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: failure to thrive, gastric adenocarcinoma major surgical or invasive procedure: 1. subtotal gastrectomy, transverse colectomy and feeding jejunostomy. 2. exploratory laparotomy history of present illness: this gentleman has had early satiety and a 40 lb weight loss over a number of months. outside evaluation by endoscopy showed a near-obstructing gastric mass. ct sgowed a mid-gastric lesion with lymphadenopathy, but no metastasis. biopsy read as adenocarcinoma. the patient was admitte with failure to thrive, severe malnutrition for intravenous nutrition and consideration of gastrectomy. past medical history: pmh: none psh: bilateral cataract surgery , ?cholecystectomy - commented on ct from osh but no surgical scard noted social history: lives with wife, retired storekeeper. no etoh, no tabacco, no drug use. family history: cousin-stomach ca, uncle-lung ca, cousin x2- rectal ca physical exam: pe: vs: 97.0, 120/70, 64, 16, 94ra heent: mmm, no lymphadenopathy cvs: normal s1, s2, mild sem resp: ctab abdomen: scaphoid abdomen, no surgical scars noted +bs, soft, nontender, nondistended, no hsm ext: warm, no edema pertinent results: 05:15pm blood wbc-6.8 rbc-3.93* hgb-10.7* hct-33.8* mcv-86 mch-27.2 mchc-31.6 rdw-16.6* plt ct-168 08:15am blood wbc-6.9 rbc-3.99* hgb-11.1* hct-34.6* mcv-87 mch-27.7 mchc-32.0 rdw-16.5* plt ct-187 04:05am blood wbc-2.8*# rbc-2.70* hgb-7.3* hct-23.1* mcv-86 mch-27.0 mchc-31.5 rdw-16.4* plt ct-140* 09:40am blood wbc-4.3# rbc-3.61*# hgb-9.9*# hct-30.4*# mcv-84 mch-27.5 mchc-32.6 rdw-15.9* plt ct-137* 05:41am blood wbc-10.5 rbc-3.51* hgb-10.1* hct-29.9* mcv-85 mch-28.8 mchc-33.8 rdw-16.2* plt ct-182 08:35am blood wbc-9.3 rbc-3.42* hgb-9.5* hct-29.4* mcv-86 mch-27.7 mchc-32.3 rdw-17.6* plt ct-581* 05:55am blood wbc-8.9 rbc-3.26* hgb-9.1* hct-29.0* mcv-89 mch-28.0 mchc-31.5 rdw-20.9* plt ct-547* 05:15pm blood glucose-80 urean-18 creat-0.9 na-138 k-4.0 cl-101 hco3-28 angap-13 07:30am blood glucose-96 urean-13 creat-0.7 na-140 k-4.3 cl-103 hco3-30 angap-11 06:43am blood glucose-121* urean-17 creat-0.6 na-141 k-3.5 cl-109* hco3-26 angap-10 04:42am blood glucose-145* urean-27* creat-0.6 na-140 k-3.3 cl-106 hco3-29 angap-8 05:41am blood glucose-124* urean-20 creat-0.5 na-138 k-3.1* cl-102 hco3-31 angap-8 06:55am blood glucose-157* urean-38* creat-0.7 na-137 k-2.6* cl-100 hco3-29 angap-11 08:35am blood glucose-99 urean-27* creat-0.5 na-136 k-3.5 cl-106 hco3-24 angap-10 06:00am blood glucose-121* urean-13 creat-0.4* na-132* k-3.7 cl-102 hco3-26 angap-8 03:55am blood glucose-139* urean-21* creat-0.3* na-135 k-3.9 cl-104 hco3-25 angap-10 09:40am blood alt-13 ast-26 alkphos-52 totbili-2.3* 05:21am blood alt-15 ast-41* alkphos-55 totbili-6.9* 09:05am blood ast-41* alkphos-83 totbili-10.6* dirbili-8.9* indbili-1.7 05:55am blood alt-74* ast-93* alkphos-109 amylase-65 totbili-4.4* 05:15pm blood caltibc-255* ferritn-18* trf-196* 05:31am blood caltibc-238* ferritn-13* trf-183* 08:45pm blood lactate-2.8* 08:48am blood glucose-113* lactate-1.7 na-135 k-3.7 cl-105 respiratory culture (final ): moderate growth commensal respiratory flora. escherichia coli. moderate growth. klebsiella oxytoca. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | klebsiella oxytoca | | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r =>32 r cefazolin------------- =>64 r =>64 r cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin--------- 0.5 s <=0.25 s gentamicin------------ =>16 r <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- =>128 r =>128 r tobramycin------------ =>16 r <=1 s trimethoprim/sulfa---- =>16 r <=1 s alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili indbili 08:46 153* 213* 139* 5.0* 05:55 74* 93* 109 65 4.4* 05:38 38 59* 97 5.0* 06:00 37 52* 89 5.2* 06:00 37 53* 87 7.0* 09:25 42* 56* 92 8.7* 08:35 29 32 154 72 7.3* 07:30 42* 53* 191 9 9 11.2* 07:55 35 46* 93 11.6* 06:55 25 37 68 17 9.5* 06:55 29 58* 80 22 10.8*ind 9.1* 05:41 25 57* 65 31 9.6* 05:21 15 41* 55 6.9* 02:52 18 36 147 47 4.4*ind3.4* 09:40 13 26 52 2.3* brief hospital course: patient was admitted to the general surgery service. hd1: nutrition status was addressed and picc line was placed and tpn started for severe malnutrition. imagies from hospital were obtained for evaluation of gastric tumor. hd6: abdomen rx: large amount of residual food in the stomach is consistent with gastric outlet obstruction. patient was given sips. continue tpn. hd 7: family meeting for discussion of pathology and prognostic and surgical options. the express their which to with tumor resection with understanding of risk and benefits. hd 8: preop evaluation cxr: the heart remains within normal limits in size and there is no evidence of vascular congestion, pleural effusion, or acute pneumonia. left hilar calcified node is again seen. right picc line extends to the lower svc. hd 10 () patient went to the or for partial gastrectomy/transverse colectomy,and feeding jejunostomy. findings: there was a very large tumor of the mid body of the stomach which extended downwards fairly close to the pylorus. there was a fair amount of bulky nodal disease at the base of the right gastroepiploic system as well as working its way down onto the middle colic vessels. there was evidence of lymphatic tumor in the stomach itself. this did not appear to extend to the duodenum. the stomach itself seemed to be reasonable proximally, however, there were some lymph nodes in the left gastric distribution as well as the right gastric as well. there was no evidence of metastatic disease to the liver. there may have been some small tumor nodules on the area of the omentum close to the tumor itself. hd 11 pod 1: () patient was transfer to the floor, there were no complications, doing fine, ngt in place with minimal out up. hd 12 pod2: tube feeds were started. hd 13 pod4: () ex lap he initially did well, but early in the morning developed a fever associated with some more abdominal pain. urine output was dropping. his white blood cell count dropped to 2.4. the initial thought was to obtain a ct scan. however, given the clinical situation, that even if the ct scan did not show a definitive problem in the abdomen this needed to be ruled out as one could not be sure that there was not an occult perforation, especially of the colon. the patient was then brought to the operating room for exploration. patient was started on zosyn iv. findings: there was a mild to moderate amount of clear fluid in the abdomen which appeared to be postoperative. there was no turbidity to the fluid, and there was certainly no evidence of enteric contents. there was no fibrin on essentially any of the surfaces of the bowel indicating infection or severe inflammation. all suture lines appeared to be intact, including the duodenal closure, the gastrojejunostomy, and the colon anastomosis. there was 1 suture on the anterior portion of the colon anastomosis which was more visible than others, but there was no evidence of perforation at this point and no discoloration. the pancreas itself had several small areas of saponification consistent with dissection around that area, but there was no evidence of leak around this area. the entire small bowel was normal. the appendix was also normal. drain was placed. after surgery patient was transferred to the icu. npo/ivf/ tpn. patient did well. hemodynamically stable. hd 13 pod () patient was transferred to the floor. lft's: increased t bili to 4.4 direct bili 3.4. normal transaminase. 1. bilateral pleural effusions, larger on the right than the left. 2. no intrahepatic bile duct dilatation or common bile duct dilatation. 3. dilated loop of bowel in the epigastric region, of uncertain significance. if clinical correlation suggests problems with the afferent limb, ct is recommended. hd 14 pod () hida scan: severe hepatocellular disease, likely acute hepatitis hepatology was consulted. recommendations as followed - wean and discontinue tpn - start ursodiol 600mg daily - please avoid hepatotoxic medications - check hepatitis a igm, hepatitis b anti core ab, hepatitis b surface antigen, hepatitic c antibody to evaluate for possible underlying viral hepatitis: was negative. hd 15 pod ( ) cxr: right basilar consolidation has slightly increased. the left bibasilar consolidation and moderate bilateral pleural effusions are unchanged. there is no pneumothorax. mild pulmonary vascular congestion is unchanged. cardiomediastinal silhouette and hilar contours are stable. the rest of study id unchanged. vancomycin was added to his abx regimen hd 16 pod () physical therapy recommends rehabilitation center when ready to d/c peritoneal cultures positive for escherichia coli ( resistant ampi and genta) and enterococcus sp. no vre isolated hd 17 tube feeds restarted hd 19 pod () started octreotide. abd duplex us 1. moderate bilateral pleural effusion are unchanged. 2. moderate ascites. 3. hepatic vasculature is patent with normal flow hd 20 pod () started on postgastrectomy diet . continue increase on lft's and t bili. cytology ascitic fluid: malignant cells consistent with adeno. social work involved for patient and family coping. ct scan: 1. extensive pneumatosis involving the majority of the small bowel. air is noted in the mesentery. there is no evidence of portal venous air. while these findings may be caused by forceful tube readings in the setting of a j- tube, a more sinister etiology such as bowel ischemia cannot be excluded and clinical correlation is necessary. 2. change in caliber in loops in the right lower quadrant with at least three transition points. these are most consistent with adhesions. overall, the picture is most likely that of a partial small-bowel obstruction. patient was made npo hd 26 pod16/13 () lft's treading down tpn restarted. continue npo hd 27 () post gastrectomy diet started. hd 28 abx were stopped 1/2 strength tube feed started at 10cc/h. patient doing fine. hd 29 patient tolerating tpn and regular diet. lft's continue to trend down. patient ambulating. hd 30 diet recomendation post gastrectomy diet continue tpn. tube feeds fibersource hn 1/2 strength 50cc advance by 10cc every 10 hours to goal 80cc/h. then continue 80cc/h for 3 days. if patient tolerate it well, change to fibersource hn strength, start 40cc/h then increase by 10 cc every 12 hours to goal 80cc/h. if patient tolerate it well please discontinue tpn. follow lft's we will see the patient in clinic in 1 week thank you medications on admission: amoxicillin-clavulin for h.pylori discharge medications: 1. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. insulin ss q6h glucose regular insulin dose 0-70 mg/dl with hypoglycemia protocol 71-150 mg/dl 0 u nits 151-200mg/dl 2 units 201-250mg/dl 4 units 251-300mg/dl 6 units > 301mg/dl notify m.d. 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. lorazepam 0.5 mg tablet : one (1) tablet po hs (at bedtime) as needed for insomnia. 6. oxycodone 5 mg/5 ml solution : po q6h (every 6 hours) as needed for pain. 7. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 8. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 9. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: - discharge diagnosis: gastric outlet obstruction for gastric tumor gastric adenocarcinoma with extension ito the co;on liver insufficiency post-op with hyperbilirubinemia abdominal pain , prompting exploratory laparotomy malignant ascites pneumotosis of the small intestine ? related to tube feedings- resolved severe protein-calorie malnutrition. discharge condition: activity status: ambulatory - independent. level of consciousness: alert and interactive. mental status: clear and coherent. discharge instructions: picc line in place. *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down 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 experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: please schedule an appointment with dr. in 1 week phone : ( procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other enterostomy reopening of recent laparotomy site partial gastrectomy with anastomosis to jejunum open and other resection of transverse colon diagnoses: unspecified pleural effusion pressure ulcer, lower back unspecified intestinal obstruction pneumonia due to klebsiella pneumoniae pressure ulcer, stage ii nutritional marasmus acquired hypertrophic pyloric stenosis secondary malignant neoplasm of large intestine and rectum other specified disorders of intestine malignant neoplasm of other specified sites of stomach malignant ascites 

Answer: The patient is high likely exposed to