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: no known allergies / adverse drug reactions attending: chief complaint: abdominal distension, hypoxia, acute renal failure major surgical or invasive procedure: paracentesis nasogastric tube placement history of present illness: 77 y.o male with dm, ckd stage iii, hypertension and cad s/p stent who initially presented for an eus with dr. and was found to be hypoxic with an o2 sat of 88% on ra. the patient was recently admitted in to for diverticulitis, where a ct of the abdomen demonstrated an incidental pancreatic mass. since then, he has had stable abdominal pain in the 4 weeks prior to his current presentation, as well as increasing abdominal distention. he then developed shortness of breath as well as nausea and vomiting over the past several days. he reports significantly decreased po intake over the last 4 days pta. said had temps to 99 at home, but no chills. denies cough but had one episode of bloody in sputum recently. no dysuria; no pain in calves or thighs; no blood in stool. he denies recent intake of nsaids or other pain rx other than apap/codeine about a month ago for belly pain. in the interim, he had also underwent a colonoscopy which showed diverticulitis but was negative for malignancy. however, this procedure did not go beyond the distal transverse colon. in the ed, initial vs were: 97.6 88 110/59 18 97% 4l. the patient's labs were notable for hyperkalemia to 5.8, gap metabolic acidosis with bicarbonate of 17, bun of 137 and creatinine of 7.4 he was also noted to have a wbc count of 17.7. the patient received 10u of insulin, 30 of kayexalate and 80mg of lasix. nephrology was consulted who felt that there was no emergent need for dialysis at this time. his repeat potassium was 4.5. on arrival to the , pt is not c/o any pain. denies cp, sob, abdom pain. past medical history: cad s/p stent in early 's hypertension dm prostatic hypertrophy diverticulitis stage iii ckd (b/l creatine 1.4-1.6) pancreatic mass found on incidental ct scan in social history: worked as electrical engineer. married, has 3 children. denies tobacco or illicits, rare etoh. family history: father had unspecified abdominal surgery; no other family h/o ca. physical exam: admission exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated (is 6-7cm at 30 deg), no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: coarse breath sounds anteriorly, no wheezes. bibasilar crackles, r>l. abdomen: markedly distended and tense, tympanic to percussion, distended flanks. bowel sounds not appreciated, no tenderness to palpation, no rebound or guarding. gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, erythema. only trace edema pretibially. neuro: cnii-xii intact, 5/5 strength upper/lower extremities bladder pressure: 21 on /12pm pertinent results: admission labs: 03:00pm blood wbc-17.7* rbc-4.69 hgb-13.5* hct-41.3 mcv-88 mch-28.8 mchc-32.8 rdw-13.3 plt ct-370 03:00pm blood neuts-91.4* lymphs-5.3* monos-2.9 eos-0.2 baso-0.2 04:26pm blood pt-12.7* ptt-24.4* inr(pt)-1.2* 03:00pm blood glucose-227* urean-137* creat-7.4* na-130* k-5.8* cl-90* hco3-17* angap-29* 03:00pm blood alt-12 ast-20 ck(cpk)-68 alkphos-59 totbili-0.3 03:00pm blood lipase-36 03:00pm blood albumin-3.3* calcium-8.9 phos-12.1* mg-3.6* 03:00pm blood d-dimer-3678* 03:00pm blood osmolal-324* 05:58pm blood type- o2 flow-2 po2-57* pco2-40 ph-7.31* caltco2-21 base xs--5 intubat-not intuba comment-green top 05:27pm blood lactate-3.9* urine: 05:54pm urine color-yellow appear-hazy sp -1.013 05:54pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 05:54pm urine rbc-4* wbc-2 bacteri-few yeast-none epi-<1 05:54pm urine hours-random creat-300 na-10 k-greater th cl-11 05:54pm urine osmolal-346 peritoneal fluid: 10:05am ascites wbc-725* rbc-2100* polys-38* lymphs-20* monos-4* macroph-2* other-36* 10:05am ascites totpro-4.0 glucose-165 ld(ldh)-336 totbili-0.5 albumin-2.5 microbiology: ucx: no growth bcx: *** mrsa screen: negative peritoneal fluid cx: *** studies: ekg: sinus rhythm. borderline left axis deviation. leftward precordial r wave transition point. cxr: bibasilar atelectasis and small left pleural effusion, underlying consolidation cannot be excluded in the appropriate clinical setting. ct abd/pelvis: 1. large volume ascites with extensive omental nodularity concerning for metastatic disease secondary to known pancreatic primary malignancy. 2. diverticulosis without diverticulitis. 3. small left pleural effusion with bibasilar atelectasis. 4. no hydronephrosis or renal abnormality to account for acute renal failure peritoneal fluid cytology: ***** abd u/s with dopplers: 1. no evidence of thrombosis. 2. somewhat flat hepatic venous waveforms which are non-specific. 3. multiple hypoechoic nodules suspicious for metastases within a fatty liver. 4. ascites. 5. gallbladder sludge. lenis: no evidence of clot in bilateral lower extremities with limited evaluation of the left sided calf veins. v/q scan: low likelihood ratio for recent pulmonary embolism. cxr: low lung volumes and bibasilar atelectasis. renal u/s with dopplers: 1. no evidence of hydronephrosis, stones, or masses within the kidneys. 2. gross patency of renal vasculature bilaterally. however, bilateral high-resistance pattern of renal arterial waveforms, with no antegrade diastolic flow. these findings may be seen with acute or chronic renal disease such as parenchymal diseases or atn. brief hospital course: 77yo man with recent pancreatic mass seen on ct in , dm, ckd stage iii, hypertension and cad s/p stent who initially presented for an eus with dr. and was found to be hypoxic with an o2 sat of 88% on ra, now with omental studding on ct, likely malignant ascites, and acute renal failure. . active issues: . # ascites: upon admission, his ascites was causing significant distention; bladder pressure was 21 upon admission. peritoneal fluid was exudative, likely peritoneal carcinomatosis, given his ct findings. while in the icu, he was covered for sbp with ctx and given albumin. he underwent therapeutic paracentesis for comfort, which removed 3l. ascitic fluid was sent for cytology on , which was positive for malignant cells. . # pancreatic mass/omental nodularity: most likely metastatic pancreatic adenocarcinoma. he was evaluated by heme/onc, who did not recommend chemo. the team discussed the situation with the family on , and the decision was made to transition to dnr/dni. . # acute on chronic renal failure / hyperkalemia: admitted with cr of 7.4, from baseline of about 1.3-1.4. initially thought to be pre-renal, but did not improve with volume challenge at admission. have also be from hypoperfusion due to increased intraabdominal pressure from ascites, although his urine output did not improve much after paracentesis. there was no clear evidence obstruction on ct either. his cr worsened to 9.6 on . the patient and his family decided not to pursue dialysis. nephrology was consulted and also did not recommend dialysis if his suspected malignancy was not going to be untreated. . # hypoxia: differential included pulmonary embolism (he had elevated d-dimer to 3678 and did have one isolated event of bloody sputum recently and likely underlying pancreatic malignancy), but no evidence of right heart strain or hemodynamic effects, and v/q scan was low probability. more likely, however, was poor ventilation due to abdominal distention and possible hydrothorax. le dopplers were negative. he remained on 2-3l supplemental o2. . # nausea: likely functional bowel obstruction given omental studding. pt was still having bms. we placed an ng tube for decompression, which significantly improved the nausea. also written for other iv anti-emetics, which offered minimal additional marginal effect. . # goals of care: a family meeting was held on , at which the wife/family decided to make the patient comfort measures only. palliative care was consulted to assist with discharge planning. ultimately, the wife felt strongly about transition to inpatient hospice. prior to planned discharge to hospice, he became agitated and more tachypneic. thus, he was kept in the hospital and treated with iv dilaudid to treat his tachypnea and zyprexa to treat acute agitation. he developed increased secretions, which was managed with a scopolamine patch. the patient died at 9:11pm on . family and pcp were notified immediately. medications on admission: medications (reconciled with pt and records): zoloft - 50mg - po (by mouth) - daily crestor - 40mg - po (by mouth) - daily (not in past few days atenolol (tenormin) - 25mg - po (by mouth) - daily aspirin - 81mg - po (by mouth) - daily colace - 100mg - po (by mouth) - prn omeprazole (prilosec) - 20mg - po (by mouth) - prn nitroglycerin - 0.4mg - sl (sublingual) - as directed, has not used recently vitamin d - 1000 unit capsule - po (by mouth) - daily multivitamin - 1 tab - po (by mouth) - daily flomax - 0.4mg - po (by mouth) - only used twice two months prior actos - 15mg - po (by mouth) - prescribed recently - pt did not start it and is not taking xalatan 0.005% - 1 drop - op (ophthalmic) - both eyes daily discharge medications: 1. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po three times a day as needed for nausea. disp:*10 tablet, rapid dissolve(s)* refills:*0* 2. lorazepam 2 mg/ml concentrate sig: 0.5 ml po every four (4) hours as needed for nausea. disp:*30 ml* refills:*0* 3. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 15-30 mg po q30 minutes as needed for pain. disp:*30 ml* refills:*0* discharge disposition: extended care facility: hospice home discharge diagnosis: pancreatic mass acute renal failure hypoxemia encephalopathy discharge condition: n/a discharge instructions: none followup instructions: none needed md procedure: percutaneous abdominal drainage diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other specified intestinal obstruction hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status chronic kidney disease, stage iii (moderate) other and unspecified special symptoms or syndromes, not elsewhere classified nausea alone hypoxemia encounter for palliative care do not resuscitate status encephalopathy, unspecified diverticulosis of colon (without mention of hemorrhage) secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of tail of pancreas respiratory malfunction arising from mental factors malignant ascites 

Answer: The patient is high likely exposed to