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: crestor / ace inhibitors / lipitor attending: chief complaint: upper gi bleed major surgical or invasive procedure: endoscopy history of present illness: history of present illness: patient is an 80yo male with pmh of duodenal ulcer, copd, and cad s/p cabg who presents with several days of black tarry stools. patient was last in his usual state of health approximately 4 days prior to presentation when he presented to his pcp for diffuse abdominal pain. at the time he did not have bloody bm and he was discharged with instructions to be mindful for the development of this. he then developed black, tarry bowel movements the following day at home. he attempted to contact his pcp and defer treatment until he could see his pcp at the next available appointment but presented to the ed after he had uncontrollable black tarry bm's resulting in him soiling 8 pairs of underpants. in the ed, initial vs were 96.8 71 148/72 16 98%. he was having melanic stool with fresh blood consisting of one large bowel movement but has had none since. there was a little blood on ng lavage which cleared with 400cc. he had a lactate of 2.1. in the ed he endorsed chest pressure and had and ecg with non-specific changes and troponin was sent. vs prior to transfer were 97.6 65, 144/68. he arrived to the floor with no further bloody bm and no more chest pain or pressure. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, constipation, denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: obesity hypertension diabetes hyperlipidemia cad status post cabg x3 vessels. copd peptic ulcer disease gout osteoarthritis renal insufficiency cataracts chronic back pain allergic rhinitis gerd diabetic nephropathy status post pilonidal cyst resection. status post anorectal fistulotomy with recurrent revisions. status post cataract extraction, right eye. social history: - tobacco: quit 20+ years ago - alcohol: drinks 1 per night family history: not obtained physical exam: admission physical exam: heent: normocephalic, atraumatic oropharynx within normal limits chest: clear to auscultation cardiovascular: normal first and second heart sounds, regular rate and rhythm abdominal: soft, nontender, nondistended rectal: black stool with some maroon stool on rectal exam; + hemorrhoids gu/flank: no costovertebral angle tenderness extr/back: no cyanosis, clubbing or edema skin: no rash, warm and dry neuro: speech fluent psych: normal mood, normal mentation heme//: no petechiae discharge physical exam: afebrile, normotensive. gen: elderly, obese gentleman in nad heent: mm dry, mild pallor. eomi, perrl, op clear cv: rrr, systolic murmur heard best at rusb, no gallops or rubs resp: ctab, no w/r/r abd: soft, nondistended, nontender, bs present extr: wwp, no e/c/c neuro: cns grossly intact, 5/5 strength, no focal deficits pertinent results: admission physical exam: 04:13pm wbc-10.4 rbc-3.85* hgb-11.7* hct-35.3* mcv-92 mch-30.5 mchc-33.2 rdw-14.3 04:13pm plt count-196 04:13pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 04:13pm urine rbc-0 wbc-0 bacteria-none yeast-none epi-<1 11:50am lactate-2.1* k+-4.8 11:40am alt(sgpt)-22 ast(sgot)-39 alk phos-49 tot bili-1.1 11:40am lipase-41 11:40am ctropnt-0.04* 11:40am ck-mb-3 11:40am albumin-3.9 calcium-10.0 phosphate-2.6* magnesium-2.3 11:40am pt-13.5* ptt-29.2 inr(pt)-1.3* discharge physical exam: 07:35am blood wbc-8.4 rbc-3.35* hgb-10.0* hct-30.9* mcv-92 mch-29.7 mchc-32.2 rdw-15.0 plt ct-186 07:35am blood plt ct-186 07:35am blood glucose-117* urean-37* creat-1.7* na-141 k-3.9 cl-106 hco3-27 angap-12 07:35am blood calcium-8.4 phos-2.7 mg-2.0 pertinent micro/path: 7:25 am serology/blood **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). pertinent imaging: 1:38 pm chest (portable ap) clip # reason: eval for ngt position medical condition: 80 year old man with ugib reason for this examination: eval for ngt position final report indication: 80-year-old man with upper gi bleed. evaluate for ng tube position. comparison: pa and lateral chest radiograph from . technique: two portable chest radiographs were provided. findings: ng tube is difficult to visualize; however, appears to be coursing below the diaphragm likely within the stomach. the patient is status post median sternotomy. there is no focal consolidation, pleural effusion, or pneumothorax. the cardiac size appears enlarged, but unchanged from the prior exam. osseous structures are intact. impression: ng tube tip likely within the stomach. the study and the report were reviewed by the staff radiologist. ecg study date of 12:25:22 pm atrial fibrillation with a mean ventricular rate of 91. diffuse non-specific repolarization abnormalities. no previous tracing available for comparison. read by: , intervals axes rate pr qrs qt/qtc p qrs t 91 0 98 376/430 0 -3 130 ecg study date of 9:19:24 am sinus rhythm with premature atrial contractions. baseline artifact. poor r wave progression in leads v1-v4 of unclear significance. diffuse repolarization changes, cannot exclude anterolateral ischemia. clinical correlation is suggested. compared to the previous tracing of sinus rhythm has replaced atrial fibrillation, st segment changes have slightly improved. tracing #1 read by: das,saumya intervals axes rate pr qrs qt/qtc p qrs t 59 /454 36 -3 146 date: saturday, endoscopist(s): , md , md (fellow) patient: ref.phys.: , md birth date: (80 years) instrument: gif-h180 () id#: medications: midazolam 5 mg iv fentanyl 125 micrograms indications: gastrointestinal bleeding procedure: the procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. a physical exam was performed. the patient was administered moderate sedation. supplemental oxygen was used. the patient was placed in the left lateral decubitus position and an endoscope was introduced through the mouth and advanced under direct visualization until the third part of the duodenum was reached. careful visualization of the upper gi tract was performed. the vocal cords were visualized. the procedure was not difficult. the patient tolerated the procedure well. there were no complications. findings: esophagus: normal esophagus. stomach: mucosa: diffuse gastropathy was noted in the whole stomach. no evidence of active or recent bleeding. duodenum: lumen: the first part of the duodenum was mildly stenosed suggesting chronic duodenitis. the scope traversed the lesion without difficulty. mucosa: erythema and congestion of the mucosa were noted in the first part of the duodenum compatible with severe duodenitis. excavated lesions a single cratered non-bleeding 15 mm ulcer was found in the first part of the duodenum. there was evidence of recent bleed but no visible vessel, active oozing, or pigmented material. impression: diffuse gastropathy in the whole stomach ulcer in the first part of the duodenum stenosis of the first part of the duodenum erythema and congestion in the first part of the duodenum compatible with severe duodenitis otherwise normal egd to third part of the duodenum recommendations: continue iv ppi. would continue iv gtt for at least the next 24 hours continue to trend hcts q6-8h further plans per inpatient gi team additional notes: the attending was present for the entire procedure. the patient's home medication list is appended to this report. final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology _ _ _ ______________________________ _________________________________ , md electronically signed by , md on 7:35:34 pm , md (fellow) electronically signed by , md (fellow) on 7:35:34 pm brief hospital course: reason for hospitalization: patient is an 80yo male with pmh of cad s/p cabgx3, copd and duodenal ulcer who presents with ugib and findings of duodenal ulcer on egd. active issues: #duodenal ulcer bleed: patient developed abdominal pain followed by several days of black tarry stools at home. he then presented to the ed when the volume of black, tarry stool became concerning to him. he underwent resuscitation with 1u prbc and crystalloid resuscitation and was transferred to the micu team. he experienced st changes on his ekg (see below) consistent with demand ischemia. egd revealed duodenal ulcer. he was continued on iv protonix gtt started in the ed. egd showed active oozing but no overtly bleeding ulcers. the most likely etiology of his bleeding was a bleeding duodenal ulcer from recen increased heavy nsaid use. once transferred to the floor, he was transitioned from iv protonix to po. he did not require additional units of prbcs, he was hemodynamically stable, with no recurrence of cardiac demand ischemia. he was asymptomatic at discharge, and was prescribed high dose po protonix . his h. pylori serologies were negative. # non-specific st-t wave changes on ecg: patient had this finding on presentation when he had some chest pressure. the troponing elevated to 0.04 to 0.08 in the interim. symptoms of chest pressure resolved. this likely represented demand ischemia coupled with arf leading to an acure elevation in troponin. his troponin plateaued, and he no longer had episodes of ischemia or chest pain once transferred to the floor. #a-fib: pt was fount to be intermittently in a-fib, no rvr. in order to rate control, we restarted his coreg at half his home dose (this was previously held due to gi bleed. it was started at half dose due to blood pressures running in the 100s-110s systolic). the pt remained hemodynamically stable. his primary care physician was to inform her of this new finding, and the chosen management. #frequent belching/heartburn: pt complained frequently of this. resolved with simethicone and tums. resolved by discharge. pt was discharged on these meds for symptomatic mgmt. chronic issues: #copd-stable. continued bronchodilators #cad- as above. held asa for gib. restarted asa at discharge given hx of cad and new onset paroxymal a fib. #hld-continued home statin. #htn: held antihypertensives in setting of ugib. restarted coreg at half of home dose (see above). #t2dm: held glipizide and was on insulin sliding scale. #gout: held allopurinol for arf. transitional issues: #gi recommended that the pt continue po protonix for at least one month and to d/c nsaids. a follow up egd is not necessary. #a-fib: pt was found to be in irregularly irregular rhythm without known history of a-fib. he did not have rvr. he was started on half his dose of home coreg. #antihypertensive regimen: all but coreg were held due to gib. coreg started at half dose. will need bp recheck in outpatient setting for further adjustment. #constipation: the pt was discharged on bowel regimen. medications on admission: allopurinol - allopurinol 300 mg tablet 1 tablet(s) by mouth once a day amlodipine - amlodipine 5 mg tablet 1 tablet(s) by mouth once a day carvedilol - carvedilol 25 mg tablet take 1 tablet by mouth twice a day fluticasone-salmeterol - advair diskus 250 mcg-50 mcg/dose for inhalation 1 inhalation(s) twice a day glipizide - glipizide er 5 mg tablet,24 hr extended release 1 tab(s) by mouth once a day for diabetes ipratropium-albuterol - combivent 18 mcg-103 mcg/actuation aerosol inhaler inhael 2 puffs four times a day as needed for short of breath pravastatin - pravastatin 80 mg tablet 1 tablet(s) by mouth once a day triamcinolone acetonide - triamcinolone acetonide 0.1 % topical cream apply to affected area twice a day discharge medications: 1. acetaminophen 650 mg po q6h:prn pain/fever 2. albuterol-ipratropium puff ih q6h:prn shortness of breath or wheeze 3. calcium carbonate 500 mg po qid:prn indigestion rx *calcium carbonate 500 mg calcium (1,250 mg) 1 tablet(s) by mouth four times daily disp #*120 tablet refills:*0 4. carvedilol 12.5 mg po bid hold for sbp<100 or rr<55 rx *carvedilol 12.5 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 5. docusate sodium 100 mg po bid:prn constipation rx *docusate sodium 100 mg 1 tablet(s) by mouth twice daily disp #*60 tablet refills:*0 6. fluticasone-salmeterol diskus (250/50) 1 inh ih 7. pantoprazole 40 mg po bid rx *pantoprazole 40 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 8. pravastatin 80 mg po daily 9. senna 1 tab po bid:prn constipation rx *sennosides 8.6 mg 1 tab by mouth twice daily disp #*60 tablet refills:*0 10. simethicone 40-80 mg po qid:prn dyspepsia rx *simethicone 80 mg 1 tab by mouth two times daily disp #*60 tablet refills:*0 11. allopurinol 300 mg po daily 12. glipizide xl 5 mg po daily 13. aspirin 81 mg po daily rx *aspirin 81 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 discharge disposition: home discharge diagnosis: primary diagnoses: 1. duodenal ulcer 2. anemia 3. demand ischemia of the heart 4. acute kidney injury secondary diagnoses: 1. chronic obstructive pulmonary disease 2. hypertension 3. hyperlipidemia 4. coronary artery disease 5. type 2 diabetes mellitus 6. gout discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to for bleeding from your upper gi tract. you had an endoscopy performed which showed an ulcer in your upper intestines (a duodenal ulcer). you were given blood to replace what you had lost. you also received a strong dose of antacid through your iv. your blood counts stabilized, and you improved. as part of your treatment, you will continue to take this antacid, known as pantoprazole, twice a day for the next month at least. you will also need to avoid taking over the counter pain medications such as advil/ibuprofen/motrin/aleve/excedrin. you should only take tylenol over the counter for pain from now on. we made the following changes to your medication list: stop advil/ibuprofen/motrin/aleve/excedrin stop amlodipine 5mg by mouth daily change carvedilol (coreg) from 25mg by mouth twice daily to 12.5mg by mouth twice daily **start pantoprazole 40mg by mouth twice a day start simethicone 80mg twice a day as needed for gas/belching start docusate 100mg twice a day as needed for constipation start senna 1 tab twice a day as needed for constipation start calcium carbonate 500mg up to 4 times daily as needed for heartburn start aspirin 81mg daily please be sure to follow up with your pcp at the appointment made below. followup instructions: department: - adult med when: wednesday at 11:15 am with: , md building: (, ma) campus: off campus best parking: free parking on site md procedure: other endoscopy of small intestine diagnoses: esophageal reflux acute posthemorrhagic anemia acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use chronic kidney disease, stage iii (moderate) osteoarthrosis, unspecified whether generalized or localized, site unspecified obesity, unspecified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction duodenitis, without mention of hemorrhage diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled other acute and subacute forms of ischemic heart disease, other unspecified disorder of stomach and duodenum 

Answer: The patient is high likely exposed to