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: e-mycin attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp history of present illness: mrs. is a 67 year old female with a history of crohn's disease s/p multiple abdominal surgeries with ileostomy and short gut syndrome and recent development of acute cholecystitis s/p open cholecystostomy tube in and ercp with stent placement on who presents from home with worsening abdominal pain and nausea. per the surgical team she initially underwent surgery for acute cholecystitis in . the procedure was unable to be completed secondary to significant adhesions and was converted to an open cholecystostomy tube placement. her cholecystostomy tube drained both fluid and stones well for four weeks but subsequently migrated out and healed over. she underwent ercp with stent placement on . since procedure she has had persistent mid epigastric pain radiating to her back with associated nausea for which she was taking oxycodone and zofran. her pain increased and was associated with worsening mental status starting at 5:30 am on the morning of admission. per her husband she was doubling over in pain and had severe nausea and vomiting. there was questionable blood in her vomit. she has had no documented fevers or chills. no lightheadedness, dizziness, chest pain, difficulty breathing, change in ostomy output, dysuria, hematuria, leg pain or swelling. all other review of systems negative in detail. . in the ed, initial vs were: t:98.0 p: 74 bp: 160/72 r: 16 o2 sat 99% on ra. she received 50 mcg fentanyl and 4 mg zofran en route. blood pressures were consistently in the 200s systolic and she received 5 mg iv metoprolol x 2 and 5 mg iv hydralazine. she received approximately 2 liters of ivf. she received 40 meq potassium, ciprofloxacin 400 mg iv x 1, flagyl 500 mg iv x 1, zofran 4 mg iv x 2, morphine 4 mg iv x 2, pantoprazole 40 mg iv x 1, unasyn 3 grams iv x 1, and ativan 1 mg iv x 1 after which time she became slightly confused. she also received vitamin k 5 mg iv x 1. she was transfused 1 unit of ffp. ekg showed norumal sinus rhythm, normal axis, left bund branch block, no significant change from . family declined ngt placement. she had a right upper quadrant ultrasound which showed the common bile duct stent in place with 13 mm dilitation and internal hypoechoic material, possibly debris or sludge. she was evaluated by the surgical team who recommended ct scan of the abdomen for further evaluation and admission to the for close monitoring. . on the floor, she is currently too somnolent to respond to questions. she grimaces on abdominal exam. past medical history: past medical history: 1. crohn's disease, as above, status post multiple surgeries with small short bowel syndrome. 2. recurrent small bowel obstruction. 3. left bundle branch. 4. history of line sepsis. 5. nephrolithiasis. 6. osteomyelitis of the distal right femur in . 7. osteoporosis. 8. elevated alkaline phosphatase (this was worked up and it is felt to be of bone origin and not liver in origin). . past surgical history: 1. ileocolectomy in . 2. transverse colostomy for pelvic abscesses and small bowel obstruction in . 3. pan proctocolectomy with ileostomy in . 4. ileal resection (18 cm) in 2 feet proximal to stoma. 5. lysis of adhesions complicated by wound infection and enterocutaneous fistula. 6. exploratory laparotomy and lysis of adhesions with take down of enterocutaneous fistula with small bowel resection 8/. 7. synovectomy and debridement of right distal femur in . 8. status post tonsillectomy and adenoidectomy. 9. status post exploratory laparotomy and take down of enterovesiculo cutaneous fistula . 10. incision and drainage of intraabdominal abscess . 11. status post laparotomy and lyses of adhesions and excision on enterocutaneous and enterovesicular fistular . 12. exploratory laparotomy take down of enterocutaneous fistula small bowel resection . 13. s/p open cholecystostomy tube 14. s/p ercp with stent placement social history: the patient denies tobacco and alcohol use. she is married with two children who are healthy. she works as a homemaker. she lives with her husband. family history: mother with inflammatory bowel disease. father died of heart problems and in his early 60's. physical exam: on admission : vitals: t: 99.9 bp: 170/67 p: 96 r: 22 o2: 98% on ra general: somolent, wakes to voice, answers simple questions, no distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp flat, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, diffusely tender, non-distended, bowel sounds present, no rebound, voluntary guarding, left sided ostomy in place with dark guaiac positive output gu: foley draining clear urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . on transfer to surgery : 98.7 71 114/54 13 97% 2l nc gen: awake, alert, answering questions appropriately, no distress lungs: bibasilar crackles cv: rrr, nl s1, s2, no m/r/g abd: s/diffusely tender (greatest in rlq), +bs, no r/g ext: wwp, 2+ pulses, no c/c/e pertinent results: on admission : wbc-16.2*# rbc-3.28* hgb-9.4* hct-29.2* mcv-89 mch-28.6 mchc-32.1 rdw-14.0 plt ct-327 neuts-87.9* lymphs-8.0* monos-2.8 eos-1.0 baso-0.2 pt-21.5* ptt-61.6* inr(pt)-2.0* fibrino-615*# fdp-80-160* glucose-146* urean-10 creat-0.8 na-140 k-2.8* cl-103 hco3-24 angap-16 alt-54* ast-112* alkphos-585* totbili-0.7 lipase-109* calcium-8.5 phos-2.2* mg-2.0 hapto-311* . on transfer from to surgery (): wbc-15.5* rbc-3.47* hgb-10.6* hct-30.9* mcv-89 mch-30.5 mchc-34.2 rdw-15.1 plt ct-233 pt-12.9 ptt-22.5 inr(pt)-1.1 glucose-121* urean-20 creat-0.9 na-140 k-3.7 cl-108 hco3-26 angap-10 alt-86* ast-80* alkphos-344* totbili-4.8* calcium-7.4* phos-2.8 mg-2.2 . micro: mrsa - positive bcx - staph aureus, coag + - speciation pending bcx portacath - gnr bcx venipuncture - ngtd ucx - no growth . imaging: ruq us: -common bile duct stent in place. -common bile duct dilatation up to 13 mm with internal hypoechoic material, possibly debris or sludge. -gallbladder contains small stones and sludge with no evidence of pericholecystic fluid or gallbladder wall thickening. . ct /pelvis: 1. no evidence of acute intraabdominal or pelvic process. no organized fluid collection identified. 2. mild intra- and extrahepatic biliary dilatation with common bile duct stent in place. no filling defects identified. 3. distended gallbladder with gallstones. no overt wall edema. 4. mild right renal pelvicaliectasis and prominence of the right proximal ureter down to level of the mid pelvis adjacent to a surgical clip. . ekg : norumal sinus rhythm, normal axis, left bund branch block, no significant change from . . ercp : -fresh and clotted blood was seen in the major papilla. -2 plastic stents placed in the biliary duct were found in the major papilla. both plastic stents were removed using a snare. -evidence of a previous sphincterotomy was noted in the major papilla -cannulation of the biliary duct was successful and deep with a balloon catheter using a free-hand technique. -filling defects were noted within the bile duct which were consistent with blood clots. -a balloon sweep of the bile duct yielded multiple large clots,which were successfully extracted. -some fresh blood was also seen oozing from the ampulla following clot removal. brief hospital course: course 67 year old female with a history of crohn's disease s/p multiple abdominal surgeries with ileostomy and short gut syndrome, cholecystitis s/p open cholecystostomy tube in and ercp with stent placement on who presents from home with worsening abdominal pain and nausea. . #respiratory failure ?????? patient was intubated for ercp on . she was extubated and continued to saturate well on 3-4l nc. . # pt with gpc and gnr. pt did not meet sirs/sepsis criteria as she was afebrile and hr, rr were wnl. she did have leukocytosis. unasyn was changed to zosyn with continued vancomycin coverage. per surgery, pt to be treated through this as port has been in place for 9 years with surveillance cultures. . #abdominal pain/leukocytosis: patient presented with diffuse abdominal pain, leukocytosis with left shift, and rising lfts. bilirubin initially not elevated but then increased to 2.3. pain developed shortly after recent ercp which is concerning for stent occlusion or accumulation of sludge. other potential etiologies of her abdominal pain include ischemic bowel given diffuse pain with soft abdomen and guaiac positive stools, obstruction (less likely given exam), perforation, abscess, biliary/peritoneal fistula. ruq us and ct done with results above. pt underwent repeat ercp with results above. she was started on vancomycin and unasyn (changed to zosyn for gnr bacteremia). on hd3, her abdominal pain had resolved, she had good stool output. pt had brief period of wbc 27-29 (entire cbc elevated) which resolved, most likely lab error. pt was given fluids in case it was due to hemoconcentration and c. diff sent although she was afebrile. . #tachycardic/hypertension - pt developed tachycardia with hr 130s-140s and sbp 170s-180s. her tachycardia did not respond to fluid bolus. pt was given 5mg iv metoprolol with decrease to sbp 130s and hr 80s as there was concern she was having rebound from holding bb. pt's pain was also better controlled at this time, which may have improved her symptoms. . #coagulopathy: patient with inr of 2.0 on presentation. 1.1 at transfer. unclear etiology. she has been as high as 1.6 in the past. most likely etiology is nutritional deficiencies but in this setting must be concerned for consumptive coagulopathy (less likely given normal platelet count). she has received 5 mg iv vitamin k and one unit of ffp. dic labs not concerning and inr was monitored. . #guaiac positive stools: most likely etiology is her known crohn's disease, but in this setting also concerned for ischemic colitis, ulcers, other etiologies of gastrointestinal bleeding. patient refusing ngt. hematocrit currently stable. port for access. pt was started on ppi iv bid and hct monitored. . # crohn's disease: as above, s/p multiple surgeries with ileostomy with short gut syndrome. pt was unable to take po's. po meds were held and electrolytes closely monitored given short gut syndrome. unclear if steroids were given by endocrine for adrenal insufficiency. per pt, given by gi for crohn's. pt on stress dose steroids on admission. quick taper done to home dose. . # code: full (discussed with patient) . # communication: patient, husband (h), (c) (daughter) - home (, cell ( medications on admission: medications: enalapril 20 mg sulfasalazine 1000 mg tid ciprofloxacin 500 mg diphenoxylate/atropine 2 tablets qid omeprazole 20 mg folic acid 1 mg zoloft 50 mg daily atenolol 25 mg daily vitamin d 50,000 u qid cortisone 50 mg 2 days a week, 37.5 mg other days opium tincture 15 drops tid multivitamin daily vitamin c 500 mg tums 2 tablets tid ursodiol 300 mg fish oil 1200 mg daily b complex vitamins 1 tablet daily calcitriol 0.25 mcg three capsules daily nystatin prn oxycodone 5 mg prn zofran 4 mg prn discharge medications: 1. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 2. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 3. cortisone 25 mg tablet sig: 1.5 tablets po daily (). 4. enalapril maleate 10 mg tablet sig: two (2) tablet po bid (2 times a day). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 9. sulfasalazine 500 mg tablet sig: two (2) tablet po tid (3 times a day). 10. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 11. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 2 weeks. disp:*14 grams* refills:*0* 12. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 gram intravenous q8h (every 8 hours) for 14 days. disp:*189 gram* refills:*0* discharge disposition: home with service facility: healthcare discharge diagnosis: cholecystitis discharge condition: afebrile, vital signs stable; tolerating po intake, ambulating; ostomy output wnl discharge instructions: you came to the hospital for worsening abdominal pain and nausea. we obtained a ct scan of your abdomen which noted a distended gallbladder with gallstones. an ercp was performed which noted multiple gallstones and a balloon sweep was performed. we started to give you a diet which you tolerated well, and had our ostomy nurses see you during your hospitalization. please continue to take your home medications as prescribed. please return to the hospital or closest emergency department for abdominal pain, nausea, vomiting, chest pain, changes to your ostomy output, fever greater than 101 or any other symptoms that you may find concerning. followup instructions: you will need to follow up with dr. in clinic to discuss surgical management options. please call to schedule an appointment within 2-3 weeks. you should call to make this appointment as soon as possible. please follow-up with your primary care provider weeks regarding your hospitalization. the following appointments have been made for you: provider: , md phone: date/time: 10:30 provider: , md phone: date/time: 10:30 provider: , rn,ms,: date/time: 10:30 procedure: venous catheterization, not elsewhere classified removal of t-tube, other bile duct tube, or liver tube endoscopic retrograde cholangiopancreatography [ercp] diagnoses: unspecified essential hypertension acute posthemorrhagic anemia bacteremia blood in stool other left bundle branch block other specified disorders of biliary tract hypovolemia cholangitis other and unspecified coagulation defects other and unspecified postsurgical nonabsorption calculus of gallbladder with acute cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to