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: nausea / vomiting major surgical or invasive procedure: -placement of percutaneous g-j tube converted to gastrotomy tube -placement of port-a-cath -placement of picc line history of present illness: this is a 40 year old male with history of metastatic gastric cancer status post subtotal gastrectomy with billroth ii anastamosis and omentectomy in with complicated post-operative course mostly notable for mechanical complications or operative and radiation management of his primary maligancy who was found to have recurrence in peritoneal nodules in and presented with nausea / vomiting. patient had been last seen in surgical clinic for post-operative follow-up on and was reportedly doing well and tolerating diet without any issues. at the time of presentation to the ed the patient reported two weeks of nausea and vomiting. this was severe enough so that he was not able to tolerate any po intake without vomiting despite vigorous encouragement from his partner. reported feeling quite lethargic and uncomfortable. per his wife the patient was having regular bowel movements. no fevers, chills, night sweats and other review of systems negative. while in triage, pt was hypotensive with sbp 89/63. received 1.5l of ivf, several doses of morphine and anti-emetics. found to have potassium of 6.6 and was treated with kayexalate, insulin, bicarbonate and dextrose. he also received vancomycin, ciprofloxacin, and flagyl. he was admitted to the surgical intensive care unit for further management. past medical history: past oncologic/ surgical history: gastric cancer, metastatic -: subtotal gastrectomy with billroth ii anastamsosis and omentectomy as well as radical lymph node dissection, because of positive omental margins patient received adjuvant chemoradiation with radiotherapy and 5fu -: developed biliary stricture managed with choleycystotomy tube -: roux-en-y hepaticojejunostomy to right posterior hepatic and confluence of right anterior and left hepatic ducts over two 5-french feeding tubes in for refractory post-radiation cbd stricture -: patient presented with sbo and at exploratory laparotomy found to have peritoneal carcinomatosis and obstruction of roux limb, had operative repair of colon enterotomy and biopsy of peritoneal nodules showing recurrent gastric cancer other past medical history: -carbapenemase resistant escherichia blood stream infection -chronic pain social history: lives in with his wife. a son from a prior marriage. unemployed chef. tobacco: denies. etoh: denies. illicits: denies family history: maternal grandmother with "stomach cancer" father with diabetes physical exam: admission exam: vitals: 99 109 103/38 17 100 2l nc gen: lethargic, somnolent, sleepy, feels thirsty heent: sunken fontanelle, dry mucous membranes, anicteric lungs: cta cardio: rrr abd: soft, incisions c/d/i, transhepatic tubes in place and to gravity with dark bilious drainage (some drainage to skin), tender to drain site, act bs rectal: refused ext: no edema, palpable distal pulses pertinent results: laboratory results: admission labs: wbc-12.3*# rbc-5.16# hgb-13.5* hct-38.1* mcv-74*# plt- 687 --neuts-87.2* lymphs-10.2* monos-2.3 eos-0.1 baso-0.1 pt-17.3* ptt-30.5 inr(pt)-1.6* alt-153* ast-80* ld(ldh)-170 alkphos-688* totbili-2.5* lipase-104* glucose-138* urean-129* creat-6.6*# na-124* k-6.6* cl-79* hco3-20* calcium-7.9* phos-5.2* mg-2.2 albumin-4.8 discharge labs: wbc-6.9 rbc-3.19* hgb-8.7* hct-27.7* mcv-87 rdw-16.2* plt ct-448* pt-12.6 ptt-29.9 inr(pt)-1.1 glucose-107* urean-19 creat-0.4* na-135 k-3.8 cl-102 hco3-26 alt-25 ast-22 alkphos-246* totbili-3.2* calcium-6.8* phos-3.5 mg-1.8 microbiology: blood cultures *2 from and : no growth radiology results: ct abdomen and pelvis w/ contrast : impression: moderate gastric and esophageal fluid-filled distention . findings are concerning for gastric outlet obstruction. there is no evidence of small or large bowel obstruction. ugi series : impression: no significant passage of contrast into the jejunostomy, with concurrent gastroesophageal reflux. brief hospital course: this is a complicated 40 year old man with metastatic gastric cancer presenting with nausea/vomiting likely due to gastric outlet obstruction from metastatic disease. 1) nausea/ vomiting/gastric outlet obstruction: upon presentation the patient was initially admitted to the surgical intensive care unit for management of his volume depletion and presumed gastric outlet obstruction. he was fluid resuscitated and called out to the floor where he continued to have persistent refractory nausea. on a percutaneous g-j tube was placed beyond the site of gastric outlet obstruction but was not able to transverse a distal jejunal obstruction. he was not able to tolerate feeds through this tube and due to pain at the site and no clear utility it was exchanged on for a simple venting gastrotomy tube. given multiple sites of bowel wall involvement and peritoneal carcinomatosis intolerance of po's thought most likely to severe functional impairment as well as likely multiple sites of mechanical obstruction. therefore, decision was made to medically manage nausea with ondansetron, lorazepam, and prochlorperazine while patient remained on tpn feeds and attempts were made to address his total body disease burden. on the noted anti-emetics the patient did intermittently complain of nausea but generally was without emesis and managed to tolerate small amounts of liquids by mouth. 2) metastatic gastric cancer: the patient had peritoneal carcinomatosis and a large burden of intra-abdominal disease leading to significant symptom burden. in conversation with his oncologist, after mechanical attempts to bypass obstructions failed, the patient and his partner chose to pursue palliative ecf regimen with goal of tumor bulk reduction and symptomatic improvement (primarily a hope of being able to tolerate more of a po diet). to this end the patient was transferred from the surgical to medical oncology service on and his chemotherapy was initiated. he tolerated the initiation of chemotherapy without initial ill effects and was discharged on continuous infusion chemo to follow up with his primary oncologist. 3) nutrition: patient was unable to tolerate any significant po nutrition so received tpn through picc placed and then portacath placed . an attempt at enteral feeds was briefly made but was not tolerated. his tpn was adjusted with the nutrition services recommendations and he evidenced no major electrolyte abnormalities or worsening hepatitis. 4)pain: the patient initially presented primarily with nausea but then developed rather significant abdominal pain. initial attempts to control this led to significant oversedation but eventually was able to tolerate fentanyl patch and oral hydromorphone regimen with minimal pain unless abdomen was pushed on or other provocative events occured. patient would often moan in pain and be very resistant to exam making full evaluation difficult but no signs/ symptoms of acute intra-abdominal process. the patient was discharged on oral hydromorphone and a fentanyl patch as his standing pain regimen. 5) depression/ psychosocial: throughout his hospitalization the patient had a great deal of difficulty engaging in discussions of his care and was often in significant emotional and or physical distress, moaning in pain and/or refusing to respond to providers or other questions. he did acknowledge great difficulty coping with his recurrent cancer diagnosis and the extremely burdensome symptoms that came with this. he expressed a clear preference for his spouse to perform all line and dressing cares, which was very understandably taxing on her and social work and palliative care remained involved to help with coping and support decision-making as best as they were able. 4) goals of care: despite multiple well cited conversations with the family where providers explained the patient had incurable disease with goals aiming at comfort and palliation the patient and particularly his wife expressed sentiments relating to his cancer being "cured." these difficult decisions will be continued in the outpatient environment. 5) chronic biliary obstructions: the patient was continued on his standing levofloxacin and ursodiol, there were never any signs of current, active infection so antibiotics started in the ed were stopped on . the patient was discharged with with plans for home tpn and infusional chemo through port and picc lines in place. medications on admission: hydromorphone 4 mg every four hours p.r.n. pain, prochlorperazine maleate 10 mg every eight hours p.r.n., ursodiol 300 mg p.o. twice daily, colace 100 mg p.o. twice daily, iron sulfate 325 mg p.o. daily, and senna 8.6 mg p.o. twice daily. discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. fentanyl 75 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 3. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for anxiety, nausea. disp:*200 tablet(s)* refills:*0* 4. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 5. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. disp:*90 tablet, rapid dissolve(s)* refills:*0* 6. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. disp:*120 tablet(s)* refills:*0* 7. hydromorphone 4 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*300 tablet(s)* refills:*0* 8. outpatient lab work please check weekly cbc with differential, alt, ast, alk phos, total bilirubin, sodium, potassium, chloride, hco3, bun, cr, and glucose, calcium, magnesium, and phosphate and fax results to , rn and , md at discharge disposition: home with service facility: healthcare discharge diagnosis: metastatic gastric cancer with gastric outlet obstruction discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for an obstruction of your stomach. the surgeons evaluated you and placed a tube to decompress your stomach as well as starting you on tpn. you then came to the oncology service to receive chemotherapy in hopes of shrinking your tumor and allowing you to eat. you are being discharged on one chemotherapy as well as tpn. your medications have been changed. please take your medications exactly as prescribed. followup instructions: , md phone: date/time: 12:30 , rn phone: date/time: 1:30 cat scan phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine percutaneous [endoscopic] gastrostomy [peg] arterial catheterization insertion of other (naso-)gastric tube percutaneous [endoscopic] gastrojejunostomy transfusion of packed cells insertion of totally implantable vascular access device [vad] other cholangiogram injection or infusion of cancer chemotherapeutic substance other percutaneous procedures on biliary tract replacement of stent (tube) in biliary or pancreatic duct diagnoses: acidosis hyperpotassemia acute kidney failure, unspecified hyposmolality and/or hyponatremia encounter for palliative care obstruction of bile duct other and unspecified coagulation defects anemia in neoplastic disease neoplasm related pain (acute) (chronic) secondary malignant neoplasm of retroperitoneum and peritoneum acquired hypertrophic pyloric stenosis essential thrombocythemia malignant neoplasm of stomach, unspecified site 

Answer: The patient is high likely exposed to