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: history of present illness: patient is a 46-year-old male with past medical history significant for hepatitis c and alcoholic cirrhosis with a history of variceal bleed status post banding and recently admitted for hepatic encephalopathy, discharged . he had been doing well over the weekend, however, on the morning of the 21st, he was found by family to be unresponsive and incontinent of stool. the family called 911, and the patient was taken to , where he was found to be lethargic, but still arousable, but he was abusive and combative with the staff. at , his head ct scan was negative. his creatinine which is at a baseline at 1.3 was at 2.2. his ammonia level was 162, and he was given 1 mg of ativan for his combativeness. the patient was transferred to hospital. past medical history: 1. hepatitis c virus. 2. cirrhosis. 3. patient is on the transplant list. he failed interferon therapy. 4. esophageal varices status post banding. 5. history of alcohol abuse. 6. suspected hepatocellular carcinoma (hcc). 7. recent admissions for fevers, mental status changes, and encephalopathy. 8. chronic renal failure. medications on admission: 1. lactulose prn. 2. nadolol 40 mg po q day. 3. lasix 20 mg po q day. 4. aldactone 50 mg . 5. ursodiol 300 mg tid. 6. protonix 40 mg q day. social history: the patient has a history of alcohol abuse. he quit one year ago. no smoking, no iv drug use. allergies: no allergies to any medicine. the patient lives with his wife. physical examination on admission: his blood pressure was 100/57. his heart rate was 60. respiratory rate 12, and he was 100% 2 liters oxygen by nasal cannula. heent: pupils are equal, round, and reactive to light and accommodation. neck is supple, no lymphadenopathy. cardiovascular: regular, rate, and rhythm, no murmurs. chest was clear to auscultation bilaterally. abdomen is soft, nontender to palpation, nondistended, bowel sounds were hypoactive. extremities: he had + pitting edema in his ankles up to his calves. neurologically he was disoriented, somnolent, but moving all four extremities. laboratories of significance on admission: his hemoglobin was 11.2, hematocrit 32, which was near his baseline of 32-33. his inr was 1.7. his complete blood count was significant for creatinine of 1.9 which is higher than his baseline of 1.2-1.3. urinalysis showed large blood, 21-50 red blood cells, white blood cells, few bacteria. tox screen negative. urinalysis was negative for nitrates and leukocyte esterase. ammonia level on admission was 87, which was up from 22 at the last admission. ct scan of the head: was negative. abdominal ultrasound: from the previous admission showed a small nodular liver with appropriate direction of blood flow. small ascites, splenomegaly, no hydronephrosis, plus cholelithiasis, but no bile duct dilatation. the patient was admitted to the intensive care unit to observe his airway as there was a chance that he would need to be intubated. 1. gi: hepatic encephalopathy. the patient had several recent admissions this summary for hepatic encephalopathy. there were no localizing symptoms, no fever, white blood cell count. increased white blood cell count suggests infection as an inciting factor. the patient has been compliant with his diet, but it was possible that he had increased protein intake, although it was difficult to get this history on admission. again, there is a possibility that there was a gi bleed or that the patient had decreased lactulose intake. he was kept npo while he had decreased mental status. he was put on a low protein diet once he was able to tolerate po. he was continued on his standing dose of lactulose with a goal of bowel movements per day, and the liver service was consulted. on the evening of the 22nd, the patient was transferred out of the unit as his mental status had improved. while in the intensive care unit, the patient's lasix and aldactone were held. the patient's mental status continued to improve while in the intensive care unit. the liver service was consulted, and decision was made to transfer the patient to a medicine bed on the evening of the 22nd. the patient was continued on lactulose. in the intensive care unit, it was noted that the patient's hematocrit was dropping and his stools were guaiac positive. his hematocrit nadir was 25 on the morning of the 23rd, so the decision was made to further evaluate this with colonoscopy and endoscopy, which were done on the . given the patient's history of questionable hepatocellular carcinoma, he has three nodules on his liver which has not been biopsied. more extensive evaluation for possible metastases was done. the patient was sent for a bone scan, which showed he had increased activity diffusely within his abdomen likely secondary to ascites. more focal tracer activity in the region of his liver representing acute inflammatory process (hepatitis c), posttraumatic activity in the left 7th rib. no evidence of osseous metastases. the patient also had a ct scan of the chest, which showed no evidence of pulmonary metastases. again, it was noted that the patient does have a gallstone. on the 23rd, the patient was transfused 2 units of packed red blood cells. his follow-up hematocrit again was in the range of 32-33 which is his baseline. on the 24th, the patient had colonoscopy which showed that he had rectal varices, and a small sessile 5 mm nonbleeding polyp. there was no biopsy done secondary to his platelets being 54 and his inr of 1.7. an egd was done on the same day which showed that he had varices in the lower of the esophagus and middle of the esophagus. he had erythema, and congestion, and nodularity, and a normal vascularity in the antrum, which is consistent with gastropathy. no other gi workup was done at this time. the patient was continued on his protonix q day. he was told to continue taking lactulose 30 cc prn for goal of bowel movements per day. he was started on flagyl in the intensive care unit. he was told to continue taking 250 mg until he receives his transplant. the aldactone would be restarted on monday as an outpatient, and his lasix was discontinued. 2. renal: the patient had acute on chronic renal failure on admission. his lasix and aldactone were discontinued in the intensive care unit. the patient's creatinine improved towards his baseline of 1.2-1.3, and on the day of discharge, it was 1.0. when the patient was in the intensive care unit, the renal service was consulted. their recommendations were to hold the lasix and to address the issue of questionable gi bleed and optimize his volume status which was done. 3. cardiovascular: the patient has a history of blood pressure in the range of 90/60. after the colonoscopy and endoscopy on the 24th, his nadolol was increased to 60 q day, however, the patient's blood pressure dropped to the 80 systolic, and while he was asymptomatic, the decision was made to resume his normal dose of nadolol of 40 q day. 4. anemia secondary to blood loss versus dilutional effect: there was no active bleeding once the patient arrived to medicine from the intensive care unit. he received a transfusion of 2 units of packed red blood cells. his hematocrit remained stable throughout his hospital stay. 5. fluids, electrolytes, and nutrition: the patient was given a low sodium-low protein diet. nutrition therapy did teaching with the patient about dietary intake. the patient was discharged on the 25th. discharge instructions: he was to continue taking lactulose 30 cc as often as needed to have a goal of bowel emergency room if becoming increasingly confused, having difficulty speaking, if he was experiencing lightheadedness or dizziness when he got up from a sitting to standing low, to followup with urology on his appointment, , dr. for his evaluation of microscopic hematuria. to followup in the liver clinic with dr. on at 9:15 am, and to continue taking all of his medications as he was before with the following changes: he is take flagyl 250 mg po bid until he receives his transplant. to continue taking protonix. the lasix was discontinued, and he was to restart his aldactone on monday, . final diagnoses: 1. hepatic encephalopathy. 2. cirrhosis. 3. hepatitis c. 4. esophageal varices status post esophagogastroduodenoscopy, no evidence of bleeding. 5. rectal varices status post colonoscopy, no bleeding. 6. anemia secondary to blood loss versus dilutional effect, status post transfusion of 2 units of packed red blood cells. 7. question hepatocellular carcinoma. 8. chronic renal failure. 9. cholelithiasis. surgical invasive procedures during his stay: 1. egd. 2. colonoscopy. discharge condition: stable. discharge medications: 1. metronidazole 250 mg tablet po bid. 2. ursodiol 300 mg capsule po tid. 3. protonix 40 mg po q day. 4. lactulose 30 cc prn. 5. nadolol 40 mg q day. 6. restart taking his aldactone 50 mg po bid on monday, . , md dictated by: medquist36 d: 14:32 t: 15:28 job#: procedure: other endoscopy of small intestine closed [endoscopic] biopsy of large intestine diagnoses: thrombocytopenia, unspecified chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified malignant neoplasm of liver, primary hepatic encephalopathy varices of other sites benign neoplasm of colon 

Answer: The patient is high likely exposed to