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 attending: chief complaint: jaundice, abdominal pain major surgical or invasive procedure: : ercp : ir- guided biliary drain placement : endoscopic ultrasound with biopsy : open cholecystectomy, gastrojejunostomy and hepaticojejunostomy history of present illness: 69 yo f w/ family history of pancreatic cancer presents with chronic mid abdominal cramps for several months since esophageal hernia repair in , not made worse or better with food or bowel movements, and non-radiating. she's had 35lb weight loss since then, decreased appetite, and alternating constipation/diarrhea. about 9 days ago, she developed icterus and jaundice and was referred to hospital. labs revealed obstructive cholangiopathy (tbili 15.1), and mild hypovolemic hyponatremia (s-na 128->132). outside hosptial abdominal ct showed marked biliary dilation of cbd and pd as well as hypodensities in the tail and head of the pancreas, and no obvious liver mets. an ercp was attempted at outside hospital and was unsuccessful. she was referred to for reattempt. this was done today, but was unsuccessful after small sphincterotomy. the general surgery was consulted for possible surgical resection. past medical history: - hypertension - diabetes type 2: (dx'd 6 wks ago) - coronary artery disease - hyperlipidemia - hypothyroidism - h/o pancreatitis - s/p hysterectomy & uso - s/p l knee surgery - s/p r eye surgery - mild anxiety disorder social history: divorced. lives with boyfriend. former 30 pk*yr history of smoking, quit 20yr ago. rare etoh (1 drink every other week). three children involved in her life -- all named as hcp (one lives in ). family history: father - cad (died 50s) mother - dm, cad, cva had nine siblings: pancreatic ca - brother breast ca - sister, niece ca - brother cad - brother, sister physical exam: admission exam: jaundiced, in nad. pain = "" afeb, 159/80, 69, 16 99% ra (+) icterus, op clear, (+) temporal/fascial wasting, no lungs: cta bilaterally cor: rrr no audible mrg abd: soft, non-tender, no r/g, no palpable masses or hsm ext: no edema, clubbing, cyanosis skin: jaundiced neuro: a & o x three, nl speech/cognition lymph: no palpable ln on discharge: vs: 98.4, 90, 130/66, 20, 97% ra gen: aao x 3, nad cv: rrr, no m/r/g lungs; diminished throughout abd: bilateral subcostal incision open to air with stri strips and c/d/i extr: warm, no c/c/e pertinent results: cbc: wbc 4.7, hgb 11.5, hct 33.7, plt 233, inr 1.1 chem 7: na 132, k 3.5, cl 100, hco3 26, bun 6, cr 0.6, glu 155 other labs: ca 8.4, tbili 15.1, dbili 9.5, ast 89, alt 100, tp 5.6, albumin 2.2, alkphos 305, lip 20 04:02am blood wbc-6.7 rbc-2.60* hgb-8.5* hct-24.9* mcv-96 mch-32.8* mchc-34.2 rdw-18.5* plt ct-265 04:23am blood glucose-131* urean-16 creat-0.3* na-132* k-4.0 cl-102 hco3-23 angap-11 04:51am blood totbili-5.0* dirbili-3.4* indbili-1.6 ercp: impression: limited exam of the esophagus showed hiatus hernia. limited exam of the stomach was normal. dudoenum was deformed due to involvement with tumor. ampulla and duodenum were involved with tumor. cannulation of the biliary duct was unsuccessful with a sphincterotome using a free-hand technique. contrast medium was injected and partial oacification of pancreatic duct was achieved. a small precut was performed to facilitate biliary access,however this was unsuccessful eus: impression: mass #1: a 45mm x 30 mm ill-defined mass was noted in the head of the pancreas. the mass was hypoechoic and heterogenous in echotexture. the borders of the mass were irregular and poorly defined. fna of the mass was performed and aspirate was sent for cytology. mass #2: the was a second 26mm x 26mm mass noted in the body of the pancreas. this mass likely represents a second tumor deposit and may involve the splenic vein. vessels : due to the distorted anatomy, the portal vein could not be fully assessed. vessels : the celiac artery take-off from the aorta was imaged. this did not appear to be invaded by the mass. the superior mesenteric artery take-off from the aorta was imaged. this did not appear to be invaded by the mass. the superior mesenteric artery was partially imaged from the second/third part of the duodenum. the mass did not appear to invade the visualized superior mesenteric artery. pancreatic parenchyma: the pancreas appeared to be mostly replaced by the tumors. the parenchyma showed marked atrophy. the remainder of the eus exam was limited due to the inability to enter the second/third duodenum. additionally, due to the patient's fluctuating oxygen saturations throughout the procedure, examination time was limited and attention was focused to sampling the pancreatic head lesion. abd ct: impression: 1. 2.6-cm heterogeneously enhancing pancreatic head mass concerning for pancreatic adenocarcinoma with resultant massive dilatation of the cbd, distention of the gallbladder, and intrahepatic biliary ductal dilatation. 2. abnormal heterogeneous enhancement of a 2.8-cm portion of the pancreatic body, concerning for multifocal involvement vs. area of pancreatitis with resultant splenic venous thrombosis and collateral formation. 3. primary tumor abuts smv with approximately 25% involvement. remainder of the vasculature appears free of tumors aside from the gastroepiploic artery. 4. conventional hepatic and vascular anatomy with the exception of duplicated right renal arteries. ct chest: impression: 1. small non-hemorrhagic bilateral pleural effusions with bibasilar atelectasis, left greater than right. 2. left upper lobe residual consolidative abnormality may be resolving pneumonia or hemorrhage. 3. no strong evidence of metastasis. a 4-mm right middle lobe nodule is indeterminate. cytology report pancreatic head mass procedure date of report approved date: specimen received: pancreatic head mass specimen description: received in cytolyt prepared 1 thinprep slide clinical data: 70 yo with 2.6 cm heterogeneously enhancing pancreatic head mass. there was a second mass at the panc body concerning for a second tumor deposit. ercp not successful on due to mass involvement of duodenum and ampulla. ptbd placed by ir but not able to traverse stricture or obtain cytology. previous specimens: common bile duct brushings report to: dr. . diagnosis: eus, pancreatic head mass: positive for malignant cells, consistent with adenocarcinoma. brief hospital course: 69 year old woman who presented with obstructive jaundice due to a tumor involving the pancreas and duodenum. ms. presented with jaundice and elevated total bilirubin. imaging showed a mass at the head of the pancreas. patient underwent several attempts at ercp prior to arrival. on she underwent placement of an external drain with some improvement in her liver function tests and bilirubin. on and she went back to the ir suite for internalization of her drain, though both attempts were unsuccessful due to being unable to pass the pancreatic blockage. there was a high suspicion for malignancy. different samples were sent to evaluate this. ir sent brushing from and biopsy of cbd and an eus with biopsy was performed on . she will need follow-up with oncology, dr. , as the cytology from the eus was consistent with pancreatic adenocarcinoma. shortly after the placement of the external biliary drain on , she became hypotensive and hypoxic. she was placed on neo synephrine and a non-rebreathe in the pacu. she was fluid resuscitated. her initial lactate was 7.1. she was then transferred to the icu. her pressors were switched to levophed. she was initially covered with gentamicin, vancomycin, and zosyn. her biliary and blood cultures grew out e. coli. out of concern for esbl, her antibiotics were changed to meropenem and she was continued on this (she had severe sepsis). she developed thrombocytopenia. the etiology of this was likely multifactorial. her sq heparin was stopped. platelets began to improve, although so did her sepsis. a hit ab was sent and returned negative. her home antihypertensives were initially held while her blood pressures were low. the patient was stabilized in the icu and was transferred back on the floor in stable condition. on , the patient was transferred to pancreatico-biliary service for elective surgical resection. on , she underwent hepatojejunostomy, gastrojejunostomy and open cholecystectomy, which went well without complication (reader referred to the operative note for details). in the pacu, the patient desaturated, she was re-intubated and transferred in icu. in icu the patient was stabilized, extubated on pod # 1 and transferred on the floor. the patient arrived on the floor npo with ngt, on iv fluids, tpn and antibiotics (meropenem), with a foley catheter, and dilaudid pca for pain control. the patient was hemodynamically stable. neuro: the patient received dilaudid pca with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. cardiac echocardiogram () revealed normal levf > 55%. pulmonary: the patient was re intubated post operatively thick secretions and hypoxemia. she was extubated on pod # 1, and remained stable from pulmonary stand point until discharge. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi/gu/fen: the patient was started tpn on hd # 12, and continued on until hd # 21 (pod # 7). post-operatively, the patient was made npo/ngt with iv fluids. diet was advanced when appropriate, which was well tolerated. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. tpn was discontinued on pod # 7, the patient able to tolerate regular diet prior discharge. id: the patient underwent two weeks course of meropenem for e-coli bacteremia. surveillance blood cultures were negative. the patient's white blood count and fever curves were closely watched for signs of infection. wound was evaluated daily and no signs or symptoms of infection were noticed. endocrine: the patient's blood sugar was monitored throughout his stay; insulin dosing was adjusted accordingly. when on regular diet, the patient was restarted on her oral glyburide. the patient was recommended to follow up with her primary care after discharge to continue monitoring her blood sugar level. hematology: the patient developed thrombocytopenia with platelets of 83 on hd # 5, a hit ab was sent and returned negative. platelets level improved and was wnl prior discharge. the patient was transfused with 2 units of plasma increased inr (1.9). prophylaxis: the venodyne boots were used during this stay; patient was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating with bystander assist, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: atenolol 50mg daily diltiazem la 300mg daily omeprazole 40mg daily quinapril 20mg daily rifaximin 550mg pravastatin 20mg daily levothyroxine 125mcg daily reglan 10mg tid vitamin d 400iu daily polyethylene glycol 1 pk senna 2 tabs qhs prn constipation additional home meds on hold now: glyburide 10mg asa 325mg daily omega 3fa daily xanax prn anxiety probiotics 1 tab daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 3. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 4. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 5. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 6. quinapril 20 mg tablet sig: one (1) tablet po daily (daily). 7. glyburide 5 mg tablet sig: two (2) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn. 10. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 11. diltiazem hcl 300 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 12. pravastatin 20 mg tablet sig: one (1) tablet po once a day. 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 14. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 15. one touch ultra system kit kit sig: one (1) kit miscellaneous qam. disp:*1 kit* refills:*0* 16. lancets misc sig: one (1) lancet miscellaneous qam. disp:*1 box* refills:*2* 17. test strip sig: one (1) strip qam. disp:*1 box* refills:*2* 18. alcohol pads pads, medicated sig: one (1) pad topical qam. disp:*1 box* refills:*0* discharge disposition: home with service facility: community vna, discharge diagnosis: pancreatic adenocarcinoma biliary obstruction e coli septicemia thrombocytopenia bilateral pleural effusions discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: provider: , md phone: date/time: 3:00 provider: , md phone: date/time: 3:00 9, . provider: , md phone: date/time: 12:45 , , , . please follow up with dr. (pcp) in weeks after discharge. call dr. office to schedule a follow up appointment. procedure: parenteral infusion of concentrated nutritional substances endoscopic sphincterotomy and papillotomy cholecystectomy other gastroenterostomy without gastrectomy closed [aspiration] [needle] [percutaneous] biopsy of pancreas other percutaneous procedures on biliary tract anastomosis of hepatic duct to gastrointestinal tract other closed [endoscopic] biopsy of biliary duct or sphincter of oddi central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified abnormal coagulation profile anemia, unspecified coronary atherosclerosis of native coronary artery unspecified pleural effusion unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism diaphragmatic hernia without mention of obstruction or gangrene septic shock other constipation septicemia due to escherichia coli [e. coli] accidents occurring in unspecified place insomnia, unspecified other respiratory abnormalities nonspecific abnormal electrocardiogram [ecg] [ekg] other accidents malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to