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: morphine / codeine / ciprofloxacin attending: chief complaint: abdominal pain, coffee ground emesis major surgical or invasive procedure: esophagogastroduodonoscopy () history of present illness: 42 year old man with a history of alcohol dependence, alcoholic cirrhosis with grade ii varices s/p banding, and chronic pancreatitis, presenting with one day of coffee-ground emesis and abdominal pain. mr. was recently admitted to from to for coffee ground emesis and abdominal pain following an episode of heavy drinking, which was thought to be due to esophagitis/gastritis in the setting of vomiting from an exacerbation of chronic pancreatitis. upon discharge from , he drank 1.5 pints of vodka and a few beers 1 day prior to admission and 1 pint of on the day of admission. . in the late morning on the day of admission, mr. began to feel sharp, epigastric/right upper adbominal pain that was in severity and radiated to the back. associated with the pain was nausea, which resulted in 3 episodes of emesis. the first episode was yellow in color, but the last vomitis had a coffee ground appearance. he presented to the ed at due to this emesis. . his current abdominal pain is more severe than his baseline epigastric pain associated with his chronic pancreatitis and was similar past episodes of acute on chronic pancreatitis. in the past, his similar pain has been improved by sitting still and dilaudid, and his nausea has subsided with zofran. he last ate a large breakfast at 10 am the day of admission. he denies recent the consumption of fatty or spicy foods or coffee. . last fever was in the hospital. he reports several weeks of intermittent night sweats. he has mild, intermittent chronic right knee pain. he has mild pain in the nasal passageway from an ng tube from his recent hospitalization. he has experience recent episodes of loose stool without hematochezia, melena, or bright red blood. he denies the use of aspirin or tylenol. . in ed, he continued to experience abdominal pain and nausea. he received protonix 80 mg iv, ivf, zofram4 mg , dilaudid 3mg iv, and ciprofloxacin 400mg iv, and octreotide bolus + drip. he was seen by gi, and a ng lavage revealed brown coffee grounds that cleared after 500 ml. he was guaiac negative. vitals afebrile hr 68 bp 133/71 rr 18 o2sat 93% ra. . past medical history: -alcoholic cirrhosis with on with grade ii varices. -variceal bleeds, 6 episodes from to s/p multiple bandings. bleed in was grade ii on , s/p banding. -chronic pleural effisions -chronic pancreatitis -alcohol dependence: heavy drinking started at age 30-35. has been to detox and dual diagnosis clinics in the past. has had periods of sobriety. h/o delirium with past withdrawal; no h/o seizures. -bipolar disorder and anxiety disorder nos, well controlled on citalopram, quetiapine, and ativan. has psychiatrist in the community. -s/p cholecystectomy on -s/p right acl replacement and meniscectomy in social history: currently homeless. divorced. has daughter in and son in . 12 year history of drinking 1-1.75 liters of vodka daily. denies tobacco or other illicits. family history: history of alcoholism. paternal grandfather died of prostate cancer. maternal grandmother died of mi; no other family h/o cvd. father alive, with h/o kidney cancer. mother and children healthy. physical exam: general: comfortable, nad. heent: no scleral icterus, mmm, oropharynx clear. lungs: cta bilaterally with no w/r/r. cv: rrr with no m/r/g. abdomen: soft, non-distended. no mottling of skin. +bs in all 4 quadrants. warm to touch. diffusely positive to light palpation and percussion but increased tenderness in epigastric and right upper quadrants. no guarding or rigidity. scar located in right upper quadrant from prior cholecystectomy. no caput medusa. no angiomas. ext: warm, well perfused, 2+ dp and pt pulses, no clubbing, cyanosis or edema. no asterixis. neuro: a+o to person, place, time. pertinent results: 05:50am blood wbc-2.5* rbc-4.25* hgb-10.6* hct-33.8* mcv-80* mch-25.0* mchc-31.4 rdw-14.9 plt ct-126* 03:45pm blood hct-33.6* 06:25am blood wbc-1.7* rbc-4.08* hgb-10.8* hct-32.3* mcv-79* mch-26.6* mchc-33.6 rdw-14.9 plt ct-111* 12:05am blood hct-32.4* 12:43pm blood hct-30.7* 07:57am blood hct-31.0* 04:30am blood wbc-2.0* rbc-3.82* hgb-10.1* hct-29.9* mcv-78* mch-26.5* mchc-33.9 rdw-15.8* plt ct-105* 12:29am blood hct-31.1* 08:20pm blood hct-30.8* 01:15pm blood wbc-2.9* rbc-4.34* hgb-11.7* hct-33.5* mcv-77* mch-27.0 mchc-35.0 rdw-15.8* plt ct-113* 05:50am blood glucose-117* urean-3* creat-0.8 na-142 k-3.6 cl-104 hco3-28 angap-14 01:15pm blood glucose-117* urean-9 creat-0.8 na-142 k-3.5 cl-105 hco3-22 angap-19 05:50am blood alt-18 ast-31 amylase-8 01:15pm blood alt-25 ast-49* ld(ldh)-170 alkphos-255* totbili-0.8 05:50am blood lipase-8 01:15pm blood lipase-12 05:50am blood calcium-8.7 phos-3.8 mg-1.8 04:30am blood albumin-3.8 calcium-8.3* phos-3.7 mg-1.7 iron-30* 04:30am blood caltibc-334 vitb12-501 folate-greater th ferritn-23* trf-257 01:15pm blood asa-neg ethanol-154* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . : : stage 1 varices, portal hypertensive gastropathy, and 2cm non-bleeding nodule consistent with pancreatic rest . : ekg: sinus rhythm. mildly prolonged q-t interval. non-specific inferior and anteroseptal t wave changes. compared to the previous tracing of the heart rate is slower. qt interval prolonged. qtc: 466 . : sinus rhythm. non-specific anterolateral st-t wave changes. compared to the previous tracing of the q-t interval is not as long on the current tracing. qtc: 410. brief hospital course: assessment/plan: this is a 42 yo with extensive alcohol abuse, alcoholic cirrhosis with grade i varices s/p banding, and chronic alcoholic pancreatitis, micu transfer, admitted for coffee-ground emesis following and acute drinking binge. . # upper gi bleed: due to findings of bright red blood via nasogastric lavage, patient was admitted directly to the micu. patient's vital signs and hct were stable. liver service was consulted, and pt underwent endoscopy, which showed stage 1-2 varices, portal hypertensive gastropathy, and 2 cm non-bleeding nodule consistent with pancreatic rest grade. there was no active bleeding visualized. esophagitis was noted. pt was continued with protonix. cipro was started for sbp prophylaxis, then held for hx or prolonged qtc. as patient's symptoms improved, he was restarted on a regular diet, and was considered stable for call out to the floor. . upon reaching the floor, vital signs and hematocrits were measured often and remained steady. an active type and screen was maintained. patient was continued with ppi and sucralfate. given lack of variceal bleeding found on , ciprofloxacin and octreotide were no longer warranted. patient did not experience any further episodes of vomiting, nausea, or melena. upon discharge, patient was started on nadolol to decrease portal hypertension and reduce the risk of future episodes of variceal bleeding. given lack of ascites, patient was not initiated on spironolactone. . patient has extensive past medical history of alcoholic cirrhosis complicated by history of numerous episodes of ugi bleeding and grade ii varices that were banded in the past. the lack in finding an active source of bleeding via makes it difficult to cite a clear source, but bleeding etiology may have been multifactorial. it was thought by gi that the most likley cause of bleeding was from esophagitis secondary to alcohol consumption and vomiting. patient was discharged on nadolol for reduction in portal hypertension and reduction in the risk of variceal bleeding. patient will follow up with dr. in 2 weeks for follow up. . # alcohol dependence. given extensive alcohol abuse, recent binge, and history of prior withdrawal episodes (no prior seizures), patient was at risk for alcohol withdrawal during this admission. upon reaching the micu, pt was started initially on ciwa scale but later discontinued. it was believed by the micu team that pt was unlikely to develop significant withdrawal as he was abstinent from alcohol from /09 during his prior admission. however, patient reported binging upon returning home and appeared anxious, jittery, and tachycardic upon reaching the floor. he was restarted on diazepam 10mg po q3h:prn for ciwa > 10 and agitation. patient's sympathetic symptoms improved. patient was continued on outpatient regimen of folate, thiamine, and mvi. addictions social work saw the patient and provided counselling regarding cessation. patient also spoke with social work and agreed to follow up with alcoholics anonymous. . #abdominal pain and nausea: patient has chronic baseline pain secondary to chronic pancreatitis that was exacerbated with alcoholic binge prior to admission. lack of fever, leukocytosis, and abdominal distension was less worrisome for spontaneous bacterial peritonitis. lfts and lipase were within normal limits. patient was initially placed npo, with diet advanced and tolerated well. patient was given po dilaudid with an attempt to wean doses throughout her admission. zofran was given for nausea. ppi and sucralfate were continued as above. patient was discharged with 20 pills (4 day supply) of 5mg oxycodone po q6-8 hours and told to follow up with his scheduled appointment with his primary care physician 4 days of discharge. patient will follow up with dr. in 2 weeks for follow up. . # alcoholic cirrhosis: complicated by coagulopathy, varices, and gastric changes on consistent with portal hypertension gastropathy. lft, , and cbc abnormalities were at baseline during this admission. no indication of hepatic encephalopathy was observed. lactulose was given and no signs of encephalopathy were present. . # leukopenia, anemia, thrombocytopenia: lab disruptions were most likely secondary to bone suppression secondary to alcoholic suppression of bone marrow. stable during this admission. liver disease also likely contributing. patient given ferrous sulfate upon discharge to help with anemia secondary to bleeding. . # coagulopathy. believed to be secondary to liver cirrhosis, but may also be due to poor absorption due to poor nutritional status. patient reported complying with vitamin k supplements. recently received vitamin k injection x 1 during hospitalization at in prior week. . #bipolar disorder and anxiety disorder nos: conditions were well controlled on outpatient regimen of citalopram, quetiapine, ativan, and trazadone. medications on admission: medications on admission: -ciprofloxacin 500 mt po daily for 7 days until was being given for sbp ppx -oxycodone 5 mg po q6-8h prn pain. takes ~10 mg q4h but does not frequently run out of medication. -citalopram 40 mg po daily -quetiapine 400 mg sr once daily -trazadone 100 mg po qhs prn insomnia -amylase-lipase-protease 20,000-4,500-25,000 unit capsule, one capsule three times daily with meals. -folic acid 1 mg po daily -thiamine 100 mg po daily -multivitamin once daily -pantoprazole 40 mg po q12h -propanolol 10 mg po bid hold for pulse <60 -sucralfate 1 gram po qid -ativan 0.5 mg, rablets po q8h prn anxiety -lactulose 10 gram/15ml, 30 ml po tid prn constipation. . medications on transfer: citalopram 40 mg po daily folic acid 1 mg iv q24h dilaudid 2 mg po q4h:prn pain lactulose 30 ml po tid titrate to bm, hold after bm lorazepam 0.5-1 mg po q8h:prn anxiety, hold for sedation (ciwa scale d/c'ed in am of ) mvi zofran 8 mg iv q8h: prn nausea quietiapine xr 400 mg po daily sucralfate 1 gm po qid thiamine 100 mg iv daily, for 5 days trazodone 100 mg po hs: prn insomnia discharge medications: 1. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 2. quetiapine 200 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 3. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 4. lactulose 10 gram packet sig: one (1) po three times a day as needed for constipation. 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. oxycodone 5 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain. disp:*20 tablet(s)* refills:*0* 8. trazodone 100 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 9. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po three times a day: take with meals. 10. multivitamin tablet sig: one (1) tablet po once a day. 11. ativan 0.5 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for anxiety. 12. nadolol 20 mg tablet sig: tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: - upper gastrointestinal bleed - alcohol dependence - alcoholic cirrhosis - chronic pancreatitis . secondary: - stage i esophageal varices - portal hypertensive gastropathy - 2cm non-bleeding nodule/pancreatic rest - bipolar disorder discharge condition: afebrile, vital signs stable. nausea and vomiting have resolved. no melena. abdominal pain significantly improved. discharge instructions: you were admitted for coffee ground vomitting and abdominal pain. you spent 2 days in the intensive care unit due to your upper gastrointestinal bleeding. you underwent a scoping procedure and were found to have no active bleeds. it is believed that your bleeding was from irritation of your esophagus. you were also treated for alcohol withdrawal. upon going home, please do not consume any alcohol. . we have added the following new medications: 1) nadolol 10mg po daily 2) ferrous sulfate 325mg twice a day . please take all other medication as previously directed. we have made the following changes to your medications: -stopped the cipro -stopped the propranolol . should you develop worsening abdominal pain, fever, chills, lightheadedness, bloody vomiting, please contact your primary care physician or visit the emergency room. followup instructions: please follow up with your previously scheduled appointment with your primary care physician, . . she will also be availble any tuesday of the month for walk-in appointments. date: at 9:30am phone: . please follow up with a hepatologist, dr. : at 8:30 am. phone number: phone: . please attend the alcoholic anonymous meetings, as directed by paperwork given to you by social work. procedure: other endoscopy of small intestine diagnoses: alcoholic cirrhosis of liver portal hypertension hemorrhage of gastrointestinal tract, unspecified esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum chronic pancreatitis bipolar disorder, unspecified other and unspecified alcohol dependence, continuous alcohol withdrawal other esophagitis 

Answer: The patient is high likely exposed to