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: penicillins attending: chief complaint: gi bleed major surgical or invasive procedure: egd eus history of present illness: 56 yo male with hx of htn, cad and a-fib on anticoagulation who initially presented to the osh today with a chief complain of progressive weakness, lightheadedness and tiredness. he was found to have a drop in hct and was in afib with rvr at 180, sbp of 90. pt was given lopressor 5mg iv with good response in hr and bp, pt was then transferred to and admitted to the micu. pt reports several episodes of unusually dark stools over the past 3-4 weeks with some intermittent epigastric pain. pt also endorsed nsaid use prn pain (at most tylenol or motrin/day) but denies any hx of gi bleed. . pt received 1 l ns, vitamin k, iv ppi and one unit of prbcs. hct remained stable and pt remained hemodynamically stable with a heart rate in the 80s. pt was transferred to the medicine floor on . past medical history: hypertension coronary artery disease hyperlipidemia ethanol abuse smoking social history: significant for current tobacco use (approx 50 pack years). pt has a history of significant alcohol use which he has decreased significant ly and now takes approx 2 glasses of wine or beer per day. no h/o ivdu family history: brother and father with cad in 50s physical exam: tm/c 100.3 115/69;97-126/31-82 rr 17-29 hr 89,70-89, 91-100% ra gen: well appearing, nad heent: mmm, mildly icteric sclera, eomi pulm: ctab, no w/r/r cv: hrrr, no m/r/g abd: s/nd/nabs. large palpable liver. mild ttp throughout extr: no c/c/e neuro: aox4, cn 2-12 intact grossly pertinent results: 06:15am blood wbc-14.8* rbc-3.04* hgb-8.4* hct-26.8* mcv-88 mch-27.7 mchc-31.4 rdw-16.4* plt ct-455* 01:05pm blood wbc-16.0* rbc-2.70*# hgb-6.8*# hct-22.2*# mcv-82# mch-25.0*# mchc-30.4*# rdw-15.5 plt ct-595*# 01:05pm blood pt-36.1* ptt-31.7 inr(pt)-3.8* 06:15am blood pt-16.0* ptt-27.5 inr(pt)-1.4* 01:05pm blood glucose-94 urean-32* creat-1.3* na-136 k-4.8 cl-104 hco3-21* angap-16 06:15am blood glucose-94 urean-18 creat-0.9 na-137 k-4.6 cl-103 hco3-24 angap-15 01:05pm blood alt-49* ast-121* ld(ldh)-355* alkphos-363* totbili-1.6* 06:20am blood alt-52* ast-100* ld(ldh)-267* alkphos-286* totbili-9.9* 06:15am blood alt-53* ast-108* ld(ldh)-299* alkphos-271* totbili-8.9* 06:30am blood ggt-367* 06:20am blood lipase-30 06:15am blood calcium-9.0 phos-3.5 mg-2.1 06:20am blood albumin-3.0* calcium-8.7 phos-3.3 mg-1.9 06:30am blood hapto-159 06:14am blood tsh-2.8 06:30am blood hbsag-negative 01:05pm blood hbsab-positive hav ab-negative 10:26am blood ama-negative . abdomen u.s. (complete study) study date of 8:07 am impression: 1. echogenic and coarsened liver are consistent with chronic liver disease. 2. thrombosis of the left portal vein; main and right portal veins as well as splenic vein are patent. 3. small ascites. . chest (portable ap) study date of 4:39 pm impression: no acute cardiopulmonary process identified. . ct abd : 1. large complex mass centered at the gastroesophageal junction with erosion into the gastric lumen. 2. innumerable hepatic metastases. 3. two 7-mm pulmonary nodules in the left lung are indeterminate. one or both may represent a small focus of infection, a benign nodule, or metastatic disease. 4. severe coronary artery calcifications. . egd on : mass in the gastroesophageal junction normal mucosa in the stomach the duodenum was not entered due to the findings at the ge junction. biopsies were not taken due to elevated inr. otherwise normal egd to pylorus. . eus : mass in the gastroesophageal junction and cardia - this was biopised. eus of the mass could not be performed due to constriction of esophageal lumen by tumor. eus imaged of middle and upper third of the esophagus were normal. brief hospital course: 56 yo male with pmhx of etoh abuse, afib on coumadin p/w anemia, rvr, hypotension with h/o melena. new mass seen at ge junction & e/o metastatic disease on ct scan. biopsy results pending. . # ge junction mass/anemia: pt presented with hct drop and egd performed on revealed a large polyploid mass at the ge junction that was actively bleeding. pt had a ct performed that revealed a large complex mass centered at the gastroesophageal junction with erosion into the gastric lumen and innumerable hepatic metastases. patient, family and pcp were explained the results of these tests and biopsy was pending at time of discharge. pt was eager to return home to family with plan for outpatient follow up with gi onc. hct has been essentially stable s/p transfusion with prbcs but had trended down slightly with multiple transfusions of ffp. pt had developped antibodies and blood bank was having difficulty finding an appropriate match for transfusion. hct was 26.8 on day of discharge and pt agreed to have follow up labs drawn and followed up by his pcp . . # afib: pt presented in a.fib with rvr in setting of acute anemia. pt was initially rate controlled with iv lopressor and admitted to the micu where he remained hemodynamically stable on po bb. pt was transferred to the floor and maintained good rate control with metoprolol. coumadin was held on admission due to gi bleed and supratherapeutic inr. pt received vitamin k for 5 days & a total of 7u ffp to correct his inr for eus & biopsy. pt was explained the risk of bleeding on coumadin given his poor synthetic function and the ongoing bleeding seen in the esophageal mass. pt was instructed to stop taking coumadin and discuss this with his pcp in follow up. . # cholestatic jaundice: pt was noted to have a significant cholestasis with only mild transaminitis. ct abdomen revealed innumerable mets in the diffusely enlarged liver. the overwhelming burden of metastases is likely causing cholestasis & impaired synthetic function in setting of underlying etoh cirrhosis. pt was started on ursodiol 300mg to help with pruritis and biopsy was taken of esophageal mass. biopsy results were pending at time of discharge and pt was scheduled to follow up with gi onc as outpt. . # chronic chf: pt has a significant cad history s/p nstemi and etoh abuse likely contributing to cardiomyopathy & ef 30%. pt maintained his sats well on ra without any evidence of volume overload on exam. pt was continued on metoprolol and lisinopril 5mg daily. pt was instructed to continue taking lasix prn as he was doing prior to admission. . # leukocytosis: pt was noted to have low grade fevers and significant leukocytosis on admission. ros was negative and all blood/urine cx were ngtd, cxr showed no evidence of infiltrate. ct scan showed large esophageal mass and it was thought likely that the leukocystosis was due his primary malignancy. . # etoh abuse: pt was a heavy drinker and now reports significantly less intake, currently drinking glasses of wine or beer per day. pt reports that last drink was 3 days pta. pt was monitored on ciwa for five days without any ativan requirements. pt was given folate, thiamine, miv daily and was counseled on the importance of complete cessation of alcohol intake. social work was consulted. . # hypothyroidism: tsh was in normal range and pt was continue home regimen of levothyroxine 25mcg daily. medications on admission: - lisinopril 10 mg - levothyroxin 25 mcg - coumadin 5 mg - furosemide 40 mg - metoprolol succinate 50 mg - folic acid 1 - aspirin 81 mg - magnesium 400 discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 5. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*1* 6. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. 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* 8. ativan 1 mg tablet sig: one (1) tablet po three times a day as needed for anxiety for 14 days. disp:*14 tablet(s)* refills:*0* 9. outpatient lab work please draw a cbc and send results to dr. office # discharge disposition: home discharge diagnosis: primary: gastrointestinal bleed esophageal/gastric mass . secondary: coronary artery disease s/p mi cirrhosis discharge condition: good discharge instructions: you were admitted with low blood counts and found to have a bleeding mass between your esophagus & your stomach. a biopsy was taken and the results are pending. it is very important that you keep all of the scheduled follow up appointments below. . we have decreased your lisinopril to 5mg daily and you should not be taking any coumadin anymore. we have started ursodiol 300mg twice daily and ativan 1mg up to twice daily as needed for anxiety. we have stopped the aspirin & lasix, but these may need to be restarted as an outpatient. please discuss these with dr. in follow up. . you need to go into dr. office on monday to have labs drawn to monitor your blood counts. dr. will let you know if you need additional transfusions. . if you develop any new chest pain, shortness of breath or any other general worsening of condition, please call your pcp or come directly to the emergency room. followup instructions: you have a follow up appointment with dr. on wednesday at 2:15pm. . you have a follow up appointment with dr. in gi oncology on at 10am. md procedure: other endoscopy of small intestine esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acidosis coronary atherosclerosis of native coronary artery malignant neoplasm of liver, secondary congestive heart failure, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation alcohol abuse, unspecified other and unspecified hyperlipidemia blood in stool old myocardial infarction chronic systolic heart failure other ascites esophageal varices in diseases classified elsewhere, without mention of bleeding malignant neoplasm of cardia 

Answer: The patient is high likely exposed to