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: shortness of breath, fatigue major surgical or invasive procedure: endoscopy colonoscopy small bowel capsule study history of present illness: patient is a 78 year old female with past medical history of autoimmune cirrhoisis and esophageal varices, hypertension, and diabetes mellitus, who presents with weakness and dyspnea. pt reports being in her usoh until approximately 1 month ago when she had a uri, with cough. since then she reports feeling fatigued, increasingly dyspneic on exertion, having abdominal distention and blood sugars running high. 2 days pta, she reports having increasing abdominal pain, and passing a large "tomato red" bowel movement. she then felt dizzy, fell to the ground and hit her head, but denies loc. abdominal pain resolved with bowel movement. she then felt weak, with difficulty getting up. of note she does report baseline abdominal pain, worse with constipation, and bms at baseline black, also today. pt also reports exertional shortness of breath and chest pressure. she has been having a cough, productive of white phlegm. ros also positive for chills but no fevers, epistaxis (5times over last month)and occasional nausea/vomiting (nonbloody). . in the ed, hr 50's, 122/24 121/82, rr nl, 94% ra, 100% 2l. pt had cxr with rll infiltrate c/w pna. labs were significant for hct 19, cr 1.2 (baseline), hyponatremia (131, baseline normal), and inr 1.3 (at baseline). cardiac enzymes were negative and ekg was sinus bradycardia with tw flattening in leads v1-v3. no lavage was performed as suspicion for upper source was low. she was given 40 mg iv protonix, and 750 mg of iv levofloxacin. 2u prbcs were ordered but not transfused. . upon arrival to the icu, pt was comfortable, afebrile 98, with hr 49, bp 144/78, rr 16, satting 100% on 2l. past medical history: - diabetes - thyroid nodule - hypertension - anemia, baseline hct ~30 - cirrhosis secondary to auto-immune hepatitis - history of variceal bleeding, with obliteration of varices through endoscopy, last done - depression - status-post cholecystectomy and cataract surgery - history of pyelonephritis - history of positive ppd social history: patient lives alone but with family close by. granddaughter helps take care of her. has home health aide. used to work at the as housekeeping. originally from family history: non-contributory physical exam: gen: pleasant elderly lady, appears stated age, wn/wd, alert and talkative, with granddaughter translating. heent: perrla, eomi, + conjunctival pallor, mmm, no oral lesions or op erythema/swelling. no lad cv: bradycardic, no murmurs, nl s1/s2 pulm: diffuse minimal crackles, worst at right lower lung. do not clear with cough. abdomen: soft, slightly ttp in epigastrium and rlq, nondistended, +bs, no hsm, liver edge not palpable, no sign, no rebound or guarding. no ascites ext: strong distal pulses, no edema neuro: a+ox3, follows commands and answers questions appropriately. sensation and strength in tact throughout, cn2-12 in tact. discharge exam: vss, afebrile no gross bleeding pleasant abd benign pertinent results: 02:00pm blood wbc-5.4# rbc-2.42* hgb-5.8*# hct-19.0*# mcv-79*# mch-24.1*# mchc-30.7* rdw-16.3* plt ct-122* 02:02am blood wbc-7.1 rbc-3.26*# hgb-8.4*# hct-25.4*# mcv-78* mch-25.9* mchc-33.2 rdw-17.3* plt ct-116* 02:00pm blood neuts-77* bands-0 lymphs-15* monos-6 eos-2 baso-0 02:02am blood pt-15.0* ptt-29.4 inr(pt)-1.3* 02:00pm blood glucose-191* urean-32* creat-1.2* na-131* k-4.1 cl-98 hco3-26 angap-11 02:02am blood glucose-67* urean-26* creat-1.1 na-133 k-4.2 cl-101 hco3-24 angap-12 02:02am blood alt-18 ast-21 ld(ldh)-195 alkphos-125* totbili-1.0 02:00pm blood ck(cpk)-53 02:00pm blood ctropnt-<0.01 02:02am blood albumin-3.5 calcium-8.5 phos-3.6 mg-2.0 02:02am blood wbc-7.1 rbc-3.26*# hgb-8.4*# hct-25.4*# mcv-78* mch-25.9* mchc-33.2 rdw-17.3* plt ct-116* 09:20pm blood hct-26.4* 07:00am blood wbc-6.3 rbc-3.22* hgb-8.3* hct-24.7* mcv-77* mch-25.9* mchc-33.7 rdw-17.6* plt ct-132* 07:10pm blood hct-27.3* 07:05am blood wbc-4.8 rbc-3.30* hgb-8.4* hct-25.9* mcv-79* mch-25.4* mchc-32.4 rdw-18.4* plt ct-133* 02:02am blood glucose-67* urean-26* creat-1.1 na-133 k-4.2 cl-101 hco3-24 angap-12 07:00am blood glucose-104 urean-18 creat-0.9 na-130* k-3.5 cl-96 hco3-27 angap-11 07:05am blood glucose-49* urean-15 creat-0.9 na-135 k-3.8 cl-100 hco3-28 angap-11 02:02am blood alt-18 ast-21 ld(ldh)-195 alkphos-125* totbili-1.0 11:06am urine color-straw appear-clear sp -1.007 11:06am urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 11:06am urine rbc-7* wbc-4 bacteri-few yeast-none epi-2 transe-<1 --------- colonoscopy findings: mucosa: the mucosa of the colon was very friable. flat lesions a single small angioectasia was seen in the ascending colon that started oozing upon examination. there were 2 small avm's noted in the transverse colon that were not bleeding. a gold probe was applied for hemostasis successfully to the ascending colon avm. other there were cords of engorged veins noted in the rectum suggestive of rectal varices. there was no active bleeding noted in this area. impression: angioectasia in the ascending colon (thermal therapy) abnormal mucosa in the colon there were cords of engorged veins noted in the rectum suggestive of rectal varices. there was no active bleeding noted in this area. otherwise normal colonoscopy to cecum and terminal ileum recommendations: 1. follow serial hct 2. consider small bowel capsule study to evaluate small bowel for avm's. 3.follow up with clinical team. additional notes: the efficiency of colonoscopy in detecting lesions was discussed with the patient. it was explained that colon cancer and colon polyps on rare occasions may be missed during a colonoscopy.the procedure was done with attending physician and gi fellow. the patient's reconciled home medication list is appended to this report. --------- egd findings: esophagus: mucosa: patchy erythematous mucosa was noted in the gastroesophageal junction. protruding lesions trace varices that flattened with air insufflation were noted at the ge junction. stomach: mucosa: patchy mild erythema, congestion and mosaic appearance of the mucosa were noted in the fundus, stomach body and antrum. these findings are compatible with mild portal gastropathy. duodenum: mucosa: normal mucosa was noted in the first part of the duodenum and second part of the duodenum. impression: esophageal varices erythema in the gastroesophageal junction erythema, congestion and mosaic appearance in the fundus, stomach body and antrum compatible with mild portal gastropathy normal mucosa in the first part of the duodenum and second part of the duodenum otherwise normal egd to second part of the duodenum recommendations: 1. continue nadolol 2. colonoscopy for further evaluation. 3. follow up clinically additional notes: the procedure was done with attending supervision. the patient's reconciled home medication list is appended to this report brief hospital course: patient is a 78 year old female with past medical history of autoimmune cirrhosis, diabetes mellitus, and hypertension who presents with fatigue, sob and exertional chest pain in setting of chronically bloody stools and hct of 19. #1) anemia/gib: pt's baseline hct fluctuating around 30, last checked in . reports having black bowel movements regularly (not taking iron) and one large bowel movement with frank blood. no active bleeding since arrival. hct responded appropriately to 2u prbcs and pt reported symptomatic improvement in her strength and dyspnea. regarding etiology of bleed, egd was unremarkable (see reports section) and colonoscopy remarkable for avms. pt was followed by the liver service while the hospital. she had no further evidence of active bleeding. she was advised of her rectal varices, and continued on nadolol. she also underwent a capsule study on the last day of her admission, to assure there was no small bowel source of bleeding. the results remain to be read on discharge. she has follow up with dr. , her pcp, one week for a hct check and follow up with dr. in one month. #2) ?pneumonia: cxr in ed with questionable infiltrate and pt given 750 mg of levofloxacin. however given her subacute presentation, afebrile, no leukocytosis, levofloxacin was discontinued.. #3) weakness/fall: likely related to bleed, as has been gradual. also given report of fall in setting of large bowel movement, with associated nausea, may be a vagal reaction. neuro exam is reassuring as pt retains full strength, bulk and tone. pt reports subjective improvement s/p transfusion. culture data without infectious etiology to date and no cardiac events on telemetry. #4) diabetes mellitus type 2: followed by and on lantus 50u daily with humalog 10u tid at home. started on home regimen at 1/2 dose while on clears/npo. she was monitored and treated with qid fs with ss in addition to her standing doses on insulin. #5) hypertension: pt's bp meds were initially held in setting of gib but given sbp >150, she was restarted on hctz and lisinopril. nadolol was held due to bradycardia and restarted prior to transfer to the floor as bp and hr improved and for simultaneous variceal bleeding protection. #6) : peaked at cr 1.2, now at baseline 1.1 after blood volume resuscitation, thought to be prerenal in etiology. pt made good volume of urine throughout the admission. #7) cirrhosis: followed at liver center at as outpt and by liver team while admitted. known to have secondary varices with h/o bleeds and banding. liver function: inr 1.3, albumin last normal, plt 120s. last abdominal ultrasound with cirrhosis and splenomegaly. no focal hepatic lesions. no signs of ascites. medications on admission: 1) ursodiol 300mg qam and 600mg qpm 2) lantus 50u daily 3) lexapro 10mg qam 4) humalog 10u tid 5) nadolol 40mg po daily 6) ativan 1mg po qhs 7) hctz 25mg daily 8) lisinopril 30mg po daily 9) timolol .5% q drop both eyes 10) omeprazole 40mg delayed release po daily 11) drisdol 50,000u po qweek 12) zolpidem 5mg po hs 13) carmol 40% topical cream aaa 14) docusate 100mg po daily prn discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po qam (once a day (in the morning)). 2. ursodiol 300 mg capsule sig: two (2) capsule po qpm (once a day (in the evening)). 3. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 4. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 6. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 7. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 8. nadolol 80 mg tablet sig: 0.5 tablet po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. insulin glargine 100 unit/ml solution sig: fifty (50) units subcutaneous at bedtime. 11. humalog 100 unit/ml solution sig: one (1) unit subcutaneous tid before meals: please take as previously prescribed by dr. . discharge disposition: home discharge diagnosis: 1. chronic blood loss anemia, likely from colonic avms 2. cirrhosis with esophageal varices 3. rectal varices discharge condition: hematocrit stable, afebrile discharge instructions: you were admitted with anemia, likely from losing blood from your gastrointestinal tract. please call dr. with concerns and questions, and return to the hospital if you have vomiting, bloody or black stool, chest pain, lightheadedness, abdominal distension or any other alarming symptoms. followup instructions: provider: , m.d. phone: date/time: 11:30 provider: , m.d. phone: date/time: 11:00 provider: , m.d. phone: date/time: 3:45 please make sure you attend your next visit: 09:15a , (liver center) lm , liver center (sb) please call dr. at to schedule your appointment for next week to check your blood level. procedure: other endoscopy of small intestine endoscopic destruction of other lesion or tissue of large intestine diagnoses: unspecified essential hypertension cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) depressive disorder, not elsewhere classified long-term (current) use of insulin unspecified disorder of kidney and ureter angiodysplasia of intestine with hemorrhage esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum internal hemorrhoids without mention of complication nontoxic uninodular goiter autoimmune hepatitis 

Answer: The patient is high likely exposed to