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: sulfonamides / naprosyn attending: chief complaint: abdominal pain nausea/vomiting major surgical or invasive procedure: 1. diagnostic laparoscopy. 2. open cholecystectomy with intraoperative cholangiogram. history of present illness: 69f, well-known to dr. , with pmh of gallstone pancreatitis/ercp pancreatitis/dm/htn/hypercholesterolemia with who presents to er for 72 hours ruq abdominal pain and 48 hours n/v past medical history: pmh: dmii htn gallstone pancreatisit () oa psh: ercp appendectomy right breast lumpectomy bilateral knee replacements social history: occ etoh, no tobacco, married physical exam: admission pe- 99.1 80 132/70 18 98%ra heent: anicteric, nad, mmm, no jvd/bruit cor: reg, s1s2 pulm: diminished bs but clear no crackles abd: soft obese, (+), no hernia, no mass ext: no c/c/ 1+ ext edema pertinent results: admission labs ------------------ 03:45pm blood wbc-14.1*# rbc-4.68 hgb-14.3 hct-42.6 mcv-91# mch-30.6 mchc-33.6 rdw-13.8 plt ct-215 03:45pm blood neuts-85.1* lymphs-9.3* monos-4.4 eos-1.1 baso-0.1 03:45pm blood plt ct-215 03:45pm blood glucose-166* urean-12 creat-0.7 na-137 k-4.6 cl-98 hco3-28 angap-16 03:45pm blood alt-21 ast-37 alkphos-71 totbili-1.3 07:10am blood alt-14 ast-17 ld(ldh)-222 alkphos-65 amylase-23 totbili-1.3 dirbili-0.4* indbili-0.9 03:45pm blood lipase-24 07:10am blood albumin-3.6 calcium-8.3* phos-3.5 mg-1.8 discharge labs ------------------- 03:49am blood wbc-7.7 hct-28.6* plt ct-406 03:49am blood plt ct-406 03:49am blood glucose-111* urean-9 creat-0.4 na-143 k-3.6 cl-98 hco3-37* angap-12 03:15am blood lipase-19 02:35am blood ck-mb-6 ctropnt-0.25* 08:13am blood ctropnt-0.40* probnp-3711* 10:06am blood ck-mb-11* mb indx-3.2 ctropnt-0.35* 06:40pm blood ck-mb-10 mb indx-3.4 03:15am blood ctropnt-0.33* 09:46am blood ck-mb-7 ctropnt-0.33* 03:48pm blood ck-mb-6 ctropnt-0.30* 03:49am blood albumin-2.6* calcium-8.3* phos-3.8 mg-2.1 operative note ------------------- preoperative diagnosis: acute cholecystitis. postoperative diagnosis: acute and chronic cholecystitis with cystic duct obstruction secondary to stone. operation: 1. diagnostic laparoscopy. 2. open cholecystectomy with intraoperative cholangiogram. assistants: dr. and dr. . anesthesia: general endotracheal. indications for procedure: mrs. is a 69-year-old lady with a history of non-insulin-dependent diabetes mellitus, hypertension, and gallstone pancreatitis status post sphincterotomy in who presented with a 3-day history of right upper quadrant pain. she had a fever and leukocytosis and normal liver function tests. given the duration of her symptoms we attempted conservative treatment with bowel rest and intravenous antibiotics. after 24 hours, she continued to have fevers and right upper quadrant tenderness and leukocytosis. accordingly, i advised a cholecystectomy. i explained that given the duration of the symptoms there would be a high likelihood of conversion to an open cholecystectomy but that we would attempt a laparoscopic approach. the risks and benefits of the procedure were discussed with the patient and she consented to proceed. intraoperative findings: 1. upon diagnostic laparoscopy there was serous fluid in the right upper quadrant. the omentum was firmly adherent to the liver edge and gallbladder. limited inspection of the fundus of the gallbladder showed it to be ischemic with a portion of the wall necrotic. accordingly, we elected to convert fairly quickly to open cholecystectomy. 2. an attempted cholangiogram was unsuccessful. we were unable to successfully pass a cholangiocatheter beyond the cystic duct/common duct junction. upon opening this further, it was clear that there was a stone impacted here which we could not safely retrieve. we did not wish to further dissect the common bile duct given the tremendous edema of the tissues. description of procedure in detail: the patient was identified in the preoperative holding area and taken to the operating room where she was positioned supine on the operating room table. after the adequate induction of general endotracheal anesthesia, her abdomen was widely sterilely prepped and draped in the usual fashion. intravenous unasyn was administered. a timeout was performed identifying the patient and the procedure to be performed. the infraumbilical space was anesthetized with 0.5% marcaine plain. a vertical midline incision was made here and the fascia was opened in the midline and the peritoneal cavity entered bluntly without incident. #0 vicryl sutures were placed in the fascia and the trocar secured. a carbon dioxide pneumoperitoneum was achieved. an angled 30 degree laparoscope was inserted. limited inspection of the lower abdomen and left upper quadrant was unremarkable. inspection of the right upper quadrant showed a large amount of serous fluid about the liver and an omentum firmly adherent to the gallbladder and liver edge. additional local anesthetic was infiltrated in the epigastrium and a 12-mm transverse incision was made and a 12-mm port placed. a smooth grasper was placed via this port. it was clear that the omentum was firmly tethered to an ischemic, if not necrotic, gallbladder. an additional 5-mm port was placed in the right subcostal space in the mid-clavicular line to facilitate better retraction of the omentum and inspection of the gallbladder. the omentum was bluntly taken off the fundus and body of the gallbladder, and there was a portion of the gallbladder wall which appeared necrotic. it was clear that we could not safely complete this operation laparoscopically and so the ports were removed and the pneumoperitoneum evacuated. we elected to convert at this time to an open procedure. a right subcostal incision was made, joining our two previous port incisions. this was carried down through the subcutaneous tissues and fascia with the cautery. the rectus muscle was divided with the cautery. peritoneal cavity was entered without incident. retractor system was placed. a malleable retractor was placed on a lap pad and retracted the duodenum and colon caudally. we then placed a right angle retractor on the subcostal margin cranially. there was some bleeding from the liver edge near the fundus of the gallbladder which was successfully cauterized. we scored the wall of the gallbladder approximately 3 mm away from the liver bed. we mobilized the gallbladder from the fossa by staying in this plane, leaving a fairly significant rind of tissue on the liver surface. we carried this dissection all the way down toward the neck of the gallbladder. we placed clamp on the fundus of the gallbladder as well as clamp on the neck of the gallbladder to aid in retraction. the cystic artery was identified and cauterized. at this point we identified what we believed to be the cystic duct with the cystic duct lymph node; however, there was an extensive amount of inflammation and edema of the tissues. we dissected some of this edematous tissue from the anterior aspect in the porta and exposed what we believed to be the common bile duct. however, we did not persist a great deal in this dissection given an increased potential risk of injury to structures here. accordingly, we elected to perform a cholangiogram. an opening was made in the neck of the gallbladder and we attempted to place a cholangiocatheter but met resistance after passing it only 1-2 cm. a clip was placed on the opening and we attempted a cholangiogram with half- strength conray. this filled the infundibulum of the gallbladder and potentially the proximal cystic duct, but we were unable to opacify the biliary ductal system or duodenum. accordingly, i aborted this procedure. i consulted dr. intraoperatively. we elected to transect what we believed to be the cystic duct and passed the gallbladder off the field. we then explored the cystic duct stump with a schnidt and identified a gritty structure which appeared to be a stone at the cystic duct/common bile duct junction. with potts scissors we opened up the cystic duct stump to better visualize this. given its gritty nature, we were somewhat concerned about possible carcinoma at this site. accordingly, a biopsy was taken of the cystic duct and sent for frozen section. this returned as only fibrosis. we were unable to safely retrieve the stone. given that we were quite close to the common bile duct, we did not wish to open up the cystic duct any further and risk encroaching upon the common bile duct lumen. thus, we simply closed the cystic duct stump with two figure-of-eight 3-0 pds sutures,tacking a flap of edematous fatty tissue over this repair with an additional 3-0 pds. there was no leakage of bile from this stump at any point during the exploration, again suggesting that the cystic duct was indeed obstructed. the right upper quadrant was copiously irrigated and hemostasis was assured. there appeared to be a small leakage of bile from the liver bed at the lower aspect of the gallbladder fossa, and this was extensively cauterized with good effect and after observation for several minutes was noted to be free from bile leakage. a #19 drain was placed in the right upper quadrant and brought out through a separate stab incision lateral to our incision. the fascia was then closed in two layers with running #1 looped pds sutures. subcutaneous tissues were irrigated and the skin was closed with staples. a sterile dressing was applied. the patient tolerated the procedure well. there were no complications. given the amount of fluids and narcotics the patient received, she was kept intubated and transferred to the pacu in stable condition. intraoperative fluids: 4 liters of crystalloid. urine output: 170 cc. estimated blood loss: 50 cc. abdomen u.s. (complete study) reason: h/o of gallstones, now with ruq pain, r/o cholecistitis medical condition: 69 year old woman with h/o gallstones now with ruq pain reason for this examination: r/o choley abdominal ultrasound at 17:09 hours. history: history of gallstones with right upper quadrant pain. comparison: . findings: there are multiple echogenic foci, predominantly in the central portal triad with relative dirty acoustic shadowing highly suggestive of air. there is a marked hyperechoic focus extending the length of the common bile duct. these findings suggest an indwelling biliary stent or may be result of pneumobilia from prior sphincterotomy. portal venous gas is felt much less likely given distribution. the liver echotexture is relatively echogenic, which is likely, in part, due to body habitus. the portal vein is normal in diameter with hepatopetal flow with a normal doppler waveform. the common bile duct measures between 4 and 7 mm. the head of the pancreas is not visualized. the body is seen and there is no evidence of pancreatic ductal dilatation. the gallbladder is distended. no overt wall thickening is seen. there may be trace pericholecystic fluid. at least one small gallstone is noted at the gallbladder neck. no movement is seen on decubitus views suggesting possible impaction. the patient was focally tender over the gallbladder during the examination. the right kidney measures 11.7 cm in length. the left kidney measures 10.3 cm in length. both kidneys demonstrate normal echotexture with no hydronephrosis or stones identified. the spleen is normal in size at approximately 9.4 cm in length. impression: 1. distended gallbladder with questionable impacted small stone and minimal- to-trace pericholecystic fluid. given tenderness over gallbladder at the time of examination (positive sign), acute cholecystitis remains in the differential diagnosis. if further imaging correlation is required based on equivocal clinical examination, consider hida scan. 2. apparent pneumobilia as above. correlate with prior procedure and surgical history. does the patient have indwelling biliary stent or history of prior sphincterotomy? results were immediately posted to the ed dashboard and discussed with dr. , er resident, at time of dictation. echo measurements: left atrium - long axis dimension: *4.8 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.9 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.5 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 0.9 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 0.9 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.1 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 3.1 cm left ventricle - fractional shortening: 0.39 (nl >= 0.29) left ventricle - ejection fraction: >= 60% (nl >=55%) aorta - valve level: 2.6 cm (nl <= 3.6 cm) aorta - ascending: 2.8 cm (nl <= 3.4 cm) aorta - arch: *3.3 cm (nl <= 3.0 cm) aortic valve - peak velocity: *2.6 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 27 mm hg aortic valve - mean gradient: 16 mm hg mitral valve - e wave: 1.1 m/sec mitral valve - a wave: 1.1 m/sec mitral valve - e/a ratio: 1.00 mitral valve - e wave deceleration time: 168 msec interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. left ventricle: symmetric lvh. normal lv cavity size. overall normal lvef (>55%). transmitral doppler and tvi c/w grade ii (moderate) lv diastolic dysfunction. no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. mildly dilated aortic arch. aortic valve: moderately thickened aortic valve leaflets. minimally increased gradient c/w minimal as. no ar. mitral valve: mildly thickened mitral valve leaflets. trivial mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild tr. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: trivial/physiologic pericardial effusion. conclusions: the left atrium is mildly dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets are moderately thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. brief hospital course: was admitted to the surgery service on under the care of dr. . ruq ultrasound was consistent with cholecystitis. wbc count was 14.1. lfts were wnl. (+) uti. she was made npo. iv fluids and unasyn were started. at hd 2 she had decreased urine output. fluid boluses were provided. at hd 3 she was febrile to 101.4. cxr showed slightly increased fluid overload, with no evidence of pneumonia. she continued with ruq abdominal pain and leukocytosis. she was taken to the operating room where she underwent diagnostic laparoscopy, open cholecystectomy; cystic duct biopsy; and cholangiogram. upon diagnostic laparoscopy there was serous fluid in the right upper quadrant. the omentum was firmly adherent to the liver edge and gallbladder. limited inspection of the fundus of the gallbladder showed it to be ischemic with a portion of the wall necrotic. it seemed that there was an impacted stone at the common/cystic duct junction and this was opened with the finding of a gritty material which was concerning for carcinoma. a biopsy was taken from the site. (see operative note). she tolerated the procedure well. given the amount of fluid and narcotics the patient received during surgery she remained intubated and monitored in the pacu overnight. at pod 2 she was extubated without event and returned to the floor. later that night she was intubated for respiratory distress r/t pulmonary edema and taken to the icu. she was febrile to 102.7. wbc count was elevated at 16.2. troponins were elevated. ecg was negative for ischemia. bnp was elevated. cardiology was consulted and felt that the elevation of cardiac labs was r/t acute pulmonary edema. an echo was performed which showed lvef>55% (see report). at pod 3 she was afebrile and was undergoing diuresis. she was extubated without event. at pod 5 she was transferred from the floor. she was afebrile and wbc count was 7.7. blood and urine cultures were negative. she was tolerating a regular diet. at pod 6 she was complaining of left hand pain. xray negative for acute process/fracture. plastic surgery was consulted and recommended splint. she was discharged to pine rehab in good condition. she was to follow up with dr. and hand clinic. medications on admission: asa 81' atenolol 50' avandia 2' compazine diovan 40' lipitor 40' metformin vicodin/nsaids/tylenol discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. disp:*qs qs* refills:*0* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. menthol-cetylpyridinium cl 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). disp:*30 lozenge(s)* refills:*2* 5. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. metformin 500 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). disp:*90 tablet sustained release 24 hr(s)* refills:*0* 7. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*0* 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*40 tablet(s)* refills:*0* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. rosiglitazone 2 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. valsartan 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 12. insulin regular human 100 unit/ml solution sig: one (1) injection per sliding scale: per sliding scale. disp:*qs qs* refills:*0* 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection three times a day: discontinue when walking at least 2-3 times per day. discharge disposition: extended care facility: center discharge diagnosis: acute calculous cholecystitis discharge condition: stable discharge instructions: please return or contact for: * fever (> 101 f) or chills * abdominal pain * nausea or vomiting * inability to pass gas or stool * redness or drainage from incision site * any other concerns you may continue your previous medications as prescribed. you may shower. gently wash incision and pat dry. no lifting over pounds or abdominal stretching exercises for 4-6 weeks. followup instructions: please call dr office for a follow up appointment (. please follow up in weeks in hand clinic. please call for an appointment. the number is (. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube cholecystectomy intraoperative cholangiogram exploration of common duct open biopsy of gallbladder or bile ducts diagnoses: congestive heart failure, unspecified unspecified essential hypertension laparoscopic surgical procedure converted to open procedure calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction 

Answer: The patient is high likely exposed to