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: sulfa (sulfonamide antibiotics) attending: chief complaint: abdominal pain major surgical or invasive procedure: : exploratory laparotomy with lysis of adhesions and resolution of small bowel obstruction. : egd : reopening of recent laparotomy with control of intra-abdominal hemorrhage. : replacement of -intestinal feeding tube (line cracked) : angiogram : attempted ptc placement: no ducts identified, no drain left in place history of present illness: 51y f s/p olt/kidney txp , well-known to transplant surgery service presents w/acute onset of abdominal pain, nausea/vomiting beginning 12 hours earlier. the pain is constant, initially epigastric and becoming more diffuse. the was described as coffee ground in appearance, it is non-bilious. she has had normal bowel movements, and has been passing flatus. the patient denies fever/chills, change in bowel/urinary habits. she had been tolerating tube feeds as well as po intake prior to this episode. of note her post-transplant course was complicated by breakdown of the jeju-jejunosotomy requiring revision, as well as hepatic artery stenosis requiring stenting, resp failure requiring tracheostomy, atrial fibrillation/flutter which resolved prior to discharge. details of her post-operative course are listed below dcd liver transplantation with portal vein to portal vein, roux-n-y hepaticojejunostomy, common hepatic artery (donor) to proper hepatic artery (recipient) dcd kidney tranplantation, left kidney to right iliac fossa splenectomy exploratory laparotomy, small bowel resection, enteroenterostomy x 2 open tracheostomy ct guided drainage of splenic bed fluid collection and aspiration of anterior abdominal wall collection right hepatic artery stent placement past medical history: - esld etoh cirrhosis - hisory of alcohol hepatitis refractory to steroids. diagnosed , followed by dr. since . - hrs requiring hd - s/p liver/kdney transplant and splenectomy social history: heavy etoh use w/ last drink , actively involved in etoh relapse prevention counseling. patient was drinking 1 l of hard alcohol over 3 days for the past year (up until ). she denies any history of tobacco use or other substance use. she is not currently working, but was previously a human resources director. she lives at home with her husband and when not at . she has two children ages 21 and 18, who live near her. family history: her are alive at ages 79 and 80 and in good health. she has four siblings, none of whom have any chronic illnesses. physical exam: physical exam 98.1 111 127 91 20 100 ra gen: appears uncofortable cardio: nsr, converted to afib w/rvr while awaiting ct resp: ctab abd: soft, bruised, diffusedly tender,+ guarding, + rebound ext: mild le edema pertinent results: on admission: wbc-7.4 rbc-2.77* hgb-8.9* hct-27.0* mcv-98 mch-32.2* mchc-33.0 rdw-16.7* plt ct-656*# pt-12.5 ptt-23.2 inr(pt)-1.1 glucose-123* urean-25* creat-0.9 na-138 k-5.0 cl-99 hco3-28 angap-16 alt-22 ast-27 alkphos-384* totbili-0.3 lipase-16 albumin-3.3* calcium-9.2 phos-4.8* mg-2.7* triglyc-315* hdl-20 tsh-9.5* pth-17 at discharge: wbc-14.1* rbc-3.13* hgb-9.2* hct-28.8* mcv-92 mch-29.6 mchc-32.1 rdw-14.9 plt ct-760* glucose-117* urean-12 creat-0.5 na-131* k-5.2* cl-94* hco3-28 angap-14 calcium-8.7 phos-2.8 mg-1.5* alt-27 ast-28 alkphos-258* totbili-0.3 brief hospital course: 51 y/o female s/p combined liver and kidney transplant with splenectomy in and protracted post op course who now presents with abdominal pain and coffee ground emesis. on admission she underwent ct exam of the abdomen which showed massive dilation of the distal roux limb, just proximal to the anastamosis, and moderate dilatation of the proximal roux limb concerning for obstruction at the roux- en- y anastomosis. small amount of free fluid in the leaves of the mesentery. she was taken emergently to the or with dr for exploratory laparotomy with lysis of adhesions and resolution of small bowel obstruction. upon entering the abdomen they found dilated and matted bowel down to the terminal ileum and she required extensive lysis of adhesions. there was also some thick contents in the bowel, and it seemd there was fecalization of the small bowel and that this material was quite hard. this was broken up manually and pushed through to the ileocecal valve to make sure that she could pass them. the roux tube was no longer in the bowel and this was removed. she tolerated the surgery without complication and was transferred to the sicu. that same day she underwent an egd due to the coffee ground emesis and was noted to have a small amount of altered blood in the fundus with no active bleeding source. there were no gastric varices or tear seen on retroflexion. mucosa normal without evidence of congestive gastropathy or ulceration. small amount of blood seen refluxing from the pylorus. later the same day she dropped her hematocrit to 17%. of note she had been on aspirin and plavix as an outpatient which had been stopped on admission. she was taken back to the or again with dr for reopening of recent laparotomy with control of intra-abdominal hemorrhage. upon reopening, they immediately met with approximately 2 units of blood in the abdomen. the blood was evacuated and seemed to be coming from a prolene suture which was in the abdominal wall fascia. no other sites could be found. she was transferred back to the icu. over the course of these events she received 7 units rbcs, 1 u platelets and ffp and her hematocrit stabilized. she was transferred to 10 and then on developed melenotic stool and she was transferred back to the icu. on the same day she had a positive gi bleeding study with tracer uptake on the first image. there was concern this could be from the roux limb. she underwent cta showing new intraperitoneal fluid seen in the abdomen and pelvis, not present on the prior scan. higher attenuation material within this fluid is suspicious for hemorrhage. no obvious source of bleeding is identified on this examination. hematocrits continued to be monitored, she had another egd, this time not showing evidence of any active bleeding. hematocrit had dropped to 22%. she received an additional 4 units rbcs over the 22nd and 23rd and 1 unit platelets and has remained stable since. stools have become normal brown again. aspirin and then plavix have been added back in to the medication regimen (for the hepatic artery stent) a dobhoff was placed on and tube feeds were resumed with reasonable tolerance. the feeds were adjusted to isosource with less diarrhea. due to increasing alk phos a transjugular liver biopsy was performed on . results showing one fragment with zonal necrosis involving periportal zone and zone 2 hepatocytes with mixed inflammation including plasma cells, liver parenchyma with bile ductular proliferation with associated neutrophils, focal mild lobular inflammation with plasma cells and no features of rejection seen. due to the necrosis picture, a liver ultrasound was obtained. resistive indices were low and an abnormal waveform in the hepatic arteries was reported. an angiogram was performed based on the ultrasound findings showing patent celiac artery, common hepatic artery, right hepatic artery and left hepatic artery. there is mild narrowing of the distal common hepatic artery, presumably at the level of the anastomotic site, with no significant change in comparison with exam performed on . there is good flow through the previously placed stent at the origin of the right hepatic artery. the patient is continued on aspirin and plavix. as the alk phos continued to be elevated, a ptc was attempted on . percutaneous transhepatic passes made in an attempt to perform ptc which was not possible as no ducts are opacified. note that simultaneous ultrasound shows evidence of passes throughout the left lobe but does not show any visible ducts. no drain was left in place. the alk phos very slowly has trended to about 200. wbc was elevated to 17 for a few days. the central line was removed, cath tip not showing significant growth, urien culture was negative and blood cultures are negative to date but not finalized. she has remained afebrile and the wbc has slowly trended back down to 15 at discharge. the patient remains on tubes feeds which she is tolerating without problems. she is ambulatory with a walker and needs major assistance with rehab for home. medications on admission: plavix 75 mg p.o. daily famotidine 20 mg p.o. twice daily fluconazole 400 mg p.o. daily levothyroxine 112 mcg p.o. daily lorazepam 0.5 mg p.r.n. anxiety metoprolol sustained release 100 mg p.o. daily, mirtazapine 7.5 mg p.o. q.h.s. p.r.n. insomnia mycophenolate mofetil 500 mg p.o. twice daily ondansetron 4 mg every eight hours p.r.n. nausea, oxycodone 5 mg every four hours p.r.n. pain, pentamidine monthly prednisone 5 mg p.o. daily tacrolimus 1.5 mg p.o. twice daily ursodiol 600 mg p.o. twice daily valcyte 900 mg p.o. daily aspirin 325 mg p.o. daily calcium carbonate two tablets p.o. twice daily sulfate one tablet p.o. twice daily discharge disposition: extended care facility: hospital - discharge diagnosis: small bowel obstruction upper gi bleed abdominal wall hematoma uti moderate malnutrition hypothyroidism s/p liver transplant discharge condition: stable/fair a+ox3 minimal ambulation, needs extensive pt discharge instructions: please call the transplant clinic at for fever, chills, nausea, vomiting, diarrhea, inability to take or keep down food fluids or medications, abdominal pain. monitor for any evidence of bleeding such as nosebleed, rectal bleeding, easy bruising. monitor the incision for redness, drainage or bleeding. call if there are problems with the post pyloric feeding tube or the patient is not tolerating tube feeds labs to be drawn q monday and thursday with results faxed to the transplant clinic at . labs include cbc, chem 10, ast, alt, t bili, alk phos, trough prograf and u/a tsh, free t4 should be rechecked week of for dosage increase end of followup instructions: , md, phd: date/time: 10:40 procedure: other endoscopy of small intestine other endoscopy of small intestine insertion of other (naso-)gastric tube other lysis of peritoneal adhesions arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries reopening of recent laparotomy site transfusion of packed cells transfusion of other serum other cholangiogram transfusion of platelets transjugular liver biopsy diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified unspecified acquired hypothyroidism atrial fibrillation hemorrhage complicating a procedure disorders of phosphorus metabolism blood in stool other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation mechanical complication due to other implant and internal device, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation duodenitis, without mention of hemorrhage liver replaced by transplant unspecified gastritis and gastroduodenitis, without mention of hemorrhage kidney replaced by transplant intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) malnutrition of moderate degree 

Answer: The patient is high likely exposed to