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: no known allergies / adverse drug reactions attending: chief complaint: gib major surgical or invasive procedure: upper endoscopy, 2 endoclip placement over the duodenal ulcer history of present illness: 29m with no significant pmh presents after 5 days of dark black stool and abdominal cramping, noted to have ? flecks of bile vs. food vs. coffee ground in the vomitus at triage, hyotension, tachycardia, and anemia. per patient, he took pepto-bismol 3 times earlier in the weeks for 3 days. he started because of gas discomfort. he stopped after he noticed dark black stool. he reports time bowel movement daily which is unchanged. he was seen at on friday and was suppose to see his pcp today for /u. he was prescribed a medication but he has not started it. he was told that he could try gas-x, but he also did not start it. he denies a hx of heavy etoh use, prior gi bleeds or any medical problems. reports drinking last night. he reports taking excedrin about 2 weeks ago for headahce. he drinks 1 extra-large coffee a day in the ed, initial vs were bp 74/46 with hr 60 in the setting of ongoing emesis. he was triggered for hypotension which was thought to be vasovegal. he apparently became unresponsive and passed out. this rapidly improved to 109/56 102 29 98% ra by the time he left triage. guaiac was noted to be positive brown stool. ekg was reported to be sinus with twi throughout and no st changes. later, he received 1l ivf, however remainined hypotensive to sbp 70s, mentating well. therefore, he was given 2 liters of ivf and 1 units of uncross-matched blood given. 18 g x2 iv placed. protonix bolus and gtt were started. gi was made aware of him. icu transfer was therefore initiated. on arrival to the micu, patient is feeling well except for the dark black stool and intermittent gas discomfort past medical history: - headache social history: - works as a cna - denies tobacco and drugs - reports etoh 2.5 servings on weekends only - lives by self, separated, has a 2.5 yo son, has a girlfriend family history: - denies ibd and other gi disease - denies bleeding disorder - denies cva, cardiac, dm family history physical exam: admission exam vitals: 98.3 f, hr 102, bp 119/68-> sitting 110/60s with hr up to the 110s, rr 20, o2sat 100% ra, weight 90.6 lb general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding rectal: dark brown liquid stool, guaiac + 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. discharge exam tmax: 37.1 ??????c (98.7 ??????f) tcurrent: 36.9 ??????c (98.4 ??????f) hr: 84 (79 - 104) bpm bp: 116/71(80) {97/44(64) - 131/85(93)} mmhg rr: 15 (0 - 23) insp/min spo2: 99% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding rectal: dark brown liquid stool, guaiac + 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 pertinent results: admission labs 05:05am blood wbc-10.7 rbc-3.71* hgb-9.6* hct-29.0* mcv-78* mch-25.8* mchc-33.0 rdw-15.0 plt ct-290 05:05am blood pt-11.6 ptt-22.9* inr(pt)-1.1 05:05am blood glucose-119* urean-34* creat-0.8 na-142 k-3.3 cl-104 hco3-22 angap-19 05:05am blood alt-31 ast-28 totbili-0.1 05:05am blood ctropnt-<0.01 12:10pm blood ctropnt-<0.01 05:05am blood caltibc-280 vitb12-703 folate-7.6 ferritn-126 trf-215 discharge labs 01:40pm blood hct-35.9* 04:01am blood glucose-111* urean-13 creat-0.7 na-141 k-3.6 cl-106 hco3-26 angap-13 egd findings: esophagus: lumen: a small size hiatal hernia was seen. mucosa: localized erythema of the mucosa with no bleeding was noted in the gastroesophageal junction. these findings are compatible with mild esophagitis. stomach: mucosa: localized erythema and congestion of the mucosa with no bleeding were noted in the cardia. these findings are compatible with possible mw tear. localised erythema in antrum complatible with mild-moderate gastritis. duodenum: excavated lesions a single cratered 1.5 cm ulcer was found in the duodenal bulb. an adherent clot suggested recent bleeding. two endoclips were successfully applied to the duodenal bulb ulcer for the purpose of hemostasis. impression: mild esophagitis small hiatal hernia possible mw tear mild-moderare gastritis ulcer in the duodenal bulb (endoclip) otherwise normal egd to third part of the duodenum recommendations: the findings account for the symptoms. the duodenal ulcer is likely nsaid induced. but h. pylori possible too. antireflux regimen: avoid chocolate, peppermint, alcohol, caffeine, onions, aspirin. elevate the head of the bed 3 inches. go to bed with an empty stomach. prilosec 40 mg po bid liquid diet and advanced as tolerated. check h. pylori ab in serum and treat if positive. serial hct. avoid all nsaids. avoid excedrin. brief hospital course: 29 m with no significant pmh who p/w 1 week of dark black stools and coffee ground emesis at 3am on day of admission, found to be to have pud and upper gi bleed. . # gib/pud. he had a brisk bleed, in the ed was hypotensive to sbp 70's, and got 2 units there. he had innapropriate bump to this, and got 2 more units in the micu. ppi was started. an endoscopy was done that showed peptic ulcer disease and a possible mw tear. he had 2 endoclips placed to ulcer in duodenal bulb. unclear what his risk factors for pud are, as he takes excedrin, though minimally, and does not drink excessive etoh or smoke. he was started on a ppi. h pylori serologies are still pending at time of discharge, and if they return positive he should be treated. nsaids should be avoided. upon discharge his hct was stable, he was hemodynamically stable, and was tolerating a regular diet well. omeprazole 20mg was added to his home regimen, and gi f/u was arranged. . # hypotension. sbp down to the 70s on arrival, initially thought to be from vasovagal, improved transiently, but then persistent with reported ams, not responsive to 1l ivf. received 2 l ivf and total 4 units prbc. ugib treatment per above. resolved by discharge. # anemia, microcytic. be from gi bleed per above. iron studies were checked and were normal, as were b12 and folate. peripheral smear w/ microcytes. hemolysis labs negative. should have repeat cbc / iron labs in outpatient setting, and if still microcyctic consider a hemoglobin electropheresis. . # sinus tachycardia and diffuse twi. most likely result of demand given acute blood loss. asymptomatic with negative ce x 4 . # code status: full . ============================== transitional issues # microcytic anemia: iron studies normal. consider repeat cbc and iron studies in outpatient setting, consider hemoglobin electropheresis if iron studies remain normal # f/u pending h pylori serology, treat if positive # f/u w/ gastroenterology for further pud care medications on admission: - tylenol - excedrin discharge medications: 1. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day: take 30 minutes before you eat breakfast and dinner. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 2. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for headache. discharge disposition: home discharge diagnosis: primary diagnosis: - duodenal ulcer - hypotension - anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. you were admitted to because of low blood pressure and dark stool you received 4 units of blood. you had an upper endoscopy, a camera that goes into your esophagus, stomach, and part of the small intestine. your low blood pressure and dark stool are due to bleeding from an ulcer in your small intestine (duodenum). it is possible that you have been bleeding slowly for some time based on your anemia. you were started on a new medication to decrease the acid secretion from your stomach. one of your lab test is still not back yet. this is to check if you have an infection that caused the ulcer. you should avoid chocolate, peppermint, alcohol, caffeine, onions, and aspirin. elevate the head of the bed 3 inches. go to bed with an empty stomach. it will be very important for you to see your doctors below. you should see your primary care doctor and have repeat test to check for any more blood loss. you should see the gastroenterologist for follow up of the ulcer. please note the following changes in your medicine. - stop excedrin. this can make the ulcer worse. - start omeprazole 40 mg, 1 tab, by mouth, twice a day. this is to reduce the acid. take 30 minutes before breakfast and dinner. followup instructions: name: dr (works with dr location: address: . ste 5c, , phone: appt: at 10:45am department: div. of gastroenterology when: tuesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage md procedure: endoscopic control of gastric or duodenal bleeding diagnoses: acute posthemorrhagic anemia other specified cardiac dysrhythmias chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction hypovolemia unspecified analgesic and antipyretic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to