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: ciprofloxacin attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp for biliary sweep and sphincterotomy repeat ercp for bleeding at sphincterotomy site; cauterized and injected with epinepherine. history of present illness: 76 y/o woman with a history of valvular heart disease, chronic diastolic heart failure, atrial fibrillation, who is admitted to the medical service from the gi suite following a failed attempt at ercp. the patient initially presented to hospital with dyspnea, abdominal pain, and elevated lfts. an ercp was attempted, but cannulation of the cbd was unsuccessfull. she wsa transfered to for repeat attempt, but this too was unsuccessfull. her inr was 1.7 and she received two units ffp prior to transfer. in the ercp suite a small pre-cut attempted to aid cannulation, but cannulation still not successful. she is being transfered to the medical service for monitoring with plans for a repeat ercp on monday, . she currently feels well. there is no discharge summary or imaging reports available at this time for veiwing. there is documentation that she had a common bile duct stone on the ercp consent form. past medical history: # valvular heart disease - echo reports requested from brokton # open heart surgery - in , patient states there was an aneurysm, but is unclear of further details. she does not think she has a prosthetic valve. # chf - chronic diastolic # atrial fibrillation - anticoagulated on coumadin social history: no smoking, etoh abuse or other drug use family history: nc physical exam: 97.8 140/84 100 16 97%ra gen: frail, elerly appearing woman not in any distress heent: prominent external jugular vein cv: irregular, systolic murmur appreciated throughout precordium, no mechanical click abd: soft, nt/nd no masses ext: no edema . discharge: tm 100.4 99.1 103/58 77 20 98ra gen: frail appearing female, appears comfortable. heent: eomi, mmm. cv: irreg irreg. 3-4/6 sem radiating throughout, maximal rusb. jvp approx 14 cm and distended. abd: soft, nt/nd. no rebound. ext: rle 1+ pitting edema. no lle edema. neuro: cn2-12 grossly intact. pertinent results: labs on admission: 06:40pm wbc-3.5* rbc-3.99* hgb-12.4 hct-39.4 mcv-99* mch-31.2 mchc-31.6 rdw-13.2 06:40pm glucose-94 urea n-33* creat-0.9 sodium-144 potassium-3.7 chloride-105 total co2-28 anion gap-15 06:40pm alt(sgpt)-45* ast(sgot)-62* alk phos-542* tot bili-1.3 dir bili-0.7* indir bil-0.6 06:40pm pt-16.8* ptt-31.9 inr(pt)-1.5* . . discharge: 06:14am blood wbc-4.5 rbc-2.95* hgb-9.5* hct-28.4* mcv-96 mch-32.3* mchc-33.6 rdw-15.7* plt ct-98* 06:14am blood pt-13.5* inr(pt)-1.2* 05:45am blood glucose-136* urean-48* creat-1.5* na-148* k-3.4 cl-111* hco3-24 angap-16 06:14am blood glucose-110* urean-21* creat-1.1 na-139 k-3.6 cl-100 hco3-27 angap-16 06:05am blood alt-70* ast-77* alkphos-350* totbili-1.2 06:30am blood alt-78* ast-96* alkphos-382* totbili-1.4 05:20am blood alt-71* ast-99* alkphos-414* totbili-1.2 05:40am blood alt-67* ast-77* alkphos-378* totbili-1.4 06:14am blood alt-60* ast-73* alkphos-399* totbili-1.4 08:54pm blood ck-mb-3 ctropnt-<0.01 04:25am blood ck-mb-3 ctropnt-<0.01 12:34pm blood ck-mb-3 06:14am blood calcium-8.2* phos-2.7 mg-2.0 12:33pm blood heparin dependent antibodies- negative 12:32pm urine color-red appear-hazy sp -1.014 12:32pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-mod 12:32pm urine rbc->1000* wbc-8* bacteri-none yeast-none epi-0 urine urine culture- negative mrsa screen mrsa screen- negative ercp reports: impression: cannulation of the biliary duct was attempted with a sphincterotome, 5-4-3 cannula using a free-hand wire guided technique. cannulation was unsuccessful, and a small needle knife sphincterotomy was attempted. cannulation was still not able to be achieved. small amount of self limited oozing was noted. impression: evidence of a known previous small pre-cut sphincterotomy was noted in the major papilla. cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in complete opacification. a moderate dilation was seen at the cbd with the cbd measuring 12-13mm. there were a few small filling defects at the distla cbd consistent with sludge. a biliary sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. sludge was extracted successfully using a balloon catheter. impression: clotted blood and oozing was seen in the major papilla. epinephrine 1/ hemostasis with success. -cap electrocautery was applied for hemostasis successfully. cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in complete. a moderate dilation was seen at the cbd with the cbd measuring 12-13mm. a 10fr by 5cm double pigtail biliary stent was placed successfully using a microvasive 10fr stent introducer kit. rle leni: prelim: incomplete study, but visualized exam was negative for dvt. brief hospital course: 76 yo female with hx of dchf, severe tr, presented with choledocolithiasis for ercp. initial attempt at ercp was unsuccessful, and pt returned to ercp the following day which was successsful, but was complicated by gib in the post-procedure period. pt underwent repeat ercp (3rd) with hemostatsis via cautery and epinepherine injection at the sphincterotomy site. pt received a transfusion of prbc for anemia and was monitored in the icu. after returning to the medical floor, pt developed hematuria, oliguria, and dchf. she was treated with continuous bladder irrigation with clearing of her urine, her diuretics were restarted, and she was provided vitamin k to further reverse her inr. see below for details, issue by issue. . # choledocolithiasis, s/p ercp pt underwent ercp with removal of sludge and a sphincterotomy was performed. pt's lft's maintained a fluctuating course, but appears to have a general trend of improvement. if lft's do not continue to improve, then we would recommend a hepatology consult for further evaluation. pt was treated with iv unasyn for biliary obstruction, and this was transitioned to augmentin on . we recommend continuing through or . please monitor temperature curve to ensure remains afebrile. the ercp recommends repeat ercp in weeks. . # gi bleed at site of sphincterotomy after pt's ercp with sphincterotomy, pt subsequently developed large melena requiring urgent repeat ercp for hemostasis. pt was treated with cautery and epinepherine injection at the bleeding sphincterotomy site. she was monitored in the icu for 1+ days. her inr was kept normal with po vitamin k. - ercp states ok to resume aspirin/coumadin on . . # asmmetric le swelling on day of transfer, pt was noted to have assymetric swelling of her lower extremities, r>l, which was concerning for possible dvt. pharmaocologic dvt ppx had been held thus far d/t significant gib s/p ercp that required emergent procedure. rle leni was obtained which was negative, but did not visualize one of the popliteal veins. - start sq heparin dvt prophylaxis . # oliguria, hematuria, acute renal failure after patient was called out of the icu, pt was noted to have oliguria, hematuria, and acute renal failure. the hematuria was presumed due to foley catheter trauma, and her inr was slightly elevated at the time (1.6). she was provided vitamin k, and she was started on continuous bladder irrigation with resolution of her hematuria. her low urine output and acute renal failure were determined to be due to acute decompensation of her heart failure, with poor forward flow. she was restarted on her lasix and spironolactone (which had been held d/t hypotension and gi bleed), and her uop/renal failure improved. foley was discontinued. . # afib, with episode of pt had an episode of tachycardia while in the icu, and she was started on po metoprolol after several doses of iv. during this episode, she was found to have st depressions and t-wave inversions in her lateral leads. her hr became controlled and she was monitored on telemetry. it was noted in her outpatient records that she had previously been taken off of metoprolol in the past due to bradycardia, however, pt's hr remained well controlled without episodes of bradycardia. was started on metoprolol in icu d/t . hr controlled without brady. - holding aspirin/coumadin d/t bleeding; resume . # thrombocytopenia; stable pt was hit negative in the icu. . # acute on chronic diastolic heart failure pt with acute decompensation on with low bp, tachycardia, poor urine output, and significantly distended and elevated jvp. her diuretics were restarted with improvemetn in uop, bp, and hr. her jvp improved, but remained elevated and distended at the time of discharge. she also has been noted to have +peripheral edema, improving over recent days, and decreased bs on l although she is breathing comfortably with good o2 sats. her lasix doses were increased to 60 mg po q day several days ago, and was still requiring iv doses of lasix daily. she was continued on spironolactone 25, although she may benefit from larger doses to help with heart failure and to minimize her potassium losses, as she is requiring frequent repletion. she was also placed on 1200 cc fluid restriction. . # delirium pt had a period of delirium during the hospitalization, but this improved significantly with above treatments as clinical condition improves. . # hypokalemia pt has been requiring frequent repletion of her potassium, and she frequently refuses oral potassium, as she states that it upsets her stomach. - replete prn . # hypernatremia pt had a period of hypernatremia which was d/t sodium load of unasyn. resolved with discontinuation of unasyn. . . code: full dispo: transferred to ltac under care of dr. . medications on admission: aldactone 25mg po qday furosimide 40mg po qday captorpil - ?unclear if she is on this, no dosage listed coumadin 6mg po qday discharge medications: 1. lasix sig: forty (40) mg injection once a day: titrate as needed. 2. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for a fib . 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po tid (3 times a day) for 2 days. 6. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for abodminal pain. 7. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection three times a day. discharge disposition: extended care facility: northeast - discharge diagnosis: cholodocholithiasis severe tricuspid regurgitation acute on chronic diastolic heart failure gi bleed at sphincterotomy site hematuria acute renal failure atrial fibrillation, with episode of hypokalemia hypernatremia delirium discharge condition: stable for transport for ongoing care. discharge instructions: you were transferred to with concern for gallstones. you underwent an ercp with relief of the obstruction. during the hospitalization, you also developed blood in your urine, diastolic heart failure, gi bleed, and acute renal failure. you are being transferred to an ltac for ongoing care. . the following changes were made to your medical regimen: 1. your coumadin dose was held given your ercp procedure. this should be restarted xxxxxxxxxxxx. . . . if you develop worsening symptoms of abdominal pain, fevers, nausea, vomiting, chest pain, shortness of breath, or other worrisome symptoms, please contact your primary care physician or the emergency department. followup instructions: pt with ongoing acute on chronic diastolic heart failure, requiring prn iv lasix doses, in addition to her scheduled oral lasix. hypokalemia; requiring frequent repletion and monitoring. recommend cardiology follow up for her diastolic heart failure and severe tr. . patient should remain off of aspirin and coumadin until at which time it may be resumed. patient should remain on augmentin through today . please monitor temperature curve to ensure she remains afebrile. procedure: endoscopic sphincterotomy and papillotomy endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct endoscopic excision or destruction of lesion of biliary ducts or sphincter of oddi diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure hypopotassemia heart valve replaced by other means hemorrhage complicating a procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hyperosmolality and/or hypernatremia urinary complications, not elsewhere classified hematuria, unspecified diseases of tricuspid valve delirium due to conditions classified elsewhere calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to