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: doxycycline attending: chief complaint: gastric adenocarcinoma major surgical or invasive procedure: total gastrectomy history of present illness: mr. is a 78-year-old man with history of hypertension, as s/p avr, atrial fibrillation/ flutter, chf, s/p cva, and gastric cancer which was found on upper endoscopy.it has been staged as having a resectable lesion which is t2 lesion. no obvious nodes wereseen on endoscopic ultrasound, and metastatic survey was negative for distal disease. a lesion was seen in his skull which seemed to be a meningioma, as this has been followed for awhile and has not changed and was pet negative. he presents now for resection. past medical history: anemia, iron def, resolved hypertension afib/ flutter aortic stenosis, s/p porcine valve replacement @ in , lvef 50-55% chf, lvef 50-55% s/p cva (post-op complication from avr) in with residual speech difficulty and l facial droop gerd ckd (baseline cre 1.5-1.7) chronic back pain djd colon polyps gastric cancer bph s/p turp x 2 . all: doxycycline (per omr, patient does not recall) social history: previous work as insurance salesman 1 daughter, lives in : 100 pack-yr smoking history (3ppd x 35yrs), quit 15yrs ago no etoh or illicits. lives with wife in . independent adls family history: 3 siblings passed away from pancreatic cancer 2 siblings passed away from lung cancer physical exam: post-op check: vitals: t-98.2, hr-80, bp-100/52, rr-16, o2 sat-97 on 3l nc gen:nad, a/ox3 pulm:ctab cv:rrr abd:incision ttp, decreased bowel sounds, dressing with minimal serosanguinous drainage. pertinent results: 07:15am blood wbc-9.4 rbc-3.41* hgb-9.6* hct-30.4* mcv-89 mch-28.2 mchc-31.7 rdw-19.7* plt ct-893* 09:18pm blood wbc-10.5# rbc-4.13* hgb-11.8* hct-36.6* mcv-89 mch-28.7 mchc-32.4 rdw-22.4* plt ct-304 07:15am blood pt-14.4* ptt-27.9 inr(pt)-1.3* 02:02am blood pt-11.9 ptt-30.7 inr(pt)-1.0 10:14am blood pt-14.7* ptt-31.7 inr(pt)-1.3* 07:15am blood glucose-98 urean-37* creat-1.4* na-138 k-5.0 cl-101 hco3-30 angap-12 09:18pm blood glucose-136* urean-26* creat-1.5* na-144 k-4.4 cl-111* hco3-23 angap-14 02:02am blood alt-45* ast-25 ld(ldh)-173 alkphos-48 amylase-21 totbili-0.6 07:15am blood calcium-8.6 phos-3.9 mg-2.6 09:18pm blood calcium-9.3 phos-4.4 mg-1.9 . pathology examination diagnosis: i. portal lymph node (a): 1. lipogranulomas and hyperplasia. 2. no tumor. ii. perigastric nodes (b): 1. hyperplasia. 2. no tumor. iii. first proximal margin (c): fragment of esophagus with squamous epithelium: no tumor. iv. anastomotic ring, most proximal margin (d): fragment of esophagus with squamous epithelium: no tumor. v. esophagogastrectomy (e-y): 1. adenocarcinoma of the gastric cardia, see synoptic report. 2. gastric fundic mucosa, within normal limits. 3. esophageal mucosa with squamous epithelium at the proximal margin, and duodenal tissue at the distal margins stomach: resection synopsis macroscopic specimen type: total gastrectomy. tumor site: cardia. tumor configuration: exophytic (polypoid). tumor size greatest dimension: 4.5 cm. additional dimensions: 3.1 cm x 1.3 cm. microscopic histologic type: adenocarcinoma, hyperplastic glandular type. histologic grade: g2: moderately differentiated. primary tumor: pt1b: tumor invades submucosa. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 18. number involved: 0. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma. distal margin: uninvolved by invasive carcinoma. omental (radial) margins lesser omental margin: uninvolved by invasive carcinoma. greater omental margin: uninvolved by invasive carcinoma. distance from closest margin: 45 mm. specified margin: proximal margin, including separate specimens. lymphatic (small vessel) invasion: present in submucosa. venous (large vessel) invasion: absent. comments: the tumor invades under the adjacent squamous epithelium. clinical: gastric adenocarcinoma. . cardiology report ecg study date of 2:14:44 am atrial flutter with moderate ventricular response. compared to the prior tracing of the ventricular response has slowed. otherwise, no diagnostic interim change. intervals axes rate pr qrs qt/qtc p qrs t 86 0 82 344/389 0 3 16 . radiology final report esophagus 2:19 pm medical condition: 78 year old man s/p total gastrectomy with concern regarding the esophago-jejunal anastomosis impression: 1. no evidence for leak or obstruction at anastomotic site. 2. mild amount of free esophageal reflux.\ . echocardiogram conclusions: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets are thickened. the transaortic gradient is normal for this prosthesis. a paravalvular aortic valve leak is probably present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. mild pulmonic regurgitation is seen. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. brief hospital course: mr. operative course was uncomplicated. he was routinely observed in the pacu. he was admitted to sicu from pacu for pain issues, hypotension, & fluid requirement postoperatively. . pain:he had an epidural place intra-op. he became hypotensive in pacu. on : he was switched to epidural demerol 1mg/mg @ 12cc/h with some relief. his pain continued be unmanaged. on : his bp became more stable with iv resuscitation, he was switched back to the aps 10 solution. on : he continued with the aps 10 solution at 4-8cc/h. he began to hallucinate. the aps team was aware, and geriatric team was consulted. he is currently well managed with oxycodone elixir and po tylenol. he is currently rating his pain . . : he was evaluated per team on . per exam, he was difficult to arouse, but able to answer some questions. he denied pain anywhere. tylenol was orderd around the clock because he was not able to verbalize pain due to delirium. oxycodone use was minimized due to opiate sensitivity, and haldol order was minimized. a sitter vs pharmacologic measures was recommended as well. these recommendations were initiated, and his mental status cleared significantly. . nut: he was evaluated per nutrition in the icu, and followed once transferred to surgical unit. he was started on tube feeds via the jtube in the icu. the rate was advanced slowly as his bowel function and cognitive function cleared. he was advanced to his goal rate. he is currently being fed with 3/4 str impact with fiber at 120cc/h x 12 hours. in addition, he is tolerating small frequent meals, regular food with ensure supplements. his blood sugars were checked qac&hs. he was treated with regular insulin per sliding scale. his bloods sugars were stable during the past 3-4 days on cc6. he should continue to have his blood sugars checked at least daily, and treated as needed. . cardio:his hr persisted in 90-100's afib in icu. he was managed with iv lopressor. cardiology was consulted because he was in aflutter with hr in 150s on . he was started on a diltiazem drip in icu with better controlled heart rate.he was told weaned off diltiazem drip, and started on diltiazem po and beta-blocker. he underwent an echo (refer to results section). he did have a few bursts of aflutter over this past weekend (). he was re-evaluated per cardiology, and electrophysiology were considering cardioversion vs. ablation. he has remained stable, and cardioversion/ablation was not indicated at this time. he continues to be stable on the current medication regimen. he will follow-up with his cardiologist and the ep lab for management in the future. . inr/coumadin: his goal inr is . he should continue with 5mg of coumadin daily, and have his doses adjusted according to daily inr values. . elim: his foley was removed post-op. he has been urinating adequate amounts of urine. he has had multiple loose stools related to tube feeds. . abd: his abdominal binder is intact. he has a midline abdominal, and multiple ex/lap incisions ota with steris. the sites are clean and healing. his old jp site continues to drain scant amounts of serous fluid, dsd applied. the llq jtube site is intact and tube is patent.he has active bowel sounds. he denies abdominal tenderness with no visible distention. . extrem: he has 2+ lower extremity edema. he will continue with oral lasix. his pulses are strong and palpable bilaterally with normal sensation & circulation. he ambulates with an assist, but is steady on his feet. he was evaluated per physical therapy, and will required conditioning due to extended surgical recuperation. medications on admission: coumadin 5', atenolol 50', feso4 325", lasix 20', omeprazole 20' discharge medications: 1. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 6. warfarin 5 mg tablet sig: one (1) tablet po at bedtime: goal inr: . titrate accordingly. 7. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 9. oxycodone 5 mg/5 ml solution sig: 0.5 po q6h (every 6 hours) as needed for breakthrough pain. discharge disposition: extended care facility: rehab center discharge diagnosis: primary: exophytic t2no fundic gastric adenocarcinoma hiatal hernia post-op hypovolemia managed with iv fluid resuscitation post-op arrhythmia managed with iv diltiazem drip in icu post-op pain managed per consultation with acute pain service post-op delirium managed per consultation with geriatric service . secondary: porcine avr, htn, bph, anemia, gerd discharge condition: stable tolerating small amounts of regular food, and tube feeds. adequate pain control with medication administered orally and via jtube. discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomitting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to amubulate several times per day. . incision care: -your steri-strips will fall off on their own. please remove any remaining strips 7-10 days after surgery. -please wear abdominal binder with ambulation and activity. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: 1. provider: , . call to schedule appointment in weeks. 2. please follow-up with your primary care provider, . a. , for future management of your coumadin dosing. 3. please follow-up with dr. (cardiology) ( as needed. procedure: other total gastrectomy other enterostomy enteral infusion of concentrated nutritional substances insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt diagnoses: other iatrogenic hypotension esophageal reflux congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified acute on chronic diastolic heart failure atrial flutter diaphragmatic hernia without mention of obstruction or gangrene heart valve replaced by transplant hypovolemia accidents occurring in residential institution drug-induced delirium unspecified sedatives and hypnotics causing adverse effects in therapeutic use diseases of tricuspid valve malignant neoplasm of cardia other acute postoperative pain 

Answer: The patient is high likely exposed to