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: clindamycin / iv dye, iodine containing contrast media attending: chief complaint: constipation major surgical or invasive procedure: exploratory laparotomy, right hemicolectomy, descending loop colostomy, end ileostomy, rectal biopsy history of present illness: admitted on : the patient is an 81m with remote h/o prostate cancer s/p xrt and radiation-induced proctitis who is presenting with increasing abdominal pain and distention x 1 months. according to gerontology notes in omr, the patient has been evaluated for these symptoms as recently as . at the time, his abdominal bloating was attributed to fecal impaction, and his laxative regimen was escalated to include miralax. the patient states that he has not had a normal bm during the past month, as all of his stools have been small volume and containing mucous. he also endorses decreased po intake over past several months. his wife reports that he has been steadily losing weight since , up to 40 lbs. his most recent bm was last , very little stool. passing flatus today. denies history of prior abdominal surgeries or hernias. with respect to his radiation proctitis, the patient has developed leakage of stool and occasionally some blood in the stool over the past few years. a sigmoidoscopy in mid- showed abnormal mucosa up to 19 cm, consistent with radiation proctitis. there was also a mass versus hypertrophic mucosa in the distal rectum, for which he was scheduled to be biopsied next week. in the ed, initial vs were: 97.9 63 132/78 16 100% ra. his abdomen was ttp diffusely on the left without rebound. labs were significant for cr 1.6 and hct 31.4. ct a/p showed segment of descending colon with bowel wall thickening with small-moderate ascites, colitis (infectious/inflammatory/ischemic) cannot be excluded. moderate bilateral hydronephrosis with full column hydroureter extending all the way to the bladder with no obstructive calculi noted which may represent radiation induced stricture of ureter. vs prior to transfer were: 98.3 hr 60 b/p 166/79 rr 20. past medical history: 1. prostate cancer six years ago, status post xrt currently on lupron q6mo - apparently recently rising psa. 2. radiation proctitis per reports of prior colonoscopy. 3. mild copd. 4. obstructive sleep apnea, uses cpap. 5. cad status post stent many years ago, no recurrent symptoms. 6. pacemaker. 7. spinal stenosis and djd. 8. hypertension. 9. total hip replacement in . 10. submucosal gastric lesion, likely gist tumor status post eus in - plan to follow conservatively. social history: he is a former smoker and drinks only occasional alcohol. he lives with his wife and as i mentioned, his daughter is a nurse, who is very involved with his care. his daughter is getting married in the near future and they hope he feels well enough for the wedding. family history: there is no family history of inflammatory bowel disease or any other gi conditions as far as he is aware. his father died in his 70s with an mi and his mother died in her 80s of a stroke. physical exam: vitals: 98.1, 67, 137/72, 20, 100% ra general: nad, pleasant elderly caucasian gentleman heent: perrl, eomi, mucous membranes dry neck: no carotid bruits, no lymphadenopathy lungs: ctab, no wheezing rhonchi, or rales heart: rrr, normal s1 s2, no mrg abdomen: no abd distention, soft, nontender to palpation, open abdominal wound packed with gauze, erythema around wound due to fungal infection, ileostomy on right, colostomy on left, both in place, +bss extremities: no c/c/e neurologic: a+ox3 pertinent results: () ct abdomen: 1. significant fecal loading involing entire colon. 2. diverticulitosis witout diverticulitis. 3. segment of descending colon with bowel wall thickening with small-moderate ascites;colitis (infectious/inflammatory/ischemic) cannot be excluded. given fecal loading, stercoral colitis remains in the differential. recommend correlation with lactate. 4. moderate bilateral hydronephrosis with full column hydroureter extending all the way to the bladder with no obstructive calculi noted. findings may be secondary to radiation induced stricture of ureter. 5. renal hypodensities in right upper and mid pole likely cysts 6. small -moderate ascites. 7. presacral thickening likely sequela of prostate cancer treatment. kub dilated right and transverse large bowel loops. distal large bowel obstruction with competent ileocecal valve cannot be excluded. pathology examination name birthdate age sex pathology # , 81 male report to: dr. /dr. . patwardhan/dr. /dr. gross description by: dr. , ,e/mtd specimen submitted: rush...gi bx (1 jar). procedure date tissue received report date diagnosed by dr. /rna diagnosis: rectal mass, mucosal biopsies: adenocarcinoma of the prostate involving the colonic mucosa; confirmed by immunopositivity for prostate specific antigen and prostate specific acid phosphatase. immunostain for cdx-2 highlights background colonic epithelial cells and is negative within the tumor. clinical: large bowel obstruction. rectal mass lesion on previous sigmoidoscopy. gross: the specimen is received in one formalin-filled container labeled with the patient's name, ", ", the medical record number, and is additionally labeled "rectal mass". it consists of multiple tissue fragments measuring up to 0.3 cm which are entirely submitted in cassette a. brief hospital course: mr is a 81 caucasian male with remote h/o prostate cancer s/p xrt and radiation-induced proctitis who is presenting with increasing abdominal bloating and distention. pt has not had a substantial bm x 1 month. he recently had a sigmoidoscopy with dr. on that showed: abnormal mucosa up to 19cm, consistent with radiation proctitis; mass versus hypertrophic mucosa in the distal rectum. - abd ct on admission showed fecal impaction through the entire colon, without obvious transition point. cv: there was some concern for intraoperative ischemia, but troponins were negx3, and ecg was unchanged from pre-op. on (pod #1), he was admitted to the sicu for hypotension and low uop. this resolved with aggressive fluid resuscitation and 2u prbc, and he was transferred back to the floor pod #2 (). he was restarted on his antihypertensives when tolerating po, and his bp remained around 130-140s systolic. after consultation with cardiology, his aspirin was restarted , and it was decided he no longer needed plavix. pulm: patient had some dyspnea with exertion pod #5 and a cxr was obtained, showing clear lung fields and no acute pulmonary process. his dyspnea resolved. he has a history of obstructive sleep apnea, uses cpap at setting ps 7, used during this admisison. gi: for his original constipation/impaction, pt was first tried with an aggressive bowel regimen with little improvement. gi was consulted and recommended even more aggressive regimen. manual disimpaction was first tried by primary team intern on without success. surgery was consulted, tried another manual disimpaction on without any success again. gi performed sigmoidoscopy on that showed almost completely obstructing mass in the rectum ~4cm from the anal verge. differential includes malignancy vs. severe inflammation and hyperplasia in the setting of radiation proctitis. colorectal surgery consulted and an ex-lap, right hemicolectomy, end ileostomy, descending loop colostomy, and rectal biopsy was performed on . there was some fecal spillage intraoperatively. he tolerated the procedure well and was transferred to the pacu in stable condition. upon discharge, he was at goal ileostomy output (between 500 and 1200cc/day), with gas in his ileostomy and colostomy bag. his wound was opened due to increased drainage and was being packed with moist to dry tid. nut/fen: he was advanced to a cld pod #3, which he tolerated well, and then advanced to a regular diet pod #4, which he again tolerated well. he had repeated hypokalemia post-operatively, and needed repletion daily. k 2.5 on , improved to 3.7 upon admission. gu: upon admission he had low uop with hydronephrosis on ct and elevated cr to 1.6, which resolved rapidly and returned to baseline within 2-3 days. he had a foley placed with cystoscopy by urology. the foley was cut accidentally in the or and replaced without difficulty on . he again had increased cr to 1.3 pod , but again resolved with hydration and has remained at baseline 1.0 with good uop. rectal biopsy showed adenocarcinoma of the prostate involving the colonic mucosa; confirmed by immunopositivity for prostate specific antigen and prostate specific acid phosphatase. psa was 16.8 from psa . patient was diagnosed with recurrent/metastatic prostate cancer that failed lupron treatment, and was seen by heme/onc and was recommended to undergo hormone therapy, without further surgery. he will follow-up with heme/onc 2 weeks after discharge. urology will also see the patient wed to do a voiding trial. the foley should remain until then. he remained on tamsulosin 0.4 mg qd during his admission. id: no issues. psych: patient has a long history of depression, starting depression medication a few years ago. he now takes mirtazapine 15mg at bedtime and duloxetine er 60mg daily post-surgical complications during inpatient admission: post-operative ileus resolving w/o ngt post-operative ileus requiring management with ngt uti wound infection anastomotic leak staple line bleed congestive heart failure arf acute urinary retention, failure to void after foley d/c'd acute urinary retention requiring discharge with foley catheter dvt pneumonia abscess none social issues causing a delay in discharge: delay in organization of vna services difficulty finding appropriate rehabilitation hospital disposition. lack of insurance coverage for vna/ rehab services lack of insurance coverage for prescribed medications. family not agreeable to discharge plan. patient knowledge deficit related to ileostomy delaying discharge. no social factors contributing in delay of discharge. medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from patientwebomr. 1. albuterol inhaler puff ih q6h:prn wheeze 2. atenolol 12.5 mg po bid hold for sbp<100, hr<60 3. duloxetine 60 mg po daily 4. fenofibrate *nf* 145 mg oral daily 5. fluticasone propionate 110mcg 2 puff ih 6. hydrocortisone acetate 10% foam 1 appl pr hs 7. mesalamine 400 mg po tid 8. mesalamine (rectal) 1000 mg pr daily 9. mirtazapine 15 mg po hs 10. montelukast sodium 10 mg po daily 11. fish oil (omega 3) dose is unknown po bid 12. tamsulosin 0.4 mg po hs 13. vitamin d dose is unknown po daily discharge medications: 1. albuterol inhaler puff ih q6h:prn wheeze rx *albuterol 1-2 puffs every six (6) hours disp #*1 inhaler refills:*1 2. duloxetine 60 mg po daily rx *cymbalta 60 mg 1 capsule(s) by mouth once a day disp #*30 capsule refills:*0 3. fluticasone propionate 110mcg 2 puff ih rx *flovent hfa 110 mcg/actuation 2 puff ih twice a day disp #*1 inhaler refills:*1 4. mirtazapine 15 mg po hs rx *mirtazapine 15 mg 1 tablet(s) by mouth at bedtime disp #*30 tablet refills:*0 5. montelukast sodium 10 mg po daily rx *singulair 10 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 6. tamsulosin 0.4 mg po hs rx *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime disp #*30 tablet refills:*1 7. acetaminophen 650 mg po tid rx *acetaminophen 650 mg 1 tablet(s) by mouth every six (6) hours disp #*60 tablet refills:*0 8. aspirin 81 mg po daily rx *aspirin 81 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*1 9. hydrochlorothiazide 12.5 mg po daily rx *hydrochlorothiazide 12.5 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 10. loperamide 2 mg po bid rx *imodium a-d 2 mg 1 tablet by mouth twice a day disp #*60 tablet refills:*1 11. losartan potassium 50 mg po daily rx *losartan 50 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*1 12. miconazole powder 2% 1 appl tp :prn rash posterior to abdominal wound yeast rash rx *miconazole nitrate 2 % 1 application twice a day disp #*1 unit refills:*1 13. nitroglycerin sl 0.3 mg sl prn chest pain page ho prior to giving rx *nitrostat 0.3 mg 1 tablet sublingually once, mr1 disp #*10 tablet refills:*0 14. oxycodone (immediate release) 2.5 mg po q4h:prn pain rx *oxycodone 5 mg 0.5 (one half) tablet(s) by mouth every four (4) hours disp #*40 tablet refills:*0 15. psyllium wafer 2 waf po bid rx *metamucil 2 wafer by mouth twice a day disp #*60 unit refills:*0 16. sucralfate 1 gm po bid rx *sucralfate 1 gram/10 ml 10 milliliter by mouth twice a day disp #*600 milliliter refills:*1 17. pantoprazole 40 mg po q24h rx *pantoprazole 40 mg 1 tablet(s) by mouth q24h disp #*30 tablet refills:*0 18. atenolol 50 mg po daily rx *atenolol 50 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*1 discharge disposition: extended care facility: nursing and therapy center discharge diagnosis: advanced prostate cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital after a right colectomy for surgical management of your obstructing rectal mass. you have recovered from this procedure well and you are now ready to return home. samples from your colon were taken and this tissue has been sent to the pathology department for analysis. you will receive these pathology results at your follow-up appointment. if there is an urgent need for the surgeon to contact you regarding these results they will contact you before this time. you have tolerated a regular diet, passing gas and your pain is controlled with pain medications by mouth. you may return home to finish your recovery. please monitor movement prior to your discharge which is acceptable, however it is important that you have a bowel movement in the next 1-2 days. after anesthesia it is not uncommon for patient??????s to have some decrease in bowel function but your should not have prolonged constipation. some loose stool and passing of small amounts of dark, old appearing blood are expected however, if you notice that you are passing bright red blood with bowel your bowel function closely. if you are passing loose stool without improvement please call the office or go to the emergency room if the symptoms are severe. if you are taking narcotic pain medications there is a risk that you will have some constipation. please take an over the counter stool softener such as colace, and if the symptoms does not improve call the office. if you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or constipation. you have a long vertical incision on your abdomen that is closed with staples. this incision can be left open to air or covered with a dry sterile gauze dressing if the staples become irritated from clothing. the staples will stay in place until your first post-operative visit at which time they can be removed in the clinic, most likely by the office nurse. please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, opening of the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if you develop a fever. please call the office if you develop these symptoms or go to the emergency room if the symptoms are severe. you may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. no heavy lifting for at least 6 weeks after surgery unless instructed otherwise by dr. or dr. . you may gradually increase your activity as tolerated but clear heavy exercise for 6 weeks. you will be prescribed a small amount of the pain medication oxycodone. please take this medication exactly as prescribed. you may take tylenol as recommended for pain. please do not take more than 4000mg of tylenol daily. do not drink alcohol while taking narcotic pain medication or tylenol. please do not drive a car while taking narcotic pain medication. you have a new ileostomy. the most common complication from a new ileostomy placement is dehydration. the output from the stoma is stool from the small intestine and the water content is very high. the stool is no longer passing through the large intestine which is where the water from the stool is reabsorbed into the body and the stool becomes formed. you must measure your ileostomy output for the next few weeks. the output from the stoma should not be more than 1200cc or less than 500cc. if you find that your output has become too much or too little, please call the office for advice. the office nurse or nurse practitioner can recommend medications to increase or slow the ileostomy output. keep yourself well hydrated, if you notice your ileostomy output increasing, take in more electrolyte drink such as gatorade. please monitor yourself for signs and symptoms of dehydration including: dizziness (especially upon standing), weakness, dry mouth, headache, or fatigue. if you notice these symptoms please call the office or return to the emergency room for evaluation if these symptoms are severe. you may eat a regular diet with your new ileostomy. however it is a good idea to avoid fatty or spicy foods and follow diet suggestions made to you by the ostomy nurses. please monitor the appearance of the ostomy and stoma and care for it as instructed by the wound/ostomy nurses. the stoma (intestine that protrudes outside of your abdomen) should be beefy red or pink, it may ooze small amounts of blood at times when touched and this should subside with time. the skin around the ostomy site should be kept clean and intact. monitor the skin around the stoma for bulging or signs of infection listed above. please care for the ostomy as you have been instructed by the wound/ostomy nurses. you will be able to make an appointment with the ostomy nurse in the clinic 7 days after surgery. you will have a visiting nurse at home for the next few weeks helping to monitor your ostomy until you are comfortable caring for it on your own. you have a new colostomy. it is important to monitor the output from this stoma. it is expected that the stool from this ostomy will be solid and formed like regular stool. you should have bowel movements daily. if you notice that you have not had from your stoma in days, please call the office. you may take an over the counter stool softener such as colace if you find that you are becoming constipated from narcotic pain medications. please watch the appearance of the stoma, it should be beefy red/pink, if you notice that the stoma is turning darker blue or purple, or dark red please call the office for advice. the stoma (intestine that protrudes outside of your abdomen) should be beefy red or pink, it may ooze small amounts of blood at times when touched and this should subside with time. the skin around the ostomy site should be kept clean and intact. monitor the skin around the stoma for bulging or signs of infection listed above. please care for the ostomy as you have been instructed by the wound/ostomy nurses. you will be able to make an appointment with the ostomy nurse in the clinic 7 days after surgery. you will have a visiting nurse at home for the next few weeks helping to monitor your ostomy until you are comfortable caring for it on your own. thank you for allowing us to participate in your care! our hope is that you will have a quick return to your life and usual activities. good luck! followup instructions: please follow up with dr. at his general urology clinic on wednesday . call ( to make an appointment for a voiding trial. please follow up with dr. (oncology) in 2 weeks. call ( to make an appointment. please call the colorectal surgery department at to make an appointment with , np or , np for follow-up 7-14 days after surgery. at this visit an appointment will be made for you with dr. for your second post-operative visit. procedure: parenteral infusion of concentrated nutritional substances temporary ileostomy open and other right hemicolectomy exteriorization of large intestine insertion of indwelling urinary catheter closed [endoscopic] biopsy of rectum diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) anemia, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other specified intestinal obstruction aortocoronary bypass status percutaneous transluminal coronary angioplasty status hypopotassemia chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease loss of weight malignant neoplasm of prostate retention of urine, unspecified cardiac pacemaker in situ other ascites hydronephrosis other specified disorders of rectum and anus hip joint replacement stricture or kinking of ureter late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure secondary malignant neoplasm of large intestine and rectum full incontinence of feces 

Answer: The patient is high likely exposed to