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: abdominal distension and constipation major surgical or invasive procedure: paracentesis on history of present illness: 72 year old chinese-speaking male with widely metastatic gastric adenocarcinoma involving pancreas and surrounding vasculature sent in by vna for distended abdomen and no bowel movement. he was recently admitted to surgical service from for dehydration, n/v. he was not felt to be a surgical candidate. he was tolerating small amounts of po's. per patient his last bowel movement was (day of discharge). he has been taking small amounts of po's at home and has been having some abd pain in epigastrium after eating. he also notes at night bilateral abdominal discomfort but better now since fentanyl patch was added. he is not clear which medications he is taking, although brings bag of meds (see below) . ros: no fevers, chills, no current abdominal pain, nausea or vomiting. no chest pain, shortness of breath. mild ankle swelling bilaterally. no blood in stools. . ed: hr 120's-130's. bp stable. ng tube placed. cxr, kub done. ct abd/pelvis done with ileus and increased ascites. given ondansetron x 2. rectal done and no stool in the vault. oncology was notified of admission to . received 1l ns. past medical history: metastatic gastric adenocarcinoma: egd with biopsy of gastric body on revealed invasive poorly differentiated adenocarcinoma with rare signet ring cells. ct findings of a 5.6 x 6.7cm gastric mass extending to the pancreas with circumferental narrowing of the cardia. local encasement of the celiac artery and common hepatic artery as well as a 1.8cm retroperitoneal node were present. a 4mm hypodense lesion was seen in the liver. two sub-centimeter small pulmonary nodules were seen as well. started on xeloda . htn hyperlipidemia cad s/p cardiac stent copd/asthma history of gastric ulcer and colon polyps (adenoma) possible h/o tuberculosis treated with 3 month "injections" social history: single, no children. lives in . remote tobacco (2-3ppd x 2- yrs, quit > 20 yrs ago), no heavy etoh. immigrated from in . family history: mother with pancreatic cancer, father with liver cancer; no gastric or colon cancer physical exam: v: 95.0f hr 121 164/80 20 94/2l gen: awake, alert and oriented, audibly wheezing, tachypneic heent: perrl, anicteric sclera, op dry but clear neck: supple, no jvd cv: regular, tachycardic, no murmurs pulm: bibasilar crackles, expiratory wheezing throughout abd: hypoactive bowel sounds, tense, distended, nontender to palpation, unable to assess hepatosplenomegaly ext: warm, bilateral lower extremity edema, nontender skin: no rash rectal: guaiac neg, no stool in vault pertinent results: wbc-13.1* rbc-4.62 hgb-13.6* hct-38.3* mcv-83 mch-29.5 mchc-35.5* rdw-13.4 plt ct-492* neuts-87.5* lymphs-6.7* monos-4.9 eos-0.8 baso-0.1 wbc-15.6* rbc-4.50* hgb-13.3* hct-38.6* mcv-86 mch-29.5 mchc-34.4 rdw-13.7 plt ct-562* 04:10pm blood pt-11.9 ptt-25.6 inr(pt)-1.0 glucose-155* urean-17 creat-0.7 na-128* k-4.5 cl-90* hco3-25 alt-18 ast-26 alkphos-95 amylase-32 totbili-0.7 glucose-128* urean-14 creat-0.6 na-130* k-4.5 cl-93* hco3-calcium-7.9* phos-3.8 mg-2.0 albumin-2.8* glucose-167* urean-17 creat-0.7 na-132* k-5.0 cl-97 hco3-27 calcium-8.2* phos-3.2 mg-2.2 03:33am ascites wbc-690* rbc-3635* polys-25* lymphs-33* monos-9* mesothe-3* macroph-30* 03:33am ascites totpro-3.6 glucose-110 creat-0.5 ld(ldh)-351 amylase-17 totbili-0.6 albumin-2.1 3:33 am peritoneal fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture : negative anaerobic culture : negativ fungal culture : no fungus isolated. ekg : sinus tachy hr 120, nl axis/intervals, flattened t waves ii, iii, avf. no q waves. ct abd/pelvis: gastric mass with extension posteriorly to pancreas as previously noted with diffuse peritoneal carcinomatosis and worsening of large volume ascities. abnormal hepatic perfusion with new mild intrahepatic biliary dilatation. reticulonodular pattern at lung bases new and may represent metastatic disease though infection should be excluded clinically. large bilateral hilar lymph nodes bilaterally. new small pleural effusions. cxr: reticular and nodular opacities in the lower lungs, right greater than left, which are worrisome for metastatic disease. chronic changes in the right lung apex may be related to prior tuberculosis. ng tube extending into the left upper quadrant. kub: no evidence of bowel obstruction or ileus. ng tube in good position. <b>discharge labs:</b> 06:40am blood wbc-14.0* rbc-4.77 hgb-13.9* hct-41.2 mcv-86 mch-29.2 mchc-33.8 rdw-13.7 plt ct-542* 06:40am blood glucose-125* urean-22* creat-0.7 na-134 k-5.1 cl-97 hco3-30 angap-12 06:40am blood alt-13 ast-16 alkphos-90 totbili-0.5 06:40am blood calcium-8.6 phos-3.3 mg-2.3 brief hospital course: 72 year old male with newly diagnosed stage iv gastric adenocarcinoma, peritoneal carcinomatosis presenting with increased abdominal distension, ascites and no bowel movement x 3 days. . # widely metastatic gastric cancer - patient has been evaluated by surgery and is not a surgical candidate. he was seen by heme-onc during his last hospitalization and scheduled for outpt follow-up with dr. for palliative chemo options (has not yet seen dr. . seen by palliative care yesterday who spoke with nephew, . appreciate interventions. are willing to assist in family meeting. oncology recommended continuing with xeloda as an outpatient and they will continue to follow. continue pain management with fentanyl patch and morphine elixir at home. hospice service will follow the patient at home. # abd distension - initial concern for ileus on admission, however, no evidence of ileus on admission. patient has been constipated for 2 weeks although had a bowel movement 3 days prior to admission. he was not taking bowel regimen (colace, senna, mom) at home. he had 4 bowel movements on after restarting colace, senna and lactulose so this can be held for a few days. his abdominal distension was from large ascites. he had a paracentesis with 3.5l amber colored drainage (some blood so from malignant ascites from peritoneal carcinomatosis). patient will be set up with interventional radiology paracentesis after discharge. will likely need outpatient paracentesis every 5-7 days. he is not a candidate for port placement (for home drainage) until he is on hospice (ie - no longer taking xeloda or other chemotherapy) per oncology. he is tolerating po's. # tachycardia - resolved the night of admit with paracentesis of 3.5l, reinstitution of metoprolol and fluid bolus of 1l. thus, likely resultant from hypovolemia, increased abdominal pressure and b-blocker withdrawal. also considered dehydration, not taking metoprolol, side-effect from xeloda and pe. no note of tachycardia on his last discharge, ekg on w/ hr 95. heart rate 70's-90's thereafter. # wheezing - has asthma and emphysema. patient denies feeling short of breath. abdominal ascites may have been contributing to taking rapid breaths and wheezing. started nebulizer treatments. patient set up with home oxygen prior to discharge as he remained on 2l oxygen after paracentesis (o2 sat < 88% at rest and with ambulation on room air). continued on home inhalers on discharge. # hyponatremia - improved, although seen on last hospitalization. volume status consistent with hypovolemia. given ns as iv fluid and sodium improved. # htn - resolved. improved night of admit s/p paracentesis and reinitiation of metoprolol. continued on home dose of metoprolol. after patient was initially in the icu, he was transferred to the floor and remained stable. medications on admission: home meds: metoprolol 12.5mg po bid fluticasone 110 mcg/actuation 2 puffs inh metoclopramide 10 mg po qidachs fentanyl 25 mcg/hr patch 72 hr meds on d/c summary - not taking at home pantoprazole 40 mg po daily albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inh q6hrs prn ativan 0.5 mg po q8hrs prn compazine 10 mg po tid colace/senna/milk of magnesia 311 mg po tid prn morphine 10 mg/5 ml solution: ml po q2h hrs prn sodium chloride 1 g tablet po daily (?) discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 4. combivent 103-18 mcg/actuation aerosol sig: inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inh* refills:*2* 5. morphine 10 mg/5 ml solution sig: ml po q2hrs as needed for pain. disp:*qs ml* refills:*0* 6. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs. disp:*120 tablet(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po twice a day. 8. fentanyl 25 mcg/hr patch 72 hr sig: one (1) transdermal once a day. disp:*10 patches* refills:*0* 9. fluticasone 110 mcg/actuation aerosol sig: one (1) inhalation twice a day. disp:*1 inhaler* refills:*2* 10. milk of magnesia concentrated 2,400 mg/10 ml suspension sig: 30ml po twice a day as needed for constipation. disp:*qs 1 month * refills:*1* 11. xeloda 500 mg tablet sig: one (1) tablet po twice a day. 12. lactulose 10 g/15 ml solution sig: 15-30 ml po twice a day as needed for constipation. disp:*600 ml* refills:*2* discharge disposition: home with service facility: hospice of and greater discharge diagnosis: metastatic gastric adenocarcinoma copd malignant ascites hypertension discharge condition: hemodynamically stable on 2l nc. discharge instructions: you were admitted with a fast heart rate and ascites (fluid accumulation in your abdomen). you received a paracentesis to remove fluid from your abdomen. no infection was found. you should follow up for the paracenteses and oncology appointments as scheduled. you were constipated when you came in, it is important that you take stool softeners if you feel constipated. we have started you on colace twice daily and senna to be taken twice daily as needed to help you have a bowel movement. we have arranged to have oxygen delivered to your home. it is important to wear this at home (2l by nasal canula) as your oxygen levels are low. . please call your doctor or return to the emergency room for: -increased abdominal pain or swelling -difficulty breathing -fever followup instructions: you were scheduled to have another paracentesis performed on at 1:00 pm in the (), . you also have a paracentesis on at 1pm in the same location. please call ( if you have any questions or to reschedule the appointment. . oncology: , md phone: date/time: 4:00. center, . . pcp: . . . please call for a follow up appointment in weeks. procedure: percutaneous abdominal drainage diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion unspecified essential hypertension unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia hypoxemia encounter for palliative care chronic obstructive asthma, unspecified secondary malignant neoplasm of lung secondary malignant neoplasm of other digestive organs and spleen personal history of colonic polyps secondary malignant neoplasm of retroperitoneum and peritoneum personal history of peptic ulcer disease malignant neoplasm of body of stomach malignant ascites 

Answer: The patient is high likely exposed to