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: patient recorded as having no known allergies to drugs attending: chief complaint: dizziness, black stool major surgical or invasive procedure: egd colonoscopy history of present illness: this is a 63 year old f with dm, afib on coumadin who p/w dizziness and low bp. she reports that she was in her usual state of health until yesterday. yesterday, she whent to her doctor's office to have her inr checked. she reports that she missed lunch. later on in the day she began feeling lightheaded and dizzy, but attributed this to missing a meal. her doctor subsequently called and told her not to take her coumadin. she awoke this morning around 6am and noticed dark black, sticky stool. she took her bp at home: 95/40. she denies any diarrhea, no hematemasis. she reported an intermittent sharp "poke" in right chest just below her present, which has now resoved; no sob, no n/v, no sweating. . in the ed: in the ed, she did not tolerate ng lavage, but there was no overt blood. she was noted to have dark marroon stool but no melena. her hct was 18; inr 6.4. two 18 guage iv's were placed. she was given vitk 10mg and protonix. she was started on fluids and ordered 2 units ffp and 2 units prbc's but did not receive it yet. vitals on arrival: temp 98.3 hr67 bp130/53 rr18 100%ra vitals on transfer: hr 51 (bb) 110/40->95/36 . ros: (+)as in hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no dysuria. denied arthralgias or myalgias. past medical history: type ii diabetes complicated by retinopathy, neuropathy, nephropathy, atrial fibrillation on chronic coumadin therapy hypertension, hypercholesterolemia breast cancer four years ago which was resected; she also had lymph node resection, received chemo and radiotherapy in , no recurrence she also had three c-sections av fistula surgery therapy for her retinopathy. social history: the patient emigrated from approximately 25 years ago. she has 4 children and lives with 2 of them here in . she has been a widow for 2 years and suffered some depression after her late husband's death. she is a never smoker, drinks rare wine, and denies drug use. family history: n/c physical exam: vs: hr 70 bp 115/60 general: awake, alert, nad. heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. pertinent results: ekg: sinus bradycardia, biphasic twaves in v4-v6 and i, avl unchanged from prior . egd: impression: erosion and erythema in the antrum compatible with erosive gastritis (biopsy) erythema in the duodenum a white nodularity was seen in the duodenum, likely consistent with cholesterol deposition. (biopsy) otherwise normal egd to third part of the duodenum recommendations: routine post procedure orders will inform patient of biopsy results and direct treatment accordingly. trend hct. proceed to colonoscopy. ppi. avoid all nsaids and -2 inhibitors. take tylenol for pain. . colonscopy: impression: polyps in the cecum (polypectomy) polyps in the ascending colon (polypectomy) polyps in the transverse colon (polypectomy) polyps in the sigmoid colon (polypectomy) otherwise normal colonoscopy to cecum recommendations: etiology of bleeding may have been from the vascular appearing polyp in the cecum. recommend outpatient capsule endoscopy. will follow up biopsy results and inform patient. repeat colonoscopy in 1 year given fair prep and multiple polyps. would wait 2 days before restarting coumadin if safe from a cardiovascular standpoint. . nebh : hct 33 . labs on admission: 11:35am blood wbc-11.6*# rbc-2.05*# hgb-6.2*# hct-18.7*# mcv-91 mch-30.2 mchc-33.2 rdw-17.9* plt ct-179 11:35am blood neuts-80* bands-0 lymphs-16* monos-2 eos-0 baso-0 atyps-2* metas-0 myelos-0 nrbc-4* 11:35am blood pt-54.8* ptt-30.5 inr(pt)-6.4* 11:35am blood glucose-294* urean-119* creat-2.8* na-137 k-3.7 cl-99 hco3-26 angap 03:57am blood calcium-8.8 phos-3.9 mg-2.6-16 . cardiac enzymes: 11:35am blood ck(cpk)-297* 09:34pm blood ck(cpk)-276* 11:35am blood ctropnt-0.06* 09:34pm blood ck-mb-4 ctropnt-0.06* . labs on discharge: 05:40am blood wbc-8.5 rbc-3.19* hgb-9.1* hct-28.0* mcv-88 mch-28.6 mchc-32.6 rdw-17.9* plt ct-145* 05:40am blood pt-13.4 ptt-22.6 inr(pt)-1.2* 05:40am blood glucose-126* urean-50* creat-2.1* na-141 k-3.7 cl-107 hco3-25 angap-13 brief hospital course: 63 year old f with dm, afib on coumadin who p/w symptomatic anemia, elevated irn, melena c/w gib who is currently hd stable. . # gib: the patient had a dramatic drop in her hct from a baseline of 33 down to 18 on admission. even though the patient's vital signs were stable on admission, she was on a beta blocker, thus was admitted initially to the icu for concern for hypovolemia. the gi bleed was thought to be precipitated by being significantly supratherapeutic with her inr. in the icu, the patient was placed on protonix iv bid, received 2 units ffp and 2 units prbc's. as she was hd stable, she was monitored overnight in the micu on telemetry but was did not receive endocsopy immediately then transferred to the floor. the patient's asa and warfarin as well as diuretics and anti-hypertensives were held. the patient had a colonoscopy and egd during admission, which showed evidence of gastritis and multiple polyps, likely the source of bleeding in supratherapeutic inr. will need capsule endoscopy as an outpatient as may have a small bowel lesion contributing to bleed. she will follow up with dr. as an outpatient. . # troponin leak: as the patient had atypical chest pain cardiac enzymes were drawn. two sets showed no increasing trend, most likely at the patient's baseline. the patient's cardiac medications were held given gi bleed including aspirin, carvedilol, but restarted prior to discharge. . # type 2 dm: while the patient was npo she received only dose of patient's home nph which is 20 (gets 45 and 40 at home). continued insulin sliding scale, qidachs fs bg. . # a fib: the patient was in sinus bradycardia during her hospitalization thus far. chads score high 2+. continued amiodarone as it was likely maintaining normal sinus rhythm because of antiarrhythmic properties. no need for beta blockers at this time, but restarted low dose on discharge. held warfarin as was supratherapeutic on admission and has gi bleed, but restarted on discharge. monitored on telemetry. . # htn: as above, the patient had borderline blood pressures during admission in the setting of gi bleed. held multiple antihypertensives including carvedilol, isosorbide dinitrate, torsemide, metolazone, hydralazine and candesartan during admission, but restarted carvedilol and candesartan prior to discharge. . # diastolic dysfunction: echo in had ef 60% and mild diastolic dysfunction with inc e/e'. the patient was euvolemic on admission and during hospitalization. . # hyperlipidemia: continued atorvastatin. . # esrd: secondary to diabetic nephropathy. not currently on hd. restarted calcitriol. monitored daily. . # glaucoma: switched bimatorpost to latanoprost as home med non-forumlary. continued dorzolamide. continued timolol . # sleep apnea: cpap at night . prophylaxis: ppi , sc heparin . fen: clears, replete lytes prn . access: pivs (2) . code status: full . medications on admission: amiodarone 200 mg tablet - 1 tablet(s) by mouth once a day atorvastatin - 80 mg tablet - 1 tablet(s) by mouth once a day bimatoprost - 0.03 % drops - 1 drop both eyes at bedtime calcitriol 0.25 mcg capsule - 1 capsule(s) by mouth once a day candesartan 32 mg tablet - 1 tablet(s) by mouth once a day carvedilol - 3.125 mg tablet - 1 tablet(s) by mouth once a day dorzolamide-timolol 0.5 %-2 % drops - 1 drop both eyes twice a day hydralazine - 50 mg tablet - 1 1/2 tabs tablet(s) by mouth twice a day isosorbide dinitrate - 40 mg tablet - 20 tablet(s) by mouth once a day latanoprost - 0.005 % drops - 1 gtt ou at bedtime metolazone - - 5 mg tablet - 1 tablet(s) by mouth q thursday torsemide - - 20 mg tablet - 3 tabs tablet(s) by mouth twice a day warfarin - 5 mg tablet - 1 tablet(s) by mouth once a day aspirin - 81 mg tablet, chewable - 1 tablet(s) by mouth once a day insulin nph & regular human - 100 unit/ml (70-30) suspension - 45 in the am and 40 in the pm twice a day discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. coumadin 2 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. candesartan 32 mg tablet sig: one (1) tablet po once a day. 9. carvedilol 3.125 mg tablet sig: one (1) tablet po twice a day. 10. torsemide 20 mg tablet sig: three (3) tablet po twice a day. 11. aspirin 81 mg tablet sig: one (1) tablet po once a day. 12. bimatoprost 0.03 % drops sig: one (1) ophthalmic at bedtime. 13. insulin nph & regular human 100 unit/ml (70-30) suspension sig: as directed subcutaneous twice a day: 45 units in the am, 40 units in the pm. 14. outpatient lab work please check cbc and pt, ptt, inr discharge disposition: home discharge diagnosis: primary diagnoses: gi bleed, gastritis, colonic polyps . secondary diagnoses: type ii diabetes complicated by retinopathy, neuropathy, nephropathy, atrial fibrillation on coumadin therapy hypertension hypercholesterolemia breast cancer av fistula surgery therapy for retinopathy discharge condition: the patient was hemodynamically stable and afebrile prior to discharge. discharge instructions: you were admitted to for evaluation of dizziness and lightheadedness, you were found to have a gi bleed. the source of this bleed is not entirely clear, however you had an egd and colonoscopy which showed evidence of gastritis and polyps. you will need to be seen by a gi physician in the next 2 weeks for a follow up and likely a capsule endoscopy to look for other signs of bleeding. you should have your labs drawn at your office visit on friday of this week for your fistula. you will be provided with a prescription for these labs. . medication changes: stop hydralazine stop isordil stop metolazone . continue: candesartan, carvedilol and toresmide for your blood pressure - restart tomorrow am. amiodarone for your atrial fibrillation. restart coumadin 2mg tomorrow am. restart aspirin 81mg tomorrow am. . please have your labs drawn on friday at your appointment for your fistulagram. . if you experience chest pain, shortness of breath, bright red blood per rectum, black tarry or sticky stools, fever, chills or any other worrisome symptoms. followup instructions: please follow up with dr. in the gi department to schedule an outpatient endoscopy and to get the results of the biopsies on at 3:30p. the number to reschedule the appointment is ( . please follow up with dr. next week. the number to schedule the appointment is (. . please keep the following appointments: provider: , md phone: date/time: 12:30 provider: . phone: date/time: 8:45 provider: , m.d. phone: date/time: 10:00 procedure: endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: end stage renal disease acute posthemorrhagic anemia atrial fibrillation personal history of malignant neoplasm of breast diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes unspecified glaucoma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified long-term (current) use of insulin unspecified sleep apnea long-term (current) use of anticoagulants hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy other specified gastritis, without mention of hemorrhage unspecified drug or medicinal substance causing adverse effects in therapeutic use lymphangioma, any site 

Answer: The patient is high likely exposed to