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: codeine / gentamicin / shellfish / morphine attending: chief complaint: bright red blood per colostomy bag major surgical or invasive procedure: egd history of present illness: ms. is a 71yo female with past medical history of crohn's disease s/p total colectomy with end ileostomy, perforated gastric ulcer s/p bilroth ii on home tpn short gut syndrome, on coumadin presenting with bloody osteomy output. the patient had a dilation of her j-j anastomosis on with egd. she held her warfarin starting on sunday, in anticipation of the procedure and restarted the warfarin on the day of admission. the patient began to notice increased osteomy output the day prior to admission, she had to change her bag 6x at home. in the er, 70cc of blood mixed with osteomy output and then 3 hours later, 100cc of dried, old blood is emptied just as she presents to the micu. the patient does report that she had syncope after standing on the day of admission around noon. she reports that she was standing after emptying her bag in the bathroom, she recalls feeling lightheaded and "the next thing i knew" she was on her back on the bathroom floor. she did not notice any headache, head pain, bruises. her husband heard her fall and came immediately, she was already awake by the time he was there. he called ems and she was transferred to hospital. her baseline hct at leimeister is 35 (although around 27 at ) and her hct was 26 with an inr of 1.7. by the time of her presentation at , 3 hours later, her hematocrit had dropped 3 points. in the ed, initial vs were: 98.8 82 116/56 14 99% ra on arrival to the micu, the patient appears well. she has no complaints. she does report that her osteomy bag needs to be emptied, and 100cc of dark old blood is produced. past medical history: past medical history: - severe crohn's disease since early 20's, pt reports no flares since 's, not currently on any disease modifying agents - short gut syndrome (home tpn since ) - h/o pancreatitis - pud, perforated gastric ulcer - osteopenia - kidney stones - multiple catheter-associated dvt's, on long-term coumadin - anemia past surgical history: - antrectomy with bilroth ii () - transverse w/ colostomy in and frequent revisions/reversals since then for complications of cd (including abscesses, bowel perfs, and bowel obstructions) - total colectomy with end ileostomy - multiple small bowel resections - ccy - appendectomy - multiple port insertions (current r hickman catheter in place x8y) social history: retired, lives with husband. etoh or tobacco use. family history: sister with breast cancer. mother, father, and brother with cad. physical exam: admission physical exam: vitals: t: af bp: 121/79 p: 88 r: 18 o2: 100% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly. osteomy bag present, about 100cc in the bag. multiple well healed surgical scars. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, grossly normal sensation, gait deferred. discharge physical exam: vs - 98.3, 108/56, 80, 18, 98ra gen: well-appearing caucasian female in nad heent: ncat, eomi, perrl, sclera anicteric, mmm and pale, op clear. cv: rrr, 2/6 systolic murmur heard best at rusb, no gallops or rubs. resp: ctab, no w/r/r abd: multiple surgical scars, no bowel sounds, ostomy at ruq, well-dressed, no erythema around site. soft, nontender, nondistended, no organomegaly appreciated. extr: wwp, 2+ peripheral pulses, no e/c/c neuro: cn ii-xii grossly intact, 5/5 strength, no focal deficits msk: l knee with osteoarthritic deformity, limited rom pain skin: no rashes, bruising, or echymoses. piv in l hand with surrounding swelling. pertinent results: admission labs: 12:40pm wbc-6.3 rbc-3.29* hgb-9.9* hct-28.7* mcv-87 mch-30.0 mchc-34.5 rdw-13.6 12:40pm pt-19.9* inr(pt)-1.9* 12:40pm plt count-177 09:33am glucose-98 urea n-55* creat-0.7 sodium-139 potassium-4.8 chloride-107 total co2-26 anion gap-11 09:33am wbc-5.9 rbc-3.09* hgb-9.4* hct-27.2* mcv-88 mch-30.3 mchc-34.5 rdw-13.4 04:13am hgb-7.7* calchct-23 04:10am glucose-154* urea n-59* creat-0.8 sodium-135 potassium-4.7 chloride-107 total co2-24 anion gap-9 04:10am wbc-5.1 rbc-2.57* hgb-7.7* hct-23.3* mcv-91 mch-30.0 mchc-33.1 rdw-13.3 04:10am neuts-74.8* lymphs-18.9 monos-4.9 eos-0.9 basos-0.5 04:00am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg discharge labs: 06:40am blood wbc-4.8 rbc-2.68* hgb-8.1* hct-23.6* mcv-88 mch-30.0 mchc-34.1 rdw-13.6 plt ct-150 02:22pm blood hct-27.7* 06:40am blood glucose-108* urean-31* creat-0.6 na-140 k-4.0 cl-104 hco3-28 angap-12 06:40am blood calcium-8.6 phos-5.1*# mg-1.9 pertinent micro: none pertinent path: none pertinent imaging: egd: impression: stricture with clean based ulcer at the jejunal-jejunal anastomosis. otherwise normal egd to third part of the duodenum brief hospital course: 71f with pmh crohns, multiple abd surgeries, s/p total colectomy and recent egd for j-j dilation, on coumadin for hx of dvts, presents with brb per ostomy and generalized weakness. # brb per ostomy: likely attributed to j-j anastomotic dilation done on in conjunction with coumadin therapy for dvt. pt received 1 unit prbc in unit, and hematocrit remained stable. egd confirming ulceration of j-j anastomtic site, no active bleeding. she was put on iv protonix, transitioned to high dose oral . no longer had bloody ostomy output, weakness resolved and she remained hemodynamically stable. coumadin was held, pt advised to restart and to watch for warning signs of dvt or pe. encouraged close follow up with outpatient gi specialist. # hx of dvt: pt has history of multiple tpn catheter-associated clots and dvt. she has been on coumadin therapy for over 20 years. was held to , she restarted on , then d/c'd again on due to gi bleed. she also received 2 units ffp for bleeding reversal prior to egd. gi recommended holding coumadin for 5 days total from - restart on . she still received prophylactic dose heparin while in hospital, informed of the warning signs of dvt/pe prior to discharge. # crohns disease: s/p colectomy and multiple abd surgeries, now with short bowel syndrome. known hx of strictures, now with j-j anastamosis. receives tpn for nutritional support through hickman's catheter. not on home crohn's meds. tolerated regular diet and received tpn while inpatient. #osteoporosis prevention: continued home ca and vit d. transitional issues: #restart coumadin # ppi for 1 week, then change to daily ppi ongoing medications on admission: sodium-k+-mag-ca-chlor-acetate - 35 meq-20 meq-5 meq-4.5 meq-35 meq-29.5 meq/20 ml solution - 2.5 l at bedtime warfarin - 4 mg tablet - one tablet(s) by mouth daily acetaminophen calcium carbonate-vitamin d3 - (prescribed by other provider) - 600 mg calcium (1,500 mg)-400 unit tablet, chewable - 1 tablet(s) by mouth daily chlorophyll copper complex - (otc) - 100 mg tablet - 1 tablet(s) by mouth once a day doxylamine succinate - (prescribed by other provider) - 25 mg tablet - one tablet(s) by mouth once a day fish oil-dha-epa - (otc) - 1,200 mg-144 mg capsule - one capsule(s) by mouth daily discharge medications: 1. calcium carbonate 600 mg po daily 2. vitamin d 400 unit po daily 3. chlorophyll copper complex *nf* 100 mg oral daily 4. doxylamine succinate *nf* 25 mg oral daily 5. fish oil (omega 3) 1000 mg po daily 6. omeprazole 40 mg po bid duration: 7 days 1 pill twice daily through , then decrease to 40mg daily ongoing rx *omeprazole 40 mg 1 capsule(s) by mouth twice a day disp #*35 capsule refills:*0 7. outpatient lab work please draw a cbc (complete blood count) on wednesday, . fax results to dr at fax: , phone: . icd-9 code: 285.9 (anemia) discharge disposition: home discharge diagnosis: gi bleed from j-j anastamosis after dilation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , you were admitted to for bloody stool, weakness, and loss of consciousness. you were found to be anemic, presumably from your gi blood loss. you received a blood transfusion and your anemia and symptoms improved. you had an endoscopy which showed ulceration at the site of your recent dilation, but no active bleeding. you were put on an iv medicine to help stop the bleeding. your blood counts remain stable, and we now feel it safe for you to leave the hospital. we made the following changes to your medications: start omeprazole 40mg twice daily through , then 40mg once daily ongoing stop coumadin through , restart on at prior home dose, have inr checked please call your pcp and gi doctor to update them on your admission, and have your cbc drawn midweek to check your blood counts (your pcp will need to order this lab). off coumadin, you are at higher risk for blood clots. if you experience any sudden shortness of breath, rapid heart rate, chest pain, swelling and pain around your port or in one of your extremities, these are signs of dvt and/or pulmonary embolus and you would need to go to the emergency room. if you continue to have bleeding, please seek immediate care. followup instructions: please call the telephone numbers below to make appointments with your pcp and your gastroenterologist within the next 2 weeks. name: , location: healthcare - group address: , , , phone: fax: name: , a office phone: ( office location: , ste 8e md procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine diagnoses: acute posthemorrhagic anemia 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 long-term (current) use of anticoagulants personal history of venous thrombosis and embolism other and unspecified postsurgical nonabsorption acquired absence of intestine (large) (small) gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction other digestive system complications 

Answer: The patient is high likely exposed to