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: aspirin attending: chief complaint: ugib major surgical or invasive procedure: egd history of present illness: 64 m with history of cirrhosis presumed due to etoh, pud s/p past billroth transfer from with melena and brbpr. patient was admitted on with melena and brbpr x 2 days. also associated with crampy abdominal pain and nausea. initial hematocrit 26.5, inr 1.8, developed thrombocytopenia to 60s as well. had egd in ed which showed no varices, obvious ulcers or tears. source thought to be "dusky" patch in stomach. stomach filled with blood and unable to visualize duodenum. per ho report 6 units prbcs given in addition to 2 units ffp (though nursing reports 10 units prbcs, ffp and platelets). per notes, repeat egd performed . bright red blood in gastric reminant without ulceration seen. also appears to have had bleeding scan performed with results unavailable currently. continued to have evidence of bleeding during hospital course; ho reported cessation of bleeding and then restart, though not clear from notes. patient has complained of epigastric area abdominal pain, but nothing out of ordinary from usual chronic abdominal pain. denies hematemesis. no chest pain or shortness of breath. + occasional palps. denies abdominal swelling/ascites. patient also with afib with rvr (to 160) on presentation requiring diltiazem gtt with eventual transition to dilt po and digoxin po. notes some hypotension (as low as 84/50 seen in notes) but not requiring pressors at any time. sodium 157 today; d5w with k started. patient also noted to have leukocytosis to 24k on , also with slight amylase elevation, prompting ct (report not included with paperwork; per ho was normal with ?no ascites; progress notes suggest "air within thickened gastric remnant - air trapped in folds vs. contained perforation"). given zosyn due to leukocytosis and ?concern for bowel ischemia since admission. . vitals prior to transfer: 98.1, hr 87, 114/90, 23, 100% on 2l nc. . past medical history: - cirrhosis etoh. noted to have grade i varices on endoscopy report, none in (though did have gastric varices). - h/o billroth ii for pud "many years ago" and about 5 abdominal surgeries (between age 20 and ~) - recurrent ugib with pud as above. reports last gi bleeding about 10 years ago, but osh notes with melena and hematocrit drop (49 down to 24), found to have gastritis without ulcer or varices on egd. - history of etoh abuse, none since ~. - chronic pain of bilateral arms (thought due to oa) and abdomen. - atrial fibrillation. on coumadin in the past. - depression, psychosis - history of dvt and s/p ivc filter placement - chronic pancreatitis, history of pseudocyst with resection. - htn social history: phd in english, once worked at . currently on disability. no tob, drug use. no etoh in 10 years. lives in x yrs family history: denies family history of liver disease. mother with increased bleeding of unclear etiology. physical exam: vs: t: 97.9 bp: 140/72 hr: 74 afib rr 16 100% on 2l nc gen: nad, chronically ill appearing, pleasant heent: nc/at, eomi, perrl, no op lesions, poor dentition cv: irregularly irregular, no mrg pulm: coarse breath sounds abd: +bs, soft, ntnd ext: 2+ hand edema, 2+ lls to knees neuro: cn 2-12 intact, ue/le strength 5/5 bilat, psych: appropriate pertinent results: 03:13pm blood wbc-11.1* rbc-3.85* hgb-11.4* hct-32.7* mcv-85 mch-29.7 mchc-35.0 rdw-17.0* plt ct-114* 04:52am blood wbc-11.1* rbc-3.73* hgb-11.0* hct-32.2* mcv-87 mch-29.6 mchc-34.2 rdw-17.5* plt ct-153 10:39pm blood wbc-19.5* rbc-3.02* hgb-9.0* hct-27.3* mcv-91 mch-29.9 mchc-33.0 rdw-17.4* plt ct-195 12:59pm blood wbc-10.0 rbc-2.99* hgb-9.0* hct-26.6* mcv-89 mch-30.0 mchc-33.6 rdw-18.1* plt ct-271 05:20am blood wbc-8.5 rbc-3.05* hgb-9.2* hct-27.3* mcv-90 mch-30.2 mchc-33.6 rdw-17.6* plt ct-319 05:16am blood wbc-6.1 rbc-3.04* hgb-9.2* hct-27.4* mcv-90 mch-30.2 mchc-33.5 rdw-17.0* plt ct-355 03:17am blood neuts-79.5* lymphs-11.0* monos-7.8 eos-1.4 baso-0.2 06:00pm blood neuts-77.2* lymphs-13.9* monos-6.4 eos-2.2 baso-0.3 03:09am blood pt-14.1* ptt-29.0 inr(pt)-1.2* 03:59am blood pt-14.8* ptt-28.9 inr(pt)-1.3* 05:33am blood pt-14.5* ptt-47.3* inr(pt)-1.3* 05:33am blood plt ct-363 03:17am blood ret aut-2.4 03:12am blood glucose-156* urean-20 creat-0.9 na-142 k-3.9 cl-109* hco3-31 angap-6* 04:52am blood glucose-113* urean-11 creat-1.0 na-145 k-3.5 cl-110* hco3-30 angap-9 03:27am blood glucose-85 urean-12 creat-1.1 na-139 k-3.2* cl-108 hco3-24 angap-10 05:39am blood glucose-94 urean-12 creat-0.9 na-140 k-3.9 cl-108 hco3-25 angap-11 05:16am blood glucose-93 urean-13 creat-1.0 na-139 k-4.1 cl-107 hco3-27 angap-9 03:17am blood alt-56* ast-45* ld(ldh)-282* ck(cpk)-141 alkphos-39 totbili-0.8 04:52am blood alt-30 ast-30 ld(ldh)-304* alkphos-49 totbili-0.9 05:52am blood alt-18 ast-27 ld(ldh)-335* alkphos-49 totbili-0.4 03:09am blood lipase-22 03:12am blood ck-mb-4 ctropnt-0.02* 11:22am blood ck-mb-notdone ctropnt-0.04* 10:39pm blood ck-mb-notdone ctropnt-0.05* 03:59am blood ck-mb-notdone ctropnt-0.05* 03:12am blood totprot-4.0* albumin-2.7* globuln-1.3* calcium-8.6 phos-2.9 mg-1.7 02:29pm blood calcium-9.1 phos-2.1* mg-1.8 05:16am blood calcium-8.9 phos-3.8 mg-2.4 03:17am blood caltibc-234* vitb12-1205* folate-15.9 ferritn-23* trf-180* 03:12am blood pep-no specifi 05:20am blood digoxin-1.0 05:52am blood digoxin-0.9 09:00pm blood lactate-1.3 09:47am blood lactate-2.8* 11:34am blood lactate-1.8 09:00pm blood freeca-1.13 . . imaging studies: echo : the left atrium is elongated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal global biventricular systolic function. limited study. . cxr ap semi-upright chest: there is a right internal jugular central venous catheter whose tip extends into the right atrium. this could be pulled back approximately 3 cm for placement in the cavoatrial junction if desired. the lungs are hyperinflated. there is no evidence of pulmonary edema. the thoracic aorta is tortuous. the heart is enlarged. the osseous structures demonstrate bilateral abnormalities of the shoulders and proximal humerus, nonspecific, possibly relating to neuropathic joint or prior trauma. please correlate with history and consider dedicated plain films. in the upper abdomen, note is made of multiple clips as well as a linear structure possibly represents an ivc filter. . cxr since yesterday, right internal jugular catheter still ends in the very low right atrium, could be pulled back 5 cm to end in the cavoatrial junction. tortuosity of the aorta and hyperinflation are unchanged. old left rib fractures and bilateral humeral deformities are stable. cardiomegaly is mild and unchanged. volume overload increased. small left pleural effusion increased. clips are in the abdomen. an ivc filter is probably in place. there is no free air. . abd xray findings: two supine views of the abdomen reviewed. an upright chest radiograph obtained one hour previously was also reviewed. there is a nonobstructive bowel gas pattern without dilated bowel loops or air-fluid levels. scattered phleboliths are seen in the pelvis. no other soft tissue calcifications. there are surgical clips in the left upper quadrant. an ivc filter is in place. patient is status post right hip fracture with surgical hardware present. on recent chest radiograph, there was no free air seen under the diaphragms. impression: no free air. non-obstructive bowel gas pattern without pneumatosis or bowel wall thickening. . ct abd/pel ct of the abdomen without iv contrast: impression: limited study. 1. no evidence of small-bowel obstruction or ileus. 2. new, small amount of free air adjacent to small bowel loops in the left upper quadrant, in the abscence of a recent procedure this is concerning for local perforation. no extraluminal oral contrast is noted. 3. anasarca. 4. new bilateral small pleural effusions with associated atelectasis. 5. multiple compression fractures of the lower thoracic and lumbar spines ofunknown chronicity. . bil ue us : bilateral upper extremity doppler ultrasound: -scale and color doppler son images were obtained that demonstrate an occlusive thrombus in the right subclavian vein. acoustic windows were limited on this patient given his right internal jugular catheter and other, so the study was therefore limited. flow is demonstrated in the distal right subclavian vein and axillary vein but one of two brachial veins demonstrates occlusive thrombus. on the right, the basilic and cephalic veins compressed and appear normal. the left internal jugular and axillary veins demonstrated normal compressibility and wall-to-wall flow, however, the left subclavian vein could not be imaged. a non-compressible thrombus was demonstrated in one left brachial vein. the left cephalic was visualized and appeared normal. impression: occlusive thrombus in the right subclavian vein and in one brachial vein on each side. . echo : due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. impression: suboptimal image quality. focused views. normal right ventricular size and function. overall normal left ventricular function. compared with the prior study (images reviewed) of , right ventricular size and function are similar. the images are suboptimal for comparison. . cxr since , a right picc was installed with its tip in the distal . right internal jugular catheter still ends in the low right atrium, should be pulled back 5 cm for optimal placement. in ivc filter and clips in the abdomen are unchanged. tortuosity of the aorta and hyperinflation are stable. old left rib fractures and deformity of both shoulders are also unchanged. . cta-chest findings: scattered bilateral small subsegmental pulmonary emboli (in right lower lobe 3:47, 60, 68 and left upper lobe in 3:44). no evidence of right heart strain. scattered small peripheral parenchymal opacities, some patchy, some ground-glass (probably representing infection) and some nodular with wedge shape (probably representing infarction areas), most prominent in the right upper lobe. peripheral atelectasis, septal thickening, bronchial wall thickening and peribronchial nodularity are seen in lung bases. enlarged lymph nodes are seen in right hilum, ap window, bilateral lower paratracheal stations. small bilateral pleural effusions with adjacent compressive atelectasis are more prominent on the left side. prominent ascending aorta. at the level of the pulmonary artery bifurcation, ascending aorta measures 37 mm and descending aorta measures 22 mm. limited visualization of abdominal organs reveal presence of small hypodense lesion in right kidney, likely cyst. multiple anterior wedge compression fractures in the spine of indeterminate chronicity. old bilateral rib fractures and old deformities of both shoulders. impression: 1. scattered bilateral small subsegmental pulmonary emboli, in right lower and left upper lobes.. 2. multiple peripheral parenchymal opacities that could represent infection. the wedge-shaped consolidations probably represent infarction, in right upper lobe. . ecg atrial fibrillation with mean ventricular rate 92. marked precordial t wave inversion. no previous tracing available for comparison. . ecg: atrial fibrillation. extensive st-t wave changes in the precordium and inferior leads may be due to myocardial ischemia. compared to the previous tracing of the st-t wave changes are actually somewhat improved. . brief hospital course: in summary, mr. is a 64 year old male with alcoholic cirrhosis cirrhosis and atrial fibrillation, and hx of dvts, admitted with an upper gi bleed of unclear etiology. . #upper gi bleed. patient has history of alcoholic cirrhosis so was started on octreotide drip. however, egd showed one cord of grade i varices and friabilitiy of anastamosis site from prior bilroth surgery which was initially thought to be the likely source of bleeding. he was initially on ppi drip, but this was transitioned to iv ppi . he was evaluated by surgery for possible surgical resection of bleeding site, however, they felt him to be a poor surgical candidate given multiple surgeries in the past. hematocrits remained stable after the initial 3 units of prbcs transfused on /08. etiology of the bleeding is not clear as repeat egd on did not show any varices or bleeding or friability at the anasamosis site. hepatology/gi recommended a colonoscopy both to look for source of bleeding and given pts apparent hypercoaguability given hx of dvts and current bilaterally upper extremety dvts. colonoscopy was unremarkable. hepatology recommended outpatient follow up with a capsule study and not restarting any coagulation until follow up given risk of re-bleeding. pt was schedule to have follow up at the liver center. . #air in mesentery. concern for microperforations, per surgery, perhaps related to scope trauma from osh egd. initailly with abdomominal pain, though this has improved. has been evaluated by surgery who wanted conservative management given multiple prior surgeries. he was made npo and monitored with serial abdominal exams. he was started on fluconazole and zosyn per surgery. pt completed an empiric 7 day course of antibiotics. his abdominal pain resolved, and he has remained afebrile and his wbc count has trended down. . #pulmonary embolism. pt was transferred back to the micu after an episode of chest pain, hypoxia, and tachicardia to the 160s-170s with bigeminy. pt had no acute st-t changes on ekg, and ces remained flat 0.05, down from 0.07 on admission. on cta chest, patient noted to have bilateral subsegmental pes. he had several episodes of a. fib with rvr likely secondary to pes, possibly related to his bilateral upper extremity dvts. given patient's recent significant gi bleed, decision was made not to anticoagulate unless patient was stable for more than two weeks. an filter was placed. patient had an ivc filter in place prior to admission. an echo was performed and shows normal right ventricular function. since placement of pt has had no furthe episodes of rvr, chestpain or hypoxia. his o2 sats have remained normal on room air. . # b/l upper extremity clots. patient has significant clot burden, making line placement difficult. unable to anticoagulate at present due to gib. cachexia, weight loss, and extensive clot burden concerning for malignancy. anticoagulation was not initiated given ongoing gi bleed. an filter was placed when patient was found to have pes. pt underwent colonoscopy which was normal. patient will need outpatient age appropriate cancer screening. . # abdominal pain. patient has chronic abdominal pain secondary to pancreatitis, but with concern for microperforation as above. on methadone and percocet at home for pain, which was held due to microperforation. abdominal pain resolved. . # afib. patient in a. fib. initially managed at osh on diltiazem drip. patient had a few episodes of a. fib with rvr associated substernal chest pain and st depressions on ekg, concerning for rate related demand ischemia. he was started on lopressor to improve hr control to avoid tachycardia. patient is not anticoagulated due to gi bleed. echo was performed during admission. . # cirrhosis. patient has well compensated alcoholic cirrhosis. he was followed by liver. he was noted to have one band of grade i varices on egd on , but none were noted on the repeat egd, on . he will have follow up with liver center as an outpatient. . medications on admission: (upon transfer from osh): diltiazem 120 mg daily pantoprazole po 40 mg daily methadone 5 mg q8h lasix 20 daily digoxin 0.125 daily zosyn 4.5 g q12h ( planned through ) oxycodone 10 mg q6h prn morphine iv 2 mg prn zofran 4 mg iv prn. d5w with 40k at 70/hr discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 4. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 7. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for sscp. discharge disposition: extended care facility: health care center discharge diagnosis: gastrointestinal bleeding deep vein thrombosis discharge condition: stable for rehab/skilled nursing facility procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine diagnostic ultrasound of heart interruption of the vena cava colonoscopy endoscopic control of gastric or duodenal bleeding transfusion of packed cells transfusion of other serum diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery cirrhosis of liver without mention of alcohol alcoholic cirrhosis of liver other and unspecified alcohol dependence, in remission atrial fibrillation paroxysmal ventricular tachycardia hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft iron deficiency anemia, unspecified pressure ulcer, heel hyperosmolality and/or hypernatremia accidents occurring in residential institution chronic pancreatitis other pulmonary embolism and infarction internal hemorrhoids without mention of complication pressure ulcer, stage i acute venous embolism and thrombosis of unspecified deep vessels of lower extremity esophageal varices without mention of bleeding chronic osteomyelitis, other specified sites 

Answer: The patient is high likely exposed to