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: egg attending: chief complaint: brbpr/dark stools . major surgical or invasive procedure: egd history of present illness: 63 yo m h/o nash cirrhosis with varices/gave (just banded last week), multiple admissions for gi bleeds in setting of asa/plavix for cad who presents with brbpr and dark stools x one day. states he had four bowel movements yesterday and four more this am. he states he normally has bowel movements daily and this is not more than his normal pattern. he noted some dyspnea and chest tightness yesterday evening, but has not had any since. he denies abdominal pain/vomiting/nausea/hematemasis. patient also notes a 12-lb weight gain in the past few days. he does note increased abdominal distension. no changes in his appetite. denies dietary indiscretion and states he takes all of his medications. . of note the patient had an egd and 2 cords of grade ii varices were seen in the ge junction. the varices were not bleeding. 2 bands were successfully placed. 2 cords of grade i varices were seen in the mid-esophagus. the varices were not bleeding at that time. . in the ed, initial vs were: 97.4 70 140/47 18 100%. rectal exam showed maroon guaiac positive stool. ng lavage was negative. hct 23.0 (from 28.9 ). cr stable at 1.2. started on octreotide and pantoprazole gtts and given a dose of ceftriaxone. liver was in the . ekg: nsr rate of 74, no ischemic changes. has 18g pivs x 3, vs prior to transfer: 66 18 109/51 99% ra. . on arrival to the micu, patient feels well without complaints. past medical history: - cad: cabg , stenting in , des, cath in all grafts and stents patent. cards dr , nebh. recently discontinue plavix due to multiple gi bleeds. - nash cirrhosis: followed by dr , c/w distant h/o ascites, encephalopathy, grade 2 esophogeal varices, s/p banding . - h/o obscure gi bleed: gastric antral vascular ectasia (gave) noted on egd and avms noted on capsule, varices, diverticulosis, and rectal varices - dm ii on insulin with frequent episodes of hypoglycemia in the past - tia followed by dr - squamous cell carcinoma - htn - hl social history: he works as a plumber for . smoked 3.5-4 packs per day for over thirty years and quit in . he has not drunk in many years. he says he was a heavy drinker as a teenager, but not since that time. no illicit drug use. he is married family history: brother with asthma. mom with diabetes and breast cancer, sister who had a heart attack in stroke in her 50s and father who died of stomach cancer at age 63. physical exam: admission exam vitals: t:98.6 bp:111/49 p: 65 r: 16 o2: 100% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, mildly distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. trace edema in ble. rectal: guaiac positive brown stool neuro: no focal deficits discharge exam vs: 98.2,67, 116/49 (116/49-129/61), 100 % ra general: well appearing m who appears stated age. comfortable, appropriate and in good humor heent: sclera icteric. perrl, eomi. neck: supple with low jvp cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, s1 s2 clear and of good quality without murmurs, rubs or gallops. no s3 or s4 appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use, moving air well and symmetrically. ctab, no crackles, wheezes or rhonchi. abdomen: distended but soft, non-tender to palpation. dullness to percussion. extremities: warm and well perfused, no clubbing or cyanosis. no peripheral edema neuro: cn ii-xii intact, strength 5/5 bilaterally, sensation in tact to light touch. pertinent results: admission labs: 03:00pm blood wbc-5.8 rbc-2.36* hgb-7.2*# hct-23.0* mcv-98 mch-30.6 mchc-31.3 rdw-16.3* plt ct-142* 03:00pm blood neuts-69.2 lymphs-14.4* monos-6.8 eos-9.1* baso-0.6 03:00pm blood pt-12.0 ptt-25.8 inr(pt)-1.1 03:00pm blood glucose-139* urean-23* creat-1.2 na-131* k-4.7 cl-103 hco3-21* angap-12 03:00pm blood alt-37 ast-46* ck(cpk)-103 alkphos-82 totbili-0.5 04:42am blood albumin-2.6* calcium-7.4* phos-4.0 mg-2.2 . discharge labs 06:20am blood wbc-3.9* rbc-2.77* hgb-8.5* hct-26.1* mcv-94 mch-30.6 mchc-32.5 rdw-16.2* plt ct-119* 06:20am blood glucose-186* urean-14 creat-1.0 na-134 k-4.3 cl-107 hco3-20* angap-11 06:20am blood alt-28 ast-36 alkphos-66 totbili-0.5 03:00pm blood ck-mb-3 ctropnt-<0.01 11:11pm blood ck-mb-3 ctropnt-<0.01 04:42am blood ck-mb-3 ctropnt-<0.01 06:20am blood pt-12.9* ptt-27.6 inr(pt)-1.2* egd: varices at the middle third of the esophagus and lower third of the esophagus two sites of recent banding visualized at the ge junction, with one band still in place. small overlying ulcer seen without active bleeding. erythema, and petechiae noted in the antrum consistent with known gave. in the stomach otherwise normal egd to second part of the duodenum ruq us 1. known non-occlusive thrombus in the main portal vein within the hepatic hilum is not visualized, possibly due to technical factors. intrahepatic portal veins, hepatic veins, and hepatic arterial system are patent. 2. shrunken nodular liver consistent with cirrhosis. no focal hepatic lesions. 3. mild gallbladder wall thickening likely related to chronic liver disease. known gallstones are not well seen, however, there are no signs of acute cholecystitis. 4. unchanged splenomegaly measuring 14 cm. 5. no intra- or extra-hepatic biliary dilatation. 6. stable moderate ascites. brief hospital course: assessment and plan: 63 yo m h/o nash cirrhosis, recurrent gi bleeds, cad presenting with brbpr and dark stools and a six point hct drop in 11 days. . active issues . # gi bleed: given patients recent esophageal banding presentation was most concerning for misplacement of the bands or an ulcer around the recent bands. differential also included bleeding from avms, gave, esophageal varices (all seen on recent egd) as well as lower sources including diverticulosis and rectal varices. patient had a negative ng lavage. hct was noted to be 23 on admission from a baseline of around 30. the patient was transfused 2 units prbcs with appropriate increase in his hct. he underwent egd which demonstrated an small ulcer at the site of recent variceal banding in addition to extensive gastropathy. it was ultimately felt that bleeding was likely resultant from the patient's gave. patient may require laser ablation at a later date. octreotide was discontinued and the patient was transitioned to po protonix. the patients hct remained stable and he was transferred to the floor where he was noted to have a brown non bloody stool. the patient was able to tolerate a regular diet. hct was 26.1 at the time of discharge. . # weight gain: patient notes weight gain in past few days. weight on admission 211.4 lbs and was noted to be 201 on . differential includes worsening portal hypertension/cirrhosis, congestive heart failure or renal failure. synthetic function and lfts were stable. normal biventricular function in echo in and cr was at baseline. ruq us showed patent intrahepatic portal veins, hepatic veins, and hepatic arteries. be reflective of increased ascites burden. the patient was restarted on his home diuretics at the time of discharge. he will follow-up with dr. regarding up-titration of these medications. . # nash cirrhosis: patient is followed by dr. in the outpatient. not on transplant list at present. as above home furosemide/spironolactone/nadolol was held in the acute setting and restarted at the time of discharge. . # hyponatremia: patients sodium was 131 on admission. this was felt to likely be secondary to hypervolemic hyponatremia. sodium normalized and was 134 at the time of discharge. . stable issues . # cad: the patient was chest pain free throughout admission. he does have a significant history of coronary artery disease requiring a cabg and stenting. the patient recently stopped plavix in early due to recurrent gi bleeds. his home asa 81 mg was held on admission. patient will restart this medication 2 days after discharge. he was continued on his home atorvastatin and zetia. . # hyperlipidemia: patient was continued on his home atorvastatin and zetia. . # hypertension: patients home lisinopril was held in the setting of a gi bleed. this medications was restarted at the time of discharge. . transitional issues - patient will follow-up with dr. - patient was full code throughout this admission medications on admission: 1. rifaximin 550 mg tablet po bid 2. atorvastatin 20 mg po daily 3. ezetimibe 10 mg tablet po daily 4. folic acid 1 mg po daily 5. furosemide 20 mg po once a day. 6. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day) as needed for < 3bms per day: titrate to bms daily. 7. nitroglycerin 0.1 mg/hr patch 24 hr sig: one patch 24 hr transdermal q24h 8. protonix 40 mg tablet po twice a day. 9. spironolactone 50 mg tablet po daily 10. aspirin 81 mg one po daily 11. coenzyme q10 50 mg capsule sig: one (1) capsule po once a day. 12. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: one (1) tablet po daily (daily). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 14. nadolol 20 mg po daily 15. lisinopril 2.5 mg daily 16. lantus 35 units qhs 17. novolog sliding scale discharge disposition: home discharge diagnosis: primary diagnosis upper gi bleed gastric antral vascular ectasia (gave) esophageal ulcer secondary diagnosis non alcoholic steatohepatitis diabetes hyperlipidemia coronary artery diease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure participating in your care while you were admitted to center. as you know you were admitted because you had blood in your stool that was concerning for a gi bleed. you blood counts were noted to be low and you were given a blood transfusion. an endoscopy was performed that showed a small ulcer where one of your varices had been banded in addition to dilated vessels in your stomach which were likely the source of the bleed. you blood counts were monitored closely and remained stable. you were also started on antibiotics to prevent infection. you will need to continue these for 3 more days. we made the following changes to your medications 1. start ciprofloxacin 500 mg daily for 3 more days 2. start sucralfate 1 gram three times a day 3. stop you aspirin for the next 2 days. you can restart this medication on you should continue to take all other medications as instructed. please feel free to call with any questions or concerns. followup instructions: * you should at call on monday to make an appointment to be seen by dr. in the next 1-2 weeks . department: liver center when: tuesday at 9:30 am with: , md building: lm campus: west best parking: garage * you should call on monday to have this appointment moved up department: dermatology and laser when: thursday at 9:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: podiatry when: tuesday at 11:20 am with: , dpm building: ba ( complex) campus: west best parking: garage procedure: other endoscopy of small intestine diagnoses: unspecified essential hypertension cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia aortocoronary bypass status other and unspecified hyperlipidemia long-term (current) use of insulin other ascites esophageal varices in diseases classified elsewhere, without mention of bleeding other chronic nonalcoholic liver disease ulcer of esophagus without bleeding angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to