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: history of present illness: the patient is a 64 year old man with several medical problems listed below. he was in his usual state of health until four to five months ago when he began to experience a significant weight loss (total 30 pounds). he also appreciated the development of relatively painless jaundice. he stated that he lost his appetite completely and is nauseated most of the time. the patient was scheduled for endoscopic retrograde cholangiopancreatitis beyond the date of admission, however, laboratory evaluation prior to the procedure revealed a markedly elevated inr (greater than 18). the procedure was scrapped. the patient received vitamin k 10 mg subcutaneously and was admitted to the medical service pending return of his inr to the normal range. once admitted to the medical floor he passed approximately 200 cc of blood per rectum without pain. he remained awake, comfortable and normal and had normal blood pressures throughout this, however, he was tachycardiac to approximately 100 beats/minute. this rate did not respond to fluid resuscitation. he received a total of 2 liters of normal saline prior to transfer to the intensive care unit. review of systems: constitutional loss of weight and depressed appetite as described above. head, eyes, ears, nose and throat: no visual changes, hearing loss or difficulty swallowing. no rashes, colds or sweating. cardiac: no angina, dyspnea, orthopnea, diaphoresis or peripheral edema. he has occasional palpitations, owing to his longstanding atrial fibrillation. pulmonary: no cough, hemoptysis or pleurisy. he has stable shortness of breath attributed to his chronic obstructive pulmonary disease. gastrointestinal: nausea as above, no vomiting, diarrhea, constipation or hematemesis, hematochezia as described above. there has not been any episodes of melena. musculoskeletal: there are no plans to take his exercise tolerances down as described below. allergies: none reported. medications on presentation: 1. spironolactone 50 mg daily 2. sustained action verapamil 240 mg every 12 hours 3. furosemide 80 mg daily 4. warfarin 4 mg every monday, tuesday, thursday and sunday, 6 mg every wednesday and saturday 5. fluticasone 2 puffs b.i.d. 6. ipratropium 2 puffs b.i.d. 7. xopenex 125 mcg twice daily, nebulized solution past medical history: 1. atrial fibrillation, rate-controlled with calcium channel blockers as described above, he was on warfarin for stroke prophylaxis; 2. chronic obstructive pulmonary disease, status post lung resection. his exercise tolerance is approximately one mile, he uses oxygen at home, 2 liters at night as well as bronchodilators and steroids as described above; 3. presumed pseudomembranous colitis in during an admission to for a chronic obstructive pulmonary disease exacerbation. he received vancomycin per us, however, he stopped this medication owing to nausea and. he continued to take his regular dose of warfarin during that time. 4. testicular cancer, status post orchiectomy; 5. hypertension, treated with calcium channel blockers as described above; 5. appendicitis, status post appendectomy; 6. cholecystitis, status post open cholecystectomy. family history: non-contributory. social history: he has remote alcohol use and tobacco exposure as well. he lives with his wife. owns an insurance agency. physical examination: temperature 97.8, heart rate 125 and irregular, blood pressure 115/75, oxygen saturation 94% on 4 liters. general: he is a jaundiced-appearing man, sitting upright in bed, speaking in full sentences. head, eyes, ears, nose and throat: normocephalic, atraumatic, anicteric sclerae, normal conjunctiva, pupils equal, round and reactive to light and accommodation from 4 mm to 2 mm with extraocular movements intact without nystagmus. clear oropharynx. there is subungual icterus. neck: supple, full range of motion. jugulovenous pressure is 4 cm at 45 degrees. there is no carotid bruit. there is no thyromegaly. nodes: there is no anterior cervical, posterior cervical, supraclavicular or infraclavicular, axillary or inguinal adenopathy. heart: point of maximal impulse is in the fifth rib space in the midclavicular line. rate is irregular, normal s1 and s2, there is no s3, s4, murmurs, rubs or gallops. lungs: good effort, normal excursions. clear to auscultation and percussion bilaterally. abdomen: protuberant, normal bowel sounds, soft, nondistended. there is a right upper quadrant 8 cm diameter firm mass that is tender to palpation without rebound or guarding. a mcburney's incision is well-healed as is an open cholecystectomy scar. back: there is normal curvature of the spine without costovertebral angle tenderness. vascular: carotid, radial, femoral, dorsalis pedis pulses are brisk and equal. extremities: there is no rash, cyanosis, clubbing or edema. there is jaundice over the entire body. neurological examination: mental status is alert, oriented to person, place and time. he has normal attention with preserved short and longterm memory. he has euthymic mood and broad affect. he has grossly full visual fields. writing sample was not obtained. cranial nerves: i, not tested formally; ii, iii, iv and vi, normal as described above; v and vii symmetric, intact sensation in all three branches; viii he could hear the examiner's watch ticking bilaterally; ix, x and xii tongue is midline. there is normal gage. clear phonation. , normal shoulder shrug. motor: normal bulk and tone with preserved strength in all muscle groups of the upper and lower extremities. sensory examination: grossly normal, he had normal rapid alternating hand movements, the deep tendon reflexes were brisk and equal bilaterally. laboratory data: white blood cell count was 10, 500, hemoglobin 14 mg/dl, hematocrit 41.1%, platelets 254,000/mcl. sodium 137, potassium 2.7, chloride 94, bicarbonate 31, blood urea nitrogen 33, creatinine 0.7, glucose 118, calcium 8.5, phosphate 2.8, magnesium 1.3. alt 200, ast 148, alkaline phosphatase 244, total bilirubin 10.2, amylase 40, lipase 24, carcinoembryonic antigen was 6.9. ca19-9 was pending at the time of this dictation. repeat hematocrit was 43.1. the patient underwent abdominal imaging showing a mass in the porta hepatis as well as a calcified mass in the right upper pole of the right kidney. arrangements were made for him to undergo esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography and possibly colonoscopy after the computerized tomography scan was obtained. hospital course: after admission to the medical intensive care unit the patient had his inr reversed completely with a total of 4 units of fresh frozen plasma. he also received transfusion of 1 unit of packed red cells. the patient underwent endoscopic retrograde cholangiopancreatography. an incomplete of the lower third of the common bile duct was identified with proximal dilation. intraductal ultrasound confirmed that the lesion was not a stone. there was bleeding from the site of compression. a stent was placed with passage of clotted blood. plans for a more detailed esophagogastroduodenoscopy and colonoscopy were scrapped owing to the finding of hemobilia. the patient was returned to the medical intensive care unit after question of cytologic samples and brushings. at the time of this dictation the results of those pathological examinations are pending. on the day following his endoscopic retrograde cholangiopancreatography he was found to have stable hematocrit, electrolytes had returned to as had his inr. however, his amylase and lipase were markedly elevated (amylase was 1,062, lipase was ), however, the patient had no pain. his diet was slowly advanced. hepatobiliary surgery consultation was obtained. plans for surgery are pending at the time of this dictation. , m.d. dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures aortography endoscopic insertion of stent (tube) into bile duct transfusion of packed cells transfusion of other serum diagnoses: congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation blood in stool long-term (current) use of anticoagulants acute pancreatitis malignant neoplasm of intrahepatic bile ducts malignant neoplasm of pancreas, part unspecified 

Answer: The patient is high likely exposed to