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: no known allergies / adverse drug reactions attending: chief complaint: gi bleed major surgical or invasive procedure: : egd and ercp : ir angiography with embolization : ir right ij triple lumen line placement history of present illness: 57m with duodenal adenoma underwent endoscopic mucosal ressection today by ercp. patient intially tolerated the procedure well, but post procedurally developed bright red blood per rectum and melanotic stools. patient underwent a second endoscopy which showed a large adherant clot at the site of the resection and 4mg of epinephrine was injected into the site with out obtaining hemostatis. patient continued to pass melanotic stools and brbpr and was emergently transferred to the . per report patient was not on any blood thinning or platelet inhibiting medications preprocedurally. hct prior to procedure was 44.8 to 38.1. he did not become hypotensive nor tachycardic while in gi. . upon arrival to the 71, 112/83, 93% on 2l nc. patinet was rigorous and actively exsangunating from his rectum with blood soaked bed sheets. an attempt to place a 16 gauge peripherial iv was made with out success and patient underwent emergent placement of trauma line in the right groin. during the placement of the line patient had several vagal episodes with passage of bright red stool and dropped his systolic pressures to the 60s. the massive transfussion protocol was initiated and the patient given 2 units of prbcs prior to his systolic pressures recovering to the 110's systolic. he was brought emergently from the icu to ir for attempt at embolization. . in the ir suite the 9f right femoral line was confirmed to be placed in the r femoral artery by fluroscopy. vascular surgery was consulted and recommended removing the line and holding pressure. patient remained hd stable through out the subsequent procedure acessed through the left femoral artery with coiling of the gda. patient then had 9f trauma line placed in the right ij for access. a thrid unit of prbcs was transfused while in the ir suite. past medical history: gerd social history: - lives at home with wife, does not smoke - drinks 2-3 whiskey's a week. family history: not obtained physical exam: physical exam on admission to the icu vitals: 71, 112/83, 19, 93% on nc general: shivering, pale, diaphoretics, mentating well heent: sclera anicteric, mm dry, oropharynx clear, eomi, perrl cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: non-tender non distented, active bleeding seen from rectum ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: moving all extremities. physical exam on discharge tmax: 37.2 ??????c (98.9 ??????f) tcurrent: 37.1 ??????c (98.8 ??????f) hr: 72 (61 - 85) bpm bp: 111/67(78) {103/49(61) - 136/97(104)} mmhg rr: 16 (5 - 22) insp/min spo2: 97% general: awake and alert, nad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: minimal epigastric discomfort, soft, non-tender non distended, bowel sounds present ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema; r groin ecchymosis stable neuro: moving all extremities. pertinent results: labs on admission 08:50am blood wbc-7.6 rbc-5.04 hgb-14.9 hct-44.8 mcv-89 mch-29.6 mchc-33.3 rdw-13.1 plt ct-212 04:14pm blood wbc-12.9*# rbc-4.31* hgb-13.1* hct-38.1* mcv-88 mch-30.3 mchc-34.3 rdw-13.1 plt ct-258 08:50am blood pt-10.2 ptt-31.5 inr(pt)-0.9 08:50am blood urean-21* creat-1.1 na-144 k-4.7 cl-108 hco3-24 angap-17 08:50am blood alt-33 ast-33 alkphos-57 amylase-64 totbili-0.3 dirbili-0.0 indbili-0.3 08:50am blood lipase-50 labs on discharge imaging/procedure: - egd: esophagus: normal esophagus. stomach contents: small amount of dark blood was seen in the stomach. this was suctioned. duodenum: other: site of endoscopic mucosal resection in the duodenum is identified. there is a large clot at the site of emr. active bleeding is noted. 12-14 cc of epinephrine is injected around the clot. inspite of that some oozing persisted ath the site of emr. impression: small amount of dark blood was seen in the stomach. this was suctioned. site of endoscopic mucosal resection in the duodenum is identified. there is a large clot at the site of emr. active bleeding is noted at the site of emr. 12-14 cc of epinephrine is injected around the clot. inspite of that some oozing persisted ath the site of emr. - ercp: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: a flat polyp 5 cm in size was identified in the second portion of the duodenum. the ampulla was clearly identified and was approximately 2 cm proximal to the polyp. it was not involved by the polyp. a submosal injection was performed using methylene blue and saline into the polyp to create a saline pillow. the polyp was completely removed using piece meal polypectomy technique. major papilla: normal major papilla 2 cm proximal to the flat duodenal polyp. impression: a flat polyp 5 cm in size was identified in the second portion of the duodenum. the ampulla was clearly identified and was approximately 2 cm proximal to the polyp. it was not involved by the polyp. a submosal injection was performed using methylene blue and saline into the base of the 5 cm duodenal polyp to create a saline pillow. the polyp was completely removed using piece meal polypectomy technique. - ir procedure (preliminary): 1. fluoroscopic assisted right femoral access and retrieval. 2. fluoroscopic assisted left femoral access. 3. celiac angiogram. 4. super selective celiac angiogram. 5. gda coil/gelfoam embolization. 6. superior mesenteric artery angiogram. contrast: 120 ml of optiray were used. medication: moderate sedation was provided by divided doses of versed for a total of 4 mg and fentanyl for a total of 200 mcg. patient's hemodynamic parameters were continuously monitored by a trained radiological nurse. procedure: prior to initiation of the procedure, written informed consent was obtained and preprocedure timeout was performed. patient was placed supine on the angiography table and both groins were prepped and draped in the usual sterile manner. under fluoroscopic and palpatory guidance, icropuncture access to the right common femoral artery was obtained. as the microwire was advanced, it was noted that the femoral line placed earlier by the icu was lateral to the microwire. at this moment, suspicion for a femoral artery line placement was raised, and as one of the lumens of the line was open, pulsatile blood was identified. subsequently, the access on the right side was aborted, the needle and microsheath were removed, and 10 minutes of manual compression achieved hemostasis. following, a left common femoral approach was obtained. under fluoroscopic and palpatory guidance, micropuncture access to the left common femoral artery was obtained and a 5 french long sheath was placed. subsequently, a cobra 2 catheter was navigated over an angled terumo glidewire into the celiac trunk. as the celiac trunk was selected, the wire was removed and a dsa run was obtained. following this, based on the results of the angiography, it was decided to catheterize selectively the gastroduodenal artery. a renegade microcatheter was navigated over a 0.16 headliner into the gastroduodenal artery. selective angiograms were obtained. based on these results, it was decided to embolize the gda artery with gelfoam/ coils. the technique was used, with coils and gelfoam subsequently over and over. coils with the size of 3 x 3, 3 x 4, 1 x 5, 6 x 5 and 3 x 4 were used for a total of 13 coils. selective angiography after coil/gelfoam embolization demonstrates no further flow into the gda artery. subsequently, the sma was catheterized. an angiography was obtained. there was no evidence of contrast extravazation. following this, the catheters were removed. it was decided to leave the sheath overnight. the long 5f sheath was exchanged for a short 5f sheath, which was securely sutured to patient's skin. patient tolerated the procedure well and was returned to the icu in stable condition. no complications ensued. findings: 1. conventional celiac trunk anatomy. 2. no active extravasation was identified; however, known region of leeding was supplied by the gda artery. multiple selective and super selective angiograms were obtained, without exactly identifying the source of bleeding. 3. successful coil and gelfoam embolization of the gda artery, with a andwich technique, until successful stasis was achieved. impression: prophylactic embolization of a gda artery given patient's significant duodenal bleeding symptoms. - ir guided rij triple lumen central line placement procedure: as this was an emergency line placement and the patient had previously consented to central line placement 2 hrs prior, no new consent was obtained. procedure was explained to the patient, and subsequent timeout was performed. after anesthetizing the skin and subcutaneous tissues, a micropuncture needle was inserted into the right internal jugular vein under ultrasound guidance. the hard copy ultrasound images were saved; however, due to technical problems, not transferred to pacs. a 0.018 nitinol wire was then advanced into the superior vena cava. after additional anesthesia, a small was made in the skin. the micropuncture needle was exchanged with the micropuncture sheath. the inner cannula and nitinol wire were removed. a 0.035 wire was advanced into the inferior vena cava. the micropuncture sheath was removed initially and 7 french dilator was used over the wire. subsequently, this dilator was removed and a 12 french dilator was also used. finally, the dilator was removed and a triple-lumen trauma line was placed with its tip positioned in the distal superior vena cava. the wire and inner cannula were removed. fluoroscopy spot image demonstrated the catheter tip in the distal svc. the three lumens withdrew blood and were flushed easily. catheter was secured with 2-0 silk sutures. dry sterile dressings were applied. no immediate post-procedure complications were noted. the patient tolerated the procedure well. impression: successful placement of a triple-lumen internal 9f french trauma line through the right internal jugular vein approach. the tip is located in the distal svc and the catheter is ready for use. - ct abd/pelvis lung bases: there are small bilateral effusions with associated atelectasis. there is no focal consolidation or nodule seen. the heart is normal in size. abdomen: limited assessment of the abdomen and pelvis without intravenous contrast demonstrates no contour abnormality of the liver, spleen, and bilateral kidneys. no evidence of hydronephrosis or nephrolithiasis. small nodule posterior to the pancreatic body is seen, measuring 1.7 cm, previously seen on the recent mri of , whic was characterized as tuber omentale. within the tail there is loss of feathery apperance, corresponding to accessory spleen seen on mri. again seen multiple embolization coils within the gda territory. there is minimal stranding around the second segment of the duodenum and pancreatic head, post-procedure and embolization.small amount of high attenuating stranding within the right anterior pararenal fossa (2:53), without evidence of hematoma. there is no hematoma. there is contrast within the gallbladder, consistent with vicarious excretion from the prior embolization study. the adrenal glands are normal in appearance. the visualized small and colonic loops of bowel within the upper abdomen are normal in appearance with no evidence of abnormal dilatation or wall thickening. there is a small fat-containing ventral hernia. pelvis: the urinary bladder is collapsed and contains a foley catheter. prostate gland is normal in size, and seminal vesicles are normal. the colonic and small loops of bowel within the pelvis are normal in ppearance. tiny bilateral fat-containing inguinal hernias are noted. there is fat stranding around the right inguinal region, post-placement of a femoral line; however, there is no evidence of retroperitoneal or inguinal hematoma. atherosclerotic plaques are seen along the aorta and iliac arteries without aneurysmal dilatation. osseous structures: minimal lumbosacral spondylosis without evidence of destructive lytic lesions. bilateral pars defect, more pronounced on the right side. impression: 1. status post duodenal adenoma removal and gda embolization. no evidence of hematoma within the abdomen or pelvis. 2. minimal stranding around the second segment of the duodenum and the pancreas, likely related to post-procedure, however correlation with biochemical pannel is recommended to assess for potential pancreatitis. 3. tiny bilateral pleural effusions with associated atelectasis. 4. stranding along the right inguinal region, post-central line placement, however, with no evidence of retroperitoneal or inguinal hematoma. 5. small nodule posterior to the body of pancreas and loss of feathery appearance within the pancreatic tail, which correspond respectievely to tuber omentale and accessory spleen seen on the prior mri. pathology - gi biopsy: pending discharge labs 01:51am blood wbc-15.0* rbc-3.82* hgb-11.3* hct-33.4* mcv-87 mch-29.6 mchc-33.9 rdw-14.5 plt ct-132* 01:51am blood glucose-104* urean-10 creat-0.9 na-141 k-3.3 cl-105 hco3-30 angap-9 brief hospital course: 57m with duodenal adenoma who underwent endoscopic mucosal resection by ercp with post procedural gi bleed. active issues 1. gi bleed: post-procedure patient developed bright red blood per rectum and melanotic stools. patient underwent a second endoscopy which showed a large adherent clot at the site of the resection and 4mg of epinephrine was injected into the site with out obtaining hemostatis. patient continued to pass melanotic stools and brbpr and was emergently transferred to the . hct prior to procedure was 44.8 to 38.1. an attempt to place a 16 gauge peripherial iv was made with out success and patient underwent emergent placement of trauma line in the right groin. during the placement of the line patient had several vagal episodes with passage of bright red stool and dropped his systolic pressures to the 60s. the massive transfusion protocol was initiated and the patient given 2 units of prbcs prior to his systolic pressures recovering to the 110's systolic. he was brought emergently from the icu to ir for attempt at embolization. in the ir suite the 9f right femoral line was confirmed to be placed in the r femoral artery by fluroscopy. vascular surgery was consulted and recommended removing the line and holding pressure. patient remained hd stable through out the subsequent procedure acessed through the left femoral artery with coiling of the gastroduodenal artery. a thrid unit of prbcs was transfused while in the ir suite. hemostasis was achieved after embolization. his hematocrit was monitored closely over the next two days and continued to slowly trend down. out of concern for hematoma formation at the groin sites or a retroperitoneal bleed, ct scan was performed which showed no hematoma or rp bleed; there was no pseduoaneurysm of the femoral arteries. he was maintained on a iv pantoprazole drip. hemoglobin and hematocrit remained stable, and the patient was discharged with gi follow-up. he should have a repeat cbc in 1 week for monitoring of h/h. chronic issues 1. gerd: stable during admission. transitional issues 1. the patient should have a cbc checked in 1 week after admission for monitoring of h/h. additionally, he did have an elevated white blood cell count without signs of infection; this should be followed with the cbc in a week. 2. biopsy of duodenal adenoma pathology pending. medications on admission: "acid reducer," name of medication unknown discharge medications: 1. pantoprazole 40 mg po q12h rx *pantoprazole 40 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*2 2. outpatient lab work please check a cbc on with results faxed to dr. at (discharge hct 33, hgb 11) icd-9, 285.1 discharge disposition: home discharge diagnosis: doudenal adenoma ercp biopsy hemorrhage mistaken insertion of 9french trauma line to the right femoral artery discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted to the intensive care unit after having massive bleeding from the biopsy in your small intestine earlier in the day. you were emergently transfused 4 units of red blood cells and had the bleeding artery embolized by our interventional radiologists. you tolerated this procedure well and had no signs of further bleeding for 2 days afterwards. during your bleeding a large iv was need to be placed in your leg in order to transfuse you blood as quickly as possible and keep your blood pressure up. unfortunately this "trauma line" was placed in your right femoral artery and not the vein as intended. you were seen by our vascular surgeons who removed the line and felt comfortable that it had healed properly. we are terribly sorry for this mistake. over the next few days you should avoid any heavy lifting or long distance walking to ensure the leg heals properly. if you develop any bleeding in your leg, your neck or in your stool please call your doctor immediately. you will need to have a blood count checked in a week's time to ensure that there is no further bleeding. your hematocrit was 33 and your hemoglobin was 11 at the time of discharge. followup instructions: please call dr. office in gastroenterology to schedule a follow up appointment for your adenoma in 3 months. procedure: endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries endoscopic excision or destruction of lesion of duodenum transcatheter embolization for gastric or duodenal bleeding central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: esophageal reflux personal history of tobacco use hemorrhage complicating a procedure hypotension, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified complications of procedures not elsewhere classified leukocytosis, unspecified benign neoplasm of duodenum, jejunum, and ileum performance of correct operation (procedure) on wrong side/body part 

Answer: The patient is high likely exposed to