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 / morphine / codeine attending: chief complaint: obstructive jaundice, abdominal pain. major surgical or invasive procedure: : 1. exploratory laparotomy. 2. liver wedge biopsy. 3. open cholecystectomy. 4. biliary bypass consisting of roux-en-y choledochojejunostomy. 5. gastroenterostomy. history of present illness: this 83-year-old woman presented initially with obstructive jaundice. she was found to have a stricture which was a very short segment in her distal bile duct originally. ercp was performed for this, and she received a stent. however, she also had a very significant post-ercp pancreatitis event. this is close to 3 months ago. this set her back significantly for a number of weeks. after all this settled out she met with dr. and discussed the finding of her biliary stricture. he was convinced that this was amalignant stricture given the fact that there was a double-duct sign including the pancreatic duct. she initially required more medical reconditioning prior to being able to embark on a significant cancer resection operation. unfortunately, in the interim she became floridly septic from a stent migration process. this was recovered and a new stent was placed. on a second occasion after this, she also presented with evidence of cholangitis once again. the stents were not managing her stricture and jaundice problem and she required yet another stent placement. since this event was more self-limiting and less threatening, plans were made for a whipple procedure to follow within 7-10 days of the last event. past medical history: pmhx: af (not on coumadin), cad, htn, hypothyroidism, type ii dm, hypercholesterolemia, anemia, h/o myasthenia , gerd, dysphagia, h/o bronchitis, chronic pancreatitis, periampullary cancer. . pshx: tah, sinus surgery, orif ue fx w/ bone grafting social history: retired from work in accounting office and as florist. no tobacco, alcohol, drugs. patient will be discharged to a skilled nursing facility, where her husband resides. family history: non-contributory physical exam: on admission: temp 98 hr 88 sl irreg bp 140/80 rr 18 heent: ncat, conjunctiva pale, sclera sl injected perrla neck: supple, no jvd, no thyromegly chest: clear cor: sl irreg, ii/vi sem abd: soft, minimally tender ext: tr edema, calves soft . at discharge: vs: 97.2 po, 76, 140/74, 20, 96% ra heent: sclerae anicteric. o-p clear. neck: supple. no . lungs: cta(b). cor: irregular, ii/vi sem loudest @ lsb. abd: subcostal chevron incision with steri-strips c/d/i with minimal marginal erythema. (r)lq prior jp sire c/i with dsd cover and min. serous drainage (just d/c'd today). bsx4. soft/nt/nd. (+) flatus and bm. extrem: trace edema. wwp. neuro: markedly deconditioned. a+ox3. mental status at baseline. pertinent results: 11:25am hgb-10.0* calchct-30 11:25am glucose-141* lactate-1.4 na+-133* k+-2.9* cl--98* 09:28pm glucose-153* urea n-15 creat-1.8* sodium-137 potassium-4.2 chloride-106 total co2-23 anion gap-12 09:28pm ck(cpk)-158* 09:28pm ck-mb-4 ctropnt-<0.01 09:28pm calcium-7.6* phosphate-4.5 magnesium-2.2 09:27pm urine hours-random creat-92 sodium-51 02:55pm glucose-137* urea n-16 creat-2.1*# sodium-139 potassium-3.8 chloride-106 total co2-23 anion gap-14 02:55pm ck(cpk)-57 02:55pm ck-mb-notdone ctropnt-0.01 02:55pm wbc-8.9# rbc-3.07* hgb-10.0* hct-31.1* mcv-101* mch-32.7* mchc-32.3 rdw-16.4* 02:55pm plt count-373 02:55pm pt-12.5 ptt-25.7 inr(pt)-1.1 01:52pm freeca-1.17 . or pathology : 1. liver lesion (a): metastatic moderately differentiated adenocarcinoma best seen on level 2. 2. gallbladder (b-c): chronic cholecystitis. 3. portion of jejunum (d): small intestinal mucosa, no diagnostic abnormalities recognized. note: given the histology and the history of a pancreatic mass, the findings are consistent with metastatic pancreatic adenocarcinoma. . ecg: sinus rhythm. compared to the previous tracing of t wave inversions in the precordial leads are slightly more prominent. intervals axes: rate pr qrs qt/qtc p qrs t 76 202 98 440/468 70 -15 172 . brain mri : gadolinium-enhanced images not obtained secondary to low egfr limiting evaluation for metastasis. foci of hyperintensity in the left temporo-occipital and left cerebellar regions could be due to subacute infarcts given the configuration but metastatic disease cannot be excluded in absence of gadolinium-enhanced images. moderate brain atrophy and small vessel disease are identified. if clinically indicated further evaluation can be obtained with gadolinium enhanced images following informed consent and consultation with renal service. no acute infarcts or mass effect seen. . bilateral lower ext veins: 1. no evidence of acute deep venous thrombosis. the peroneal vein on the left was not visualized. 2. prominent bilateral subcutaneous edema. . echocardiogram: *left atrium: mild la enlargement. *right atrium/interatrial septum: mildly dilated ra. *left ventricle: mild symmetric lvh with normal cavity size. mild regional lv systolic dysfunction. no lv mass/thrombus. no resting lvot gradient. *right ventricle: normal rv chamber size and free wall motion. *aorta: normal diameter of aorta at the sinus, ascending and arch levels. *aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. *mitral valve: mildly thickened mitral valve leaflets. no mvp. mild mitral annular calcification. calcified tips of papillary muscles. moderate (2+) mr. *tricuspid valve: normal tricuspid valve leaflets with trivial tr. normal pa systolic pressure. *pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. *pericardium: no pericardial effusion. . conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with inferior/inferoseptal hypokinesis (most c/w cad). the remaining segments contract normally (lvef = 45%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . impression: mild regional left ventricular systolic dysfunction, c/w. moderate mitral regurgitation. no left ventricular thrombus seen. brief hospital course: mrs. was admitted to the hospital and taken to the operating room where she underwent the aforementioned procedure. a palliative procedure was done due to positive liver metastasis. see operative note for specific details. she tolerated the procedure well and returned to the pacu in stable condition. her pain was controlled with a dilaudid pca. following full recovery from anesthesia she was transferred to the surgical floor for further management. . over the first few post operative days, she was very weak and was unable to do much for herself as she had no stamina. she was unable to stand with assistance, required a lift to get out of bed, and had generalized muscle weakness. her mestinon was resumed post-operatively at the baseline dose. she was followed by physical therapy services. she was discharged to a rehabilitation facility for continued post-operative conditioning. . the neurology service followed her closely post-operatively, and a brain mri was done to rule out metastatic disease. after reviewing the study with the neurology radiologists, it was felt the picture was most indicative of a subacute stroke. this prompted lower extremity venous studies and trans-thoracic echocardiogram to rule out a source of a thrombus, which were unremarkable. pre-operative aspirin was restarted as soon as possible. nifs and vital capacities were monitored daily for days post-operatively. the patient remained hemodynamically stable. in consultation with dr. , the patient's outpatient neurologist, imuran was discontinued. . once the ng tube was discontinued, her diet was gradually advanced after she had return of bowel function, although her appetite initially was only fair, but improved by discharge, at which time she was tolerating a diabetic regular. pain was initially well controlled with a dialudid pca, which was transitioned to dilaudid po plus acetaminophen prn for pain control with good effect. home medications were restarted at this time as well. a urine performed on #2 was consistent with a uti, for which she received a three day course of ciprofloxacin with symptomatic resolution. urine culture was pending at the time of discharge. the foley catheter was discontinued on #3; she subsequently voided without problem. on #8, the jp was discontinued and staples removed. steri-strips were placed. . at the time of discharge on , the patient was doing well, afebrile with stable vital signs. the patient was tolerating a diabetic regular diet, voiding with assistance due to immobility, and pain was well controlled. she required maximum assistance using a lift to get out of bed to a chair. physcial therapy documented discharge recommendations. the patient was discharged back to a rehabilitation facility for further conditioning and nursing care. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. levothyroxine 125 mcg tablet sig: one (1) tablet po once a day. 3. lopressor 50 mg tablet sig: one (1) tablet po twice a day. 5. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po bid (2 times a day). 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain. 8. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 9. lisinopril 40 mg tablet sig: one (1) tablet po daily (daily). 10. azathioprine 50 mg tablet sig: one (1) tablet po bid (2 times a day). 11. lovastatin 20 mg tablet sig: one (1) tablet po at bedtime. 12. alprazolam 0.25 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 13. metformin 500 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 14. aspirin, buffered 325 mg tablet sig: one (1) tablet po once a day. 15. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po qam. discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. levothyroxine 125 mcg tablet sig: one (1) tablet po once a day. 3. lopressor 50 mg tablet sig: one (1) tablet po twice a day. 4. dilaudid 2 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 5. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po bid (2 times a day). 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. colace 100 mg capsule sig: one (1) capsule po at bedtime as needed for constipation. 8. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 9. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain. 10. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 11. lisinopril 40 mg tablet sig: one (1) tablet po daily (daily). 12. lovastatin 20 mg tablet sig: one (1) tablet po at bedtime. 13. alprazolam 0.25 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 14. metformin 500 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 15. aspirin, buffered 325 mg tablet sig: one (1) tablet po once a day. 16. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po qam. discharge disposition: extended care facility: country manor - discharge diagnosis: primary: 1. pancreatic cancer - metastatic to the liver. . secondary: 1. myasthenia 2. type 2 dm 3. hypothyroidism discharge condition: stable discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: please call ( to arrange a follow-up appointment with dr. (oncology) in weeks. . provider: , md phone: date/time: 9:45. location: 3, . . please call ( to arrange a follow-up appointment with , md, neurology in weeks. procedure: exploratory laparotomy cholecystectomy other gastroenterostomy without gastrectomy open biopsy of liver choledochoenterostomy diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia malignant neoplasm of liver, secondary mitral valve disorders urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation malignant neoplasm of head of pancreas unspecified disorder of kidney and ureter hypovolemia cholangitis obstruction of bile duct cerebral artery occlusion, unspecified with cerebral infarction iatrogenic cerebrovascular infarction or hemorrhage disruption of external operation (surgical) wound chronic cholecystitis myasthenia gravis without (acute) exacerbation 

Answer: The patient is high likely exposed to