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 known allergies / adverse drug reactions attending: chief complaint: nausea/vomiting/jaundice; mass causing duodenal and biliary obstruction major surgical or invasive procedure: percutaneous transhepatic cholangiography/biliary decompression () exploratory laparotomy with biopsy of periduodenal nodule, cholecystectomy, roux-en-y, choledochojejunostomy and gastrojejunostomy () history of present illness: chief complaint: nausea, vomiting, jaundice reason for micu transfer: hypotension after nausea 71f scientist who presented with a 2 month history of abdominal pain, nausea and vomiting. the patient and her family reported that she had not been able to eat well and had lost 15-20 lbs. her family first noted that she became jaundiced 1 month prior. she denied fevers, chills, diarrhea and constipation. her last formed bowel movement had been 2 days prior. she denied brbpr. she denied pain radiating to her back. the patient resides in , ny and came to massachussetts for medical care at the scientist "benevolant association" a non-medical care facility. it was there that she fell due to weakness and hit her head. she had no loss of consciousness and minor facial abrasions. she decided on to pursue further medical care and arranged transport to the ed. past medical history: none documented social history: lives with family. no alcohol or tobacco use. -scientist since . family history: no cancer in the family. father died of heart disease at age of 88. mother died of diabetes. physical exam: admission exam: general: aaox3, nad, grossly jaundiced heent: sclera severely icteric, mm relatively dry, oropharynx clear, , perrl cv: rrr, + s1/s2, 2/6 systolic murmur best heard at rusb, no rubs or gallops lungs: ctab, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. +1 edema b/l neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. exam upon discharge: vitals: general: aaox3, nad heent: cv: rrr, +s1/s2, systolic murmur resp: ctab abdomen: right subcostal incision open to air with steri strips and c/d/i. ext: no cyanosis/clubbing/edema, warm, well-perfused bilaterally, 2+ distal pulses bilaterally pertinent results: admission labs: 09:35am blood wbc-16.4* rbc-4.99 hgb-15.2 hct-43.9 mcv-88 mch-30.4 mchc-34.6 rdw-17.7* plt ct-424 09:35am blood neuts-85.6* lymphs-9.1* monos-4.9 eos-0.1 baso-0.2 09:35am blood pt-16.5* ptt-33.0 inr(pt)-1.6* 09:35am blood glucose-126* urean-52* creat-1.6* na-126* k-2.0* cl-69* hco3-39* angap-20 09:35am blood alt-128* ast-174* alkphos-530* totbili-42.4* dirbili-28.8* indbili-13.6 09:35am blood lipase-48 09:35am blood albumin-3.4* calcium-9.7 phos-2.7 mg-3.3* 09:48am blood lactate-2.7* 02:55pm urine color-dkamb appear-hazy sp -1.014 02:55pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirub-lg urobiln-neg ph-6.0 leuks-neg 02:55pm urine rbc-<1 wbc-3 bacteri-few yeast-none epi-0 02:55pm urine casthy-5* 02:55pm urine mucous-rare ct head w/o contrast : there is no evidence of hemorrhage, edema, mass, mass effect, or infarction. the ventricles and sulci are normal in size and configuration for the patient's age. the basal cisterns are patent. there is preservation of -white matter differentiation. atherosclerotic calcifications are noted in the internal carotid arteries. no fracture is identified. the visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. the soft tissues are unremarkable. impression: no acute intracranial abnormality. ct c-spine w/o contrast : 1. no fracture or malalignment. 2. multilevel degenerative changes with multilevel neural foraminal narrowing due to facet arthrosis. 3. multiple nodules in the thyroid gland. if clinically indicated, recommend further evaluation with a thyroid ultrasound. ruq u/s : 1. severely dilated intra- and extra-hepatic biliary ducts without definite associated mass. recommend mrcp for further evaluation if there are no contraindications to mri. alternatively, a multiphasic ct of the abdomen should be performed. 2. distended gallbladder with cholelithiasis and sludge, but no other findings to suggest evidence of acute cholecystitis. cxr : no intrathoracic process. ct abdomen/pelvis : there is a mass lesion involving the ampullary region which results in severe dilatation of the intra and extrahepatic biliary tree as well as mild main pancreatic ductal dilatation. differential considerations include a cholangiocarcinoma versus a pancreatic neoplasm. there is no evidence of distant metastases. trace ascites is seen. incidental hepatic and renal hypodensities, likely cysts as described above. incidental pancreatic cystic lesions, most compatible with ipmn. egd : the duodenal bulb was dilated. there was a complete obstruction in the duodenal bulb preventing an ercp from being performed. percutaneous transhepatic cholangiography : 1. marked intra and extrahepatic biliary dilatation to the level of the distal cbd. 2.successful placement of an 8 french percutaneous transhepatic biliary drain throught the obstruction which has been left on free drainage. operative pathology: (periduodenal nodule): metastatic well differentiated adenocarcinoma present in fibroadipose tissue. discharge labs: 04:15am blood wbc-10.5 rbc-3.01* hgb-9.3* hct-29.1* mcv-97 mch-31.0 mchc-32.1 rdw-15.9* plt ct-246 04:15am blood plt ct-246 04:15am blood glucose-107* urean-13 creat-0.7 na-137 k-3.7 cl-106 hco3-25 angap-10 04:15am blood alt-71* ast-77* alkphos-245* totbili-7.0* dirbili-4.7* indbili-2.3 04:15am blood calcium-7.3* phos-3.4 mg-2.1 04:20am blood triglyc-278* brief hospital course: at the time of her admission on the patient was hypotensive and had an elevated wbc to 16 with a left shift. she was therefore transferred to the icu for further management. she was started on zosyn and given vitamin k and ffp to reverse her coagulopathy. due to her hypotension, ct scan was initially post-poned. upon stabilization of the patient's blood pressure, it was decided to proceed with ercp on . ercp was unsuccessful due to an obstructing duodenal mass. an ng tube was placed, and three liters of gastric contents were removed from her stomach. at this time, the hepatobiliary surgical team was consulted for evaluation. upon review of ct abdomen/pelvis, it was determined that the patient had a potentially operable lesion. the patient was scheduled for an upcoming surgical procedure on . for immediate biliary decompression and relief of the associated symptoms and abnormal laboratory values, on , the patient underwent percutaneous transhepatic cholangiography with decompression and drain placement. in the days thereafter, the patient was noted to have significant improvement in her tbili laboratory values, and some improvement her jaundiced appearance. additionally, on , the patient had a picc line placed, and tpn was started. the patient was repleted with intravenous fluids to replace the losses from both her abdominal drain as well as her ng tube. the patient had notable improvement in laboratory values and clinical appearance in this manner, over the following days, leading up to her scheduled operation on . on , the patient underwent an exploratory laparotomy with biopsy of periduodenal nodule, cholecystectomy, roux-en-y, choledochojejunostomy and gastrojejunostomy, which went well without complication (reader referred to the operative note for details). after a brief, uneventful stay in the pacu, the patient arrived on the floor npo with an ng tube, on iv fluids, on a single-day-course of iv zosyn, with a foley catheter, and her ptbd in place, and an epidural for pain control. the patient was hemodynamically stable. on pod#1 (), she continued to have the epidural for pain control. she therefore continued to have a foley catheter. she required aggressive iv fluid hydration post-operatively, which she responded well to, as gauged by her urine output and vitals, which remained hemodynamically stable and normal throughout. her tpn was held on this day, and she remained npo with her ngt n place. on pod#2 (), her pain remained well-controlled with the epidural. due to a hematocrit of 23, she was transfused 2 units of packed red blood cells on this day. through follow-up of post-transfusion hematocrit, it was determined that she had responded well to this step. she worked on ambulating with physical therapy on this day. her ng tube and foley catheter were maintained, and she remained npo. tpn was restarted on this day. on pod#3 (), she continued to have good pain control with the epidural. her foley catheter was therefore also maintained. her ngt was clamped on this day, and residuals were checked every four hours. she consequently also remained npo. she ambulated twice with physical therapy. on pod#4 (), she continued to have good pain control with the epidural. her foley catheter was also maintained. her ngt was removed, and she was permitted to have sips of liquids, which she tolerated well. she ambulated with physical therapy. on pod#5 (), the patient's epidural was removed, and she was transitioned to oral pain medications, which she tolerated well. diet was advanced to clears, in addition to having tpn, which she also tolerated well. she continued to ambulate multiple times per day. the foley catheter was removed, and she voided successfully. on pod#6 (), the patient's ptbd drain was removed. she was advanced to full liquids, which she tolerated well. she was continued on tpn. she continued to ambulate multiple times daily, with physical therapy. on pod#7 (), the patient was continued on tpn, and enlive supplementation was added to her full liquid diet. her pain was well controlled with oral medications. she continued to ambulate frequently and regularly. on pod#8 (), per recommendations by hematology/oncology, a ct chest was obtained for staging purposes. she was continued on tpn, but the volume was decreased to half. she continued to have good pain control, tolerating full liquids, and ambulating regularly. on pod#9 (), she was advanced to a regular diet with enlive supplementation, and continued on half-volume tpn. she continued to ambulate regularly, and have good pain control. on pod#10 (), she was maintained on half-volume tpn, regular diet with enlive supplementation, ambulating regularly, working with pt. during this hospitalization, the patient ambulated early and frequently, was adherent with respiratory toilet and incentive spirometry, and actively participated in the plan of care. the patient received subcutaneous heparin and venodyne boots were used during this stay. the patient's blood sugar was monitored regularly throughout the stay; sliding scale insulin was administered when indicated. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. *********staples were removed, and steri-strips placed.***** the patient was discharged home without/with services.***** the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: none discharge medications: 1. omeprazole 20 mg po daily rx *omeprazole 20 mg 1 capsule(s) by mouth once a day disp #*30 capsule refills:*5 2. docusate sodium 100 mg po bid rx *docusate sodium 100 mg 1 capsule(s) by mouth twice a day disp #*60 capsule refills:*1 3. senna 1 tab po bid:prn constipation 4. folic acid 1 mg po daily rx *folic acid 1 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*1 5. megestrol acetate 400 mg po daily rx *megestrol 400 mg/10 ml (40 mg/ml) 1 suspension(s) by mouth once a day disp #*30 packet refills:*0 6. metoclopramide 10 mg po qidachs rx *metoclopramide hcl 10 mg 1 by mouth qidachs disp #*56 tablet refills:*0 7. oxycodone (immediate release) 5-10 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth every four (4) hours disp #*120 tablet refills:*0 discharge disposition: home with service facility: health discharge diagnosis: 1. metastatic well differentiated adenocarcinoma. 2. chronic cholecystitis and cholelithiasis. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the surgery service at for surgical evaluation of your biliary obstruction. you have done well in the post operative period and are now safe to return home to complete your recovery with the following instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. please call your doctor or nurse practitioner if you experience the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. followup instructions: please call dr. office at ( if you have any questions or concerns. . please follow up with your pcp 2 weeks after discharge procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine cholecystectomy other gastroenterostomy without gastrectomy other cholangiogram other percutaneous procedures on biliary tract open biopsy of small intestine choledochoenterostomy diagnoses: acute kidney failure, unspecified acquired coagulation factor deficiency hyposmolality and/or hyponatremia hypopotassemia hypotension, unspecified loss of weight calculus of gallbladder with other cholecystitis, without mention of obstruction hypovolemia cholangitis obstruction of bile duct other malignant neoplasm without specification of site other alteration of consciousness secondary malignant neoplasm of other digestive organs and spleen unspecified disease of pancreas acquired hypertrophic pyloric stenosis secondary malignant neoplasm of small intestine including duodenum persistent vomiting 

Answer: The patient is high likely exposed to