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: lisinopril / adhesive tape / vancomycin attending: chief complaint: coffee ground emesis major surgical or invasive procedure: upper endoscopy history of present illness: 74 yo f with h/o gi avms but none on scope 1 year ago, on warfarin for mechanical mitral valve. showed up at clinic and had an episode of coffee ground emesis there. denies fever, chills, chest pain. . in the ed, initial vs were: 97.4 70 130/35 100. patient reported as having pallor and appearing fatigued at presentation. ng lavage initially with scant coffee grounds and cleared on second 500 ml lavage. hct at 23.4 in ed down from 33 on . patient was crossmatched for six units. no vitamin k or ffp given in the ed. receiving first unit of prbc at time of signout to floor. vitals at time of signout to icu were t afebrile, hr 76, bp 136/76, rr 16, o2sat 100% ra. gi reportedly aware of patient and planning to scope in am unless becomes unstable. . upon arrival, patient appears fatigued, pale. her husband describes that she was recently admitted for acute decompensated right sided heart failure and was aggressively diuresed. she was discharged to home and about 24 hours later began to have worsening nausea and began to vomit. she vomited for several days without evidence of coffee grounds or hematemesis, and reduced po intake. she eventually came in to for further evaluation where she vomited and was found to have coffee grounds in her emesis and was sent to the ed. the only recent medication changes were that her spironolactone was increased from 25mg to 100mg, and that she was told to stop taking her diovan. she has had no sick contacts or travel. she admits to chills but no fevers. no diarrhea or abdominal pain, no dysuria or shortness of breath. . review of systems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. rheumatic mitral valve disease s/p valvuloplasty in 01/90, s/p st-judes mvr in 03/. s/p multiple cardiac catheterizations with clean coronaries. 2. h/o lgib thought to be secondary to avm's 3. atrial fibrillation. 4. s/p vvi placement for symptomatic bradycardia in , now s/p two replacements with last replacement in 5. dm type 2 6. history of chf 7. hypercholesterolemia 8. history of hepatic congestion of unclear etiology with multiple abdominal ultrasounds over last few years, as well as history of hemangiomas improved after mvr 9. depression 10. breast mass with negative work-up. 11. vitamin b12 deficiency anemia. social history: - tobacco: none - alcohol:none - illicits:none she is married with 3 children, lives with her husband in . no history of etoh or tobacco use. originally from . worked running a pizza shop on mass ave but now not able to work due to chf. family history: mother with diabetes, lived to 92 physical exam: vitals: t: bp: 139/38 p: 70 r: 18 o2: 99% 2l general: fatigued, somewhat somnolent but arousable heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bibasilar crackles. cv: regular rate and rhythm, iii/vi holosystolic murmur heard best at llsb with mechanical s1. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding. significant hepatomegaly with liver edge palpated to 4 finger-breadths below the costal margin. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: cardiology report ecg study date of 2:09:36 pm ventricular paced rhythm. compared to the previous tracing of there is no change. intervals axes rate pr qrs qt/qtc p qrs t 69 0 176 462/477 0 -74 109 radiology report chest (pre-op ap only) port study date of 12:25 am single portable ap semi-upright chest radiograph: severe multichamber cardiomegaly, pulmonary vascular engorgement and right basal septal thickening persist. the patient is status post mitral valve replacement. there are multiple median sternotomy wires in unchanged position. the left chest wall pacemaker is in unchanged position. there is no large pleural effusion, consolidation or pneumothorax. impression: persistent severe cardiomegaly. probably no acute decompensation. liver or gallbladder us (single organ) study date of 2:30 pm findings: the hepatic veins and their confluence are markedly distended, consistent with provided history of heart failure. the hepatic echotexture is normal, without evidence of a focal lesion. the main portal vein is patent with hepatopetal flow, with pulsatility again reflective of right heart failure. small gallstones are present within the gallbladder, without secondary findings for cholecystitis. there is no intra- or extra-hepatic biliary ductal dilatation with the cbd measuring 2 mm. the spleen is normal in size measuring 11 cm. no ascites is evident. the pancreas is normal in echotexture, without evidence for peripancreatic or fluid collection. no pancreatic ductal dilatation or calcifications are evident. impression: 1. no peripancreatic fluid identified. 2. markedly distended hepatic veins and pulsatility of the portal vein, compatible with provided history of tricuspid regurgitation. 3. cholelithiasis. ct abd w&w/o c study date of 11:09 am findings: in the liver, segment iv hypodense lesion measuring less than 1 cm is again identified, too small to characterize, but unchanged from prior study. impression: 1. no ct evidence of acute pancreatitis or complications thereof, including no peripancreatic stranding, peripancreatic fluid collections, vascular compromise, or evidence of pancreatic necrosis. 2. findings reflecting known congestive failure, including marked dilation of the ivc and hepatic veins, contrast reflux into the venous system on arterial phase imaging, heterogeneous hepatic parenchymal perfusion, and periportal edema/gallbladder wall edema secondary to third spacing. 3. multiple bilateral low-attenuation renal lesions, previously characterized as cysts by ultrasound. 02:00pm blood wbc-10.8 rbc-3.10*# hgb-7.8*# hct-23.4*# mcv-76* mch-25.3* mchc-33.5 rdw-16.4* plt ct-306 05:55am blood wbc-9.9 rbc-3.36* hgb-9.1* hct-28.4* mcv-85 mch-27.2 mchc-32.2 rdw-17.1* plt ct-220 02:00pm blood neuts-90.7* lymphs-5.5* monos-3.2 eos-0.2 baso-0.4 02:00pm blood pt-51.9* ptt-30.0 inr(pt)-5.7* 12:40pm blood pt-29.6* inr(pt)-2.9* 05:45am blood pt-20.3* ptt-33.6 inr(pt)-1.9* 05:55am blood pt-22.3* inr(pt)-2.1* 02:00pm blood glucose-282* urean-174* creat-1.7* na-125* k-3.8 cl-77* hco3-28 angap-24* 09:33am blood urean-130* creat-1.3* na-139 k-3.2* cl-93* hco3-36* angap-13 03:45am blood glucose-129* urean-70* creat-1.0 na-140 k-3.4 cl-101 hco3-34* angap-8 05:55am blood glucose-180* urean-20 creat-0.9 na-136 k-4.3 cl-98 hco3-32 angap-10 02:00pm blood alt-13 ast-22 ck(cpk)-23* alkphos-119* totbili-0.6 06:00am blood alt-18 ast-29 ld(ldh)-220 ck(cpk)-20* alkphos-89 totbili-0.8 05:55am blood alt-14 ast-20 alkphos-110* 02:00pm blood lipase-138* 06:00am blood lipase-146* 02:00pm blood ctropnt-0.03* 06:00am blood ck-mb-2 ctropnt-0.03* 05:55am blood calcium-8.6 phos-1.9* mg-2.3 05:40am blood caltibc-391 vitb12-442 ferritn-76 trf-301 05:40am blood triglyc-85 03:45am blood digoxin-1.6 brief hospital course: 74 yo f with history of right sided chf admitted with ugib found to have acute renal failure in the setting of aggressive diuresis, presenting with gi bleed. #. upper gi bleed- the patient was admitted to the micu after having coffee ground emesis at . she was placed on a protonix drip and received 2 units of prbcs and 2 units of ffp while in the ed prior to admission to the micu. due to her mechanical valve, her supratherapeutic inr was not reversed with vitamin k. she underwent an egd on micu day 2 which showed evidence of erosive gastritis. she had no further bleeding after the egd and was called out to the floor, with her diet being advanced to clears. she has a known history of avms in her small bowel and colon, which could have contributed to gi bleed, but bleeding was felt to be secondary to gastritis. patient's hct trended downwards slowly on floor, and she was transfused 1u prbcs, after which her hct was stable for several days. aspirin was held and may be restarted by primary care physician in the future if felt to be safe. # anticoagulation s/p mechanical mitral valve and paroxysmal afib upon discharge, inr was subtherapeutic for mechanical mitral valve, felt to be secondary to poor absorption of warfarin when taken with sucralfate, which was discontinued upon discharge. she was initially on enoxaparin bridge until noted to have slow hct drop on floor; enoxaparin bridge was stopped because of gi bleed risk -- risk for stroke in a few days felt to be less than risk of gi bleed. inr should be rechecked on monday at followup appointment. #. acute renal failure - her creatinine was rising upon discharge from her last admission after aggressive diuresis and symptoms of nausea and vomiting very likely related to marked uremia with bun of 174 on admission. bun/creatinine ratio and urine electrolytes were in keeping with a pre-renal cause. patient was noted to be auto-diuresing in micu, which may have been post-atn diuresis. patient did take low dose valsartan for 1-2days post discharge when creatinine was elevated after aggressive diuresis; this may have exacerbated an atn. patient has also had poor po intake for several days, likely worsening prerenal state at home prior to presentation, worsening uremia. on the floor, kidney function was stable at baseline 0.9, and patient was re-started on po diuretic regimen. #. right sided heart failure - managed by dr. at 's with recent admission for decompensation. she was intravascularly volume deplete from aggressive diuresis and ugib. diuresis was held during her icu stay and she was given gentle iv fluids. upon transfer to floor, a po diuretic regimen was started after a few of days of monitoring gi bleed and question pancreatitis. she was discharged on spironolactone 25mg and furosemide 120mg daily. she was restarted on low dose valsartan, which she was on previous to the last hospitalization, for cardioprotection. #. pancreatitis - patient was noted to have epigastric pain radiating to the back with eating, initially attributed to her gastritis, though she likely had some component of pancreatitis. her lipase was elevated to 140s, and she complained of pain and nausea. she tolerated a diet of clears for a few days, and diuresis was held initially. abdominal ultrasound and pancreatic protocol ct did not show any signs of gallstone pancreatitis, peripancreatic fluid or pseudocyst. #. cholelithiasis - patient was noted to have gallstones on abdominal ultrasound. she intermittently complained of right sided scapular pain which may be secondary to her cholelithiasis. she did complain of some right side abdominal discomfort radiating to the back with eating fatty foods. ultrasound showed no evidence of cholecystitis. patient may benefit from general surgery evaluation as an outpatient. #. iron deficiency anemia - patient has chronic iron deficiency anemia, for which she takes iron supplements. she does have known avms and newly discovered erosive gastritis with no signs of ulcers on egd. b12 and folate are not low. medications on admission: aspirin 81 mg tablet sig: one (1) tablet po once a day. atorvastatin 10 mg tablet sig: one (1) tablet po daily calcium carbonate ferrous sulfate 325 mg metformin 850 mg tablet sig: one (1) tablet po twice a day. glyburide 2.5 mg tablet sig: one (1) tablet po once a day. gabapentin 300 mg capsule sig: one (1) capsule po q12h omeprazole 20 mg capsule daily warfarin 5 mg tablet digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). spironolactone 100 mg tablet daily furosemide 80mg discharge medications: 1. 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* 2. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 3. metformin 850 mg tablet sig: one (1) tablet po twice a day. 4. glyburide 2.5 mg tablet sig: one (1) tablet po once a day. 5. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. valsartan 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 10. furosemide 80 mg tablet sig: 1.5 tablets po daily (daily). disp:*45 tablet(s)* refills:*2* 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. calcium carbonate-vitamin d3 600 mg(1,500mg) -400 unit tablet, chewable sig: one (1) tablet, chewable po twice a day. disp:*60 tablet, chewable(s)* refills:*2* 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid: prn. disp:*60 capsule(s)* refills:*2* 14. acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary diagnosis: upper gi bleed secondary diagnoses: iron deficiency anemia chronic diastolic heart failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , you were admitted to the hospital because you had vomited up some dark blood which was concerning. your blood counts dropped, so you were given blood transfusions. you had an upper endoscopy while in the icu; with the small camera, they were able to look inside your stomach and the beginning part of your small intestine and saw that you have bad gastritis, which means that your stomach lining is very inflamed. they did not see any ulcers. while you were here, you kidney function appeared to become normal. you have a little bit of extra fluid but it is stable. please weigh yourself every morning, call your doctor if weight goes up more than 3 lbs. please remember to avoid as much sodium/salt in your food and drink as possible. while you were in the hospital, we also found that your pancreas was a little inflamed for a little while, but it improved. your gall bladder has some stones, but it is not clear whether this is causing your right sided back pain or not. when you see dr. in , you may discuss this issue with him and whether or not you should go to general surgery clinic to be evaluated or not. the following changes have been made to your medications: - please increase your furosemide back to your old dose of 120mg daily - please decrease your spironolactone dose back to your old dose of 25mg daily - please restart your valsartan (diovan) 40mg daily - please start pantoprazole 40mg twice daily to reduce your stomach acid - please stop your aspirin 81mg for now because it can irritate your stomach further - please start calcium carbonate with vitamin d3 twice daily - you may take tylenol extra strength (500mg) for pain at home-- please do not take more than 4 of these pills per day (2 grams total) - you may take docusate (colace) stool softeners twice daily to help soften your stool and make it easier for you to pass bowel movements your visiting nurse should check your blood pressure when she visits your home to make sure it is not too low and to make sure you are not having symptoms of lightheadedness or dizziness. you will also need to have your inr (coumadin level) checked on monday at your primary care appointment at . please also remember to check your blood sugars every morning and two hours after finishing lunch. please do not drink juice as this will raise your blood sugar. followup instructions: please be sure to keep all of your followup appointments as listed below. department: when: monday at 11:30 am with: post clinic building: sc clinical ctr campus: east best parking: garage --> at this first visit, please have your inr (coumadin level) checked. department: gastroenterology when: monday at 8:30 am with: , md building: lm campus: west best parking: garage department: div. of gastroenterology when: wednesday at 3:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage department: when: tuesday at 1:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 2:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage md procedure: other endoscopy of small intestine diagnoses: abnormal coagulation profile pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation heart valve replaced by other means other specified cardiac dysrhythmias long-term (current) use of anticoagulants iron deficiency anemia, unspecified cardiac pacemaker in situ calculus of gallbladder without mention of cholecystitis, without mention of obstruction anticoagulants causing adverse effects in therapeutic use acute pancreatitis chronic diastolic heart failure other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to