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: abdominal pain major surgical or invasive procedure: : ercp with sphincterotomy and stent placement : ercp with prior stent removal, new stent placement, balloon sweep with extraction of multiple stones : laproscopic cholecystectomy history of present illness: 77 m with history of htn, hl, cad s/p cabg, afib, dmii, presents with acute onset of diffuse abdominal pain, nausea, and vomiting. . mr was in usual state of health until lunch yesterday when he developed poor appetite and nausea that worsened throughout the day. in the evening he developed acute onset abdominal pain in the epigastrium that radiated to his back. he had two episodes of non bloody emesis prompting self referral to the ed. he denies any fevers, chills, cp, sob, dyspnea, diarrhea, brbpr, melena. he endorses single episode of small of amount his blood in his urine. . in the ed inital vitals were, 96.8 92 156/68 18 89%. physical exam was notable for tender ruq and epigastrum. labs showed leukocytosis to 17.4. lipase of 4050, and elevated lfts and bilirubin. ct scan showed concern for cholecystitis as it showed distended gallbladder with multiple stones with small foci of air in nondependent areas. there was no definitive evidence of wall thickening, stranding or duct dilation. patient then spiked a fever to 101.5. surgery and ercp were consulted given concern for an impacted stone and cholangitis. he received a total of 3 l of iv fluids, unasyn 3g iv, morphine 10 mg, and zofran. tentative plan is to have inr reversed with ffp and go for ercp. vitals prior to transfer: 76 108/50 17 95% 2l . on arrival to the icu, initial vitals were: 97.6 82 121/52 95% ra 17. he reported 0/10 pain. he appeared comfortable and was accompanied by his wife. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough. denies chest pain, chest pressure, palpitations, or weakness. denies diarrhea, constipation, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: htn hl dmii cad s/p cabg afib on coumadin ?chf - ef 45% in glaucoma elevated psa w/ high grade intraephithelial neoplasm social history: lives with his wife. used to work as a cutter in the garment industry many years ago. - tobacco: quit in , smoked since 20s - alcohol: none - illicits: none family history: significant for coronary artery disease as well as type ii diabetes physical exam: admission physical exam: vitals: 97.6 82 121/52 95% ra 17 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, with faint crackles at the bilateral lung bases, without wheeze or rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, trace tenderness in epigastrium, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema on discharge: vitals: 97.2 64 136/70 95% ra 20 general: alert, oriented, no acute distress lungs: clear to auscultation bilaterally, with faint crackles at the bilateral lung bases, without wheeze or rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-distended, appropriately tender at lap sites. bowel sounds present, no rebound tenderness or guarding, no organomegaly. lap sites with primary dressings c/d/i ext: warm, pink, well perfused, no edema pertinent results: labs: on admission: 12:40am blood wbc-17.4*# rbc-2.77* hgb-9.7* hct-28.4* mcv-103* mch-34.9* mchc-34.0 rdw-17.1* plt ct-346# 12:40am blood neuts-82* bands-5 lymphs-7* monos-3 eos-1 baso-0 atyps-0 metas-1* myelos-1* 12:40am blood hypochr-1+ anisocy-1+ poiklo-occasional macrocy-1+ microcy-normal polychr-normal ovalocy-occasional tear dr 12:40am blood pt-27.5* ptt-39.3* inr(pt)-2.6* 12:40am blood glucose-306* urean-31* creat-1.2 na-140 k-3.7 cl-100 hco3-25 angap-19 12:40am blood alt-30 ast-67* alkphos-140* totbili-1.6* dirbili-1.3* indbili-0.3 12:40am blood lipase-4050* 12:40am blood calcium-9.4 phos-3.7 mg-1.8 03:12pm blood type-art po2-58* pco2-34* ph-7.43 caltco2-23 base xs-0 12:54am blood lactate-2.9* imaging: cxr: impression: central pulmonary vascular congestion with moderate interstitial edema, concerning for cardiac decompensation. ct abdomen: impression: 1. distended gallbladder containing multiple gallstones and gas. even with lack of significant wall thickening, the findings are concerning for early cholecystitis. a hida examination can be considered if there is a need for further confirmation. 2. multiple hypodense pancreatic lesions likely representing side branch ipmns. mrcp is recommended for further characterization. 3. no intra- or extra-hepatic bile duct dilation. 4. large bilateral inguinal hernias. 5. enlarged prostate. ercp cannulation of the biliary duct was successful and deep after a guidewire was placed. contrast medium was injected resulting in complete opacification. several 5 mm round stones that were causing partial obstruction were seen at the common bile duct. given gallstone pancreatitis, decision was made to perform a sphincterotomy. a careful, limited sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. pus and sludge was noted to extrude from the common bile duct. given cholangitis, decision was made to place a stent rather than stone extraction. a 7cm by 10fr plastic biliary stent was placed successfully. ercp a plastic stent placed in the biliary duct was found in the major papilla - this was removed. a previous sphincterotomy was seen and the ampulla appeared open. there was some mild oozing at the papilla from previous sphincterotomy - a gold probe was applied for hemostasis successfully. multiple small stones were seen in the common bile duct. balloon sweep x 4 was performed with extraction of multiple stones successfully. final cholangiogram was without filling defects. a 8cm by 10fr plastic biliary stent was placed successfully. mutiple large stones were seen in the gallbladder. brief hospital course: 77 m with h/o htn, hl, cad s/p cabg, afib, chf, dmii presented from osh with abdominal pain concerning for pancreatitis and cholangitis as a result of gallstone obstruction. active issues by problem: #. ascending cholangitis: classic presentation with ruq pain, fevers, leukocytosis, elevated lft (total bili), and evidence of gallstones on imaging. ercp and surgery both consulted immediately on admission. started on ciprofloxacin and flaygyl initially, then changed to zosyn on hospital day 2. coumadin held and attempted inr reversal with 4 units ffp (however inr still 3.5) prior to ercp. ercp on showed frank pus coming from the ampulla, stones in the common bile duct, and evidence of pancreatitis. sphincterotomy performed and stent placed, however stone still left in the duct. after procedure, pt developed rising billirubin (max tbilli 9). he had a second ercp with removal of several stones in the common bile duct. prior stent was removed and new stent placed. some small oozing of blood was noted at ampulla which was cauterized. pt tolerated procedure well and will have follow up with gi outpatient for stent removal and elective cholecystectomy. #. gallstone pancreatitis: lipase to 4050 on admission, ercp pancreatogram consistent with active pancreatitis. likely secondary to gallstones. pt initialy npo and given ivf. his diet was advanced after second ercp. # pneumonia/pulmonary edema: after first ercp procedure, pt noted to develop o2 requirement. likely multifactorial: pulm edema from aggressive iv hydration in pt with shf as well as pneumonia. he was given lasix and initially covered broadly with zosyn and vancomycin. however, it was felt that his o2 requirement was more likely from pulmonary edema than pneumonia, so his vancomycin was discontinued and he was continued on lasix prn for diuresis. # anemia: history of chronic anemia with complete w/u by pcp in past revealing anemia of chronic disease. baseline hct ~ 30, hct 28 on admission but has dropped to as low as 20 now in the setting of ercp and iv fluids. he was transfused 1 uprbc. bleeding source was likely from sphincterotomy site which had some blood oozing visualized on second ercp. the area of oozing was cauterized and hct remained stable at 31.1 on discharge. #. systolic chf - ef 45% in w/ pt report of h/o of chf although no hospitalizations. mild crackles on exam, slight volume overload on initial cxr. in setting of aggressive iv hydration, pt became volume overloaded with pulmonary edema. he was diuresed with 20mg iv lasix up to . #. htn - initialy held home antihypertensives while inhouse given concern for cholangitis. systolics increased on hospital day 2, could restart amlodipine then atenolol as tolerated #. hl - hold statins for now given elevated lfts. restarted postoperatively. #. dmii: held metformin and glipizide, insulin sliding scale for now. home dm medications restarted prior to discharge when tolerating a regular diet. #. cad - s/p cabg 3v disease. held aspirin initially given procedures, and held statin, bb, ace-inhibitor in setting of acute infection. all medications restarted prior to discharge when stable. #. afib - primarily in sinus. was given ffp and vit k for inr reversal in setting of ercp. coumadin held perioperatively and restarted at 4 mg at discharge. bridged with lovenox sc (therapeutic dosing), started the morning of discharge. plans for vna to check inr on . surgery course: mr. was taken to the operating room on and underwent a laparoscopic cholecystectomy. please see operative report for details of this procedure. postoperatively, his care was transferred to the acute care surgery service. he tolerated the procedure well and was extubated upon completion. he was subsequently taken to the pacu for recovery. he was transferred to the surgical floor hemodynamically stable. his vital signs were routinely monitored and he remained afebrile and hemodynamically stable. he was initially given iv fluids postoperatively, which were discontinued when he was tolerating po's. his diet was advanced on the morning of pod#1 () to regular, diabetic diet, which he tolerated without abdominal pain, nausea, or vomiting. his home diabetes medications were restarted at that time. his home antihypertensive medications were also restarted. the morning of his inr was 1.5, and he was started on lovenox to bridge to coumadin for discharge. vna services were set up to continue lovenox teaching. he was voiding adequate amounts of urine without difficulty. he was encouraged to mobilize out of bed and ambulate as tolerated, which he was able to do independently. his pain level was routinely assessed and well controlled at discharge with an oral regimen as needed. on , he was discharged home with scheduled follow up in clinic on and follow up with his pcp . medications on admission: amlodipine 5 mg daily atenolol 150 mg daily enalapril 40 mg daily gemfibrozil 600 mg daily glipizide 15 mg daily hctz 25 mg daily lovastatin 40 mg daily metformin 1000 mg warfarin 4 mg daily aspirin 81 mg daily multivitamin 1 tablet daily discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. lovastatin 20 mg tablet sig: two (2) tablet po daily (). 4. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 5. atenolol 50 mg tablet sig: three (3) tablet po daily (daily). 6. enalapril maleate 10 mg tablet sig: four (4) tablet po daily (daily). 7. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain: do not exceed > 4000 mg of tylenol in 24 hours. cause sedation. disp:*10 tablet(s)* refills:*0* 10. lovenox 80 mg/0.8 ml syringe sig: 0.7 ml subcutaneous twice a day: to be administered until inr therapeutic on coumadin. goal inr . disp:*14 syringes* refills:*0* 11. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 12. gemfibrozil 600 mg tablet sig: one (1) tablet po daily (daily). 13. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). 14. glipizide 5 mg tablet sig: three (3) tablet po daily (daily). 15. outpatient work pt/inr, please draw and fax results to dr. office: phone: fax: goal inr 2.0-3.0 discharge disposition: home with service facility: all care vna of greater discharge diagnosis: gallstone pancreatitis and cholelithiasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with gallstone pancreatitis and cholelithiasis. you underwent two ercp's and then had your gallbladder removed laparoscopically. you tolerated the procedure well and are now being discharged home with the following instructions: your coumadin was held while you were in the hospital. you should restart your coumadin tonight at your regular home dose (4 mg). your inr will be drawn tomorrow by the vna and the results will be sent to your pcp's office, who will continue to manage your coumadin dosing. because it may take a few days for your blood levels to be therapeutic on the coumadin, you are being bridged with lovenox until that time. please administer the lovenox twice/day as instructed until your pcp's office tells you to stop the lovenox injections. activity: do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. you may climb stairs. you may go outside, but avoid traveling long distances until you see your at your next visit. don't lift more than lbs for 4 weeks. (this is about the weight of a briefcase or a bag of groceries.) this applies to lifting children, but they may sit on your lap. you may start some light exercise when you feel comfortable. you will need to stay out of bathtubs or swimming pools for a time while your incision is healing. ask your doctor when you can resume tub baths or swimming. heavy exercise may be started after 4 weeks, but use common sense and go slowly at first. how you feel: you may feel weak or "washed out" for 4 weeks. you might want to nap often. simple tasks may exhaust you. you may have a sore throat because of a tube that was in your throat during surgery. you might have trouble concentrating or difficulty sleeping. you might feel somewhat depressed. you could have a poor appetite for a while. food may seem unappealing. all of these feelings and reactions are normal and should go away in a short time. if they do not, tell your . your incision: tomorrow you may shower and remove the gauzes over your incisions. under these dressing you have small plastic bandages called steristrips. do not remove steri-strips for 2 weeks. (these are the thin paper strips that might be on your incision.) but if they fall off before that that's okay. your incisions may be slightly red around the stitches. this is normal. you may gently wash away dried material around your incision. it is normal to feel a firm ridge along the incision. this will go away. avoid direct sun exposure to the incision area. do not use any ointments on the incision unless you were told otherwise. you may see a small amount of clear or light red fluid staining your dressing or clothes. if the staining is severe, please call your . you may shower. as noted above, ask your doctor when you may resume tub baths or swimming. ove the next 6-12 months, your incision will fade and become less prominent. your bowels: constipation is a common side effect of narcotic pain medicaitons. if needed, you may take a stool softener (such as colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. you can get both of these medicines without a prescription. if you go 48 hours without a bowel movement, or have pain moving the bowels, call your . pain management: it is normal to feel some discomfort/pain following abdominal surgery. this pain is often described as "soreness". your pain should get better day by day. if you find the pain is getting worse instead of better, please contact your . you will receive a prescription for pain medicine to take by mouth. it is important to take this medicine as directed. do not take it more frequently than prescribed. do not take more medicine at one time than prescribed. your pain medicine will work better if you take it before your pain gets too severe. talk with your about how long you will need to take prescription pain medicine. please don't take any other pain medicine, including non-prescription pain medicine, unless your has said its okay. if you are experiencing no pain, it is okay to skip a dose of pain medicine. remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. if you experience any of the following, please contact your : - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain medications: take all the medicines you were on before the operation just as you did before, unless you have been told differently. if you have any questions about what medicine to take or not to take, please call your . danger signs: please call your if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound followup instructions: department: digestive disease center when: monday at 9:00 am with: , md building: building (/ complex) campus: east best parking: main garage department: podiatry when: monday at 9:30 am with: , dpm building: ba ( complex) campus: west best parking: garage department: when: monday at 12:10 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: general surgery/ when: thursday at 3:45 pm with: acute care clinic with dr phone: building: lm bldg () campus: west best parking: garage procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy laparoscopic cholecystectomy endoscopic insertion of stent (tube) into bile duct diagnoses: anemia of other chronic disease congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status sepsis other and unspecified hyperlipidemia long-term (current) use of anticoagulants acute on chronic systolic heart failure cholangitis obstruction of bile duct other and unspecified coagulation defects acute pancreatitis calculus of gallbladder and bile duct with acute cholecystitis, with obstruction 

Answer: The patient is high likely exposed to