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: zofran attending: chief complaint: morbid obesity major surgical or invasive procedure: : 1. laparoscopic roux-en-y gastric bypass. 2. endoscopy : 1. exploratory laparotomy. 2. small-bowel resection with primary anastomosis. 3. gastrostomy tube placement. history of present illness: has class iii morbid obesity with a weight of 228.4 pounds as of (her initial screen weight on /level was 231.5 pounds), height of 63 inches and bmi of 41.8. her previous weight loss efforts have included self-initiated diet for 3 months in losing 5 pounds, 12 weeks weight watchers in losing 3 pounds, 8 weeks of the diet in losing only 5 pounds, 4 months of over-the-counter ephedra-containing metabolife in losing 10 pounds and two months of slim-fast in losing 19 to 20 pounds. she has not taken prescription weight loss medications. her highest adult weight was 234.6 pounds in and she weight 224 pounds one year ago. she stated she has been struggling with weight since childhood and cites as factors contributing to her excess weight large portions, genetics, too many carbohydrates in saturated fats and convenience heating as well as lack of exercise. she stated that she currently is not exercising due to physical limitations/knee problems. she denied history of eating disorders and does have issues with depression/anxiety but has not been followed by a therapist in no are hospitalized for mental health issues and she is on psychotropic medication (celexa). past medical history: pmh: morbid obesity, hypertension, hypothyroidism, osteoarthritis of the cervical spine with neck pain, migraine or tension headaches, shoulder impingement syndrome, bilateral carpal tunnel syndrome, eczema, allergic rhinitis, ovarian cysts, uterine fibroids, sciatica and vertigo psh: bilateral breast reduction, bilateral carpal tunnel repair and appendectomy social history: she denied tobacco or recreational drug usage, has occasional glass of beer/wine once or twice per week and does drink both carbonated and caffeinated beverages. she is employed as collector for utilities company. she is divorced and she has one son age 22. family history: her family history is noted for mother living age 56 with hyperlipidemia and arthritis; sister living age 35 with obesity. physical exam: vs upon discharge: 97.8, 75, 152/95, 18 constitutional: appropriate affect, pleasant and cooperative. neuro: alert and oriented x4, nad. cardiac: rrr, n s1, s2 no mrg. lungs: lungs clear to auscultate bilaterally. abdomen: obese, soft, nondistended, tender to deep palpation. gtube clamped. wounds: midline incision with staples, open to air; umbilicus with small amt serous drainage. gtube insertion site without drainage or erythema. ext: + pedal pulses bilaterally, warm to touch. pertinent results: labs: 07:00am blood wbc-9.8 rbc-3.54* hgb-10.8* hct-30.7* mcv-87 mch-30.5 mchc-35.2* rdw-12.7 plt ct-/05/11 07:40am blood calcium-9.2 phos-2.7 mg-2.1 glucose-100 urean-8 creat-0.6 na-139 k-3.7 cl-102 hco3-28 angap-13 hct-34.5* 01:45am blood wbc-13.3*# rbc-4.21 hgb-12.5 hct-37.9 mcv-90 mch-29.8 mchc-33.1 rdw-12.6 plt ct-321 07:15am blood hct-31.0* 07:45pm blood hct-31.1* 11:54am blood hct-35.2* imaging: ugi sgl contrast w/ kub: normal appearance of post-roux-en-y stomach with no evidence of leak or obstruction : abdomen (supine & erect): impression: small bowel dilation with air-fluid levels concerning for small bowel obstruction. : ct abd & pelvis with contrast: impression: 1. small bowel obstruction likely complete distal to the roux-en-y anastomosis with dilation of both limbs of the roux-en-y gastric bypass resulting in distention of the excluded stomach. 2. the transition point is not definitely identified, however it is not in relation to the abdominal wall hernia and there is no mass or internal hernia. thus this is most likely due to an adhesion. 3. umbilical hernia containing omentum with surrounding fluid collection. brief hospital course: the patient presented to pre-op on . pt was evaluated by anaesthesia and taken to the operating room for laparoscopic roux-en-y gastric bypass and endoscopy. there were no adverse events in the operating room; please see the operative note for details. pt was extubated, taken to the pacu until stable, then transferred to the for observation. on pod 3, the patient was noted to have a complete small bowel obstruction. she was taken back to the operating room where she underwent an exploratory laparotomy, small-bowel resection with primary anastomosis and gastrostomy tube placement. again, she was extubated and taken to the pacu. once deemed stable, she was brought to the surgical icu for further management. post-operative recovery in the sicu was uneventful, therefore, the patient was transferred to the general surgical on pod . neuro: the patient was alert and oriented throughout her hospitalization; pain was initially managed on pod0 with a morphine pca, which required adjustment to dilaudid in the pacu due to inadequately controlled pain. the patient required an increase in the amount of dilaudid on pod1 with improved pain control. following return to the operating room on pod3/0, the patient's pain was adequately controlled with a morphine pca, which was transitioned to oral roxicet once tolerating a stage 2 diet. cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. pulmonary: the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. gi/gu/fen: she was initially kept npo on pod0 with complaints of intermittent nausea, which was managed with intravenous phenergan. a methylene blue dye test, performed on pod0, and an upper gi study, performed on pod1, were both negative for a leak. given normal test results and improved nausea, the diet was advanced to a bariatric stage 1 and then a stage 2 diet. the patient initially tolerated the diet advancement, however, on the evening of pod 2, the patient's abdomen became progressively distended. jp output had also significantly increased during the day on pod2 and and changed from serosanguinous to serous. additionally, a small area of induration without fluctuance or erythema was noted at the midline port site. a kub was obtained later that evening, which suggested 'small bowel dilation with air-fluid levels concerning for small bowel obstruction'. the following day, pod3, an abdominal ct scan was obtained and suggested 'small bowel obstruction likely complete distal to the roux-en-y anastomosis with dilation of both limbs of the roux-en-y gastric bypass resulting in distention of the excluded stomach' without definitive identification of a transition point. it was also suggested that the obstruction was not related to the abdominal wall hernia, which was described as an umbilical hernia containing omentum with surrounding fluid collection, but was most likely due to an adhesion. given these findings, the patient was brought back to the operating room where she underwent an exploratory laparatomy as described above. post-operatively, the patient had a g-tube to gravity for gastric decompression. her diet was resumed on pod following return of bowel function, which was well tolerated. jp drainage decreased significantly and was removed prior to discharge from the hospital. a foley catheter, which was placed intra-operatively, was removed on pod1; urine output was adequate throughout the hospitalization. on pod , jp drain was discontinued prior to discharge. id: intravenous cefazolin was administered prophylactically for 24 hours following the roux-en-y gastric bypass. however, intravenous metronidazole and ciprofloxacin were intitiated following repair of the strangulated hernia and continued until pod . the patient's fever curves were closely watched for signs of infection, of which there were none. heme: the patient's blood counts were closely watched for signs of bleeding, of which there were none. prophylaxis: the patient received subcutaneous heparin and dyne boots were used during this stay; she was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a stage 3 diet, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: amlodipine 10 mg daily lisinopril 20 mg daily atenolol 50 mg daily levothyroxing 225 mcg daily citalopram 20 mg daily mvi w/ minerals 1 tablet daily vitamin d (dosage uncertain) discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day: crush. 2. lisinopril 20 mg tablet sig: one (1) tablet po once a day: crush. 3. levothyroxine 200 mcg tablet sig: one (1) tablet po once a day: crush. 4. levothyroxine 25 mcg tablet sig: one (1) tablet po once a day: crush. 5. citalopram 20 mg tablet sig: one (1) tablet po once a day. 6. multivitamin with minerals tablet sig: one (1) tablet po once a day: chewable. tablet(s) 7. vitamin d-3 oral 8. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: ml po every 4-6 hours as needed for pain. disp:*250 ml* refills:*0* 9. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po twice a day as needed for constipation. disp:*300 ml* refills:*0* 10. ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po twice a day for 1 months. disp:*600 ml* refills:*0* 11. ursodiol 300 mg capsule sig: one (1) capsule po twice a day for 6 months. disp:*360 capsule(s)* refills:*0* discharge disposition: home with service facility: district vna discharge diagnosis: 1. hypertension. 2. morbid obesity. 3. osteoarthritis. 4. depression. 5. strangulated hernia comprised of small intestine. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: discharge instructions: please call your surgeon or return to the emergency department if you develop a fever greater than 101.5, chest pain, shortness of breath, severe abdominal pain, pain unrelieved by your pain medication, severe nausea or vomiting, severe abdominal bloating, inability to eat or drink, foul smelling or colorful drainage from your incisions, redness or swelling around your incisions, or any other symptoms which are concerning to you. diet: stay on stage iii diet until your follow up appointment. do not self advance diet, do not drink out of a straw or chew gum. medication instructions: resume your home medications, crush all pills. you will be starting some new medications: 1. you are being discharged on medications to treat the pain from your operation. these medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. you must refrain from such activities while taking these medications. 2. you should begin taking a chewable complete multivitamin with minerals. no gummy vitamins. 3. you will be taking zantac liquid 150 mg twice daily for one month. this medicine prevents gastric reflux. 4. you will be taking actigall 300 mg twice daily for 6 months. this medicine prevents you from having problems with your gallbladder. 5. you should take a stool softener, colace, twice daily for constipation as needed, or until you resume a normal bowel pattern. 6. you must not use nsaids (non-steroidal anti-inflammatory drugs) examples are ibuprofen, motrin, aleve, nuprin and naproxen. these agents will cause bleeding and ulcers in your digestive system. activity: no heavy lifting of items pounds for 6 weeks. you may resume moderate exercise at your discretion, no abdominal exercises. wound care: you may shower, no tub baths or swimming. if there is clear drainage from your incisions, cover with clean, dry gauze. your steri-strips will fall off on their own. please remove any remaining strips 7-10 days after surgery. please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: provider: , rd phone: date/time: 8:30 provider: , md phone: date/time: 9:15 procedure: other gastroscopy other partial resection of small intestine other gastrostomy small-to-small intestinal anastomosis laparoscopic gastroenterostomy diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism depressive disorder, not elsewhere classified morbid obesity osteoarthrosis, unspecified whether generalized or localized, site unspecified incisional ventral hernia with obstruction body mass index 40.0-44.9, adult 

Answer: The patient is high likely exposed to