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: abdominal pain major surgical or invasive procedure: : 1. patch repair of a perforated pyloric channel ulcer. 2. placement of a transgastric feeding jejunostomy tube. history of present illness: y/o f transferred from for free air and abd pain found earlier today. per the note she is a f who fell at home in early and fractured her left hip. she subsequently underwent orif of the left hip on , was discharged to rehab, but had a dislocation of the repaired hip and was readmitted for open reduction. she was discharged again just yesterday. this morning she began complaining of abdominal pain, that she says is worst at her right mid abdomen. she has had some nausea but no emesis, and has not had a bowel movement in several days. she is unsure whether she is passing gas. her po intake has been poor but she did eat dinner last night without any issues. she denies any fevers or chills, and denies any changes in her urine habits. she does also complain of pain in her left hip since the surgery. she was transferred here for possible surgical repair and management. en route she has received 1 unit of ffp. she continues to have abd pain and has been afebrile and vitals have been stable during transport. past medical history: pmh: depression, hypothyroid, diverticulosis psh: orif l hip ; open reduction l hip dislocation social history: sochx: denies any tobacco, alchohol, or recreational drugs. was living alone and independent before her recent hospitalizations. family history: famhx: nc physical exam: pe: 99.5 100 140/71 16 98% 2l gen: nad. a&ox3. heent: anicteric. dry mucosal membranes. neck: no jvd. no lad. no tm. cv: rrr. pulm: expiratory wheezes b/l. abd: firm, nondistended, diffusely tender to palp, with rebound. no hernias/masses, no surgical scars. l hip dsg c/d/i. ext: warm and well perfused l leg mildly swollen from hip down, trace edema b/l. motor/sensation intact pertinent results: labs: 14.4>----<439 132| 98| 23| 33 ------------<137 89% n 4.8|21.6|1.3| ca 8.3 pt 23.6, inr 2.4 alt 32, ast 30, alp 87, tuberculosis 0.6, tp 5.8, alb 2.4, lip 68 u/a: + nitrates, 2+ bacteria, wbc, no epis labs: inr 2.1 138/ 105/ 23< 109 4.8/ 25/ 1.2 imaging: ruq us: thickened 6mm gb wall, 9mm cbd, + murphys, no evidence of stones/sludge (wet read). cxr: positive for free air endoscopy: colonoscopy in the distant past reportedly normal. never had an egd. swallow study : no evidence of leaks with administration of optiray contrast. brief hospital course: ms. was admitted to the acs service on with abdominal pain and perforated viscus on . she was taken emergently to the operating room for patch repair of a perforated pyloric channel ulcer and placement of a transgastric feeding jejunostomy tube. a 5 mm perforated ulcer was noted at the pyloric channel with copious fibrin as well as an acutely inflamed stomach and duodenum. she underwent patch repair with g/j tube placement on . neurologic: she was extubated without problem postoperatively and was initially watched in the icu and then transferred to floor on pod 1. she initially had inadequate pain control but was transitioned to tylenol, ultram,a nd small dose oxycodone with adequate control. cardiovascular: she had no acute issues during this hospitalization and remained hemodynamically stable throughout. pulmonary: she was noted to have crackles on exam pod3 and was given iv lasix 20mg x2 with good urine response and improved exam. she was then restarted on her spironolactone and was saturating well on room air. gastrointestinal / abdomen: she had exploratory laparotomy with placement of a jejunal and gastric feeding tubes. initially the j-tube was capped and the g-tube was kept to gravity. tube feeds were started on pod 2 and patient was quickly advanced to goal feed rate of 55cc/hr without any issues. she had a speech and swallow evaluation on pod 5 that showed no leak and was started on a regular diet, which she tolerated. her po intake was limited in quantity despite lack of symptoms so her tube feeds were continued on discharge at goal rate of 55cc/hr. h. pylori testing was done that was negative. patient was instructed to get an outpatient egd and told to discuss this with dr. and pcp at follow up appointment. nutrition: see gastrointestinal above. renal: she initially had a foley placed that was discontinued on pod 2. she had good urine output throughout this admission. hematology: on admission her inr was 2.1. since she was being taken to the or she was given 1 unit ffp preoperatively. she ahd good hemostasis at the end of the case and her hematocrit was stable postoperatively. she was kept on heparin 5000 units subq tid during this hospitalization and had her coumadin held. this coumadin was prophylactic after orthopedic surgery and so was not restarted but instead patient was continued on subcutaneous heparin. endocrine: known hypothyroid condition. she was restarted on her synthroid postoperatively and had no issues. infectious disease: on meropenem and fluconazole x 48 hours. peritoneal fluid showed multiple organisms including gnr, gpr, and yeast. blood cultures were drawn on that showed no growth to date. patient was afebrile and not tachycardic throughout admission and so no further antibiotic treatment was necessary. at time of discharge she had blood and urine cultures pending. tubes/lines/drains: as stated above she ahd g/j tube placed in the oeprting room as well as drain. the drain continued to put out minimal serosanguinous fluid. the jp drain was left in place at time of discharge. she walso had a picc line placed for difficult access on pod 2. the picc was confirmed to be in the correct position and was used for iv access for the remainder of hospitalization. medications on admission: : celexa 20' synthroid 100' evista 60' latanoprost timolol senna prn vitamin d roxicodone prn coumadin 5' duclolax prn milk of mag prn tylenol prn zofran 4 prn trazodone 50' calcium discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for wheezing. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. raloxifene 60 mg tablet sig: one (1) tablet po daily (). 7. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 8. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 9. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 10. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 11. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 12. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 14. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. 15. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 16. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: rehab unit at - discharge diagnosis: perforated pyloric channel ulcer secondary: depression hypothyroid diverticulosis s/p orif l hip discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: mechanical lift transfer. discharge instructions: you were transferred from an outside hospital after you were found to have free air in your abdomen, which was attributed to a perrforated ulcer in the pyloric channel of your stomach. you were taken to the operating room soon after your arrival to the hospital and had patch repair placed over this hole. you also had a gastric and jejunal tube placed during this operation to assist with feeding options postoperatively. you have done well after the operation. you have been passing gas and had a speech and swallow exam, which showed no evidence of leak. you were started on a regular diet in addition to getting tube feeds through your j-tube. you were tolerating the regular food but not taking a large amount and so your tube feeds were continued. please make your appointment for follow up as listed below: you are not to resume your coumadin on discharge but instead continue subcutaneous heparin. general discharge instructions: you have had an abdominal operation. this sheet goes over some questions and concerns you or your family may have. if you have additional questions, or ??????t understand something about your operation, please call your . activity: do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. you may climb stairs. you may go outside. but avoid traveling long distances until you see your at your next visit. ??????t lift more than 20-25 pounds for 6 weeks. (this is about the weight of a briefcase or a bag of groceries.) this applies to lifting children, but they may sit on your lap. you may start some light exercise when you feel comfortable. you will need to stay out of bathtubs or swimming pools for a time while your incision is healing. ask your doctor when you can resume tub baths or swimming. heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. you may resume sexual activity unless your doctor has told you otherwise. how you feel: you may feel weak or ??????washed out?????? for 6 weeks. you might want to nap often. simple tasks may exhaust you. you may have a sore throat because of a tube that was in your throat during surgery. you might have trouble concentrating or difficulty sleeping. you might feel somewhat depressed. you could have a poor appetite for a while. food may seem unappealing. all these feelings and reactions are normal and should go away in a short time. if they do not, tell your . your incision: your incision may be slightly red around the stitches or staples. this is normal. you may gently wash away dried material around your incision. do not remove steri-strips for 2 weeks. (these are the thin paper strips that might be on your incision.) but if they fall off before that, it??????s ok. it is normal to feel a firm ridge along the incision. this will go away. avoid direct sun exposure to the incision area. do not use any ointments on the incision unless you were told otherwise. you may see a small amount of clear or light red fluid staining your dressing or clothes. if the staining is severe, please call your . you may shower. as noted above, ask your doctor when you may resume tub baths or swimming. over the next 6-12 months, your incision will fade and become less prominent. your bowels: constipation is a common side effect of medicine such as percocet or codeine. if needed, you may take a stool softener (such as colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tablespoon) twice a day. you can get both of these medicines without a prescription. if you go 48 hours without a bowel movement, or have pain moving the bowels, call your . after some operations, diarrhea can occur. if you get diarrhea, ??????t take anti-diarrhea medicines. drink plenty of fluids and see if it goes away. if it does not go away, or is severe and you feel ill, please call your . pain management: it is normal to feel some discomfort/pain following abdominal surgery. this pain is often described as ??????soreness.?????? your pain should get better day by day. if you find the pain is getting worse instead of better, please contact your . you will receive a prescription from your for pain medicine to take by mouth. it is important you take this medicine as directed. do not take it more frequently than prescribed. do not take more medicine at one time than prescribed. your pain medicine will work better if you take it before your pain gets too severe. talk with your about how long you will need to take prescription pain medicine. if you are experiencing no pain, it is ok to skip a dose of pain medicine. to reduce pain, remember to exhale with any exertion or when you change positions. remember to use your ??????cough pillow?????? for splinting when you cough or when you are doing your deep breathing exercises. if you experience any of the following, please contact your : sharp pain or any severe pain that lasts several hours pain that is getting worse over time pain accompanied by fever of more than 101 a drastic change in nature or quality of your pain medications: take all the medicines you were on before the operation just as you did before, unless you have been told differently. in some cases, you will have a prescription for antibiotics or other medication. if you have any questions about what medicine to take or not to take, please call your . followup instructions: please follow up with dr. at in days after your discharge. the number to call and make this appointment is (. her office location is , . procedure: other enterostomy enteral infusion of concentrated nutritional substances suture of gastric ulcer site central venous catheter placement with guidance diagnoses: unspecified acquired hypothyroidism depressive disorder, not elsewhere classified osteoporosis, unspecified long-term (current) use of anticoagulants diverticulosis of colon (without mention of hemorrhage) other suppurative peritonitis chronic kidney disease, stage ii (mild) history of fall acute gastric ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to