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: anemia major surgical or invasive procedure: egd history of present illness: 60m with pmh of cad s/p 3 vessel cabg, iddm and anemia who presents with one day of dizziness. the patient states that he woke up at 4am to go to the bathroom this morning and felt dizzy. he returned to bed and was persistenly dizzy with all subsequent attempts to get out of bed. patient notes that he had a dark bowel movement this morning. he also vomited once this orning. this afternoon, he came to dermatology clinic for scheduled biopsy of an umbilic nodule. on , the patient had had a ct scan of his abdomen that revealed a 4.5cm pancreatic mass with mesenteric and umbilical nodules concerning for metastases. following the derm appointment, the patient came to the ed for further evaluation. . in the ed, initial vs were: t 97.6 p 106 bp 94/61 r 18 o2 100% ra patient did not take his insulin this am and had a blood glucose of 707 in the ed for which he received 10 units of insulin. repeat fsbs was 489. the patient was also noted to have a positive troponin of .27 and an index of 9.1. cardiology was contact and it was thought to be due to demand in the setting of a hematocrit of 20. cardiology recommended giving the patient and aspiring, which was done. in addition, the patient received 2l ns. cxr showed no acute cardiopulmonary process. ekg showed t wave inversions in inferior leads, st elevation in , depression in v5 and v6. . on arrival to the icu, vitals 98.5 102 101/55 12 95% on 2l. pt had no complaints. ros as below. pt received additional 10 units of insulin for persistently elevated blood glucose. . review of systems: (+) per hpi. in addition, constipation on fe, dry cough, and loss of appetite for the last few weeks. he also notes a 7 pound intentional weight loss since . (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied shortness of breath. denied chest pain or tightness, palpitations. denied nausea, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: pancreatic tumor with abdominal lymphadenopathy anemia insulin-dependent diabetes mellitus chronic renal insufficiency diabetic nephropathy bilateral hernia repair age 5 congestive heart failure coronary artery disease s/p 3-vessel cabg hypertension hyperlipidemia atrial septal defect repair exposure in diabetic retinopathy social history: mr. works as a data center manager for , has been quite stressed and busy at work in the past 5 years. he is married, has 3 children. he never smoked, drinks only occasionally. he was exposed to in . family history: his father died at the age of 84 from liver cancer, had htn. mother is in her 80s and alive, had breast ca. he has one brother who has asthma, his children are healthy. physical exam: vitals: t: 97.1 bp: 130/80 p: 80 r: 18 o2: 100% 2l general: nad heent: no oropharyngeal erythema or exudate. lungs: decreased breath sounds, rales at basees. cv: rrr. no m/r/g. abdomen: +bs. soft. ntnd. palpable ln umbilicus s/p bx incision. rectal: dark brown, guaiac positive stool. ext: no c/c/e. pertinent results: images: ct abd - - 1. 4.5-cm spiculated mass centered in the distal pancreas, highly concerning for malignancy. mesenteric nodule and umbilical nodules are compatible with metastatic foci. 2. splenomegaly. 3. cholelithiasis, no evidence of acute cholecystitis. 4. limited assessment of solid organs due to lack of iv contrast. . cxr - - no acute cardiopulmonary process. . ekg: regular rate and rhythm, q waves in ii with questionable st segment elevations. new t wave inversion in ii, st segment depression in v5 and v6. . echo - the left atrium is mildly dilated. a possible secundum type atrial septal defect is seen with left to right flow (clips 43/46 - vs. prominent caval flow). there is mild (non-obstructive) focal hypertrophy of the basal septum. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the basal half of the inferior septum, inferior, and inferolateral walls. the remaining segments contract normally (lvef = 35 %). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , the regional left ventricular systolic function is more extensive and the severity of mitral regurgitation has increased. a possible secundum type atrial septal defect is now seen. if the clinical suspicion for an asd is high, a tee or follow-up tte with saline contrast is suggested. brief hospital course: 60m with h/o dm1, cad s/p 3 vessel cabg and new pancreatic mass and abdominal lymphadenopathy concerning for metastatic presenting with symptomatic anemia. # pt most likely gib from mets to the gi tract from known pancreatic mass. other possibilities include gastritis/duodenitis, pud, avms, or colonic lesions. pt received a total of 8units prbc, and stable to 32 transferred to the floor. egd/ revealed only gastritis/duodenitis and coffee grounds in stomach. capsule with coffee grounds as well. pt had black loose stool, first bm since admission, expected to pass old blood. pt was continued on iv ppi and had hct remained stable, and was sent out with close follow up. # elevated trop- demand ischemia vs. - pt has wma on echo, discussed with cards, and since clinically stable, and overall ce trending downward, and ekg not associated w/ new cp, cardiology agrees w/ egd tomorrow. concerning troponin 2.0 from 1.7, overall trending down from peak 2.5, and reassuring that ck, ckmb . continued asa, statin. # pancreatic mass- newly diagnosed with pancreatic cancer, deferred treatment to outpatient. # congestive heart failure - last ef 35%, got 2l ns in ed. no o2 requirement. pt remained euvolemic. # pt was below baseline of 3.0 during admission. medications on admission: atorvastatin - 80 mg po daily calcitriol - 0.5 mcg po daily insulin lispro - 100 unit/ml solution - sliding scale once a day as needed for sq injection dm metoprolol tartrate - 12.5mg po bid omeprazole - 20 mg po bid cyanocobalamin - 2,000 mcg po daily ferrous gluconate - 325 mg po bid insulin nph human recomb - 100 unit/ml suspension - inject ut dict for dm niacin - 500 mg tablet po daily vitamin a-vit c-vit e-zinc-cu - 1 tablet po daily senna discharge medications: 1. atorvastatin 40 mg tablet sig: two (2) tablet po hs (at bedtime). 2. calcitriol 0.25 mcg capsule sig: two (2) capsule po daily (daily). 3. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 6. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 7. niacin 500 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 8. ocuvite preservision tablet sig: one (1) tablet po daily (). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. insulin regular human 100 unit/ml cartridge sig: other injection once a day: per sliding scale as needed. discharge disposition: home discharge diagnosis: primary diagnosis: - upper gi bleed - gastric wall invasion vs. gastric varices - demand ischemia of the heart (while you had low blood counts) secondary diagnosis: - metastatic pancreatic cancer - chronic renal disease - diabetes - coronary artery disease s/p 3-vessel cabg - hypertension - hyperlipidemia - atrial septal defect repair - diabetic retinopathy discharge condition: good, hematocrit stable discharge instructions: you had a gi bleed that may be due to metastasis from your pancreatic cancer or from gastritis. you were hospitalized until your blood counts remained stable. you may expect more dark stools while the remaining blood is passing through, but if you have persistent black stools, or start feeling light-headed or weak please return to the ed or contact dr. immediately. also return if you have a fever >101, or new chest pain medication changes: - start taking omeprazole 40mg twice a day until you see dr. - take aspirin 81mg once per day followup instructions: after speaking with you, you said you prefer to make the appointment with your primary care doctor, dr. , for convenience of coordinating with your work. please make sure to follow up in weeks. you already have an appointment with dr. , your gi doctor at 12:45pm. at time of discharge the pathology report for your skin biopsy was still pending, please have him follow up with this. you also mentioned you already have an appointment with your cardiologist, dr. . provider: , md phone: date/time: 3:30 provider: , md phone: date/time: 3:30 md procedure: other endoscopy of small intestine closed biopsy of skin and subcutaneous tissue diagnoses: acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin secondary malignant neoplasm of skin hemorrhage of gastrointestinal tract, unspecified varices of other sites other and unspecified coagulation defects diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy secondary malignant neoplasm of other digestive organs and spleen long-term (current) use of aspirin malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to