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 allergies/adrs on file attending: chief complaint: gi bleed major surgical or invasive procedure: egd history of present illness: 79 yo russian-speaking f with hx of iddm, diverticulitis s/p hemicolectomy presents with 2 days of black stools and generalized weakness. . in ed, denied fevers, chest pain, dyspnea, abdominal pain. previous diverticulitis associated with abdominal pain, rectal bleeding. she did have a normal colonoscopy 2 years ago at with diverticuli. . in the ed, initial vs: 97.6, 98, 102/74, 20, 96%. exam with llq ttp. labs significant for creatinine 1.2, bun 33 (baseline unknown), wbc 11.1 with normal differential, hct 38.2, coags with ptt 21.9, inr 1.1. she was started on a pantoprazole drip, given glargine 50. ct abdomen showed partial colectomy, no diverticulitis or abscess. ekg showed nsr without st changes. patient had coffee-ground emesis. ng tube placed with 750cc coffee ground material which cleared after 500cc of sterile water. she was seen by gi who recommended prep tonight for egd/colonoscopy tomorrow. . vs on transfer were: 94, 120/49, 23, 98%/2l she has an 2 x 18g. protonix gtt at 8mg/hr. she did have a hct drop to 31 and was crossmatched for 2 units at that time. immediately prior to transport 1 l of ns hung for sbps to 70s. . on the floor, she is here with her daughter. she states that earlier she had lower crampy abdominal pain and indicates that she now has epigastric pain. denies nausea. her biggest complaint is the annoyance of her ng tube placement. as of late she has had normal bms daily without blood of black color. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: dm htn diverticulitis s/p sigmoid resection s/p central hernia repair colonic polyps tah and b/l spo gerd depression anxiety social history: divorced with 2 adult children. no tobacco or etoh. retired fashion designer. family history: parents died in their 60s. no siblings physical exam: admission physical exam vitals: 94, 151/91, 100/2l general: alert, comfortable, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: at admission: 01:15pm blood wbc-11.1* rbc-4.78 hgb-13.0 hct-38.2 mcv-80* mch-27.3 mchc-34.1 rdw-12.8 plt ct-300 01:15pm blood neuts-58.4 lymphs-36.1 monos-3.9 eos-1.3 baso-0.3 01:15pm blood pt-12.5 ptt-21.9* inr(pt)-1.1 01:15pm blood glucose-251* urean-33* creat-1.2* na-142 k-4.2 cl-103 hco3-27 angap-16 01:15pm blood alt-24 ast-19 ld(ldh)-156 alkphos-66 totbili-0.3 03:12am blood calcium-8.0* phos-3.5 mg-1.5* 01:15pm blood albumin-3.8 01:32pm blood glucose-234* 01:32pm blood hgb-12.9 calchct-39 10:30pm urine color-straw appear-clear sp -1.047* 10:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 10:30pm urine color-straw appear-clear sp -1.047* 10:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg serology/blood helicobacter pylori antibody test-pending inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final inpatient ct abd/pelvis impression: 1. status post sigmoid colectomy without evidence of complication. no evidence of diverticulitis. 2. right lower lobe pulmonary nodule, 6 mm. in the setting of no risk factors (non-smoker and no cancer history), follow-up ct in one year is recommended to document stability. 3. bilateral adrenal nodules; a dedicated adrenal ct or mr may be considered for further evaluation. findings discussed with 12:05 am on by over the phone. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 8:51 pm egd : findings: esophagus: normal esophagus. stomach: mucosa: erythema of the mucosa was noted in the antrum. erosions and two small (5mm) clean based, non-bleeding ulcers were seen in the antrum. a large (2cm) ulcer with three visible vessels and stigmata of recent bleeding was noted in the lesser curvature of the stomach. five clips were placed around the ulcer with one over a visible vessel. electrocautery was applied to another visible vessel which resulted in some mild oozing. epinephrine 1:10,000 was injected (total of 7cc) with resolution of the oozing. despite this therapy this is a high risk ulcer to re-bleed. other sub mucosal mass (8cm) was seen in the body of the stomach. duodenum: normal duodenum. impression: erythema in the antrum erosions and two small (5mm) clean based, non-bleeding ulcers were seen in the antrum in the stomach large 2cm ulcer with three visible vessels and stigmate of recent bleeding in the lesser curvature of the stomach. this ulcer is at a high risk to re-bleed. sub mucosal mass (8mm) was seen in the body of the stomach. otherwise normal egd to third part of the duodenum recommendations: continue protonix drip for now (72 hours) please send h. pylori serology and treat if positive if re-bleeds call gi on call for evaluation for re-egd. patient may require mac for repeat procedure. transufse one unit of blood now trend hct continue to monitor in icu for now ir and surgery consult additional notes: the attending was present for the entire procedure. final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology egd findings: esophagus: mucosa: normal mucosa was noted. stomach: excavated lesions a single healing non-bleeding 4 cm ulcer was found in the stomach body with 4 clips adjacent to it. duodenum: other loss of vilious architecture was noted in the duodenum. biopsies were obtained. cold forceps biopsies were performed for histology at the duodenum . other procedures: cold forceps biopsies were performed for histology at the stomach body. impression: normal mucosa in the esophagus loss of vilious architecture was noted in the duodenum. biopsies were obtained. (biopsy) ulcer in the stomach body (biopsy) otherwise normal egd to third part of the duodenum recommendations: avoid all nsaid usage continue high dose ppi therapy repeat egd in 6 weeks to confirm healing avoid alcohol follow up biopsy results, and treat if they come back positive for hpylori additional notes: the attending was present for the entire procedure. the patient's home medication list is appended to this report. final diagnosis are listed in the impression section above. estimated blood loss = zero. specimens were taken for pathology as listed. brief hospital course: brief hospital course: # gi bleed: 75f with hx of diverticulosis s/p hemicolectomy, diabetes, admitted to micu with large volume coffee ground emesis and anemia. she had an egd which demonstrated a nonbleeding submucosal mass, and large lesser curvature ulcer with 3 large vessels. she was intervened upon with multiple clips and was noted to have continued ooze. she was treated with a ppi drip. she was transferred to the floor and rescoped due to the continued ooze on first egd. rescope showed multiple clips in place, no bleeding and multiple ulcers. biopsies were taken. h pylori serology was positive and she was started on triple therapy with amoxicillin, clarithromycin and pantoprazole. her h/h remained stable and was ~36 upon discharge to rehab. - continue amoxicillin, clarithromycin until . - restart enablex and glucotrol - monitor for signs of myalgias (simvastatin and clarithromycin interaction) - follow-up with gi, and rescope in 6 weeks to ensure healing - do not administer # transient hypoxia: she would desaturate to 88% on ra while sleeping. this resolved with activity and on waking the patient. this was likely a combo of obesity hypoventilation vs. osa vs. atelectasis. would recommend outpatient sleep evaluation. # dm type 2: patient is on lantus 42 units at night, metformin 1000mg and glucotrol 5mg daily. please hold glucotrol until and cover with humalog ssi # htn: normotensive in house. held benicar and metoprolol in setting of gi bleed. restarted on transfer to rehab. # migraine: tylenol, max 2gm daily, prn fioricet # depression: cymbalta at home was dosed at 60mg, however, new recommendations are for a max dose of 40mg daily. we dose reduced her to 40mg and she tolerated this change. # communication: patient, , son # code: full (discussed with patient) transitional issues # repeat egd in 6 weeks to confirm no more bleeding. # desaturation to 80s overnight requiring 2.5 l o2 by nasal cannula. potential sleep apnea. recommend following up as outpatient. medications on admission: cymbalta 60 mg cap 1 capsule(s) by mouth once a day . enablex 15 mg 24 hr tab 1 tablet(s) by mouth once a day . benicar hct 40 mg-25 mg tab 1 tablet(s) by mouth daily . glyburide 5 mg tab 2 tablet(s) by mouth twice a day . metformin 1,000 mg tab 1 tablet(s) by mouth twice a day . metoprolol succinate er 100 mg 24 hr tab 1 tablet(s) by mouth once a day . ibuprofen 600mg occassionally for pain discharge medications: 1. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 3. amoxicillin 250 mg capsule sig: four (4) capsule po q12h (every 12 hours) for 13 days: finish . 4. clarithromycin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 13 days: finish . 5. olmesartan-hydrochlorothiazide 40-25 mg tablet sig: one (1) tablet po once a day. 6. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 7. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 8. insulin lantus 42 units sq at bedtime 9. zocor 20 mg tablet sig: one (1) tablet po once a day. 10. outpatient lab work please check ck in 5 days 11. multivitamin capsule sig: one (1) capsule po once a day. 12. diazepam 2 mg tablet sig: one (1) tablet po once a day as needed for anxiety. 13. glucotrol 5 mg tablet sig: one (1) tablet po once a day: restart on . 14. enablex 15 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day: restart . discharge disposition: extended care facility: healthcare center - discharge diagnosis: upper gi bleed h. pylori infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking part in your care. you were admitted to for weakness and dark stools. you had an endoscopy which showed blood in your stomach from multiple ulcers. this was treated with clips and you your bleeding stopped. you were found to have an infection called h. pylori which is associated with ulcers. we started you on antibiotics for this infection. you had a repeat endoscopy which showed the clips were in the correct place and there was no further bleeding. you will need repeat endoscopy in 6 weeks to ensure healing. we made the following changes to your medications: start pantoprazole 40mg by mouth 2x a day start amoxicillin 1g by mouth 2x a day for 14 days, ending on tuesday, . start clarithromycin 500mg by mouth 2x a day for 14 days, ending on tuesday, . change your celexa (citalopram) to 40 mg/day. this is the maximum recommended dose for treatment of depression. restart your enablex after you finish the clarithromycin (start on ) due to interactions between the medications restart your glucotrol after you finish the clarithromycin (start on ) due to interactions between the medications please take all other medications as prescribed and follow-up at your appointments below. followup instructions: name: , address: 1272-., , phone: *please call primary care physician and book follow up appointment within 1 week of discharge from rehab. please follow-up in the russian clinic on with . department: div. of gastroenterology when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: endoscopic control of gastric or duodenal bleeding esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) pulmonary collapse long-term (current) use of insulin unspecified disorder of kidney and ureter chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction hypovolemia unspecified gastritis and gastroduodenitis, without mention of hemorrhage helicobacter pylori [h. pylori] unspecified disorder of stomach and duodenum obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to