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 pain major surgical or invasive procedure: ercp with sphincterotomy and stone extraction. laparoscopic cholecystectomy () history of present illness: hospitalist attending acceptance note date: at 18:00 53yo m with history of htn who presented to with htn and abdominal pain for the past 5 days. patient reports his abdominal pain began on sunday. it was sharp , all over the abdomen but worse in the ruq. he vomitted once but it was none bloody and not coffee grounds. initially he thought it was indigestion and took antiacids with some relief. the pain wax and waned for the next few days and he noticed it was worse with food so he began taking ibuprofen with some improvement. when the pain returned he thought it could be constipation or gas so he took gas-x and gave himself an enema. this improved the pain slightly. today it became constant so he decided to go to neeham for evaluation. of note, he has not been taking his quinapril back in but stopped it then due to cough and has not taken anything since. . patient originally was seen at and had bp of 260/160. he was started on intravenous labetalol and nitroglycerin drip. ekg shows left bundle branch block without old ekg for comparison. ct of chest and abdomen shows a tense gallbladder with a thickened wall and pericholecystic fluid consistent with but not diagnostic of cholecystitis. lfts were elevated, and he received unasyn 3 g intravenously. . in the ed, initial vitals were 99.4, 68, 200/116, 18, 95% ra. patient was weaned off of nitro gtt. he had a ruq u/s which showed gallbladder distention with dilated intra and extrahepatic ducts. no specific signs of acute cholecystitis. given his hypertension, he was given 100mg labetalol po and 20mg iv x 2. surgery evaluated him and recommended ercp and admission to medicine. he was admitted to the micu given his htn. vitals on transfer were 66, 206/103, 17, 97% ra. he was admitted to the icu. on admission, ros: denies fever, chills, night sweats, cough, shortness of breath, or wheezing. denies chest pain, palpitations, or weakness. denies diarrhea. all other systems negative past medical history: htn hyperlipidemia h/o hydrocele s/p knee surgery s/p r hand amputation in accident at age 2 social history: he drinks 3-4 beers daily, ppd cigarettes, occasional marijuana use. lives with family members. as home improvement contractor and umpire for little league baseball. family history: no family history of gallstones or cad. mother with htn. physical exam: t=96.8 bp=198/106 before hydralazine iv, sbp=136 approx 1 hr after hydralazine administered; hr=64; rr=18, sao2=98%ra gen: in nad heent-negative lungs-ctab cv-rr, no m/r/g abd-soft, slightly distended, mildly tender in ruq, nabs extr-no edema neuro-negative skin-no rashes pertinent results: 03:38pm lactate-1.3 01:37pm glucose-104* urea n-22* creat-1.8* sodium-142 potassium-3.3 chloride-101 total co2-30 anion gap-14 01:37pm alt(sgpt)-375* ast(sgot)-121* alk phos-316* tot bili-3.2* 01:37pm calcium-9.2 phosphate-4.1 magnesium-2.1 01:37pm wbc-15.3* rbc-4.92 hgb-14.9 hct-44.1 mcv-90 mch-30.4 mchc-33.9 rdw-14.1 01:37pm neuts-86.3* lymphs-9.1* monos-3.0 eos-0.7 basos-0.8 01:37pm plt count-222 01:37pm pt-12.1 ptt-21.7* inr(pt)-1.0 liver or gallbladder us (single organ) study date of : 1. moderately distended gallbladder containing stones and sludge. while no signs specific for acute cholecystitis are present, this cannot be excluded. a hida scan can be obtained for further evaluation. 2. moderately dilated intra- and extra-hepatic biliary ducts, with nonvisualization of the distal aspect of the cbd due to overlying bowel gas ercp impression: small hiatal hernia, normal stomach, two small- to medium-sized submucosal lesions were seen at the beginning of the duodenal sweep with unclear etiology. biospies were deferred because of the unclear nature of the lesion. two small stones in distal cbd, s/p ercp with sphincterotomy and stone extraction with balloon. mild intrahepatic and extrahepatic ductal dilatation secondary to choledocholithiasis otherwise normal ercp to third part of the duodenum recommendations: consider cholecystectomy within 2 weeks for submucosal lesions of duodenum, need outpatient eus for further assessment brief hospital course: 53yo m with history of htn presenting with hypertensive urgency and acute cholecystitis due to obstructive cholelithiasis. . hypertension: he has a history of hypertension but has not taken antihypertensives in 15 years. suspect his current extreme hypertension is not far from his current baseline and is exacerbated by medical noncompliance and no ongoing outpatient care. he had signs of lvh and strain on ekg. he was started on labetolol and iv nitroglycerin initially, in the icu, for an initial bp of 260/160 at presentation. the nitroglycerin was discontinued and he was switched to hydralazine. nephrology was consulted to assist in the management of his htn and recommended checking a plasma renin activity and aldosterone levels. of note, this patient had stopped ace-i in the distant past due to cough. his htn was succesfully controlled with oral labetalol, hydralazine and amlodipine..... he requires ongoing outpatient monitoring of this issue including outpatient fundoscopic exam to look for end-organ damage from chronic, uncontrolled hypertension. ruq pain: his elevated lfts and ruq u/s were suggestive of biliary obstruction from probable stone (most likely given cholelithasis on u/s) or stricture. he underwent ercp on and this showed several small cbd stones which were extracted during the procedure. a sphincterotomy was performed. there was no evidence of esophageal or gastric varices. his abdominal pain resolved after the procedure and his diet was advanced. his lfts improved. he was covered with unasyn peri-procedurally. the patient, in consultation with the general surgery service, decided to undergo cholecystectomy during this hospital stay. the patient tolerated the procedure well without any complications. post-operatively the patient was stable. his diet was advanced as tolerated and his pain was well controlled. he had normal bowel function at discharge. the patient will follow up with the clinic in weeks for a post-op check. hypertensive heart disease: the patient underwent stress testing for pre-op risk stratification due to multiple cardiac risk factors and uncontrolled hypertension. it is worth noting that at baseline the patient has excellent exercise tolerance without cardiac symptoms. stress testing (p-mibi done due to gout flare in left ankle preventing walking on treadmill) revealed reversible defects seen in the inferior and lateral regions and a dilated hypokinetic lv. echo revealed no regional wall motion abnormalities and changes most consistent with hypertensive heart disease. the patient was evaluated by cardiology for consideration of pre-operative cardiac management. it was their recommendation that the patient be managed medically without cardiac catheterization in the pre-op setting. the stress test findings were attributed to lvh associated with chronic uncontrolled hypertension and not true flow limiting coronary artery disease - this was verified by the echo with chronic hypertensive heart disease and no regional wall motion abnormalities. ckd 3. the patient presented with acute on chronic renal failure with cr 1.8. his cr improved to 1.4-1.5 but then plateaued and this seems to represent baseline cr due to probable hypertensive nephropathy. he was seen by the nephrology consult service. he has renin/aldosterone levels pending. he was found to have an elevated microalbumin/cr ratio. on renal u/s he had slightly elevated resistive indices in both kidneys. he should have a repeat renal ultrasound in 1 year. the patient requires ongoing outpatient nephrology follow-up. probable crystal arthropathy. the patient developed sudden onset of left ankle swelling and pain while in the hospital. he had arthrocentesis by the rheum consult service with findings of synovial fluid with wbc 20 rbc poly's 77% without any crystals. despite no crystals, this seemed clinically most consistent with a crystal arthropathy. he was started on colchicine with slow improvement in symptoms. serum uric acid level was normal. he can follow-up as an outpatient for further care including consideration of allopurinol therapy. incidental: -two small- to medium-sized submucosal lesions were seen at the beginning of the duodenal sweep with unclear etiology. biospies were deferred because of the unclear nature of the lesion. outpatient eus is recommended for further characterization of these lesions. the patient will be contact the ercp team to have this procedure but he was also given the number to schedule this test if he does not hear from the ercp team. medications on admission: aspirin niacin motrin discharge medications: 1. labetalol 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*4* 2. hydralazine 10 mg tablet sig: 3.5 tablets po q6h (every 6 hours). disp:*420 tablet(s)* refills:*4* 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*5* 4. colchicine 0.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*14 capsule(s)* refills:*0* 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*14 tablet(s)* refills:*0* 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. acetaminophen 500 mg capsule sig: capsules po every hours as needed for pain. 9. morphine 15 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*60 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: acute cholecystitis obstructive choledocholithiasis hypertensive urgency acute renal failure alcohol abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with abdominal pain. this was due to a blockage of the bile by gallstones. you were found to have 2 small lesions in the small bowel. these were seen during your ercp procedure. you must have an endoscopic ultrasound look at these. you will be called by the ercp team to schedule this procedure. if you do not hear from them within 3 weeks, please call to schedule this test. you also had uncontrolled blood pressure. please take the blood pressure medicines as prescribed. you must regularly see a primary care doctor for further monitoring of this issue. you should have an eye fundoscopic eye exam to see if the blood pressure injured the eyes. you also should follow-up with the kidney specialists for further care of chronic kidney injury due to uncontrolled blood pressure. you were transferred to the acute care surgery service for a laparoscopic cholecystectomy. please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please take the prescribed analgesic medications as needed. you may not drive or heavy machinery while taking narcotic analgesic medications. you may also take acetaminophen (tylenol) as directed, but do not exceed 4000 mg in one day. please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 20 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: you need to follow up in the clinic. please call on monday to schedule an appointment in weeks. please follow up with your primary care provider 2 weeks after discharge. procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy laparoscopic cholecystectomy arthrocentesis diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder acute kidney failure, unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) other specified disorders of stomach and duodenum alcohol abuse, continuous acute pancreatitis acute gouty arthropathy calculus of gallbladder and bile duct with acute cholecystitis, with obstruction hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to