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: service: history of present illness: mr. is a 64-year-old male with a history of alcohol use, grade ii/iii varices, alcoholic cirrhosis, and an esophagogastroduodenoscopy which demonstrated no evidence of recent bleeding performed secondary to a hematocrit drop in , and a was admitted to the intensive care unit secondary to hematemesis. the patient notes that he began to feel nauseated 36 hour prior to admission which led decreased oral intake. he induced himself to vomit, and the vomitus was significant for bright red blood. he called his primary care physician in the emergency department, a nasogastric lavage was significant for blood which did not clear after 3 liters of normal saline. the patient was noted to have a hematocrit drop from 39 to 35 after four hours. two large-bore peripheral intravenous lines were placed, and the patient was administered 2.5 liters of normal saline. the patient was started on protonix intravenously and octreotide in the emergency department. the patient was transferred to the medical intensive care unit, and the gastrointestinal service was consulted. an esophagogastroduodenoscopy was performed, and grade iii varices were demonstrated in the lower third of the esophagus. four bands were placed near the gastroesophageal junction for nonbleeding varices. there was also noted clotted blood in the stomach. while in the medical intensive care unit the patient was continued on octreotide, transfused 4 units of packed red blood cells, and transfused 2 units of fresh frozen plasma. mr. was transferred out of the medical intensive care unit to the medical floor in good condition on . upon speaking with mr. , he denied lightheadedness, headache, chills, and night sweats. the patient also denied chest pain, substernal chest pain, shortness of breath, back pain, abdominal pain, nausea, vomiting, constipation, and hematochezia. prior to transferring mr. to the floor, he had tolerated clear liquids without incident. past medical history: 1. coronary artery disease; status post myocardial infarction in ; status post 2-vessel coronary artery bypass graft. the patient's bypasses included a left internal mammary artery to the left anterior descending artery and saphenous vein graft to the obtuse marginal. this mi occurred in the setting of an ugib. 2. congestive heart failure; echocardiogram in demonstrated an ejection fraction of greater than 75% with a left ventricular outflow obstruction. 3. hypertension. 4. alcohol abuse with cirrhosis and grade iii varices. 5. hypothyroidism. 6. depression. 7. anxiety. 8. iron deficiency anemia. 9. herniated disk (l5-l6). 10. esophagus demonstrated in . 11. talc pleurodesis for pleural effusion on . medications on admission: (medications on admission included) 1. aspirin 81 mg p.o. q.d. 2. lasix 20 mg p.o. q.d. 3. synthroid 112 mcg p.o. q.d. 4. mavik 4 mg p.o. q.d. 5. propranolol 20 mg p.o. q.d. 6. wellbutrin 150 mg p.o. b.i.d. 7. protonix 40 mg p.o. q.d. 8. multivitamin. 9. iron supplement. 10. vitamin c. allergies: no known drug allergies. social history: mr. has a history of alcohol abuse (as above). he had a several-month history with abstinence from alcohol; however, he noted that he had several drinks a few days prior to this admission. he has a remote history of tobacco use. he quit 25 to 30 years ago. he is a retired bakery owner and also worked for the court system. family history: family history was significant for head and neck cancer. the patient also has a family history of alzheimer's present in the patient's father. his mother had diabetes mellitus and congestive heart failure. physical examination on presentation: physical examination on transfer to the medical floor revealed vital signs with a temperature of 98, blood pressure was 140/100, heart rate was 80, respiratory rate was 20, oxygen saturation was 94% on room air. in general, a well-developed, well-nourished, obese male in no acute distress, sitting upright, dressed in street clothes. head, eyes, ears, nose, and throat examination revealed normocephalic and atraumatic. sclerae were anicteric. mucous membranes were moist. the oropharynx was clear. neck revealed jugular venous pressure not appreciated secondary to body habitus. chest revealed no dullness to percussion, clear to auscultation bilaterally (anteriorly and posteriorly). cardiovascular examination revealed a regular rate and rhythm. a soft first heart sound and normal second heart sound. a grade 3/6 systolic ejection murmur at the upper sternal border. no gallops or rubs were appreciated. the abdomen was obese, soft, nontender, and nondistended, normal active bowel sounds. no shifting dullness. no hepatosplenomegaly. extremities revealed no clubbing, cyanosis, or edema. neurologically, alert and oriented times three. cranial nerves ii through xii were intact. sensory and motor were grossly intact. pertinent laboratory data on presentation: laboratories on admission revealed white blood cell count was 8.1, hematocrit was 39.2, platelets were 128. sodium was 138, potassium was 4.1, chloride was 104, bicarbonate was 26, blood urea nitrogen was 11, creatinine was 0.7, and blood glucose was 162. liver function tests were significant for an alt of 35, ast was 39, alkaline phosphatase was 150, total bilirubin was 2.2. cardiac enzymes demonstrated a creatine kinase of 41. significant laboratories during admission revealed hematocrit dropped from 39.2 on admission to 28.7 on the day after admission. on the day of discharge, the patient's hematocrit increased to 34.3. the patient's peak creatine kinase was 56. troponin i was less than 0.3 on two laboratory draws. the patient's inr was 2.1 on admission; it was 1.9 on the day of discharge. the patient's liver function tests were significant for an alkaline phosphatase of 100 and a total bilirubin of 2 on discharge. several laboratories were pending at the time of discharge; including a ferritin level, iron level, hemoglobin a1c, and a thyroid-stimulating hormone. procedures/radiology/imaging: the patient had an esophagogastroduodenoscopy performed on with findings as in the history of present illness. hospital course: 1. gastrointestinal system: mr. presented to the emergency department with a history of nausea, induced vomiting, and hematemesis. the patient subsequent received nasogastric lavage which was significant for blood that did not clear with several liters of normal saline. an esophagogastroduodenoscopy was performed in the intensive care unit which demonstrated grade iii varices; however, no active bleeding varices were visualized. four varices were successfully banded near the gastroesophageal junction. the patient was maintained on intravenous protonix twice per day and octreotide while admitted. serial hematocrits were followed; the lowest hematocrit was 28.3, dropping from 39 on presentation. mr. received a total 4 units of packed red blood cells, and his hematocrit on discharge was 34. upon discharge, mr. was restarted on a beta blocker and he was provided instructions to follow up with his gastroenterologist in two weeks in order to have a repeat esophagogastroduodenoscopy performed. 2. cardiovascular system: mr. has a history of myocardial infarction in the setting of anemia in the past. he ruled out for a myocardial infarction by cardiac enzymes while admitted. secondary to his coronary artery disease, his goal hematocrit was greater than 30. on presentation, his blood pressure medications were held secondary to his active bleeding. the patient's ace inhibitor, beta blocker, and furosemide was restarted on the day prior to discharge. mr. remained hemodynamically stable and tolerate oral medications well. 3. hematology: mr. has a history of iron deficiency anemia. his hematocrit significantly dropped in the setting of active bleeding on presentation. he was transfused as indicated above with packed red blood cells and fresh frozen plasma. on presentation, his inr was noted to be evaluated, and he was admitted vitamin k. mr. was to be discharged on iron supplementation. secondary to the patient's upper gastrointestinal bleed, it was decided to hold aspirin therapy for one week upon discharge. 4. psychiatry: the patient has a history of alcohol abuse as above. he was maintained on a ciwa scale with ativan as needed. he did not demonstrate any significant signs of withdrawal while admitted. on discussion with mr. , he seemed motivated to quit alcohol use at this time and notes several ways to change behavior which leads to his alcohol abuse including a trip to , removing alcohol from home, and going to a different alcohol anonymous group. mr. was to follow up with his primary care physician at and will be put in contact with the social work service during his next visit. discharge disposition: the patient was to be discharged to home upon successfully tolerating a full liquid diet. condition at discharge: condition on discharge was stable. discharge status: the patient was to be discharged to home with followup by his primary care physician and gastroenterology. discharge diagnoses: 1. upper gastrointestinal bleeding. 2. grade iii esophageal varices. 3. anemia. 4. hypertension. 5. type 2 diabetes mellitus. 6. hypothyroidism. 7. cirrhosis with coagulopathy. medications on discharge: 1. propranolol 40 mg p.o. b.i.d. 2. lasix 20 mg p.o. q.d. 3. mavik 4 mg p.o. q.d. 4. paxil 20 mg p.o. q.d. 5. synthroid 112 mcg p.o. q.d. 6. protonix 40 mg p.o. q.d. 7. xanax 0.5 mg p.o. t.i.d. as needed (for anxiety). 8. aspirin 81 mg p.o. q.d. (the patient was to hold off on taking this medication for one week after discharge). discharge followup: 1. mr. was to see his primary care physician at (dr. ) on . 2. mr. will also need to follow up with gastroenterology. he will be called by this service to schedule a follow-up appointment within two weeks after discharge. dr., 12-797 dictated by: medquist36 procedure: endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: congestive heart failure, unspecified alcoholic cirrhosis of liver iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism esophageal varices in diseases classified elsewhere, with bleeding other specified disorders of stomach and duodenum other and unspecified alcohol dependence, unspecified 

Answer: The patient is high likely exposed to