days of ciprofloxacin and 5 days of sucralfate. prior to discharge, her ppi was transitioned to oral omeprazole, she will follow up with dr. in 2 weeks for repeat endoscopy and banding as outpatient. consider starting nadolol at that time. . # ascites - prior to discharge, pt reported abdominal distension, on exam mostly tympanitic with some dull areas, u/s was done to evaluate for fluid and showed moderate ascites. pt was not uncomfortable with distension. we performed a diagnostic tap which was negative for sbp. she was started on lasix 20mg and aldactone was increased to 50mg from 25mg daily. she will f/u in liver clinic for titration of these medications. . # hepatocellular carcinoma: diagnosed in , s/p rfa and transarterial chemoembolization in , with lesions shown to be improving on ct surveillance. most recent ct showed no new lesions, stable pulmonary nodule, and new pvt (see below). oncology was made aware of her admission, and recommended that she follow up as outpatient for initiation of sorafinib for unresectable hcc. she has f/u appt with dr. in 2 weeks. . # hepatitis b cirrhosis: lamivudine was changed to tenofovir to prevent resistant, pt discharged with rx. . # portal venous thrombosis - new thrombus found on ct from - complete occlusion of the posterior right portal vein, partial occlusion of the proximal anterior right portal vein, and near complete occlusion of the segmental left portal vein. last ct in so not clear when pvt originated. given this chronicity and recent bleed, anticoagulation was not initiated. . # htn: increased laxis to 20mg daily and aldactone 50mg daily, will f/u in liver clinic. medications on admission: home medications: lamivudine 150 mg daily lisinopril 2.5 mg once a day spironolactone 25 mg daily calcium carbonate-vitamin d3 500 mg-400 unit docusate sodium 50 mg prn multivitamin . transfer medications: ciprofloxacin 250 mg docusate sodium 100 mg senna 1 tab k/mg sliding scale pantoprazole 40 mg q12h tenofovir disoproxil (viread) 300 mg daily discharge medications: 1. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. aldactone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 5. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 6. prilosec 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po twice a day. disp:*120 capsule, delayed release(e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: variceal bleed secondary: hcc hbv discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for a variceal bleed. your varices were banding during an endoscopy procedure. you were stabilized in the micu and then transferred to the floor. your blood counts remained stable and you were able to tolerate a normal diet. we did an ultrasound of your abdomen which showed some fluid, we took a sample of that fluid and it did not show an infection. you should have another endoscopy in 2 weeks with dr. to make sure there is no more bleeding. please make sure to come for this procedure on . . you should follow with dr. at the appointment date below for your hepatocellular carcinoma. . we have made the following changes to your medications: take 20mg lasix once daily and 50mg aldactone once daily to keep fluid out of your belly we have changed your lamivudine to tenofovir take prilosec (omeprazole) to help reduce acid in your stomach and prevent future gi bleeding followup instructions: dr. will call you with the date/time of your endoscopy (about 2 weeks from discharge) . name: ,md specialty: primary care when: thursday, at 10:10am location: center address: , , phone: . department: hematology/oncology when: monday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: insertion of endotracheal tube percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: cirrhosis of liver without mention of alcohol acute kidney failure, unspecified other ascites malignant neoplasm of liver, primary esophageal varices in diseases classified elsewhere, with bleeding other specified disorders of stomach and duodenum viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta nontoxic multinodular goiter portal vein thrombosis 

Answer: The patient is high likely exposed to