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: flagyl / iodine attending: chief complaint: acute blood loss anemia due to gastric ulcers with bleeding major surgical or invasive procedure: upper endoscopy history of present illness: 66 year old female with esrd on peritoneal dialysis due to hypertensive nephropathy, and h/o nsclc on tarceva and nephrolithiasis who presents with symptomatic anemia. the patient typically adjusts her weekly epo injections between 4000-6000 units depending on her symptoms of fatigue and dyspnea. two and a half weeks ago her dialysis nurse had her terminate epo in the setting of an elevated hmg > 12 per her report. she has been waiting to hear back from her dialysis clinic regarding when to restart her epo. she titrates her own epo, given a similar episode of severe symptomatic anemia. in the interim she developed excruciating flank pain earlier this week for which she presented to the ed, a ct demonstrated bilateral stones. she was given toradol and vicodin and discharged home with total resolution of her pain. however, as the week progressed, she has become progressively constipated and fatigued with suprapubic abdominal pain. she reports her pd fluid has been clear. she had an episodic visit at on thursday which prompted referral to the ed. her blood pressure was 112/72 laying and 94/68 standing. blood cultures were taken, but patient denied any fevers or chills. she got ivf (approximately 500 cc). her labs were significant for a hematocrit of 27, down from 36 on . she was guiac negative. her potassium was elevated at 6, she was given kayexalate. she had an abdominal ct which showed nothing acute. a cxr was negative for acute processes. repeat orthostatics were: lying hr 75 bp 135/63, standing hr 85 bp 127/61. on transfer to the floor her abdominal pain had completely resolved in the setting of a large dark brown bowel movement after receiving kayexalate. she did not receive pd o/n. ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, vomiting, diarrhea, brbpr, hematochezia. she makes trace amounts of urine. she notes acid reflux for the past 3 days that has been constant. she has only been eating peppermints do to her poor appetite. past medical history: medical & surgical history: - nsclc on erlotinib - esrd on pd - recurrent nephrolithiasis - depression - insomnia - seasonal rhinitis - papillary thyroid ca s/p excision social history: divorced, lives in same house as 3 friends (, , ). 2 adult sons. remote tobacco (quit 20 years ago)denies etoh or illicit drug use. family history: mother- diabetes father with kidney disease physical exam: admission: vs: 98.7 143/69 85 18 100 ra general - in nad, comfortable, appropriate, pale heent - nc/at, mmm lungs - ctab, no r/rh/wh, good air movement, resp unlabored heart - rr, no mrg, nl s1-s2 abdomen - soft/nt/slightly distended, no rebound/guarding, pd catheter in lower abdomen with clean bandage, skin without erythema, non-tender extremities - trace le edema, wwp, 1+ peripheral pulses neuro - awake, a&ox3, gait intact discharge: general: nad, comfortable, upright in pain, returned color lungs: decreased breath sounds and mild crackles at left lower lung base heart - rr, no mrg, nl s1-s2 abdomen - soft/nt/slightly distended, no rebound/guarding, pd catheter in lower abdomen with clean bandage, skin without erythema, non-tender extremities - trace le edema, wwp, 1+ peripheral pulses pertinent results: chest xray pa and lateral views of the chest: the cardiac silhouette is normal in size. the mediastinal and hilar contours are stable. chain sutures within the left lower lobe are again demonstrated. pulmonary vascularity is not engorged. left lower lobe mass is again noted, better seen on the prior ct, but similar compared to the prior study. nodular opacity within the left upper lobe appears relatively unchanged from prior. small left pleural effusion persists. the right lung is grossly clear. no pneumothorax is identified. multiple clips are demonstrated within the thyroid bed. left proximal humeral fracture appears chronic. impression: no significant interval change in appearance of left lower lobe lung mass, and nodule in the left upper lobe. persistent small left pleural effusion. ct abdomen w/out contrast ct of the abdomen: there is unchanged left lower lobe round nodule with associated surgical material and small left pleural effusion and mild bibasilar atelectasis. unchanged multiple pulmonary nodules at the right lung base. segment iii liver hypodensity is stable and was previously characterized as a hemangioma. adjacent sub-cm hypodensity in the left lobe is also unchanged. the gallbladder, spleen, bilateral adrenal glands and pancreas are normal. unchanged splenic artery calcifications. the kidneys are atrophic with numerous calcifications, likely vascular, and cysts, unchanged from priors. the stomach, duodenum, small bowel are normal. a peritoneal dialysis (pd) cathether is visualized in the left lower quadrant with unchanged small 17 x 8 mm seroma in the subcutaneous soft tissues and moderate amount of ascites. unchanged calcification of the aorta and its major branches. there is no retroperitoneal or mesenteric lymphadenopathy. ct of the pelvis: the urinary bladder is normal. there is no pelvic lymphadenopathy, no pelvic hernias. bones: there are moderate degenerative change at l5-s1 with intervertebral disc disease. . impression: no acute process or interval change from 2 days prior, including no evidence of diverticulitis or appendicitis. . portable chest xray impression: ap chest compared to : mild interstitial abnormality in the right lung is probably edema. moderate left pleural effusion is increasing. large left lung lesions also appear grown since , though this is probably mostly a function of projection between the pa and ap orientations. heart size top normal. mediastinal veins and upper lobe pulmonary vessels are slightly dilated. pertinent labs 06:55am blood wbc-8.3 rbc-3.48* hgb-10.9* hct-31.1* mcv-90 mch-31.5 mchc-35.1* rdw-14.2 plt ct-227 07:15am blood wbc-7.9 rbc-3.38* hgb-10.6* hct-29.5* mcv-87 mch-31.3 mchc-35.9* rdw-14.5 plt ct-211 07:10am blood wbc-8.4# rbc-3.23* hgb-10.0* hct-28.5* mcv-88 mch-31.1 mchc-35.2* rdw-14.3 plt ct-231 07:10am blood wbc-8.4# rbc-3.23* hgb-10.0* hct-28.5* mcv-88 mch-31.1 mchc-35.2* rdw-14.3 plt ct-231 04:15pm blood wbc-17.0*# rbc-3.02* hgb-9.3* hct-26.8* mcv-89 mch-30.8 mchc-34.8 rdw-14.1 plt ct-249 09:00am blood wbc-8.4 rbc-2.59* hgb-8.0* hct-22.7* mcv-88 mch-31.1 mchc-35.5* rdw-14.0 plt ct-295 02:40am blood hct-22.8* 01:20am blood wbc-10.9 rbc-2.58* hgb-7.9* hct-22.5* mcv-87 mch-30.6 mchc-35.2* rdw-14.1 plt ct-308 05:27pm blood wbc-10.9 rbc-3.09* hgb-9.5* hct-27.2* mcv-88 mch-30.8 mchc-35.1* rdw-14.1 plt ct-347 05:27pm blood neuts-83.7* lymphs-12.1* monos-1.3* eos-2.2 baso-0.7 07:10am blood pt-12.7 inr(pt)-1.1 06:55am blood glucose-88 urean-81* creat-12.2* na-140 k-5.4* cl-100 hco3-26 angap-19 07:10am blood glucose-83 urean-95* creat-10.7*# na-138 k-4.8 cl-101 hco3-25 angap-17 01:20am blood glucose-92 urean-108* creat-11.5* na-141 k-4.6 cl-102 hco3-24 angap-20 07:15am blood alt-22 ast-27 ld(ldh)-174 alkphos-218* totbili-0.4 09:00am blood totbili-0.2 dirbili-0.1 indbili-0.1 05:27pm blood alt-26 ast-23 alkphos-263* totbili-0.2 06:55am blood calcium-7.8* phos-5.2* mg-2.1 07:10am blood calcium-7.9* phos-5.2* mg-2.1 05:27pm blood albumin-3.3* calcium-9.3 phos-3.6# mg-2.5 09:00am blood hapto-180 02:40am blood hapto-198 03:17pm blood iga-122 03:17pm blood ttg-iga-4 07:45pm blood lactate-0.9 k-5.4* 05:29pm blood lactate-1.1 05:48am other body fluid wbc-34* rbc-1* polys-4* lymphs-16* monos-0 macro-79* other-1* 5:48 am dialysis fluid improper specimen collection. interpret results with caution. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. 3:17 pm serology/blood **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). egd: impression: multiple superficial ulcers in the stomach antrum few cratered ulcers in the pre-pyloric region a single cratered ulcer with stigmata of recent bleeding in the pre-pyloric region (injection) bulbar duodenitis brunner's gland hyperplasia in the duodenal bulb scalloping folds on the mucosa of the second and third parts of the duodenum otherwise normal egd to third part of the duodenum recommendations: the findings account for the symptoms, and the distribution of the gastric ulcers suggests that they are nsaid-induced. continue ppi, avoid all aspirin or nsaid products. follow serial hcts, transfuse prbcs to hct >30. consider ddavp and/or platelet transfusion for uremic platelets. check h.pylori serology, treat if positive. check ttg and iga to exclude celiac disease. if re-bleeds will need repeat egd. brief hospital course: hospital course ms. is a 66 year old woman with esrd on pd, nsclc, anemia, and thyroid cancer who presented with an upper gi bleed. she required multiple transfusions and transfer to the micu where upper endoscopy revealed bleeding gastric ulcers secondary to recent nsaid use. active issues # acute blood loss anemia due to gastric ulcers with bleeding, duodenitis: symptomatic anemia in the setting of a significant drop in hct over a three day period. (36->27->22) etiology initially concerning for discontinuation of weekly epogen in setting of elevated hmg on routine lab draw. the patient has past history of dramatic hct drop off epo. she received 1x dose of tordol during ed visit on monday. no other nsaid use or history of gerd. most recent colonscopy in demonstrated multiple polyps. follow up colonoscopy deferred given nsclc. initially no evidence of acute bleed, guaic negative stool in the ed prior to transfer, however on the morning of admission the patient passed four melanolic stool, guaic positive. her hct dropped to 22, she was transfused 1 unit of prbc and given desmopressin. two pivs were placed, she was started on ppi gtt and 1 more unit prbc and transferred to micu for edg and further management. egd revealed multiple gastric ulcers in antrum, one of which had stigmata of recent bleed with overlying dark area. this area was injected. there was no evidence of active bleeding. the duodenal bulb was acutely inflammed and edematous w/o discrete ulcer or bleeding. patient received additional 2 units prbcs after procedure, with subsequent stabilization in hct and hemodynamics. her diet was advanced to clears, and she was stable to be transferred back to the general medicine floor. her hematocrit continued to be stable. pantoprazole was changed to po bid dosing which she will continue on for 6 weeks. she will discuss further epoitin dosing with her outpatient nephrologist. hpylori negative. iga at normal levels. # flank pain: the patient has was admitted to the ed prior to admission for left sided plank pain for which she was prescribed vicodin for pain managment. an episode of this flank pain recurred on admission. physical exam demonstrated left flank tenderness to palpation. ct abdomen on demonstrated bilateral stones and ct abdomen two days later demonstrated calcified atrophic kidneys. unclear if pain is secondary to stones as patient is pd dependant and almost anuric. would consider outpatient mri to investigate for nerve impingement. her pain was treated with vicodin. # abdominal pain diffuse: completely resolved in setting of large bowel movement on night of admission. she was afebrile, but given her history of peritonitis and pd, fluid sent for culture and gram stain. gram stain revealed 1+ polys and no microorganisms, culture was negative. blood cultures were negative at the time of discharge. # esrd: renal fellow contact regarding admission. peritoneal dialysis was started per home regimen. epoetin dosing to be discussed with outpatient nephrologist. the patient became mildly fluid overloaded in setting of multiple transfusions and clear diet. cxr demonstrated small pleural effusion. her pd dialsylate was adjusted as indicated. # hyperkalemia: hyperkalemic on admission. she received kayexalate with improvement in her potassium. no peaked t waves. # hypothyroidism: continued home levothyroxine dose. # nsclc: on tarceva every three days. patient stated she will not take until appetite improved. heme/onc was called, and placed orders for patient to continue on tarceva as per home regimen. transitional issues medical management: pantoprazole 40mg for 6 weeks, vicodin for 3 days code status: full (was dnr but do intubate on admission.) medications on admission: calcitriol - - 0.25 mcg capsule - 1 capsule(s) by mouth three times a week (mwf) epoetin alfa - - 4,000 unit/ml solution - 6000 weekly erlotinib - 25 mg tablet - 1 tablet(s) by mouth q3 days on an empty stomach levothyroxine - 150 mcg tablet - 1 tablet(s) by mouth once a day and extra tablet once weekly. sevelamer carbonate - 800 mg tablet - 5 tablet(s) by mouth tid w/ food zolpidem - 5 mg b complex-vitamin c-folic acid -vite] - 0.8 mg tablet - 1 tablet(s) by mouth once a day camphor-menthol - 0.5 %-0.5 % lotion - apply on the skin as needed for itch three to four times daily as needed discharge medications: 1. calcitriol 0.25 mcg capsule sig: one (1) capsule po qmowefr (monday -wednesday-friday). 2. epoetin alfa 4,000 unit/ml solution sig: one (1) injection once a week. 3. erlotinib 25 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 5. levothyroxine 150 mcg capsule sig: one (1) capsule po once a day. 6. sevelamer carbonate 800 mg tablet sig: five (5) tablet po tid w/meals (3 times a day with meals). 7. valsartan 80 mg tablet sig: one (1) tablet po once a day. 8. zolpidem 10 mg tablet sig: one (1) tablet po at bedtime. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): take for 6 weeks and then decreased to once daily. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 10. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain for 3 days. disp:*qs tablet(s)* refills:*0* 11. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po every six (6) hours as needed for itching. discharge disposition: home discharge diagnosis: nsaid induced gastric ulcers end stage renal disease discharge condition: mental status: clear and coherent. activity status: ambulatory - independent. level of consciousness: alert and interactive. discharge instructions: you were admitted for management of an upper gi bleed. an upper endoscopy demonstrated multiple ulcers in your stomach. it is likely that the tordol you received during your prior ed visit precipitated the development of these ulcers. a small injection of epinephrine in one of the bleeding ulcers was made which stopped the bleeding. you required multiple blood transfusions. you were started on pantoprazole twice daily. you will need to continue this medication for six weeks and then may take it just once daily. you developed left sided flank pain that appears to be an intermittant chronic issue. please discuss with your primary care physician, mri to explore the cause of your intermittant spasms. please discuss with your nephrologist how much epoetin you should be taking. followup instructions: department: when: wednesday at 10:10 am with: , md. post clinic building: sc clinical ctr campus: east best parking: garage *this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. nephrology appointment: pending **we are working on a follow up appointmentt in the nephrology department with dr. for you to be seen with in 2 weeks from your discharge. you will be called at home with the appointment. if you have not heard from in his office by wed., or have questions, please her at . procedure: endoscopic control of gastric or duodenal bleeding peritoneal dialysis diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease renal dialysis status unspecified pleural effusion acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease malignant neoplasm of bronchus and lung, unspecified chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction duodenitis, without mention of hemorrhage postsurgical hypothyroidism personal history of malignant neoplasm of thyroid other non-narcotic analgesics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to