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: penicillins attending: chief complaint: abdominal pain, nausea, and vomiting major surgical or invasive procedure: exploratory laparotomy picc line placement history of present illness: mr. is a 78 year old male with a history of colon and esophageal cancer, s/p surgical resection , who presented to an osh on with complaints of abdominal pain, nausea, and vomiting. an x-ray confirmed a small bowel obstruction, a nasogastric tube was placed. he is one week post 5fu infusion. he was transferred to -ed on via ambulance for further treatment and admitted to the surgical service. an abdominal x-ray repeated upon admission to confirmed small bowel obstruction with possible mesenteric ischemia. he was tachycardic and hypotensive, a central venous catheter was placed, he received fluid resuscitation, and was transferred to the surgical intensive care unit for further management. past medical history: past medical history: esophageal cancer colon cancer atrial fibrillation hypertension glaucoma benign prostatic hypertrophy past surgical history: laparoscopic right hemicolectomy, placement of feeding jejunostomy, and venous access device b/l cataract surgery left inguinal hernia repair repair of deviated septum social history: he admits to drinking one glass a wine daily 30 pack year of smoking, he quit 30 years ago family history: his father had renal cell cancer in his late 80's, died at age his mother had coronary artery disease and died in her 70's physical exam: upon admission by surgical service: 101.4 120's 170's/110's abd: distended, non-tender, hypoactive bowel sounds rectal: heme + stool j tube with coffee ground bloody output pertinent results: admission: 12:40am blood wbc-17.5* rbc-4.31* hgb-12.3* hct-34.5* mcv-80* mch-28.6 mchc-35.7* rdw-14.5 plt ct-337 12:40am blood neuts-66 bands-2 lymphs-12* monos-16* eos-0 baso-0 atyps-3* metas-1* myelos-0 12:40am blood pt-14.8* ptt-26.8 inr(pt)-1.3* 12:40am blood glucose-140* urean-70* creat-1.3* na-133 k-3.2* cl-99 hco3-21* angap-16 12:40am blood alt-35 ast-27 alkphos-105 amylase-13 totbili-0.4 12:40am blood lipase-12 04:37pm blood ck-mb-notdone ctropnt-<0.01 12:40am blood albumin-2.8* calcium-7.7* phos-4.2 mg-2.8* 12:41pm blood triglyc-77 01:02am blood lactate-2.4* 02:38am blood freeca-1.07* discharge: 04:42am blood wbc-23.2* rbc-3.26* hgb-9.6* hct-26.1* mcv-80* mch-29.4 mchc-36.7* rdw-15.9* plt ct-234 04:27am blood pt-19.8* ptt-60.8* inr(pt)-1.9* 06:29am blood glucose-101 urean-23* creat-0.7 na-132* k-4.1 cl-101 hco3-24 angap-11 06:29am blood calcium-7.8* phos-4.1 mg-2.3 12:40 am blood culture **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. 6:12 pm mrsa screen site: rectal source: rectal swab. **final report ** mrsa screen (final ): no staphylococcus aureus isolated. 6:12 pm swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): no vre isolated. 5:10 pm stool consistency: watery source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. 4:34 pm stool consistency: watery source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. radiology final report abdomen (supine & erect) 11:58 abdomen (supine & erect) reason: please do kub to eval for sbo, please do upright to eval for medical condition: 78 year old man with ? sbo reason for this examination: please do kub to eval for sbo, please do upright to eval for perf indication: evaluate for possible perforation. no comparison studies. two views of the abdomen and pelvis, supine and upright: there are markedly distended loops of small bowel and air-filled colon. multiple air-fluid levels are seen within the small bowel. nasogastric tube is present with tip in the gastric fundus. there is no definite evidence of free air; however, the diaphragms are well visualized. on prior chest radiograph which was done in the upright position, there was no definite evidence of free air. there is a small amount of air seen within the rectum. there is no evidence of pneumatosis. surrounding soft tissue and osseous structures are unremarkable. impression: marked distention of the small bowel diffusely. air is present within the rectum. these findings concerning for small bowel obstruction, ischemic bowel, or most likely ileus. recommend ct for further investigation. radiology final report chest port. line placement 3:22 am chest port. line placement; -77 by different physician reason: tlc placement r/o ptx medical condition: 78 year old man with portal venous air reason for this examination: tlc placement r/o ptx ap chest, 3:29 a.m. history: portal venous air. line placement. impression: ap chest compared to and at 12:13 a.m. severe generalized intestinal distention is seen in the upper abdomen. no pneumoperitoneum is evident, but free subdiaphragmatic gas might not be detected on this supine view. lungs are low in volume but clear and there is no pneumothorax. pleural effusion, if any, is minimal, on the left. heart is mildly enlarged. mediastinum midline. bilateral subclavian line tips project over the svc. nasogastric tube is looped in the stomach. radiology final report ct pelvis w/o contrast 12:52 am ct abdomen w/o contrast; ct pelvis w/o contrast reason: abd.pain.distention.colon/esoph.ca.r/o sbo field of view: 40 medical condition: 78 year old man with colon/esophageal cancer with belly pain reason for this examination: with po contrast only to eval for sbo, perf contraindications for iv contrast: none. indication: 78-year-old male with colon and esophageal cancer with pelvic pain. evaluate for intra-abdominal pathology. comparison: ct pet. technique: mdct-acquired axial images of the abdomen and pelvis were performed without iv contrast. patient's creatinine was 1.6. multiplanar reformations were performed. ct abdomen without iv contrast: the lung bases contain no focal areas of consolidation. there is mild bilateral dependent atelectasis. within the left lobe of the liver, there are multiple branching air-filled spaces consistent with portal venous gas. the pancreas, spleen, adrenal glands, and kidneys are unremarkable. oral contrast is seen layering within the stomach and not advancing into the duodenum. there are markedly distended loops of small bowel with air-fluid levels with a small amount of pneumotosis in the mid -distal small bowel. per history provided patient is status post right hemicolectomy. the remaining portion of the transverse and descending and sigmoid colon contain a moderate amount of air. air and stool are seen extending all the way down into the rectum. mesenteric and mesocolic fluid are present. there is a small amount of perisplenic fluid. no definite small bowel or large bowel wall thickening is identified. there is no evidence of pneumatosis. there are multiple lymph nodes within the mesentery and retroperitoneum, none of which appear pathologically enlarged. of note, patient is status post j- tube placement percutaneously which has now been removed. a residual soft tissue strand is seen extending from the skin through the subcutaneous tissue into the jejunum which appears stitched to the peritoneum along the lateral left anterior abdominal wall. a nasogastric tube is also seen with the tip terminating in the gastric fundus. there are moderate amount of aortic calcifications and minimal aortic calcifications seen within the celiac artery and sma. ct pelvis with iv contrast: there is a fluid-filled left inguinal hernia with no evidence of soft tissue or bowel present. there is no free fluid in the pelvis. the rectum, sigmoid colon contain air and bowel as mentioned above. the prostate is unremarkable. the urinary bladder is catheterized. bone windows: no suspicious lytic or sclerotic bony lesions. impression: 1. portal venous gas with markedly distended loops of small bowel and mesenteric fluid and pneumotosis. these findings are consistent with ischemic bowel. given diffuse distribution of bowel wall distention it is difficult to pinpoint specific distribution of ischemia. 2. there is no evidence of small or large bowel obstruction. 3. fluid-containing left inguinal hernia. radiology final report ct head w/o contrast 12:52 am ct head w/o contrast reason: ms changes.colon/esoph ca.?bleed medical condition: 78 year old man with colon/esophageal cancer w/ ms changes reason for this examination: please eval for bleed/mass contraindications for iv contrast: none. indication: 78-year-old man with colon and esophageal cancer with mental status changes. evaluate for bleed or mass. no comparison studies. technique: non-contrast ct of the head. findings: there is no evidence of intracranial hemorrhage, mass effect, or shift of normally midline structures. -white matter differentiation is preserved. there is no evidence of acute major vascular territorial infarction, with chronic micro-ischemic change in periventricular white matter, and chronic lacune in the anterior limb of the left internal capsule. the ventricles are somewhat enlarged, but are proportionate to deepened sulci, diffusely, consistent with global atrophy. the visualized paranasal sinuses and mastoid air cells are clear. the surrounding osseous and soft tissue structures are unremarkable. impression: 1. no evidence of intracranial hemorrhage or acute infarct. 2. no specific evidence of intracranial metastasis; enhanced mri would, of course, be more sensitive. the study and the report were reviewed by the staff radiologist. radiology final report (revised) abdomen (supine & erect) port 12:46 pm abdomen (supine & erect) port reason: remaining contrast in abdomen medical condition: 78 year old man with question of retained contrast from prior ct reason for this examination: remaining contrast in abdomen indication: 78-year-old man with question of retained contrast from prior ct. question remaining contrast in abdomen. comparison: ct abdomen and pelvis . findings: three supine and erect plain radiographs of the abdomen and pelvis were obtained. an ng tube appears coiled within the stomach with its tip located within the fundus. persistent dilatation of air-filled small bowel is identified, a nonspecific finding. there is no evidence of free intraperitoneal air. contrast is not definitively seen within the bowel. impression: no evidence of contrast within bowel. persistence of dilated small bowel, nonspecific finding. radiology final report ct abdomen w/contrast 11:00 pm ct abdomen w/contrast; ct pelvis w/contrast reason: colon/esophageal ca, abd distension. field of view: 48 contrast: optiray medical condition: 78 year old man with colon/esophageal cancer with belly pain, h/o portavenous air on admission scan and now increasing wbc and abd distension reason for this examination: r/o bowel ischemia vs perforation - please give both iv and po contrast & please page with read contraindications for iv contrast: none. history: colon and esophageal cancer, abdominal distention, history of portal venous air. comparison: . technique: axial contrast-enhanced images through the abdomen and pelvis with multiplanar reformats. ct of the abdomen with contrast: there are small bilateral pleural effusions and bibasilar atelectasis. there is a small pericardial effusion. there are mitral annular calcifications as well as coronary artery calcifications. the feeding tube is within the stomach. there is circumferential wall thickening of the mid to distal esophagus. there are multiple enlarged gastrohepatic ligament lymph nodes measuring approximately 1 cm. there is a 1.8 x 1.5 cm epicardial lymph node. there is interval increase in the ascites, but the portal venous air and pneumatosis has resolved. the liver, spleen, gallbladder, adrenal glands, pancreas, kidneys and ureters are unremarkable. there are multiple 1-cm paraaortic lymph nodes. there are also multiple subcentimeter mesenteric and aortocaval lymph nodes. there is a new g-tube. within the mid to distal jejunum, there is bowel wall thickening. the celiac axis, superior mesenteric artery, and inferior mesenteric arteries, including the duodenal branches are all patent. there is atherosclerotic calcification of the descending artery and its branches. there is stranding and small amount of fluid within the mesentery. the patient is status post right colectomy. ct of the pelvis with contrast: there is a catheter within the bladder and rectum, which are otherwise unremarkable. there is free fluid within the pelvis. there is a left hydrocele. there is no inguinal or pelvic lymphadenopathy meeting ct criteria. reformatted images: degenerative changes within the spine but no suspicious lesions. impression: 1. resolved portal venous air and pneumatosis. new jejunal wall thickening is concerning for ischemia, given the patient's history. less likely on the differential includes infection and inflammatory etiologies. 2. circumferential thickening of the esophagus consistent with the known carcinoma. gastrohepatic, epicardial, and retroperitoneal lymphadenopathy. 3. increased ascites. 4. bilateral pleural effusions. cardiology report echo study date of patient/test information: indication: left ventricular function. /evaluate for atrial clot/thrombus/paf. height: (in) 66 weight (lb): 211 bsa (m2): 2.05 m2 bp (mm hg): 145/88 hr (bpm): 90 status: inpatient date/time: at 11:30 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w047-0:42 test location: west sicu/ctic/vicu technical quality: suboptimal referring doctor: dr. measurements: left atrium - long axis dimension: *4.4 cm (nl <= 4.0 cm) left atrium - four chamber length: *7.6 cm (nl <= 5.2 cm) right atrium - four chamber length: *6.5 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.3 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.8 cm left ventricle - fractional shortening: 0.47 (nl >= 0.29) left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - valve level: 3.2 cm (nl <= 3.6 cm) aorta - ascending: *3.5 cm (nl <= 3.4 cm) aorta - arch: *3.2 cm (nl <= 3.0 cm) aortic valve - peak velocity: 1.5 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.1 m/sec mitral valve - e wave deceleration time: 114 msec tr gradient (+ ra = pasp): 25 mm hg (nl <= 25 mm hg) pulmonic valve - peak velocity: 1.0 m/sec (nl <= 1.0 m/s) interpretation: findings: left atrium: mild la enlargement. elongated la. thrombus in the body of the la. right atrium/interatrial septum: moderately dilated ra. left ventricle: mild symmetric lvh with normal cavity size and systolic function (lvef>55%). normal regional lv systolic function. no resting lvot gradient. right ventricle: rv not well seen. aorta: normal aortic root diameter. mildly dilated ascending aorta. mildly dilated aortic arch. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. moderate mitral annular calcification. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. normal pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. the rhythm appears to be atrial fibrillation. echocardiographic results were reviewed by telephone with the houseofficer caring for the patient. conclusions: the left atrium is mildly dilated and elongated. a 2.8 x 6.1-cm echodensity is seen attached to the posterior wall of the left atrium, consistent with thrombus. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. the ascending aorta and the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: large left atrial thrombus. mild symmetric left ventricular hypertrophy with preserved global and regional systolic function. operative report , f. signed electronically by , on mon 9:47 am name: , unit no: service: date: date of birth: sex: m surgeon: , md 2205 preoperative diagnosis: rule out ischemic intestine. postoperative diagnosis: ischemic intestine without infarction. surgical procedure: exploratory laparotomy. assistant: , res anesthesia: general. indications for surgery: this is a gentleman who has had a complicated medical and surgical history with esophageal cancer and colon cancer being diagnosed recently. he has had a colectomy for colon cancer and is undergoing radiation and chemotherapy for esophageal cancer. he presented with abdominal pain and signs of infection with ct scan several days ago showing portal venous gas and possible pneumatosis. this was treated conservatively as it was thought this might well be due to chemotherapy associated with enteritis. he has improved clinically; however, his white blood cell count has been persistently elevated and has gone up to over 30,000 without any other source. a ct scan did not show any more pneumatosis but does show a same loop of bowel with considerable edema and it was thought most prudent to do an exploratory laparotomy to ensure that there was not a small section of severely compromised intestine which may be perforated. preparation: in the operating room, the patient was given general endotracheal anesthetic. she previously had a foley catheter placed in the bladder. the abdomen was prepared with betadine solution and draped in the usual fashion. incision: a midline incision was made through the old limited laparoscopically-assisted upper midline incision going down around the umbilicus. findings: there was a mild to moderate amount of ascites, slightly turbid. there was no evidence of perforation. the small bowel appeared to be normal with the exception of a 1 to 1-1/2 foot segment somewhat distal to the jejunostomy site which was edematous but was perfectly viable. the colon also appeared to be normal. procedures: the abdomen was opened and explored with the above-mentioned findings. a few adhesions were encountered which were light. the entire small bowel was run with the above-mentioned findings. the anastomosis was inspected which was normal. some of the ascites was sent to microbiology for culture and gram stain. the area was irrigated copiously and drained and sucked dry. the bowel was then placed back into normal position. hemostasis was achieved. closure: the fascia was closed with a running suture of 0 pds. the skin was closed with staples. a dry sterile dressing was applied. the patient was then extubated and sent to the recovery area in satisfactory condition having tolerated the procedure well. drains: none. complications: none. estimated blood loss: minimal. date: signed by , rn on affiliation: wound care follow up visit to evaluate heels. pt is now out of the icu. pt's left heel is no longer red and is intact. it is mildly dry. the pt's right heel remains with dark area approx 0.5 x 1 cm with intact skin. the redness seen previously has resolved. the pt's right heel is in a waffle boot. the fms, flexiseal , remains in place. the coccyx, gluteals are intact and without redness rn caring for pt. suggest: pressure relief measures per pressure ulcer guidelines continue with waffle boots b/l continue to use barrier cream perianal tissue as the flexiseal can leak somewhat please call wound care with any questions or concerns re: pt or flexiseal(can stay in for up to 29 days) brief hospital course: mr. was admitted to the surgical intensive care unit, an abdominal ct scan confirmed portal venous gas with distended loops of small bowel and mesenteric fluid, consistent with ischemic bowel; no evidence of small or large bowel obstruction. it was suspected that he had enteritis from his recent chemotherapy, since there was no evidence of obstruction and it was decided that an operation was not necessary unless his clinical picture changed. his nasogastric tube and jejunostomy tube continued to drain bilious fluid. his had leukocytosis with wbc's 18.4k, he was placed on broad spectrum antibiotics including: levaquin, flagyl, and vancomycin. he was placed on beta-blockade for his history of atrial fibrillation, morphine as needed for pain control, an insulin sliding scale, and received fluid resuscitation for low urine output and tachycardia with good response. he was hemodynamically stable with a hematocrit of 32.5. on hd 2, tpn was initiated, his beta-blockade was increased for heart rates in the 120's, he remained afebrile, and had adequate urine output. on hd 4 he had an echocardiogram done which demonstrated a thrombus in the left atrium (see pertinent results), a heparin drip was initiated. a hematology/oncology was placed with recommendations of continuing current treatment but likelihood of 5fu enteritis was small since the patient did not experience diarrhea prior to admission, a repeat x-ray demonstrated persistent dilation of small bowel. hd 5 his white blood cell count increased to 31k despite being afebrile; all cultures up to date were negative for bacteria. on hd 5 a repeat abdominal ct scan was done with resolution or pneumatosis and new jejunal wall thickening; he was taken to the operating room for an exploratory laparotomy with no evidence of ischemia, 700cc of ascites was removed. he had no intra-operative complications and post-operatively returned to the surgical intensive care unit. on pod1/ hd 6 his nasogastric tube was removed and his pain was well controlled with a morphine pca. on pod 3 he was transferred to an in-patient nursing unit, his heparin drip continued with six hour monitoring of his ptt and adjustments made as needed. on pod 4 he was started on coumadin therapy along with the heparin drip; his diet was advanced to liquids while continuing tpn. the antibiotics were discontinued, he remained afebrile, and his white blood cell count had decreased to 23.2k. he experienced frequent episodes of loose stool, two c.diff samples were sent which were negative; imodium was started. on pod 5 his foley catheter was removed and he was voiding without difficulty, tube feeds were started which he tolerated well. on pod 7 he was tolerating tube feeds at goal, the tpn was discontinued, and he received all medications through the jejunostomy tube. on pod 7 he was hypertensive, a bladder scan demonstrated 900cc of urine and the foley was replaced with a good response in his blood pressure; he was started on terazosin for a history of bph. he received physical therapy throughout the hospitalization and it was determined that he would benefit from short term rehabilitation to increase his strength and functional mobility. the patient was discharged on after removal of his cvl; his inr was therapeutic at 2.4 and he was off the heparin drip. medications on admission: toprol xl avodart senna asa discharge medications: 1. amlodipine 5 mg tablet : one (1) tablet po daily (daily): give via j-tube. 2. terazosin 1 mg capsule : two (2) capsule po hs (at bedtime): give via j-tube. 3. loperamide 1 mg/5 ml liquid : two (2) mg po bid (2 times a day): please add to tube feeds. 4. insulin regular human 100 unit/ml solution : as directed as directed injection asdir (as directed). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily): give via j-tube. 6. oxycodone-acetaminophen 5-325 mg/5 ml solution : 5-10 mls po q4-6h (every 4 to 6 hours) as needed for pain: give via j-tube. 7. metoprolol tartrate 50 mg tablet : two (2) tablet po tid (3 times a day): give via j-tube. 8. albuterol sulfate 0.083 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for wheeze. 9. metoprolol 20 mg iv q4h:prn hold for sbp < 100 hr < 60 10. warfarin 5 mg tablet : one (1) tablet po hs x1: please monitor daily inr and adjust coumadin dose appropriately. discharge disposition: extended care facility: house discharge diagnosis: ischemic bowel without infarction esophageal cancer colon cancer discharge condition: good discharge instructions: please call/return to if you have: * increasing pain or persistent pain that is not relieved by pain medications *inability to urinate * fever (>101.5 f) *nausea or vomiting that last longer than 24 hours * inability to pass gas or stool *if j-tube is pulled out *if incision becomes red or if there is drainage * other symptoms concerning to you please take all your medications as ordered. please continue your previous medications followup instructions: follow-up with dr. in ~1 week, call ( for an appointment. follow-up with dr. , call ( for an appointment. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances exploratory laparotomy diagnoses: unspecified essential hypertension atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) personal history of malignant neoplasm of large intestine pressure ulcer, heel endocarditis, valve unspecified, unspecified cause personal history of malignant neoplasm of esophagus unspecified vascular insufficiency of intestine 

Answer: The patient is high likely exposed to