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: hemetemesis major surgical or invasive procedure: endoscopic ultrasound with fine needle aspiration history of present illness: 57 y/o m with pmh of polysubstance abuse, - tear, pancreatitis transferred from an osh for further evaluation and monitoring of hemobilia. . in brief, his symptoms started 2 days with chills/ sweats awakening him the middle of the night. he subsequently had midepigastric abdominal pain radiating to the left upper quadrant which was not relieved by pepcid. he felt nausea and had several episodes of hemetemesis followed by black tarry stool. + lightheadedness, no syncope, chest pain or shortness of breath. . he presented to an osh, where he was hd stable throughout stay: bp 114/64 hr high 90's, rr 16-20 95% ra. his initial hct was 37.8 which trended down to 31.8 over 12 hrs. he had a semi-urgent endoscopy which showed blood in the duodenum with side viewing scope confirming hemobilia. as interventional radiology was unavailable at the osh, he was transferred to for further evaluation and treatment. . on arrival to , patient complaining of significant epigastric pain once again radiating to left upper chest. past medical history: - past history iv heroin use - hx of alcoholism - hx of - tear - hx dvt - hx pancreatitis - hx seizures related to dt's - htn - hcv social history: lives at home with his wife, currently unemployed - drinks pint rum daily, last drink approx 2 day ago - remote history of ivda 40 yrs ago family history: mother: deceased from colorectal ca physical exam: vs: temp: afebrile bp: 127/83 hr: 78 rr: 13 o2sat 100% ra gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 s2; s3 best heard at apex; no murmurs/ rubs abd: nd, +b/s, soft, tenderness in luq with voluntary guarding ext: no c/c/e skin: no rashes/no jaundice; cap refill < 2 sec neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. pertinent results: admission labs: 08:16pm blood wbc-4.3 rbc-2.77* hgb-10.4* hct-30.6* mcv-110* mch-37.6* mchc-34.1 rdw-13.4 plt ct-101* 08:16pm blood pt-14.1* ptt-31.1 inr(pt)-1.2* 08:16pm blood glucose-83 urean-16 creat-0.8 na-141 k-3.5 cl-106 hco3-26 angap-13 08:16pm blood alt-168* ast-383* alkphos-63 amylase-133* totbili-1.3 08:16pm blood lipase-73* 08:16pm blood ck-mb-1 ctropnt-<0.01 08:16pm blood albumin-3.8 calcium-8.6 phos-1.9* mg-1.9 04:24am blood vitb12-933* folate-9.1 04:24am blood triglyc-115 09:09am urine color-yellow appear-clear sp -1.017 09:09am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-2* ph-5.5 leuks-neg micro: blood culture: urine culture: studies: ct abd/pelvis: 1. nonspecific high-density material noted in the gallbladder fundus is likely small stones/sludge rather then blood. no other ct findings of hemobilia. 2. poorly defined hypoattenuating lesion within the posterior pancreatic head, with suggestion of extension to portion of the uncinate process. the more focal well-defined component measures 13 x 13 mm. differential for this patient includes pancreatic adenocarcinoma or changes from focal pancreatitis. suggest correlation with eus/fna to further evaluate. scattered peripancreatic and hepatogastric lymph nodes with no other findings of metastatic disease. 3. slight dilatation of the intrahepatic biliary tree and dilated extra-hepatic biliary tree. this may be secondary to underlying obstruction with differential including ampullary stenosis or distal biliary lesion. 4. no ct findings of acute pancreatitis. no secondary complications including pseudoaneurysm or pseudocyst identified. fna, pancreas head mass: non-diagnostic, insufficient glandular cells. neutrophils, macrophages, and acellular debris suggesting acute pancreatitis. brief hospital course: 57 y/o m with pmh of polysubstance abuse, - tear, pancreatitis transferred from an osh for further evaluation and monitoring of hemobilia. the patient presented with onset of epigastric pain, nausea/vomiting and developed hematemesis and black tarry stools. he went to hospital where he underwent urgent egd showing hemobilia. because southshore does not have ir and there was concern that the patient may require intervention he was transferred to . the patient remained hemodynamically stable however required alcohol detox. additionally, pancreatic mass was found during imaging and investigation of potential malignancy was initiated. . #. hematemesis/hemobilia: endoscopy at osh revealed blood from biliary tree suggesting hemobilia. imaging was reviewed by ercp team at and felt consistent with hemobilia. they did not feel intervention was necessary as the patient was hemodynamically stable and did not require transfusion during this admission. they did note that pontaneous hemobilia is rare- but can occur in the setting of acute/chronic pancreatitis with vascular damage (hemosuccusvpancreaticus), pancreatic pseudocyst, pancreatic cancer, gallstones, bile duct tumors, and vascular anomolies of the liver or biliary tree. a ct revealed a poorly defined hypoattenuating lesion within the posterior pancreatic head. given the patient's extensive drinking history, epigastric pain and only mild elevations in amylase/lipase, this was concerning for pancreatic adenocarconima v. changes from acute pancreatitis. an eus and fna was performed on which ir felt was concerning for malignancy, however it was non-diagnostic, showing insufficient glandular cells. cea is within normal limits and ca -9 was normal. of note, the patient did have one episode of fever in the micu and was started on cipro/flagyl empirically, however it was later felt that the fever may have been withdrawal and the abx were dced without further elevated temperatures. . #. etoh dependence: the patient presented after hematemesis with likely etoh induced pancreatitis. given the patient's extensive history of heavy etoh with episodes of withdrawal seizures a few months prior to presentation, the patient was placed on a ciwa scale, q2h, managed with valium. the patient continued on the ciwa scale until . he experienced anxiety, tremors, and discomfort but did not experience hallucinations or seizures. he was also given thiamine, folate, mvi. . #. elevated transaminases: the patient was found to have elevated transaminases throughout admission. this was felt likely related to underlying alcoholic hepatitis and hcv. pattern of elevation suggests intrahepatic process rather than obstructive process. synthetic function was at baseline and the lfts were downtrending over the course of the stay. hcv ab was confirmed to be positive. . #. elevated amylase/pancreatitis: the patient had mildly elevated amylase likely acute on chronic pancreatitis from etoh abuse. though amylase was not three times the upper limit of normal, given his hx of pancreatitis, it is possible that he has a partially burned out pancreas and therefore is unable leak as high levels of amylase. elevated amylase could also be related to the pancreatic mass seen on imaging. the patient was made npo and treated with morphine and zofran to relieve related pain and nausea and diet was progressed as tolerated. the patient was able to tolerate a full meal at time of discharge. . #. thrombocytopenia: likely cirrhosis . #. anemia: macrocytic anemia likely hcv vs nutritional deficiencies with etoh abuse . # social: the patient's further medical care may be complicated by the fact the he currently does not have insurance. appts were made for him clinic for both pcp and for financial counseling. he was also scheduled for an appt with dr. for further management of pancreatic mass, however as he is currently self-pay, he was advised to call office and work with them to find a financially feasible solution. he has applied to mass health but service won't be initiated for a few weeks, so he may need to delay his appt or see if he can be billed retroactively. hopefully his lack of insurance will not impede his receiving appropriate medical care as an outpatient. . code: full medications on admission: medications at home: none . meds on transfer: - ativan per ciwa scale - dilaudid 0.5mg q 3hrs - zofran 4mg q 4hrs - protonix gtt - folic acid - thiamine 100mg daily - mvi discharge medications: 1. oxycodone 5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: 1. pancreatic mass of unknown etiology 2. alcohol withdrawal 3. hemobilia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to with epigastric pain, vomiting blood, and blood from your rectum. you were found to have blood in your duodenum and biliary tree and a mass in your pancreas. this mass was biopsied and the results are pending. you will need to follow up very closely with the appointments we have made for you. we also detoxed you from alcohol while you were admitted. you need to stop drinking alcohol. new medications: oxycodone: this is a pain medication for short term use. do not drive or operate heavy machinery while taking this medication as it causes drowsiness. please follow-up as indicated below. since you do not have health insurance, you have an initial appointment for financial counseling. you also have an appointment with dr. (primary care doctor), which is listed as self-pay. it is recommended to call dr. office before the appointment and let them know about this self-pay status so that the office is aware and can try to make arrangements for you in the interim as you have applied to mass health/other insurance agencies. it is essential that you follow-up because you have medical conditions that need to be evaluated on a chronic basis. followup instructions: department: health center when: wednesday at 11:00 am with: building: (, ma) campus: off campus best parking: free parking on site **this appointment is for financial services. please bring a picture id, proof of address and 2 pay stubs or unemployment benefits** . department: health center when: monday at 11:45 am with: , md building: (, ma) campus: off campus best parking: free parking on site . department: radiology when: monday at 8:45 am with: cat scan building: campus: east best parking: garage ** currently this appt. is registered as self pay . department: surgical specialties when: monday at 9:30 am with: , md building: campus: east best parking: garage ** currently this appt. is registered as self pay procedure: other endoscopy of small intestine closed [aspiration] [needle] [percutaneous] biopsy of pancreas diagnostic ultrasound of digestive system diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol unspecified viral hepatitis c without hepatic coma other specified disorders of biliary tract personal history of venous thrombosis and embolism hematemesis chronic pancreatitis acute pancreatitis other and unspecified alcohol dependence, continuous alcohol withdrawal unspecified disease of pancreas 

Answer: The patient is high likely exposed to