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: penicillins / codeine attending: chief complaint: brbpr major surgical or invasive procedure: colonoscopy esophagogastroduodenoscopy history of present illness: this is an 80 year old male with history of coronary disease s/p cabg with a patent lima-lad per cath on plavix, peripheral disease s/p popliteal to posterior tibial graft on right lower extremity, atrial fibrillation on coumadin, presenting with new onset of bright red blood per rectum. mr developed acute onset of bright red blood this am prior to making it to the bathroom - he had no abdominal pain or cramping, but daughter reported that he felt weak and looked pale. he passed about 200 ccs of blood in the toilet. ems arrived on the scene and apparently had a difficult pressure to appreciate; however consequently bp was noted in the 160s. he's never had hematochezia before. does take plavix and coumadin; inr was 3.9. usually inrs are within range of . no recent history of motrin, aspirin, ibuprofen. had colonoscopy in which showed just external hemorrhoids with no other lesions. transferred to micu for further workup. gi evaluated and plan on scoping in am (endoscopy and colonoscopy). past medical history: diabetes dyslipidemia hypertension pvd w chronic le ulcers chf nyha class ii, ef 20-30% (echo ) cad s/p cabg x4 (lima->lad, svg->diag->left-pl, svg->ramus) in cath with svgx2 occluded, patent lima-lad in vt s/p placement ( confient model e030 dual-chamber ) s/p rsxn r 1st mt joint s/p r bk -dp w/nrsvg s/p plasty of bpg s/p agram arteriogram 12/10 r 3rd toe debrid by podiatry right bk to pt bypass w/ nrsvg social history: married. has 6 children. previously worked with polaroid. tobacco. quit etoh 25 years ago. illicits. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam vs: hr 80, bp 120/80, rr 12, 98% ra, temp 99 gen: black male, pleasant, alert, in no apparent distress cardiac: nl s1/s2, rrr pulm: clear bilaterally abd: soft, nt, nd, normoactive ext: no edema noted . discharge exam vs: 97.9 118/65 (118/65-141/68) 59 (59-75) 16 97% ra general - well-appearing man in nad, comfortable, appropriate heent - sclerae anicteric, mmm neck - supple, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - irregular, 2/6 systolic murmur heard throughout, nl s1-s2 abdomen - nabs, soft/nt/nd, no rebound/guarding extremities - wwp, trace to 1+ pitting edema l>r, 2+ peripheral pulses (radials, dps) neuro - awake, a&ox3 pertinent results: admission labs 12:56pm blood wbc-10.8 rbc-2.78* hgb-8.0*# hct-25.3*# mcv-91 mch-28.8# mchc-31.7 rdw-15.8* plt ct-238 12:56pm blood neuts-55.4 lymphs-38.1 monos-3.9 eos-1.7 baso-0.8 12:56pm blood pt-36.8* ptt-29.2 inr(pt)-3.6* 12:56pm blood glucose-195* urean-37* creat-1.5* na-143 k-3.8 cl-105 hco3-21* angap-21* 03:38am blood alt-21 ast-26 ld(ldh)-177 alkphos-43 totbili-0.9 03:38am blood calcium-9.0 phos-2.6* mg-2.1 01:01pm blood hgb-8.3* calchct-25 . other labs: 12:56pm blood wbc-10.8 rbc-2.78* hgb-8.0*# hct-25.3*# mcv-91 mch-28.8# mchc-31.7 rdw-15.8* plt ct-238 10:04pm blood hct-24.3* 03:38am blood wbc-9.8 rbc-2.59* hgb-7.3* hct-23.4* mcv-90 mch-28.0 mchc-31.0 rdw-16.0* plt ct-266 05:45pm blood hct-23.9* 07:00am blood wbc-9.9 rbc-2.78* hgb-8.0* hct-25.0* mcv-90 mch-28.7 mchc-31.9 rdw-16.8* plt ct-246 04:10pm blood hct-29.4* 06:55am blood wbc-7.0 rbc-2.94* hgb-8.8* hct-26.6* mcv-91 mch-30.0 mchc-33.1 rdw-16.3* plt ct-271 03:38am blood pt-23.6* inr(pt)-2.3* 07:00am blood pt-16.1* ptt-30.0 inr(pt)-1.5* 10:44pm blood ck(cpk)-59 07:00am blood ck(cpk)-80 04:10pm blood ck(cpk)-87 10:44pm blood ck-mb-4 ctropnt-0.04* 07:00am blood ck-mb-6 ctropnt-0.11* 04:10pm blood ck-mb-5 ctropnt-0.12* . discharge labs 11:20am blood hct-28.2* 06:55am blood pt-13.4* ptt-29.1 inr(pt)-1.2* 06:55am blood glucose-111* urean-15 creat-1.4* na-142 k-4.1 cl-108 hco3-26 angap-12 06:55am blood ck(cpk)-66 06:55am blood ck-mb-3 ctropnt-0.10* 06:55am blood calcium-8.7 phos-2.6* mg-2.0 . micro helicobacter pylori antibody test (final ): positive by eia. . studies ecg . hr 82, axis -30, old inferior q wave, non-specific t wave i, avel and t wave inversions laterally ? lvh. . ecg : hr 88, ns, + apc, old q waves inferiorly, <1mm st elevation iii, t wave flatening i -avl and v4-v6 . ecg : hr 65, nsr, biphasic t wave waves v2-v3-v4 compared to prior. . egd: excavated lesions five cratered non-bleeding ulcers, with clean white base, ranging in size from 5 mm to 10 mm were found in the duodenal bulb. no fresh or old blood was noted. impression: ulcers in the duodenal bulb otherwise normal egd to third part of the duodenum recommendations: check h. pylori serology and eradicate if positive. f/u with inpatient gi team. . colonoscopy: protruding lesions: small internal & external hemorrhoids were noted. excavated lesions: a few diverticula were seen in the whole colon. diverticulosis appeared to be of mild severity. other semi-solid and liquid stool was noted scattered in the whole colon. this was copiously irrigated and the patient was re-positioned to improve mucosal visualization. despite these measures, small size pathology may have been missed. normal terminal ileum no fresh or old blood was noted. impression: diverticulosis of the whole colon bowel prep was fair. normal terminal ileum no fresh or old blood was noted. otherwise normal colonoscopy to cecum recommendations: f/u with inpatient gi team. . brief hospital course: initial presentation: 80 yo m with hx of cad, pvd, htn, hld on plavix and coumadin who presented with gi bleed found to have drop in hct and elevated inr. . # gi bleed: patient presented to the ed after found to have 1 episode of blood mixed with stool. in the ed he had stable vital signs but was found to have a hgb/hct of (down from 12/35 in , however was previously anemic with hcts between 25-30), and an elevated inr of 3.6. patient was given 2 units of ffp and subsequently developed hives. he was then given benadryl and hives resolved. he was evaluated by gi with plans to do egd/colonoscopy the following morning. his asa, plavix, and coumadin were held. patient was monitored overnight in the micu. he was given ivf but no additional blood products. hct remained stable around 24-25. he subsequently underwent an egd/colonoscopy and was transferred to the medicine floor. endoscopy was significant for duodenal ulcers, diverticulosis, and small internal and external hemorrhoids. he was transfused with 2 units of prbc given demand ischemia (see below) and responded appropriately. asa, plavix, and warfarin were restarted. h. pylori serology was ordered and patient was started on omeprazole 40 mg po bid. patient had no further episodes of hematochezia or melana and hct remained stable through remainder of admission. he was discharged with plans to follow up with his pcp and with gastroenterology. after discharge h.pylori serology were +, patient will need to be treated by pcp as an outpatient. . # chest pain: on evening after endoscopy, patient had an episode of substernal chest pain with associated ecg changes. troponins were elevated but ckmb was wnl. his chest pain resolved with sublingual nitro x2. the patient was evaluated by cardiology and it was felt this chest pain was most likely due to demand ischemia in the setting of gi bleed and anemia. he was subsequently transfused 2 units of prbc. he remained chest pain free through the remainder of the admission and his troponins started to trend down by time of discharge. he was continued on his asa, statin and plavix. he was also started on metoprolol. he has plans to follow up with cardiology as an outpatient. . # chronic systolic chf - patient remained euvolemic throughout admission. his torsemide was initially held in the setting of gi bleed. however, it was subsequently restarted prior to discharge. he was also started on metoprolol and lisinopril during admission. . # diabetes - metformin was held during admission. his blood sugars were controlled with insulin sliding scale. . # afib on coumadin - inr initially supratherapeutic (3.6) on presentation. he was treated with ffp initially and coumadin was held in the setting of gi bleed. coumadin was restarted prior to discharge. he has plans to have his inr rechecked on at pcp follow up . # htn - cont medications as above . # hld - continued pravastatin . # pvd - plavix and asa initially held with gi bleed but restarted prior to discharge . transitional issues: - just after discharge patients h. pylori antibody returned as positive. pcp and gastroenterologist were notified. patient should be treated with prevpac. - patient was started on omeprazole 40 mg for pud until gi follow up. - patients inr was subtherapeutic upon discharge. his inr will need close follow up after discharge and coumadin dosing will likely need additional adjustment. - patient was started on metoprolol and lisinopril during admission given his hx of cad and chf. patient will need his electrolytes checked within 2 weeks of discharge. he will also need his blood pressure and heart rate rechecked. - patient was full code during admission medications on admission: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 4. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. metformin 850 mg tablet sig: one (1) tablet po bid (2 times a day): please start on 9/31. 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. coumadin 2 mg tablet sig: 1-2 tablets po once a day: as directed by your pcp your home dose. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 3. torsemide 20 mg tablet sig: one (1) tablet po once a day. 4. metformin 850 mg tablet sig: one (1) tablet po twice a day. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. coumadin 2 mg tablet sig: two (2) tablet po once a day: please take as directed by your pcp. 7. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 8. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain : take 1 tablet at onset of chest pain. if chest pain continues for 5 minutes take a second tablet. if chest pain contines after 10 minutes take a 3rd tablet and call 911. 9. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 10. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: gi bleed, peptic ulcer disease, chest pain secondary diagnoses: coronary artery disease, congestive heart failure, diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you while you were admitted to . you were admitted because you were bleeding from your gastrointestinal tract. you were evaluated by the gastroenterologists and underwent an egd and colonoscopy which showed some ulcers in the beginning of your small intestines and mild outpouchings of your colon. there was no evidence of an active bleeding site. you were started on a medication called omeprazole for your ulcers. . during your admission, your also had an episode of chest pain. your electrocardiogram showed some changes and your heart enzymes were elevated. you were evaluated by the cardiologists who felt there was no need for intervention or additional testing and that the chest pain was most likely due to your low blood counts. you were subsequently transfused with 2 units of blood. you were also started on two medications to help your heart health. . the following changes have been made to your medication regimen please start taking - omeprazole 40 mg twice daily for your ulcers (you can discuss decreasing this dose at your follow up appointment with your gastroenterologist) - lisinopril 2.5 mg daily - metoprolol succinate 25 mg daily please take the rest of your medications as prescribed and follow up with your doctors . . you will need to have your inr checked on monday at your appointment with . you will need to have your electrolytes rechecked in 2 weeks to monitor your potassium and creatinine with your new medications. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: name: , pa (works with dr location: medical address: , , phone: appt: at 11am department: cardiac services when: thursday at 2:40 pm with: , md building: campus: east best parking: garage department: div. of gastroenterology when: wednesday at 1:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: other endoscopy of small intestine colonoscopy diagnoses: abnormal coagulation profile subendocardial infarction, initial episode of care congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases personal history of tobacco use mitral valve insufficiency and aortic valve insufficiency other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified chronic systolic heart failure long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction diseases of tricuspid valve helicobacter pylori [h. pylori] atherosclerosis of native arteries of the extremities with ulceration internal hemorrhoids without mention of complication external hemorrhoids without mention of complication ulcer of other part of lower limb allergic urticaria other transfusion reaction 

Answer: The patient is high likely exposed to