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: carcinoid syndrome with liver mets, small bowel carcinoid major surgical or invasive procedure: right hepatic lobectomy, resection of cystic duct mucocele, resection of segment ivb mass, resection of umbilical fissure segment ivb mass, segment ivb mass #2 resection, caudate lobe resection, resection of segment iii mass, small bowel resection, intraoperative ultrasound and resection of left lateral segment mass, incisional hernia repair. history of present illness: 60 y.o. male who presented with episodic facial flushing without diarrhea. a 24 hour urine for 5-hiaa was 45.4 and a repeat 24 hour urine in was 50.3. in a ct of the abd/pelvis was done revealing a left hepatic lobe 5.2x5.2cm lesion and a right anterior lobe lesion measuring 3.7x 2.8cm. there was fatty infiltration of the liver. an mri revealed 3.5cm lesion in the dome of the right lobe, a 2.1cm lesion in the anterior segment of the right lobe and a 3rd 4.1cm lesion more caudad to the 2.1 cm lesion. in the posterior right lobe there was a 1.9cm lesion. a 2.4cm soft tissue mass was noted in the right midline. a 5cm lesion was noted in the left lateral segment. an arterial scan revealed five sites of abnormal tracer uptake in the liver. no other activity was noted in the lungs, spleen, gi tract or gu tract. he was referred to dr. who felt that this was most likely a small bowel carcinoid with mesenteric lymph node metastasis and multiple liver mets. in a triphasic ct demonstrated multiple liver lesions. liver volume was insufficient (1951cc)to perform the liver resection for these lesions. right portal vein embolization was done in preparation for right hepatic lobectomy. repeat ct demonstrated significant hypertrophy of the left lobe. past medical history: carcinoid syndrome htn diagnosed in polio as a child social history: he is married with two adult children. he has a high school education and is a maintenance manager. family history: father died of lung ca mother died at age 43 from pneumonia he has two sisters, one has breast ca and the other has uterine ca physical exam: a&o anicteric, mild facial flushing, op clear, neck supple, no lad, no bruits s1s2 rr lungs clear abd soft, nt/nd, no masses, no hsm incision c/d/i jp drains intact, draining serosanguinous fluid ext edema, lue atrophied with decreased strength pertinent results: wbc-11.1*# rbc-4.16* hgb-12.2*# hct-36.0*# plt ct-255 wbc-17.9*# rbc-3.44* hgb-10.3* hct-29.5* plt ct-190 wbc-11.2* rbc-3.05* hgb-9.2* hct-25.6* mcv-84 mch-30.1 mchc-35.8* rdw-15.3 plt ct-246 neuts-89.6* bands-0 lymphs-4.1* monos-5.9 eos-0.2 baso-0.2 pt-15.7* ptt-40.6* inr(pt)-1.4* pt-13.6* ptt-32.1 inr(pt)-1.2* fibrino-133* fibrino-458* glucose-153* urean-15 creat-1.0 na-141 k-4.7 cl-110* hco3-20* angap-16 glucose-89 urean-17 creat-0.6 na-139 k-3.2* cl-104 hco3-27 angap-11 alt-1079* ast-863* alkphos-52 amylase-60 totbili-2.9* alt-1530* ast-989* alkphos-93 totbili-1.9* dirbili-0.7* indbili-1.2 alt-320* ast-83* alkphos-78 totbili-2.0* lipase-89* lipase-38 ck-mb-3 ctropnt-<0.01 ck-mb-3 ctropnt-<0.01 ck-mb-3 ctropnt-<0.01 albumin-3.2* calcium-8.5 phos-5.4*# mg-1.8 calcium-7.4* phos-3.2 mg-2.4 type-art po2-144* pco2-37 ph-7.43 caltco2-25 base xs-1 type-art po2-177* pco2-39 ph-7.38 caltco2-24 base xs--1 glucose-162* lactate-1.7 na-138 k-3.9 cl-105 lactate-1.9 freeca-1.15 imaging: us intr-op 90 mins 7:30 am reason: exp lap right hepatic trisegmentectomy medical condition: 60 year old man with exp lap right hepatic trisegmentectomy reason for this examination: exp lap right hepatic trisegmentectomy intraoperative ultrasound, 90 minutes. indication: guidance for trisegmentectomy of the liver and for localization of mesenteric mass. two separate intraoperative studies were performed initially, intraoperative ultrasound guidance was provided to dr. to document location of masses in both the left and right lobes of the liver. in particular, the proximity of the mass in the left lobe to the left portal and hepatic vein was demonstrated. several small hypoechoic lesions were also shown to be present in the superficial regions of segment iv-a. following initial resection of all of the liver lesions, intraoperative ultrasound guidance was used which demonstrated an initial small lesion in the superficial portion of segment ii. cauterization was performed over this lesion to facilitate resection. in addition, ultrasound was also used in the midline to document the presence of hypoechoic lymph nodes in the mesenteric mass from regional metastases. the proximity of these masses to peripheral branch of the superior mesenteric artery was documented. impression: intraoperative guidance provided to dr. to localize multiple masses in left and right lobes of liver and to document the proximity of mesenteric lymph nodes to the superior mesenteric artery. dr. approved: mon 7:14 pm chest port. line placement 6:10 pm reason: please eval line & ett position; r/o ptx medical condition: 60 year old man s/p r hepatic lobectomy, small bowel resection reason for this examination: please eval line & ett position; r/o ptx study: single portable ap chest radiograph. indication: 60-year-old male status post small-bowel resection, evaluate line and endotracheal tube position. comparison: . findings: endotracheal tube tip is approximately 8 cm from the carina with optimal position being 4-5 cm. a new retrocardiac opacity is identified obscuring the left hemidiaphragm which may represent effusion, atelectasis or infiltrate. a new right superior mediastinal soft tissue density is identified with a right ij catheter sheath in the expected region of the right internal jugular vein, which may represent an extrapleural hematoma from attempted right ij catheter placement. no definite pneumothorax identified. a chest tube is identified in the low right hemithorax, with apparent termination in the right cardiophrenic angle. a nasogastric tube courses through the mediastinum and into the stomach. the right costophrenic angle is not well visualized, suggesting a small to moderate- sized right pleural effusion. impression: 1. endotrachael tube appears to be placed too high which may be secondary to head positioning. recommened repeat radiographs with patient in neutral position. 2. new retrocardiac opacity which may represent effusion/atelectasis although new infiltrate cannot be excluded. 3. soft tissue density in the right superior mediastinum which may represent extrapleural hematoma from attempted central venous catheter placement. findings relayed to dr. at the time of dictation. the study and the report were reviewed by the staff radiologist. dr. dr. approved: wed 12:00 pm radiology final report chest port. line placement 10:58 am chest port. line placement reason: placment of new cvl. medical condition: 60 year old man s/p r hepatic lobectomy, small bowel resection s/p rewired rij cvl reason for this examination: placment of new cvl. indication: recent placement of new central venous line. history of prior small- bowel resection and right hepatic lobectomy. comparison: prior chest radiograph from . technique and findings: a portable chest radiograph was obtained in semi-upright position. a new right internal jugular central venous line is present since yesterday, with its tip located in the cranial portion of the superior vena cava. no pneumothorax or new pleural effusion is seen. the position of the nasogastric tube and the two abdominal drains appears unchanged. there has been interval removal of the endotracheal tube. the appearance of the cardiomediastinal silhouette, and in particular the right superior mediastinal border, remains stable as compared to yesterday. again noted is the left cortical retrocardiac opacity, which appears relatively stable. dr. d' approved: tue 3:58 pm cardiac: ecg study date of 8:10:32 pm sinus rhythm short pr interval possible inferior infarct - age undetermined nonspecific t wave changes in leads v2-v3 since previous tracing of , t wave changes present read by: , k. ecg study date of 6:16:06 am sinus rhythm inferior infarct - age undetermined t wave inversion in leads v1-v4 - consider ischemia since pervious tracing, t wave changes noted read by: , k. pathology: name birthdate age sex pathology # , p. 60 male report to: dr. gross description by: dr. /cofc specimen submitted: fs portal lymph node, gallstone, mucoscele wall, portal lymph node, right liver lobe, left lateral segment carcinoid tumor, segment 4b nodule, umbilical fissure segment 4b mass, segment 4b cephalad, left caudate lobe, mesenteric lymph node, left inferior lateral segment nodule, small bowel, more margin on inferior left lateral segment nodule. procedure date tissue received report date diagnosed by dr. . /kg diagnosis: i. small bowel (a-j): 1. malignant endocrine cell (carcinoid) tumor of the small intestine, extending to the serosa. 2. metastatic tumor in the mesentery. 3. margins free of tumor. ii. right hepatic lobe (k-q): 1. metastatic carcinoid tumor, extending to the cauterized margin. 2. venous emboli of foreign material. iii. segment ivb cephaloid (r-s): 1. mild steatosis. 2. no tumor. iv. segment ivb mass, umbilical fissure (t-u): metastatic carcinoid tumor, extending to cauterized margin. v. segment ivb nodule (w): metastatic carcinoid tumor, excised. vi. left caudate lobe (x-y): metastatic carcinoid tumor, excised. vii. left lateral proximal segment (z-ab): metastatic carcinoid tumor, excised. viii. inferior left lateral segment nodule (ac-ad): metastatic carcinoid tumor, excised. ix. inferior left lateral segment nodule, additional margin (ae-af): 1. multiple liver fragments with no tumor. 2. venous emboli of foreign material. x. portal lymph node (ag-ak): 1. tiny focus of metastatic carcinoid tumor. there is no tumor in the frozen section fragment. 2. hyperplasia and lipogranulomas. . portal lymph node (): 1. hyperplasia and lipogranulomas. 2. no tumor. xii. mesenteric lymph node (am): metastatic carcinoid tumor. xiii. murocel wall (an-ao): 1. chronic inflammation and fibrosis. 2. no tumor. xiv. gall stones: mixed stones, gross examination. clinical: metastatic carcinoid tumor. gross: the specimen is received fresh in fourteen parts, all labeled with the patient's name ", p" and the medical record number. part 1 is additionally labeled "small bowel", and consists of a length of small bowel, measuring 45 cm with average diameter of 2 cm. there is an attached mesentery measuring 45 x 5.5 x 1.5 cm. in the middle of the mesentery, abutting the radial resection margin of the specimen is a 5 x 3.5 x 2.2 cm mass, with a homogenous firm tan-yellow cut surface. on the serosal surface of the small bowel is a region of puckering and muscular contraction, measuring 0.9 x 0.5 cm, with a palpable mass underneath. the segment of small bowel is opened on its antimesenteric surface to reveal a tan-yellow circular mass, measuring 1 x 0.9 x 0.2 cm, located 13.5 cm from one stapled margin and 31.5 cm from the other stapled margin. there are otherwise no other gross abnormalities noted on the mucosal surface. representative sections of the specimen are submitted as follows: a=section through one of the margins, b=section through the other margin, c-f=full thickness section of the mass, entirely submitted in relation to the serosal surface, g-h-representative section of the mesenteric mass, i-j=possible lymph nodes. part 2 is additionally labeled "right liver lobe", and consists of a right hepatic lobectomy specimen, measuring 17.3 x 13.5 x 8.1 cm. the parenchymal margin is identified with a region of cautery, all together measuring 14.3 x 7.5 cm. there is yellow- discoloration throughout the surface of the capsule. the specimen is serially sectioned from superior to inferior to reveal numerous small and large metastatic nodules, varying in appearance from tan-yellow and diffusely necrotic to maroon-red and spongy in texture. the nodules vary in size from 1 cm in length to 5 x 4 x 3.7 cm. several of the larger metastatic nodules appear to grossly abut the parenchymal margin. representative sections of the specimen are submitted as follows: k=section of liver through capsule away from tumor nodule, l-p=sections of tumor nodule in relation to parenchymal nodule and capsular surface, q=sections of biliary and vascular structures deep in the specimen. part 3 is additionally labeled "segment 4b cephalad", and consists of a segment of liver, measuring 4 x 3 x 2.1 cm with an overlying capsule measuring 4.2 x 3.5 cm. the specimen is serially sectioned to reveal tan-yellow fatty appearing liver parenchyma with no grossly obvious tumor. the smaller liver fragment is sectioned to reveal tan yellow parenchyma with no apparent lesions. representative sections of the specimen are submitted in r-s. part 4 is additionally labeled "umbilical fissure segment 4b mass", and consists of two segments of liver parenchyma with overlying capsule, with one measuring 2.5 x 2 x 0.9 cm, and the other measuring 3 x 2.8 x 2.6 cm. the larger segment is serially sectioned to reveal a poorly defined white lesion measuring 0.5 x 0.4 cm, located 0.3 cm away from the parenchymal margin, and 1.6 cm away from the capsular margin. there is an additional soft tan-white lesion, measuring 1.1 x 0.5 x 0.5 cm, that appears to abut the parenchymal margin. representative sections of the specimen are submitted as follows: t=section through poorly defined region, u-v=section through soft tan-yellow region in relation to margin and capsule. part 5 is additionally labeled "segment 4b nodule", and consists of a segment of liver parenchyma with overlying capsule, measuring 3.5 x 3 x 1.6 cm. the specimen is serially sectioned to reveal a discreet tan-yellow nodule measuring 0.6 x 0.4 x 0.4 cm, abutting the liver capsule and coming to within 0.5 cm of the closest parenchymal margin. representative sections of the tumor nodule in relation to the capsule and parenchymal margin are submitted in w. part 6 is additionally labeled "left caudate lobe", and consists of a segment of liver, measuring 7.6 x 5 x 4.3 cm. the specimen is serially sectioned to reveal a subcapsular tumor nodule, tan to yellow-pink and soft, measuring 2.2 x 2.1 x 1.5 cm, located 0.5 cm away from the closest parenchymal margin and abutting the liver capsule. representative sections of the mass in relation to the parenchymal margin and capsule are submitted in x-y. part 7 is additionally labeled "left lateral segment proximally", and consists of an enucleated tumor mass with overlying liver capsule, measuring 8.4 x 7.5 x 3.5 cm. the tumor mass appears to come within less than 0.1 cm of the parenchymal resection margin. representative sections of the mass in relation to the parenchymal margin and capsule are submitted in z-ab. part 8 is additionally labeled "inferior left lateral segment nodule", and consists of a segment of liver parenchyma and overlying capsule, measuring 2.5 x 2 x 1.9 cm. the specimen is serially sectioned to reveal a tan-yellow tumor nodule, measuring 0.6 x 0.5 cm, located 0.4 cm away from the closest parenchymal margin and 0.4 cm away from the capsule. representative sections of the nodule in relation to the parenchyma and capsule are submitted in ac-ad. part 9 is additionally labeled "more margin inferior left lateral segment nodule", and consists of multiple unoriented tan-brown fragments of liver parenchyma aggregating 3.5 x 3 x 0.5 cm entirely submitted in ae-af. part 10 is additionally labeled "portal lymph node", and consists of a 2.8 x 2.5 x 1.5 cm tan-yellow segment of fatty tissue with a yellow cut surface. a portion is taken for frozen section, and diagnosis is made by dr. as follows: "lymph node with reactive hyperplasia; no tumor seen". the specimen is entirely submitted as follows: ag=frozen section remnant, ah-ak=serially sectioned lymph node. part 11 is additionally labeled "portal lymph node", and consists of a segment of tan-yellow tissue with surrounding cautery, measuring 2 x 0.6 x 0.5 cm. entirely submitted in . part 12 is additionally labeled "mesenteric lymph node", and consists of a small tan-yellow fragment of fibrofatty and lymphoid tissue, measuring 1 x 0.8 x 0.5 cm, bisected and entirely submitted in am. part 13 is additionally labeled "mucocele wall", and consists of three fragments of membranous tissue with an inner smooth lining, maroon-red in appearance. the smallest fragment measures 2 x 1 x 0.5 cm. the largest fragment measures 4 x 2.5 x 0.3 cm, and the last fragment measures 2.8 x 2.5 x 1 cm, and contains small yellow excrescences of soft tissue, measuring up to 0.5 x 0.4 cm. representative sections of the smaller and larger fragment are submitted in an. representative sections of the fragment with yellow excrescences are submitted in ao-ap. part 14 is additionally labeled "gallstones", and consists of two mixed stones, together measuring 2.3 x 2 x 1.5 cm. the specimen is for gross examination only, and has been reviewed by dr. . operative: operative report name: , p. unit no: service: hepatobiliary surgery date: date of birth: sex: m surgeon: , md, phd 2366 preoperative diagnosis: carcinoid syndrome, small bowel carcinoid, liver metastases. postoperative diagnosis: carcinoid syndrome, small bowel carcinoid, liver metastases. name of operation: right hepatic lobectomy, resection of cystic duct mucocele, resection of segment ivb mass, resection of umbilical fissure segment ivb mass, segment ivb mass #2 resection, caudate lobe resection, resection of segment iii mass, small bowel resection, intraoperative ultrasound and resection of left lateral segment mass, incisional hernia repair. first assistant: , md (res) second assistant: , md anesthesia: general endotracheal. preoperative status and diagnosis: the patient is a 60-year- old male who presented with episodic facial flushing without diarrhea. a 24-hour urine for 5-hiaa was 45.4. a ct scan of the abdomen and pelvis on demonstrated 2 rounded hypodense lesions in the left lobe of the liver, 1 measuring 5.2 x 5.2 cm, and the second in the right lobe measuring 3.7 x 2.8 cm. there was no evidence of small bowel lesions or lymphadenopathy. an mri on demonstrated a 3.5 cm lesion in the dome of the right lobe, a 2.1 cm lesion in the anterior segment of the right lobe, and a third 4.1 cm lesion more caudad to the 2.1 cm lesion. in the posterior right lobe there was a 1.9 cm lesion. there was also a 2.4 cm mass in the mesentery to the right of midline and a 5 cm lesion in the left lateral segment. he was subsequently evaluated as a potential surgical candidate. on review of the scans, it was apparent that he was going to require a right lobectomy or possibly trisegmentectomy with resection of the large lesion in the left lateral segment in order to render his liver free of disease. therefore, we proceeded with right portal vein embolization which was initially unsuccessful because of recanalization of the portal vein. however, re-embolization was successful with permanent thrombosis of the right portal vein and significant hypertrophy of the left lobe of the liver. therefore, he is now brought to the operating room for right hepatic lobectomy, possible right trisegmentectomy, resection of the left lateral segment mass, intraoperative ultrasound, and small bowel resection. operative findings: at the time of exploration, he was found to have a large mucocele of the cystic duct with 2 large stones in the cystic duct remnant. in addition, he did have a replaced right hepatic artery arising from the superior mesenteric artery and an accessory left hepatic artery arising from the left gastric artery. he had a known large lesion in the left lateral segment that was able to be enucleated. he had a second lesion anteriorly in the left lateral segment found by intraoperative ultrasound. he had multiple lesions in the right lobe. he also had a lesion in segment ivb near the edge of the liver, a lesion in segment ivb near the umbilical fissure, and lesions in the caudate lobe. the small bowel mass was found in the distal ileum. this was a solitary 2 cm lesion with puckering of the small bowel serosal surface. there was extensive lymphadenopathy at the root of the mesentery that completely encircled and encased the superior mesenteric artery and vein. operative procedure: the patient was brought to the operating room and placed on the operating table in supine position. after the successful induction of general endotracheal anesthesia and placement of foley catheter and appropriate monitoring and infusion lines, the patient was prepared with betadine and draped in a sterile routine fashion. a bilateral subcostal skin incision was made and carried down through the subcutaneous tissue. the anterior rectus sheath, rectus muscle, posterior rectus sheath and the peritoneum were incised. the abdominal cavity was entered. the falciform ligament was doubly clamped and divided. the abdomen was thoroughly explored. the adhesions between the liver and the anterior abdominal wall were taken down. a retractor was then able to be placed. we initially ran the small bowel and identified the primary small bowel lesion, as well as the extensive mesenteric lymphadenopathy. we then directed our attention to the liver. the falciform ligament was divided down to the level of the suprahepatic vena cava. the right lobe of the liver was then mobilized by dividing the right triangular and coronary ligaments. there had been significant hypertrophy of the left lobe of the liver which was rounded, globular and not easily mobile. the left lateral segment was also mobilized by incising the left triangular and coronary ligaments. the accessory left hepatic artery was identified, and care was taken to avoid injury to this structure. intraoperative ultrasound was then performed with the findings as noted above. we then proceeded to perform our portal dissection. the duodenum was adherent to the undersurface of the liver, and this was taken down sharply. we were able to identify a large cystic mass with hard stones that was in continuity with the common bile duct. the common bile duct was identified, separated from surrounding structures and circumferentially isolated. the cystic duct remnant was identified and followed from the common duct into the gallbladder fossa. this was opened, and 2 large stones were removed. there was communication with the common bile duct. we were able to completely mobilize this cystic structure and were able to divide this close to the common bile duct and doubly ligate this with 2-0 silk ties. this was now the true cystic duct remnant. no other stones were identified. attention was then directed to the replaced right hepatic artery which was identified posterior to the common bile duct and posterior to the portal vein. this was identified and circumferentially isolated. in a similar fashion, the portal vein was identified and cleaned of its attachments anteriorly. the right portal vein was identified and circumferentially isolated and looped with a vessel loop. next, the right hepatic artery was followed up lateral to the common bile duct where it was doubly ligated and divided. in a similar fashion, the right portal vein was doubly clamped with vascular clamps and divided. this was oversewn with running 5-0 prolene sutures. because of the extensive adhesions prior, it was not easy to identify the right hepatic duct at this stage, and this was left for the time when we transected the liver. attention was then directed to the vena cava. small hepatic veins entering the vena cava were identified, doubly ligated and divided. several of these were suture ligated with 5-0 prolene. one large accessory right hepatic vein was stapled with the vascular stapler. the right hepatic vein was quite small and easily isolated and divided using the vascular stapler. the caudate lobe was mobilized up off the vena cava as well. the parenchyma was then divided using the harmonic scalpel with the argon beam for hemostasis. the entire right lobe was removed. this was sent to pathology. the right hepatic duct was identified as we were transecting the liver, and this was doubly ligated with 2-0 silk ties. the caudate lobe was divided. it was not removed in continuity because of the difficulty mobilizing the caudate lobe because of the presence of the accessory left hepatic artery and because of the large globular configuration of the left lobe due to the portal vein embolization. following resection of the right lobe, our attention was then directed to segment ivb. there was a lesion along the inferior aspect of segment ivb that was resected with a wide- margin using the harmonic scalpel. a second mass in segment ivb near the umbilical fissure was also identified and resected using the harmonic scalpel. there was another segment ivb mass more cephalad that was also resected. the more inferior segment ivb nodule, the first one that was resected, was close to the margin and additional tissue was resected in the area of this nodule. we next turned our attention to the large mass in the left lateral segment. because of its close proximity to the draining left lateral segment vein and the blood supplying the left lateral segment portal vein, we very carefully enucleated this lesion without violating its capsule. in this fashion, we did not endanger those vessels and did not sacrifice any additional liver tissue. this was sent to pathology for permanent section. there was another left lateral segment nodule in the inferior surface that was identified by ultrasound, and this was similarly resected. attention was then directed to the small bowel. the mesentery was cleaned of its attachments. the small bowel was divided. the mesentery was divided using the vascular stapler. our line of resection was carefully selected to remove as many of the mesenteric lymph nodes as possible. however, we were not able to resect down to the level of the superior mesenteric artery which we had identified by ultrasound. there was extensive lymphadenopathy both anterior, posterior and on both sides of the superior mesenteric artery and vein. therefore, we did not feel that we could adequately resect this without endangering the entire small bowel and superior mesenteric artery. therefore, we completed the transection. vessels were suture ligated with 2-0 silk ties. all the mesenteric vessels were securely suture ligated. we then performed a stapled side-to-side small bowel anastomosis with stapler. the enterotomies were closed with 4-0 silk interrupted lembert sutures. mesenteric defect was closed using interrupted 3-0 sutures. the abdomen was copiously irrigated with antibiotic-containing saline solution. the resection areas were recauterized with the argon beam for hemostasis. they were covered with bioglue. two 19 drains were placed through separate stab incisions and secured to the skin using 3-0 nylon. the abdomen was then closed using running #1 pds for the posterior layer, for the anterior layer and for linea . it should be noted that he had a small incisional hernia from prior surgery in the midline, and this was identified, isolated and closed using interrupted 0 prolene sutures. subcutaneous tissue was irrigated, and the skin closed using 4-0 monocryl subcuticular. steri-strips and dressings were placed. the patient tolerated the procedure well and returned to the sicu in stable condition. sponge, needle and instrument counts were correct. the patient received 5500 cc of crystalloid, 750 cc of albumin and made 325 cc of urine. estimated blood loss was 500 cc. , md, phd dictated by: medquist36 d: 17:43:48 t: 20:00:20 job#: brief hospital course: he was taken to the or by dr. on for right hepatic lobectomy, resection of cystic duct mucocele, resection of segment ivb mass, resection of umbilical fissure segment ivb mass, segment ivb mass #2 resection, caudate lobe resection, resection of segment iii mass, small bowel resection, intraoperative ultrasound and resection of left lateral segment mass, incisional hernia repair. he was replaced with 5500 of crystalloid, ebl was 2,500mol and uop was 325cc. please see op report for further details. he was admitted to the sicu postop intubated. he experienced hypotension likely due to hypovolemia. albumin was given. u/o was 30cc/hour. hct was stable. propofol was weaned. on pod 1, hct decreased from 36 to 29 that was felt to be dilutional. he received lr boluses. vital signs were stable. coags were corrected. hct stabilized. bilirubin decreased to 1.9, alt/ast were elevated c/w or. jps continued to drain non-bilious fluid. he was extubated on pod 1. unasyn was stopped after 2 doses postop. on pod 2, pain was controlled, lfts trended down, hr increased to low 100s after ambulation. hct was 29.5. a repeat hct was stable at 29.9. ng was removed for 25cc. jps drained 460/340 non-bilious fluid. he remained npo. on pod 3 (), he started clears po, which he tolerated well and had begun to ambulate with nursing staff. he complained of some mild sternum pain and ekg along with cardiac enzymes were performed. these all did not demonstrate any cardiac ischemia. his chest pain eventually resolved on its own and did not return. his foley catheter was removed on pod 4 () and he voided without problem. was evaluated by physical therapy and they recommended ambulating with a cane for added stability. on pod5 (), his jp drains were still draining out 100, 130cc (lateral and medial, respectively). he was tolerating a regular diet and ambulating well. he was discharged in good condition with his drains intact. medications on admission: enalopril, hctz discharge medications: 1. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 2. enalapril maleate 10 mg tablet sig: four (4) tablet po daily (daily). 3. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*40 tablet(s)* refills:*0* 4. colace 100 mg capsule sig: one (1) capsule po twice a day for 7 days. disp:*14 capsule(s)* refills:*0* discharge disposition: home with service facility: americare at home inc discharge diagnosis: 1- metastatic carcinoid 2- hypertension discharge condition: stable, afebrile, tolerating a diet, ambulating without assistance, with adequate analgeisa on oral medications with two peri-hepatic drains in place (~100cc x24hr = lateral jp; 130cc x24hr = medial; both serosanguinous in character) discharge instructions: please continue your home medications as previously prescribed. shower now, no bath tub/swimming/whirlpool while drains are in place. followup instructions: see dr. in his clinic/office this wednesday ; please call monday to confirm your appointment. md, procedure: other partial resection of small intestine incisional hernia repair excision of other bile duct lobectomy of liver diagnoses: malignant neoplasm of liver, secondary incisional hernia without mention of obstruction or gangrene other specified disorders of biliary tract secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of other specified sites of small intestine 

Answer: The patient is high likely exposed to