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: anorexia, weight loss for 1 year, recurrent cholangitis with history of bile duct injury. major surgical or invasive procedure: exploratory laparotomy, extensive adhesionolysis, open cholecystectomy, central bile duct excision, roux-en-y hepatoicojejunostomy, feeding j tube placement history of present illness: 66-year-old gentleman has suffered from polio all of his life and has significant scoliosis. more importantly, however, he suffered a traumatic injury to the right upper quadrant from a motor vehicle accident 30 years ago. the specifics of that operation were available to me from his original surgeon, dr. , at hospital. at that time, mr. had a significant right upper quadrant dissociation that involved a duodenal laceration, a hepatic laceration, and a complete transection of the common bile duct. his portal vein and hepatic artery remained intact. in the process of that operation, he coded on the table, and a salvage drainage procedure for his biliary system was performed. this consisted of a cholecystoenterostomy with a downstream enteroenterostomy (omega loop). mr. has done well through the years, but this summer presented with fatigue, malaise, and evidence of active cholangitis. he was quite ill and recovered from this, but required a tracheostomy, as well as bilateral percutaneous transhepatic drainage tubes. he was subsequently transferred to the in the middle of the summer for definitive management of his biliary problem. it was found, at that point, that he had evidence of high strictures in the hilum of the common hepatic duct at the takeoff of each of the right and left sides. furthermore, it was unclear if there was downstream strictures of his biliary drainage conduits, because there was extreme distortion and dilation of all its components including the bowel. after extensive investigations and preparation in our system over a 2 month period, it was decided to definitively operate on mr. . he had multiple attacks of cholangitis and this persisted even with the tube drainage on a couple of occasions. we were unable to provide better nutrition through tpn or tube feeds, in that his insurance company would not allow for this approach. therefore, for a 2 month period, we had to rely on his own oral intake to gain back weight for this chronically malnourished gentleman. finally, we were ready to proceed, and on , we went to the operating room with the intention of an exploration of the right upper quadrant and definitive resection of the gallbladder, common bile duct, and repair with a roux-en-y hepaticoenterostomy. past medical history: 1. motor vehicle accident in with hepatic laceration, biliary tree disruption and pancreatitis 2. status post thoraco-abdominal repair of an extensive liver laceration and he had a repair of the lacerated duodenum with debridement of his pancreas and drainage and a cholecystojejunostomy with a jejunojejunostomy in . 3. history of right leg fracture 4. polio at age seven with initial total paralysis, iron lung, quadraparesis 5. recurrent cholangitis 6. t2-t9 fusion 7. chronic malnutrition 8. scoliosis social history: lives with wife, non , non drinker family history: non contributory physical exam: general: emaciated male in no apparent distress head and neck: pupils were equally round and reactive to light. extraocular muscles and movements were intact. lungs: breath sounds were noted to be decreased at the right base. cardiovascular: normal s1 and s2, regular rate and rhythm without murmurs, rubs or gallops. abdominal examination: positive bowel sounds. soft, nontender musculoskeletal examination: within normal limits. neurologically intact throughout. pertinent results: 1. gallbladder (a-b): a. chronic active cholecystitis. b. small intestinal mucosa at opened end, with chronic inflammation. c. no tumor. 2. bile duct (c-f): a. chronic active cholangitis, with fibrosis, diffuse. b. no tumor. 3. jejunal loop (g-n): segment of small intestine, within normal limits. : small bowel follow through: impression: high-grade partial small bowel obstruction affecting the proximal jejunum. this is likely caused by the percutaneous j-tube or an adhesion. : t tube cholangiogram: 1. patent outflow from the intrahepatic ducts with rapid drainage into the anastomosis and through the anastomosed small bowel loop. 2. position of the sidehole of the left-sided biliary drain under the skin with leakage into the dressing. removal of this tube since it now does not have any more function, and the junction between the liver and anastomosed small bowel is widely patent. ct abdomen : impression: 1) compared to the pre-operative ct exam of , there is a new intraperitoneal air/fluid collection in the prior location of segments 8 and 4a of the liver. this raises concern for liver necrosis in this region. given the disproportionate amount of air within this collection, and the proximity of the collection to the adjacent air- filled bile ducts there is concern for communication between the intrahepatic ducts and the collection. a nuclear hida scan could be helpful in demonstrating communication with the biliary tree. 2) markedly dilated roux limb, as described above, consistent with an obstruction at the level of a surgical anastomosis. 3) new bilateral pleural effusions with adjacent bibasilar consolidations. please correlate clinically, as these findings could represent pneumonias bilateral upper and lower extremity ultrasounds : impression: no deep venous thrombosis within the right common femoral, superficial femoral, deep femoral, or popliteal veins. impression: no deep venous thrombosis in the right jugular, subclavian, axillary, brachial, and basilic veins. upper gi : impression: markedly distended loop of proximal small bowel, including duodenum, and possibly a portion of proximal jejunum. a small amount of contrast passage to normal appearing small bowel is seen distally. there is no opacification of the afferent loop. these findings are indicative of functional or partial small bowel obstruction, possibly located at the jejunojejunostomy site. discharge labs: wbc-7.3 rbc-3.09* hgb-9.6* hct-29.6* mcv-96 mch-31.2 mchc-32.5 rdw-15.1 plt ct-314 glucose-83 urean-23* creat-0.4* na-141 k-4.0 cl-98 hco3-40* angap-7* alt-19 ast-27 alkphos-257* totbili-0.3 lipase-42 calcium-8.9 phos-1.9* mg-2.0 brief hospital course: the patient was admitted ot the surgical intensive care unit after the surgical procedure. refer to surgical dictation for full details. the patietn tolerated the procedure well, had an estimated blood loss of 1400 cc and received 1875 in packed red blood cells as well as 642 cc of fresh frozen plasma. the patient was maintained on a ventilator on post operative day 1 and was receiveing unasyn. his post operative hematocrit was 29.9, and the remainder of his laboratory evaluation was within normal limits. drainage from his two jp tubes as well as his t tubes were recorded. the patient required a 1 liter fluid bolus on post operative day 1 for decreased blood pressure. his ventilator was weaned on post operative day 1. on postoperative day 2 the patients perioperative antibiotics were scheduled to be stopped and half strength tube feeds were begun. these were subsequently advanced toward goal on post operative day 3. diuresis was begun to aid in vent weaning, and a spontaneous breathing trial resulted in tachypnia and shallow breaths. nutrition services was consulted given the patients chronically malnourished state. the patient was transitioned to trach collar during the day and ventilator at night by post operative day 4, and then was transitioned to trach mask. his ng tube was discontinued on post operative day 5. the patient was also evaluated by physical therapy at this point to help in recovering function in his deconditioned state. by post operative day 6 the patient was doing well and was transferred to the floor. on post opeartative day 7 the patient developed repeated vomiting followed by unresponsiveness. the patient was gien phenergan and morphine during this time period. when the patient was unresponsive, the patient continued to have oxygen saturation in 97% with one transient decrease to 87-90%. the patient was placed on a vent mask, and received narcan, and awoke and followed commands. the patient was subsequently transfered back to sicu, an ng tube was placed and the tube feeds were stopped. he was placed back on the ventilator and was started on levofloxacin and flagyl for pneumonia. the patient spiked a fever on post operative day 7 to 101.6 and was pan cultured for this. the patient also had some low blood pressure and tachycardia and was bolused with iv fluid. tpn was started on the patient as the tube feeds continued to be held. the patient received aggressive pulmonary toilet and received further fluid boluse on post operative day 8 for decreased urine output. a small bowel follow through demonstrated partial small bowel obstruction. the left ptc was pulled and tube feeds wer restarted on post operative day 9. the ventilator was weaned on post operative days 9 and 10, however the pressure support was eventually increased secondary to low tidal volumes and increased respiratory rate. the patient was passing flatus at this point. the ptc was discontinued on post operative day 12, tube feeds were advanced, and tpn was stopped. he failed a ng tube clamping trial on post operative day 13 secondary to high residuals. the patient was transfused one unit of packed red blood cells for a low hematocrit on post op day 14. he also required further fluid bolus for low blood pressure. he was weaned from the vent however and tolerated trach mask for 12 hours. the trach was changed on post op day 16. he continued to be on antibiotics at this point for a total 14 day course. by post operative day 17 the patient had tolerated better than 24 hours of continuous trach mask trials. the patient was transferred to the floor on post operative day 19 with a continued nasogastric tube in place. the patient was having loose stools at this point but continued to have high ng residuals and the possibility of and afferent loop syndrome or proximal stricture were entertained, given a dilated roux limb on imaging and a question of narrowing at the j j junction. the patient had an endoscopy on . there was a question of a stricture in one of the jejunal limbs but it could not be dilated. a repeat egd on the 13th demonstrated no signs of obstruction in either limb. his ng tube was removed by post operative day 21. he was was recovering well and by post operative day 21 the patient was ambulating around the halls, had good pain control. he was kept npo and continued to get his tube feeds via a j tube. he continued to pass flatus and stool. the patient was given sips of clears on post op day 23. the patient was advanced to clears on post operative day 24 and his diet was subsequently advanced. tube feeds were decreased and set up to be run only at night. case management reviewed the case and plans were made for discharge with home services. he was doing well and was discharged on in stable condition. medications on admission: protonix, cipro, flagyl discharge medications: 1. percocet 5-325 mg tablet sig: 1-2 tablets po every six (6) hours. disp:*100 tablet(s)* refills:*0* 2. lorazepam 0.5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. disp:*50 tablet(s)* refills:*0* 3. metoclopramide hcl 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). disp:*100 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: -severe malnutrition -hypotension/hypovolemia requiring fluid bolus -blood loss anemia requiring transfusion -aspiration pnuemonia -ventilatory failure -small bowel obstruction/ileus -post operative fever -status post exploratory laparotomy, extensive adhesionolysis, open cholecystectomy, central bile duct excision, roux-en-y hepatoicojejunostomy, feeding j tube placement -motor vehicle accident in with hepatic laceration, biliary tree disruption and pancreatitis -status post thoraco-abdominal repair of an extensive liver laceration and he had a repair of the lacerated duodenum with debridement of his pancreas and drainage and a cholecystojejunostomy with a jejunojejunostomy in . -history of right leg fracture -polio at age seven with initial total paralysis, iron lung, quadraparesis -recurrent cholangitis -t2-t9 fusion discharge condition: good discharge instructions: maximize food intake. followup instructions: patient to call and make appointment to be seen by dr. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy other endoscopy of small intestine enteral infusion of concentrated nutritional substances arterial catheterization cholecystectomy other lysis of peritoneal adhesions removal of t-tube, other bile duct tube, or liver tube transfusion of packed cells other cholangiogram anastomosis of hepatic duct to gastrointestinal tract excision of other bile duct diagnoses: other iatrogenic hypotension unspecified protein-calorie malnutrition depressive disorder, not elsewhere classified constipation, unspecified hemorrhage complicating a procedure pneumonitis due to inhalation of food or vomitus other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obstruction of bile duct tracheostomy status chronic cholecystitis biliary cirrhosis other specified disorders of gallbladder personal history of poliomyelitis late effects of motor vehicle accident acquired hypertrophic pyloric stenosis late effect of internal injury to intra-abdominal organs 

Answer: The patient is high likely exposed to