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: nsaids / acetaminophen attending: chief complaint: hematemesis major surgical or invasive procedure: egd, tips history of present illness: 59 yo old gentleman with alcoholic cirrhosis transfered from hospital, nh for hematemesis from esophageal and gastric varices. reports drinking 2 cases of beer daily and last bleed with banding. he states he had increased fatigue over the course of ten days without nausea, vomiting, abdominal pain, hematemesis, melena hematochezia. day of admission to patient with hematemesis. this was the patients third admission in recent months. banding performed in admission only. while admitted, it appears from review of the records that his hematocrit remained stable and he did not receive any blood products. egd revealed grade i-ii varices in esophagus and gastrocardiac junction without stigmata of recent hemorrhage. no evidence of banding. he was maintained on an iv ppi, no octreotide nor antibiotics were administered. patient was transferred for further evaluation and potential tips. several episodes of encephalopathy in the setting of bleed in the past. . the patient reports that he continues to have small episodes of hematemesis as recently as this morning. he has abdominal pain, chronic back/leg pain and a headache that has lasted several days. has loose, non-melanotic guaiac positive stools. . vs on admission to the floor: 98.7 158/60 61 18 96%ra. patient was transferred to micu for closer monitoring and potential egd. . past medical history: alcoholic cirrhosis chronic alcohol abuse, last drink "was the superbowl" portal hypertension gastric/esophageal varices copd hypothyroidism chronic back pain social history: lives alone. history of etoh abuse. 70pkyr history, (current 1.5ppd). unable to obtain other illicity use family history: father died from unknown ca @ 77, brother died, age unknown from esophageal ca. physical exam: vitals: t: 98.2 bp:115/57 p:59 r: 11 o2: 97% on ra general: arousable, ill appearing. 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, no murmurs, rubs, gallops abdomen: soft, distended, non-tender, bowel sounds present, no rebound tenderness or guarding. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a+ox0. no asterixis. non focal. skin: palmar erythema, numerous tatoos, telangiectasia. no caput pertinent results: - cxr 1v (): pulmonary vascular congestion which improved between and has returned suggesting a borderline cardiac decompensation. right basal consolidation is most consistent with pneumonia, while left basal abnormality which has improved since is probably resolving atelectasis, although it may be related to aspiration. heart size is normal. lateral aspect of the right lower chest is excluded from the examination. the other pleural surfaces are normal. right jugular sheath ends just above the junction with the right subclavian vein. nasogastric tube passes into the stomach and out of view. - tips () - ruq ultrasound (): limited doppler examination due to the covered tips shunt is causing acoustic shadowing and preventing doppler examination of the flow within the tips shunt itself. indirect evidence suggests tips patency with appropriate direction based on the flow in the main, anterior right common and left portal veins. followup ultrasound in one week is recommended when the tips shunt may be interrogated with ultrasound. - tips () - tte (): the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. moderate (2+) aortic regurgitation is seen, secondary to incomplete central leaflet coaptation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. moderate aortic regurgitation. mild pulmonary hypertension. - egd (): varices at the lower third of the esophagus (4 cords of grade i-ii varices); varices at the cardia, injected; otherwise normal egd to third part of the duodenum and stomach antrum. wbc-10.3 hgb-11.0* hct-31.0* mcv-88 plt ct-71* pt-17.6* ptt-35.0 inr(pt)-1.6* glucose-115* urean-22* creat-0.5 na-143 k-2.9* cl-109* hco3-25 calcium-8.6 phos-1.9* mg-1.8 alt-492* ast-498* ld(ldh)-289* alkphos-113 totbili-5.0* brief hospital course: 58 year-old male with cirrhosis secondary to alcohol complicated by esophageal and gastric varices s/p banding in transferred from outside hospital on with hematemesis. patient was admitted directly to the micu, and transferred to the medical on . hospital course was as follows. hematemesis was most likely secondary to variceal bleeding. patient was started on an ocretotide gtt, iv ppi, ciprofloxacin, and transfused to keep hct > 25. nadolol and spironolactone were held in the setting of acute gi bleed. patient was kept npo during admission. liver team was consulted. they performed an egd on the night of admission. egd revealed large gastric varix, which was injected 2cc, 6cc, with bleeding (hematemesis). bleeding appeared to stop. however ng tube with dark blood, clots. patient looked unwell. bp transiently dropped to 80's. patient was typed and cross matched and received 2 units of blood. ir was contact for urgent tips. he was intubated prior to tips, with permission from daughter, his health care proxy. in procedure, initial porto-systemic gradient of 22. brought down to 6 after tips. saw esophageal varices. pre-tips saw splenorenal shunt. slower filling after tips. they did not perform any embolization on initial tips. the following morning , patient had a second episode of hematemesis, 200cc. vital signs and hct were stable. ir performed a redo of tips procedure. patient was extubated on . on patient was started on ceftriaxone and flagyl for aspiration pneumonia seen on chest x-ray. the following day a meeting was held with the health care proxy and the micu team. the daughter concluded that the patient should have no more care other than treating his hepatic encephalopathy (i.e. continuing lactulose, rifaximin, but discontinuing all antibiotics). central lines were discontinued, and one peripheral iv was placed. she did not want further antibiotics, lab draws, blood products, intubation, or resusitation. patient was made cmo, with the exception of treating hepatic encephalopathy in the event that mental status clears and the patient does not continue to bleed. on transfer to the medical service, patient's ng tube fell out. per discussion with daughter, the patient would not want tube replaced. she reported that this was based on lengthy discussions with her father following recent hospitalizations. patient received one dose of lactulose pr. pain was controlled with morphine po; agitation with olanzapine. patient required the use of restraints given danger to himself; he made repeated attempts to get out of bed, and was at risk of falling. he was alert at times although with limited interaction; he was not oriented to place or time on discharge. he was hemodynamically stable on discharge. medications on admission: oxycontin 30mg po q8 oxycodone 5mg po q6h prn ativan 1mg iv/po q4h prn anxiety albuterol q2h prn wheezing/dyspnea duoneb qid pantoprazole 40mg iv bid celexa 60mg po daily aldactone 100mg po daily mvi po daily nadolol (both 20 & 40 listed)mg po daily vit d3 1000 units daily nicotine 21mg tp discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 0.5 ml po q8h (every 8 hours): hold for sedation or rr<12. 2. morphine concentrate 20 mg/ml solution sig: 0.25 to 0.5 ml po q4h (every 4 hours) as needed for pain: hold for sedation or rr<12. 3. olanzapine 5 mg tablet, rapid dissolve sig: 2.5 to 5 mg po q4h (every 4 hours) as needed for agitation. discharge disposition: extended care facility: family hospice house discharge diagnosis: gastric varices esophageal varices hepatic encephalopathy alcoholic cirrhosis aspiration pneumonia discharge condition: hemodynamically stable. encephalopathic. arousable, but unable to interact. not orient to place or time. discharge instructions: you were admitted to on with variceal bleeding. the liver team was consulted. you were initially treated with ocreotide, proton pump inhibitor, ciprofloxacin, iv fluids, and blood transfusions. an egd was performed on the night of admission, which revealed esophageal varices, and a bleeding gastric varix. you subsequently had hematemesis (vomiting blood), and had an emergent tips performed. you were intubated for this procedure. the following morning, you had repeat hematemesis and a redo tips procedure. after a family meeting with you daughter, your health care proxy, it was decided to withdraw further interventions. this included no further blood products, no ventilation or rescusitations, no lab draws, no iv fluids for rescusitation. you were initially treated for hepatic encephalopathy with lactulose and rifaximin, although your nasogastric tube fell out and was not replaced and after discussion with your daughter. you will be going to family hospice house in new . followup instructions: you will be cared for at family hospice house. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours endoscopic control of gastric or duodenal bleeding other endovascular procedures on other vessels injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt phlebography of the portal venous system using contrast material phlebography of the portal venous system using contrast material diagnoses: esophageal reflux alcoholic cirrhosis of liver portal hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified aortic valve disorders other chronic pulmonary heart diseases personal history of tobacco use pneumonitis due to inhalation of food or vomitus esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy backache, unspecified other and unspecified alcohol dependence, unspecified other specified disorders of circulatory system 

Answer: The patient is high likely exposed to