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: hematemesis and "dark" stool major surgical or invasive procedure: 1.egd (esophagogastroduodenoscopy) 2.colonoscopy 3.pass through capsule endoscopy study history of present illness: the patient is a 38yo male with known who cirrhosis presents after coughing about a half a cup of blood on friday night followed by "dark" and tarry looking stool on saturday morning. on friday night () he did not feel well after vomiting, but the remainder of the evening was uneventful. initially he did not have headaches, dizziness or lightheadedness but on saturday morning after having a large episode of melena he admits to feeling "dizzy" followed by a brief syncopal episode witnessed by his girlfriend. denies any associated head injuries or hitting his head or other extremities. he was brought to the ed by his girlfriend shortly thereafter. he reported malaise and general weakness over the week prior to this presentation. . on additional ros he had a dry cough last week and 2-3 episodes of diarrhea. he also reports a subjective fever and night sweats. he denies any nausea, heartburn symptoms or additional episodes of emesis. he initially had some mild, diffuse pain is his lower abdomen upon waking saturday morning but denies any additional abdominal pain, nausea or vomiting since his admission. he denies any sick contacts. state that his most recent alcohol consumption was 6 days ago, when he consumed beers at a football game. on arrival to the ed his temperature was 98.4f, hr 85, bp 132/71, rr 18, spo2 100% on room air. tmax 99.5 (oral)in ed. he received octreotide bolus, iv pantoprazole, ciprofloxacin and 3l normal saline ivfs along with 1 unit prbc blood transfusion. . he states he had previously been a "very heavy" drinker and was diagnosed with cirrhosis in the republic in after an acute presentation for a perforated duodenal ulcer which required surgery. per patient, he had a liver biopsy at that time but efforts to obtain official records have been unsuccessful to date. he was initially admitted to the micu for stabilization where he received an additional unit of blood and he underwent an egd which was unremarkable. the patient had some additional melena in the micu but no abdominal pain, nausea, vomiting or chest pain/palpitations. he had two pivs (18 gauge) set up for access and ciprofloxacin was continued in the setting of his gi bleed. he had a climbing hct to the 26-27 range, up from nadir of 24.6 on presentation. he was hemodynamically stable upon admission to the general medical service. of note, the patient's cocaine screen returned as positive soon after transfer from the micu. past medical history: cirrhosis gastric varices h/o alcohol abuse duodenal ulcer, status post billroth i performed in dr social history: lives with girlfriend. as a stone . he has a prior history of heavy etoh use, usually beer, stopped briefly after duodenal ulcer/surgery in republic in but continued to struggle with etoh-ism. currently, he reports occasional beer ( /week) or wine with dinner, but consumed 8 beers at a football game the week prior to admission. no history of dts, hallucinations or seizures. attended aa for a period of but last meeting about 6 months ago. patient admits to intermittent intranasal cocaine use. denies ivdu. he has never used tobacco. family history: noncontributory. denies any known etoh-ism in other siblings or close family members. known liver or gi diseases in family per patient. physical exam: tc 98.3, tm 99.3, rr 16-18, hr60-70s, bp 110/80 , 100%ra general: no acute distress. oriented to person, place and time, affect appropriate. heent: nc/at. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no active bleeding. neck: supple with jvp of cm. no lymphadenopathy noted. no thyromegaly. cardiac: rrr, s1/s2 appreciated, no murmurs/rubs/gallops. no s3/s4. lungs: no chest wall deformities. cta bilaterally. no crackles, wheezes or rhonchi. abdomen: large vertical scar at midline (10") and ventral herniation noted, soft, nt/nd, liver edge palpable at costal margin. no abdominial bruits. no splenomegaly. extremities: 1+ peripheral le edema, 2+ pedal pulses bilaterally skin: no rashes, telangiectasias, stasis dermatitis, ulcers or lesions neuro: cns grossly intact, no focal sensory or motor deficits, gait assessment deferred . pertinent results: microbiology: blood cultures x 2 - negative/no growth . other studies/imaging: . cxr : the lungs are clear without consolidation or edema. the mediastinum is unremarkable. the cardiac silhouette is within normal limits for size. no effusion or pneumothorax is noted. the visualized osseous structures are unremarkable. . ekg : rate 80s, nsr, occasional t wave flattening,compared to the previous tracing there is a decrease in voltage in the inferior leads. . right foot xray : no significant underlying degenerative joint disease is noted. no fracture is seen throughout the foot. the regional soft tissues are unremarkable. . egd: no clear source of bleeding found . colonoscopy:colonoscopy revealed some diverticulitis of the sigmoid colon, but no source of bleeding . capsule endoscopy: the capsule remained in the stomach for 2h 39 min - suggestive of gastroparesis 2. no definitive site of gi bleeding or cause of anemia was identified . egd of : normal mucosa in the esophagus 3 cords of non-bleeding varices at the fundus granularity, friability, congestion and erythema in the whole stomach compatible with portal hypertensive gastropathy normal mucosa in the duodenum otherwise normal egd to third part of the duodenum ultrasound of liver and abdomen of : cirrhosis, no ascites, splenomegaly (constant) of 14.9 cm. otherwise normal. . other admission labs: . 04:43pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-pos amphetm-neg mthdone-neg 04:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-4* ph-7.0 leuks-neg 12:20pm blood hct-27.7* 02:45pm blood glucose-117* urean-14 creat-0.8 na-137 k-4.0 cl-102 hco3-24 angap-15 02:45pm blood alt-46* ast-69* ld(ldh)-173 alkphos-106 totbili-0.7 12:20pm blood hct-27.7* 03:42am blood wbc-4.3 rbc-2.85* hgb-8.0* hct-24.6* mcv-86 mch-28.0 mchc-32.4 rdw-14.9 plt ct-125* 08:05pm blood hct-26.4* . discharge labs: 07:00am blood wbc-3.8* rbc-3.06* hgb-8.5* hct-26.3* mcv-86 mch-27.9 mchc-32.5 rdw-15.4 plt ct-136* 07:00am blood plt ct-136* 07:00am blood glucose-108* urean-9 creat-0.8 na-135 k-4.0 cl-102 hco3-25 angap-12 06:55am blood albumin-3.7 mg-2.2 brief hospital course: in summary, mr. is a 38 yo male with alcoholic cirrhosis who presented after an episode of hematemasis followed by melena and then a brief witnessed syncopal episode at home. he presented to the ed and he was immediately admitted to the medical icu for close monitoring. on admission, he had a marked hematocrit drop from the low 30s down to 24 and he required 2 units of transfused blood. fortunately, he appeared to stabilize thereafter. additional details outlined below: . gi bleed: mr. has a previous history of bleeding from a ruptured duodenal ulcer and a history of gastric varices noted on prior egd, but emergent egd on this admission revealed no bleeding source all the way to the jejunum. therefore his initial octreotide was discontinued. the team decided to continue with his daily protonix for gi protection and was started on a 1 week regimen of ciprofloxacin 500mg for infection prophylaxis. serial hcts were monitored and his diet was advanced very slowly from npo to clears and then regular. on after he stabilized further he underwent a colonoscopy which revealed some diverticulitis of the sigmoid colon, but no obvious source of bleeding. thus, it was recommended per the gi team that he proceed to a capsule endoscopy. the capsule study showed that the capsule remained in the stomach for about 2 hours and 39 minutes which was suggestive of gastroparesis, otherwise there were no definitive sites of gi bleeding identified to explain the cause of mr. anemia. ultimately, a specific source was not identified despite three thorough gi scoping methods (egd, colonoscopy and capsule study). fortunately, he had no additional bouts of concerning active bleeding during his hospital stay, with the exception of a small amount of melena on hospital day #1 in the micu, and his hematocrit continued to stabilize while he recovered. at time of discharge his hct was in the 26 range and repeat labs done showed hct 27.6. he will plan to follow-up in the gi/liver clinic soon after discharge with weekly hct checks, additional studies and management for his cirrhosis. . substance abuse: mr. had a prior history of alcohol abuse which dates back to his twenties and early thirties. he admits to prior binge drinking and having as many as 15 drinks a day. now, he states that he has cut back and drinks 3-4 drinks/week, though he recently had 8 beers one week ago at a game. from this history it was felt that etoh withdrawal was unlikely but he was nonetheless monitored closely and placed on a ciwa scale with prn valium ordered. he also admitted to intermittent cocaine use after his urine toxicology screen tested positive. he was reminded that cocaine use can also be very addictive any can have serious health consequences such as acute heart attacks and strokes. he was seen by a social worker/addictions counselor during his hospital stay. mr. expressed some interest in attending aa meetings to use them for a "crutch" in helping him decrease his drinking. he explained that he has several sober friends who have offered to take him to meetings and he is aware of where/when they are (and plans to look at schedule on line at home). he declined any offers for professional addictions support or formal therapy. at time of discharge he appeared to be coping well and he was reminded to utilize the resources which were discussed to help him cut back on his drinking and avoid cocaine use. he was asked to take a daily multivitamin, thiamine, & folate supplements. . syncope: the patient's syncope event was attributed to orthostasis in the setting of acute acute blood loss. blood loss was fairly substantial as it dropped his hct close to 10 points from the low 30s to 24 range. the patient's girlfriend witnessed the syncope and confirmed no head injuries or other injuries. throughout his hospital stay orthostatics were assessed and he had stable supine and standing blood pressures by time of discharge and he denied palpitations, dizziness, lightheadedness or nausea. . cirrhosis: although there is no logged biopsy or tissue evidence to date the patient reports that he had a liver biopsy done in in the republic and was told that he had cirrhosis at that time. given his history, this is likely alcohol related. per reports, previous work-up has included normal hepatitis a, b and c serologies. hiv ab, ama, , sma, igg level, alpha-1 antitrypsin and ceruloplasmin have also all been normal. during this hospital stay he had evidence of mild dysfunction with elevated inr 1.3, high pt levels, and elevated lfts (alt 85, ast 157). otherwise, no prominent hsm, jaundice or other stigmata of alcoholic cirrhosis was noted. the patient will continue his nadolol and will plan to follow-up at liver center with dr. . . foot/ankle pain: the patient complained of right sided foot and ankle pain and swelling for the past 1 1/2-2 weeks. he denied any injury to the area during his recent fall with his syncopal event. a set of plain films were performed and revealed no fractures or abnormalities. he was given additional pillows, ice packs and offered a small amount of tylenol prn for his joint pain. he will plan to follow-up on this complaint more thoroughly on an outpatient basis. . fluids, electrolytes, nutrition: the patient was switched from npo to clears and then to a regular diet which he tolerated very well with no evidence of nausea, vomiting or additional ugi/lgi bleeding. as noted, thiamine and folate were supplemented and his electrolytes were monitored daily and repleted as needed. . prophylaxis: he was encouraged to ambulate and get up and out of bed for dvt prophylaxis and pneumatic boots were also ordered. protonix was given for ongoing gi protection. . the patient was maintained as a full code status for the entirety of his hospital stay and communication occurred directly with the patient on a daily basis regarding his health care plans and status. medications on admission: nadolol 20 mg daily multivitamin discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 days: take every 12 hours and complete on . disp:*6 tablet(s)* refills:*0* 5. nadolol 20 mg tablet sig: one (1) tablet po once a day. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours) for 1 months. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. outpatient lab work please have weekly blood lab checks (hematocrit)faxed to dr. at the liver center at up until your appointment with him on . (fax #). you can go to the atrium suite between 8:30am and 4pm (phone ) monday through friday to have labs drawn. discharge disposition: home discharge diagnosis: cirrhosis acute gastrointestinal bleed alcoholism discharge condition: stable. at the time of discharge the patient had stable vital signs and he appeared to be in no distress. he had no abdominal pain or complaints of nausea, vomiting or bloody bowel movements. the patient's hematocrit had greatly improved and remained stable. discharge instructions: it was a pleasure taking care of you during your stay here at . you were admitted to the hospital after complaints of bloody vomit, bloody stool, and an episode of syncope/fainting. you were initially treated in the intensive care unit and received a blood transfusion and iv fluids to help stabilize you and then you were transferred to the regular medical floor. gastroenterology (gi) specialists were consulted and you underwent an egd or upper gi endoscopy, a colonoscopy and lastly, a capsule endoscopy study. the results of these tests will be reviewed further at your follow-up visit to the liver center. your upper gastrointestinal bleeding and lower gastrointestinal bleeding are likely related to your alcoholic liver disease. you should avoid alcohol use as it may worsen your liver disease and increase your risks for serious, harmful bleeding. . medication instructions: please take your daily nadolol as previously prescribed for blood pressure control and to help prevent variceal/gi bleeding. please continue your daily multivitamins. begin taking the following new medications : daily thiamine and folic acid supplements as prescribed. please complete your antibiotic course with ciprofloxacin for a total of 7 days for prevention of bacterial infections which can spread from your gastrointestinal tract to your bloodstream. you have already completed the first 4 days of ciprofloxacin therapy, so please finish the remainder as instructed until . also, you can continue taking protonix for anti-acid protection after discharge. additional instruction: you will need to have weekly blood lab checks (hematocrit)faxed to dr. at the liver center at up until your appointment with him on . (fax #) . call your primary care doctor or go to them emergency room if you have any additional bloody vomit, lightheadedness, dizziness, shortness of breath, fainting, bloody stools, worsening abdominal pain, fevers, chills or any other concerning symptoms. followup instructions: 1. please follow-up with dr. on wednesday at 9:50am in the atrium suite on the of the building/ (phone #). you will still keep your new primary care appointment with dr. on . . . 2.please follow-up with the liver center with dr. in the , . on at 3:30pm . phone # . 3.you will need to have weekly blood lab checks (hematocrit)faxed to dr. at the liver center at up until your appointment with him on . (fax #). please go to the atrium suite blood lab on the of the building/ (phone #between 8:30am and 4:00pm. . 4.please call your health insurance company/provider to let them know of the above appointments prior to your visit. . 5. please consider follow up with alcoholics anonymous () . md procedure: other endoscopy of small intestine colonoscopy diagnoses: acute posthemorrhagic anemia blood in stool hematemesis hypovolemia esophageal varices in diseases classified elsewhere, without mention of bleeding syncope and collapse other and unspecified alcohol dependence, continuous acquired absence of organ, stomach 

Answer: The patient is high likely exposed to