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: toe pain- found to have upper gi bleeding. major surgical or invasive procedure: esophagogastroduodenoscopy : l cia stent and l cfa angioplasty : l cfa and l pfa endarterectomies and dacron patches, l eia stents history of present illness: 81 year old female peripheral disease status post right sided endarterectomy and stenting in , as well as atrial fibrillation/flutter on coumadin, and diastolic chf, who presented to an outside hospital on the morning of admission complaining of toe pain, found to have a hematocrit of 18, with further history elicited of melena, transferred to the ed and being admitted to the micu for upper gi bleed. . the patient says that she has had dark stools for the last 5 days, but what really prompted her to come in was her left foot pain, which also started a few days ago. she is a poor historian and has trouble telling the story of what has been going on. she denies any abdominal pain, nausea, or vomiting. no hematochezia, no hemoptysis, or hematuria. she denies any chest pain, dyspnea above her baseline, lightheadedness. no fevers or chills. she has been taking her daily aspirin, and denies any nsaid use. . at the outside hospital vitals were unremarkable on arrival - she was actually mildly hypertensive. she was given 10 mg of sc vitamin k. vitals on arrival to our ed were 98.2, 83, 142/70, 18, 100% on ra. she was guaiac positive and had an ng lavage with dark stomach material but no overt blood or coffee grounds. she was seen by surgery regarding her left foot, who wanted to correct her hematologic problem before considering any intervention. she received 400 cc of normal saline in the ed and no blood products prior to transfer to the micu. past medical history: 1) type 2 diabetes mellitus, complicated by neuropathy, on gabapentin and fentanyl patch. 2) hypertension, poorly controlled 3) peripheral disease, status post right external iliac artery stent, endarterectomy of the eia, cfa, pfa with bovine patch angioplasty and iliac and femoral angiography in . 4) lung cancer status post right lower lobe resection without chemo in 10/. 5) chronic obstructive pulmonary disease 6) diastolic congestive heart failure, ef 60% in on p-mibi, but no echocardiograms in our system. she has been on lasix. 7) left pleural effusion 8) atrial fibrillation/flutter on coumadin, discovered in after peripheral disease intervention 9) renal insufficiency, with recent baseline creatinine around 1.1, but episodes of acute renal failure with creatinine up to 2.3 in . 7) high grade av block with pacer placement in 6/. social history: denies any alcohol use. quit tobacco 5 years ago; previously smoked ppd. no iv drug use. family history: she denies any family history of clotting problems. mother had cancer but she doesn't recall what kind. physical exam: 97.3, 157/41, 99, 19, 100% on 2l nc. general: obese caucasian female resting comfortably in bed, with occasional tonic-clonic movements of the left extremity and blinking of the left eye. heent: moist mucous membranes, pale conjunctiva and mucous membranes. neck: jvp difficult to localize. cor: rr, normal rate, no murmurs. lungs: rales way up on the left, with absent breath sounds in the right lower lung. abd: normoactive bowel sounds, soft, non-tender, loud peri-umbilical bruit. pulses: b rad palp, r fem/ palp, r dp/pt dop+, l fem palp (with thrill)/ dop+, l pt/dp wounds: c/d/i pertinent results: 08:45am blood wbc-7.4 rbc-3.56* hgb-10.2* hct-31.5* mcv-89 mch-28.7 mchc-32.4 rdw-17.2* plt ct-288 08:45am blood plt ct-288 09:03pm blood pt-13.0 ptt-32.1 inr(pt)-1.1 05:45am blood glucose-109* urean-48* creat-1.7* na-137 k-4.3 cl-103 hco3-25 angap-13 11:00am blood alt-9 ast-19 alkphos-116 amylase-38 totbili-0.9 05:45am blood calcium-8.6 phos-4.6* mg-2.2 brief hospital course: 81 year old female with peripheral disease status post right sided endarterectomy and stenting in , atrial fibrillation/flutter on coumadin, and diastolic chf, who presented to an outside hospital on the morning of admission complaining of toe pain, found to have a hematocrit of 18, with further history elicited of melena, admitted to the micu for upper gi bleed. . 1) upper gi bleed: likely subacute in nature given hemodynamic stability. in terms of etiology, patient denies nsaids or abdominal pain. possibly avm/gastritis. gi consult obtained, egd, coumadin held / pcp to restart on f/u, 2 large bore ivs strted. on dc iv removed, iv pantoprazole - changed to once a day on dc. q 6 hour hematocrit checks - once stabalized qd checks, hct stable on dc. initially 2 u prbc now, goal hct 28, goal met on dc. will need repeat egd in 8 weeks to assess for healing as well as to obtain biopsies to check for barrett's esophagus. avoid nsaids. . 2) left foot cyanosis/ischemia, peripheral disease: patient seen by who feel this is likely a manifestation of severe peripheral disease with worsened ischemia in the setting of diminished o2 carrying capacity (severe anemia). pt had arterial studies. underwent a: a)abdominal aortogram with limited left lower extremity runoff, left common iliac artery stent, left common femoral artery angioplasty. b)left common femoral endarterectomy and dacron patch angioplasty. c)pelvic angiogram, left common iliac angioplasty of previously placed stent, left external iliac artery stenting. pt tolerated the procedure well. there were no complications. pt bloodflow restored, foot symptoms much improved. . 3) acute renal failure: creatinine appears to be around 1.1 at baseline, but has been elevated to 2.3 on recent admissions. currently 1.7, with a high of 2.0 this admission. . 4) chf: diastolic, however on 120 mg furosemide po daily, and currently with rales way up on the left, therefore in the setting of large fluid administration will give 40 mg iv lasix and reassess between products. currently 100% on ra. on dc lasix stared on her home dose, cxr much improved on dc. . 5) atrial fibrillation: hold coumadin on admission. held throught out hospital stay. pcp called on dc. continue to hold untill f/u arranged. . 6) diabetes, type 2: will start insulin sliding scale, hold glipizide, on dc glypizide restarted. . 7) hypercholesterolemia: continue atorvastatin. . 8) fen: npo. . 9) code: full. medications on admission: 1. atorvastatin 40 mg po daily 2. warfarin 5 mg po hs 3. lisinopril 40 mg po daily 4. furosemide 120 mg po daily 5. gabapentin 600 mg po bid, 300 mg qhs 6. diltiazem hcl 360 mg sust. release 24hr po once a day 7. glipizide 2.5 mg sust release po bid 8. tramadol 50 mg po prn 9. metoprolol tartrate 25 mg po bid 10. aspirin ec 325 mg po once a day 11. omeprazole 20 mg po daily discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 6. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 7. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): if not ambulatory. 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 12. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed. 13. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 14. glipizide 2.5 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po twice a day. 15. furosemide 40 mg tablet sig: three (3) tablet po once a day. discharge disposition: extended care facility: healthcare - discharge diagnosis: left foot pain gi bleed hypovolemia afib dm2 htn copd chf cri discharge condition: stable discharge instructions: division of and endovascular surgery lower extremity bypass surgery discharge instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , md phone: date/time: 10:30 please call dr office immediatly upon dc. you have to see him regarding your coumadin. he will restart upon his discretion. , procedure: angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries aortography esophagogastroduodenoscopy [egd] with closed biopsy insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) endarterectomy, lower limb arteries cranial or peripheral nerve graft insertion of one vascular stent transposition of cranial and peripheral nerves insertion of two vascular stents procedure on two vessels procedure on two vessels procedure on two vessels diagnoses: acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atrial flutter chronic kidney disease, unspecified long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage cardiac pacemaker in situ esophagitis, unspecified hypovolemia diastolic heart failure, unspecified atherosclerosis of native arteries of the extremities with rest pain peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to