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: osh transfer for ugib major surgical or invasive procedure: egd history of present illness: yo m with a history of afib on coumadin, ckd, and dchf who presents with 2 days of weakness and shortness of breath complained of bloody stools x2 on and abdominal cramping. he was admitted to osh on , with a hct of 15.5. he had guaiac positive black stools. he was given 5mg vitamin k an inr of 4.0 and started on a protonix gtt. he was transferred to osh icu. in icu she had 500cc brown emesis. ngt placed and put out 2300cc fluid. she received 5 units rbcs and 3u ffp. repeat hct after transfusions was 17.5 with inr of 2.5. . bps were 80s/40, so he was started on levophed today at 3:30pm. vitals prior to transfer were bp 111/45 hr 109. he continues to have melenotic stools. his 6th unit of prbcs was hanging on transfer. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: ckd stage 3 htn chf -diastolic hypothyroidism paroxysmal afib bph gout venous stasis l hip fracture 1 year ago social history: he is the sole caregiver of his wife who has dementia. - tobacco: none - alcohol: none family history: nc physical exam: admission exam: vitals: t: bp:127/68 p: 106 r: 18 o2: 98% on ra general: alert, ng tube in place, breathing comfortably heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 08:14am pt-19.4* ptt-33.0 inr(pt)-1.8* 08:14am plt count-193 08:14am wbc-14.1* rbc-2.37* hgb-7.3* hct-20.1* mcv-85 mch-30.6 mchc-36.1* rdw-17.7* 08:14am calcium-7.3* phosphate-3.6 magnesium-2.5 08:14am ck-mb-4 ctropnt-0.06* 08:14am alt(sgpt)-14 ast(sgot)-18 ld(ldh)-160 ck(cpk)-79 alk phos-46 tot bili-1.6* 08:14am glucose-146* urea n-108* creat-2.4* sodium-151* potassium-4.0 chloride-113* total co2-27 anion gap-15 10:51am freeca-0.98* 10:51am lactate-4.3* 10:51am type-art ph-7.36 10:54am plt count-144* 10:54am wbc-12.5* rbc-2.32* hgb-7.1* hct-19.5* mcv-84 mch-30.7 mchc-36.6* rdw-17.5* 10:58am freeca-0.96* 10:58am o2 sat-97 10:58am lactate-3.0* 10:58am type-art temp-36.6 rates-16/0 tidal vol-500 peep-5 o2-60 po2-240* pco2-36 ph-7.50* total co2-29 base xs-5 intubated-intubated vent-controlled . discharge labs: 146 110 35 ------------< 107 3.4 27 1.8 . 6.0 > 9.2/27.4 < 199 . inr 1.2 . studies: cxr : the tip of the endotracheal tube terminates 6.6 cm above the level of the carina. the nasogastric tube tip is in the stomach. the lungs are clear. there is no vascular congestion or pleural effusions. the cardiac silhouette is moderately enlarged. tortuosity of the aorta is noted. the remainder of the mediastinal and hilar contours are normal. there is no pneumothorax. impression: 1) standard position of support devices. 2) moderate cardiomegaly and tortuosity of the aorta. 3. no pneumonia or pulmonary edema. . ct torso, noncontrast : 1. lobulated mass extending from the pylorus, into the first portion of the duodenum; however, it is unclear whether this mass originates from the pylorus, or the duodenum. no obstruction to oral contrast transit. 2. numerous regional lymph nodes, none of which necessarily meet ct criteria for enlargement, but the number of these nodes is concerning for local metastatic disease. slight stranding of the adjacent mesenteric fat. no signs, however, of distant metastatic foci, although solid organs, such as the liver, are limited in evaluation. 3. cardiomegaly, coronary artery disease, and aortic atherosclerosis. . transthoracic echocardiogram : the left atrium is normal in size. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: poor technical quality study. left ventricular function is probably normal, a focal wall motion abnormality cannot be fully excluded. at least moderate tricuspid regurgitation with moderate pulmonary artery systolic hypertension. . egd : contents: coffee ground heme was seen in the fundus and stomach body. food was found in the stomach body and fundus. protruding lesions a large fungating mass of malignant appearance with friability and stigmata of recent bleeding was found at the pylorus. the scope traversed the lesion easily. cold forceps biopsies were performed for histology at the pyloric mass. duodenum: normal duodenum. impression: blood in the fundus and stomach body food in the stomach body and fundus mass in the pylorus (biopsy) otherwise normal egd to third part of the duodenum recommendations: mass with stigmata of recent bleeding. no blood or bleeding post-pylorus. f/u bx results. cont supportive care w blood and inr reversal. suggest ct scan and surgical consult. . pyloric mass biopsy : adenocarcinoma, at least intramucosal, arising in a background of low and high grade dysplasia. note: no submucosal tissue is present. stain is negative for h. pylori. brief hospital course: hospital course mr. is a pleasant yo male with a history of paroxysmal atrial fibrillation on coumadin, hypertension, diastolic heart failure, who was transferred from osh with a large volume gi bleed, attributed to a bleeding pyloric mass identified as adenocarcinoma. the patient was discharged with general surgery and oncology follow-up to discuss further treatment plan. . active issues: # upper gi bleed/pyloric adenocarcinoma: he initially presented to osh with weakness and fatigue and was found to have a hematocrit of 15.5. he had further hematemesis in their icu and had a minimal hematocrit response to 5 units prbc. he was hypotensive on pressors and transferred to , where he maintained his hemodynamic stability and pressors were weaned. he was intubated for airway support prior to egd. his admission hematocrit was 20.1. he received 4 units prbc with an appropriate rise. he was continued on iv ppi infusion and did not require pressors. gi team performed upper endoscopy which revealed a large fungating pyloric mass with stigmata of recent bleeding, and retained food products in the stomach suggesting possible gastric outlet obstruction. biopsies were taken but no hemostatic procedure was done. surgery was consulted. ct torso without contrast showed this pyloric mass with possibly enlarged lymph nodes nearby, but no widespread metastatic disease. as his hematocrit remained stable, no emergent surgery was performed overnight on hd1. he was extubated on hd2. discussion with his family yielded a dnr code status change. biopsy result returned as adenocarcinoma. after discussing diagnosis with patient, family, and surgery team, will stay current course of supportive therapy. if he bleeds again, he will require surgery or interventional radiology itnervention. his hematocrit was stable for the duration of his hospitalization. plan for follow-up with oncology and general surgery for discussion of management. . # hypotension: he was hypotension on admission secondary to acute blood loss but was aggressively resuscitated with fluids and blood products. required several fluid boluses on hd2 for borderline low blood pressures to 90s systolic, though hct was stable. his hydralazine and amlodine were discontinued. lasix was down titrated. . # right arm swelling: etiology unclear. upper extremity ultrasound revealed a non-occlusive thrombus in the right cephalic vein which did not extend to the axillary vein and no evidence of deep vein thrombosis. appearance likely to be thrombophlebitis superinfection. mr. was started on a 10 day course of kephlex with significant improvement in edema at the time of discharge. . inactive issues # diastolic heart failure: outpatient cardiologist echo showing ef=50% with evidecne of diastolic dysfunction. he became progressively edematous by hd3 due to fluid/blood resuscitation. wound care was consulted to help manage lower extremity edema which was treated with aquafor ointment and kerlex wraps. his peripheral edema was improving at the time of discharge. no ulcers on exam. his lasix had been held on admission and was restarted at a lower dose than home dose. . # atrial fibrillation: has paroxysmal atrial fibrillation. coumadin was held. he was started on low dose metoprolol tartrate 12.5 on due to rvr to 120s and hypertension. metoprolol succinate on discharge. . # hypertension: developed bp to 160s-180s on hd3, felt to be related to fluid overload. . # hypothyroidism: continue synthroid . # ckd: creatinine stabilized. . transitional issues # follow-up: general surgery, hematology oncology, primary care # disposition: home with nursing care was suggested for managment of significant medication changes and peripheral edema. mr. and his family strongly objected to home nursing; they agreed to arrange their own services if needed. # code status: do not rescussitate, but do intubate medications on admission: amlodipine 2.5mg po daily lasix 120mg po qd lasix 80mg po qhs hydralazine 50mg po bid synthroid 25mg po daily warfarin 5mg po daily allopurinol 300mg po daily amlodipine 2.5mg po daily discharge medications: 1. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 2. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 3. lasix 20 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*2* 4. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 5. cephalexin 500 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 6 days. disp:*12 capsule(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. aquaphor ointment sig: one (1) topical three times a day. disp:*1 tube* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: upper gi bleed gastric adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for management of large volume gastrointestinal bleeding in our intensive care unit. you were transfused packed red blood cells. an upper endoscopy demonstrated a large mass in your stomach. biopsy revealed a gastric cancer. your coumadin was stopped in the setting of your bleed and your bleeding ultimately stopped. you will have close follow-up with oncology and surgery for ongoing management. . you were started on antibiotic therapy for a skin infection on your right arm that continued to improve throughout your hospital stay. please continue this medication for six more days. . your blood pressure was noted to be low, and your heart rate was higher than normal, therefore multiple changes were made to your medication list. it will be important for your to follow-up with all of your physicians to discuss these changes. . the following changes were made to your medication list. 1. stop coumadin 2. stop aspirin 3. stop amlodipine 4. stop hydalazine 5. decrease lasix to 60mg twice daily 6. start pantoprazole 40mg twice a day 7. start metoprolol succinate 25mg daily 8. start cephalexin for six more days . your family opted to provide home services for further managment of your care. followup instructions: name: np (works with dr location: family practice address: ., lunenberg, phone: appt: at 11:30am . name: , md dept: surgery/critical care medicine address: , , ma phone: appt: we are working on an appt for you within the next few weeks. dr office will call you at home with an appt. if you dont hear from them by thursday, please call the office directly to book. . department: hematology/oncology when: friday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation chronic kidney disease, stage iii (moderate) acute respiratory failure hypotension, unspecified blood in stool cellulitis and abscess of upper arm and forearm long-term (current) use of anticoagulants phlebitis and thrombophlebitis of superficial veins of upper extremities hyperosmolality and/or hypernatremia chronic diastolic heart failure venous (peripheral) insufficiency, unspecified acquired hypertrophic pyloric stenosis malignant neoplasm of pylorus 

Answer: The patient is high likely exposed to