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: iodine-iodine containing / wellbutrin attending: chief complaint: nausea, abdominal pain, poor appetite major surgical or invasive procedure: mrcp egd colonoscopy history of present illness: mr. is a 59 year old male with a history of a schatzki's ring and intermittant chronic abdominal pain who presents with 3 weeks of abdominal discomfort, nausea, and decreased appetite. he has had intermittant abdominal pain for the past 4-5 years for which he stops eating for a day or two and then it goes away. approximately 3 weeks ago, however, he developed a different kind of abdominal pain that is primarily epigastric and less intense that his usual bouts of abdominal pain, but much longer lasting. he denies any significant vomiting, but has been eating relatively little due to poor appetite. he has also been primarily bed bound during this period and now feels very weak overall. he does endorse weight loss, but is unsure how much he has lost. he had fevers and chills during the first 6 days of his illness but denies any within the last week. he had a bowel movement yesterday that was dark black in color. urine is also darker and foul smelling, but no dysuria. in the ed, initial vs were: pain 4, t 97, hr 104, bp 107/64, r 16 100% ra. labs were notable for elevated lfts and a wbc count of 21.3k. ruq ultrasound demonstrated dilated biliary tree with an ill-defined pancreatic head mass. surgery and teams were consulted. patient was given 2l ns, ciprofloxacin 400 mg iv, flagyl 500 mg iv for ?cholangitis, oxycodone 5 mg po, and zofran 4 mg iv. vitals on transfer were hr 86, bp 110/60, r 16, 96% ra. review of systems: (+) per hpi, + lightheadedness, +doe (new), + chronic lbp and sciatica, + hx of intermittant numbness in extremities (not currently) (-) denies night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough. denied chest pain or tightness, palpitations. denied diarrhea. no dysuria. denied myalgias. past medical history: 1. schatzki's ring, most recent dilation 2. depression 3. emphysema 4. sciatica 5. chronic back pain 6. history of left foot drop and peripheral neuropathy, resolved 7. status post lipoma removal from the neck, ~20 years ago 8. history of multiple broken ribs, s/p falls social history: former software programer, not currently working, lives alone. drinks two 12 oz cans of beer daily, though none in the last few weeks. smokes 1.5 - 2 ppd x 38 years, but no tobacco the last couple of weeks. family history: mother - has "gallbladder problems" but still has her gallbladder in father - healthy diabetes in some great aunts. maternal grandmother died of a mi in her 50s. no family history of cancer. multiple suicides in the family. physical exam: vitals: t: 98.9 bp: 150/60 p: 96 r: 16 o2: 100% ra general: alert, oriented, no acute distress, gaunt heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi, no cvat cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, ttp in the epigastrium, non-distended, bowel sounds present, no rebound tenderness or guarding, negative sign. ext: warm, well perfused, no clubbing, cyanosis or edema neuro: cnii-xii intact; 5/5 strength in the biceps, triceps, hip flexors, foot flexors and extensors bilaterally. sensation grossly intact throughout and equivalent bilaterally. pertinent results: wbc hgb hct mcv mch rdw plt ct :15am 10.2 11.3* 33.9* 96 32.0 17.1* 828* :48am 13.6* 10.7* 32.2* 94 31.2 17.2* 775* :40pm 30.6* :09pm 30.1* :18am 9.5 9.8* 29.7*# 91 29.9 17.1* 730* :36pm 23.5* :32pm 9.0 8.3* 23.7* 94 32.9* 15.8* 660* :30am 9.4 7.8* 24.6* 99* 31.1 15.5 934* :55am 10.4 7.1* 21.0*# 97 32.8* 15.3 842* :40am 11.9* 9.4* 29.3* 98 31.4 15.2 853* :05am 16.5* 9.2* 27.9* 97 31.8 15.1 808* :25am 21.8* 10.4* 31.7* 97 31.7 15.2 889* :00pm 21.3*# 12.4* 36.9* 97 32.3* 15.3 911*# . differential neuts lymphs monos eos baso 04:15am 71.8* 22.6 4.0 1.3 0.4 07:05am 85.1* 9.6* 4.8 0.2 0.1 02:00pm 84* 2 6* 7 0 0 0 0 1* . red cell morphology hypochr anisocy poiklo macrocy microcy polychr 02:00pm normal normal normal 1+ normal normal basic coagulation pt ptt inr(pt) 04:15am 12.4 25.1 1.0 02:18pm 13.6* 28.7 1.2* 09:00pm 14.5* 31.1 1.3* . chemistry renal & glucose glu bun crt na k cl hco3 angap :15am 132* 13 0.6 134 4.6 99 28 12 :48am 123* 9 0.6 133 4.8 98 27 13 :18am 105 10 0.4* 132* 4.3 100 26 10 :55am 134* 16 0.4* 131* 4.7 97 27 12 :40am 138* 12 0.5 132* 4.2 96 31 9 :05am 111* 13 0.4* 131* 4.2 95* 26 14 :25am 99 8 0.5 129* 4.1 94* 26 13 :00pm 114* 9 0.5 126* 4.1 90* 27 13 :00pm 113* 11 0.5 127* 5.1 86* 28 18 . alt ast ld(ldh) alkphos totbili dirbili indbili :55am 45* 31 545* 0.4 :40am 54* 25 760* 0.5 :05am 74* 31 919* 0.7 :25am 115* 79* * 1.6* :00pm 165* 130* 1677* 1.7* 0.7* 1.0 . lipase 02:00pm 105* calcium phos mg iron 04:15am 9.0 2.9 2.4 06:48am 8.9 3.4 2.1 05:18am 8.4 3.7 1.6 06:55am 8.1* 3.3 1.7 06:40am 8.5 2.8 1.8 07:05am 8.3* 2.9 2.0 41* 07:25am 8.7 3.4 1.8 02:00pm 9.3 3.8 2.0 . hematologic caltibc vitb12 folate hapto ferritn trf :05am 138* greater th 12.9 399* 833* 106* . immunology cea 07:05am 3.3 . blood gas lactate 02:47pm 1.5 . test result reference range/units ca -9 12 <37 u/ml this test was performed using the siemens () chemiluminescent method. . studies: pa & lat cxr - impression: 1. no free air under the diaphragms. 2. emphysema. 3. no acute cardiopulmonary abnormality. . ruq ultrasound - impression: 1. intra- and extra-hepatic biliary dilatation to the level of the pancreatic head where a heterogeneous ill-defined mass is identified, suspicious for pancreatic neoplasm. 2. 1.6-cm indeterminate liver lesion. 3. gallbladder sludge, without secondary signs of cholecystitis. . - impression: a biliary stricture was found in the lower third of the bile duct. there was severe post-obstructive dilation of the bile duct. a sphincterotomy was performed. the stricture was brushed for cytology. a biliary stent was placed. (sphincterotomy, cytology, stent placement) otherwise normal to third part of the duodenum . mrcp - impression: findings: there is a 5.4 x 3.8 cm complex cystic mass in the head and neck of the pancreas, the pancreatic duct is dilated upstream as well as downstream. the inferior aspect of the head of pancreas is the only pancreatic tissue that has normal high signal intensity on pre-contrast t1-weighted sequences, the remaining pancreatic parenchyma has decreased signal intensity and is isointense to spleen. the downstream pancreatic duct demonstrates mild increased signal intensity on t1-weighted sequences, which is hypointense compared to the signal intensity of bile in the gallbladder on t2 weighted images. the appearances are suggestive of mucin within the downstream pancreatic duct. the overall appearances of the pancreatic mass are most consistent with an invasive adenocarcinoma arising from an ipmn. there are several enlarged upper abdominal lymph nodes, some of which demonstrate cystic change versus necrosis (image 66, series 200). the superior mesenteric vein, splenic vein and portal vein are occluded at their confluence (image 64, series 200). the intrahepatic course of portal vein remains patent. collateral venous flow from the spleen is noted through an enlarged gastroepiploic vein. the hepatic artery is encased with abnormal soft tissue consistent with direct involvement with the tumor versus lymphadenopathy (image 16, series 5). there are multiple upper abdominal venous collaterals including dilated gastroepiploic vein. the intra- and extra-hepatic bile ducts are dilated and the suprapancreatic common bile duct measures 14 mm (image 3, series 7). a common bile duct stent is seen in situ and the intrapancreatic cbd as it traverses through the pancreatic head mass tapers down. there is enhancement of the intrahepatic bile ducts as well as the wall of the cbd highly suggestive of cholangitis. however, this could also be related to recent instrumentation. the gallbladder is distended and there is mucosal hyperenhancing with an area of interruption of the mucosal lining of the gallbladder mucosal, which is worrisome for gangrenous cholecystitis (image 80, series 200). there is mild hyperemia of the liver parenchyma around the gallbladder fossa. there are several liver lesions which demonstrate mild high-signal intensity on t2-weighted sequences, low-signal intensity on pre-contrast t1-weighted sequences with enhancement on the dynamic series. the largest of these is a 2.9 x 2.6 cm segment 7 lesion (image 9, series 5). one of the lesions in segment viii demonstrates a subtle halo of low-signal intensity on the dynamic series (image 27, series 200). overall appearances of these liver lesions are highly worrisome for metastatic disease. a less likely possibility would be hepatic abscesses. the spleen, adrenal glands and kidneys appear unremarkable. there is no free fluid in the abdomen. there is no abnormal marrow signal. multiplanar 2d and 3d reformations and subtraction images provided multiple perspectives for the dynamic series. impression: 1. unresectable large complex pancreatic head/neck mass most consistent with pancreatic adenocarcinoma arising from an ipmn. alternatively, the fluid filled collections could be pseudocysts in the setting of pancreatitis due to an obstructing adenocarcinoma. there is extensive venous and arterial involvement as described above. 2. multiple liver lesions with appearance worrisome for metastatic disease. a less likely possibility is multiple liver abscesses. 3. upper abdominal lymphadenopathy. 4. enhancement of the intra- and extra-hepatic bile ducts, possibly indicating cholangitis. 5. distended gallbladder with hyperenhancing mucosa and foci of interruption of the mucosal lining worrisome for gangrenous cholecystitis. clinical correlation is recommended. . egd: normal mucosa in the whole stomach no acitve bleeding or stigmata of recent bleeding was noted from the sphincteortomy site. the apex of the sphincterotomy was emperically cauterized . not clear if this is the site of gi bleeding. otherwise normal egd to second part of the duodenum . colonoscopy: diverticulosis of the whole colon polyp in the sigmoid colon (polypectomy) grade 3 internal hemorrhoids preparation was fair. therefore, any underlying small lesions may have not been visible. no source of bleeding identified. terminal ileum was intubated with no bleeding. otherwise normal colonoscopy to terminal ileum . cytology: common bile duct brushing: atypical. a few groups of atypical glandular epithelial cells in crowded groups, non-specific, in a background of reactive glandular epithelial cells, bile pigment and bacteria. . blood and urine cultures were negative brief hospital course: mr. is is a 59 year old male who presented with dehydration, nausea, abdominal pain, and poor appetite who was found to have a pancreatic head mass and cholangitis. . # cholangitis - the patient's wbc count was elevated on presentation. he spike a fever shortly after arrival on the floor. he was treated with ciprofloxacin and flagyl and had an the morning after admission with sphincterotomy, stent placement, and brushings for cytology. the following day, his wbc count was lower, he was afebrile, pain free, and his diet was advanced. he was discharged with antibiotics to complete a 14 day course. the ciprofloxacin needed to be switched to levofloxacin because cvs careplus did not have ciprofloxacin. . # pancreatic head mass - initially seen on abdominal ultrasound and concerning for malignancy. as the patient was unable to get ct scan due to iodinated contrast allergy, surgery recommended an mrcp for further evaluation. mrcp showed an unresectable large complex pancreatic head and neck mass and multiple liver lesions with appearance worrisome for metastatic disease or less likely possibility is multiple liver abscesses. hematology oncology was consulted and their recommendations were to await the cytology and ca19-9 an abnormality in either of which would be diagnostic of pancreatic cancer. surgery was consulted and they determined that the mass was unresectable. his ca -9 was normal. he needs an eus for diagnosis which is scheduled with dr. . he also has an appointment with dr. in oncology. . # thombosis: per heme-once, thrombi in mesenteric veins do not embolize into the lungs, and they do not reccommend anticoagulating for this. . # hyponatremia - the patient was hyponatremic on presentation with a serum sodium of 127. his hyponatremia improved with iv fluids. . # acute blood loss anemia/gi bleeding- on patient was noted to have a maroon colored stool. at that time his pressure was noted to be systolic 80-90 and a hct was 21 down from 29 (although a repeat was noted to be 24.6). he was transferred to the micu for concern for a post-sphincterotomy bleed. he was transfused blood and an endoscopy was performed that day in the micu and no source of bleeding could be found. the sphincterotomy site was cauterized prophylactically. the patient tolerated the procedure without any complications and was called out to the floor team on . he also had a colonoscopy which revealed a sigmoid polyp which was removed but no evidence of bleeding. his hematocrit remained stable. . # depression - the patient has a history of chronic, severe depression. he was continued on prozac. social work also saw the patient to facilitate finding services to help him in the community. his psychiatrist dr. c was contact and he had an appointment with him on the day of discharge. he denied suicidal ideation. . # concern for gangrenous cholecystitis on mrcp - felt to be low prob as had no abdominal pain after stenting . # code status was discussed and he wished to be full code but expressed hesitation about life prolonged life support if it became necessary and there was low probability for recovery. in his word, "for now, please resusitate me." medications on admission: prozac 60 mg daily ibuprofen and aspirin prn back pain discharge medications: 1. fluoxetine 20 mg capsule sig: three (3) capsule po daily (daily). 2. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 6 days: 6 more days plus dose for tonight. disp:*19 tablet(s)* refills:*0* 3. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 6 days. disp:*6 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: 1. cholangitis 2. pancreatic head mass, likely malignant 3. multiple liver masses, likely metastases 4. gastrointestinal bleed secondary diagnosis: major depression discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: dear mr. , you were admitted to the hospital for evaluation of nausea and abdominal pain. you were found to have cholangitis (an infection of the bile tract). you had a procedure called and they placed a stent to help keep this open. you will need a repeat in about 2 months. this appointment has been made for you. you will also need to continue taking antibiotics for six more days. you were also found to have masses in your pancrease and liver that are concerning for cancer. you have an appointment with an oncologist (cancer doctor) this week. you will also be scheduled for an endoscopic ultrasound to evaluate the lesions in your liver. you also developed a bleed in your gastrointestinal tract. this may have been related to the procedure you had and is a complication of this procedure. the endoscopist did not find any source of bleeding but they cauterized the area around the stent to prevent further bleeding. they also did a colonoscopy and removed a polyp but did not see any sign of bleeding. the following additions have been made to your medications: take the antibiotics levofloxacin and metronidazole (flagyl) for six more days to completely treat the bile infection. one of your antibiotics (ciprofloxacin) is being switched to a nearly equivalent medicine that is available at the pharmacy. it is called levofloxacin. we will give you your second dose of ciprofloxacin here and then start the levofloxacin, which is once a day tomorrow morning. followup instructions: tuesday at 4pm with dr. . dr. office will call you and schedule you for an endoscopic ultrasound soon. oncology: provider: , md phone: date/time: 10:00 provider: , md phone: date/time: 10:00 dr. specialty: internal medicine-primary care date/ time: 8:10am location: , - jp phone number: your repeat is scheduled as follows: provider: 2 (st-4) gi rooms date/time: 11:00 provider: , md phone: date/time: 11:00 procedure: other endoscopy of small intestine endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct endoscopic polypectomy of large intestine endoscopic excision or destruction of lesion of biliary ducts or sphincter of oddi diagnoses: sciatica other chronic pain anemia, unspecified malignant neoplasm of liver, secondary acute kidney failure, unspecified hyposmolality and/or hyponatremia hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure malignant neoplasm of head of pancreas other emphysema cholangitis benign neoplasm of colon chronic vascular insufficiency of intestine diverticulosis of colon (without mention of hemorrhage) stricture and stenosis of esophagus internal hemorrhoids without mention of complication essential thrombocythemia 

Answer: The patient is high likely exposed to