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: abdominal pain major surgical or invasive procedure: ercp history of present illness: m w/ho gallstones presenting to the emergency department from an for likely cholangitis. patient reports having right upper quadrant and epigastric abdominal pain for the last 24-36 hours. at the outside hospital his initial vs were 96.8, 116/65, 65 16, 100ra, and he spiked a temp to 102.2 and he had an episode of nbnb emesis. his labs were notable for evated t. bili to 1.6 as well as elevated alkaline phosphatase. he was given 3g iv unasyn, morphine, zofran and md for likely cholangitis transferred. the patient has had ercp with sphincterotomy approximately a year ago. right upper quadrant ultrasound did demonstrate sludging and stones but no evidence of cbd dilatation or cholecystitis. also received tylenol at the osh for his fever. was initially stable here initial vs were: 99.5 65 130/53 18 98% ra. had increased o2 requirement and became hypotensive sbp 70s, got 1l at osh, 1.5l here. had rij put in 92/33, vpaced. rr 20 99%2l. started on norepi in ed, also vanc here. ercp fellow contact. do it in the morning. ffp will need to be given. on arrival to the micu, patient's vs were bp 77/53 (not on pressors), hr 65 vpaced, 20 97% 2l. he was mentating well with complaints of a slightly upset stomach and feeling like his speech was slurred from the pain medicaitons. he denied any abdominal pain currently, chest pain, shortness of breath, dizziness or lightheadedness. he reports recently trying a low fat diet. pt reports the pain comes on when he eats. review of systems: (+) per hpi (-) denies fevers, chills, dysuria, nausea, vomiting currently. past medical history: atrial fibrillation on coumadin htn cad hypercholastrolemia osa on cpap aaa repair pacemaker spinal surgery social history: no etoh or drug abuse. family history: not relevant to the current hospitalization physical exam: admission: vitals: 98.2 83/41 65 17 96% 2l nc general: alert, oriented, no acute distress, very comfortable-appearing heent: mmm, oropharynx clear, eomi, perrl neck: supple, no jvd cv: normal rate, reg ryhthm, +systolic murmur lungs: crackles at bases bilaterally abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aaox3, moves all extremities, gait deferred. discharge exam: t 99.2 hr 60 bp 130/64 rr 18 98% ra general: alert, oriented, no acute distress, very comfortable-appearing heent: mmm, oropharynx clear, eomi, perrl neck: supple, no jvd cv: normal rate, reg ryhthm, +systolic murmur lungs: crackles at bases bilaterally abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pitting edema le bilaterally, with scrotal edema (improving) neuro: aaox3, moves all extremities, gait deferred. pertinent results: admission: 09:45pm wbc-12.7* rbc-3.69* hgb-12.5* hct-37.0* mcv-100* mch-34.0* mchc-33.9 rdw-13.4 09:45pm neuts-91.6* lymphs-4.6* monos-3.5 eos-0.1 basos-0.2 09:45pm alt(sgpt)-207* ast(sgot)-556* alk phos-399* tot bili-3.1* 09:45pm lipase-18 09:45pm glucose-119* urea n-21* creat-1.1 sodium-140 potassium-3.8 chloride-103 total co2-25 anion gap-16 09:53pm pt-28.3* ptt-37.5* inr(pt)-2.7* ercp -impression: evidence of a previous sphincterotomy was noted in the major papilla. cannulation of the biliary duct was successful and deep with a balloon catheter using a free-hand technique. contrast medium was injected resulting in partial opacification. thick sludge was seen exuding out of the ampulla after cannulation. a mild diffuse dilation was seen at the main duct with the cbd measuring 10 mm. multiple stones ranging in size from 6 mm to 10 mm that were causing partial obstruction were seen at the main duct. given cholangitis, only limited contrast injection was made. given cholangitis and elevated inr, a 5cm by 10fr double pig tail biliary stent was placed successfully in the main duct. otherwise normal ercp to third part of the duodenum -recommendations: return to . npo overnight with aggressive iv hydration as tolerated with lr at 100-150 cc/hr. follow for response and complications. if any abdominal pain, fever, jaundice, gastrointestinal bleeding please call ercp fellow on call (). continue iv antibiotics. will need antibiotics for total of 2 weeks. can be transitioned to oral antibiotics prior to discharge. repeat ercp in 5 weeks for stent removal and extraction of stones. hold coumadinn for 5 days prior to ercp. urine culture-final no growth urine culture-final no growth brief hospital course: yo male with cad, afib, htn p/w hypotension requiring pressors in setting of likely cholangitis. active issues: #sepsis: pt was initially hypotensive despite fluid resuscitation and required bp support with norepinephrine. though his u/s is unchanged from prior study, in the setting of his fever, hypotension, and rising enzymes and bili, most likely cause is cholangitis. ercp on showed stones and some sludge. pt had stent placed but did not have sphincterotomy given elevated inr. pt had 1 of 4 bottles at osh growing pan sensitive e coli. pt was initially treated with iv vancomycin and unasyn. weaned off norepinephrine once his paced rate was increased from 65 to 85 bpm. wbc and lfts continued to down trend and normalized by the time of discharge. ua concerning for uti so pt was started ciprofloxacin po. vancomycin and unasyn were discontinued on given results of blood cultures and switched to po cipro at 750mg per ercp and pharmacy recs. he tolerated a regular diet and had complete resolution of his abdominal pain. pt needs repeat ercp in 5 weeks, and will need to hold warfarin 5 days prior to procedure. he will need a total of 14 days of oral antibiotics to treat the cholangitis. #hypotension: presumed sepsis in the setting of cholangitis. low cardiac output could also be contributing to the hypotension since his bp responded to increasing his paced rate to 85 from baseline 65. pt needed norepinephrine to support bp despite receiving fluids but was weaned off once his hr was increased. tte showed 45% lvef, markedly dilated ra, moderately dilated la. overall lv systolic function is mildly depressed (lvef = 45 %) secondary to pacemaker-induced dyssynchrony and to ventricular interaction, with a pressure/volume overloaded right ventricle. pt also had moderate to severe tricuspid regurgitation, moderate pulmonary artery systolic hypertension. these results indicate that he is preload dependent and requires to be hydrated optimally. on transfer to the floor, however, and on day of discharge to the , he was significantly volume overloaded with extensive le edema and scrotal edema. he was given lasix 40 mg iv over last 3 days to assist in getting rid of the extra fluid, and discharged on lasix 40 mg po daily. please continue to monitor his renal function and electrolytes with diuresis. # ? uti. ua with pyuria. pt asymptomatic but was started on ciprofloxacin (see above). urine cultures negative to date. #afib: paced rhythm (see above). on warfarin with therapeutic inr, pt was given ffp x 2 to correct coagulopathy but inr was 2.1 at time of ercp, so no sphincterotomy was performed. pt's rate was increased to 85 given hypotension by ep service and was reverted back to 60 by ep on discharge. he tolerated this reversion back to his baseline hr without any problems. the coumadin was restarted initially at 2.5 mg qhs and then 2 mg qhs on once his inr became therapeutic. #cad: continue statin. asa was initially held given plan for ercp but restarted aftewards given absence of sphincterotomy. carvedilol, enalipril, furosemide were all held due to hypotension. these medications can be resumed if his bp continues to be elevated. of note, the patient has not taken his furosemide in approximately 2 years because he feels he does not have swelling but his cardiologist is not aware. # urinary retention: due to significant scrotal and penile edema, a foley was placed in the icu. the foley needed to be performed by the urology - reportedly due to phimosis (likely from the extra swelling). mr. also has a history of urinary retention most consistent with bph. he was placed on flomax and should be continued.. once the extra fluid and edema is properly eliminated, the foley should be discontinued. #osa: continue cpap. #hld: continue statin. # communication: patient , wife # code: dnr/dni medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. calcium carbonate 1000 mg po daily 2. nexium *nf* (esomeprazole magnesium) 40 mg oral daily 3. enalapril maleate 5 mg po daily hold for sbp<100 or hr<60 4. warfarin dose is unknown po daily16 5. coreg cr *nf* (carvedilol phosphate) 30 mg oral daily 6. furosemide 40 mg po daily 7. vitamin d 1000 unit po daily 8. aspirin 81 mg po daily 9. clonazepam 0.25 mg po qhs:prn insomnia discharge medications: 1. aspirin 81 mg po daily 2. warfarin 2 mg po daily16 3. acetaminophen 650 mg po q4h:prn pain 4. albuterol 0.083% neb soln 1 neb ih q6h:prn wheezing/sob 5. ciprofloxacin hcl 500 mg po q12h 6. docusate sodium 100 mg po bid:prn constipation 7. tamsulosin 0.4 mg po hs 8. enalapril maleate 5 mg po daily hold for sbp<100 or hr<60 9. clonazepam 0.25 mg po qhs:prn insomnia 10. calcium carbonate 1000 mg po daily 11. furosemide 40 mg po daily 12. nexium *nf* (esomeprazole magnesium) 40 mg oral daily 13. vitamin d 1000 unit po daily discharge disposition: extended care facility: nursing center - discharge diagnosis: - cholangitis - hypotension (chronotropic insufficiency) - peripheral edema - urinary tract infection 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 with an infected common bile duct (cholangitis) and low blood pressure. the infected common bile duct was attributed to stones obstructing the duct pathway. an ercp was performed to remove the stones and place a stent to facilitate emptying of the bile. you were treated with antibiotics and should continue on oral antibiotics for another 7 days. you will need to return on to have the stent removed. you had low blood pressure - which warranted a stay in the intensive care unit. you were given iv fluids and your pacemaker was temporarily increased in rate. your blood pressure is now stable and thus the pacemaker was reverted to its previous settings. you have substantial extra fluid and will benefit from continued lasix (diuretic). followup instructions: department: endo suites when: thursday at 1 pm department: digestive disease center when: thursday at 1 pm with: , md building: building (/ complex) campus: east best parking: main garage procedure: endoscopic insertion of stent (tube) into bile duct central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation other chronic pulmonary heart diseases hypopotassemia other and unspecified hyperlipidemia septic shock chronic systolic heart failure long-term (current) use of anticoagulants retention of urine, unspecified cardiac pacemaker in situ hypovolemia cholangitis other and unspecified coagulation defects calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to