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: penicillins / motrin / latex / iv dye, iodine containing / trees and grass attending: chief complaint: fatigue, black stools major surgical or invasive procedure: picc line placement history of present illness: 66 yo w with a hx of itp (questionable dx), cirrhosis, epilepsy, gerd, htn, and chronic pain presenting with worsening fatigue and dark stools for 2-3 days and admitted to the icu for hypotension. hct checked at osh was 27 (down from a baseline in the high 30s). her hematologist referred her to our ed for further evaluation. on presentation, bp in the 90/60 range with hr 60-70 (takes low-dose bb at home) and patient in no acute distress complaining of some mild fatigue and lightheadedness. hct in ed 27.9 with plts of 74. she was given 2l ns in the ed, 1 pack of plts, and 1 u prbc. rectal exam in the ed was notable for guiaic positive brown stool. ng lavage was requested, but not performed. . an abdominal ct was done for further evaluation of the abdominal pain, which she has had since having a hysteroscopy + d&c done on at . per preliminary read, it showed a cirrhotic liver with some peri-hepatic fluid, but was otherwise unremarkable for source of hct drop. gi was consulted and recommended ppi bolus + drip, they will evaluate her this am. . on arrival to the , the patient reports that she has been feeling weakness and fatigue since her recent hospital discharge, occasional increased dyspnea on exertion, and intermittent chest pain. she denies hematemesis or hematochezia. regarding her recent hospitalization, she reports that she presented to osh for evaluation of an excruciating headache. she states she had a reaction to the anesthesia from her recent procedure possibly complicated by depakote therapy, and had high ammonia levels. she spent two weeks in the hospital and at that time her depakote was weaned off and keppra started. . review of sytems: + per hpi - for fever, chills, sweats, nausea, vomiting, prutitus, dysuria, rashes. no hx of known liver disease, hepatitis, blood transfusions, or iv drug use. past medical history: itp-extent of evaluation unclear bleeding s/p d&c gerd epilepsy polio, wheel chair bound htn hld ptsd social history: wheelchair bound polio married, no children no tobacco, hx of or current etoh or iv drug use family history: no hx of liver disease grandmother with myasthenia mother with breast ca physical exam: admission physical exam: vs: 95.2, 91/46, 56, 17, 96% on ra general: alert, oriented, no acute distress, obese, pale complexion heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: +bs, soft, obese, tender to deep palpation diffusely with voluntary guarding throughout ext: warm, well perfused, symmetric pulses, 1+ pitting edema neuro: face symmetric, moves all four extremities pertinent results: 07:45am blood wbc-6.2 rbc-2.99* hgb-10.3* hct-30.1* mcv-101* mch-34.5* mchc-34.3 rdw-15.6* plt ct-81* 01:48pm blood hgb-10.2* hct-29.9* 04:18am blood wbc-6.2 rbc-2.86* hgb-9.7* hct-28.5* mcv-100* mch-34.0* mchc-34.0 rdw-16.3* plt ct-73* 08:18pm blood wbc-7.5 rbc-3.07* hgb-10.6* hct-31.0* mcv-101* mch-34.5* mchc-34.2 rdw-16.3* plt ct-76* 03:00pm blood wbc-5.1 rbc-2.80* hgb-9.6* hct-28.8* mcv-103* mch-34.2* mchc-33.2 rdw-16.3* plt ct-76* 07:24am blood wbc-5.6 rbc-2.74* hgb-9.5* hct-28.3* mcv-103* mch-34.8* mchc-33.7 rdw-16.2* plt ct-unable to 12:51am blood wbc-6.2 rbc-2.71*# hgb-9.6*# hct-27.9*# mcv-103* mch-35.3* mchc-34.3 rdw-15.8* plt ct-74* 12:51am blood neuts-67.5 bands-0 lymphs-21.6 monos-4.2 eos-2.7 baso-0.5 07:45am blood plt ct-81* 07:45am blood pt-16.7* ptt-30.9 inr(pt)-1.5* 04:18am blood plt ct-73* 04:18am blood pt-16.6* ptt-31.6 inr(pt)-1.5* 08:18pm blood plt smr-very low plt ct-76* 07:24am blood plt smr-unable to plt ct-unable to 12:51am blood plt ct-74* 12:51am blood pt-15.2* ptt-28.0 inr(pt)-1.3* 07:24am blood fibrino-366 07:45am blood glucose-121* urean-12 creat-0.8 na-141 k-3.7 cl-109* hco3-25 angap-11 04:18am blood glucose-106* urean-16 creat-0.8 na-142 k-3.9 cl-111* hco3-22 angap-13 12:51am blood glucose-104* urean-20 creat-0.8 na-143 k-4.1 cl-110* hco3-27 angap-10 07:45am blood alt-30 ast-57* ld(ldh)-264* alkphos-83 totbili-0.9 04:18am blood alt-31 ast-57* alkphos-82 totbili-1.0 12:51am blood alt-36 ast-68* ld(ldh)-301* alkphos-110* totbili-0.4 01:48pm blood probnp-261 07:45am blood calcium-8.0* phos-2.6* mg-1.8 04:18am blood calcium-8.1* phos-4.0 mg-2.2 iron-58 12:51am blood albumin-3.3* cholest-143 04:18am blood caltibc-325 ferritn-97 trf-250 02:39pm blood caltibc-339 ferritn-86 trf-261 12:51am blood hapto-21* 12:51am blood triglyc-82 hdl-66 chol/hd-2.2 ldlcalc-61 12:51am blood tsh-4.4* 04:18am blood hbsab-pnd hbcab-pnd hav ab-pnd 02:39pm blood hav ab-positive 12:51am blood hbsab-negative hbcab-negative hav ab-negative 02:39pm blood ama-negative smooth-positive * 02:39pm blood -positive * titer-pnd 02:39pm blood afp-3.0 02:39pm blood igg-1556 04:18am blood hcv ab-pnd 12:51am blood hcv ab-negative 02:39pm blood ceruloplasmin-pnd 02:39pm blood alpha-1-antitrypsin-pnd . echo-the left atrium is elongated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mildly dilated right ventricle with vigorous global biventricular systolic function. mild mitral regurgitation. mild pulmonary hypertension. . ct abd/pelvis-mpression: 1. cirrhotic liver with small amount of perihepatic and trace mesenteric, paracolic gutter, and pelvic ascites. spleen upper limits of normal in size. 2. colonic diverticulosis without diverticulitis. 3. cholelithiasis without evidence for cholecystitis. 4. uterus was better evaluated on recent prior ultrasound. multiple incidental findings without any acute inflammatory changes on this non-contrast examination, which limits evaluation for fine parenchymal detail. . cxr-findings: relatively low lung volumes. signs of mild-to-moderate pulmonary edema. moderate cardiomegaly. no visible nasogastric tube on the radiograph. no evidence of pneumonia. no larger pleural effusions. . ruq u/s-impression: 1. irregular heterogeneous-appearing liver suggestive of cirrhosis with no focal lesions. 2. cholelithiasis without cholecystitis. 3. mild splenomegaly. 4. minimal free fluid in the morison's pouch. 5. patent portal vein, hepatic veins, hepatic artery, and the inferior vena cava. . cxr -cardiomegaly is moderate-to-severe in particular involving the left ventricle, unchanged. mediastinal contours are stable. there is diffuse interstitial engorgement, right more than left, grossly unchanged since . the right picc line tip can be seen to the level of low svc. small amount of pleural effusion cannot be excluded bilaterally. . ueni-impression: no deep venous thrombosis of the left upper extremity. . leni- impression: no right lower extremity deep venous thrombosis. the deep veins in the calf are not visualized. brief hospital course: 66 yo w with itp(?), possible cirrhosis, presents with anemia and hypotension in the setting of days of dark stools. given substantial hct drop, and hypotension admitted to for continued evaluation and monitoring of status. . # acute blood loss anemia/gastrointestinal bleeding- patient presented with hct about 10 points lower than recent baseline, as well as symptoms of fatigue, weakness, dyspnea on exertion. she reported 3 days of black tarry stools, concerning for upper gi bleed. rectal exam revealed guaiac positive brown stool and the pt had no melena during her stay. ct a/p revealed no evidence of bleed. given her new ct finding of cirrhosis (and laboratory findings supporting this), gi/hepatology was consulted who performed an egd that revealed grade ii non-bleeding varices and portal gastropathy, the likely source of her blood loss. she was started on nadolol, ppi, and sucralfate. pt transfused 1 unit of prbcs on . hct on discharge 31. . # hypotension: clinic notes show sbp ranges 120??????s. given recent bleed, hypovolemic hypotension is likely and responded to iv fluid boluses. she did not appear septic; however given cirrhosis/ascites with possible ugi bleed, translocation of intestinal flora is possible. she was started on a 7 day course of ciprofloxacin. hypotension did not reoccur on the medical floor. . # thrombocytopenia: initially detected in late after presenting to the ed with epistaxis. extent of work up unclear from records available in . be related to underlying cirrhosis rather than itp (as initially suspected). pt has a schedule hematology follow up. . #cirrhosis: has never had a formal evaluation. cirrhotic-appearing liver and ascites seen on ct imaging. varices seen on egd, pt with thrombocytopenia, elevated inr, and likely encephalopathy with elevated ammonia level at osh. no strong risk factors for viral hepatitis and no etoh use. be ai hepatitis or nash based on lab work-see results section. hepatitis serologies are still pending at the time of discharge. the patient will follow up with dr. after discharge for further treatment and assessment. . #pulmonary edema/noctural hypoxia- chest xray had findings consistent with pulmonary edema. she also had peripheral edema on exam and reported long standing orthopnea. it also appears that outpatient furosemide was recently discontinued. an echocardiogram was obtained that showed an ef of 55%, a mildly dilated rv, and vigorous global biventricular systolic function. repeat cxr showed stable interstitial markings. pt was on room air during the day. she did have desats at night and has known osa. pt was not discharged on lasix given the above. . #?allergic reaction: pt reported 2 inner lip lesions on day of discharge. she denied any mouth/tongue/lip/facial swelling, rash or sob. pt stated this happened prior when she was exposed to latex. her room was latex free and there are no latex gloves on the floor. this was monitored during the day of discharge and did not worsen. pt has an epi pen at home in case of severe allergic reaction. she was advised to continue to monitor symptoms at home. she knows how to use the epi pen. . # seizure d/o: continued outpt regimen of keppra 250 mg and zonegran 200 mg qhs . # chronic pain: continued outpt lyrica daily and oxycodone prn. pt given rx for 8 tablets of oxycodone upon discharge. . # asthma: continued outpatient flovent . # htn: initially held antihypertensives given suspected gi bleed and hypotension. however as this stabilized, she was started on nadolol for varices and her metoprolol was stopped. . #rle edema-leni negative for dvt. lue edema-neg for dvt . # hld: held simvastatin as ldl 60 and given dx of cirrhosis . # full code confirmed . # contact with husband at medications on admission: - latanoprost 0.005 % drops 1 drop by eye daily - tizanidine 2 mg tablet 1 tablet(s) by mouth daily - pramipexole 1.5 mg tablet 1 tablet(s) by mouth hs - lyrica 300 mg qhs - simvastatin 20 mg tablet 1 tablet(s) by mouth daily - metoprolol tartrate 25 mg tablet 1 tablet(s) by mouth daily - flovent 220 2 twice daily - keppra 250 mg - imitrex 50 rarely - oxycodone 5 mg q4-6 prn pain - zonegran 100 mg 2 caps at bedtime - acetaminophen 650 mg daily 1 tab q 4-6 hrs discharge medications: 1. latanoprost 0.005 % drops sig: one (1) ophthalmic once a day. 2. lyrica 300 mg capsule sig: one (1) capsule po at bedtime. 3. pramipexole 1.5 mg tablet sig: one (1) tablet po at bedtime. 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. levetiracetam 250 mg tablet sig: one (1) tablet po bid (2 times a day). 6. zonisamide 100 mg capsule sig: two (2) capsule po hs (at bedtime). 7. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 10. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): titrate to produce bowel movements daily. disp:*qs ml(s)* refills:*0* 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days. disp:*8 tablet(s)* refills:*0* 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. oxycodone 5 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain: do not drive when taking this medication. take only as directed. disp:*8 tablet(s)* refills:*0* discharge disposition: home with service facility: life care at home of mass discharge diagnosis: cirrhosis of the liver acute blood loss anemia due to gastrointestinal bleeding/gastritis varices thrombocytopenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted with bleeding from your gastrointestinal tract. for this, you underwent an endoscopy that showed varices and gastritis. you were given a blood transfusion. you were also found to have evidence of cirrhosis of the liver and were evaluated by the hepatology (liver) team. you were started on nadolol, cipro, protonix and lactulose for this. the cause of the cirrhosis is still being determined. you should be sure to follow up with dr. in clinic for continued care. . you reported some sores on your lower lip on day of discharge, but did not have lip/mouth/tongue swelling or shortness of breath. your symptoms did not worsen during admission. please continue to monitor your symptoms. you already have an epi pen at home and can use this as directed/as needed if your symptoms were to worsen. . medication changes: 1.start nadolol and stop metoprolol 2.continue cipro for 4 more days 3.start protonix 40mg twice a day 4.start lactulose take so that you have ~3bowel movements daily . please take all of your medications as prescribed and follow up with the appoints below. followup instructions: please call your pcp . at to schedule a follow up appointment after discharge. . please also call dr. office at ( to schedule a follow up appointment after discharge. the office is aware that you need an appointment. . department: hematology/oncology when: wednesday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: neurology when: monday at 10:00 am with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: other endoscopy of small intestine central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia portal hypertension asthma, unspecified type, unspecified diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia hypotension, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction epilepsy, unspecified, without mention of intractable epilepsy esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum mononeuritis of unspecified site diverticulosis of colon (without mention of hemorrhage) immune thrombocytopenic purpura late effects of acute poliomyelitis 

Answer: The patient is high likely exposed to