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: lidocaine / codeine / iodine; iodine containing / tylenol attending: chief complaint: melena. major surgical or invasive procedure: 1. endoscopy 2. colonoscopy history of present illness: this is an 84-year-old woman who presented today with the ed after three episodes of melena starting on the afternoon of admission. the patient reports that she was running errands downtown in the morning, and when she got home she saw black stool on the toilet paper. patient reports that she has long-standing problems with heartburn, and is unable to eat anything sour or spicy. her heartburn has been worse over the past few weeks, and she said that two nights prior to admission she developed "terrible" heartburn where she felt the acid coming up her throat and she had to "take everything" to try to relieve her pain, including maalox. she denies any recent additional nsaid use besides her daily baby aspirin. she denies vomiting, bright red blood per rectum, or retching. she does endorse gerd symptoms and abdominal pain in the left upper quadrant. she denies any prior episodes of black stools, and she notes that she does not take iron supplements. . of note, the patient was recently admitted to from for evaluation of chest pain and dizziness. at that time, three sets of cardiac enzymes were negative, and her chest pain was attributed to gerd. her ppi was increased to and ranitidine was started. she notes that she was not able to take ranitidine because she felt unwell while taking it. also of note, during the pt's recent admission (and on outpatient visit to dr. in gi) the patient refused egd. . in the ed, initial vital signs were: 98.7 66 138/64 16 99% ra. ms. was noted to have guaiac positive dark stool on rectal exam. she was given pantoprazole 40 mg iv. gi was notified and requested that patient go to icu for possible urgent egd overnight and close monitoring of hematocrit. . on the floor, the patient appears comfortable and is very talkative. she denies abdominal pain or gerd symptoms currently. past medical history: 1. cad- s/p emergent cabg in after failed pci, last cath with 3-vessel native cad, known occluded svg-pda, patent svg-d1-om2, s/p pci to rca 2. htn 3. hypercholesterolemia 4. ibs 5. djd 6. pvd 7. hiatal hernia 8. hemorrhoids 9. gerd . cardiac risk factors: dyslipidemia, hypertension . cardiac history: cabg, in anatomy as follows: svg-d1-om2, svg-pda. . percutaneous coronary intervention, in anatomy as follows: 3v native cad, known occluded svg-pda. social history: she lives alone and has elder services. she states she performs adls independently. in close contact with her landlady, but is worried that landlady just "wants my money." her brother recently died, and she denies any other living relatives besides that she is not close with. she formerly worked in bookkeeping, and denies tobacco use. she does endorse a history of alcohol use, but reports that she quit drinking at the age of 35. family history: there is no family history of premature cad. physical exam: exam on admission: vitals: t: bp: 150/61 p: 61 r: 18 o2: 100% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, ii/vi systolic murmur at apex abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a+ox3, cn ii-xii intact motor: strength 5/5 upper and lower extremities gait assessment deferred pertinent results: 05:30pm blood wbc-6.1 rbc-3.54* hgb-11.8* hct-35.5* mcv-100* mch-33.4* mchc-33.3 rdw-14.1 plt ct-302 06:30am blood wbc-5.3 rbc-3.45* hgb-11.4* hct-34.5* mcv-100* mch-33.1* mchc-33.1 rdw-14.0 plt ct-279 04:20pm blood pt-18.1* ptt-19.8* inr(pt)-1.6* 04:20pm blood glucose-119* urean-19 creat-1.2* na-139 k-5.9* cl-105 hco3-24 angap-16 11:07pm blood alt-55* ast-75* ld(ldh)-255* ck(cpk)-52 alkphos-96 totbili-0.8 04:20pm blood ck-mb-1 ctropnt-<0.01 11:07pm blood ck-mb-notdone ctropnt-<0.01 06:30am blood ck-mb-notdone ctropnt-<0.01 02:44pm blood ck-mb-notdone ctropnt-<0.01 . chest (pa+lateral): the heart is enlarged. there is evidence of previous sternotomy. no failure is present. costophrenic angles are clear. no evidence of pneumonia or pneumothorax is present. there has been no significant change since the prior film of . impression: no acute process. . colonoscopy : a single pedunculated 6 mm polyp of benign appearance was found in the ascending colon. a single-piece polypectomy was performed using a cold snare. the polyp was completely removed. two pedunculated polyps of benign appearance and ranging in size from 4 mm to 5 mm were found in the descending colon. single-piece polypectomies were performed using a cold snare. the polyps were completely removed. a single sessile 5 mm polyp of benign appearance was found in the sigmoid colon. a single-piece polypectomy was performed using a cold forceps. the polyp was completely removed. a single pedunculated 2.5 cm polyp was found in the sigmoid colon. after polyp removal, a 2 cm clot was seen to form at the site of polypectomy. 7 clips were applied to the polypectomy site and hemostasis was achieved. a single-piece polypectomy was performed using a hot snare in the sigmoid polyp. the polyp was completely removed. recommend repeat colonoscopy in 3 months due to poor prep. brief hospital course: this is an 84-year-old woman with a history of severe gerd, cad, paroxysmal afib, and htn who is admitted for 3 melanotic stools. . # melena: the patient was admitted to the micu for further management. ms. was monitored overnight and remained hemodynamically stable, with unchanged hematocrit, and was not transfused. the patient was started on a pantoprazole drip, which was changed pantoprazole 40mg . her aspirin, coumadin, and were held in the setting of acute bleed. patient had endoscopy on , which demonstrated antral gastritis and a pedunculated polyp (likely inflammatory). however, no obvious bleeding source was discovered. a colonoscopy was performed on , which showed numerous polyps including one large polyp in the sigmoid colon, which was thought to be the likely cause of bleeding. polyp was clipped and patient was observed for 48 hours. patient will need repeat colonoscopy in 3 months as prep was very poor. after colonoscopy, patient had no more episodes of bleeding and remained hemodynamically stable. her coumadin and aspirin continued to be held in the peri-bleed period. these medications can be restarted at the discretion of patient's pcp. was re-started. patient will have gi follow-up as well. . # gerd: patient continued to complain of gerd-like symptoms throughout the duration of her admission. she had a moderate response to "magic mouth wash" and maalox. she was continued on home medication of lansoprazole. (patient's nurse speculated however, that patient is not taking her medications properly at home). . # paroxysmal atrial fibrillation: patient continued to be in normal sinus rhythm throughout hospital admission. her coumadin, aspirin, and were stopped in light of gi bleed. her toprol xl 50mg was restarted on discharge, but coumadin and aspirin were held. these medications can be restarted at the discretion of patient's pcp or cardiologist (both of whom were contact during admission). . # ischemic cardiomyopathy: ef from echo in is 30-40%. lasix was originally held in light of gi bleed, but was restarted toward the end of hospital stay. patient complained of feeling "swollen" after missing lasix for a few days. patient will follow-up with cardiology for further management of heart failure. . # elevated lfts/pancreatic mass: patient has elevated lfts, dilated cbd, and pancreatic masses as seen on abdominal ct in . as per radiology report, masses are likely consistent with intraductal papillary mucinous neoplasm of the pancreas (ipmn). according to gi note, there is malignant potential and these masses will need to be worked up (possible with mrcp). statin was held in light of elevated lfts but can be restarted at the discretion of patient's pcp. . # vna and insurance: patient's insurance was unable to pay for both vna and home pt. patient needs pt due to a recent fall in the bathroom (and pt could not be canceled). she will be able to reapply for vna after she finishes with pt. this can be coordinated at discretion of patient's pcp. medications on admission: 1. nitroglycerin 0.3 mg prn 2. amiodarone 100 mg po qhs 3. atorvastatin 40 mg po daily 4. furosemide 80 mg po daily 5. isosorbide dinitrate 20 mg po bid 6. lisinopril 5 mg daily 7. succinate 25 mg po bid 8. warfarin 1 mg daily 9. aspirin 81 mg 10. maalox oral 11. sucralfate 1 gram po tid 12. potassium chloride 10 meq po daily 13. lansoprazole 30 mg tablet, po bid discharge medications: 1. amiodarone 200 mg tablet : 0.5 tablet po daily (daily). 2. nitroglycerin 0.3 mg tablet, sublingual : one (1) tab sublingual q5min as needed for chest pain. 3. furosemide 80 mg tablet : one (1) tablet po daily (daily): take 80mg once a day and 120mg on sundays. 4. isosorbide dinitrate 20 mg tablet : one (1) tablet po bid (2 times a day). 5. lisinopril 5 mg tablet : one (1) tablet po daily (daily). 6. sucralfate 1 gram tablet : one (1) tablet po tid (3 times a day). 7. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension : 15-30 mls po qid (4 times a day) as needed for heartburn. 8. potassium chloride 10 meq capsule, sustained release : one (1) capsule, sustained release po once a day. 9. lansoprazole 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po twice a day. 10. succinate 50 mg tablet sustained release 24 hr : one (1) tablet sustained release 24 hr po twice a day. discharge disposition: home discharge diagnosis: primary: 1. lower gi bleeding, likely from colonic polyps . secondary: 1. paroxysmal atrial fibrillation 2. hypertension 3. high cholesterol discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you on this admission. you came to the hospital because you were having bloody bowel movements. you had an endoscopy, which showed some irritation (gastritis) and a small polyp. you had a colonoscopy, which showed multiple polyps throughout your colon. a large polyp in your sigmoid colon was clipped and the bleeding stopped. your blood levels remained stable throughout entire hospital stay. . you were also found to have elevated liver enzymes and your atorvastatin was stopped. this can be restarted at the discretion of your primary care physician. also have cysts in your pancreas, which need to be followed up. your primary care physician might suggest further imaging for this issue. . the following changes were made to your medications: 1. stop taking atorvastatin 2. stop taking coumadin until told otherwise 3. stop taking aspirin until told otherwise . please take all of your medications as prescribed. please keep all of your follow-up appointments. . return to the hospital if you develop chest pain, shortness of breath, continued blood in your stools, trouble swallowing, weakness on any side of your body, dizziness, headache, palpitations, fevers, sweats or any other concerning signs or symptoms. followup instructions: department: sq when: thursday at 2:00 pm with: , md building: (, ma) campus: off campus best parking: on street parking department: div. of gastroenterology when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage we are working on a follow up appointment with dr within the next 4-8 days. you will be called at home with the appointment. if you have not heard or have questions, please call . we are working on a follow up appointment with dr within the next month. you will be called at home with the appointment. if you have not heard or have questions, please call . md, procedure: endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: esophageal reflux pure hypercholesterolemia unspecified essential hypertension atrial fibrillation aortocoronary bypass status percutaneous transluminal coronary angioplasty status other specified forms of chronic ischemic heart disease blood in stool benign neoplasm of colon unspecified disease of pancreas other specified gastritis, without mention of hemorrhage dysuria 

Answer: The patient is high likely exposed to