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: patient recorded as having no known allergies to drugs attending: chief complaint: constipation / obstruction abdominal pain major surgical or invasive procedure: exploratory laparotomy. end transverse colostomy with mucous fistula development history of present illness: this is a 50 year old male with pancreatic ca diagnosed who presents with abdominal distension and constipation/obstipation for 1 1/2 weeks. he has not moved his bowels or passed gas during this time. he tried stool softeners, laxatives and suppositories without effect. he has no nausea, vomitting, fevers. he reports abdominal pain, that is sharp and intermittent. past medical history: pancreatic ca, s/p chemotherapy neuropathy from chemo psoriasis social history: he reports no etoh, and no tobacco currently (1.5 packs for 20 years, age 16-36). he works as a school custodian. married with 3 children family history: father died at age 60 of colon cancer physical exam: 95.2, 92, 149/57, 18, 100% ra gen: comfortable, a+o x 3, cachectic chest: cta bilat. cv: rrr abd: distended, nontender, no inguinal hernia present rectal: no stool in vault ext: no edema pertinent results: 12:15pm wbc-9.4 rbc-4.14* hgb-12.8* hct-37.9* mcv-92 mch-30.9 mchc-33.7 rdw-16.0* plt ct-262 06:25am wbc-9.4 rbc-3.31* hgb-10.3* hct-30.4* mcv-92 mch-31.3 mchc-34.0 rdw-15.5 plt ct-200 12:15pm glucose-131* urean-46* creat-0.9 na-130* k-6.2* cl-94* hco3-25 angap-17 07:35am glucose-152* urean-11 creat-0.5 na-136 k-3.6 cl-105 hco3-20* angap-15 12:15pm calcium-8.7 phos-4.7* mg-3.0* 07:35am albumin-3.0* calcium-7.9* phos-1.9* mg-2.0 iron-pnd ct abdomen w/contrast 3:03 pm indication: 50-year-old with metastatic pancreatic ca and now likely sbo. please evaluate extent. impression: 1) extensive dilatation and fecalization of the majority of the large and small bowel, with transition point at the mid sigmoid colon at which there appears to be abnormal soft tissue suspicious for peritoneal implants causing distal large bowel obstruction. additionally, the dilated bowel demonstrates enhancing thickened wall, which because of its diffuse extent is likely reactive from carcinomatosis . 2) pancreatic carcinoma with extensive metastases as described above, with peritoneal carcinomatosis. 3) occluded splenic vein as before. moderate ascites. right hepatic lesion previously characterized as a hemangioma. 06:29am wbc-7.6 rbc-2.95* hgb-9.0* hct-26.6* mcv-90 mch-30.6 mchc-33.9 rdw-15.4 plt ct-120* 08:58am glucose-104 urean-13 creat-0.6 na-137 k-3.5 cl-99 hco3-29 angap-13 08:58am calcium-8.1* phos-3.8# mg-1.9 06:29am caltibc-131* trf-101* brief hospital course: he was admitted on . a ct showed extensive dilatation and fecalization of the majority of the large and small bowel, with transition point at the mid sigmoid colon at which there appears to be abnormal soft tissue suspicious for peritoneal implants causing distal large bowel obstruction. additionally, the dilated bowel demonstrates enhancing thickened wall, which because of its diffuse extent is likely reactive from carcinomatosis. he was made npo with ngt and iv fluids. he was putting out brownish, feculent drainage. he received an iv bolus for hypovolemia. several enemas were tried, including mineral oil and tap water. these were without success. a gi consult was obtained. on , gi attempted to delineate the stricture using a balloon catheter. contrast was injected. no contrast was seen to pass the stricture. we then attempted to pass the stricture using the catheter and guidewire. we exhanged the therapeutic scope for a diagnostic scope to gain a better position but we were still unable to pass the stricture. after 45 minutes the procedure was abandoned. impression: 1. obstructing extraluminal sigmoid colon lesion. 2. failed colonic stent placement. recommendations: 1. npo, ng decompression. 2. iv fluids 3. consider surgical decompression. . he had a picc line placed and tpn was started on . he then went to the or on for a exploratory laparotomy. end transverse colostomy with mucous fistula development. he recovered well from the surgery. he continued on tpn for nutritional support. gi/ostomy: he had a ngt and was npo. the ngt was d/c'd on pod 3. he was slowly started back on a diet and was tolerating a regular diet at time of discharge. he was seen by the ostomy nurse for care of both pouches. both pouches intact. patient states he will not be able to perform ostomy/fistula care due to his medical condition,and his wife will not be capable of assisting in ostomy care. ostomy note: removed ostomy pouch ruq, protrudes about inch. stoma is 80% pink, with edges of mucous sloughing off dark tissue. effluent is pasty brown.mucocutaneouns junction is intact,and peri-stoma skin also intact. cleanse skin with warm water, measured stoma,placed convatec 2 piece 1 inch wafer -fit natura with transparent drainable pouch. mucous fistula luq,pink mucous tissue, oval shape, measures 1 x inch. small amount of liquid brown effluent in pouch. peri-fistula skin intact. cleanse skin with warm water, cut out wafer, placed convatec one piece active life. discussed function of fistula. discussed with patient pouches need to be changed 2x/wk, and emptied when full. pain: he had morphine pca and had good pain control. he was transitioned to po meds once tolerating a diet. cv: he had post-op tachycardia and hypovolemia and received a bolused of ivf. he was then started on lopressor iv for rate control. his hr was 90 to low 100's at time of discharge. ascities: his ascites was expanding. he received lasix starting on pod 5 and then aldactone was added. these continued for 2 days to help with diuresis after all the fluid resuscitation and becoming slightly hypervolemic. he was noted to have some lower extremity edema also. abd: the wicks were removed from the incision on pod 7. the wound was slightly red along the incision line, and there was no suspicious drainage from the wound. id: he was on fluconazole, zosyn, vancomycin post-operatively for prophylaxis. he continued on the antibiotics for 7 days and then these were stopped. he wbc normalized to 7.6 on pod 4. endo: was consulted for post-op tpn related hyperglycemic glucose management. his glucose increased while on tpn and he will continue with testing and administration at home. hypokalemia: he received iv potassium repletion for post-op hypokalemia. palliative care and hospice: he was seen by palliative care and understands his grave situation. he will go home with vna and then bridge to hospice care. medications on admission: fentanyl patch, dulcolux discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 2. morphine 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for 1 months. disp:*50 tablet(s)* refills:*0* 3. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. multi-vitamin w/minerals capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 5. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): see sliding scale. administer if sugar >160. give at meals and bedtime. disp:*qs * refills:*2* 6. insulin syringe 0.5cc/28g syringe sig: one (1) miscellaneous four times a day. disp:*qs * refills:*2* 7. glucose test strips sig: one (1) four times a day. disp:*qs * refills:*2* 8. lancets misc sig: one (1) miscellaneous four times a day. disp:*qs * refills:*2* discharge disposition: home with service facility: discharge diagnosis: malignant bowel obstruction. metastatic pancreatic cancer discharge condition: poor discharge instructions: * increasing pain * fever (>101.5 f) * inability to eat or persistent vomiting * inability to pass gas or stool * increasing shortness of breath * chest pain . please resume all of your regular medications and take any new meds as ordered. . monitor your incision for signs of infection - redness, drainage, fevers. change dressing daily. . continue with care of your ostomy and mucous fistula as instructed by the ostomy nurse . please monitor your sugars 4x/day. administer insulin per the sliding scale as needed. please call your doctor sugars are above 200. followup instructions: please follow-up with dr. in weeks. call ( to schedule an appointment. please follow-up with oncolgy in weeks. call to schedule an appointment. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances exploratory laparotomy colonoscopy permanent colostomy biopsy of peritoneum diagnoses: hypopotassemia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use hypovolemia other psoriasis unspecified intestinal obstruction secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of other specified sites of pancreas malnutrition of moderate degree polyneuropathy due to other toxic agents 

Answer: The patient is high likely exposed to