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: lisinopril / hydrochlorothiazide attending: chief complaint: gi bleed major surgical or invasive procedure: capsule endoscopy single balloon enteroscopy history of present illness: this is a 77 year old male with pmh of cad s/p mi years ago, pvd s/p bilateral lower extremity bypass surgery with y graft in , claudication, and chronic kidney injury presenting in transfer from the icu at for further evaluation of gi bleeding. he first presented to his primary care physician for further evaluation of claudication on . routine lab work at that time revealed a hct of 25 and he was referred for an outpatient egd/colonoscopy at . he received 1 unit prbcs as an outpatient on and again on . on , the egd revealed an irregular z-line, suspicious for short segment barrett's esophagus. he also had a non-obstructing mild schatzki's ring with erythematous gastric mucosa and a normal duodenal bulb. the colonoscopy showed old tarry blood in his colon and terminal ileum with non-bleeding initernal hemorrhoids. following this outpatient procedure, he was referred for admission to for observation and received another unit of prbcs. he received a total of 3 units that week and remained hemodynamically stable throughout his hospital course. given his chronic kidney insufficiency, there was concern about administering contrast for a cta abdomen. he was therefore referred to for further management and potential enteroscopy. . on arrival to the micu, the patient had no acute complaints. he has not had any bowel movements since his bowel prep for the colonoscopy on . he reports that he noticed dark stools at home over the last couple of weeks, but did not see any frank blood. he thought that the change in his stool color was secondary to eating more black olives and chocolate cake recently. past medical history: -cad s/p mi in -pvd s/p bilateral lower extremity bypass with y-graft in , on coumadin -claudication -chronic kidney injury -cva social history: lives with his wife of 53 years in a senior living housing complex in . he is independent in his adls, iadls. he is retired since and used to manage a warehouse for a living. his oldest son just passed away at age 51. otherwise, he has a daughter who is a nurse and a son who is 50. he smoked ppd for 20 years, but quit 31 years ago after his mi. he does not have a history of alcohol or ivdu. family history: positive for cad, mother passed away at age 52. physical exam: vitals: t: 97.9, bp: 169/68, p: 64, r: 11, o2: 93% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple cv: regular rate and rhythm, 2-3/6 systolic ejection murmur noted lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: vss gen: patient lying comfortably in bed nad a+ox3 heent: mmm oropharynx clear neck: supple no thyromegaly cv: rrr no m/r/g resp: ctab no w/r/r abd: soft nt nd bs+ extr: no le edema good pedal pulses bilaterally derm: no rashes, ulcers or petechiae neuro: cn 2-12 grossly intact non-focal psych: normal affect and mood pertinent results: admission labs: 05:26pm glucose-101* urea n-31* creat-1.7* sodium-142 potassium-3.7 chloride-105 total co2-26 anion gap-15 05:26pm alt(sgpt)-20 ast(sgot)-24 ld(ldh)-143 alk phos-77 tot bili-0.5 05:26pm albumin-4.1 calcium-9.4 phosphate-2.8 magnesium-2.2 iron-40* 05:26pm caltibc-298 ferritin-47 trf-229 05:26pm wbc-5.5 rbc-3.98* hgb-11.4* hct-32.8* mcv-82 mch-28.8 mchc-34.9 rdw-15.8* 05:26pm neuts-57.5 lymphs-30.1 monos-5.7 eos-5.7* basos-1.1 05:26pm plt count-215 05:26pm pt-16.3* ptt-39.0* inr(pt)-1.5* 05:26pm ret aut-3.9* ekg: normal sinus rhythm at 83 with pvcs, q waves in inferior leads suggestive of prior infarct . egd- irregular z-line, suspicious for short segment barrett's esophagus. non-obstructing mild schatzki's ring. erythematous gastric mucosa. normal duodenal bulb. . colonoscopy- old tarry blood in colon and terminal ileum. tortuous colon. non-bleeding internal hemorrhoids. . capsule endoscopy () 1) fresh blood is seen in a segment of the small bowel (0:1:46:18), likely in the proximal to mid jejunum. debris are seen in the lumen but an underlying mass lesion cannot be excluded. 2)a single lymphangiectasia is seen in the duodenum. 3) multiple venous structures are seen throughout the small bowel. 4)limited visualization of the stomach due to excessive debris. . single ballon enteroscopy () normal esophagus. normal stomach. normal duodenum. the distal jejunum was reached. it was tattooed with indian ink. there was a sharp angulation that prevented further advance of the scope. otherwise the exam of the jejunum was normal. no evidence of bleeding or mass was seen . otherwise normal single balloon enteroscopy to distal jejunum under fluoroscopic guidance and with direct endoscopic view. . mr enterography ( ): preliminary reportimpression: 1. no mass lesion identified on this limited study. cta is more sensitive for identifying occult gi bleeds and should be considered in this patient. 2. cholelithiasis without evidence of cholecystitis. 3. prior aortobifemoral bypass with some irregularity of the left common iliac graft. this could also be further evaluated at the time of cta if required. discharge labs: 06:35am blood wbc-7.7 rbc-3.40* hgb-9.4* hct-29.0* mcv-85 mch-27.7 mchc-32.5 rdw-15.0 plt ct-264 01:45pm blood hct-28.6* brief hospital course: 77 year old male with pmh of cad s/p mi years ago, pvd s/p bilateral lower extremity bypass surgery with y graft in , claudication, and chronic kidney injury presenting in transfer from the icu at for further evaluation of gi bleeding. on arrival to the micu the evening of , the patient had no acute complaints. he has not had any bowel movements since his bowel prep for the colonoscopy on . he reports that he noticed dark stools at home over the last couple of weeks, but did not see any frank blood. he thought that the change in his stool color was secondary to eating more black olives and chocolate cake recently. he remained hemodynamically stable throughout the micu course with hct at 33 and was transferred to the general medicine service on . just before transfer, he received vitamin k 5mg po x1. on arrival, he states that he feels well. . #. gi bleed. source is likely small bowel. patient reports 2 weeks of dark stools prior to presentation, but no brbpr. egd shows gastritis, likely short segment barrett's esophagus, and mild schatzki's ring. colonoscopy showed old tarry blood in colon and terminal ileum with a tortuous colon and non-bleeding internal hemorrhoids. hct stable on admission at 32.8 after 3 units of prbc transfusion since admission on at outside hospital. initial hct was 25. possibility of syndrome given that he has a murmur suggestive of aortic stenosis. was transferred to the for capsule endoscopy which on revealed a lesion in the jejumum. he received an additional 2 units prbcs on for hct of 25. he underwent single balloon enteroscopy, which did not reveal a bleeding source. since the enteroscopy, his hematocrit has remained stable, although he continues to have guaic + stools. he underwent an mre to evaluate for small bowel pathology which showed no masses although it could not be done with iv contrast. his hct was slight downtrending on day of discharge (28.6), but he was asymptommatic and he will have a close pcp follow up and call dr. for double balloon enteroscopy. he was discussed with gi who thought he was stable for discharge. the patient will have a copy of his capsule endoscopy and balloon enteroscopy when he is discharged. pcp f/u on and then with dr. . . #hx of stroke 14 year ago placed on coumadin with goal inr : coumadin and asa were initially held prior to enteroscopy/capsule endoscopy. after discussion with the gi team, primary team and family the patient was restarted on his asa 81mg and coumadin was held. patient will f/u with pcp . coumadin should be held until bleeding source can be found. #. ckd iii -. patient's admission creatinine is 1.7 which has decreased slightly to 1.6. after mr enterography a suggestion to have cta to evaluate for occult bleed was made by radiology, but with pt already having enteroscopy and capsule endoscopy, planned for a double balloon enteroscopy and concern for worsening his renal disease (contrast induced nephropathy), the ct scan was deferred. he will follow up with gi for his bleed and pcp will /u with ckd. . #. cad: initially asa was held in setting of bleeding. after enteroscopy, asa was restarted. statin was continued throughout his hospitalization . medications on admission: -gemfibrozil 600mg po qhs -furosemide 20mg po daily -amlodipine 20mg po daily -zetia 10mg po daily -clonidine 0.2mg po bid -asa 81 mg -coumadin 2.5mg /tu/th, 1.25mg m/w/f/sat -pravachol 80mg - per patient recently started pletal but has only taken one dose timolol 0.5% 1-2 drops each eye daily discharge medications: 1. gemfibrozil 600 mg tablet sig: one (1) tablet po daily (daily). 2. ezetimibe 10 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 bid (2 times a day). 4. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily) as needed for gout flare. 5. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). 6. clonidine 0.1 mg tablet sig: two (2) tablet po bid (2 times a day). 7. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 8. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge disposition: home discharge diagnosis: gi bleed discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for low blood counts from a gi bleed. a single ballon enteroscopy was performed but could not find a source of the bleeding. a capsule endoscopy and mr enterography were also performed, but no clear source of bleeding was found. you were transfused 2 units of blood on and your blood counts increased appropriately. on the day of discharge your blood counts had been stable for 4 days and were slightly downtrending, but you did not have any symptoms. you will have a follow up with your primary care physician 2 days and will also follow up with dr. for a procedure to look for a bleeding source(double balloon enteroscopy). please stop taking coumadin because it could make your bleeding worse. medication change 1. stop taking coumadin 2. hold your lasix until you are seen by pcp followup instructions: name: np location: medical group address: , ste 3a, , phone: appointment: thursday 11:00am *this is a follow up appointment for your hospitalization. you will be reconnected with your primary care physician after this visit. please contact dr. office to set up your followup procedure(double balloon enteroscopy) procedure: other endoscopy of small intestine diagnoses: coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia peripheral vascular disease, unspecified personal history of tobacco use other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hemorrhage of gastrointestinal tract, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage barrett's esophagus acute gouty arthropathy internal hemorrhoids without mention of complication hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to