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: amoxicillin attending: chief complaint: abdominal pain perforated duodenal ulcer major surgical or invasive procedure: 1. exploratory laparotomy. 2. repair of perforated duodenal ulcer with patch. 3. small-bowel resection with primary anastomosis. 4. placement of a feeding jejunostomy tube. history of present illness: this 83-year-old gentleman who presented with acute onset of upper abdominal pain with focal peritonitis. a cat scan was performed and showed clear-cut free air around the liver with what looked to be a direct communication into the duodenum. he was taken to the surgical intensive care unit and was in surprisingly good physiologic shape but resuscitated prior to the operation. he was taken to the operating room within a few hours of the cat scan. past medical history: 1. htn 2. aaa repair - 90' 3. bph social history: formerly in army now retired. smokes 1 ppd but quit 13 years ago. occasional etoh use. no drugs lives independently, active family history: mother had unknown ca. father had hypertension physical exam: vs: afebrile, 80, 135/45, 27, 98% 5l gen: alert, oriented x 3, grimacing in pain. cv: rrr, no m/r/g resp: cta bilat. abd: midline scar from aaa repair; normal to percussion, tender to epigastric on palpation, soft, no rebound tenderness or peritoneal signs. ext: no edema, +1 pulses bilat. pertinent results: 07:35am blood wbc-9.7 rbc-4.21* hgb-13.2* hct-36.4* mcv-87 mch-31.4 mchc-36.3* rdw-13.6 plt ct-178 05:31am blood wbc-11.7* rbc-3.43* hgb-10.8* hct-30.7* mcv-89 mch-31.6 mchc-35.3* rdw-13.4 plt ct-136* 05:31am blood glucose-117* urean-18 creat-1.2 na-139 k-4.0 cl-108 hco3-25 angap-10 07:35am blood alt-11 ast-22 ck(cpk)-157 alkphos-66 amylase-195* totbili-0.6 07:35am blood lipase-263* 07:35am blood ctropnt-<0.01 05:31am blood calcium-8.1* phos-2.1* mg-1.7 . chest (portable ap) 8:15 am medical condition: 83 year old man with abd pain, free air on ct reason for this examination: eval for free air and preop, indication: 83-year-old man with abdominal pain. free air on recent ct, preop. impression: 1. pneumoperitoneum. 2. bibasilar atelectasis. . cta abd w&w/o c & recons 7:39 am impression: 1. gastric antral perforation, likely due to underlying ulcer, with moderate amount of free air within the abdomen and free fluid. 2. hutch diverticulum of the urinary bladder containing a small stone. 3. uncomplicated small and large bowel containing ventral hernias as described. 4. bilateral fat-containing inguinal hernias containing a small amount of fluid on the left side. 5. extensive degenerative changes of the aorta and its branches with intraabdominal thrombus and calcified plaques and small ulcers. the is occluded at its origin. mild fusiform dilatation of the left common iliac artery. 6. diverticulosis without evidence of diverticulitis. 7. severe degenerative changes of the lumbar spine with spondylolisthesis grade i at the level of l1-2, l3-4, and l4-5 and compression deformities of l1 and l4, age indeterminate. . cardiology report ecg study date of 8:26:56 am sinus rhythm. low qrs voltage in limb leads. possible inferior myocardial infarction. compared to previous tracing of no diagnostic change. intervals axes rate pr qrs qt/qtc p qrs t 76 132 94 -13 26 . ugi air w/kub 9:57 am impression: no evidence of leaks or extravasation of contrast material through the duodenal patch. the study is limited because the patient ws uable to turn prone for appropriate evaluation of the anterior wall. 09:21pm blood wbc-10.4 rbc-3.49* hgb-10.7* hct-31.5* mcv-90 mch-30.7 mchc-34.0 rdw-14.0 plt ct-213# . **final report ** helicobacter pylori antibody test (final ): positive by eia. . 10:43 am stool consistency: watery source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. . ct abdomen w/contrast 4:38 pm impression: 1. status post duodenal perforation withsurgical repair and segmental small bowel resection with post- operative fat stranding in the upper abdomen and small amount of fluid anterior to the liver, without evidence of rim- enhancing or gas-containing focal fluid collection to suggest abscess. no residual free air. 2. large bladder diverticulum with air and air in the urinary bladder. please correlate clinically with the history of recent intervention. 3. diverticulosis. 4. elevated left hemidiaphragm with bibasilar atelectasis. 5. gynecomastia. 6. compression deformities of the lumbar spine as described above. . chest (pa & lat) 3:19 pm medical condition: 84 year old man with crackles on exam and coughing reason for this examination: ? pneumonia, acute process indication: crackles on exam and coughing, query pneumonia or acute process. chest two views: cardiac size, mediastinal and hilar contours are unchanged. there is a persistent tortuous aorta that apparently indents the trachea; the lateral view does not demonstrate any aneurysmal aortic dilatation. cardiophrenic and costophrenic angles are clear. there is no pneumothorax or pleural effusion. there is mild left basilar atelectasis. there is persistent elevation of the left hemidiaphragm. no gross skeletal abnormality. impression: no acute cardiopulmonary process. brief hospital course: he was admitted on and went to the or on for: 1. exploratory laparotomy. 2. repair of perforated duodenal ulcer with patch. 3. small-bowel resection with primary anastomosis. 4. placement of a feeding jejunostomy tube. duodenal ulcer: he was npo with ivf and a ngt. the ngt was left in place and he had a tube study performed on pod 4. this showed no evidence of leaks or extravasation of contrast material through the duodenal patch. a ct on showed no focal fluid collection to suggest abscess. his incision was c/d/i. the staples were d/c'd prior to discharge. the j-tube was secure and in place. helicobacter pylori antibody test was positive and he was started on flagyl and clarithromycin, and protonix . diarrhea: he began having frequent, large loose stool on pod . c.diff was checked and was negative x 3. he was volume depleted due to the severe diarrhea. once the tubefeedings were stopped, his diarrhea slowed. dehydration: due to the large volume diarrhea, he had some dehydration resulting in hypernatremia, hyperchloremia, and a bump in his bun/cr. he continued on iv fluid and his po intake increased. eventually, his diarrhea slowed. although his c.diff cultures were negative, we assumed he was positive and the flagyl that was started for the h.pylori seemed to also be effective for the diarrhea. pain: he complained of abdominal pain and was refusing pain meds including pr tylenol. once on a po diet, he was taking tylenol and oxycodone. fen: he was started on clears on pod 5. he was also started on tubefeedings and these were slowly advanced. he began having severe diarrhea, possibly related to the tubefeedings. the rate was slowed and then the tubefeedings were discontinued. his diet was advanced, but he did not have much of an appetite due to the diarrhea. we encouraged an increase in his diet and he required two iv fluid bolus for low urine output and then continuous iv fluid to correct his dehydration. his iv fluids were continued while his creatinine improved and was 1.4 on . his appetite was poor and calorie counts revealed <600kcal/day. we started him on trophic tubefeedings again on pod 15 and slowly advanced these. we recommend tubefeeding at 30ml/hr as a supplement to his regular po diet. if he is taking in adequate calories, tubefeedings can be tapered and cycled at night as to not suppress his appetite. we also do not want to run the tubefeedings at a high rate as this may result in his return of diarrhea. medications on admission: doxazosin 1'', asa 325' discharge medications: 1. outpatient lab work chem 10; creatinine - adjust flagyl prn 2. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 14 days. disp:*42 tablet(s)* refills:*0* 3. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po twice a day: twice a day for two weeks, then switch to once/day. 4. acetaminophen 160 mg/5 ml solution sig: 320-640 mg po tid (3 times a day) as needed for pain. 5. oxycodone 5 mg/5 ml solution sig: 1.25 mg po bid (2 times a day) as needed for pain. 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for bp<100, hr<60 . 7. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed. 8. psyllium packet sig: one (1) packet po daily (daily). 9. megestrol 40 mg tablet sig: one (1) tablet po qid (4 times a day). 10. promethazine 25 mg/ml solution sig: 12.5 mg injection q8h (every 8 hours) as needed. discharge disposition: extended care facility: center discharge diagnosis: perforated duodenal ulcer multiple enterotomies from dense adhesions to abdominal wall diarrhea dehydration (hypernatremia, hyperchloremia) malnutrition discharge condition: good tolerating a diet discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomitting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomitting, 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. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * 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. * continue to amubulate several times per day. followup instructions: please follow-up with dr. in weeks. call ( to schedule an appointment procedure: other enterostomy other partial resection of small intestine suture of duodenal ulcer site diagnoses: unspecified essential hypertension unspecified protein-calorie malnutrition dehydration hyperosmolality and/or hypernatremia electrolyte and fluid disorders not elsewhere classified peritonitis (acute) generalized acute duodenal ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to