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: lethargy, generalized weakness, worsening jaundice major surgical or invasive procedure: paracentesis ercp history of present illness: 56 yo woman with stage iv cholangiocarcinoma metastatic to liver diagnosed during ex lap in , who presents with lethargy, generalized weakness and increasing jaundice. pt had been feeling relatively well until , when she started her second cycle of chemo (gemzar and cisplatin). following chemo, she noted feeling gradually more fatigued. her family reports she was more slow w/ responses to questions & seemed more tired. the pt notes no specific complaints except for ongoing hemorrhoidal pain and occasional, transient knee pain. she denies n/v/d, f/c, abd pain. no sob/cp. no dysuria. her appetite has also become quite poor, and she not been eating or drinking much. she has been taking ibuprofen (about 800-1200mg daily per pt over last wk). she notes decreased uop. . in the ed, rectal temp 99.6, 89, sbp 80s, 97 on 2l. she was given 1l of ns w/ improvement in sbp to 90s-100s. her primary onc reports that her baseline sbp is 90s-100s. her labs were notable for tbili 7.2 (was reportedly ~4 last week per primary onc). crt was elevated at 1.2 (bl 0.5). u/s liver showed new ascites, stable cbd & e/o gb ca w/ stones in gb as well. seen by surgery, who felt she did was not operative candidate & recommended ercp c/s. a diagnostic paracenteisis was performed & peritoneal fluid sent for cx. . ros: as above, plus b/l le edema. pt took lasix 10mg po day prior to admission b/c of this. otherwise, ros negative. past medical history: - cholangiocarcinoma diagnosed during aborted cholecystectomy, undergoing chemotherapy. was initially getting gemzar w/ irinotecan. however, b/c of elevated bili, cisplatin substituted for irinotecan. now day 1 of 2nd cycle was . oncologist is dr. at - dm2 - htn social history: from originally, denies tobacco or drugs family history: nc physical exam: vs: t 98.6, bp 114/69, hr 88, rr 16, 96%ra gen: ill appearing, jaundiced heent: eomi, icteric sclera, mm dry neck: supple, no lad, r ij intact chest: porta-cath side c/d/i lung: ctab heart: rrr no m/r/g abd: obese with slight epigastric/ruq firmness in the area, laparoscopic scars noted, healing well ext: 1+ pitting edema, ext warm skin, jaundiced neuro: no asterixis pertinent results: admission labs: wbc-16.8* rbc-3.09* hgb-8.6* hct-28.5* mcv-92# mch-27.9 mchc-30.3* rdw-23.3* plt ct-129* neuts-82.8* bands-0 lymphs-16.3* monos-0.4* eos-0.4 baso-0.2 hypochr-1+ anisocy-2+ poiklo-2+ macrocy-2+ microcy-1+ polychr-1+ target-1+ schisto-1+ tear dr pt-16.7* inr(pt)-1.5* glucose-157* urean-38* creat-1.4* na-128* k-5.5* cl-100 hco3-20* angap-14 alt-51* ast-141* alkphos-586* totbili-7.2* dirbili-5.7* indbili-1.5 albumin-1.4* calcium-7.5* phos-3.7# mg-1.6 ammonia-124* ekg: sinus rhythm, lad, rbbb with lafb, peaked t waves, unchanged from . imaging: abd ct: impression: 1. findings most consistent with gallbladder carcinoma with direct invasion of the liver. there is tumor infiltration into the mesenteric fat with small tumor nodules and concern for infiltration of the duodenum as described above. 2. a gallstone is seen relatively to the remainder of the gallbladder and is likely located in a displaced cystic duct. less likey it has erroded through the gallbladder wall and is located outside the lumen of the gallbladder. 2. compression of the left portal vein by large liver lesion without portal vein thrombosis. 3. multiple liver metastasis. 4. lymphnode metastases in the porta hepatis. 5. multiple tiny 1-2 mm hypoattenuating lesions within the right kidney, too small to characterize, but likely representing cysts. 6. moderate bilateral lower lobe atelectasis and small bilateral pleural effusions. 7. small amount of free intraperitoneal air from recent surgical procedure. . abd us: again seen is abnormal gallbladder wall thickening, with multiple gallstones and soft tissue in the region of the neck, consistent with known tumor. also again seen is abnormal liver architecture adjacent to the gallbladder, consistent with metastases. the common duct again measures approximately 5 mm. normal direction of flow again seen within the portal vein, which again appears diminutive. there is new small-to-moderate amount of ascites. right pleural effusion is also seen. impression: 1. findings again suggestive of cholangiocarcinoma with hepatic metastases, not significantly changed in appearance from prior study. common duct appears relatively stable compared to prior at 5 mm in diameter. 2. new small-to-moderate amount of ascites. 3. right pleural effusion. 7:00 pm peritoneal fluid peritoneal fluid. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. brief hospital course: 55f with recently diagnosed stage iv cholangiocarcinoma, dm2, and htn, who presents with lethargy, weakness, worsening jaundice after cycle of chemotherapy was found to be hypotensive w/ new arf and worsening hyperbilirubinemia with persistent fluid responsive hypotension. after surgery declined any operative intervention, gi was consulted for possible palliative ercp. the procedure was scheduled for but was postponed as the patient was felt to be too unstable to undergo the procedure. eventually, went to ercp on and developed respiratory distress with hypoxia requiring intubation in the pacu. was admitted to the icu where initial abg significant for ph 7.08, worsening ag, and lactate of 8.2. was started on pressors, broad spectrum antibiotics, and stress dose steroids. she received iv albumin to support her intravascular volume given her extensive ascites. despite these interventions, she developed worsening renal failure and mods with persistent hypoperfusion and elevated lactate. her coags were consistent with low grade dic. she was switched to levophed with no improvement. after discussion with her family, hcp, and oncologist on the night of icu admission, she was made dnr with a plan to continue aggressive treatment for approximately 24 hours. after this timeframe had past and the patient exhibited no improvement in her severe septic shock with multi-organ dysfunction, and in consultation with her family, the transistion was made to comfort measures. she expired on friday, . . medications on admission: 1. loperamide 2 mg po qid as needed for diahrrea. 2. zolpidem 5 mg po hs as needed. 3. percocet 5-325 mg po q6h:prn. 4. metoprolol succinate 200 mg tablet sustained release 24 hr 5. nystatin 100,000 unit/ml suspension (5) ml po qid 6. hydrocortisone acetate 1 % as needed for hemorhoid pain. 7. acetaminophen 500 mg tablet po q6h as needed. 8. prilosec 20 mg capsule, delayed release(e.c.) po once a day. 9. insulin glargine 100 unit/ml solution sig: fourteen (14) units subcutaneous at bedtime. 10. insulin lispro 100 unit/ml solution sig: 2-10 units according to the sliding scale 11. lasix 10mg po prn 12. ibuprofen prn 13. serax prn discharge medications: n/a discharge disposition: expired discharge diagnosis: n/a discharge condition: expired discharge instructions: n/a followup instructions: n/a md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube percutaneous abdominal drainage transfusion of packed cells transfusion of other serum transfusion of platelets endoscopic retrograde cholangiopancreatography [ercp] diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis acute respiratory failure defibrination syndrome septic shock calculus of gallbladder without mention of cholecystitis, without mention of obstruction other ascites hypovolemia secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of gallbladder 

Answer: The patient is high likely exposed to