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: abdominal pain major surgical or invasive procedure: ercp (endoscopic retrograde cholangiopancreatography) with sphincterotomy and pancreatic duct stent placement history of present illness: ms. is a year old russian-speaking female with dmii, hypothyroidism, afib who presents from rehab with several hours of acute onset of abdominal pain. she reports that she first experienced diffuse abdominal pain radiating to the back earlier this afternoon that did not improve with pain medications and made it difficult to eat. she was able to move her bowels three times today, but did not have any diarrhea, hematochezia or melena. she also had no nausea or vomiting until arriving in the ed, when she had an episode of bilious non-bloody emesis. there, the staff was concerned about her ability to protect her airway while vomiting, but no clear episode of aspiration was noted. . in the ed, ms. had vs: t101.7 p 98 bp 184/86 rr 20 pox 96 o2 sat but remained hemodynamically stable. labs showed an elevated lipase. a ct abd/pelvis showed fat-filled umbilical hernias. blood cultures were sent. she received zosyn, acetaminophen, morphine, zofran, and 3l ns. vs at the time of transfer were: t 101 p84 bp 111/41 r20 o2sat 96% on 3l. . on the floor, the patient is asleep and rouses briefly to significant physical stimulation. past medical history: cad: per pcp's office, pt had echo in , ef=65% and dchf noted. in had dual chamber placemaker placed for heart block. spinal stenosis- was recently admitted to () for weakness, found to have spinal stenosis, had been at rehab for one month prior to admission atrial fibrillation diabetes mellitus hypothyroidism, s/p thyroidectomy cataracts mild dementia psoriasis copd chronic lower back pain lumbrosacral spondylitis gait disorder ventral hernia urinary incontinence s/p pacemaker placement s/p cholecystectomy s/p hysterectomy social history: patient lives at rehab. at baseline, she is able to feed herself, but uses a wheelchair and requires assistance with all other adl's. per daughter, had been at rehab for one month prior to admission after admission to 6 weeks ago for weakness, found to have spinal stenosis and osteoarthritis. prior to that admission, had been living at home getting home health aide and assistance from daughter who lived very closeby. tobacco: none etoh: none illicits: none family history: non contributory physical exam: vitals: t: 97.7 bp: 100/43 p:77 r: 16 o2: 94% on 3l general: sleeping soundly, no acute distress heent: sclera anicteric, mmd, oropharynx clear neck: supple, jvp difficult to assess, no lad lungs: diffuse expiratory wheezes, no rales, rhonchi cv: distant heart sounds, regular rate and rhythm, no murmurs, rubs, gallops abdomen: soft, obese, distended, prominent firm ventral hernia, no bowel sounds, no guarding or grimace to palpation, negative sign gu: foley draining dark yellow urine ext: warm, well perfused, 2+ pulses, 1+ pitting edema to the mid-calf bilaterally pertinent results: 09:00pm blood wbc-14.9* rbc-4.82 hgb-13.0 hct-38.8 mcv-81* mch-27.0 mchc-33.5 rdw-15.3 plt ct-255 03:54am blood wbc-16.2* rbc-3.56* hgb-9.5* hct-29.8* mcv-84 mch-26.6* mchc-31.8 rdw-15.4 plt ct-209 06:30am blood wbc-11.7* rbc-3.52* hgb-9.3* hct-29.4* mcv-84 mch-26.5* mchc-31.7 rdw-15.3 plt ct-233 06:55pm blood wbc-12.1* rbc-3.63* hgb-9.5* hct-30.2* mcv-83 mch-26.2* mchc-31.5 rdw-15.3 plt ct-247 05:40am blood wbc-9.8 rbc-3.68* hgb-9.8* hct-30.8* mcv-84 mch-26.8* mchc-32.0 rdw-15.4 plt ct-238 05:30am blood wbc-7.5 rbc-3.61* hgb-9.7* hct-30.0* mcv-83 mch-26.9* mchc-32.4 rdw-15.3 plt ct-284 05:30am blood glucose-109* urean-12 creat-0.5 na-139 k-3.6 cl-99 hco3-30 angap-14 09:00pm blood alt-611* ast-851* ld(ldh)-677* ck(cpk)-78 alkphos-573* totbili-2.1* 03:54am blood alt-211* ast-67* ld(ldh)-141 alkphos-256* amylase-138* totbili-0.9 06:30am blood alt-143* ast-32 alkphos-225* totbili-0.6 05:40am blood alt-117* ast-27 ld(ldh)-184 alkphos-214* amylase-32 totbili-0.5 09:00pm blood lipase-6260* 03:41am blood lipase-3165* 03:54am blood lipase-278* 05:40am blood lipase-50 05:30am blood phos-2.8 mg-1.6 04:13pm blood lactate-3.0* cxr impression: no definite acute process. no free air. ct abd/pelvis w/contrast impression: 1. acute uncomplicated pancreatitis. 2. diverticulosis without diverticulitis. multiple large duodenal diverticuli, one of which is periampullary, although without biliary ductal dilatation. 3. trace bilateral pleural effusions. 4. small fat-containing paraumbilical hernias. 5. small pulmonary nodules as noted. assuming no known primary malignancy or risk factors for primary lung neoplasm, followup chest ct suggested in 12 months. leni lue/lle: no evidence of dvt. ercp impression: a single periampullary diverticulum with large opening was found at the major papilla cannulation of the biliary duct was then successful and deep with a sphincterotome after a guidewire was placed. contrast medium was injected resulting in complete opacification. a 5cm by 5fr geenen pancreatic stent was placed successfully to assist with biliary cannulation there was a filling defect that appeared like sludge at the lower third of the common bile duct. due to the clinical picture and a high suspicion for cholangitis, a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. biliary sludge was extracted successfully using a 12 mm balloon. the bile duct was clear at the end of the procedure. otherwise normal ercp to third part of the duodenum recommendations: repeat ercp in 1 week for pancreatic stent removal no aspirin, plavix, nsaids, coumadin for 7 days post procedure follow for response and complications. if any abdominal pain, fever, jaundice, gastrointestinal bleeding please call ercp fellow on call (). brief hospital course: ms. is a year old russian-speaking female who presents with several hours of acute onset of abdominal pain, fevers, nausea, & vomiting consistent with acute gallstone pancreatitis and cholangitis. pt was likely initially septic, and was initially managed in the icu. she underwent ercp with sphincterotomy, biliary sweep with sludge removal. patient clinically improved after ercp. please see below for details, issue by issue. . # acute pancreatitis: patient with clinical, radiographic, and hematologic signs of pancreatitis. lactate 3.3. criteria score of 3 on admission, estimating approximately 15% mortality. lipase 6260 with elevated tbili and alk phose suggestive of gallstone pancreatitis. lipase trended down to 3165 by the following morning. an ercp was performed. no stones were removed, but sphincterotomy was performed and a biliary stent was placed. diet was advanced, which she tolerated without difficulty. . # gi bleed: on icu day #2, the patient was noted to have one episode of maroon stooling. this was thought to possibly be due to a complication of ercp, however, the patient and her daughter (hcp) were offered re-exploration by ercp and deferred, wishing to avoid any further invasive procedures or possible intubation. h/h subsequently remained stable. pt passed black stool, guiac positive, but this is thought to be old blood from previous bleed; there is no evidence of ongoing bleed. discussed with ercp, and they will check h/h at time of return for pd stent removal. . # anemia, acute blood loss: as noted above, no evidence of ongoing bleeding. h/h was followed and remained stable. . # acute cholangitis: pt underwent ercp and she received empiric zosyn x 3 days. pt was afebrile at the time of discharge. - repeat ercp for pancreatic stent removal scheduled for later this week. importance of procedure explained to patient and daughter via interpreter; in agreement. - no aspirin, plavix, nsaids, coumadin for 7 days post procedure. continue to hold in anticipation of repeat procedure later this week. . # atrial fibrillation: unclear cardiac history, though patient is s/p pacemaker and has e/o cardiomegaly on cxr. home medications suggest possible chf or cad history, though none recorded. patient with chads score of 3 should warrant anticoagulation, unclear why patient is not on coumadin. regardless, pt is not currently a candidate for initiation of coumadin considering current procedures and gi bleed. defer to pcp. contin home metoprolol, nitrate, statin, hctz - aspirin held d/t sphinctertomy. recommend continuing to hold until after pancreatic stent removal. please follow up ercp recommendations for timing of resuming after that procedure. . # copd: history of copd. does not use o2 at baseline. per daughter and osh records, pt uses albuterol as an outpatint. pt felt sob yesterday; improved with albuterol mdi and nebs. pt's sats/vitals remained stable. . # diabetes mellitus: patient with history of dm, but per report, not on any medications as an outpatient. patietn was covered with an insulin sliding scale with excellent glycemic control. . # hypothyroidism: contin home dose of levothyroxine 50mcg daily. . # altered mental status: the patient had frequent episodes as disorientation. lines & tubes were minimized, and the patient was frequently reorientated. improved. . # spinal stenosis severe leg weakness. per family recently wheelchair bound. - pt will return to rehab. . # lue swelling pt was noted to have some swelling in l arm and lle. an u/s ue/le was negative for dvt; edema resolved. . # incidental finding: pulmonary nodules please see radiology report. ** repeat ct chest recommended in 12 months for follow up. ** . fen: regular; diabetic/consistent carbohydrate . prophylaxis: received subcutaneous heparin . access: peripherals . code: dnr/dni (confirmed with daughter who is hcp, except for procedure) . communication: patient and daughter, (cell) pcp: . () . disposition: discharge to rehab long-term care with outpt pd stent removal on thursday . medications on admission: aspirin 81 mg po daily isosorbide mononitrate 30 mg po daily metoprolol 50 mg po bid levothyroxine 50 mcg po daily simvastatin 40 mg po daily hydrochlorothiazide 25 mg po daily celexa 20 mg po daily omeprazole 20 mg po daily tylenol prn vitamin d calcium carbonate senna maalox dovonex cream discharge medications: 1. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 3. fluocinolone topical 4. dovonex topical 5. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 9. simvastatin 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: # sepsis # cholangitis # acute pancreatitis # acute gi bleed # anemia acute blood loss # copd discharge condition: mental status: clear and coherent level of consciousness: alert and interactive russian-speaking only (via interpreter) activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted with nausea, vomiting, and abdominal pain and were found to have an obstuction in your biliary system which caused infection in your bile duct, and inflammation in your pancreas called pancreatitis. you underwent ercp and a pancreatic duct stent was placed; this stent will need to be removed on thursday . do not take any aspirin, plavix, nsaids, coumadin for 7 days post procedure. please continue to hold these medications in anticipation of stent removal later this week. followup instructions: department: endo suites when: thursday at 12:00 pm department: endoscopy suite when: thursday at 12:00 pm with: , md building: building (/ complex) campus: east best parking: main garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances insertion of endotracheal tube endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into pancreatic duct diagnoses: acidosis coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation blood in stool septic shock cardiac pacemaker in situ spinal stenosis, unspecified region cholangitis obstruction of bile duct diastolic heart failure, unspecified acute pancreatitis calculus of bile duct without mention of cholecystitis, without mention of obstruction postsurgical hypothyroidism diverticulosis of small intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to