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: no known allergies / adverse drug reactions attending: chief complaint: pancreatitis major surgical or invasive procedure: dobhoff tube (for feeding) nasogastric tube placement picc (longer iv line) x 2 history of present illness: 57 year old woman with known history significant for spinal stenosis, ibs, and gerd who presents via hospital with 2 days of abdominal pain and vomiting. initial diagnosis at hospital was pancreatitis with persistent tachycardia. she reports nausea and dry heaves with upper abd pain since saturday night. no fevers, t 95.3 at home. on the day of admission, she had a syncopal episode at home with loc while going to the bathroom, but denies head strike. lowered to ground by her husband. ems was called; initially patient with sbp 50 and hr 130s. at , received 3l ivf and no significant improvement in hrs. ct showed pancreatic edema and ascites on imaging; no gallstones seen. the patient was transferred to the medical icu and later transitioned to the medical floor. denies history of alcohol use aside from 0-1 drink each day while on vacation over the past week and prior to that 2 drinks/month. no new medicines or supplements. no family hx of pancreatitis. labs at osh: wbc 16.4, na 135, k 3.5, ca 8.2, cr 2.67, amylase 1661, lipase 758. denies prior history of pancreatitis or gallbladder conditions. past medical history: spinal stenosis exercise induced asthma (no intubations) hypertension vaginal dryness hepatitis a ear surgery appendectomy c-section tonsillectomy gerd ibs s/p recent c-scope, egd reported per pt as "normal" normal stress test w/in last 5 yrs for palpations social history: - tobacco: quit over 30 years ago - alcohol: reports less than 2 drinks / month, 0-1 drink /day x 5 days while on vacation - illicits: denies family history: denies pancreatic or hepatic conditions in her family. physical exam: admission exam to icu: vitals: 98.7 126 156/58 19 97 ra general: alert, oriented, appears uncomfortable but nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: mild rales at bases b/l, nonlabored breathing cv: regular rhythm, tachy, no m/r/g abdomen: soft, no shake tenderness, mild guarding, diffuse tenderness to moderate palpation, no rebound tenderness, gu: foley in place ext: warm, well perfused, no clubbing, cyanosis or edema pertinent results: ct report from osh (oral contrast, no iv): no gallstones seen, but gb distended and likely "sludge" no ductal dilitation, "severe" pancreatitis, w/ extensive extrahepatic inflammation in abdominal pelvic mesentary, moderate pancreatic ascites, thickening of wall of descending colon. ruq us 1. no evidence for gallstones or sludge in the gallbladder. 2. the common bile duct is mildly dilated to 8 mm, a region for this such as choledocholithiasis is not identified on this scan; however, cannot be excluded as the distal portions of the common bile ducts are not visualized. therefore, mrcp is recommended. 3. moderate amount of ascites and small right pleural effusion. . cxr findings: there is improved aeration in the region of the right mid/upper lung described previously. there continue to be bilateral pleural effusions, but these are somewhat smaller compared to prior. there is volume loss at both bases. an underlying infectious infiltrate cannot be excluded at the bases. . ct abdomen -impression: 1. worsening acute pancreatitis, with areas of necrosis, as well as surrounding edema and fluid. there is no well formed fluid collection on this study. 2. reactive changes of the duodenum and left colon. 3. large bilateral pleural effusions with adjacent atelectasis. 4. moderate amount of abdominal ascites. . mri abdomen- impression: 1. heterogenous signal intensity of the pancreas consistent with patient's known pancreatitis. a small region of necrosis at the neck cannot be excluded. 2. peripancreatic fluid, some hemorrhagic or proteinaceous fluid. likely early pseudocyst formation, however, no drainable collection seen. 3. moderate perihepatic ascites. 4. bilateral pleural effusions, larger on the right. the study and the report were reviewed by the staff radiologist. . kub -impression: dobhoff tube with tip projecting over the proximal jejunum. bilateral pleural effusions. . ct abdomen -impression: 1. evolving pancreatic pseudocyst formation. 2. evidence of smv thrombosis with accompanying mucosal edema of the ascending colon. 3. no evidence of hemorrhagic pancreatitis. 4. no evidence of pancreatic necrosis. 5. improving right pleural effusion, stable left pleural effusion . head ct -impression: no acute intracranial hemorrhage or mass effect. small amount of fluid and mucosal thickening in the left side of sphenoid sinus- correlate given the symptoms. . abd ct indication: severe pancreatitis, now with fevers and bacteremia. evaluate for evidence of bleeding or further infection of pseudocyst to explain fever/bacteremia. technique: mdct images were obtained from the lung bases to the pelvic outlet without intravenous contrast. coronal and sagittal reformats were obtained. comparison: ct of the abdomen and pelvis on and , . findings: ct of the abdomen: bilateral pleural effusions are again noted and appear enlarged from prior examination, particularly on the right side. the visualized portions of the heart are normal in size and there is no pericardial effusion. the liver has a slightly nodular contour to the right lobe without caudate lobe enlargement. there also appears to be a partially recanalized umbilical vein that is visualized on prior examination. there are no focal liver lesions and the hepatic and portal veins are patent. the gallbladder is again noted to be edematous similar to a prior study on . on this non-contrast ct the pancreas is not high density and not suggestive of hemorrhage in the pancreatic parenchyma. a pancreatic pseudocyst with likely internal hemorrhage is again noted (2:45). grossly the pancreatic pseudocysts appear similar in size and distribution. however an anterior pancreatic pseudocyst that measured 5.8 cm on prior examination appears smaller on today's examination, measuring approximately 4.9 cm (2:43). the exact delineation of these collections is unclear but they do not appear to have worsened. there is no gas noted in any of the pancreatic pseudocysts to suggest infection. the stomach and small bowel appear are unremarkable. an ng tube is noted coursing into the fundus of the stomach. the ascending and transverse colons are edematous. there is more ascites than on prior study tracking perihepatically and into the left paracolic gutter. there is more third spacing into the subcutaneous fat throughout the mesentery and into the transverse mesocolon. the spleen, adrenal glands and kidneys are unremarkable. there are no renal stones. there is no intra-abdominal lymphadenopathy. there is no free air. ct of the pelvis: the distal transverse, descending and sigmoid colon and rectum are all collapsed, unchanged. an unchanged amount of pelvic free fluid is again noted. the uterus and adnexa are unremarkable. a foley catheter is noted in the bladder, which is unremarkable. there is no free air. osseous structures: there are no suspicious lytic or blastic lesions. impression: 1. worsening bilateral pleural effusions particularly on the right. 2. no overt worsening of pancreatic pseudocysts. the pancreatic pseudocyst in the region of the transverse mesocolon appears slightly smaller. there is no gas within the pseudocyst to suggest infection. 3. increased amount of ascites. 4. nodular contour to right lobe of the liver with a partially recanalized umbilical vein. 5. ascending and transverse colon mucosal edema, likely secondary to pancreatitis. 6. gallbladder wall edema likely secondary to pancreatitis. 7. no evidence of hemorrhagic pancreatitis. . kub : final report indication: c-diff colitis, complaining of worsening abdominal pain and discomfort, evaluate for megacolon. comparison: . findings: one supine frontal view of the abdomen was obtained. there is mild distention of the transverse colon. there is no dilation of small bowel. there is no free air. the osseous structures are unremarkable. there are no soft tissue calcifications. impression: no radiologic evidence of toxic megacolon. microbiology- urine urine culture-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient urine urine culture-final {yeast} inpatient urine urine culture-final inpatient stool clostridium difficile toxin a & b test-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient stool ova + parasites-final inpatient serology/blood rapid plasma reagin test-final inpatient stool fecal culture-final; campylobacter culture-final; ova + parasites-final inpatient blood culture blood culture, routine-final inpatient urine urine culture-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient urine urine culture-final inpatient urine not processed inpatient mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final {escherichia coli}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final inpatient blood culture blood culture, routine-final {escherichia coli}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): reported to and read back by dr. on at 0315. gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). 08:32am blood hct-24.3* 05:13am blood wbc-14.4* rbc-2.32* hgb-7.0* hct-21.0* mcv-91 mch-30.3 mchc-33.5 rdw-15.0 plt ct-419 06:45am blood wbc-11.5* rbc-2.70* hgb-8.2* hct-24.5* mcv-91 mch-30.4 mchc-33.5 rdw-15.1 plt ct-453* 05:08am blood wbc-9.7 rbc-2.65* hgb-8.1* hct-23.6* mcv-89 mch-30.5 mchc-34.2 rdw-15.2 plt ct-463* 06:05am blood wbc-12.5* rbc-2.90* hgb-8.9* hct-26.1* mcv-90 mch-30.8 mchc-34.2 rdw-15.2 plt ct-505* 08:54pm blood hct-23.4* 01:10pm blood hct-24.7* 05:50am blood wbc-13.8* rbc-2.93* hgb-9.0* hct-26.4* mcv-90 mch-30.8 mchc-34.1 rdw-15.4 plt ct-558* 05:11am blood wbc-13.5* rbc-3.36*# hgb-10.2*# hct-30.2*# mcv-90 mch-30.5 mchc-33.8 rdw-15.3 plt ct-491* 10:50am blood wbc-25.6* rbc-3.01* hgb-9.3* hct-27.3* mcv-91 mch-30.9 mchc-34.1 rdw-14.6 plt ct-391 07:32am blood wbc-8.7 rbc-3.19* hgb-10.1* hct-28.6* mcv-90 mch-31.6 mchc-35.3* rdw-13.9 plt ct-115* 04:58am blood wbc-8.4 rbc-3.98* hgb-12.5 hct-34.7* mcv-87 mch-31.4 mchc-36.0* rdw-13.2 plt ct-145* 02:00pm blood wbc-13.2* rbc-6.01* hgb-18.7* hct-52.9* mcv-88 mch-31.0 mchc-35.3* rdw-12.9 plt ct-210 07:55am blood neuts-93* bands-1 lymphs-3* monos-1* eos-0 baso-0 atyps-0 metas-1* myelos-1* 12:32am blood neuts-65 bands-15* lymphs-10* monos-10 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:13am blood pt-15.1* ptt-84.1* inr(pt)-1.3* 06:05am blood plt smr-high plt ct-505* 05:25am blood pt-13.7* ptt-22.1 inr(pt)-1.2* 04:07am blood fibrino-1254* 07:44am blood fibrino-1258* 05:13am blood glucose-105* urean-13 creat-0.5 na-138 k-4.0 cl-103 hco3-26 angap-13 05:50am blood glucose-132* urean-12 creat-0.5 na-137 k-3.9 cl-102 hco3-26 angap-13 04:59am blood glucose-136* urean-22* creat-0.8 na-140 k-3.8 cl-101 hco3-30 angap-13 04:07am blood glucose-107* urean-24* creat-0.8 na-142 k-3.0* cl-99 hco3-32 angap-14 04:58am blood glucose-144* urean-25* creat-0.8 na-141 k-3.6 cl-106 hco3-26 angap-13 02:00pm blood glucose-137* urean-48* creat-1.8* na-136 k-3.8 cl-98 hco3-25 angap-17 09:00pm blood glucose-116* urean-42* creat-1.5* na-139 k-4.3 cl-106 hco3-18* angap-19 12:32am blood glucose-130* urean-38* creat-1.2* na-136 k-4.0 cl-108 hco3-18* angap-14 05:50am blood alt-22 ast-25 alkphos-85 totbili-0.3 05:11am blood alt-23 ast-27 04:59am blood alt-20 ast-28 ld(ldh)-416* alkphos-115* amylase-91 totbili-0.6 04:58am blood alt-17 ast-31 alkphos-48 amylase-438* totbili-0.6 02:00pm blood alt-24 ast-33 alkphos-75 totbili-0.5 05:08am blood lipase-45 06:05am blood lipase-61* 05:50am blood lipase-58 05:11am blood lipase-59 10:38am blood lipase-42 04:59am blood lipase-67* 04:30am blood lipase-98* 04:58am blood lipase-200* 02:00pm blood lipase-1193* 05:13am blood calcium-9.1 phos-4.1 mg-1.9 02:35pm blood vitb12-752 folate-17.2 10:35am blood triglyc-152* 02:00pm blood triglyc-177* 02:35pm blood tsh-1.6 05:11am blood -negative 04:30am blood igg-460* 03:59am blood igg-445* 04:30am blood igg-460* 03:59am blood igg subclasses 1,2,3,4-test . 05:17am blood wbc-28.7* rbc-3.02* hgb-9.1* hct-26.2* mcv-87 mch-30.3 mchc-35.0 rdw-15.7* plt ct-462* 05:17am blood pt-14.5* ptt-23.9 inr(pt)-1.3* 05:17am blood glucose-93 urean-19 creat-0.4 na-134 k-4.0 cl-99 hco3-24 angap-15 05:17am blood calcium-8.0* phos-3.1 mg-1.9 12:55am stool clostridium difficile toxin, pcr- positive blood culture (): **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . latest labs 05:40am blood wbc-16.0* rbc-2.83* hgb-8.4* hct-25.8* mcv-91 mch-29.8 mchc-32.8 rdw-15.4 plt ct-425 05:40am blood glucose-120* urean-11 creat-0.4 na-131* k-3.8 cl-99 hco3-25 angap-11 07:53am blood alkphos-142* 06:04am blood alt-8 ast-14 alkphos-130* totbili-0.3 06:04am blood lipase-28 05:40am blood calcium-8.0* phos-3.4 mg-1.7 05:40am blood triglyc-78 02:35pm blood tsh-1.6 brief hospital course: patient is a 57 year old woman with known spinal stenosis, gerd, and ibs who presented to the medical icu via an outside hospital with 2 days of abdominal pain and vomiting w/ found to have severe acute pancreatitis of unclear etiology. . acute issues: . # acute pancreatitis and c. diff colitis: -pt tranferred to the icu from osh. initially presented with leukocytosis with bandemia, severe pain, and positive blood culture for gram negative rods, on iv zosyn and aggressively hydrated. made npo with bowel rest and tpn intially. following nj tube placement by ir, started tube feeds (which she did not tolerate at the time). gi, id, and surgery were consulted. . the etiology of pancreatitis remained unclear. osh ct scan showing distended gb and ruq showed mild cbd dilatation at 8mm but no stone/sludge. mrcp showed extensive pancreatitis, ascites, and fluid around the liver but no biliary dilitation. pt is social drinker, no fmh of pancreatitis or hyperca, hypertriglyceremia. autoimmune serologies were sent and unremarkable. no new meds, structural or anatomic abnormalities. given recent use of thiazides, this was entertained as a possible cause of pancreatitis. thiazides were discontinued. . transferred from icu on to floor. placed on dilaudid pca. had an acute rise in wbc while on zosyn (attribued to continued waxing and flare). switched to cefipime and covered empirically for c. diff for a few days on po vanc and iv flagyl which were later discontinued after c. diff pcr returned negative. repeat ct abdomen showed mild area of necrosis. gi/pancreatitis team consulted (dr. - felt there was no need for invasive intervention. . tpn was initiated on and picc was placed on . tf's were slowly started on . the patient did not tolerate tube feeds once they were advanced on and they were again stopped. she remained on tpn for nutrition at this time. tube feeds were never restarted. due to continued abdominal pain, distented abdomen, and woresening anemia, pt underwent a repeat ct scan on that showed evolving pancreatic pseudocyst, new smv thrombosis with edema of the ascending colon, no evidence of hemorrhagic pancreatitis or necrosis. pt's symptoms improved.pt was started on clears and her diet was successfully advanced to a brat diet on . dobhoff was removed on . she continued to have abd pain and was evaluated by pancreas team in the icu. a picc line was placed and the plan was to start tpn. on pt developed rigors, fever, and was developed a gnr bacteremia. on her hct dropped to 20 and she received 2 units of prbcs. she triggered on with temp of 102, worsening abdominal discomfort, increased respiratory distress. she was then transferred to the . her ct was repeated and showed no change in the pancreas, but increse in pleural effusion on the right side. surgery was consulted and there were no acute surgical intervention done. there was concern for c.diff given that pt had diarrhea on the onset of antibiotics and she started on po vanco in addition to iv flagyl. she then had worsen abd distention and decreased bs which were concerning for ileus. she did have c.diff toxin positive stool at that point. she was placed on ppn given that her picc was removed. her symptoms improved and she was transferred back to the floor on . a picc line was re-inserted on that date and tpn restarted. gi and id continued to follow her. . since transfer back to the floor, her abdominal pain has slowly improved (though she still has pain), and her nausea has improved. her ngt was removed, and po diet was slowly reintroduced. on the day of discharge, she ws still receiving tpn. she was taking in small amounts of oral liquids. gi continued to see her through the day of discharge. they recommended advancing diet as tolerated (avoiding high-fat foods), and follow-up with dr. of gastroenterology in his clinic within the next 2 weeks (they are working on an appointment - the phone number for the gi division is ). they recommended no other changes in her management at this time, and on agreed with the plan for discharge to ltac. . # e. coli bacteremia: -osh bcx with e. coli bacteremia. pt initially on zosyn and later transitioned to cefepime (when wbc increased to 28k, later attributed to pancreatitis and not bactermia). source of e. coli unclear. potential sources were transient cholangitis from blocked cbd stone, or translocation from a thickened descending colon found on abdominal ct scan. patient completed a course of cefepime on . 2 week course of therapy. blood cultures from grew e. coli as well and at this time pt. was transferred back to in setting of fever. she was put on zosyn for this for a planned 2 week course ( - ). picc line was replaced . after transfer back to the floor, the pt was placed on tigecycline for better coverage of her c. diff in the setting of a rising wbc (up to 35k) despite po/pr vanco and iv flagyl. as the e.coli is also sensitive to tigecylcine, the zosyn was discontinued. multiple sets of blood cultures since have been negative. total of 2 week of course of tigecycline was completed on . . # c diff colitis: severe. treated with po and pr vancomyinc as well as iv tigecycline. pr vanco discontinued . she will complete po vancomycin 500 mg q6h on . . # acute kidney injury: creatinine was 1.8 at the time of admission. this was likely secondary to hypoperfusion. she responded well to fluid resuscitation and her creatinine rapidly corrected. cr 0.4 on the day of discharge . # metabolic encephalopathy: pt presented a0x3 and became confused and agitated on with hallucinations of her cousin in the room, and although orientated largely to time, person and place, became agitated and pulled out her picc line and ng tube. this later completely resolved and she quickly returned to her pleasant baseline with normal cognition. . # respiratory distress: this evolved initially following aggressive fluid resuscitation. pt was started on vancomycin (and zosyn) to cover for hcap, but these were discontinued after one day given her rapid clinical improvement following diuresis with furosemide. there was also significant bilateral pleural effusion from likely pancreatic effusion. pt was later weaned to room air and then developed respiratory distress on and was transferred to the . tte showed low normal lvef, 1+ mr, borderline elevated pasp. hypoxia was felt to be due to volume overload and she was diuresed with furosemide 20mg iv with good effect. it resolved. . # hypertension: held home bp medications initially due to concerns for sirs/spesis. however, her vitals stabilised and she subsequently became hypertensive with sbp in the 200s. her hypertension was controlled initially with labetalol, and then with po metoprolol. when made npo the pt was transitioned to iv metoprolol around the clock. when able to take po, iv was discontinued and pt was started on diltiazem 30mg qid (equivalent to her home dose of 120mg daily). when unable to take po again, she was started on metoprolol iv qid. she was transitioned back to metoprolol po on (no diltiazem), with doses titrated based on bp and hr. . # question of smv thrombosis. gi requested hematology involvement. this is considered to be a provoked event and 3-6 months of anticoagulation would be recommended. pt was started on iv heparin without an initial bolus. this was stopped on the day of the transfer back to the icu, as repeat abdominal imaging was obtained, and upon further review by radiology and gi, it was determined that the patient most likely did not have an smv thrombosis, and that the occlusion in the smv was due to extrinsic compression, most likely due to significant underlying inflammation and edema from her pancreatitis. anticoagulation was stopped. . # spinal stenosis: at home, was controlled with ibuprofen 2 tabs - lidocaine 5% patch 1 ptch td daily:prn pain. narcotics were limited due to her severe ileus. she did not complain of severe back pain, but as she begins rehabilitation this may flare up again. . # exercise induced asthma: at home was on singulair 10mg daily. in the hospital she received: - ipratropium bromide neb 1 neb ih q6h:prn shortness of breath - albuterol 0.083% neb soln 1 neb ih q6h:prn shortness of breath - fluticasone propionate 110mcg 2 puff ih . # gerd: at home was on ranitidine 300mg daily. - continued on pantoprazole 40 mg iv q12h until she started taking po, then transitioned to oral form\ . # elevated alk phos: unclear cause and significance, perhaps medication-related. alkphos 142 on . . # hyponatremia: likely related to fluid shifts and limited nutrition. na 131 on the day of discharge. . #weakness -due to prolonged hospitalization and severe illness. no focal findings. needs inpatient physical therepy and rehabiliation before returning home. medications on admission: diltiazem 120mg daily hctz 12.5mg daily singulair 10mg daily ranitidine 300mg daily flovent 110 mcg 2 puffs daily fluticasone prop 50 mcg 2 puffs per nostril daily as needed pro air 90 mcg as needed vagifem vag tab 25 mcg 1-2x weekly loratadine calcium w/ vitamin d 2 tabs 2x daily probiotic mv1 daily ibuprofen 2 tabs dulcolax daily fibercom 2 daily discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation every 4-6 hours. 2. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily) as needed for congestion. 3. ipratropium bromide 0.02 % solution sig: one (1) puff inhalation q6h (every 6 hours) as needed for shortness of breath. 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath. 6. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 7. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash. 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) grams po daily (daily) as needed for constipation. 11. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 12. vancomycin 250 mg capsule sig: two (2) capsule po q6h (every 6 hours): through . 13. lorazepam 0.5 mg tablet sig: 0.5 tablet po q8h (every 8 hours) as needed for pain, anxiety, nausea. 14. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 15. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 17. zofran 2 mg/ml solution sig: four (4) mg intravenous every eight (8) hours as needed for nausea. 18. hydromorphone (pf) 1 mg/ml syringe sig: 0.5 mg injection q3h (every 3 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis - acute pancreatitis - ecoli bacteremia - hypertension - severe c. diff infection minor spinal stenosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: independent discharge instructions: you were admitted on to the medical intensive care unit for significant pancreatitis and inflammation. you also were found to have bacteremia (bacteria in the blood) which was likely related to your pancreatitis. multiple images here revealed that the pancreas was significantly inflamed. you were treated with antibiotics for the bacteremia and also for possible pancreatic necrosis. the cause of the pancreatitis remains unclear and may have been due to a passed stone. due to the pancreatitis, you were not able to eat. you had a nasal feeding tube placed, but were not able tolerate tube feedings. you were then transferred back to the icu with new infections, bacteria (e.coli) in your blood stream and bacteria (c.diff) in your colon. due to inability to tolerate po intake, you had picc line placed and you were started on iv nutrition (tpn). you have completed a course of antibiotics for the e coli bloodstream infection. you will need to complete a course of antibiotics for the c diff colon infection (continue oral vancomycin through ). followup instructions: it is recommended that you see dr. of gastroenterology in his clinic within the next two weeks. they are working on an appointment. if you do not hear from them, you can call gastroenterology at . after discharge from the ltac, please make an appointment with your primary care doctor to be seen within 7 days. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified hyposmolality and/or hyponatremia hypopotassemia bacteremia intestinal infection due to clostridium difficile metabolic encephalopathy spinal stenosis, unspecified region other malaise and fatigue acute pancreatitis cyst and pseudocyst of pancreas other nonspecific abnormal serum enzyme levels irritable bowel syndrome other and unspecified escherichia coli [e. coli] essential thrombocythemia exercise induced bronchospasm 

Answer: The patient is high likely exposed to