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: codeine / antihistamines attending: chief complaint: planned admission for ercp to dilate post-stent stenosis of cbd major surgical or invasive procedure: ercp biliary drain procedure by ir x 3 history of present illness: 70 year old female with a history of metastatic colon ca to liver and lungs, admitted following ercp to dilate post-stent stenosis of cbd. briefly ms was diagnosed with metastatic colon cancer in and treated with resection and 5fu / leucovorin. unfortunately she had a recurrence in with mets to liver and lungs. she has had multiple biliary stents placed in the past for obstructive disease. recently her bilirubin has been elevated and she has undergone several ercp's with dr who was unable to remove all of the sludge distal to the stents. her chemotherapy regimen has been held for the past several weeks due to the elevated bili and it was recommended that she have the percutaneous biliary procedure which was performed on . she was then re-admitted on at which time ir replaced her percutaneous biliary drain. . according to the preliminary procedure documentation: 1. previously placed metal stent was seen in the major papilla with distal occlusion. 2. cannulation of the biliary duct was performed with a balloon catheter using a free-hand technique. 3. cholangiogram showed partial stent occlusion with a normal right hepatic system. the left hepatic system was dilated with the external biliary drain in place. 4. biliary sludge was extracted from the biliary stent with a balloon catheter. . ros: feels sleepy after procedure but otherwise well. no f/c/n/v/sob since recent discharge. last bm today. . past medical history: cva on plavix, with residual deficit of dysarthria hypothyroidism pre-diabetes htn patent foramen ovale . onc hx: metastatic colon cancer; stage c when diagnosed in and treated with resection and 6 cycles of adjuvant 5-fu and leucovorin. recurrence in with liver and lung metastasis. had biliary stenting in . has been treated with folfox/avastin since 1/. . s/p chole s/p hernia repair social history: patient lives at home with her husband. now retired, but used to work as a real estate and lead inspector for 20 years. prior history of smoking (roughly 10 ppy); quit 30 years ago. no alchol use or illicit drugs. family history: no fh of cancer physical exam: vs: tc 98.7, bp 175/83, hr 57, rr 18, 97% on ra general: obese woman, in nad, resting comfortably in bed heent: icteric sclerae; perrla resp: ctab cv: s1, s2, rrr, sys murmur rusb abd: hypoactive bs. obese. soft, nd, no hsm, no rebound. percutaneous drain in place with no evidence of erythema, bleeding or drainage at site. mildly ttp around perc drin site ext: trace le edema; no cyanosis or clubbing pertinent results: 10:00am blood wbc-7.4# rbc-3.56* hgb-12.0 hct-36.5 mcv-103* mch-33.6* mchc-32.8 rdw-14.1 plt ct-170 12:00am blood wbc-8.3 rbc-3.02* hgb-10.3* hct-30.6* mcv-101* mch-34.2* mchc-33.7 rdw-14.0 plt ct-226 05:17pm blood neuts-73.5* lymphs-19.8 monos-5.3 eos-1.0 baso-0.4 11:30am blood pt-15.6* inr(pt)-1.4* 12:15am blood pt-18.3* ptt-42.8* inr(pt)-1.7* 10:00am blood urean-6 creat-0.6 na-139 k-3.6 cl-102 hco3-25 angap-16 12:00am blood glucose-117* urean-6 creat-0.5 na-132* k-3.8 cl-97 hco3-28 angap-11 10:00am blood alt-41* ast-79* ld(ldh)-149 alkphos-637* totbili-5.4* dirbili-3.6* indbili-1.8 05:00am blood alt-34 ast-72* alkphos-496* totbili-12.1* dirbili-8.9* indbili-3.2 12:00am blood alt-35 ast-77* alkphos-442* totbili-10.2* 12:00am blood alt-24 ast-68* alkphos-435* totbili-7.9* 10:00am blood ggt-286* 10:00am blood totprot-7.0 albumin-2.7* globuln-4.3* 12:00am blood albumin-2.1* calcium-7.9* phos-3.0 mg-2.2 12:15am blood osmolal-267* 12:15am blood tsh-3.2 12:00am blood cea-4.2* . ercp procedures: biliary sludge was extracted from the biliary stent with a balloon catheter. impression: 1. previously placed metal stent was seen in the major papilla with distal occlusion. 2. cannulation of the biliary duct was performed with a balloon catheter using a free-hand technique. 3. cholangiogram showed partial stent occlusion with a normal right hepatic system. the left hepatic system was dilated with the external biliary drain in place. 4. biliary sludge was extracted from the biliary stent with a balloon catheter. . tube cholangeogram impression: successful placement of a 8.5-french right biliary drainage tube, placed through the stent within the common bile duct into the duodenum for internal drainage. successful replacement of pre-existing left biliary drainage tube with a 6f nephrostomy catherter for external drainage. . cxr there is a large mass (4.7 x 5.7 cm) at the left lung apex. allowing for low inspiratory volumes, no chf, focal infiltrate or effusion is identified. the patient's numerous pulmonary nodules are faintly visible. drains noted over the upper abdomen. no acute pneumonic infiltrate identified. tip of right- sided port- a-cath type catheter overlies the svc/ra junction. . egd: impression: the esophagus was normal. the stomach was normal with no blood within. the ampullary area was examined using a duodenoscope. there was a small mount of ooze around the previously placed metal stent. the ir placed biliary stent could be seen within the metal stent. there was no blood draining from the stent. the ooze was flushed several times and seemed to be originating from the periampullary area secondary to trauma from ir stent insertion +/- metal stent change of position. the oozing had stopped by the end of the procedure. . gi bleeding study: interpretation: following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen for 90 minuteswere obtained. a left lateral view of the pelvis was also obtained. dynamic blood pool images show increased uptake throughout possibly small bowel seen only in the delayed images (60-90). the precise cause of the increased uptake or the location cannot be determined. impression: increased uptake possibly in the small bowel seen only in the delayed images (60-90min) likely representing slow upper gi bleeding. . ct abd/pelvis: ct abdomen with iv contrast: there are multiple lung nodules at the lung bases. the largest is located within the left lower lobe and measures 2.9 x 2.1 cm and previously measured 2.7 x 2.0 cm. a right upper lobe nodule has increased in size and now measures 0.6 x 0.6 cm (series 4, image 1). the patient is status post ptc and two catheters are seen within the liver entering via frontal and right lateral approaches. there is a small amount of perihepatic and perisplenic ascites. a common bile duct stent is unchanged in appearance. the subcapsular mass in the lateral right lobe which previously measured 2.1 x 2.2 cm is now ill- defined, perhaps secondary to phase of contrast administration, but measures approximately 2.2 x 1.2 cm. there remains mild intrahepatic biliary dilatation, which has decreased and an expected small amount of pneumobilia. there is evidence of tumor extension up the porta hepatis encircling the left portal vein, decreased compared to the prior study. lymph nodes within the porta hepatis, some with mucinous calcification are unchanged. a cystic lesion in an enlarged spleen is stable. cysts in the right kidney are also unchanged. the pancreas, right adrenal gland, left kidney, and stomach are unremarkable. a new 1.6 x 1.0 cm left adrenal nodule likely represents metastasis. small retroperitoneal lymph nodes do not meet criteria for pathologic enlargement. there is a small ventral hernia containing unremarkable appearing mesentery. ct pelvis with iv contrast: the rectum, bladder, and uterus are unremarkable. there is mild sigmoid diverticulosis. there are no enlarged lymph nodes and no free fluid within the pelvis. bone windows: no suspicious lytic or sclerotic foci. impression: 1. interval progression of disease. new left adrenal lesion suspicious for metastasis. enlargement of right upper lobe pulmonary nodule. the right lateral hepatic lesion is more ill-defined but has likely mildly decreased in size as has tumor extending up the porta hepatis. . cholangiogram: impression: 1. bilateral cholangiograms performed demonstrate decompressed system and right-sided biliary catheter retracted into the liver parenchyma. the left- sided biliary catheter presents in good position and drainage of the left- sided biliary ducts. 2. successful exchange for right-sided biliary catheter for a 10 french biliary catheter, the pigtail was coiled in the duodenum. . cxr impression: 1. smaller apparent size of left apical mass, which may related to technique. if detailed comparison for interval change is desired, then pa and lateral radiographs could be helpful. 2. bibasilar opacities, probably atelectasis brief hospital course: a/p: 70 f metastatic colon ca admitted for for ercp to dilate post-stent stenosis of cbd. # hyperbilirubinemia: it was never completely clear why we were unable to get her bilirubuin down further than we did. the ct scan did not show progression of disease. ? paraneoplastic syndrome. however, after multiple ercp/ir procedures (detailed below), her bilirubin started to trend down by discharge. - on , she underwent successful ercp during which they dilated the distal cbd stent stenosis. she was started on levofloxacin after this procedure. - on , ir placed a drain to her r biliary system that was also internalized to her duodenum. they also replaced her l- biliary drain (this could not be internalized). - on , she had a lg amt of marroon blood per rectum. a bleeding scan suggested an upper-gi bleed. she was transferred to the and an egd was performed which showed a slow bleed from around the site of entry of the cbd into the duodenum, thought to be secondary to prior procedures. the bleeding had stopped by the end of th egd. her hct was stable and she did not require any transfusions during her hospital course. - on , the same day that she was transferred to the , she spiked a fever to 101. cxr did not show a pna and ua did not show a uti. vanc/zosyn were started with concern for biliary source with possible catheter-site infection. on approximately , vancomycin was stopped and she was switched to unasyn, based on sensitivities (her biliary fluid grew out enterococcus and k. pneumoniae.) on , cipro was added based on new sensitivity data for the k. pneumoniae and the fact that she spiked a low-grade fever. she remained afebrile for the remainder of her hospital course. on discharge, she was sent out on augmentin and cipro to be taken ongoing. - on , ir performed another cholangiogram as her bilirubin was persistently elevated and her drains seemed only to be intermittently draining. they increased her r drain to a 10 f and showed that the l drain was working. - prior to d/c we also consulted hepato-biliary surgery. they stated that they could offer her a surgical procedure to attempt to provide better drainage but based on the fact that here bili began to trend down and her drains seemed to be working, she decided to defer surgery for now. she will have a f/u appointment w/ dr. as an outpatient. - she is at very high risk for infection given her 2 biliary drains. . # hpothyroidism: cont armour . # htn: atenolol held during her gi-bleed and for approx 6 days after and re-started at a lower dose prior to d/c - d/c of quinipril as did not seem to need it . # metastatic colon cancer: tx per dr. (dr. covering initially and dr. took over her care prior to d/c) - her colon cancer does not appear to be very agressive but she likely cannot receive any further chemotherapy hyperbilirubinemia - will continue to follow her bilirubin/cbc as an outpatient. . medications on admission: plavix 75 mg once daily (held x 14 days), quinapril 60 mg daily, protonix 40 mg b.i.d., atenolol 50 mg once daily, citalopram 60 mg once daily, armour 120 mg daily. oxycodone 5 mg prn. discharge medications: 1. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 4. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 5. thyroid 120 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed: titrate to bm per day. disp:*1000 ml(s)* refills:*1* 8. atenolol 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever: not to exceed 2gm daily . 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*2* 11. augmentin 500-125 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 12. outpatient lab work total bilirubin to be drawn every monday, wednesday and friday. please fax results to , np at (. 13. outpatient lab work ast/alt/alk phos/albumin/cbc to be drawn every monday. please fax results to , np at (. 14. daily heparin port-a-cath flushes per therapy protocol disp: 2 week supply refills: 4 15. daily normal saline flushes per therapy protocol disp: 2 week supply refills: 4 16. weekly 20 gauge inch needles for weekly needle changes disp: 2 week supply refills: 4 17. vad kits disp: 2 week supply refills: 4 discharge disposition: home with service facility: home health services discharge diagnosis: metastatic colon cancer hypertension hypothyroidism discharge condition: hemodynamically stable. ambulatory. discharge instructions: you were admitted for ercp and ir biliary drain revision. please continue the antibiotics as instructed. we also decreased your blood pressure medications as you did not need as much as you were receiving. . please seek medical attention immediately if you develop fever, chills, nausea, vomiting, increased abdominal pain or any other concerning symptoms. followup instructions: will call you regarding your lab results and to schedule follow-up w/ dr. or dr. . . please call dr. (hepato-biliary surgeon) office to obtain the date and time of your appointment w/ him. tel. (. . please make a follow-up appointment w/ dr. within the next 2 weeks. tel . . provider: suite gi rooms date/time: 4:00 provider: , md phone: date/time: 4:00 procedure: other endoscopy of small intestine endoscopic dilation of ampulla and biliary duct other cholangiogram other cholangiogram other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract computer assisted surgery with fluoroscopy diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension unspecified acquired hypothyroidism ostium secundum type atrial septal defect personal history of malignant neoplasm of large intestine secondary malignant neoplasm of lung hemorrhage of gastrointestinal tract, unspecified cholangitis obstruction of bile duct other complications due to other internal prosthetic device, implant, and graft secondary malignant neoplasm of other digestive organs and spleen 

Answer: The patient is high likely exposed to