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: pancreatic head mass obstructive jaundice major surgical or invasive procedure: whipple procedure laparoscopic staging with intraoperative ultrasound history of present illness: this very healthy 72-year-old gentleman presented to hospital recently with a number of weeks of progressive relatively painless jaundice. he initially presented to hospital on with obstructive jaundice x 10 days. he has had intermittent episodes of painless jaundice for the last 20 yrs, always resolving after a few days; he never sought evaluation for these, as they resolved after a few days. in , he had an episode in , at which time he had severe diffuse abdominal pain. the abdominal pain resolved after ~ 1 hour and his jaundice went away a few days after that. he has not had abdominal pain since that time. his jaundice recurred at the beginning of . he had a ct of his abdomen , which showed intra and extrahepatic biliary dilitation, pancreatic duct dilation. it also noted a cystic uncinate process mass and low attenuation in the pancreatic head. he underwent a mrcp which showed high grade biliary obstruction with a fluid multilobulated lesion in the pancreatic head. he underwent a repeat ercp on , with extension of prior sphincterotomy, however, again the biliary duct could not be cannulatedhe was worked up with an ercp which included a pancreatogram which showed a pancreatic ductal stricture. however, technical problems, due to a periduodenal diverticulum prevented a cholangiogram from being achieved. during this procedure, bleeding was incurred at the site and the patient was transferred to our institution for further management. follow-up ercp showed evidence of huge clot in this diverticulum and at the ampullary region and there was no possible way to perform another interrogation of the bile duct. the patient then had a significant gi bleed from this and was found to be extravasating from this area. an interventional radiology technique took place and was able to embolize the bleeding pancreaticoduodenal arcade vessels. once this was under control, we then sought to figure out why he was suffering from a well developed progressive deep jaundice from biliary obstruction. his bilirubin was in the 20 range. i performed a number of measures in the days preceding this operation including a ct scan with an angiogram, mri scan and an endoscopic ultrasound test. these were all equivocal in demonstrating a suspected tumor mass. however, they did show stricturing of the bile duct and in some cases, hyperenhancing tissue within the bile duct. there was still some concern that this was a benign process like stone disease but, for the most part, the evidence weighed towards a malignant process in that both the ducts were strictured. we also did a ca19-9 level which was over 2100 and his deep standing high bilirubin of 20 weighed against stone disease, particularly in the fact that he had no stones in his gallbladder or bile duct on ultrasound. past medical history: htn, atherosclerosis, gout, recurrent jaundice, hypothyroidism social history: lives in with his wife. in . 7 grandchildren. retired. wife has severe osteoporosis and chronic pain issues. no alcohol use. no tobacco or ivdu. family history: noncontributory physical exam: afebrile, avss. a+o x 3 cv: rrr chest: lungs clear bilat. abd: +bs, nt, nd pertinent results: 10:15am blood wbc-5.2 rbc-3.91* hgb-13.0* hct-36.5* mcv-93 mch-33.2* mchc-35.6* rdw-16.6* plt ct-286 04:00am blood wbc-4.8 rbc-2.20*# hgb-7.1*# hct-21.3*# mcv-97 mch-32.4* mchc-33.5 rdw-17.2* plt ct-267 05:43am blood wbc-6.2 rbc-3.35* hgb-10.5* hct-28.7* mcv-86 mch-31.3 mchc-36.5* rdw-16.9* plt ct-216 11:15am blood wbc-10.3 rbc-2.95* hgb-9.5* hct-28.6* mcv-97 mch-32.1* mchc-33.1 rdw-15.8* plt ct-441* 01:15am blood glucose-153* urean-26* creat-1.3* na-140 k-3.7 cl-104 hco3-25 angap-15 06:55am blood alt-290* ast-145* alkphos-531* totbili-21.7* 01:15am blood alt-84* ast-60* alkphos-212* amylase-20 totbili-18.3* 10:15am blood lipase-150* 01:15am blood lipase-25 01:15am blood calcium-8.3* phos-3.1 mg-2.9* . trancatheter embolization 8:41 am medical condition: 72 year old man with acute bleeding at site of pre-cut sphincterotomy (ampulla). now has melena, bp was 60 now 90 after 3 units. getting ffp for inr of 1.6, platelets normal. needs angiography. impression: successful embolization of pancreaticoduodenal branches supplying the abnormal focus in the periampullary / mid descending duodenum, as above. . cta abd w&w/o c & recons 12:46 pm impression: 1. marked intrahepatic and central bililary ductal dilatation without pancreatic ductal dilatatation and without a definite pancreatic mass. subtle differential enhancement in the region of the abrupt caliber change of the cbd may be further evaluated with endoscopic ultrasound or repeat ercp. 2. outpouching adjacent to medial duodenum likely representing diverticulum, however given reported history, cannot exclude small contained duodenal perforation. 3. proximal ascending aortic aneurysmal dilation, up to 5.1 cm in diameter. 4. splenic infarcts. . mrcp (mr abd w&w/oc) 9:15 pm impression: 1. marked intra and extrahepatic biliary ductal dilatation. while no filling defects are demonstrated in the visible portion of the duct, the distal duct, including the portion at the ampulla, are obscured by susceptibility artifact and therefore cannot be evaluated. 2. minimal dilation of the pancreatic duct at the head and neck, with a cluster of cysts in the pancreatic head. 3. hepatic cysts. 4. bilateral renal cysts. 5. gallstones. . liver or gallbladder us (single organ) 10:04 am impression: 1. marked intrahepatic biliary ductal dilatation, without focal lesions seen. 2. dilated gallbladder without stones. 3. a 13 mm simple cyst. . echo study date of conclusions: the left atrium is mildly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. impression: mild symmetric left ventricuclar hypertrophy with normal cavity size and preserved global biventricular systolic function. dilated thoracic aorta. mild aortic regurgitation. mild-moderate mitral regurgitation. these findings are c/w hypertensive heart. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . brief hospital course: he was transferred to for a repeat ercp, which he underwent . this revealed fresh clot in the duodenum with oozing at the major papilla. epinephrine was applied to the site with successful hemostasis. he is now being transferrred to the general medical service for further management. he notes 3 episodes of maroon stool today (small amount). no abdominal pain, nausea, vomiting. (+) diffuse pururitis. no fevers, chills 1) obstructive jaundice: s/p 3 failed ercps - concern for possible pancreatic neoplasm given uncinate cyst/heterogeneous pancreatic head cea was 1.3 and ca -9 was 2123 . 2) rectal bleeding: suspect this is secondary to bleeding from sphincterotomy site, as visualized on endoscopy (s/p epi). he received 7 u of prbc, 2 u ffp. went into a-fib with rvr, started on dilt gtt, now off and was converted to nsr with diltiazem . 3) htn: continue lisinopril; hold atenolol for now . 4) gout: continue allopurinol . 5) hypothyroidism: continue levothyroxine . 6) f/e/n: clear liquids for now, npo after mn . 7) ppx: pneumoboots = = = = = = = = = = = = = = = = = = = ================================================================ surgery was then consulted and a cta was ordered on showing - marked intrahepatic biliary ductal dilatation; 1.5 cm cystic structure in left hepatic lobe, adjacent to the middle hepatic vein branch; marked dilatation of the central bile duct and cystic ducts with abrupt narrowing just proximal to the level of the ampulla; no pancreatic ductal dilatation; no obstructing mass in pancreas; small, cystic mass in the uncinate process; pancreas is normal, without peripancreatic inflammatory changes. ruq us - marked intrahepatic biliary ductal dilatation, without focal lesions seen. dilated gallbladder s stones. a 13 mm simple cyst. eus - dilated bile duct with hyperechoic intrinsic lesion - stone versus cholangiocarcinoma. on he went to the or for a whipple procedure. post-operatively he followed the whipple pathway. post-op hypotension. he had a bp of 82/50 in the pacu on pod 0. he received a post-op fluid bolus and responded well. post-op hyperglycemia: he initially had some elevated blood sugars. this was treated with an insulin sliding scale. gi/abd: he was npo with ivf and a ngt. per the pathway, his ngt was removed on pod 3 and his diet was slowly advanced over the next few days. his incision was c,d,i with no redness or signs of infection. a jp amylase was tested on pod 6 and this was 3800. the drain was removed on the evening of pod 7 because it was a low output leak. shortly thereafter he began developing intense abdominal pain and exhibited peritoneal signs in the rlq. a ct was obtained the next morning and showed a large perianastomotic fluid collection, and additional marked stranding and fluid within the right lower quadrant. he continued to have pain to the rlq. another ct was obtained on and showed stable appearing collection and clinically his pain improved and vs continued to be stable. we decided to watch and wait and allow his body to absorb this fluid. he continued to improve without incident and was tolerating a regular diet. the staples on his incision were removed prior to discharge. pain: he was started on an epidural for pain control. he was then switched to a pca and eventually po narcotics for pain control. post-op shortness of breath: he complainded of sob on pod 4. an ekg and cxr were negative. he was slightly fluid overloaded with crackels at the bases. he received iv lasix with good effect and relief of his sob. he received an additional 10mg iv lasix on pod 5 with good diuresis. he continued to have +2 le edema. he received 20 mg iv lasix on pod 7. pathology: adenocarcinoma, pt3 - no lymph node involvment, margins uninvolved by invasive carcinoma. medications on admission: atenolol 50mg daily lisinopril 20mg daily levothyroxine 112mcg daily zocor hctz allopurinol asa 325 mg daily discharge medications: 1. metoclopramide 10 mg tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. dilaudid 2 mg tablet sig: one (1) tablet po q4h prn as needed for pain. disp:*30 tablet(s)* refills:*0* 4. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*0* discharge disposition: home with service facility: vna assoc. of discharge diagnosis: pancreatic head mass cbd obstruction atrial fibrilation gi bleed s/p ercp (sphinctorotomy site) post-op shortness of breath pancreatic leak abdominal pain discharge condition: good tolerating diet pain well controlled. discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomitting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomitting, 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. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . please resume all regular home medications and take any new meds as ordered. . continue to amubulate several times per day. followup instructions: provider: , md phone: date/time: 9:45 please follow-up with dr. in 2 weeks. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine radical pancreaticoduodenectomy cholecystectomy arteriography of other intra-abdominal arteries other endovascular procedures on other vessels endoscopic retrograde cholangiopancreatography [ercp] diagnoses: abdominal pain, unspecified site coronary atherosclerosis of native coronary artery unspecified essential hypertension unspecified acquired hypothyroidism gout, unspecified atrial fibrillation hemorrhage complicating a procedure obstruction of bile duct chronic cholecystitis malignant neoplasm of other specified sites of pancreas shortness of breath 

Answer: The patient is high likely exposed to