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: melena major surgical or invasive procedure: peg tube revision left ij cvl - removed intubation - extubated biliary stent placement s/p ir embolization of right hepatic artery egd history of present illness: this is a 74 yom with significant medical history of cholangiocarcinoma, severe pneumonia, aspiration requiring peg tube, and anemia who presents from rehab after episode of melena.he has been at rehab for several days and doing well with pt. his respiratory status was back to baseline. today he had a sudden on set of lower abdominal pain, , sharp without radiation. patient states that it lasted ~30m and ended when he passed out from the pain. no pain sense that time. had melena per rehab report, patient states he knows he had bm around the time of the pain but did not see it. in the ed, initial vitals were t97.1 hr 105 bp 104/49 rr20 93% on 2l. he was given iv pantoprazole, 2l of ns and 2 units of prbcs. remained normotensive and tachycardic. lavage done via peg tube with no return of blood or coffe ground material. attempted ng lavage but unable to pass tube. ros (+)cough with white sputum. (-)headache, chest pain, sob, hemoptysis, nausea, emesis past medical history: -recent admit for pneumonia/empyema (strep milleri), still on vancomycin and zosyn until . discharged to rehab . -recurrent aspirations, now npo with peg tube -peg tube compilcated by melena -anemia (baseline hct 26) -alcohol abuse -liver mass, biopsy consistent with cholangeocarcinoma - c scope: polyp in the ascending colon (polypectomy). otherwise normal colonoscopy to cecum . - egd: normal esophagus.dobhoff in place, past the second portion of the duodenum. as the scope was retrieved, the dobhoff was removed accidently. there was no evidence of active bleeding seen in the stomach or small intestine. normal duodenum. . - copd, emphysema on home o2 at 4 liters nasal cannula. . -splenectomy trauma >30 years ago. social history: retired from the special forces. he traveled while he was in the services, to , , and . he startedsmoking at the age of 10, he smoked 2 packs per day until he quit 4 years ago. he has over 120-pack-year history. he drank alcohol approximately beverages a day prior to his hospitalization, in the past had drank more than that.no alcohol in more than 30 days. family history: nc physical exam: vitals: t:97.3 bp:112/50 p:102 r:12 sao2:96% on 4l general: awake, alert, cachetic man heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmdry, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: crackles at bases cardiac: distant heart sounds. rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds. liver enlarged. peg c/d/i. extremities: no edema, 2+ radial, dp and pt pulses b/l. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout pertinent results: _ _ _ _ _ ________________________________________________________________ cxr at admission there is improved aeration in the right lower lung. linear opacities persist, likely in part atelectasis versus resolving airspace disease. there is a persistent right pleural effusion blunting the right costophrenic angle which may have slightly decreased in size as well. there is no volume overload. no discrete visceral pleural line is seen to suggest pneumothorax. the left lung is hyperexpanded but otherwise unremarkable. there is a minimal tortuosity to an atherosclerotic aorta. the cardiac silhouette is within normal limits for size. a tube of indeterminate origin or etiology is seen overlying the included abdomen. there is a high attenuation focus projecting within the lateral right upper lung which is clearly extrapulmonary when compared to prior studies. this is likely within the axillary soft tissues. . cxr severe pulmonary edema is new. consolidation at the right lung base is partially obscured but probably unchanged. heart size normal. pulmonary artery dilatation reflecting pulmonary hypertension due to longstanding chronic lung disease, unchanged. et tube in standard placement. no pneumothorax. . ct abd/pelvis ct of the abdomen with iv contrast: degree of consolidation in both lower lobes appears to have progressed slightly. there are superimposed interstitial densities compatible with fibrosis at the lung bases. there is an unchanged rim-enhancing pleural fluid collection in the right lung base. there is new filling of the prior lumen of the common bile duct and intrahepatic ducts with high-density material which has the hounsfield units (60-70) of acute blood clot. the gallbladder is abnormal in appearance with heterogeneous areas of high density, also likely indicating hematoma/blood clot. in some images (series 2, image 35), there is a suggestion that there is hemorrhage both in the lumen and in the gallbladder wall. there is worsening intrahepatic biliary ductal dilatation. there is redemonstration of the large mass in the junctions of segments vii and viii which is not changed in size or appearance. located anteriorly and just slightly inferior to the largest portion of the lesion, there is a new 6-mm tubular collection of arterial phase contrast seen adjacent to a branching vessel from the right hepatic artery (which is replaced, arising from the sma). on reconstructed images, this appears to be more tubular in shape. no delay-phase images were acquired. there is also a heterogeneous area of slightly increased attenuation in the liver parenchyma near the porta hepatis. the portal vein is small but remains patent, along with the smv and likely splenic vein. a gastrojejunostomy tube is present. there is mild dilatation of the pancreatic duct measuring up to 4 mm. the common bile duct is massively dilated, measuring up to 2.6 cm. at a similar level on , the duct measured 13 mm. there is no ascites. multiple splenules are present. the adrenal glands, kidneys, and bowel loops are unremarkable. . ct of the pelvis with iv contrast: scattered air-fluid levels are present in the colon. there is no colonic wall thickening. there is no free fluid in the pelvis or blood in the pelvis. . ercp - findings: ten fluoroscopic images obtained during ercp procedure were submitted to be evaluated by radiology. no radiologist was present during the procedure. the scout image demonstrates surgical clips in the right upper quadrant. cannulation and opacification of the biliary duct is noted. there is marked dilation of the cbd with a large filling defect may represent blood. there is partial opacification of the pancreatic duct with borderline diffuse dilatation. a double pigtail biliary stent was placed. impression: successful ercp with placement of a double pigtail biliary stent. . hepatic artery embolization - 1. selective and superselective arteriograms through the superior mesenteric artery and the replaced right hepatic artery showed the suspected pseudoaneurysm coming off a cranial branch of the right hepatic artery, without active extravasation of contrast. 2. successful flow-directed embolization of the branches supplying the pseudoaneurysm with multiple straight coils and gelfoam slurry, until stasis was achieved. 3. follow-up angiogram demonstrates good angiographic results with stasis at the level of the branches supplying the pseudoaneurysm and no more opacification of the pseudoaneurysm. . peg placement - impression: successful replacement of percutaneous gastrojejunostomy tube. the tube is now ready for use. brief hospital course: 74yo m with biliary carcinoma a/w melena who later than developed ugib complicated by respiratory failure. # ugib: pt admitted on for evaluation of melena. since hct remained stable and felt to be slow bleed, scope deferred. however, on sunday , at 7:30 am vomitted up ~250 cc of bright red blood and had abrupt onset of abdominal pain. called gi for urgent endoscopy, and surgery for evaluation of abdominal pain. pt was also intubated for respiratory distress and airway protection for hematemasis. patient was found on chemistries to have developed new billiary obstruction. endoscopy showed blood coming from ampulla. collective decision among all involved services to get cta of abdomen to evaluate further. ct showed large bleed in the billiary system. pt was transfused a total of 4 units of blood and 4 units of ffp. ir was called, and patient went for embolization. hct remained stable after transfusion and embolization of the right hepatic artery. for biliary obstruction from blood clot, ercp done the following day, to remove clot and pig tail stent placed. during that procedure, the existing peg tube was removed due to visual obstruction. the stent resulted in resolution of obstruction. he was fluid resuscitated and was briefly on levophed gtt for a day. since , patient has been hemodynamically stable with stable hct and no further evidence of bleeding. no signs of obstruction at this time. total bilirubin is now down to 1.8 from a peak of 21, continues to improve. recommend checking later this week to ensure improvement. peg tube was replaced on prior to discharge. patient was receiving tube feeds through ngt prior to replacement of peg tube. discharge hct stable at 27, continue to trend to ensure stability. # respiratory failure: pt has a baseline o2 requirement of 4l when he was initially admitted to the micu. pt then later developed respiratory distress/failure which was multifactorial in cause with copd/sirs//ards, recent aspiration pna and aspiration of hematemasis. pt was intubated for respiratory distress/failure on . he was continued on vanc and zosyn until for aspiration pneumonia. pt was extubated successfully on and weaned o2 to 5l via nasal cannula. he remains stable from this standpoint and is no longer on any iv antibiotics. his wbc is still slightly elevated but stable and he has remained afebrile. #id - patient was continued on vancomycin and zosyn for his aspiration pna and ?cholangitis until . he has remained afebrile. wbc continues to be elevated between 14-16, would recheck later this week to ensure stability. blood cx and other cx have remained negative to date. # biliary adenocarcinoma: pt has biliary adenocarinoma with a liver lesion and a ? of pulmonary nodule. pt was previously followed by dr. and dr. . dr. was made aware of pt's admission. he will need to undergo ct pet in the near future to further evaluate any metastasis. if pt has metastatic disease, pt has a poor prognosis. he has a follow-up appointment with dr. next week. # hypotension - during active bleed and intubation. sirs vs sepsis. also was on a lot of peep. started on levophed which was weaned quickly with fluid resuscitation. pt was continued on vanc and zosyn empirically as there was a concern for cholangitis in the setting of biliary obstruction and respiratory failure thought to be /ards. he improved quickly and was weaned off levophed on . he has not required any further pressors or fluid boluses. he is off antibiotics as well as specified above. he has remained afebrile, but with an elevated wbc which remains stable. stable abdominal exam as well. # copd - continue spiriva, advair and nebs prn. # aspiration - tube feeding through peg tube. however, tip of g-j had to be cut off during ercp for visualization and had to be replaced by ir on . in the interim, pt was tube fed via oj and ngt. #prophylaxis : ppi, pneumoboots, bowel regimen while having hematemasis. sc heparin was later added once hct has been stable given his cancer. #fen: tube feeding as above. #access: picc, placed - will keep in place as patient has poor access in the event he needs access at rehab. further decision about whether to keep picc in place will be made by the rehab facility. #code status: dnr but do intubate after discussion with patient and wife. medications on admission: acetaminophen 325 mg tablet : 1-2 tablets po q4-6h prn heparin (porcine) 5,000 unit tid docusate sodium 100 mg po bid bisacodyl 10 mg suppository prn senna 8.6 mg tablet prn ferrous sulfate 325 (65) mg daily tiotropium bromide 18 mcg daily thiamine hcl 100 mg tablet po daily folic acid 1 mg tablet : one (1) tablet po daily (daily). albuterol sulfate 0.083 % neb q4h prn ipratropium bromide 0.02 % neb q6h prn sertraline 50 mg tablet po daily fluticasone-salmeterol 250-50 mcg/dose inhalation lansoprazole 30 mg tablet po bid piperacillin-tazobactam 4.5 g q8h vancomycin 1,000 mg twice a day morphine 2 mg/ml syringe : two (2) mg (every 4 hours) prn discharge disposition: extended care facility: center discharge diagnosis: primary - biliary adenocarcinoma s/p upper gib s/p respiratory failure recent pneumonia secondary - -recent admit for pneumonia/empyema (strep milleri), still on vancomycin and zosyn until . discharged to rehab . -recurrent aspirations, now npo with peg tube -peg tube compilcated by melena -anemia (baseline hct 26) -alcohol abuse -liver mass, biopsy consistent with cholangeocarcinoma - copd, emphysema on home o2 at 4 liters nasal cannula. -splenectomy trauma >30 years ago. discharge condition: stable on 5 l/nc, hemodynamically stable discharge instructions: -continue with all medications as prescribed -please keep all appointments as listed below -continue physical therapy, chest therapy as needed -patient is a dnr, but intubation ok -discharge hct stable at 27, wbc slightly elevated at 16 but stable, total bilirubin 1.8 (has been decreasing rapidly from a peak of 21) -please check cbc, chemistries, lfts later this week to ensure improvement or stability followup instructions: provider: , md phone: date/time: 1:30 provider: , md phone: date/time: 1:30 provider: suite gi rooms date/time: 8:30 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization endoscopic insertion of stent (tube) into bile duct other endovascular procedures on other vessels transfusion of packed cells transfusion of other serum replacement of gastrostomy tube diagnoses: malignant neoplasm of liver, secondary chronic airway obstruction, not elsewhere classified alcohol abuse, unspecified acute respiratory failure hypotension, unspecified pneumonitis due to inhalation of food or vomitus blood in stool hematemesis hypovolemia obstruction of bile duct gastrostomy status personal history of colonic polyps malignant neoplasm of intrahepatic bile ducts aneurysm of other visceral artery 

Answer: The patient is high likely exposed to