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: acyclovir attending: chief complaint: nausea, vomiting, diarrhea major surgical or invasive procedure: n/a history of present illness: 68-year-old female with a history of basal cell ca, breast ca, etoh cirrhosis, multiple etoh related falls, ? history of gib (5-6 years ago)who presented to the ed this morning with nausea, vomiting and diarrhea that started acutely (no sick contacts, no new foods) 4 days prior. pt states her diarrhea has been "very dark" 4-5 times a day. vomiting without blood or coffee grounds, denies any abdominal pain. last night, felt week and fell backwards into chair but denies hitting her head or any loss of consciousness. has been sober for 2 months but for the last two weeks was drinking, reports last drink last friday (5 days ago). on aspirin 81 mg daily no other anticoagulation, no other nsaid use. last egd , no varices, mild gastritis, no ulcers. however, patient reports that 5-6 years ago she thinks she had an ulcer and was on a ppi for a couple of years but has not been using it recently. of note, patient took her atenolol 75mg po this morning. . in the ed, initial vs were: 97.8 77 94/47 16 96%on ra. exam notable for pale conjunctiva, non-tender abdomen, dark brown guaiac positive stool. ng lavage was negative. patient was given 40iv pantoprazole and 2 livf, sbps increased to sbp >105s. her labs were notable for hct 20.1, sodium 131, serum tox negative, lfts within normal limits. . on transfer to the unit her vs were 113/36 74 12 98% on ra , she has 2 18 guage peripheral ivs in place. typed and crossed for 2 units which the ed resident reported would be started in the ed prior to transport. liver seeing her right now and plan for egd on arrival to icu. . on the floor, the patient reports no nausea, abdominal pain, dizziness, chest pain, palpitations, and reports her last bm in the ed. . review of systems: (+) per hpi and + weight loss (-) denies fever, chills, night sweats, recent weight gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations. denies dysuria, frequency, or urgency. denies rashes or skin changes. past medical history: --etoh cirrhosis - etoh abuse --: upper gi bleed. endoscopy at the time revealed multiple erosions in the stomach. there was a shatzki's ring in the esophagus. - breast cancer, stage ic: underwent lumpectomy on and lymph node biopsy which was negative. her tumor consisted of 1.4-cm, grade 2, er+, pr-, her-2-negative infiltrating ductal carcinoma. following surgery she received xrt and started adjuvant arimidex on . - cardiomyopathy in past? presumed due to etoh. most recent ef 50% - single known episode of afib in , seen on holter monitor. briefly on coumadin, but difficulty with controlling inr. - htn - osteoarthritis - basal cell carcinoma in remission social history: patient lives alone. she is retired from working at bloomindale's. she is divorced but is still in touch with her ex-husband. etoh longstanding was sober for 2 months after new year's but began drinking again 2 weeks prior. denies any other drug use or smoking. patient's daughter is her health-care proxy. family history: uterine ca physical exam: tmax: 35.9 ??????c (96.7 ??????f) tcurrent: 35.9 ??????c (96.7 ??????f) hr: 79 (79 - 79) bpm bp: 91/41(54) {91/41(54) - 91/41(54)} mmhg rr: 15 (15 - 15) insp/min spo2: 87% general appearance: overweight / obese eyes / conjunctiva: conjunctiva pale head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: not assessed respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) abdominal: soft, non-tender, obese skin: warm, pale neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): x3, movement: not assessed, tone: not assessed pertinent results: admission labs: 06:05am blood wbc-4.3 rbc-2.90* hgb-9.1* hct-28.4* mcv-98 mch-31.4 mchc-32.1 rdw-19.1* plt ct-210 06:05am blood glucose-99 urean-8 creat-0.6 na-142 k-3.9 cl-109* hco3-26 angap-11 12:15pm blood wbc-4.4 rbc-2.91* hgb-9.5* hct-28.3* mcv-97 mch-32.8* mchc-33.7 rdw-19.8* plt ct-208 02:26pm blood hct-29.6* 05:38am blood wbc-4.7 rbc-2.63* hgb-8.5* hct-25.9* mcv-98 mch-32.1* mchc-32.7 rdw-21.4* plt ct-166 12:20am blood hct-25.8* 03:04pm blood hct-27.8* 06:22am blood hct-26.6* 05:00pm blood hct-32.2* 12:20am blood hct-27.3* 01:00pm blood wbc-8.3 rbc-1.87*# hgb-6.6*# hct-20.1*# mcv-108* mch-35.5* mchc-33.0 rdw-20.5* plt ct-211 01:00pm blood neuts-67.6 lymphs-25.1 monos-5.2 eos-2.0 baso-0.2 01:00pm blood pt-13.0 ptt-27.8 inr(pt)-1.1 01:00pm blood glucose-96 urean-37* creat-1.0 na-131* k-3.3 cl-91* hco3-27 angap-16 01:00pm blood alt-29 ast-33 ck(cpk)-52 alkphos-75 totbili-0.9 01:00pm blood lipase-45 01:00pm blood ck-mb-notdone ctropnt-<0.01 01:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg micro: h pylori serology: negative studies: cxr: no acute intrathoracic process. stable cardiomegaly. egd: erythema and friability and ulcers in the lower third of the esophagus compatible with esophagitis erythema and petechiae in the antrum compatible with gastritis ulcer in the duodenal bulb otherwise normal egd to third part of the duodenum . . ruq ultrasound final report liver or gallbladder ultrasound, indication: etoh cirrhosis, upper gi bleed. comparison: ultrasound from and mri from . findings: the liver again shows no discrete abnormalities, though evaluation is slightly limited due to unchanged left lobe atrophy. there are no focal liver lesions. there is no biliary ductal dilatation, or ascites. gallbladder is surgically absent. pancreas is obscured by bowel gas. the spleen is nonenlarged. main portal vein is patent with appropriate antegrade flow. impression: unchanged appearance of the liver. no focal liver lesions. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 7:10 pm . . brief hospital course: ms. is a 68 year old female with etoh cirrhosis, hx of gi bleed, htn, basal cell and breast carcinomas s/p tx, now presenting with dark stools, hypotensive, hct to 20 from baseline of 39. the following issues were addressed at this admission: . # gi bleed/low hematocrit: hct was 39 in and on presentation to the ed was 20. ng lavage was negative in the ed, though stool was guaiac positive and drak. egd upon arrival to the micu was notable for a large duodenal ulcer without signs of bleeding as well as esophagitis and gastritis. hct bumped to 31 after 5 units of blood. she was started on sucralfate and protonix and transferred to the medicine floor. her serum h. pylori was negative. hct then contrinued to trend down to 26 after call out to the floor, and she received another unit of blood. she was transferred back to the icu briefly for transfusion. she then stabilized and was d/c'd with hct 28. no repeat egd was performed in house since the pt was stable and did not have subsequent gi bleeding or hct drops. she is to have f/u egd in 8 weeks and to follow up as an outpatient with dr. . she is to have her hct checked at the end of the week and followed up by her pcp, . . . # etoh abuse: patient reports her last drink was the friday prior to admission. she has had no signs of recent withdrawl. etoh likely worsening her gastritis and esophagitis and may have contributed to bleeding. she was placed on ciwa scale without requirement for benzodiazepines. she was also placed on folate and thiamine and a multivitamin during this admission. the patient expresses understanding of the risks associated with contibued drinking and states a commitment to quit. she was seen by social work, who determined adequate support; the patient declined additional referrals. . # etoh cirrhosis: stable during this admission. as pt has h/o poor followup she had an inhouse ruq ultrasound. she will f/u with these results and for her cirrhosis with dr. . . #. depression: -continue lexapro and welbutrin . #. insomnia: -continue seroquel . #. breast ca s/p lumpectomy and xrt: -arimidex not on inpt formulary . #. hld: -continue lipitor . # htn: -continue atenolol . medications on admission: arimidex 1 mg tab one tablet(s) by mouth daily lipitor 10 mg tab 1 tablet(s) by mouth daily seroquel 50 mg tab 4 tablet(s) by mouth at bedtime lexapro 20 mg tab 1 tablet(s) by mouth daily aspirin 325 mg tab 1 tablet(s) by mouth daily atenolol 50 mg tab 2.5 tablet(s) by mouth daily taken in divided doses (75mg am, 50mg pm) folic acid 400 mcg tab wellbutrin sr 150 mg tab 1 tablet(s) by mouth twice a day discharge medications: 1. arimidex 1mg po daily 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. quetiapine 100 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 4. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 5. folic acid 400 mcg tablet sig: one (1) tablet po once a day. 6. atenolol 25 mg tablet sig: three (3) tablet po once a day. 7. atenolol 25 mg tablet sig: two (2) tablet po each evening. 8. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 9. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 10. glucosamine po daily 11. caltrate 12. vitamin d 13. vitamin b6 14. vitamin b12 15. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. 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:*2* 17. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn. disp:*30 tablet, chewable(s)* refills:*1* 18. outpatient lab work please check cbc (hematocrit, hemoglobin) on . please fax results to dr. at . discharge disposition: home with service facility: vna discharge diagnosis: esophagitis gastritis duodenal ulcer discharge condition: mental status: clear and coherent level of consciousness: alert and interactive ambulatory discharge instructions: you were admitted to the hospital with gastrointestinal bleeding. your hematocrit was low and you required blood transfusions. you underwent an esophagogastroduodenoscopy which revealed esophagitis, gastritis, and a duodenal ulcer. you were started on medicine to treat this inflammation and ulcer. please have your hematocrit checked on thursday and have it sent to dr. for followup. . it is important that you do not take any aspirin or nsaids as these may further irritate and cause bleeding from ulcers. please start taking sucralfate 1g four times a day. please stop taking omeprazole. please start taking pantoprazole 40mg twice a day. . you will need to have a follow-up esophagogastroduodenoscopy in 8 weeks. you will need to arrange this with the gastroenterologist, . . please take all medications as prescribed. please followup with all appointments. please do not hesitate to return to the hospital if you have any concerning symptoms at all. followup instructions: 1. primary care - dr. phone: - , 230pm - please have your bloodwork done on thurs, , faxed to dr. . . 2. gi: please call in the next 2-3 days for followup appointment. dr. is aware. you will also need to schedule an esophagogastroduodenoscopy to be performed within 8 weeks. - provider: , md phone: date/time: 11:40 . procedure: other endoscopy of small intestine diagnoses: anemia, unspecified unspecified essential hypertension alcoholic cirrhosis of liver personal history of malignant neoplasm of breast depressive disorder, not elsewhere classified hypopotassemia other and unspecified hyperlipidemia osteoarthrosis, unspecified whether generalized or localized, site unspecified obesity, unspecified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction alcohol abuse, continuous insomnia, unspecified other esophagitis ulcer of esophagus with bleeding other specified gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to