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: ketorolac / codeine attending: chief complaint: variceal bleed major surgical or invasive procedure: tips intubation placement history of present illness: this is a 50 year old male with history of cirrhosis secondary to alcohol and hep c who was admitted to hospital 2 weeks ago for a variceal bleed. he underwent an egd on that day and underwent banding. he had some further bleeding on the day of admit and underwent another egd and had some more banding. he was eventually intubated for alcohol withdraw. on durring the day it was noticed that his hb was dropping (9.3 from 10). he was started on an octreotide drip and his hb continued to drop to 7.3. he was tx 2u prbc and at approx 2am had an episoide of bright red bloody emesis. he was taken for an emergent egd which showed no active bleeding but ulcers in the eg junction where his prior banding was. there was some venous blood seen that was not bleeding. an attempt was made to sclerose blood at which point the venous blood started activly bleeding. it was unable to be controlled endoscopically. a was placed in the operating room. a cordis was placed. patient recieved 7u prbc and 4 u ffp. he recieved 1g anfec in the ed. he was paralized with vec for the minessota tube placement. he was then transferred to for further management of his bleeding and anticipated tips placement. past medical history: past medical history: - cirrhosis (alcoholic/hcv) - hepatitis c virus - type ii diabetes mellitus - alcohol abuse social history: patient is not married but has a girlfriend who works as a nurse. he has a 13-year old daughter of whom he has sole custody (her mother is about to go to prison); she is currently staying with his 80-year old mother. is an active drinker of alcohol with a history of abuse. family history: non-contributory. physical exam: general: sedated. heent: intubated. tube in place. sclera anicteric, mmm. neck: supple, difficult to assess jvp. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, mildly distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. dullness to percussion b/l on flanks consistent with ascities. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 07:08am fibrinoge-210 07:08am pt-16.1* ptt-35.8* inr(pt)-1.4* 07:08am plt count-150 07:08am wbc-18.6* rbc-3.07* hgb-9.5* hct-26.8* mcv-87 mch-30.8 mchc-35.2* rdw-15.7* 07:08am albumin-2.3* calcium-7.4* phosphate-5.1* magnesium-1.8 07:08am alt(sgpt)-36 ast(sgot)-63* ld(ldh)-289* alk phos-121 tot bili-4.1* 07:08am estgfr-using this 07:08am glucose-170* urea n-23* creat-1.1 sodium-141 potassium-5.3* chloride-107 total co2-25 anion gap-14 07:50am freeca-0.96* 07:50am type- temp-37.4 ph-7.37 comments-green top 10:00am urine mucous-few 10:00am urine hyaline-107* 10:00am urine rbc-9* wbc-11* bacteria-few yeast-none epi-1 trans epi-1 10:00am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-sm urobilngn-2* ph-5.5 leuk-neg 10:00am urine color-amber appear-hazy sp -1.019 10:00am urine bnzodzpn-pos barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 10:00am urine gr hold-hold 10:00am urine hours-random 10:00am urine hours-random labs on discharge: 05:50am blood wbc-9.3 rbc-3.02* hgb-9.1* hct-27.2* mcv-90 mch-30.1 mchc-33.4 rdw-18.1* plt ct-162 05:50am blood pt-19.3* ptt-42.4* inr(pt)-1.8* 05:50am blood glucose-128* urean-16 creat-1.0 na-137 k-3.9 cl-105 hco3-25 angap-11 05:50am blood alt-48* ast-71* alkphos-143* totbili-6.9* 05:50am blood calcium-7.0* phos-2.6* mg-1.8 studies: ecg : sinus tachycardia with delayed r wave transition. low limb lead voltage. no previous tracing available for comparison. cxr : findings: ap single view of the chest has been obtained with patient in supine position. right caliber special tube has been introduced, reaching far below the diaphragm and terminating out of the caudal border of the image. moderately inflated balloon surrounds the tube at the level of the hiatus, occupying the upper portion of the stomach fundus. the patient is intubated, the ett terminating in the trachea some 5 cm above the level of the carina. no pneumothorax is identified. pulmonary vasculature not congested. heart size is moderately enlarged with a marked prominence of left ventricular contour, as well as that of the ascending aorta. pleural effusion. impression: moderate inflation of balloon of gastric tube occupying the hiatal area. abdominal us with doppler : impression: 1. patent hepatic vasculature. 2. splenomegaly. 3. large amount of ascites. 4. no liver lesion identified and no biliary dilatation. tips : successful placement of tips; paracentesis with 3 l removed. post-tips portosystemic gradient of 15 mmhg; however, minimal inflow of varices on post-tips portal venogram. paracentesis : impression: 1. successful tips placement using 7+2, 10mm viatorr stent angioplasty to 10 mm. 2. post-tips transhepatic portography with hemodynamics demonstrating final portosystemic gradient of 15 mmhg (pre-tips portosystemic gradient of 17 mmhg). 3. placement of triple-lumen central venous line via the right internal jugular access. 4. portogram showing brisk flow up stent and substantial reduction in flow to the coronary vein varix post-tips placement. 5. paracentesis with removal of 3 liters of clear yellow ascites fluid. abdominal us with doppler : impression: 1. patent tips with appropriate directionality and flow in the portal venous vasculature. 2. cirrhosis, ascites. 3. gallbladder wall edema and distention without cholelithiasis. findings are nondiagnostic for acute cholecystitis given underlying hepatic dysfunction can explain gallbladder wall changes due to third spacing and distension may be due to a fasting state. clinical correlation or hida san as necessary is recommended. diagnostic paracentesis (us guided) : impression: uncomplicated diagnostic and therapeutic ultrasound-guided paracentesis with removal of 1250 ml of clear yellow fluid. chest x-ray : findings: in comparison with study of , there is continued enlargement of the cardiac silhouette with left ventricular prominence. the tube has been removed. some atelectatic changes are seen at both bases. on the lateral view, there are substantial pleural effusions bilaterally. no evidence of acute focal pneumonia. microbiology: blood cx 1/4 bottles positive for enteroccous faecium (sensitive) on blood cx negative or ngtd from , , , , mrsa screen negative urine cx negative peritoneal gram stain negative for organisms/pmns (cx pending) brief hospital course: 50 yo m elsd secondary to etoh abuse admitted to osh with variceal bleed s/p egd with banding x2 and subsequent alcohol withdrawal transferred to for management of recurrent refractory ugib s/p tube placement and subsequent removal one day later. tips performed although with modest drop in gradient s/p procedure. hct stable. found to have ams, generating concern for benzo withdrawal vs. hepatic encephalopathy. the following problems were addressed at this admission: # ugib: source was seen on endoscopy at osh which was venous blood that was attempted to be sclerosed, bu then opened up. ge ulcers also seen on previous banding sites that were non-bleeding. patient had banding x2 at osh. he received 7u prbcs and 4 ffp at osh, and then was transferred here for further management after a tube was placed. he received 2 more units of prbc here and underwent tips. hematocrit remained stable the rest of patient's micu stay, and he remained hemodynamically stable. tips was performed , tube removed . we continued po ppi and treated gib with ceftriaxone. patient continued to remain stable. ultrasound to evaluate tips patency on showed patent tips. patient was transferred to the floor on . he had stable hct and no further evidence of bleed. # ams: patient had ams s/p extubation. it was classic for delirium; he had been picking at sheets, inattentive and showed fluctuating mental status. thus, was encephalopathic but without asterixis and less likely due to hepatic dysfunction. respiratory status and renal function are also good. given alcohol history, also considered korsakoff. we had obtained b12, tsh. we continued lactulose, rifaximin, thiamine and po ativan ciwa. on the floor, his mental status improved and he was attentive and responding to questions appropriately. he was oriented to person and place but was unable to correctly state date and still displayed occasional word-finding difficulties (e.g. in response to "what month is this?" he would answer "the first one."). # positive blood culture. patient had 1/4 bottles positive for enterococcus faecium on . all other cultures were negative. this was felt to be possibly a contaminant. he was treated with a 6-day course of vancomycin. # volume overload. patient has ascites (1200 cc removed ) and peripheral edema, which may have been exacerbated by prbc/ffp/fluid rescusitation during his bleed. he will be discharged on lasix 40 mg po daily and spironolactone 50 mg po daily with plan to monitor electrolytes, renal function and increase as needed. most recently, patient's weight is down 0.5 kg on this regimen over past 24 hours. # respiratory status: it was unclear whether the patient was intubated for etoh withdrawal or for egd. patient had received paralysis for egd and . he was extubated successfully and has had problem with oxygenation and no subjective sob. he received a 5 day course of ceftriaxone for ? infiltrate (stopped on ). # cirrhosis: secondary to alcohol and hepatitis c. unclear if patient listed on transplant list. as he has been an active drinker, he is not currently a transplant candidate but this may be considered if he is able to successfully quit drinking alcohol in the future. # etoh withdrawal: the patient had a high benzodiazepine requirement at the osh. he required intubation and multiple drips. here, he was continued on thiamine, folate, and ciwa scale; at the time of discharge he was still mildly confused but otherwise not showing signs of active withdrawal. # hepatitis c virus: likely contributing to cirrhosis. unclear if he has been treated in the past. # diabetes mellitus: the patient was placed on an insulin sliding scale for the duration of his stay. medications on admission: flexeril neurontin insulin discharge medications: 1. lactulose 10 gram/15 ml syrup sig: forty five (45) ml po tid (3 times a day). 2. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. insulin lispro 100 unit/ml solution sig: according to sliding scale subcutaneous asdir (as directed). 7. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). discharge disposition: extended care discharge diagnosis: primary: - esophageal variceal bleed - hepatic encephalopathy - alcoholic/hcv cirrhosis secondary: - alcoholism - diabetes mellitus discharge condition: mental status: confused - sometimes (has not been able to state date correctly, but oriented to person/place) level of consciousness: alert and interactive activity status: ambulatory - pt consult has recommended walking with supervision until discharged home to prevent falls discharge instructions: you were transferred to the medical intensive care unit at after efforts to stop massive bleeding from esophageal varices were unsuccessful at hospital. you underwent a procedure called tips placement which allowed the bleeding to stop. you received transfusion of two units of red blood cells while you were here, and your blood levels stabilized. your breathing tube was removed the following day. after one week, you were transferred out of the icu to the liver service . initially, you were very sleepy and confused, but you steadily became more clear-headed. at your request, we have arranged for you to be transferred back to . please note that it is extremely important that you stop drinking alcohol. even a small amount will be very dangerous to your liver. as our social workers have discussed, there are many resources to support you in your decision to stop drinking alcohol. please ask any of your health care providers for additional hellp if you feel that you need it. followup instructions: please follow up as directed following your discharge from hospital. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube percutaneous abdominal drainage injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver iron deficiency anemia secondary to blood loss (chronic) other ascites esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy other and unspecified alcohol dependence, unspecified 

Answer: The patient is high likely exposed to