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: ibuprofen attending: chief complaint: brbpr and melena major surgical or invasive procedure: egd colonoscopy history of present illness: 83 year old woman with history of cad, hypertension, atrial fibrillation on dabigatran, osteoarthritis, hyperlipidemia, thyroid cancer who presents with brbpr and melena since 1pm today. the patient states she felt "cold and clammy," although without fevers just before starting to have bowel movements at 1pm. she described the bowel movement as dark black with bright red blood filling the toilet bowl. she developed sharp substernal chest pain with radiation to her left shoulder during this first episode; she did not feel it was like her mis in the distant past. this resolved after two sublingual ntg and patient also has nitroglycerin patch. the patient had another bloody and melanotic bowel movement at 3:30pm, none since. no abdominal pain associated with this, no light headedness or dizzyness, no presyncopal symptoms/syncope, nausea/vomiting. she did feel generally weak. . in the ed, initial vs were t97.7, hr78, bp139/74, rr18, 98% on ra. two large bore pivs were placed. the patient did not have any more bloody or melanotic stools, no hematemesis. labs showed inr 1.9 and hct 29, down from 45 (prior from ). anoscopy revealed moderate bright red blood in rectal vault without visibly active bleeding, +external hemorrhoids, no internal fissues/polyps. ng lavage initially passed clotted blood (50cc of normal saline input) and eventually cleared with 500cc lavage. ngt kept in. foley placed. prbc transfusion started with type and cross. toxicology was consulted and recommended supportive care because dabigatran can not be reversed except with dialysis. they felt the drug will be excreted fairly rapidly (renally cleared) in patients with normal renal function. pt/ptt will normallly be prolonged. gi was also consulted and given dabigatran as likely precipitating factor and +ng lavage, heme and recommended ppi 80mg iv bolus and gtt and close hct monitoring. heme felt patient should clear dabigatran by 5am given half life, recommended vitamin k 10mg po also, given inr 1.9. on transfer to the micu, vs afebrile, hr88, bp129/87, rr18, o2 sat 95% on ra. . on arrival to the micu, patient resting comfortably in bed. endorses fatigue from long afternoon/evening but otherwise denies symptoms. . review of systems: (+) per hpi (-) denies fever, recent weight loss or gain. denies headache, cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations currently. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. past medical history: * coronary artery disease with mis (?x3 in ) * hypertension * atrial fibrillation: on digoxin in the past, now on dabigatran started ~ * hyperlipidemia * osteoarthritis * cholecystectomy + ercp in * partial hysterectomy * thyroid cancer s/p thyroidectomy and parathyroidectomy social history: worked at hospital as nursing aide in the alcoholics unit for years. retired, lives in retirement community. glasses of wine/month (social), denies illicits. remote history of tobacco (quit over 40 years ago). has refused to ever have colonoscopy. family history: father had an mi in his 50s and died of renal cancer. mother had an mi in her 40s. no family history of sudden cardiac death. daughter died at 54 years old of liver cancer, brother died at 77 years old (4 years ago) of gastric cancer. no other family history of malignancies, ibd, celiac disease, blood dyscrasias. physical exam: admission exam: vs: temp: 97.7 bp: 152/80 hr: 88 rr: 16 o2sat 98% on 3l nc gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, pale conjunctiva, slightly dry mucus membranes, oropharynx without lesions, no lymphadenopathy, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no rubs or gallops, lusb w/ expiratory variation abd: nontender, nondistended, +b/s, soft ext: no cyanosis, ecchymosis; 3+ non-pitting edema of bilateral lower extremities skin: no rashes/no jaundice neuro: aaox3. cranial nerves grossly intact. strength and sensation grossly intact. . discharge exam: pertinent results: 09:55pm urine color-yellow appear-clear sp -1.016 09:55pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:55pm urine rbc-1 wbc-3 bacteria-few yeast-none epi-<1 09:55pm urine granular-1* hyaline-166* 09:55pm urine mucous-occ 06:48pm glucose-143* urea n-31* creat-1.0 sodium-141 potassium-4.7 chloride-106 total co2-28 anion gap-12 06:48pm estgfr-using this 06:48pm alt(sgpt)-16 ast(sgot)-19 ld(ldh)-170 alk phos-67 tot bili-0.5 06:48pm lipase-32 06:48pm ctropnt-<0.01 06:48pm calcium-7.9* phosphate-4.2 magnesium-1.9 06:48pm digoxin-<0.2* 06:48pm glucose-133* k+-4.6 06:48pm hgb-9.8* calchct-29 06:48pm wbc-9.7 rbc-3.20*# hgb-9.8*# hct-29.0*# mcv-91 mch-30.6 mchc-33.7 rdw-16.0* 06:48pm neuts-86.2* lymphs-11.8* monos-1.6* eos-0.2 basos-0.2 06:48pm plt count-223 06:48pm pt-20.3* ptt-40.3* inr(pt)-1.9* . ekg: atrial fibrillation, hr92, normal axis, poor r wave progression, narrow qrs, qtc 450, downsloping st intervals in v4-v6 unchanged from priors (, 3/). pseudonormalization of avf t waves. . imaging: none new echo mild calcific aortic stenosis. mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. mild pulmonary hypertension. lvef >55%. . egd: findings: esophagus: normal esophagus. stomach: mucosa: abnormal mucosa was noted in the antrum and stomach body. the mucosa was erythematous and denuded with superficial ulcerations. flat lesions two angioectasias were seen in the fundus, one with stigmata. -cap electrocautery was applied to both avm's for hemostasis successfully. duodenum: normal duodenum. impression: angioectasias in the fundus (thermal therapy) abnormal mucosa in the antrum and stomach body otherwise normal egd to third part of the duodenum recommendations: continue iv ppi. check h. pylori. continue to trend hct, and if stable, no further bleeding, start clear liquids in afternoon, and prep for colonoscopy in am additional notes: the attending was present for the entire procedure. ebl=0cc, no specimens removed. post-procedure diagnosis - gastric avms, gastritis . colonoscopy: findings: excavated lesions multiple diverticula were seen in the sigmoid colon. other large veins seen in rectum and sigmoid colon of no likely clinical significance impression: diverticulosis of the sigmoid colon large veins seen in rectum and sigmoid colon of no likely clinical significance otherwise normal colonoscopy to cecum recommendations: likely source of bleeding was upper gi tract, as before. screening colonoscopy in 10 years, depending on patient's wishes. additional notes: the procedure was performed by the fellow and the attending. the attending was present for the entire procedure. the patient's reconciled home medication list is appended to this report. the efficiency of colonoscopy in detecting lesions was discussed with the patient and it was pointed out that a small percentage of polyps and other lesions including colon cancer can be missed with the test. ebl=0cc. no specimens removed. post-procedure diagnosis - gi bleeding. brief hospital course: 83 year old woman with history of atrial fibrillation, thyroid cancer s/p thyroidectomy, hypertension, hyperlipidemia, osteoarthritis and cad s/p mis in who presents with brbpr and melena with a hospital course complicated by afib with rvr. . # brbpr and melena: concerning for upper gi bleed given dark stools, possibly brisk given brbpr, symptoms (chills, sweats, weakness, substernal chest pain) and relatively hematocrit drop. ngl was positive in ed. initial differential included peptic ulcer disease, dielafoy, av malformation in stomach vs. small intestine bleeding vs. colon cancer. all these possible sources of her bleeding were exacerbated by dabigatran anticoagulation. patient received 3units of blood in the icu. she did not bump appropriately with first 2 units but did to third. she remained hd stable. given cardiac history, active gi bleed and cardiac symptoms, her hct transfusion goal was 30. she was given vitamin k 10mg po x1 to reverse. she was started on a ppi gtt and given a bolus. she had an egd in unit and found multiple avms and gastritis, and she had her avm's ablated. the ppi gtt was continued and plans were made for colonoscopy. she underwent colonoscopy which demonstrated no acute source for her bleeding. therefore, her bleeding was thought to be secondary to her avms and gastritis. her anti-coagulation was held and she will need to have a hct check as an outpatient. her pcp will also need to discuss with her cardiologist when to restart her anti-coagulation for her atrial fibrillation. . # atrial fibrillation: she had been on digoxin in the past, recently discontinued and patient started on dabigatran. she has a history of good rate control with the anti-hypertensive nifedipine and beta blocker atenolol. when she presented to the ed, and was transfered to the icu for her gi bleed her nifedipine and atenolol were held. she was then restarted on a low dose beta blocker, metoprolol, until her colonoscopy could be preformed. prior to her colnoscopy however she did not have ideal rate control and her hr was in the 110's. she was given multiple doses of metporolol and 10 mg iv dilt in 5 mg aliquots, prior to her procedure. after her colonoscopy her home medications were re-started. she acheived good rate control prior to discharge. as noted above, anti-coagulation was held. - please have pcp talk to her cardiologist about future anti-coagulation. gi recommended that her anti-coagulation be held for several days and then restarted. . # coronary artery disease: she had substernal chest pain at the time of her ugib that was concerning for an acs given her given personal and family history of mis at young ages. have been demand ischemia and symptoms in the setting of hematocrit drop. cardiac enzymes negative. and her ekg was stable. she did not have recurrence of her chest pain while she was admitted to the hospital. . # hypertension: patient on extensive regimen at home. all meds held initially given gi bleed. new onset lower extremity edema (significant) x6-8 weeks and lusb expiratory murmur suggestive of possible chf (tricuspid regurg). last echo in with preserved ef. patient was hypertenive in unit and was started on gentle metoprolol 12.5mg . upon discharge to the floor, and prior to her colonoscopy she was hypertensive to the 190's but asymptomatic (no chest pain, shortness of breath or headache). it was felt that she was having rebound hypertension since her clonidine was held. she was slowly restarted on some of her home hypertensive medications including, clonidine prior to the colonoscopy. thereafter, she was restarted on her home regiment with adequate hypertension control. . # : her cr was initially 1.0 upon admission. prior to discharge it was 1.2 and it's nadir in the hospital was 0.7. she was given a prescription for outpatient labs, and told to follow up with her pcp. . # hyperlipidemia: she was continued simvastatin 20. . # osteoarthritis: she was kept on tylenol #3 for pain prn. . # thyroid cancer: s/p thyroidectomy and reported in remission for years. . transition of care: code: dnr/dni transition issues: 1) anti-coagulation. she was not restarted on her home anti-coagulation in the setting of a 3 u prbc bleed. she will need to follow up with her pcp and cardiologist regarding the appropriate timing for re-initiating these medications. 2) , she will need to have her cr followed as an outpatient. her lasix had been held in the setting of her gi bleed, and this may explain why her cr decreased to 0.7. 3) rate control: her hr was into the 100-110's at times probably secondary to her medications being held, in addition to a sympathetic response from her ugib. she will need to be followed as an outpatient to ensure that her current nodal blockage is achieving good rate control. medications on admission: * atenolol 50mg daily * zocor 20mg daily * clonidine 0.3mg twice daily * furosemide 60mg qam, 20mg qpm * lisinopril 40mg twice daily * nifedipine er 120mg daily * nitroglycerin 0.1mg per hour patch (12 hours on/off, daytime) * ambien 5mg prn * percocet prn * tylenol codeine 300mg-30mg tablets q6hours pain * pradaxa 150 vs 75mg * digoxin discontinued months ago discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 2. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: please take every 5 mins up to 3 doses. please call 911 if your chest pain does not resolve after the third dose. 3. nitroglycerin 0.1 mg/hr patch 24 hr sig: one (1) patch 24 hr transdermal q24h (every 24 hours). 4. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 5. furosemide 20 mg tablet sig: three (3) tablet po am (). 6. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) for 13 days. disp:*26 tablet, delayed release (e.c.)(s)* refills:*0* 8. furosemide 20 mg tablet sig: one (1) tablet po pm (). 9. nifedipine 60 mg tablet extended release sig: two (2) tablet extended release po daily (daily). 10. lisinopril 20 mg tablet sig: four (4) tablet po daily (daily). 11. clonidine 0.3 mg tablet sig: one (1) tablet po twice a day. 12. tylenol-codeine #3 300-30 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 13. outpatient lab work please get labs to check your blood counts (cbc) and kidney functions (chem7). discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis angioectasias (upper gastrointestinal bleed) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. you were admitted to the hospital due to bleeding from your stomach. you had some small abnormal blood vessels (angioectasias) in your stomach that caused your bleeding while you were on the blood thinner for your atrial fibrillation (abnormal heart rhythm). you were given some blood in the hospital, and your blood count remained stable. you also had a colonoscopy which did not show that you were bleeding from your colon. you will need to follow up with your pcp in few days to discuss when you should restart your anti-coagulation. you will also need to have your pcp arrange gi doctor's appointment in several weeks for follow up. we did not make many changes to your home medications regiment other than those listed below. in the meantime, please resume most of your home medications with the following exception: add: protonix stop: pradaxa please get labs to check your blood levels and your kidney function when you see your primary care physician. followup instructions: please call your pcp for follow up appointment in the next days. he should check a cbc (blood count) at that time to make sure you have not had any additional bleeding. he will also need to arrange for an appointment for you to see a gi doctor. do 12-bdu procedure: colonoscopy endoscopic control of gastric or duodenal bleeding anoscopy diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation other and unspecified hyperlipidemia old myocardial infarction long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified do not resuscitate status anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia angiodysplasia of stomach and duodenum with hemorrhage personal history of malignant neoplasm of thyroid 

Answer: The patient is high likely exposed to