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: gi bleed major surgical or invasive procedure: endoscopy colonoscopy selective arteriograms of sma and history of present illness: 51 yr old male with hx of hematochezia in and h/o anal fistula s/p excision w/ invasive squamous cell ca p/w brbpr x 5 days. pt states that on evening of , began having blood intermixed with stool, which continued through the weekend. then at 4pm last night, states the blood passed through his rectum "like a faucet," mostly blood and very little stool. has had no bpbpr since that time. overnight he went to bed, and this am reported feeling very fatigued and therefore presented to the ed. . in the ed, vitals on admission were 99 85 133/92 18 100% ra. hct noted to be 20.9, decreased from baseline of 40's. he remained hemodynamically stable throughout his ed course. he received 1l ns and 2 units prbc's. ng lavage was negative. placed on protonix gtt. two 18-gauge peripheral iv's were placed. gi was consulted and want to do endoscopy on the floors. vitals on transfer were 126/72, 73, 16, 98ra. . currently, he c/o mild epigastric discomfort, which has been intermittent over the past few days and not affected by eating or bowel movements. he also admits to taking motrin 800mg daily prn cluster headaches. he estimates taking motrin a total of 4 times over the past week. he has had in for evaluation of hematochezia, which showed adenoma in ascending colon, and bleeding was attributed to internal hemorrhoids. he was asked to have repeat in one year given poor prep, which he has not had. no history of liver disease. has never had upper egd. never has had h. pylori. also, has a history of anal fistula resected by dr. and perianal sinus, excision with a single, 0.5 mm focus of invasive well-differentiated squamous cell carcinoma. . denies nausea/vomiting. denies chest pain, shortness of breath. c/o weakness/fatigue. denies fevers/chills. . past medical history: dyspepsia -cluster headaches -perianal fistula, excised area had in situ squamous cell carcinoma, surgery performed at late , followed last by dr. in who has now left . -h/o adenoma s/p polypectomy in -h/o internal hemorrhoids social history: married, children, lives in , insurance inspector, beers on the weekends. came to us in from . no illicits. family history: father died of heart disease at age 72. 7 full sibs: no med probs. 4 children: healthy, ages ranging yo. no cancer, dm. physical exam: admission exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild epigastric tenderness, non-distended, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema rectal: maroon colored blood/stool on glove, multiple skin tags but no external hemorrhoids pertinent results: hct: 40 (baseline from prior) --> 20-->26-->30->29 endoscopy: erythema in the stomach body and antrum compatible with gastritis erythema in the duodenal bulb there was no blood seen. otherwise normal egd to third part of the duodenum colonoscopy diverticulosis of the proximal ascending colon and mid-ascending colon otherwise normal colonoscopy to cecum recommendations: likely right sided diverticuli bleed now resolved. and appointments can be scheduled by calling sma and arteriogram: findings: 1. superior mesenteric arteriogram reveals conventional arterial anatomy. there is no evidence of active contrast extravasation in the sma territory. 2. selective right colic and ileocolic arteriograms revealed conventional anatomy with no evidence of active contrast extravasation. 3. inferior mesenteric arteriogram reveals conventional anatomy with no evidence of active contrast extravasation. impression: sma and arteriograms revealed no evidence of contrast extravasation in the sma or territory brief hospital course: 41 m with history of hematochezia in (found to have internal hemorrhoids and adenoma of ascending colon), and h/o anal fistula in s/p excision w/ invasive squamous cell ca who was admitted for brbpr x 5 days and hct drop 40-->20. he was transfused total of 7 units and hct stabalized at 30. he was transfered to the micu for close monitorting. . #acute blood loss anemia/gi bleed: had endoscopy revealing some gastritis of stomache body and antrum as well as colonoscopy revealing several ascending colon divericuli- thoughtlikely the source of the acute gi bleed. pt then had 2nd episode of gi bleed on with cta revealing cecum as likely source. followup selective arteriography was neg for acute bleed source- likely missed the window of opportunity to intervene. had a few episodes of maroon stool a few days after but no further frank blood. he was started on pantoprazole 40mg daily. pt's hematocrit stabalized and plan was for him to follow up with gi to get colonscopy within 1-2 months to definitely rule out avm as source of bleed. there was also some discussion that pt might ultimately need a right hemicolectomy if he continues to have uncontrolled bleeding episodes. pt was strongly encouraged to avoid all nsaids. ***pt will fu with gi dr. next week. he will need to have scheduled colonoscopy appt made by dr. at that time to assess for avm and definitely rule out. . #anemia: gi bleed. hct initially dropped from 40 (baseline) to 20 on admission. s/p total of 10 uprbc and 1 u ffp. hct was monitored very carefully. hct at discharge was 29-31 range. **pt told to check his hct in a few days and forward results to pcp. will see pcp next week. . #cluster ha: stopped his nsaids in setting of acute bleed. pt should not take any more nsaids. medications on admission: motrin 800mg prn headache about x/ week omeprazole 20mg prn gas about 4-5x/week discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*4* 2. outpatient lab work hematocrit. please check on . please forward the results to primary care doctor: dr. fax: . discharge disposition: home discharge diagnosis: diverticulosis acute gastrointestinal bleed anemia gastritis of stomache discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to provide care for you during your hospitalization. you were admitted to the hospital for blood loss in your gut. you were given several blood transfusions (a total of 10). you had a thorough workup of your gut which revealed diverticuli as the likely source of the bleed. (diverticuli are little pockets in the gut that can occasionally bleed) your bleeding stopped and your blood counts stabalized. you will follow up with a gastroenterologist within the next few weeks to schedule a repeat colonoscopy. the purpose of this is to carefully evaluate and determine if an arterio-venous malformation is causing your bleeding. if it is, then it can be cauterized. it is important to follow up both with a gastroenterologist and with your primary care doctor within the next few weeks. medication changes: stop: pleaes stop any nsaids (advil, motrin, alleve, aspirin, etc...). see the list that was given to you. we reccomend that you do not take these medications again, they can make you bleed. the only medication you should take for pain would be plain tylenol or narcotics if it is severe pain. start: pantoprazole 40mg daily if you have any further bleeding, please report to the emergency department immediately. followup instructions: your appointments are: department: when: monday at 11:40 am with: , md building: campus: east best parking: garage name: , md --gastroenterology address: ,ste 8a, , phone: appt: at 1:30pm (at this appointment, dr. will evaluate you and also arrange for a follow up colonoscopy) procedure: other endoscopy of small intestine colonoscopy arteriography of other intra-abdominal arteries diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia diverticulosis of colon with hemorrhage unspecified gastritis and gastroduodenitis, without mention of hemorrhage personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus long-term (current) use of non-steroidal anti-inflammatories (nsaid) cluster headache syndrome, unspecified 

Answer: The patient is high likely exposed to