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: patient recorded as having no known allergies to drugs attending: chief complaint: gi bleed major surgical or invasive procedure: endoscopy s/p cauterization intubation x 2 central line placement history of present illness: the pt is a 61y/o m with a pmh of primary sclerosing cholangitis dx w/ cholangiocarcinoma during routine change of stent placed for recurrent biliary obstruction (ca19-9 at diagnosis about 3). cholangiocarcinoma found when ct scan demonstrated a 2.4 x 3.2 cm diameter low attenuation mass surrounding the common duct, extending into the region of the pancreatic head and through the retroperitoneum down to the renal vein and encasing the proximal portal vein as well as the hepatic artery. there was evidence also that the duodenum was encroached upon by the tumor, although not circumferentially. based on the ct findings he was deemed unresectable. received 6 cycles of gemcitabine/oxaliplatin to . pt found to have progression of pulmonary disease and chemo regimen was changed to second line of cisplatin/5fu . course complicated by thrush and fatigue. . pt presented to ed with hematochezia and hematemesis with brb. hct 19 at osh from 26 yesterday. here hemodyamically stable. s/p 2u prbc, 2livf at osh in the setting of sbps of 70s-->90s. past medical history: onc history: dx with cholangiocarcinoma -- local extension including encasing the portal vein and hepatic artery, extending into the head of the pancreas and encircling the duodenum. (not surgical candidate) -- chemotherapy: 6 cycles gemcitabine/oxaliplatin with progression (), 1 cycle 5fu and cisplatin (currently day 16 cycle 1) other pmhx: -primary sclerosing cholangitis (followed by dr. -melanoma resection mid back approx 10 years ago with negative sentinel node -cholecystectomy >20 years ago social history: physics teacher at high school. family history: married x 30 years. 2 children. no smoking, no etoh physical exam: afebrile, hr 90s, bp 110s/60s, 100% ra nad- alert and talkative, jaundiced lungs clear rrr, soft sm abdomen protuberant, liver edge palpable just below costal margin, splenomegaly not detected no peripheral edema pertinent results: 03:35pm blood wbc-5.2 rbc-3.17* hgb-8.8* hct-26.2* mcv-83 mch-27.7 mchc-33.6 rdw-18.3* plt ct-82*# 03:20am blood wbc-4.5 rbc-2.57* hgb-7.4* hct-22.0* mcv-86 mch-29.0 mchc-33.9 rdw-17.7* plt ct-74* 07:41am blood wbc-3.7* rbc-2.78* hgb-8.4* hct-23.4* mcv-84 mch-30.1 mchc-35.7* rdw-16.3* plt ct-80* 10:25am blood wbc-3.9* rbc-3.14* hgb-9.6* hct-26.4* mcv-84 mch-30.6 mchc-36.4* rdw-15.4 plt ct-72* 09:50pm blood hct-30.7* 05:39am blood wbc-2.4* rbc-3.31* hgb-10.2* hct-28.8* mcv-87 mch-30.8 mchc-35.4* rdw-16.1* plt ct-245 01:15pm blood wbc-2.8* rbc-4.07* hgb-12.1* hct-34.7* mcv-85 mch-29.8 mchc-35.0 rdw-15.6* plt ct-215 03:35pm blood neuts-84* bands-2 lymphs-4* monos-9 eos-0 baso-1 atyps-0 metas-0 myelos-0 05:39am blood neuts-67 bands-0 lymphs-18 monos-9 eos-4 baso-0 atyps-2* metas-0 myelos-0 12:00am blood pt-12.9 ptt-25.4 inr(pt)-1.1 03:20am blood pt-15.7* ptt-27.9 inr(pt)-1.4* 03:20am blood glucose-181* urean-22* creat-0.9 na-135 k-3.7 cl-103 hco3-24 angap-12 09:55am blood glucose-112* urean-33* creat-0.9 na-137 k-3.4 cl-108 hco3-21* angap-11 05:39am blood alt-39 ast-45* ld(ldh)-228 alkphos-442* totbili-1.9* 03:20am blood alt-64* ast-53* ck(cpk)-42 alkphos-322* totbili-1.0 03:20am blood lipase-15 04:36am blood lipase-7 03:20am blood albumin-2.5* calcium-7.2* phos-3.2 mg-1.7 09:55am blood calcium-7.5* phos-2.2* mg-2.0 04:11pm blood type-art po2-152* pco2-40 ph-7.35 caltco2-23 base xs--3 03:20am blood glucose-166* lactate-1.5 na-132* k-3.6 cl-103 calhco3-24 04:35pm blood freeca-1.06* 01:57pm blood freeca-1.12 angiogram #1 selective arteriograms were performed within the celiac trunk and sma without signs of active bleeding. embolization of the gastroduodenal artery was performed with one 3-mm coil, four 4-mm coils and one 5-mm coil. delayed images demonstrated no opacification of the portal vein, suggesting occlusion of this vessel. note: the patient has been stable with no further bleeding over a 24 hour period. the study and the report were reviewed by the staff radiologist. angiogram # 2 impression: selective arteriograms were performed in the celiac, sma and without signs of active bleeding. there is no flow within the gda that was previously embolized with coils. the study and the report were reviewed by the staff radiologist ct abd/pelvis: 1. marked interval increase in intra-abdominal and intrapelvic ascites with anasarca. 2. bilateral pleural effusions, right greater than left. 3. small bowel loops are dilated up to 4.2 cm with air seen distally, suggestive of an ileus. no evidence of free air. 4. evaluation of vasculature could not be performed due to lack of iv contrast. 5. sigmoid colonic wall thickening could be suggestive of procto-sigmoiditis. abdominal ultrasound : impression: large amount of ascites in all four abdominal quadrants with marking of right lower quadrant for paracentesis to be performed by clinical staff. abdominal ultrasound : limited evaluation of the four abdominal quadrants was performed. small pockets of ascites were identified in each quadrant with a moderate-sized pocket above the bladder. no site was large enough to mark for paracentesis. impression: moderate ascites without adequate spot for paracentesis marking brief hospital course: 61m w/ primary sclerosing cholangitis diagnosed with cholongiocarcinoma who presented hematemsis and brbpr. this stopped by the time he came to the er. endoscopy saw a clot in the second portion of the duodenum, and during the procedure a large amount of bleeding began apparently out of the second part of the duodenum. the procedure was stopped and the patient was transfused ~8-10u prbc. an emergent angio did not find the source of bleeding. the gastroduodenal artery was embolized as the most likely source. 24 hours later the patient rebled and was intubated for airway protection. ercp found a bleeding vessel in an ulcerated part of the tumor in the second part of the duodenum. this was injected w/ epi and cauterized. a repeat angio showed no clear target for embolization as the tumor was well-vascularized, so given that the patient was likely to rebleed and that the next bleed would be untreatable, the decision was made to make the patient cmo. he was extubated and actually did well. he remained hemodynamically stable and was transferred to the floor. on the floor, his only complaint was his abdominal distension from his ascites. this was drained for palliative purposes on by paracentesis. this made him feel much better and allowed him to eat. he had an abdominal port placed by interventional radiology on without incidence for repeat paracenteses. mr. has a very high chance of the bleeding vessel rebleeding and there is no medical intervention that can be done to alleviate it at this time. in discussion with the family, the patient, his primary oncologist, and the palliative care team, the decision was made to focus on his comfort. his daily needs are minimal but when his bleeding starts again, he will likely need an ngt quickly for managment of bleeding as well as possible associated nausea/hematemesis. he may also need a flexiseal or other similar stool management system if he begins having bright red blood per rectum. medications on admission: pancrease suppl qac ursodiol 300mg tid dexamethasone compazine clotrimazole zofran discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 3. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for diarrhea. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 7. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 8. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. 9. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 10. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 11. morphine sulfate 2-6 mg iv q1h:prn 12. lorazepam 0.5-2 mg iv q1h:prn anxiety, tachypnea 13. ondansetron 4 mg iv q8h:prn discharge disposition: extended care facility: the family hospice house discharge diagnosis: upper gastrointestinal bleed cholangiocarcinoma primary sclerosing cholangitis discharge condition: all vital signs stable, comfortable. discharge instructions: you were admitted with a severe gastrointestinal bleed. it was stabilized temporarily but will bleed again and at that time there is no treatment available to stop it. you also have acculmulations of fluid in your abdomen. you underwent one drainage procedure and then had an abdominal port placed to allow for easier drainage procedures in the future. we have stopped all medications that do not contribute to your comfort. followup instructions: none. please call dr. (primary oncologist) at ( with any questions. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube percutaneous abdominal drainage injection or infusion of other therapeutic or prophylactic substance arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries endoscopic excision or destruction of lesion of duodenum transcatheter embolization for gastric or duodenal bleeding transfusion of packed cells insertion of totally implantable vascular access device [vad] transfusion of other serum transfusion of platelets endoscopic retrograde cholangiopancreatography [ercp] diagnoses: thrombocytopenia, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia acute kidney failure, unspecified portal hypertension bacteremia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other ascites secondary malignant neoplasm of lung hemorrhage of gastrointestinal tract, unspecified esophageal varices in diseases classified elsewhere, without mention of bleeding cholangitis leukocytopenia, unspecified portal vein thrombosis malignant neoplasm of biliary tract, part unspecified site secondary malignant neoplasm of small intestine including duodenum 

Answer: The patient is high likely exposed to