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: hydralazine attending: chief complaint: hematemesis major surgical or invasive procedure: upper endoscopy exploratory laparotomy, anterior nissen fundoplication repair of paraesophageal hernia history of present illness: this is a 78 year old male who presents with repeated episodes of coffee ground emesis. he says he initially had a dry cough of one week in duration and then awoke early this morning with a coughing fit followed by transient epigastric pain and nausea. he then had several episodes of brown emesis and decided to be evaluted in the er. on presentation to the er he says his pain has mostly resolved. he did not see frank blood and had no hematochzia or melena. he has no anorexia and is not taking nsaids or aspirin; he did not recently drink alcohol. he denies fever or chills. he has no conspitation or diarrhea. past medical history: atrial fibrillation mitral valve repair in ' for regurgitation cholilithiasis hyperlipidemia homocystinemia basal cell carcinoma hemorrhoidectomy hypertension cataracts social history: the patient lives alone . he has a history of smoking but quit 40 years ago. he drinks 1 glass of alcohol a day. family history: there is a history of colon cancer physical exam: on admission: v/s 98.8, 127/89, 84, 25, 98 room air gen: wd/wn elderly male in no acute distress, alert and awake heent: nc/at, anicteric, eomi, perrl cv: irregular irregular with mechanical valve click auscultatable pulm: clear to auscultation bilaterally abd: + normoactive bowel sounds, soft, mild distension, no tenderness, no rebound, no cvat extr: warm, 2+ dp bilaterally, well-perfused rectal: no stool in vault, guaic negative pertinent results: serologies: 06:00pm blood wbc-10.3# rbc-4.74 hgb-16.0 hct-45.5 mcv-96 mch-33.7* mchc-35.1* rdw-12.9 plt ct-150 06:00am blood wbc-8.9 rbc-4.24* hgb-13.9* hct-40.7 mcv-96 mch-32.8* mchc-34.1 rdw-12.7 plt ct-120* 04:44am blood wbc-9.0 rbc-4.12* hgb-13.8* hct-39.8* mcv-97 mch-33.4* mchc-34.5 rdw-12.7 plt ct-118* 03:43am blood wbc-6.6 rbc-3.38* hgb-10.8*# hct-31.8* mcv-94 mch-31.9 mchc-33.9 rdw-14.4 plt ct-122* 05:40am blood wbc-7.0 rbc-3.62* hgb-11.7* hct-34.7* mcv-96 mch-32.3* mchc-33.7 rdw-14.0 plt ct-121* 06:28am blood wbc-9.2 rbc-3.86* hgb-12.3* hct-37.3* mcv-97 mch-31.9 mchc-33.0 rdw-13.6 plt ct-130* 05:50am blood wbc-7.7 rbc-3.62* hgb-11.6* hct-34.6* mcv-95 mch-32.0 mchc-33.5 rdw-13.4 plt ct-187 06:40am blood wbc-9.2 rbc-3.59* hgb-11.3* hct-34.5* mcv-96 mch-31.6 mchc-32.9 rdw-13.2 plt ct-261 06:00pm blood pt-19.3* ptt-30.0 inr(pt)-2.5 12:30am blood pt-20.5* ptt-31.6 inr(pt)-2.8 03:43am blood pt-14.1* ptt-28.9 inr(pt)-1.3 06:40am blood pt-16.9* ptt-66.8* inr(pt)-1.9 06:58am blood pt-17.7* ptt-70.4* inr(pt)-2.1 06:35am blood pt-19.0* ptt-68.5* inr(pt)-2.4 06:00pm blood glucose-131* urean-21* creat-1.3* na-143 k-4.8 cl-106 hco3-22 angap-20 06:00am blood glucose-129* urean-18 creat-1.2 na-146* k-3.8 cl-110* hco3-26 angap-14 04:44am blood glucose-115* urean-17 creat-1.3* na-144 k-3.8 cl-110* hco3-25 angap-13 05:50am blood glucose-118* urean-27* creat-1.3* na-146* k-4.7 cl-108 hco3-27 angap-16 07:24am blood glucose-135* urean-27* creat-1.1 na-148* k-3.7 cl-109* hco3-30* angap-13 08:30am blood glucose-101 urean-17 creat-1.1 na-143 k-2.9* cl-107 hco3-26 angap-13 05:20pm blood glucose-124* urean-16 creat-1.3* na-136 k-4.7 cl-102 hco3-26 angap-13 05:55am blood glucose-105 urean-14 creat-1.2 na-139 k-4.0 cl-105 hco3-26 angap-12 06:40am blood glucose-110* urean-13 creat-1.1 na-140 k-4.6 cl-108 hco3-21* angap-16 06:00pm blood albumin-4.4 08:30am blood calcium-8.3* phos-2.6* mg-1.8 05:55am blood calcium-9.0 phos-2.8 mg-2.3 cholest-132 06:40am blood calcium-8.7 phos-3.0 mg-2.1 05:55am blood triglyc-115 hdl-32 chol/hd-4.1 ldlcalc-77 12:34am blood glucose-120* lactate-2.3* na-148 k-3.7 cl-107 02:23am blood glucose-152* lactate-1.7 na-147 k-3.1* cl-108 06:48pm blood lactate-1.5 05:46am blood lactate-1.4 radiology: upper gi study: 1) short-segment narrowing of the distal esophagus. the differential diagnosis includes a peptic esophageal stricture. a neoplastic lesion cannot be excluded. 2) large type 3 hiatal hernia with a large paraesophageal component and elevation of the gastroesophageal junction above the level of the diaphragmatic hiatus. 3) nonpassage of contrast into the duodenum with a poorly evaluated pylorus. several images demonstrate a swirling pattern of the gastric mucosa that raises the question of gastric torsion. there is residual barium material present within the esophagus at the termination of this exam. suction via an ng tube may be considered. delayed images may also be considered. cxr: 1) increasing bilateral pleural effusions (left greater than right); left lower lobe consolidation/atelectasis. 2) interval improvement in chf/volume overload. pathology: esophageal hernia sac: fragments of fibromuscular and adipose connective tissue with vascular congestion; unremarkable skeletal muscle. gastroenterology: egd: friability and erythema in the middle third of the esophagus and lower third of the esophagus. edema and narrowing if the distal esophagus and ge junction. these changes could be secondary to severe gerd or may represent a neoplasm. deformity of the pylorus. otherwise normal egd to stomach body brief hospital course: this is a 78 year old gentleman on anticoagulation for a mitral valve who presented with several bouts of brown emesis on . on presentation in the er the patient was noted to be hemodynamically stable with a stable hematocrit at 40 but having repeated episodes of emesis with ngt lavage revealed some bright red blood. he had an endoscopy performed on hospital day 2 which revealed friability and erythema at the distal third of the esophagus with differential including esophagitis or neoplasm. he was started on carafate and protonix. a barium swallow was conducted which demonstrated a paraesophageal hernia with possible volvulus. surgery was consulted on hospital day 2 and the patient was taken to the operating room on for repair of his paraesophageal hernia via an open anterior nissen approach (please see the operative note of dr. for full details). this operation went well without complications. he was extubated uneventfully on post-operative day 1 and started on a heparin drip for his mitral valve. neurologically he did well with dilaudid iv for pain control which was transitioned to oral dilaudid. his atrial fibrillation was well rate-controlled with beta-blockade. he was started on clears on post-operative day 3 which he tolerated well; protonix was used for gi prophylaxis. his diet was advanced to a regular diet by post-operative day 5 and he had a bowel movement. he was started on coumadin with the therapeutic level attained by day of discharge and his primary care physician was notified regarding monitoring of his inr levels. he worked with physical therapy and was found to be safe for home with a visiting nurse by time of discharge. his staples were removed on post-operative day 10. he was discharged to home on post-operative day 11 with planned follow-up in weeks. all questions were answered to his satisfaction upon discharge. medications on admission: coumadin 5 mg oral qdaily vitamin b6 vitamin b 12 folate zocor 10 mg oral qdaily atenolol 50 mg oral qdaily discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 4. hydromorphone hcl 2 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 5. warfarin sodium 6 mg tablet sig: one (1) tablet po hs (at bedtime): ( total of 7 mg every night unless prescription changes). disp:*30 tablet(s)* refills:*2* 6. coumadin 1 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. pyridoxine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 9. outpatient lab work inr check on (goal level 2.5 to 3.5) 10. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary: strangulated paraesophageal hernia secondary: hypertension, history of atrial fibrillation, history of a mechanical mitral valve, history of cholelithiasis discharge condition: good discharge instructions: take all medications as prescribed. you may eat a regular diet and resume your regular activity, but no lifting of heavy objects fo up to one month. you should return to the er or call the office with any worsening abdominal pain, nausea, fever to 101, or drainage/bleeding from your wound. please call with questions. followup instructions: provider: , m.d. where: cardiac services phone: date/time: 9:00 provider: , call to schedule appointment provider: , . call to schedule appointment within 1-2 weeks you should follow-up with dr. , your primary care physician, this week. he has been notified of your hospital stay and would like to see you on friday 6/10/5. procedure: other endoscopy of small intestine transfusion of packed cells transfusion of other serum transfusion of platelets other procedures for creation of esophagogastric sphincteric competence diagnoses: unspecified essential hypertension atrial fibrillation other and unspecified hyperlipidemia heart valve replaced by other means hematemesis diaphragmatic hernia with obstruction disturbances of sulphur-bearing amino-acid metabolism 

Answer: The patient is high likely exposed to