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: coffee ground emesis major surgical or invasive procedure: egd scope history of present illness: this is a 54 year old female with h/o fe def anemia (for which she was admitted in with hct 14) who now presents with palpitations, hemetamesis and early satiety x 1 day. denies cp/sob. has no h/o liver disease. not on anticoagulation. states she did take 2 pills of motrin 4 days ago for a ha. had 2 episodes of n/v with coffee ground emesis since last night. endorses some llq discomfort but denies epigastric pain. complains of belching. denies diarrhea, melena, bprpr, or fevers. . in the ed, initial vs were t 99.1 hr 117 bp 125/92 rr 16 o2 sat 100% on ra. pt was guaiac pos with brown/black stool. ng lavage showed large amt of coffee grounds which cleared with 500cc water. gi eval pt and has plan to perform egd tomorrow am. has 2 large bore pivs for access. was t&c for 4u. cxr was unremarklable. was given gi cocktail and zofran which relieved her abdominal discomfort. pt was also given pantoprazole 80mg then started on a gtt. labs were notable for wbc of 12.0, hct of 30.7 and plts of 636. lactate was wnl as were lfts, lipase and d-dimer. on transfer, vs were hr 90 bp 145/91 rr 20 o2 sat 100% on ra. . upon arrival to the icu, pt is comfortable. denies abd pain, any new episodes of emesis. denies any pain. past medical history: iron deficiency anemia anxiety social history: very anxious female, denies tobacco, quit 12 years ago. admits to drinking about a glass of wine per night. denies drugs. currently lives with father; mother passed away last year with alot of depression and anxiety on the patients part after this. has a brother in the area.her husband passed away 10 years ago. family history: no known history of anemia or blood disorders. mother passed away at age 82 (two months ago) from pneumonia. grandmother with diabetes. no family history of colon cancer. physical exam: admission: vs: temp: bp: 120/70 hr: 79 rr: 16 o2sat: 99% on ra gen: pleasant, comfortable, nad, thin female heent: perrl, eomi, anicteric, mmm, op without lesions neck: no lad, no jvd, no masses resp: ctab cv: rrr no murmurs noted abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: - edema, - rash rectal- no skin tags or fissures noted. dark brown stool, guaiac + pertinent results: 08:49pm wbc-9.0 rbc-3.10* hgb-8.6* hct-25.3* mcv-82 mch-27.8 mchc-34.0 rdw-12.6 02:00pm glucose-109* urea n-11 creat-0.8 sodium-139 potassium-3.9 chloride-98 total co2-30 anion gap-15 02:00pm alt(sgpt)-10 ast(sgot)-16 alk phos-92 tot bili-0.3 . egd: a single cratered non-bleeding 4 cm ulcer was found in the incisura of the stomach. the ulcer was deep and large. . ct abdomen: 1. large gastric ulcer with focal mass of the lesser curvature of the stomach. there are concerning lymph nodes along the gastrohepatic ligmament and an omental deposit in the left upper abdomen. 2. cholelithiasis. brief hospital course: she was initially admitted to the medicine service. medicine hospital course as follows per dictation of medical resident: 54 year old female with pmh of iron deficiency anemia who presented with hematemesis and ugib, initially admitted to icu for careful monitoring, transferred to medicine when hemodynamically stable and with stable hct then found to have large gastric ulcer on egd and gastric mass on ct abdomen and transferred to surgery for further management of her gastric mass. . #. ugib: initially presented with hematemesis and required 1 unit prbc in the unit. she was treated with pantoprazole drip. she was then transferred to the medicine when was hemodynamically stable. upper endoscopy showed non-bleeding large gastric ulcer. biopsy not obtained in setting of upper gi bleed. pantoprazole drip was changed to omeprazole 40 mg po bid. ct abdomen obtained showed large gastric ulcer with focal mass, lymph node deposits concerning for gastric cancer. surgery was consulted she was transferred to their service. -appreciate gi recs . #. iron deficiency anemia: hematocrit at 30.7 on admission then trended down to 24.3 and she received 1 unit prbcs. her hematocrit then came back to around 30 and was stable. her home iron supplementation was held in the setting of a gi bleed as to not cause confusion with possible melena. . 3. thrombocytosis: likely reactive, stable _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ her course following transfer to acute care surgery service on : she was taken to the operating room on for exploratory laparotomy, truncal vagotomy, partial distal gastrectomy, bilroth i reconstruction and open cholecystectomy. there were no complications. findings during her operation reveled that the gastric mass was likely not a malignancy, rather a giant, benign gastric ulcer. postoperatively she recovered in the pacu and was transferred to the regular nursing unit once stabilized. she was placed on gastrectomy pathway. over the course of the next several days her diet was advanced for which she was able to tolerate. on hd# 11 she was noted with fevers >101 and was cultured, chest xray was done showing a consolidation in her right lung base. she was started on levofloxacin which will continue for 7 days. her abdominal staples will be removed when she has follow up in clinic next week she will also need to follow up with her pcp next week for general care. medications on admission: 1. ferrous sulfate 300 mg daily 2. fish oil suppl daily discharge medications: 1. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 2. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 4. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 5. milk of magnesia 400 mg/5 ml suspension sig: thirty (30) ml's po twice a day as needed for constipation. 6. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*30 tablet(s)* refills:*0* 7. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days. disp:*6 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: 1. giant gastric ulcer, probably benign secondary to type iii peptic ulcer disease. 2. cholelithiasis with chronic cholecystitis. 3. iron deficiency anemia 4. pneumonia 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 and found to have a large gastric ulcer and gallstones. you were taken to the operating room for repair of the ulcer and removal of your gallbladder. you are also being treated for a pneumonia for 7 days. please be sure to complete your entire course of antibiotics as prescribed. you are being discharged on medications to treat the pain from your operation. these medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. you must refrain from such activities while taking these medications. post gastrectomy diet: 1. eat six small meals daily to avoid overloading the stomach. limit fluids to 4 oz ( cup) during mealtimes. this prevents the rapid movement of food through the upper gastrointestinal tract and allows adequate absorption of nutrients. 2. drink liquids 30 to 45 minutes before eating and 1 hour after eating, rather than with meals. 3. rest or lie down for 15 minutes after a meal to decrease movement of food from the stomach to the small intestine. this decreases the severity of symptoms. 4. avoid sweets and sugars. they aggravate the dumping syndrome. 5. avoid very hot or cold foods or liquids, which may increase symptoms in some patients. 6. stomach surgery is performed for different reasons, so calorie requirements may vary from patient to patient. for example, a patient who has had surgery for severe obesity will need to be on a weight reduction program. a very thin patient who has had ulcer or cancer surgery will need extra calories. 7. you may have problems with vitamin b12 absorbtion. this needs to be followed with lab studies and possibly injections on a monthly basis. dr. has been notified of that. avoid aspirin, ibuprofen, motrin, naprosyn or other nsaids (non-steroidal anti-inflammatory drugs). please call your doctor or return to the emergency room if you have any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. activity: no heavy lifting of items pounds for 6 weeks. you may resume moderate exercise at your discretion, no abdominal exercises. wound care: you may shower, no tub baths or swimming. if there is clear drainage from your incisions, cover with clean, dry gauze. your steri-strips will fall off on their own. please remove any remaining strips 7-10 days after surgery. please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: follow up with clinic in weeks for removal of your staples, call for an appointment. follow up with your primary care physician next week ( and ). you will need to call for an appointment. follow up with dr. office (gastroenterology) as directed; please call to set up an appointment. you also have an appointment with the following doctor that was scheduled prior to your hospital stay: provider: , md phone: date/time: 11:00 procedure: other endoscopy of small intestine cholecystectomy partial gastrectomy with anastomosis to duodenum truncal vagotomy diagnoses: pneumonia, organism unspecified iron deficiency anemia secondary to blood loss (chronic) anxiety state, unspecified calculus of gallbladder with other cholecystitis, without mention of obstruction other respiratory complications chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction leukocytosis, unspecified essential thrombocythemia 

Answer: The patient is high likely exposed to