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: penicillins attending: chief complaint: melena, recurrent major surgical or invasive procedure: egd with endoclip placement history of present illness: pt is a 71 y.o lady w/ severe as (valve area 0.8 cm2, mean gradient >60), w/ recent admit for ugi bleed, presents with melena x 5 days. on her last admission, patient presented w/ similar presentation, dark stools over several weeks. at that time, hct was 22 and she was hemodynamically stable. egd/c scope identified brisk bleed in 2d or 3d part of duodenum on endoscope but no lesion identified despite epi injection. pt proceeded to ir, but they were unable to identify any active bleed but prophylactively embolized a gastroduodenal artery. pt transferred to the micu for observation and management of acute gib. pt remained hemodynamically stable, requiring 5 u of prbc's over 4 days, her hct stabalized, and she was discharged home on . she reports initially feeling well after discharge, had a stable hct at her pcp's follow up appt (35.8 on ). she then developed melena again, a few stools a day, "mahogany" in color, with no associated diarrhea or gi upset. she began to feel progressively weak, pale, with dyspnea on exertion. she contact her pcp, seen in the office, and was sent to the ed for eval of recurrent gi bleed. of note, pt is not symptomatic of her as and has never had syncope, chest pain, or exertional dyspnea (up until her gi bleeds). her ros is essentially negative except for the above. upon arrival to the , pt's hct was 22.6 (from 35.8 on ) with grossly positive stool guaiac. she had mild hypotension to 100's/45's, hr 70. she was not hypoxic. it was thought that patient had potential for severe hypotension, given her bleed and as, and thus she was admitted to the for close observation. past medical history: **ugi bleed as above **severe as, normal ef, valve area 0.8 cm2 on echo , mean gradient of >60 on echo last year **hypothyroidism **hypercholesterolemia **hypertension denies h/o rheumatic fever, heart disease social history: lives with husband; still works full time as office coordinator, exercises regularly at curves; leads very active lifestyle, quit tobacco at age 35 (has 20 pack year history), occasional etoh. full code family history: father with mi at age 61 brother w/ mi at age 53? mom w/ vaginal ca, 87 yo sister w/ breast ca, passed away at age 63 brother with gastric ca physical exam: pe t 98.4 bp 112/45 hr 70 r 18 sat 100% gen: healthy-appearing, middle-aged female, appears slightly older than stated age, no distress, smiling heent: mm dry, pale conjunctivae, good skin turgor, op clear, no exudates neck: supple, no thyromegaly, no jvd chest: cta cv: rrr, harsh, crescendo murmur heard everywhere, no radiation to carotids or axilla, but some radiation to apex. not late-peaking abd: soft, non tender, no rebound or guarding, nabs, no masses rectal: guaiac positive, dark brown stool, no masses extrm: benign neuro: totally intact, great historian, cn intact, moving all extrm w/ good strenght and ease, finger to nose intact pertinent results: 09:49pm hct-24.0* 09:49pm ret aut-5.3* 03:57pm hgb-7.5* calchct-23 03:20pm glucose-101 urea n-19 creat-0.7 sodium-140 potassium-4.0 chloride-107 total co2-25 anion gap-12 03:20pm wbc-8.8 rbc-2.30*# hgb-7.2*# hct-22.6*# mcv-98 mch-31.5 mchc-32.1 rdw-16.0* 03:20pm neuts-70.4* lymphs-22.3 monos-3.9 eos-2.6 basos-0.7 03:20pm hypochrom-2+ poikilocy-1+ macrocyt-2+ 03:20pm plt count-268 03:20pm pt-12.6 ptt-23.8 inr(pt)-1.0 brief hospital course: patient was admitted to the given her tight as and recurrent ugi bleed. 1. upper gi bleed: patient remained hemodynamically stable throughout her admission. she received 3 units of packed red blood cells over her first evening of admission with adequate hct bump (22.6 to 30). she had 2 large bore iv's placed, had an ng lavage in the ed which was negative, was started on iv protonix, and was seen by gi consultation. she proceeded to egd the next morning which showed an active, pulsatile bleed from a discrete spot in the duodenal sweep. no ulcers/erosions were noted. 7 cc of epinephrine (1/10k) was injected for hemostasis w/ partial success. five endoclips were then placed over the site of bleeding, and complete hemostasis was achieved. she tolerated the procedure well and was transferred back to the for continued observation. her hct remained stable (>30), as well as her hemodynamics, and she will be discharged with close pcp and gi follow up. 2. as: remained stable. worried initially for hypotension, given decreased preload, then worried for pulm edema w/ ivf, blood products. o2 sats never wavered, bp's stable, antihypertensive med held during admission but should be restarted as soon as hct fully stabalized. 3. hypothyroid: continued home dose. 4. fen: npo w/ slow advancement to regular diet. 5. hyperlipidemia: cont lipitor 6. osteopenia: held prempro. can restart as outpatient. 7. full code 8. dispo: discharged to home in stable condition with gi/ pcp follow up, hct check and hopeful re-initiation of nifedipine in coming days. medications on admission: atorvastatin 10 qd nifedipine 60 qd synthroid 150 qd prempro 0.625-5 prilosec discharge medications: 1. atorvastatin calcium 10 mg tablet sig: one (1) tablet po qd (once a day). 2. levothyroxine sodium 150 mcg tablet sig: one (1) tablet po qd (once a day). 3. pantoprazole sodium 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* 4. stop your nifedipine until discussed with dr 5. outpatient lab work hematocrit early next week discharge disposition: home discharge diagnosis: upper gi bleed discharge condition: stable discharge instructions: **take all medications as prescribed. we had stopped your blood pressure medication, nifedipine, during your bleed. we have not restarted this, but you should discuss this w/ dr next week. **if you develop progressive weakness, dark or bloody stools, dizziness, please return to the nearest emergency room. **follow up with your physicians, as stated below. followup instructions: dr next week. please call to schedule an appt to have your blood counts checked. provider: , internal medicine where: off campus internal med. phone: date/time: 9:00 md procedure: endoscopic control of gastric or duodenal bleeding transfusion of packed cells diagnoses: pure hypercholesterolemia unspecified essential hypertension unspecified acquired hypothyroidism aortic valve disorders hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to