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: adhesive bandage attending: chief complaint: significant rectal bleeding from rectal ulcer major surgical or invasive procedure: colonoscopy with biopsy rigid anascopy with oversewing of the ulcer paracentesis intubation and extubation paracentesis (2x) history of present illness: mr is a 79 y/o m with history of cirrhosis complicated by ascites and esophageal, gastric and rectal venous varices, cad s/p cabg, atrial fibrillation, pvd s/p aaa repair, and recent admission to for observation after rectal variceal glue injection, who is transferred to from hospital after another episode of rectal bleeding. he was in his usoh on the evening of when an attempt to have a bowel movement resulted in large volume of brbpr. he denied dizziness, lightheadedness, loss of consciousness, chest pain, palpitations, or diaphoresis associated with the hematochezia. he did have some dyspnea associated with the bloody bowel movement, called ems, and was brought to the osh. . in the osh ed, he was given 2 units of prbcs and 2u ffp. he was admitted to the osh icu, where he received five more units of prbcs. he was initially described as acutely short of breath, hypotensive, tachycardic, pale, lethargic and in acute hemorrhagic shock. he responded to ivf boluses and rbc transfusions. he was seen by osh gi service and requested transfer to given his recent admission and ongoing hepatology care, here. hct prior to d/c was 24.3, and 1 unit of prbcs was given on transfer. he was placed on ceftriaxone 1g iv daily for history of "cirrhosis." . on arrival to the micu, he is without complaints other than a dry mouth and feeling tired. denies further bleeding, abdominal pain, nausea, vomiting, chest pain, palpitations, or lightheadedness. . he was admitted to for observation after rectal variceal glue injection. during that admission, he also had a therapeutic paracentesis performed. . while on the medical floor, the patient had copious amounts of blood per rectum and was transferred to the micu. he had an emergent colonoscopy which was interrupted due to the presence copious amount of bright red blood; however, a single deep, oblong, spurting 3 cm ulcer was found in the rectum. given the rate and color of the blood there was concern for arterial bleeding. the limited visualization precluded endscopic management of the bleeding. sengstaken tube was placed in the rectum and the gastric balloon was inflated to 50cc and subsequently 75cc total with air to tamponade the bleeding from the rectal ulcer. approximately 1.5+ liters of blood were lost during this process. the patient was transfused 4 u prbc, 2 ffp, 1 plts, and 1.5l ns. he remained hemodynamically stable with sbp's 110-130's and hr in the 60-70's. a foley was placed and ~ 200-300 cc of urine drained upon insertion. past medical history: - end-stage liver disease with cirrhosis - portal hepatopathy with esophageal, gastric and rectal venous varices - myelofibrosis - coronary artery disease status post cabg. - chronic atrial fibrillation - peripheral vascular disease status post repair of abdominal aoritc aneurysm. - diverticulosis - anemia - moderate aortic stenosis - moderate tricuspid regurgitation social history: he lives at home with his wife, who has advanced throat cancer. several family members assist in his care. he has a history of heavy alcohol abuse - he endorses prior heavy drinking daily, including multiple beers and scotches. last drink approximately one year ago. he also has a remote smoking history (20 pack year smoking history), but denies any history of illicit drug use in the past. family history: notable for hypertension, coronary artery disease, as well as malignancy of unknown etiology. he has no family history of diabetes, and no known gi or liver disease in the family. physical exam: admission physical examination: vitals: t:96.4 bp:130/69 p:57 r:20 o2:100% ra general: alert, oriented, no acute distress heent: sclera anicteric, dry mm, oropharynx clear, eomi neck: supple, jvp not elevated, no lad cv: irregularly irregular, +systolic murmur heard throughout precordium, most prominent at rusb no rubs, gallops lungs: ctab, no wheezes, rales, ronchi. good inspiratory effort abdomen: distended, dull to percussion, non-tender, bowel sounds present, no organomegaly, +fluid wave ext: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no asterixis neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred gu: external hemorrhoids, rectal exam deferred. . discharge physical examination: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, op clear, perrl, eomi neck: supple, jvp not elevated, no lad cv: irregularly irregular, +systolic murmur heard throughout , no rubs, gallops lungs: ctab, no wheezes, rales, rhonchi abdomen: distended, dull to percussion, non-tender, bowel sounds present, no organomegaly ext: thin, warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no asterixis pertinent results: admission labs: 12:19am blood wbc-9.2 rbc-3.41* hgb-9.9* hct-28.6* mcv-84 mch-28.9 mchc-34.5 rdw-16.5* plt ct-126* 12:19am blood pt-14.2* ptt-34.4 inr(pt)-1.3* 12:19am blood glucose-134* urean-29* creat-1.4* na-139 k-4.3 cl-111* hco3-17* angap-15 12:33am blood lactate-1.7 : 06:36pm ascites wbc-33* rbc-* polys-66* lymphs-18* monos-1* mesothe-2* macroph-13* 06:36pm ascites totpro-1.6 glucose-150 ld(ldh)-122 albumin-less than 10:52am urine color-yellow appear-clear sp -1.029 10:52am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.5 leuks-tr 10:52am urine rbc-36* wbc-23* bacteri-few yeast-none epi-0 10:52am urine hours-random urean-1081 creat-134 na-58 k-25 cl-45 10:52am urine osmolal-692 10:39am blood ck-mb-1 ctropnt-<0.01 11:03pm blood ck-mb-1 ctropnt-<0.01 06:45am blood ck-mb-2 ctropnt-<0.01 01:40am blood ctropnt-<0.01 07:48am blood ctropnt-<0.01 05:22am blood triglyc-79 03:14am blood hbsag-negative hbcab-negative 03:14am blood hcv ab-negative 12:33am blood lactate-1.7 03:29am blood lactate-1.3 04:58am blood lactate-1.2 discharge labs: 05:45am blood wbc-14.1* rbc-3.08* hgb-9.0* hct-26.8* mcv-87 mch-29.3 mchc-33.7 rdw-15.7* plt ct-214 05:45am blood glucose-84 urean-14 creat-1.0 na-138 k-4.6 cl-105 hco3-26 angap-12 05:45am blood calcium-8.1* phos-3.2 mg-1.9 microbiology: mrsa screen (final ): no mrsa isolated. hbv viral load (final ): hbv dna not detected. hcv viral load (final ): hcv-rna not detected. 6:36 pm peritoneal fluid peritoneal fluid. gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture: no growth anaerobic culture: no growth 11:43 am stool consistency: not applicable clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). imaging: colonoscopy a few diverticula with small openings were seen in the sigmoid colon. diverticulosis appeared to be of mild severity. a single deep oblong non-bleeding 3 cm ulcer was found in the rectum. diverticulosis of the sigmoid colon ulcer in the rectum (biopsy) otherwise normal sigmoidoscopy to splenic flexure and cecum colonoscopy a single deep oblong spurting 3 cm ulcer was found in the rectum. attempts were made to stop the bleeding endoscopically but there was excessive bleeding from the ulcer that precluded visualization of the ulcer. a sengstaken tube was placed in the rectum and the gastric balloon was inflated to 50cc and subsequently 75cc total with air to tamponade the bleeding from the rectal ulcer. otherwise normal colonoscopy to cecum and distal descending colon cxr : findings: as compared to the previous radiograph, there is a massive increase in lung density, in particular due to an increase in vascular diameters and alveolar structures. on the left, there is a rather extensive retrocardiac atelectasis, potentially combined to a small left pleural effusion. overall, the findings are suggestive of interval appearance of pulmonary edema. kub : impression: dilated air-filled loops of small bowel, compatible with ileus. cannot rule out obstruction, given lack of air in large bowel. ct may be obtained for further evaluation. renal us : conclusion: normal-sized kidneys with no hydronephrosis. ascites and massive splenomegaly noted. cxr : interval placement of a nasogastric tube which is coursing below the diaphragm with the tip likely within the stomach. a portion of a right internal jugular central line is seen with the tip in the mid svc. overlying motion limits evaluation of the lungs. there is a scattered air in non-distended loops of bowel. multiple surgical clips are seen in the mid abdomen. elbow : no evidence of displaced fracture or dislocation of the left elbow. soft tissue swelling suggests soft tissue hemorrhage. brief hospital course: 79 y/o m with etoh cirrhosis and portal hypertension c/b multiple varices including rectal varices requiring recent glue injection, presenting with aggressive lower gi bleed, requiring multiple rbc transfusions at osh. the patient was initially stabilized in the transfered to the floor, then transfered back to the icu after large volume continued rectal bleeding. . # rectal bleeding: volume and blood resuscitated at osh with about 7 units of blood and 2 units of ffp. upon presentation to the micu, patient was no longer actively bleeding. he received 1 unit of prbcs at . there was concern for variceal bleed, and patient remained on octreotide. however, after sigmoidoscopy on , it was determined that source of bleeding was large rectal ulcer (likely in context of glue previously applied to varices). gi did not intervene, but did take biopsies of the rectal ulcer. patient remained hemodynamically stable and was called out to the floor. however, on the night of , patient began to bleed again profusely per rectum on the floor. the massive transfusion protocol was initiated, and patient was transfused a total of 12 units of blood. surgery was called, who placed tube in patient's rectum to tamponade the bleeding. the patient was then transferred to interventional radiology however they were unable to locate the source of bleeding. colorectal surgery was consulted, and immediately took the patient to the or and oversewed the area of bleeding. it remained unclear whether this was bleeding from the initial ulcer or a rectal varix. after the oversew procedure, the patient remained hemodynamically stable and did not require additional blood. he continued to be followed by colorectal surgery and the liver team. he experienced minor blood loss on stooling with no significant drop in hct. however, on the night of , he developed increased rectal bleeding and then then passed a "toilet-bowl" full of brbpr the following morning. the patient was transferred to the micu for closer observation, started on an octreotide drip, and given ceftriazone for sbp prophylaxis. he was taken to the or later in the day for exam under anesthesia, where a small oozing ulcer was observed and stitched once. he was transfused 2 units prbcs, for a total of 20 units since admission. the patient reported no further bleeding, pain, abdominal discomfort, or shortness of breath for several hours after the procedure. a goals of care discussion was conducted with the patient and his family. as a result his code status was changed to dnr/dni with a plan for hospice care. he was then called out to the floor. once returned to the floor, the patient continued to be hemodynamically stable without obvious bleeding. he was discharged home with hospice care. . # ileus: after the initial rectal ulcer repair on , patient developed abdominal pain and bloating. a kub demonstrated ileus with possible sbo. patient remained npo. an ngt was placed to reduce nausea. the patient continued to have small stools, which then increased with relief of nausea. the ngt was removed without further symptoms. . # cirrhosis: decompensated with ascites, as well as aforementioned varices. abdomen full but not tense on arrival; no abdominal pain, asterixis or encephalopathy suggestive of sbp. diuretics were held initially in the setting of gi bleed. patient's lfts and coags were trended. a paracentesis revealed no sign of sbp but did not yield significant fluid (230cc). repeat paracentesis yielded 3.3l of fluid with relief of abdominal pressure. . # metabolic acidiosis: non-anion gap, hyperchloremic, potentially due to saline volume resuscitation at osh. normal lactate. electrolytes were repleted throughout hospitalization. the acidosis resolved rapidly with volume normalization. . # : creatinine found to be elevated on admission to 1.4. obstructive pathology excluded with normal ultrasound. returned to baseline 1.1 with hydration. . # leukocytosis: no obvious source of infection. he was treated with ctx empirically following variceal bleeding. paracentesis revealed no sign of sbp. hepatitis serologies revealed no viral load. the leukocytosis was thought to be a stress response to bleeding given the timing after each significant bleeding episode. . # cad: stable ekg. home medications were continued. patient complained of chest pain the evening of . he described it as an itch, then pain in the left shoulder. this pain was present at rest and was not triggered by exertion. given the patient's cardiac history, there was concern for acs although the description is not fully consistent. ekg showed no changes, telemetry was unremarkable, and cardiac enzymes negative x3. pain resolved with morphine 2mg and ntg. there was no recurrence prior to discharge. anti-platelet therapy was held due to bleeding. . # a fib: the patient had an episode of rapid a fib on admission to the micu. this was controlled with beta blockade. thereafter he had good rate control with his home dose of nadolol. starting he had episodes of bradycardia to the 40s. nadolol was then held with no recurrence of rapid rate. . # fall: on , the patient fell in his room while walking to the commode. he fell on his left elbow. xr revealed no bony injury. there was no injury to the joint, no swelling, and no bleeding. . # pvd s/p aaa repair: palpable pulses. home medications continued. medications on admission: medications (home): allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). folic acid 1 mg tablet sig: one (1) tablet po daily (daily). nadolol 20 mg tablet sig: two (2) tablet po daily (daily). pantoprazole 40 mg tablet, delayed release (e.c.) po q12h magnesium oxide 140 mg capsule sig: two (2) capsule po daily thiamine hcl 100 mg tablet sig: one (1) tablet po daily furosemide 20 mg tablet sig: one (1) tablet po daily (daily). spironolactone 100 mg tablet sig: one (1) tablet po daily . medications on transfer: -ceftriaxone 1g iv daily -octreotide 500 mcg -nacl 50 mcg per hour -nitrostat sl prn -protonix 40 mg iv q24 discharge medications: 1. allopurinol 100 mg tablet sig: 1.5 tablets po once a day. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. furosemide 20 mg tablet sig: one (1) tablet po once a day. 6. spironolactone 100 mg tablet sig: one (1) tablet po once a day. 7. magnesium oxide 84.5 mg (140 mg) capsule sig: two (2) capsule po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*2* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 10. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 11. loperamide 2 mg capsule sig: one (1) capsule po twice a day as needed for diarrhea: please take this medication only if you are having diarrhea. . disp:*30 capsule(s)* refills:*0* discharge disposition: home with service facility: hospice of and greater discharge diagnosis: primary diagnosis: lower gastrointestinal bleed secondary to rectal ulcer cirrhosis complicated by esophageal, gastric, and rectal varices, ascites . secondary diagnosis: atrial fibrillation coronary artery disease status post coronary artery bypass grafting peripheral vascular disease status post abdominal aortic aneurysm repair discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you passed bright red blood while you were having a bowel movement at home. you initially were transferred to the intensive care unit for a colonoscopy. this determined that the source of your bleeding was a rectal ulcer. this was oversewn. you were transferred to the regular medical floor, but experienced another episode of bleeding and were once again taken to the operating room for oversewing. you were transfused 20 units of blood products during your bleeding episodes. your hospital stay was complicated by an irregular heartbeat (atrial fibrillation), slow gastrointestinal passage (ileus), and ascites. after discussions with you and your family, we all decided it is best for you to go home with hospice. you were also having some diarrhea on discharge. you did not have an infection, so you can take immodium as needed only if you are having severe diarrhea. the goal is for you to have soft stools so you don't irritate the area of the ulcer and cause it to bleed again with hard stools. we have made the following changes to your medications: - decrease nadolol from 40mg a day to 20mg a day (take one pill instead of 2 pills) - start colace to soften stool - start senna to avoid constipation please follow up with your physicians as listed below. followup instructions: department: liver center when: friday at 2:00 pm with: , md building: lm campus: west best parking: garage department: surgical specialties when: thursday at 11:15 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage aortography colonoscopy arteriography of other intra-abdominal arteries suture of artery dilation of intestine closed [endoscopic] biopsy of rectum ligation of hemorrhoids other repair of rectum other repair of rectum central venous catheter placement with guidance diagnoses: acidosis acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified portal hypertension atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders peripheral vascular disease, unspecified personal history of tobacco use hypotension, unspecified paralytic ileus other sequelae of chronic liver disease other ascites do not resuscitate status varices of other sites esophageal varices in diseases classified elsewhere, without mention of bleeding internal hemorrhoids with other complication accidents occurring in residential institution fall from other slipping, tripping, or stumbling diseases of tricuspid valve myelofibrosis leukocytosis, unspecified acute edema of lung, unspecified hemorrhage of rectum and anus ulcer of anus and rectum 

Answer: The patient is high likely exposed to