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: bright red blood per rectum major surgical or invasive procedure: central venous line placement right radial arterial catheter placement endotracheal intubation colonic arteriography via right femoral artery colonoscopy history of present illness: the patient is a 64 year old male with history of gerd who recently discontinued omeprazole presented to the ed with complaints of bright red by rectum at 1pm one the afternoon of admission. according to the patient, he had been in his usual state of good health until the the day of admission when he had six episodes of bright red blood per rectum. he states that the first episode was a "gush" of blood which "filled the toilet bowl", following that he had five more bowel movements which he initially described as diarrhea but acknowledged that is was mostly blood. he had never had similar episodes. he took two tablets of alieve two days before admission for hip pain but stated that he did not regularly take nsaids. his last colonoscopy was in at and he reported that it was normal. past medical history: gastroesophageal reflux erectile dysfunction social history: born in . he is seperated from his wife and has 5 daughters. his brother lives in and is involved in his care. he is a never smoker and drinks 1-2 beers 1-2x/week. denies illicit substances. family history: denies family history of gastrointestinal malignancy, cardiovascular disease, diabetes or malignancy. physical exam: admission exam vs: t 98.2 p:84 116/54 o2 sat 100%, vent settings assist control vt 500x16 fio2 100% general: sedated intubated male not responsive to commands or painful stiumuls heent: sclera anicteric, mmm, et tube in place, pupils 1mm and non-reactive neck: right cvl in place c/d/i 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 normoactive, no organomegaly gu: foley in place rectal: frank blood oozing from rectum ext: warm, well perfused, right groin access site c/d/i. pulses 2+ in pt and dp vs: 98.1 136/72 68 20 100% gen: well-appearing male of stated age, nad heent: ncat mmm eomi pulm: cta b/l without noted wheeze or rhonchi cor: rrr (+)s1/s2 abd: soft, mild distention, non-tender to palpation, active bs le: no le edema, distal pulses 2+ neuro: cnii-xii grossly intact, moving all extremities pertinent results: admission labs ============== 05:22pm blood wbc-9.0 rbc-4.23* hgb-13.1* hct-38.3* mcv-91 mch-31.0 mchc-34.2 rdw-13.2 plt ct-237 05:22pm blood neuts-65.3 lymphs-28.2 monos-3.9 eos-2.1 baso-0.5 05:22pm blood glucose-141* urean-20 creat-1.1 na-138 k-3.8 cl-104 hco3-25 angap-13 03:40am blood calcium-7.2* phos-3.0 mg-1.9 . hematocrit trend ================ . 05:22pm blood wbc-9.0 rbc-4.23* hgb-13.1* hct-38.3* mcv-91 mch-31.0 mchc-34.2 rdw-13.2 plt ct-237 11:33pm blood hgb-8.5* calchct-26 03:40am blood wbc-8.7 rbc-3.36* hgb-10.4* hct-29.8* mcv-89 mch-31.1 mchc-35.0 rdw-13.7 plt ct-149* 08:12am blood hct-30.8* 01:43pm blood wbc-14.4*# rbc-3.61* hgb-11.0* hct-32.1* mcv-89 mch-30.6 mchc-34.3 rdw-13.9 plt ct-150 08:41pm blood wbc-unable to rbc-unable to hgb-unable to hct-unable to mcv-unable to mch-unable to mchc-unable to rdw-unable to plt ct-unable to 09:29pm blood wbc-14.9* rbc-3.52* hgb-10.8* hct-31.3* mcv-89 mch-30.6 mchc-34.4 rdw-13.8 plt ct-159 03:10am blood wbc-9.9 rbc-3.23* hgb-9.9* hct-28.8* mcv-89 mch-30.7 mchc-34.4 rdw-13.9 plt ct-152 07:37am blood hct-30.2* 04:44pm blood wbc-8.5 rbc-3.29* hgb-10.0* hct-29.1* mcv-89 mch-30.5 mchc-34.5 rdw-13.7 plt ct-162 11:23pm blood hct-27.8* 03:30am blood wbc-8.1 rbc-3.27* hgb-10.1* hct-29.1* mcv-89 mch-31.1 mchc-34.8 rdw-13.8 plt ct-155 03:30pm blood hct-30.4* 05:50am blood wbc-7.0 rbc-3.27* hgb-10.2* hct-29.6* mcv-91 mch-31.2 mchc-34.5 rdw-13.7 plt ct-202 . discharge labs =============== . 05:50am blood wbc-7.0 rbc-3.27* hgb-10.2* hct-29.6* mcv-91 mch-31.2 mchc-34.5 rdw-13.7 plt ct-202 05:50am blood glucose-117* urean-8 creat-0.7 na-145 k-3.9 cl-111* hco3-25 angap-13 03:30am blood calcium-8.5 phos-2.8 mg-2.1 . cta abdomen (): arterial extravasation in the ascending colon, just proximal to the hepatic flexure, compatible with active gi bleeding. small hiatal hernia with fluid in the distal esophagus. left adrenal adenoma. . colonoscopy (): diverticulosis of the whole colon. otherwise normal colonoscopy to terminal ileum. due to only fair prep, which was inadequate, would recommend repeat colonoscopy within the next 1 year. brief hospital course: a 64 year old male with pmh gerd presents with bright red blood per rectum and found to have active extravasation of blood into the colon. . acute issues #lower gi bleed in the ed, initial vital signs were stable, and by report, patient was well-appearing and asymptomatic. a cta abdomen revealed active extravasation in the ascending colon. prior to being transported from the er, the patient was noted to have systolic pressures in the 60-70s, and was fluid resuscitated and transfused with packed red blood cells. in interventional radiology, the source of the bleeding could not be identified despite the cta, but due to deteriorating vital signs, the patient was electively intubated and transported to the micu for further volume resuscitation. in the micu, the patient required pressors for a brief time to support his pressure, but was easily weaned soon after arrival. over the course of his er and micu stay, the patient required a total of 4 units of prbcs. by morning, the patient was stable, thus extubated without additional signs of bleeding. his hematocrit was trended, and stabilized around 30%. the patient had a colonoscopy performed at osh 5 years before this admission, which revealed extensive diverticular disease throughout the colon. no polyps were identified at the time. because of the nature of the bleed, it was thought that this was most likely lower gi in origin, and most likely from a diverticular source. gi had been consulted in the er and agreed that the pattern of bleeding was consistent with . they deferred on performing a colonscopy during the acute bleeding phase for concern of poor visualization in the setting of bleeding. the patient was transferred to the general medicine floor and his hematocrits continued to be trended, and remained stable around 30%. he had multiple small brown stools that had some red tinge, but there were no signs of active bleeding. on the day of discharge, the patient was taken for colonoscopy by gi who again noted extensive diverticular disease in the setting of only a fair prep, but did not identify a source of bleeding. gi recommended a repeat colonoscopy in one year's time. the patient was discharged with a follow-up appointment scheduled with his pcp in one week and explicit instructions to return to the er if additional bleeding occurred or the patient experienced lightheadedness or cv symptoms. . #suspected adrenal adenoma: the cta abdomen on demonstrated a 2.2 x 1.9 cm left adrenal nodule has hounsfield attenuation of -7.2, compatible with an adrenal adenoma. . transitional issues #patient was scheduled to follow-up in one week with his pcp # will require a repeat colonoscopy in one year per gi #patient will require follow-up of an adrenal incidentaloma medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. sildenafil 150 mg po daily:prn sexual activity 2. fish oil (omega 3) 1000 mg po daily discharge medications: 1. fish oil (omega 3) 1000 mg po daily 2. sildenafil 150 mg po daily:prn sexual activity discharge disposition: home discharge diagnosis: primary diagnoses: lower gi bleed diverticulosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted because you experienced bleeding from your gastrointestinal tract. the interventional radiology team was unable to locate where the bleeding was coming from. you were transferred to the icu because your blood pressure became unstable. your were stabilized and your bleeding was stopped, and you were then transferred to the floor. you underwent colonoscopy by the gi doctors who (outpuchings of the bowel wall), but no specific source of the bleeding. they recommended a follow-up colonoscopy in one year. please continue your home medications please use tylenol for pain relief, not ibuprofen/motrin or naproxen/aleve. please follow-up with your primary care doctor, an appointment has been made on your behalf. please find the details below. if you have additional episodes of bleeding or feel lightheaded or dizzy, please proceed to the er or contact your pcp for further evaluation. it's been a pleasure taking care of you, thank you for choosing ! followup instructions: adrenal adenoma: the ct scan we did of your abdomen on showed a mass in your adrenal gland that is likely an adrenal adenoma, which is a benign mass that are commonly found on these types of ct scans. this needs to be followed up as an outpatient however to make sure it is nothing worrisome. you should discuss this with your doctor at your outpatient follow up visit. name: , n. location: address: , , phone: appointment: tuesday 10:50am md procedure: colonoscopy arteriography of other intra-abdominal arteries diagnoses: esophageal reflux acute posthemorrhagic anemia other shock without mention of trauma diverticulosis of colon with hemorrhage benign neoplasm of adrenal gland 

Answer: The patient is high likely exposed to