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: painless jaundice major surgical or invasive procedure: none history of present illness: hpi: 89 f with pmh sig for cad, af, cva and l hemiplegia presenting with painless jaundice. she was noted to have jaundice develop 5 weeks ago while living in her nursing home. she was admitted to hospital for evaluation, found to have dilated intrahepatic ducts on u/s, was referred to clinic at and sent in for further evaluation. . hx obtained per pt and her daughter, pt is a poor historian. she denies f/c/n/v. notes poor po intake x 3 weeks with 10 lb wt loss over 1 month. less interest in eating ice cream her favorite food. denies depressed mood or agitation. does have decreased energy with some lightheadedness with position changes for which her lasix was stopped on and salt tablets were added. normal bm per her, does not know of color changes to bm or urine. past medical history: cad - mi without stents placed or cardiac cath af - on coumadin, no rate or rhythm controlling meds cva with l hemiplegia ', wheelchair dependent anemia cognitive decline hypothyroidism s/p appy s/p ccy s/p hernia repair s/p hysterectomy social history: lives at nursing home, w/c dept, never smoked, rare etoh, no illicits, has numerous children in area family history: no known family history of malignancy physical exam: vitals: 96.0 106/48 80 18 99%ra genl: well appearing, pleasant, sitting up in bed heent: icteric, mmm neck: supple, no carotid bruits cv: rr nl s1/s2 no mrg appreciated resp: ctab with good air movement abd: distended, soft, tender on epigastrium and ruq with deep palpation back: no spinal or cva tenderness extrem: warm, cap refill < 3 sec, 2+ edema neuro: cn 2-12 intact, l hemiplegia, moves right arm and leg well skin: jaundiced, scaling white plaques in groin region pertinent results: labs: osh lab report wbc 7.5 hct 27.7% plt 181 cr 0.7 na 131, alb 2.8 t bil 14.8 dbili 11.6 alk phos 756 alt 57 ast 117 . 06:50am blood wbc-7.0 rbc-3.40* hgb-9.7* hct-29.8* mcv-88 mch-28.5 mchc-32.5 rdw-20.4* plt ct-224 06:50am blood plt ct-224 06:50am blood pt-53.8* ptt-53.3* inr(pt)-6.5* 06:50am blood alt-68* ast-160* ld(ldh)-174 alkphos-1006* amylase-67 totbili-20.4* 06:50am blood lipase-75* 06:50am blood albumin-2.7* calcium-8.1* phos-2.5* mg-2.1 iron-pnd . mrcp : 1. marked right and left intrahepatic biliary dilatation extending to the central ends of the segmental branches in the left lobe and central ends of the anterior and posterior division of the right biliary tree with an ill defined mass in the porta-hepatitis measuring up to 5.5cm trn x 3.4cm ap. appearances are most consistent with a klatskin- type cholangiocarcinoma which does not appear amenable to resection given the involvement of all the right and left main biliary ducts. mildly enlarged lymph node in the anterior periportal region measuring up to 1.9 cm may represent local adenopathy but no distant metastatic disese demonstrated. 2. several small (subcentimeter) pancreatic cystic lesions (cysts versus side branch ipmt). 3. small amount of intra-abdominal ascites. 4. hiatus hernia and moderate colonic diverticulosis . ecg : atrial fibrillation with a controlled ventricular response. diffuse low voltage. t wave inversions in leads v1-v2 suggestive of anteroseptal ischemia. no previous tracing available for comparison. . cxr: 05:29am blood wbc-6.2 rbc-3.54* hgb-10.9* hct-32.7* mcv-92 mch-30.9 mchc-33.4 rdw-19.6* plt ct-186 05:29am blood plt ct-186 07:36pm blood pt-13.9* ptt-33.3 inr(pt)-1.2* 05:29am blood glucose-100 urean-10 creat-0.6 na-134 k-3.6 cl-106 hco3-17* angap-15 05:29am blood alt-53* ast-114* ld(ldh)-198 alkphos-616* totbili-23.0* brief hospital course: impression/plan: 89 y/o f with painless jaundice and evidence of intrahepatic ductal dilatation on u/s, concern for malignancy . # painless jaundice: mrcp was ordered to evaluate ductal system. it revealed ductal dilation and enhancement suggestive of cholangiocarinoma, without obvious metastasis but not amenable to resection. she developed gi bleeding in setting of supratherapeutic ptt requiring 3u prbc transfusion and monitoring in the icu. this resolved with stopping the heparin and holding her coumadin. plan was initially for ercp to look for a source of bleeding as well as to stent her biliary obstruction. after family meeting on goals of care were changed to palliation and since she had no further gi bleeding or pain with stable bilirubin, it was decided that should would have the ercp and stent placement in the future if she developed any symptoms which can be arranged required no pain medication when in hospital but they can likely . # af on coumadin: this was rate controlled without any agents throughout admission. coumadin was held due to supratherapeutic inr and need for interventions. she remained supratherapeutic with elevated pt and ptts after vitamin k orally. subcutaneous vitamin k was also administered. she had the ugib as describe above so the decision was made to hold her coumadin and aspirin indefinitely due to risk of gi bleeding. she should continue on protonix twice a day since there was no clear source of gi bleeding. . # upper gi bleed: one day 3 patient was noted to have melena. her inr was 1.5 and ptt was in the 70s from subcutaneous heparin administration for dvt prevention. ng lavage revealed bright red blood and clots. she was hypotensive, tachycardic and was transferred to the for further care. a right ij tlc was placed, she was resucitated with ivf and 3 units prbcs. after hematocrits were normal for 24 hours she was sent back to the flood with a left picc line in place which we will leave in place and removal can be determined at rehab. . # hypotension: patients blood pressure was noted to be lower 90-110s/60s after admission without signs of cardiac dysfunction or infection. her lisinopril was held with good effect but restarted along with lasix due to symptoms of volume overload. . # cad: presumed stable ecg with evidence of previous ischemia, patient had no pain, she but asprin was stopped due to gi bleed. . # metabolic acidosis without gap: due to saline ivf, once these were stopped, bicarb levels improved. . # hyponatremia: initially thought to be due to hypovolemia, then found consistent with siadh. she was placed on a free water restriction 750 cc daily, sodium was monitored and increased appropriately. she never had evidence of mental status changes with levels as low as 124. chest xrays were checked for potential lung malignancy or infection as the cause and none were found. . fen: 2g na diet maintained. ppx: ppi protonix given, sc heparin when not anticoagulated on coumadin, bowel and pain regimen maintained access: l picc communication: with hcp daughter h ; w code: dnr/dni, reviewed with pt and her daughter, papers at bedside medications on admission: aspirin 81, diocts 60mg/15ml 25mg (100mg) po bid, lasix 20mg daily (has been off since ), levoxyl 50mcg, lisinopril 5, mvi, potassium 20meq, saline nasal spray, senna, saline tears, coumadin daily doses unknown, nacl 1gm x 2 days started discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. multivitamin capsule sig: one (1) cap po daily (daily). 6. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 7. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 8. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 9. docusate sodium 150 mg/15 ml liquid sig: fifteen (15) ml po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 13. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 14. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 15. dolasetron 12.5 mg/0.625 ml solution sig: one (1) intravenous q8h (every 8 hours) as needed. 16. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 17. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po every other day. 18. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). discharge disposition: extended care facility: discharge diagnosis: obstructive jaundice hyponatremia coronary artery disease anemia dementia atrial fibrillation hypothyroidism metabolic acidosis discharge condition: afebrile and vital signs stable discharge instructions: take all of your medications as directed. please call your doctors if have pain, nausea, vomiting, fevers, increased yellow skin or inability to tolerate eating well. followup instructions: see your primary care doctor in weeks after discharge. you should also have your doctor at the nursing home evaluate when to contact dr. regarding timing for ercp in the future. procedure: other endoscopy of small intestine transfusion of packed cells diagnoses: acidosis coronary atherosclerosis of native coronary artery unspecified pleural effusion acute posthemorrhagic anemia unspecified acquired hypothyroidism atrial fibrillation old myocardial infarction long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side other disorders of neurohypophysis malignant neoplasm of extrahepatic bile ducts 

Answer: The patient is high likely exposed to