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: painless jaundice, increasing fatigue major surgical or invasive procedure: exploratory laparotomy, common bile duct excision. roux-en-y choledochojejunostomy to the bifurcation of the right and left hepatic ducts. lymph node biopsy. history of present illness: patient presents with painless jaundice of one weeks duration, weight loss and noting decreasing appetite and energy since of this year. 20 pound weight loss in the last few months. denies nausea and vomiting abdominal pain but does have non-specific bloating. family noted increasing yellow appearance of skin in the last week. denies fever or chills past medical history: hypertension atrial fib bph social history: lives alone recent tobacco use occ etoh family history: non-contributory physical exam: on admission: vs: 97.9, 133/106, hr 81, 20, 99% gen: nad, skin icteric, axox3 eomi, perrla resp: cta bilaterally card: regular, s1s2, no m/r/g abd: soft, non-tender, non-distended, + bs skin: warm, dry, icteric extr: no edema pertinent results: on admission:\ 08:30am urea n-16 creat-1.3* sodium-139 potassium-3.9 chloride-104 total co2-24 anion gap-15 08:30am alt(sgpt)-87* ast(sgot)-70* alk phos-272* amylase-65 tot bili-19.7* 08:30am lipase-57 08:30am wbc-4.2 rbc-4.66 hgb-14.4 hct-44.3 mcv-95 mch-30.9 mchc-32.6 rdw-14.9 08:30am plt count-220 08:30am pt-16.0* ptt-32.1 inr(pt)-1.5* on discharge: pt/inr 19.5/1.9 on 7.5 mg coumadin brief hospital course: patient admitted with painless jaundice, weight loss. on ercp was performed with sphincterotomy and stent placement across the chd/cbd stricture that was seen. concerning for neoplastic process. bile duct brushings taken are positive for malignant cells consistent with poorly differentiated adenocarcinoma.ct performed on showed cholangiocarcinoma at the common hepatic duct-cystic duct confluence and on patient underwent exploratory laparotomy, common bile duct excision. roux-en-y choledochojejunostomy to the bifurcation of the right and left hepatic ducts. patient initially admitted post-op to the sicu. cardiology consult for history of afib, not currently treated with anticoagulation d/t difficulty with controlling inr. cardiology continued to follow throughout admission as patient in and out of afib. given short term digoxin, but this will not be continued. transferred from sicu on pod 3, advancing diet, rate controlled on beta blocker. roux study on showed patent anastomosis with free passage of contrast into the jejunum and mild dilation of the intrahepatic biliary system. seen on by heme-onc who made recommendations as to ongoing treatment as needed in the future. patient has stated he would like to pursue treatment. outpatient clinic appointment is scheduled for at 10 am with dr . blood pressures remained low during hospitalization, requiring adjustments to, and short term holding of beta blockers. resumed for discharge. proscar d/c'd. to restart flomax for bph jp drain had very high outputs, often greater than a liter during the hospitalization and required repletion with albumin and fluid boluses. on , patient was found to have left hand weakness. neuro consult immediate for stroke protocol, head ct obtained with no evidence of bleed. head mri obtained subsequently showed no evidence of acute infarction, but there is evidence of old infarct involving the left occipital lobe. patient was started on iv heparin, and will be anticoagulated with heparin on long term basis. left hand weakness resolved quickly after it started and it was determined this was most likely a tia. no more events were noted during the hospitalization. cardiac echo on showed no cardiac source of embolus identified. carotid doppler obtained, has 60-69% r. internal carotid stenosis. vascular was also consulted, who are in agreement with managing this with anti-coagulation (coumadin and aspirin) at this time. it is scheduled to be re-evaluated in 6 months, but may be done sooner if patient with continuing symptoms. picc line placement was attempted, however, this was unsuccessful. this was for the ongoing potential for fluid management, however, the drain output will be managed by limiting output to 300 cc, emptying only 3 times daily, and allowing reabsorption of any excess. patient almost to anticoagulation goal of inr by discharge on . will continue on 7.5 mg coumadin daily, have inr checked and results faxed to clinic who will, for now manage coumadin therapy. he will also be maintained on aspirin daily. will d/c to (, ) for rehab. appointment with dr. medications on admission: proscar, diovan, zocor discharge medications: 1. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 2. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. senna 8.6 mg tablet sig: one (1) tablet po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 7. warfarin 2.5 mg tablet sig: three (3) tablet po once (once): monitor inr, draw thursday and fax results to . 8. flomax 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day: for bph. discharge disposition: extended care facility: nsg and rehab discharge diagnosis: cbd brushings: positive for malignant cells consistent with poorly differentiated adenocarcinoma. probable tia atrial fibrillation discharge condition: stable discharge instructions: please call to dr if patient develops fever, chills, abdominal pain, increasing abdominal girth or weight gain greater than 3 pounds in a 2 day period. also monitor for change in drainage in jp bulb that is currently light yellow/green. call for bloody or dark green bilious dranaige in bulb. only empty jp bulb once per shif. goal is to have output at 300 cc/day and patient to reabsorb some of the dressing change once daily to insertion site of pigtail drain/roux tube on abdomen followup instructions: appointment at 11:30 with md please call ( to arrange a follow-up appointment with neurology, dr. , in 6 months. call to arrange for a repeat carotid ultrasound for the same day, in the morning. procedure: venous catheterization, not elsewhere classified endoscopic sphincterotomy and papillotomy cholecystectomy endoscopic insertion of stent (tube) into bile duct biopsy of lymphatic structure transfusion of packed cells small-to-small intestinal anastomosis transfusion of other serum other cholangiogram anastomosis of hepatic duct to gastrointestinal tract excision of other bile duct other closed [endoscopic] biopsy of biliary duct or sphincter of oddi choledochoenterostomy diagnoses: pure hypercholesterolemia tobacco use disorder unspecified essential hypertension atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified calculus of gallbladder with other cholecystitis, without mention of obstruction hypovolemia obstruction of bile duct unspecified transient cerebral ischemia malignant neoplasm of intrahepatic bile ducts 

Answer: The patient is high likely exposed to