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: aspirin / codeine / penicillins / morphine / zomig / imitrex / nsaids / prochlorperazine / luvox cr / risperdal / amitriptyline / ativan attending: chief complaint: nausea, vomiting, abdominal pain major surgical or invasive procedure: none history of present illness: 52 y.o. female with crohns and multiple abdominal surgeries s/p g tube, on tpn, who presents with one day of abdominal pain, accompanied by n/v and bloody diarrhea. she is followed in for her multiple medical problems, but was in visiting a friend at va. she reports that yesterday around lunch time she noticed the sudden onset of diffuse (worst in luq) abdominal pain consistent with a prior history of obstruction vs. pancreatitis pain. she had bowel movements yesterday up from normally. they had a black color but then turned yellow with "swirls of blood and mucus," consistent with prior crohn flares. she also felt nauseated and vomited several times. over the last several days she noticed bloody output with clots from her g-tube, but not in the last several hours. she has been eating her normal diet up until yesterday afternoon, and her last tpn was 2 nights ago. she also reports intermittent fevers over the last week ranging from 99-102.3 orally. she does not typically have fevers with her crohn's flares. her last flare was in , last need for steroids was for a flare. . she presented to for these symptoms last night and had a ct scan concerning for ? sbo (dilated lb with air fluid levels, through rectum concerning for functional vs. distal obstruction--eval of lbo). kub reportedly demonstrated a dilated large bowel. hct was 30.9. she was given demerol 75 mg iv x 1 and 100 mg iv x 2 and zofran 4 mg iv x 1. she was transferred to for surgical evaluation and possbile management. she was seen by the surgery team in the ed who did not feel that she was clinically obstructed given her ongoing bowel movements and flatus. her g-tube was hooked to low wall suction with some improvement in her symptoms. . . in the ed, vitals were 97.4, 118/74, 76, 17, 98% ra. her blood pressure dropped to 84/42 and was initially fluid responsive. she dropped again to 83/60 after 50 mg of demerol and was started on dopamine. ed attending notes a drop in bp to 70s without response to fluids. blood cultures were taken and are pending and labs were largely unremarkable to include a lactate of 0.5 with a normal wbc. bp remained 110s/50-60 on dopamine and she arrived on the floor at 127/62 on 2.5 mg dopmine infusion. per records, she received 2 l of normal saline in the ed. she did not receive antibiotics. she had guaiac positive light brown stool and green output from g-tube. . per patient report, her normal blood pressures range between sbp 89-98. she currently is nauseated and complains of abdominal pain. she feels very dehydrated and is complaining of chest spasms typical for when she has abnormal electrolytes. she denies shortness of breath, headaches, ongoing fever/chills, numbness/tingling. she has had an mi in the past and this chest discomfort is not consistent with this event. . past medical history: past medical history (obtained via copied records brought w/ pt.): 1. crohn's disease: last flare in . did steroid taper for flare in . cannot take 5-asa products due to aspirin allergy, has never been on remicade. no history of chronic steroids. multiple bowel resections per patient. 2. multiple ex-lap, loa, stricturoplasy-had ileostomy in the past and is s/p reversal. history of sbo and partial sbo in the past. has venting gastrostomy as way to avoid further surgery. 3. "extensive psychiatric history"--without records regarding specifics--? ptsd/child abuse, ? alcoholism 4. s/p cholecystectomy 5. h/o staph bacteremia related to port-a-cath 6. admission to icu in for "like a truck sitting on my chest" with clot reportedly found on end of portacath, was on "a medication for this," not currently on anticoagulation. port replaced 7. nephrolithiasis--left kidney, recurrent 8. anemia: history of b12 deficiency. per records, baseline appears to be 32.5. 9. degenerative disk disease 10. asthma 11. fibromyalgia 12. h/o breast cancer s/p lumpectomy and chemotherapy per patient, could not be more specific 13. h/o uterine carcinoma s/p tah bso--history of 14. s/p knee surgery . s/p r svc port-a-cath 16. previous ef fistula 17. coronary artery disease s/p mi in s/p poba. no stenting. . social history: separated, mother of 3 children, not currently working, smoked ppd, quit 4 years ago. no current alcohol use (though history of use in the past), no drugs, on disability. family history: chorea--paternal relatives suicide at 60 father-chf congenital heart disease in several family members physical exam: vitals: 97 127/62, 69, 98% ra general: chronically-ill appearing, intermittently uncomfortable, pleasant, speaks in full sentences, relays intermittently inconsistent history heent: perrl, mm dry, eomi, op clear neck: no jvd, no lad chest/cv: regular, iii/vi sm across precordium, loudest at apex, rad to axilla lungs: at bases but otherwise clear back/cva,flank: no midline tenderness, slight trapezius tenderness r>l, left cva tenderness abd: soft, mildly distended, several healed incisions, g-tube site c/d/i, tenderness mostly in luq/left flank, no hepatomegaly + bs. g-tube with green, nonbloody output rectal: done at osh, as above ext: trace, nonpitting le edema, area of tender asymp swelling of rlq below knee on medial side neuro: cn ii-xii intact, sensation intact to light touch, strength ue/le bilaterally, no pronator drift skin: no rash pertinent results: 06:00am blood wbc-4.4 rbc-3.06* hgb-8.9* hct-27.2* mcv-89 mch-29.0 mchc-32.8 rdw-14.9 plt ct-208 06:00am blood neuts-52.7 lymphs-41.7 monos-3.2 eos-1.6 baso-0.8 06:00am blood glucose-91 urean-10 creat-0.6 na-145 k-3.3 cl-114* hco3-24 angap-10 06:00am blood calcium-7.3* phos-3.1 mg-1.4* cholest-94 08:52am blood wbc-3.7* rbc-3.81* hgb-10.7* hct-33.9* mcv-89 mch-28.0 mchc-31.5 rdw-14.3 plt ct-247 06:26am blood neuts-56.4 lymphs-37.7 monos-4.2 eos-1.3 baso-0.4 04:27am blood pt-13.8* ptt-29.5 inr(pt)-1.2* 08:52am blood glucose-106* urean-11 creat-0.6 na-137 k-4.5 cl-99 hco3-33* angap-10 06:26am blood alt-16 ast-16 ld(ldh)-100 alkphos-85 totbili-0.2 10:17pm blood ck-mb-notdone ctropnt-<0.01 02:28pm blood ck-mb-2 ctropnt-<0.01 06:00am blood ck-mb-3 ctropnt-<0.01 06:26am blood lipase-16 06:40am blood calcium-8.9 phos-3.5 mg-1.8 06:26am blood caltibc-250* vitb12-630 folate-16.4 ferritn-68 trf-192* 06:00am blood triglyc-52 hdl-31 chol/hd-3.0 ldlcalc-53 06:26am blood tsh-0.86 02:28pm blood crp-1.3 06:04am blood lactate-0.5 02:28pm blood esr-15 echo : the left atrium is mildly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: no asd or cardiac source of embolism seen. normal global and regional biventricular systolic function. ct abd/pelvis : impression: 1. distended loops of bowel with gas and fecal matter. likely constipation with chronic colonic ileus. comparison with prior abdominal radiograph would be helpful. 2. no evidence of obstruction. ecg : normal sinus rhythm. no st/t wave changes. ecg : bradycardia. otherwise normal ecg. rle venous u/s : no evidence of dvt in rle. kub : impression: 1. distended loops of bowel with gas and fecal matter. likely constipation with chronic colonic ileus. comparison with prior abdominal radiograph would be helpful. 2. no evidence of obstruction brief hospital course: 1. hypotension in er: pt was initially hypotensive after receiving demerol iv in the er on . she was put on dopamine 2.5mcg/kg and admitted to the micu for possible sepsis. she was quickly weaned of the dopamine and was transferred to the medicine floor. throughout the rest of her hospital stay, blood pressures remained stable at 100-110s/50s-60 and the patient had no additional episodes of hypotension. she remained afebrile throughout her admission and did not have signs or symptoms of infection or sepsis. her lactate was 0.5 on admission. her initial drop in blood pressure was likely due to the demerol side effect in the setting of hypovolemia from vomiting and diarrhea. pt was given iv fluids throughout her hospital stay for rehydration. . 2. abdominal pain, colonic ileus: pt did not have any blood in g-tube on admission but reported having blood in the g-tube and blood in her bowel movements. she was started on cipro and flagyl in the ed for possible crohn's flare. she had a ct which showed a colonic ileus. the gastroenterology service evaluated the patient on admission and felt this was not a crohn's flair given that her crp and esr levels were normal and antibiotics were discontinued. she was evaluated by general surgery who did not feel that surgical intervention was indicated and the patient was not obstructed. the patient continued to complain of abdominal pain, nausea and vomiting throughout her admission. she was initially made npo and her g-tube was hooked up to low suction with some relief in symptoms. . on hd#2, her g-tube was clamped and pt attempted to eat. she tolerated a clear liquid diet. she was given demerol iv for pain relief, given her multiple allergies and intolerance to other pain medications. her tube feeds were started on hd#2 with the recommendations of the nutrition service. she continued to have loose bowel movements and did pass gas. on hd#3, she complained of increased pain and her abdomen was felt to be more distended. her g-tube was then put to low wall suction and kub was obtained which again showed a dilated colon without obstruction. she was again made npo in attempts to decompress her abdomen. she was having occasional bowel movements and passing flatus. . on hd#4, the patient again attempted a diet with her g-tube clamped. she was able to drink clear liquids and by the end of the day, requested a soft diet. she continued to receive iv demerol 25-50mg every 3 hours for pain relief. her tube feeds were continued and cycled q12 hours overnight. the patient requested to speak with the surgery service regarding surgical options for relief of her symptoms. she insisted that an ileostomy would be beneficial. per the pt, she had received an ileostomy in several years ago, and these were the best years of her life, before it was reversed. the surgical consult service and dr. of colorectal surgery met with the patient. she was told directly by colorectal surgery that surgical intervention was not indicated for her symptoms. the patient was emotional throughout her hospital stay regarding her disease and prognosis. she met with a social worker to provide support during her stay. she was visited by pastoral services per pt's request. on hd#5, patient was discharged with instructions to follow-up with her primary care doctor, dr. in . she was instructed to resume her tpn as per her home regimen. . 3. anemia the patient was found to be anemic on admission with an hct of 27.2. she was guaiac positive in the er and had been reporting bloody drainage from her g-tube and blood in her stool. iron studies were obtained and she was found to be iron deficient with an iron of 29, tibc of 250, ferritin 62, transferritin 192. this was felt to be an anemia of chronic disease vs. increased blood loss due to lower gi bleed. she was not started on iron during this admission because of side effects of constipation. she did not have any episodes of bleeding in her g-tube or in her bowel movements. she had no melena, hematochezia or hematemesis. her hematocrit remained stable throughout admission and improved to 34% on discharge. she was told to follow-up with an outpatient colonoscopy after discharge for further workup. she received a ppi during her hospital stay through her g-tube. . 4. chest pain pt reported chest pain on admission. this was a pain in the middle of her chest, which she reported was present when her electrolytes, magnesium in particular, were low. pt reported the pain was a constant dull pain. it did not radiate and was worse with sitting forward. it was not reproducible on palpation. ecg x 2 were normal. cardiac enzymes x 3 were normal. ecg was not concerning for pericarditis. pt had a normal cardiac exam. . 5. fluids, electrolytes, nutrition pt was put on iv fluids throughout her hospital stay for poor po intake. her electrolytes were checked daily and were normal. she was put on tpn on hd#2 and cycled q12 hours. her diet was advanced as stated above. upon discharge, she was tolerating a soft diet. . 6. hospital prophylaxis pt was not started on sc heparin due to history of gi bleeding. she was ordered for pneumoboots for dvt prophylaxis. she was on a ppi. she was put on a bowel regimen of colace and miralax. . 7. discharge pt was discharged with instructions to follow-up with her primary care provider, . within 2 weeks of discharge. she was also recommended to follow-up with a pain management specialist. medications on admission: b12 injections discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 2. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 3. meperidine 50 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for pain. 4. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 5. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. discharge disposition: home with service facility: knowalin discharge diagnosis: primary diagnosis: 1. colonic ileus secondary diagnosis: 2. crohn's disease discharge condition: stable, afebrile, hemodynamically stable, on tpn discharge instructions: you were admitted with nausea, vomiting and abdominal pain. you were evaluated with a ct scan which showed no obstruction but a dilated colon. you were seen by gastroenterology and surgery who did not recommend surgery. your symptoms were treated with medications. no changes were made to your medications. you should continue to receive tpn at home according to your previous regimen. you should follow-up with your primary care provider, . in upon discharge. we recommend that you follow-up with a pain management specialist through your health team in . you should call your pcp or seek medical attention if you experience fevers > 100.4 farenheit, chills, severe vomitting, worsening abdominal pain, or blood in your bowel movements. followup instructions: please follow-up with your primary care physician, . in within 2 weeks after discharge. we recommend seeing a pain management specialist. procedure: parenteral infusion of concentrated nutritional substances diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery personal history of malignant neoplasm of breast hypotension, unspecified blood in stool iron deficiency anemia, unspecified hypovolemia calculus of kidney gastrostomy status regional enteritis of small intestine with large intestine abdominal pain, left upper quadrant 

Answer: The patient is high likely exposed to