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: augmentin attending: chief complaint: jaundice major surgical or invasive procedure: transjugular liver biopsy paracentesis blood transfusions egd history of present illness: patient is a 41 yo woman who presents with jaundice. she had recently taken a 7 day course of augmentin for sinusitis, last dose 4/11. soon after starting this medication, she noticed that her abdomen was becoming more bloated. then she noted the that her eyes were more yellow, followed by her face. . she also reports that in the past 2 weeks, she has been nauseous and vomiting, nonbilious, nonbloody. she also has had 1.5 weeks of diarrhea, described as frequent urges to defecate up to 15 times a day. she does not always defecate but will occ. have watery stools. she has noted some brbpr, which she attributed to her hemorrhoids. she has had abdominal discomfort with the bloating, usually in the lower abdomen, esp. when walking. she had noted 20 lb weight gain in the last 2 weeks. she also noted a fever to yesterday; she also complains of chills and nightsweats for the past month. her husband had cold symptoms with diarrhea. her daughter had cold symptoms. . she had presented to today. there, labs were: wbc 19.3 (78%n, 4%b, 13%l), hct 34.3, plt 184. na 120, k 3.4, cl 89, co2 23, bun6, cr 0.8. albumin 1.9. tuberculosis 15.5, db 8.4, ap 222, ast 165, alt 40. inr was 2.2. esr 63. mitochondria ab, , sm & rnp pending. she had an abdominal ultrasound that revealed moderate to large amount of ascites; echogenic and nodular liver c/w cirrhosis; reversal of flow in the portal vein adn unbilican vein collateral c/w portal hypertension; spleenomegaly to 14.8 cm; sludge0filled gb wtih thickned wall. . review of systems: (+) per hpi: daily headache for the past 3 days involving the entire head. sinus symptoms are improved. she has dry cough and feels sob due to inability to full expand her lungs. she also reports back pain. easy bruising. (-) denies chest pain or tightness, palpitations. no dysuria. past medical history: motility disorder, previously taking reglan social history: pt is married with 2 children ages 3 and 9. she is a stay-at-home mom; used to be an endoscopy tech. they recently went to , world. no other travel. she quit tobacco use 5 years ago, previously smoked 1ppd x 10 years. she drinks cans of beer per day. she denies a history of problems with alcohol. she denies any recreational drugs, including iv drugs. no tattoos. no blood transfusions. ate oysters 3 weeks ago. family history: no family history of liver disease. mother with history of pud, requiring billroth ii. physical exam: vitals: t: 98.2, bp: 105/61, p: 103, r: 20, o2: 96ra general: alert, oriented, no acute distress heent: sclera icteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bibasilar crackles, decreased breath sounds at bases cv: regular rate and rhythm, ii/vi systolic murmur at rusb abdomen: distended with positive fluid wave, soft, mildly tender at lower abdomen, normoactive bs, mild hepatomegaly, difficult to assess spleen size ext: warm, well perfused, 2+ pulses, no edema neuro: cns ii-xii grossly intact, no asterixis pertinent results: admission labs: 11:12pm blood wbc-17.3* rbc-3.40* hgb-10.2* hct-32.5* mcv-96 mch-30.1 mchc-31.5 rdw-21.5* plt ct-187 11:12pm blood pt-26.0* ptt-50.0* inr(pt)-2.5* 11:12pm blood glucose-95 urean-10 creat-0.8 na-121* k-3.7 cl-91* hco3-23 angap-11 11:12pm blood alt-40 ast-160* ld(ldh)-320* alkphos-219* totbili-14.8* 11:12pm blood totprot-8.2 albumin-2.4* globuln-5.8* calcium-8.0* phos-3.2 mg-2.2 iron-52 11:12pm blood caltibc-183* ferritn-125 trf-141* 05:00am blood osmolal-253* 11:12pm blood hbsag-negative hbsab-borderline hbcab-negative igm hav-negative 11:12pm blood smooth-positive 11:12pm blood -positive * titer-1:80 11:12pm blood pep-polyclonal igg-3497* iga-1652* igm-201 ife-no monoclo 11:12pm blood acetmnp-neg 11:12pm blood hcv ab-negative . 11:12 pm immunology source: venipuncture. **final report ** hcv viral load (final ): hcv-rna not detected. . c.diff negative . abdominal u/s: 1. heterogeneous coarsened echotexture of the liver with nodular surface, compatible with cirrhosis. 2. reversal of flow within the main portal vein and recanalization of the umbilical vein. 3. small amount of perihepatic ascites with no suitable pocket marked for paracentesis. 4. splenomegaly measuring up to 12.9 cm. 5. gallbladder wall edema, likely secondary to third spacing of fluids. gallbladder sludge. . cxr: impression: bibasilar atelectasis. . abd u/s: impression: left lower quadrant of abdomen marked for paracentesis to be performed by the clinical staff. . transjugular liver biopsy: therapeutic paracentesis (ir): impression: successful diagnostic and therapeutic ultrasound-guided paracentesis yielding 3 liters of ascites. fluid was sent for cell count, culture, and chemistries as requested. results: ascites analysis wbc-60, rbc-223, polys-10, lymphs-7, monos-9, mesothe-21, macroph-53, totpro-0.9, albumin-<1.0. ecg: baseline artifact. sinus tachycardia. low lateral precordial lead qrs voltage. modest st-t wave changes. findings are non-specific. no previous tracing available for comparison. portable abdominal x-ray: impression: a single view of the abdomen is marked as having been obtained with the patient upright. that is probably accurate because there is a fluid level in the stomach. pelvis is not fully imaged. there is generalized intestinal distention. in the left upper quadrant, several loops of bowel have haustral markings suggesting that despite the redundancy, this is colon. i would like to confirm this with conventional views of the abdomen, and images of the pelvis at the same time. there is no free subdiaphragmatic air. portable cxr: comparison is made to the prior study, . there are low lung volumes. cardiac size is normal. bibasilar atelectasis have improved on the right and have worsened on the left. there is no pneumothorax or pleural effusion. portable cxr for picc placement: findings: in comparison with study of , there has been placement of a right subclavian picc line that appears to extend to the cavoatrial junction or slightly further into the right atrium. it could be pulled back approximately 3-4 cm. egd : esophagus: protruding lesions 3 cords of grade iii varices were seen in the lower third of the esophagus. there were stigmata of recent bleeding and red whale sign. 4 bands were successfully placed. stomach: contents: clotted blood was seen in the whole stomach. unable to assess for gastric varices. duodenum: not examined. impression: varices at the lower third of the esophagus (ligation) blood in the whole stomach otherwise normal egd to stomach antrum recommendations: qid carafate octreotide drip x 3 days ppi drip start clears in am if no recurrent bleeding if recurrent bleeding may consider tips . discharge labs: notable for: wbc 14.3 hct 27.1 plt 85 inr 2.1 fibrino 155 (on ) cr 0.6 na 133 k 3.1 ast 147 alt 61 ldh 296 alk phos 121 tbili 9.1 albumin 2.9 . biospy: liver, needle core biopsy: established cirrhosis with prominent sinusoidal fibrosis, confirmed by trichrome stain (stage 4). moderate macrovesicular steatosis with prominent associated intracytoplasmic hyalin ballooning degeneration, and lobular neutrophilic inflammation. mild portal/septal mixed inflammation. moderate canalicular cholestasis. iron stain shows no iron deposition. note: the findings are consistent with chronic, active toxic metabolic injury. no diagnostic features of autoimmune hepatitis are identified. brief hospital course: 41 y/o woman presents with what appears to be acute on chronic liver failure. . # acute on chronic liver failure: on admission, with synthetic dysfunction (inr 2.2, albumin 1.9), ascites. no hepatic encephalopathy. she has history of significant etoh use, may have had underlying liver disease uncovered by the another etiology. viral causes are a concern as well, including hepatitis a (ate oysters), b, c; these viral studies were all negative. tylenol negative. no evidence of portal vein thrombosis, budd-chiari on ultrasound. no history of shock for ischemic hepatitis. pt is at the right demographics for autoimmune hepatitis and positive as well as anti-smooth antibody with high igg; wilson's disease is also possible. to try to differentiate, primarily between auto-immune hepatitis and etoh cirrhosis, a transjugular liver biopsy was performed by radiology on after ffp was given. results: alcoholic hepatitis and cirrhosis, not auto-immune. treated with 30 days of pentoxyfylline. patient had therapeutic paracentesis on , with improved abdominal distention/discomfort. peritoneal fluid was analyzed for cytology and results were not consistent with sbp. patient was given vitamin k for any malnutrition component of coagulopathy. for patient's ascites, she was started on diuretics (lasix and spironolactone). not encephalopathic, discharged with rifaximin but not lactulose. on discharge, plan for f/u with outpatient gastroenterologist at center closer to where she lives, and also with f/u with hepatologist. . # gi bleed: patient anemic, doesn't appear iron deficient. on patient noted to have tarry stool, guaiac positive, hemodynamically stable. type & screen were updated. patient had been set to have 1 unit of blood transfused due to lower hct post liver biopsy (slowly drifted down so was 5 points lower than prior to liver biopsy), so transfusion was given as scheduled. repeat hct check was scheduled. later that night, patient had more tarry stool and coffee-ground emesis. nightfloat was called, and patient was tachycardic, and actively bleeding. hepatology urgently called, patient transferred to the icu on the evening of . she underwent emergent endoscopy in the icu and 3 cords of grade iii varices were seen in the lower third of the esophagus. there were stigmata of recent bleeding and red whale sign. 4 bands were successfully placed. clotted blood was seen in the whole stomach, such that it was not possible to assess for gastric varices. the patient was transfused a total of 6 units of prbcs, 6 units of ffp, and 2 units of cryoprecipitate while in the icu. hct ultimately stabilized, although the patient continued to pass dark guaiac-positive stool presumed to be old blood. she will most likely require tips in the event of a re-bleed. patient was transferred from the icu to the floor, and during her time on the floor, her hct remained stable on multiple repeat checks, she was hemodynamically stable, and she stopped bleeding. needs egd within a week of discharge, to again look for possible esophageal varices and potentially re-band. treated with 7 days of iv ceftriaxone, course completed. discharged on nadolol, ppi, 10 days sucralfate. . # hyponatremia: seems to be intravascular volume depletion (hypovolemic hyponatremia), with 3rd spacing in ascites and mild edema; na avid state based on low urine na. initially worse after administration of 1l ns and 62.5gm albumin. renal was consulted d/t concern for siadh versus hypovolemic hyponatremia. started salt tab administration and bolused ns ivf, and saw rising na improvement. with continuation of salt tabs (5mg tid) the na continued to improve (even went hypernatremic at one point, responded to free water restriction). resolved on discharge. patient instructed regarding low sodium diet. . # leukocytosis/fever: wbc elevation mostly likely from acute hepatitis. also has diarrhea, c.diff & stool culture negative, u/a negative, cxr clear. afebrile after admission while on the floor. . # low fibrinogen, hypercoagulable, anemia, low platelets: concern for the laboratory values reflecting a massive gi bleed and subsequent resuscitation, versus dic. laboratory values were stable and/or improved with repletion of the appropriate blood product type. . # hematuria: without evidence for infection, perhaps contamination from hemorroidhal bleeding or menses. repeat u/a with only 2 rbc. . # etoh use: no evidence of withdrawal now, last drink . social work consulted, treated with thiamine and folate. nutrition c/s. teaching regarding abstaining from alcohol occurred. . # e.coli uti: perhaps a contaminant from a dirty specimen, but patient treated with 7 days of iv ceftriaxone (to which the e.coli is sensitive) anyways for gib. asymptomatic. . # low back soreness: believed ascites and time in bed; improved with lidocaine patch and ambulation. . # code: full, confirmed with patient in icu # communication: patient. husband is hcp (h: , c: ). medications on admission: advil, up to 2 tablets a day, last dose sunday zantac, last dose sunday recent course of augmentin denies use of acetaminophen discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): apply to lower back. on for 12 hours, off for 12 hours. disp:*15 adhesive patch, medicated(s)* refills:*2* 3. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day) for 20 days: you have 20 more days of this medication to finish its 30 day course. disp:*60 tablet sustained release(s)* refills:*0* 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. disp:*1 tube* refills:*1* 5. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) for 8 days. disp:*32 tablet(s)* refills:*0* 6. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: alcoholic liver cirrhosis acute alcoholic hepatitis esophageal variceal bleed hyponatremia 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 with liver disease = hepatitis; studies performed to determine the cause (including lab tests, imaging, and liver biopsy) found the liver disease to be due to alcoholic cirrhosis and alcoholic liver disease / hepatitis. you had a bleed, from the blood vessels in your esophagus, because of your alcoholic liver disease. you were sent to the icu, and needed blood transfusions, blood products transfusions, urgent tying off (banding) of the bleeding esophageal blood vessels. afterwards, your bleeding stopped and your blood levels stabilized. you were also found to have a very low sodium level on admission; with salt tablets and hydration, this resolved. now that your sodium has normalized, you have to be cautious to avoid salty food and to avoid excess salt, because of your liver disease. salt restriction is an important component of your well-being. limit your sodium intake to less than 2 grams per day. . because of your new diagnosis of liver disease, you have a number of new medications to take that are all extremely important to protect against the complications of liver disease (such as bleeding). . your new medication list is attached. . you must not drink any alcohol because of your new diagnosis of liver disease. we recommend avoiding tylenol, if you do take it you can take up to a maximum of 2 grams per day. do not take any aspirin, or nsaid's (ie: motrin, ibuprofen, advil), as these will increase your chance of bleeding. if you want to take any other new medications, including any over-the-counter medications, you must ask your doctor. followup instructions: you must follow-up with your gastroenterologist this monday . he will need to check your blood levels (cbc), sodium level, chemistry panel, kidney function, and liver function. . you also will need a repeat endoscopy (egd) by your gastroenterologist within the next week, to examine the esophageal blood vessels that bled while you were hospitalized, and to likely band the blood vessels again to prevent further bleeding. when you schedule your appointment to see your gastroenterologist on monday, also schedule an egd within the next week too. . you should also attend the following appointment with a new liver doctor (hepatologist) at : dr. , md phone: date/time: at 9:30 am. procedure: venous catheterization, not elsewhere classified closed (percutaneous) [needle] biopsy of liver percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: urinary tract infection, site not specified acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia portal hypertension other ascites esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy hyperosmolality and/or hypernatremia alcohol abuse, continuous hematuria, unspecified 

Answer: The patient is high likely exposed to