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: aspirin attending: chief complaint: hemetemesis major surgical or invasive procedure: upper endoscopy (egd) history of present illness: 61yo f pmhx hcv cirrhosis c/b ascites, encephalopathy and hcc, s/p multiple tace, recent hospitalization for and ams, who presents after 2 episodes of coffee ground emesis. per hcp report she was in her normal state of health (normally aox2, mildly lethargic, secondary to chronic) when she had two witnessed episodes of hematemesis, one at home and one here while waiting for previously scheduled head mri. she reports no fevers, chills, abdominal pain. . she had a routine mri of abdomen performed yesterday to evaluate for progression of liver disease which showed a cirrhotic, heterogeneous liver with multiple hypoenhancing nodules, similar in appearance to past scans. . she had been admitted earlier this month for work up of lethargy, fatigue, elevated lactate (5.4 down to 1.9), and arf, thought to be due to acute toxic metabolic encephalopathy in the setting of hypovolemia from decreased po intake and recent addition of diuretics to her medication regimen. renal functions improved with fluids and holding of her diuretics. on that admission, received 1 unit of prbc for hct of 21.4. . in the ed, initial vs were 98.3 127 126/65 22 99%ra. exam was notable for aox2, lethargic, nontender abdomen. labs notable for lactate of 7.8 (had been 1.9 at last discharge), hematocrit of 21.6 (had been 26 at last discharge), creatinine of 1.5 (baseline 1.3), and k of 6.3 (previously normal). ekg was unchanged from prior. patient was bolused with iv fluids and tranfused 2 units of prbcs. ng lavage attempted but unsuccessful. per hepatology service iv pantoprazole and octreotide drips were initiated. 1 gram of ctx was given empirically. at time of transfer she had received 3l ns, had 3 18 gauge peripheral ivs. vitals were 99.0 hr105 121/57 18 99%ra. . on arrival to the micu, vital signs were 96.9 112 103/73 22 96ra. patient was mildly lethargic, sleeping, but arouseable, reporting no pain or discomfort. past medical history: 1. hepatitis c status post failed treatments with interferon and ribavarin. 2. hypothyroidism. 3. hypertension. 4. depression. 5. status post cholecystectomy. 6. hepatocellular carcinoma status post tace to the right liver on , left liver on , right liver , and most recently a superselective right liver segment v/ viii tace on . she underwent an mri after that on that showed good response to treatment of three lesions in segment ii, vii, and viii and no enhancement seen in those lesions, there are no new arterially enhancing lesions and the spleen was enlarged, pancreas and adrenals are unremarkable. social history: --tobacco history: denies history or current --etoh: denies- history 20 yrs ago --illicit drugs: none --home: lives with her son and daughter-in-law. she has seven children, five of whom live in the area. she is originally from the republic and has lived in united states for 15 years. --work: does not work family history: per , brother and sister are both status post liver transplant. it is unclear whether they had hcc or cirrhosis. father: mi at age 50, brother: mi with cabg at age 62, mother: htn physical exam: admission exam: vitals: 96.9 112 103/73 22 96ra general: mildly lethargic, comfortable heent: +icterus, mmm, oropharynx clear, perrl neck: supple, no jvd, no lad cv: tachycardic, no murmurs lungs: clear to auscultation bilaterally abdomen: distended, non-tender, dull to percussion, no rebound/guarding, or cva tenderness gu: + foley ext: warm, well perfused, 2+ dp/pt, no cyanosis/edema neuro: aox2 (name, "hospital"), moving all extremities, +asterixis on discharge vitals were t 99.3, bp 112/57, hr 76, rr 20, o2sat 97%ra. she was aaox2 with mild asterixis (felt to be her baseline mental status). pertinent results: admission labs: 12:25pm blood wbc-3.2* rbc-2.36* hgb-8.4* hct-25.1* mcv-106* mch-35.7* mchc-33.6 rdw-18.0* plt ct-79* 12:25pm blood neuts-56.7 lymphs-30.9 monos-10.9 eos-1.2 baso-0.3 10:10am blood pt-24.2* ptt-31.9 inr(pt)-2.3* 12:25pm blood urean-23* creat-1.3* na-136 k-5.0 cl-108 hco3-25 angap-8 12:25pm blood alt-85* ast-173* alkphos-221* totbili-2.7* 10:10am blood albumin-2.8* 06:30pm blood totprot-6.3* calcium-7.5* phos-3.7 mg-1.4* 10:19am blood lactate-7.8* k-6.3* discharge labs: 05:20am blood wbc-2.7* rbc-2.70* hgb-9.1* hct-26.2* mcv-97 mch-33.5* mchc-34.6 rdw-21.0* plt ct-41* 05:20am blood pt-21.1* ptt-35.8 inr(pt)-2.0* 05:20am blood glucose-75 urean-20 creat-1.0 na-138 k-3.6 cl-111* hco3-21* angap-10 05:20am blood alt-98* ast-211* alkphos-121* totbili-3.0* 05:20am blood calcium-7.8* phos-2.7 mg-1.6 ascitic fluid: 05:30pm ascites wbc-160* rbc-1140* polys-6* lymphs-41* monos-0 mesothe-11* macroph-42* 05:30pm ascites totpro-0.6 glucose-125 albumin-less than imaging: mri of abdomen : 1. limited evaluation of the hepatic parenchyma secondary to non-breathhold technique (used because patient was having difficultly following inststructions). 2. treated lesions in segment ii, segment vii, the junction of segments v and viii again demonstrate no enhancement and are grossly unchanged. there are no new arterially-enhancing lesions identified. 3. cirrhotic, heterogeneous liver with multiple hypoenhancing nodules, similar in appearance to . top normal spleen, small-moderate ascites, and edematous bowel wall all attest to the presence of portal hypertension. ct head : no acute intracranial process. area of white matter hypodensity on the left frontal subcortical region, likely represents sequelae of small vessel ischemic disease, correlation with mri is advised if clinically warranted. cxr : et tube in satisfactory position approximately 4 cm above the carina. apparent new patchy opacity in the left infrahilar region. : an ng tube is present, the tip lies approximately 4.8 cm above the carina. an ng tube is present, tip extending beneath diaphragm, off film. there is rotated positioning with low inspiratory volumes. this likely contributes to accentuation of the cardiomediastinal silhouette and pulmonary vasculature. compared with at 17:13 p.m., the patchy opacity at the left base is slightly more pronounced. there is minimal blunting of the right costophrenic angle and new atelectasis at the right base. : patchy opacity, left greater than right bases, ? atelectasis versus pneumonic infiltrate. overall appearances are similar to at 21:40 p.m. ruq ultrasound : patent main portal vein and hepatic veins. cirrhotic liver and multiple liver lesions, better assessed in the prior mri study of . brief hospital course: 61yof with h/o hcv c/b esld and hcc s/p multiple tace admitted for hematemesis ugib. active issues: # hematemesis / acute anemia: patient admitted to for coffee ground emesis, concerning for variceal bleed in a cirrhotic patient. patient was started on pantopraole and octreotide gtt for likely variceal bleed and started on prophylatic ceftriaxone for sbp in setting of gi bleed. patient underwent intubation and egd per hepatology where bleeding varices were found and banded. her initial hct was 21.6, and it came up to 23.3 after 2 units of rbcs, so pt received additional rbcs. she received 4 units of rbcs in total. her hct then stabilized and she was transferred to the floor without recurrence of bleeding. she completed 5 days of iv ceftriaxone for sbp prophylaxis. she was discharged home on nadolol and pantoprazole, carafate. # cirrhosis c/b ascites, encephalopathy, hcc: patient was restarted on lactulose after she was extubated. she had no e/o acute liver decompensation during admission. her aldactone and lasix were initially held in the icu in setting of acute gi bleed and then restarted on discharge. # elevate lactate: pt had elevated lactate on admission, likely representing poor perfusion of tissues in setting of poor clearance by liver in addition to hypovolemia gib. pt was resuscitated with prbcs and her lactate trended down and was wnl on discharge. # arf: creatinine 1.5 on admission (up from baseline 1.0-1.2), likely pre-renal hypovolemia in setting of gib as above. creatinine normalized after volume resuscitation with rbcs. # hyperkalemia: pt with k of 6.3 in ed, no ekg changes, likely as well as k-sparing diuretic. resolved with kayexalate, potassium remained stable for remainder of hospitalization. chronic issues: # altered mental status: at baseline patient is lethargic, has had extensive outpatient workup for her mental status. per her hcp her mental status was at her baseline. she will follow up with her pcp for ongoing evaluation. # htn: pt's home metoprolol was discontinued due to starting nadolol for variceal bleed. she was continued on amlodipine. # depression: continued fluoxetine # hypothyroidism: continued levothyroxine transitional issues: #medication changes: -start nadolol 20mg daily -start pantoprazole 40mg daily - take for 30 days -start carafate 1g four times daily - take for 2 weeks -stop metoprolol succinate - please follow up with your primary care physician about whether to restart this medication in the future -stop omeprazole while taking pantoprazole - you can resume your home omeprazole after you finish your course of pantoprazole #follow-up: she is scheduled to follow up with dr. in clinic and for repeat liver mri on the day after discharge. she is scheduled to f/u with her pcp 2 days after discharge. #code status: full medications on admission: - fluoxetine 20 mg daily - levothyroxine 100 mcg daily - omeprazole 40 mg daily - risperidone 0.25 mg qhs prn insomnia - lorazepam 0.5-1 mg qhs prn insomnia - metoprolol succinate 50 mg daily - amlodipine 5 mg daily - lactulose 30 ml qid - multivitamin 1 tablet daily - aldactone 50 mg daily - lasix 20 mg daily - ensure 1 can tid with meals discharge medications: 1. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 2. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) for 2 weeks. disp:*56 tablet(s)* refills:*0* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day for 1 months. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 4. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): for bowel movements daily. 8. levoxyl 100 mcg tablet sig: one (1) tablet po once a day. 9. spironolactone 50 mg tablet sig: one (1) tablet po once a day. 10. risperidone 0.25 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 11. lorazepam 1 mg tablet sig: 0.5-1 tablet po at bedtime as needed for insomnia. discharge disposition: home discharge diagnosis: acute blood loss due to upper gi bleed esophageal varices hepatocellular carcinoma hepatitis c cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to because you were vomiting blood. you had a procedure called an endoscopy, which showed that the blood was coming from bleeding vessels in your esophagus. we banded these vessels to stop the bleeding and started you on new medications to prevent the bleeding from happening in the future. please note the following changes to your medications: -start nadolol 20mg daily -start pantoprazole 40mg daily - take for 30 days -start carafate 1g four times daily - take for 2 weeks -stop metoprolol succinate - please follow up with your primary care physician about whether to restart this medication in the future -stop omeprazole while taking pantoprazole - you can resume your home omeprazole after you finish your course of pantoprazole we made no other changes to your medications while you were in the hospital. please continue taking the rest of your medications as prescribed by your outpatient providers. you are scheduled to follow up with dr. in clinic and have a repeat mri of your liver tomorrow, . please see below for your appointment times. it has been a pleasure taking care of you at and we wish you a speedy recovery. followup instructions: department: liver center when: thursday at 11:30 am with: , md building: lm campus: west best parking: garage department: radiology when: thursday at 4:20 pm with: radiology mri building: campus: east best parking: garage department: hmfp when: friday at 11:20 am with: , md building: ra (/ complex) campus: east best parking: main garage department: when: friday at 9:00 am with: c- , m.d. building: sc clinical ctr campus: east best parking: garage md procedure: endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: hyperpotassemia unspecified essential hypertension cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia chronic hepatitis c with hepatic coma acute kidney failure, unspecified unspecified acquired hypothyroidism depressive disorder, not elsewhere classified other acquired absence of organ other ascites esophageal varices in diseases classified elsewhere, with bleeding personal history of malignant neoplasm of liver other and unspecified coagulation defects 

Answer: The patient is high likely exposed to