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: celebrex / ceftriaxone attending: chief complaint: choledocholithiasis, ventral hernia major surgical or invasive procedure: : ercp with sphincterotomy : open cholecystectomy. ventral hernia repair with implantation of prosthetic mesh. : decompressive laparotomy history of present illness: 53m hx mechanical avr/mvr on coumadin with incidental finding choledocholithiasis during workup for ventral hernia repair admitted s/p ercp (sphincterotomy/stone extraction) for anti-coagulation in anticipation of or for cholecystectomy, possible common bile duct exploration, and ventral hernia repair with mesh. pt reports minimal, non-radiating epigastric abdominal pain s/p ercp. denies jaundice, dark urine, -colored stools, pruritis. denies fevers, chills, sharp abdominal pain, po intolerance, nausea, vomiting. reports regular, formed bms, no brbpr, no black/tarry stool. no dysuria, hematuria. denies sob, dyspnea on exertion, increased work of breathing. past medical history: pmh: sigmoid diverticulitis / colovesicular fistula s/p sigmoid colectomy/cystectomy/bilat ureteral stents c/b cardiogenic shock, atn, gib, abdominal wound infection, htn, hl, etoh abuse, etoh pancreatitis, legionella pneumonia, rheumatic valvulitis s/p avr/mvr, large ventral hernia psh: sigmoid colectomy partial cystectomy ( /); avr/mvr (carbomedics mechanical valves ); stsg to abd from r thigh ( ) : benazapril 40', carvedilol 12.5', simvastatin 80', coumadin 6 (held ), allopurinol 100' social history: works as an auto appraiser. denies drugs. quit smoking . denies alcohol in many months. family history: non contributory physical exam: p/e at discharge: vs: t: 97.4 p: 74 bp: 124/76 rr: 18 o2sat: 94ra gen: wd, obese m in nad heent: ncat, eomi, anicteric cv: rrr pulm: cta b/l, no respiratory distress abd: firm, diffuse mild tenderness particularly peri-incisional, midline laparotomy incision with staples and nylon stay sutures in place; serous oozing from inferior aspect wound with no erythema or purulence; jp in lower abdomen with serosanguinous drainage pelvis: deferred ext: wwp, 1+ edema b/l le to ankle neuro: a&ox3, no focal neurologic deficits pertinent results: laboratories: 09:10am blood wbc-6.7 rbc-3.44* hgb-10.7* hct-30.3* mcv-88 mch-31.1 mchc-35.3* rdw-14.7 plt ct-198 09:10am blood pt-15.4* ptt-30.8 inr(pt)-1.3* 09:10am blood urean-22* creat-1.3* na-145 k-4.2 cl-110* hco3-26 angap-13 09:10am blood alt-18 ast-24 alkphos-77 amylase-139* totbili-1.7* dirbili-0.3 indbili-1.4 09:10am blood lipase-117* 08:05am blood calcium-8.9 phos-2.4* mg-1.5* microbiology: none imaging: ercp : a single periampullary diverticulum with large opening was found at the major papilla; the very distal pancreatic duct was partially opacified for approximately 1.5cm and appeared unremarkable; two stones ranging in size from 4 mm to 6 mm were seen at the distal cbd. the cbd was moderately dilated at approximately 12mm. given high risk of bleeding with need for anticoagulation soon after procedure, a small sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. a sphincteroplasty was performed to 10mm with a cre balloon dilator successfully. 2 stones were extracted successfully using a balloon catheter. cxr : no acute cardiopulm pathology tte : the left ventricular cavity size is top normal/borderline dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. lv systolic function appears depressed. the right ventricular cavity is mildly dilated with normal free wall contractility. a bileaflet aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. a bileaflet mitral valve prosthesis is present. the transmitral gradient is normal for this prosthesis. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. pathology: pending brief hospital course: the patient was admitted to the general surgery service on following ercp/sphincerotomy for incidentally found choledocholithiasis during workup of ventral hernia and was admitted for observation and operative planning of hernia repair. neuro: preoperatively, patient was without pain and required no analgesia. a preop epidural was refused by the patient. post-operatively, the patient received dilaudid iv/pca but complained of pain. following takeback to or pt was sedated for ventilation. sedation weaned on extubation as per below and given dilaudid pca with good effect. transitioned to po pain meds when tolerating diet and sent home with effective po regimen. cv: pt maintained on home cv regiment preop (ace, beta blocker). held for or. following takeback to or pod1 pt required neosynephrine for bp support. this was weaned pod2/1. beta blocker resumed pod3/2. ace held postop but resumed prior to discharge. vital signs were routinely monitored. pulmonary: pod1/0 pt remained intubated on xfer to sicu. extubated pod2/1. pulmonary toilet including incentive spirometry and early ambulation were encouraged and supplemental o2 was weaned. vital signs were routinely monitored. gi/gu: workup of massive ventral hernia revealed cbd stones on imaging and pt underwent ercp with sphincterotomy . two stones were extracted. pt admitted for observation following this and made npo/ivf. laboratories were checked to eval for possible post-ercp pancreatititis and was found to be wnl. clears were initiated and pt advanced to regular diet. preoperative workup was performed including cxr, ekg, ua, etc. pt made npo on at mn for or . underwent ventral hernia repair w biologic mesh underlay as well as open ccy via midline laparotomy incision. pt remained in pacu overnight pod0 secondary to oliguria/respiratory difficulty. bladder pressure was checked at baseline pod0 and found to be in low 20s. am pod1 patient was persistently oliguric despite fluid resuscitation (pos approx 6-7l) and bladder pressure was noted to increase to high 30s. constellation of oliguria/ (cr 1.1->2.2), elevated bladder pressure, diffuse/tense distention on abdominal exam, and respiratory difficulty thought to represent compartment syndrome and patient taken back to or for decompressive laparotomy. fascia was released and mesh kept in place. pt then discharged to sicu postop and kept npo/ivf. extubated pod and transferred to floor pod . begun on clears. flatus passed pod and diet advanced to regular pod , which was tolerated well. +bm pod . he was also started on a bowel regimen to encourage bowel movement once passing flatus. pt w baseline cr: 1.1 and (cr: 2.2) pod1. this continued to rise throughout pod1 but began to return to baseline following takeback to or. patient required intermittent diuresis with lasix given positive fluid balance associated with resuscitation. foley was removed on pod# and pt voided appropriately. intake and output were closely monitored. id: pt given appropriate preop antibiotics. given bile spillage on open cholecystectomy, pt was given 2 week course of antibiotics (unasyn while in house and transitioned to augmentin on discharge). the patient's temperature was closely watched for signs of infection. heme: pt w hx aortic and mitral valve replacements and on lifelong anticoagulation. coumadin held prior to ercp. following ercp pt started on heparin gtt with goal ptt 60-80. this was held preop. resumed pod2/1. transitioned to lovenox pod4/3 and heparine gtt discontinued. resumed coumadin at this time. patient discharged on lovenox and instructed to follow up with pcp : coumadin management. instructed to discontinue lovenox when inr>2.5. vna to draw inr within 48 hours of discharge and communicate result to pcp. prophylaxis: the patient was anticoagulated as per above, and was encouraged to get up and ambulate as early as possible. dispo: pt evaluated by pt on xfer to floor from sicu and cleared for home. pt discharged to home with vna for wound checks (inferior aspect of wound with serous drainage) and inr check. at the time of discharge on pod#, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. medications on admission: benazapril 40', carvedilol 12.5'', simvastatin 80', coumadin 6 (held ), allopurinol 100' discharge medications: 1. benazepril 40 mg tablet sig: one (1) tablet po once a day. 2. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 3. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 5. augmentin 500-125 mg tablet sig: one (1) tablet po twice a day for 7 days. disp:*14 tablet(s)* refills:*0* 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 7. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. disp:*30 tablet(s)* refills:*0* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 9. enoxaparin 100 mg/ml syringe sig: one (1) syringe subcutaneous q12h (every 12 hours) for 10 days: discontinue use when inr>2.5 or otherwise instructed by your pmd. thx. . disp:*20 syringe* refills:*0* 10. warfarin 2 mg tablet sig: three (3) tablet po once daily at 4 pm: pls adjust dose per your primary care physician. . disp:*21 tablet(s)* refills:*0* 11. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* discharge disposition: home with service facility: - discharge diagnosis: 1. choledocholithiasis 2. ventral hernia 3. s/p aortic and mitral valve replacements discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the general surgery service for management of choledocholithiasis and ventral hernia. general discharge instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please take the prescribed analgesic medications as needed. you may not drive or heavy machinery while taking narcotic analgesic medications. you may also take acetaminophen (tylenol) as directed, but do not exceed 4000 mg in one day. please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. bulb suction drain care: *please look at the drain site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warmth, and fever). *maintain the bulb on suction. *record the color, consistency, and amount of fluid in the drain. call the surgeon, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. *empty the drain frequently. *you may shower and wash the drain site gently with warm, soapy water. you may also wash with half strength hydrogen peroxide followed by saline rinse. *keep the insertion site clean and dry otherwise. place a drain sponge for cleanliness. *avoid swimming, baths, and hot tubs. do not submerge yourself in water. *attach the drain securely to your body to prevent pulling or dislocation. warfarin (coumadin): what is this medicine used for? this medicine is used to thin the blood so that clots will not form. how does it work? warfarin changes the body's clotting system. it thins the blood to prevent clots from forming. what you should contact your healthcare provider : signs of a life-threatening reaction. these include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat, severe dizziness or passing out, falls or accidents, especially if you hit your head. talk with healthcare provider even if you feel fine, significant change in thinking clearly and logically, severe headache, severe back pain, severe belly pain, black, tarry, or bloody stools, blood in the urine, nosebleeds, coughing up blood, vomiting blood, unusual bruising or bleeding, severe menstrual bleedin, or rash. call your doctor if you are unable to eat for several days, for whatever reason. also call if you have stomach problems, vomiting, or diarrhea that lasts more than 1 day. these problems could affect your coumadin/warfarin dosage. coumadin (warfarin) and diet: certain foods and beverages can impair the effect of warfarin. for this reason, it's important to pay attention to what you eat while taking this medication. until recently, doctors advised taking warfarin to avoid foods high in vitamin k. this is because large amounts of vitamin k can counteract the benefits of warfarin. however, recent research shows that rather than eliminating vitamin k from your diet, it is more important to be consistent in your dietary vitamin k intake. these foods contain vitamin k: fruits and vegetables, such as: kiwi, blueberries, broccoli, cabbage, sprouts, green onions, asparagus, cauliflower, peas, lettuce, spinach, turnip, collard, and mustard greens, parsley, kale, endive. meats, such as: beef liver, pork liver. other: mayonnaise, margarine, canola oil, soybean oil, vitamins, soybeans and cashews. limit alcohol. alcohol can affect your coumadin??????/warfarin dosage but it does not mean you must avoid all alcohol. serious problems can occur with alcohol and coumadin??????/warfarin when you drink more than 2 drinks a day or when you change your usual pattern. binge drinking is not good for you. be careful on special occasions or holidays, and drink only what you usually would on any regular day of the week. monitoring: the doctor decides how much coumadin??????/warfarin you need by testing your blood. the test measures how fast your blood is clotting and lets the doctor know if your dosage should change. if your blood test is too high, you might be at risk for bleeding problems. if it is too low, you might be at risk for forming clots. your doctor has decided on a range on the blood test that is right for you. the blood test used for monitoring is called an inr. use of other medications: when coumadin/warfarin is taken with other medicines it can change the way other medicines work. other medicines can also change the way coumadin??????/warfarin works. it is very important to talk with your doctor about all of the other medicines that you are taking, including over-the-counter medicines, antibiotics, vitamins, or herbal products. followup instructions: please follow up with dr. on at 4pm. call with any questions or concerns. please follow up with dr. for inr check at 11:30am. office is located at . call with any questions or concerns. please have your inr checked as per your usual regimen on wednesday . you may have this done either by vna or at your usual facility. your primary care physician will adjust your coumadin dosing per his recommendation. discontinue lovenox when your inr is above 2.5. thank you. procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy cholecystectomy reopening of recent laparotomy site other and open repair of other hernia of anterior abdominal wall with graft or prosthesis diagnoses: acute kidney failure, unspecified heart valve replaced by other means long-term (current) use of anticoagulants other specified complications of procedures not elsewhere classified nontraumatic compartment syndrome of abdomen ventral, unspecified, hernia without mention of obstruction or gangrene calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to