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: dyspnea major surgical or invasive procedure: ivc filter placement ercp s/p sphincterotomy and stent placement in common bile duct ir guided liver biopsy thoracentesis history of present illness: 82-year-old female with a history of htn, hyperthyroidism, likely cholangiocarcinoma, recent pe/dvts on coumadin p/w progressive dyspnea. patient was recently admitted for dyspnea on and found to have rul segmental branch pe on cta. cta also showed a liver lesion with scattered pulmonary nodules concerning for malignancy. subsequent mri showed a large ill-defined heterogeneous mass concerning for an intrahepatic cholangiocarcinoma with multiple satellite nodules. biopsy not done due to need for anticoagulation for acute stage of pe. she was seen in oncology clinic today and was felt to not be a candidate for chemotherapy given her low performance status. she was noted to be sob in clinic and was admitted for further evaluation. notably, patient c/p progressive dyspnea since her last admission. she felt ok initially and using supplemental oxygen intermittently. over the course of the past 3-4 days she has had increasing dyspnea on exertion, where walking feet caused significant dyspnea. once she rested, her breathing improved. she denies cp, cough, fevers, chills n/v/d/c. she does admit to decreased appetite, abdominal fullness, and persistent right leg swelling. she has been taking all of her medications and her last inr was 2.5 2 days prior, and notably has never been subtherapeutic since starting this coumadin. on the floor, the patient appears quite dyspneic, but after sitting for some time, her tachypnea and dyspnea improved. patient states she has problems with her liver, but per her family is not aware she has cancer. per the family, she cannot understand her disease process so they are trying not to tell her to much detail. past medical history: -lower extremity dvt -pe anticoagulated on coumadin -pulmonary nodules -live mass concerning for malignancy -hypertension -hypothyroidism status post thyroidectomy on levothyroxine -cholecystitis status post cholecystectomy -scoliosis -hypersensitivity to heparin -h/o intracranial and cervical spinal meningioma s/p posterior fossa decompression, c1-c2 laminectomies, tumor resection and grafting() social history: patient is origally from . she lives in a senior housing apartment. she has been independent with her adls until recently including cooking and grocery shopping. she has no history of alcohol or tobacco use. family history: -no family history of cancer -no family history of liver disease physical exam: gen: chachectic appearing female in mild respiratory distress vs: 102/58 93 26 94% ra heent: dry mm cv: irregular, rr, no m/g/r pulm: decreased breath sounds at left base, clear otherwise, no w/r/r abd: soft, nt/nd, positive bowel sounds limbs: warm, well perfused, 1+ pitting edema in rle, no edema on left. skin: dark, no rashes; scoliosis noted neuro: cn 2-12 grossly in tact, no gross neurological abnormalities, moving all extremities pertinent results: 05:10pm pt-24.4* ptt-29.4 inr(pt)-2.3* 11:00am urea n-21* creat-0.9 sodium-136 potassium-3.9 chloride-101 total co2-24 anion gap-15 11:00am alt(sgpt)-13 ast(sgot)-35 ck(cpk)-47 alk phos-257* tot bili-0.6 11:00am ck-mb-2 ctropnt-0.01 probnp-3016* 11:00am calcium-9.0 phosphate-3.0 magnesium-1.8 11:00am wbc-9.9 rbc-4.03* hgb-10.8* hct-34.1* mcv-85 mch-26.8* mchc-31.7 rdw-15.0 11:00am neuts-84.5* lymphs-8.6* monos-3.8 eos-2.8 basos-0.2 studies: : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. moderate (2+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a small to moderate sized pericardial effusion. no right ventricular diastolic collapse or overt tampoande is seen. there is brief right atrial diastolic invagination. compared with the prior study (images reviewed) of , the pericardial effusion appears larger. there remains no overt tamponade. the degree of pulmonary hypertension detected has slightly increased. the degree of ar and the lvef are similar. cxr: 1. apparent slight increase in right pleural effusion with predominantly subpulmonic distribution. persistent collapse of right middle and right lower lobes. 2. persistent peripheral left mid lung opacity probably due to infarct in the setting of known pulmonary embolism. pleural fluid: positive for malignant cells consistent with metastatic adenocarcinoma. ecg: normal sinus rhythm, rate 86. frequent atrial premature beats. low voltage in the standard leads. generalized non-specific repolarization abnormality. delayed precordial r wave progression of indeterminate significance. compared to the previous tracing of atrial ectopy appears somewhat more frequent and the overall ventricular rate is marginally increased. liver biopsy: a. liver, left lobe lesion, core needle biopsy: adenocarcinoma, moderately differentiated, see note. b. liver, hilar lesion, core needle biopsy: adenocarcinoma, moderately differentiated, see note. note: immunostains for ck7 and ck19 are positive. cd10 is focally positive. cd20 and heppar1 are negative. cea is non-contributory. the immunophenotype and morphology are consistent with a tumor of pancreatico-biliary origin in the appropriate clinical setting. ct head: no acute intracranial process. no evidence of metastases or acute hemorrhage. findings were discussed with dr. at 12:35 am on . ct abdomen/pelvis: . new pulmonary embolism within a segmental left pulmonary artery extending to the left lower lobe. stable appearance of the posterior right upper lobe segmental artery pulmonary embolism. 2. large thrombus in the lower infrarenal ivc extending into the proximal bilateral common iliac veins. 3. right common femoral, superficial femoral, and deep femoral veins thrombosis as seen on recent lower extremity ultrasound. this thrombus does not extend superiorly into the right external iliac vein. short segment of left common femoral vein thrombus. 4. stable appearance of multiple nodules throughout the lungs, concerning for metastatic disease. stable appearance of moderately sized right pleural effusion and adjacent compressive atelectasis. 5. stable appearance of known cholangiocarcinoma with intrahepatic biliary dilatation. stable dilatation of the common bile duct and pancreatic duct. 6. moderate ascites. 7. stable pericardial effusion. brief hospital course: ms. is an 82 year old cantonese speaking female with history of dvt, pe, pulmonary nodules, and liver lesions concerning for malignancy who presented with progressive dyspnea found to have extensive thrombus burden despite therapeutic inr. #. dyspnea: likely related to her numerous and progressive pe's in setting of therapeutic inr. patient's right leg appeared quite swollen on presentation and an ultrasound was performed. this showed extensive clot burden and the superior aspect of the thrombus could not be appreciated by ultrasound as it extended into the patient's pelvis. a ct torso was then performed which showed extensive clot burden with a large thrombus in the lower infrarenal ivc extending into the proximal bilateral common iliac veins. a new pulmonary embolus was also noted. since the patient was continuing to develop thrombus in the setting of a therapeutic inr, it was felt an ivc filter should be initiated immediately. vascular was consulted placed an ivc filter from the left ij approach overnight. the patient was started on lovenox and tolerated the procedure well. regarding the patient's left pleural effusion that may be contributing mildly to dyspnea, ip was consulted. she acutely decompensated from a respiratory standpoint and required transfer to the icu. she was tachypneic and required 6l nc to maintain sats. a cxr revealed progressive accumulation of effusion and she requires a thoracentesis which drained 1.2 liters of transudative effusion. she was then able to be weaned to 2l oxygen to maintain her sats and was transferred back to the floor. on the floor her respiratory status remained stable on 1-2l o2. she was continued on lovenox with an ivc filter. pleurex catheter placement was considered for a subsequent right-sided pleural effusion but it was felt there was not enough pleural fluid to warrant placement. she was also diuresed after returning to the floor with lasix and her sob improved, although oxygenation remained stable. #. cholangiocarcinoma: she had a new diagnosis of cholangiocarcinoma on this admission. given the need to decompress the patient's bile ducts to reduce the risk of cholangitis with a liver guided biopsy, an ercp was performed . sphincterotomy performed as well as a stent placement in the common bile duct. on , patient underwent an ir guided liver biopsy without any complications. biopsy showed adenocarcinoma consistent with pancreatico-biliary origin. she was not felt to be a candidate at this time for chemotherapy given her respiratory status and overall weakness. she was discharged to rehab with plans to readdress goals of care and chemotherapy in 2 weeks with her primary oncologists. #. htn: stable, continued home amlodipine and lisinopril. #. hypothyroidism: her dose of levothyroxine was increased due to a high tsh. she will need repeat thyroid studies in 6 weeks. medications on admission: lisinopril 20 mg daily omeprazole 20 mg daily levothyroxine 100 mcg daily amlodipine 5 mg daily coumadin 2 mg daily home oxygen discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation . 9. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 10. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for sob/wheezing. 12. morphine sulfate 0.5 mg iv q4h:prn pain/sob hold for sedation or rr < 12 13. levothyroxine 125 mcg capsule sig: one (1) capsule po once a day. 14. enoxaparin 60 mg/0.6 ml syringe sig: fifty (50) mg subcutaneous q12h (every 12 hours). 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 17. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 18. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: primary diagnosis: cholangiocarcinoma dvt/pe pleural effusion secondary: hypertension 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: you were admitted because of shortness of breath. you were found to have extensive blood clots in your body, especially your lungs. this is why it is so difficult to breathe. a filter was placed in your large vein to prevent further clots from reaching your lungs. you were started on a blood thinner called lovenox. you should continue to take this medication until your oncologist tells you otherwise. you were also found to have fluid around your right lung. you had a procedure where this fluid was drained and it improved your breathing. you also had a sample of tissue taken from your liver mass. the results show that you have a type of cancer called cholangiocarcinoma. you should continue to take all of your medications as prescribed. these are the changes to your medications: start lovenox 50 mg injections to be taken every 12 hours. start lasix 20mg by mouth daily changed levothyroxine to 125mcg by mouth daily you should also have thyroid studies checked in approximately 6 weeks. followup instructions: you are to follow up with dr. and dr. in 2 weeks. you have the following appointment scheduled: provider: . / date/time: , at 9:30am location: , building, floor 9 phone: you should also have an appointment with the intervential pulmonary doctors to follow the fluid around your lung. you will be called with an appointment. if you do not hear from their clinic, please call to schedule an appointment. procedure: interruption of the vena cava closed (percutaneous) [needle] biopsy of liver thoracentesis endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct angiocardiography of venae cavae diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension long-term (current) use of anticoagulants other ascites secondary malignant neoplasm of lung acute venous embolism and thrombosis of deep vessels of proximal lower extremity obstruction of bile duct other pulmonary embolism and infarction other venous embolism and thrombosis of inferior vena cava malignant neoplasm of intrahepatic bile ducts postsurgical hypothyroidism malignant pleural effusion 

Answer: The patient is high likely exposed to