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: iodine; iodine containing attending: chief complaint: fevers, s/p multiple abdominal surgeries at osh major surgical or invasive procedure: none during his hospitalization at history of present illness: mr. is a 74 yo patient with a h/o cad, hepatitis c, djd, testicular cancer who was transferred from the regional (, fl) icu after a prolonged hospital course secondary to complications from an ercp. initially, the patient presented on for chest pain, diagnosed with cholelithiasis with dilated cbd. the patient then underwent an ercp on which was complicated by pancreaticoduodenal trauma with gastric artery laceration requiring emergency ex-lap, cholecystectomy, common duct exploration, formal sphincteroplasty, tube gastrectomy with hunt- , and diverticulization of duodenal closure over a foley catheter drain with a 4-5 l estimated blood loss. on , he had reexploration of abd for hemorrhage with evacuation of blood from stomach and small bowel, as well as suture ligation of periampullary bleeding, mesenteric defect, and repair of hunt- disruption by retained clot, and placement of vac as unable to do primary abd closure; estimated blood loss 3 l. he underwent complex abdominal wall closure with pigskin and marlex mesh on . on , he was noted to have increased bile dinage around his t-tube but was thought to be functioning and localized per cholangiogram on . he underwent tracheostomy placement on for prolonged intubation. on , pt had an intraabdominal abscess drained. in total he received 90+ units of prbc's. the abdominal wound was eventually closed with mesh. his hospital course was complicated by fevers and jaundice. on transfer he had 3 jp's, a g-tube, and biliary tube in place (with tbili of 9). he is now growing klebsiella, enterococcus from a hematoma at his open surgical wound site with a concern for infected mesh on vanc, zosyn, and antifungal. he was on tpn. he is on lovenox for ppx. he has a trach collar and is still vented. lethargic x several days (very sensitive to sedation), opens eyes, responds to pain but nonverbal and not following commands. info from osh: micro: sputum culture --> klebsiella unasyn s aztreonam s cefazolin s cefepime s ceftriaxone s gent s meropenem s zosyn s tobramycin s bactrim s abdominal fluid (hematoma, percutaneous aspirate) 1. klebsiella pneumonia (pan sensitive) 2. escherichia coli (r=ampicillin/unasyn, ciprofloxacin) 3. enterococcus faecalis (s=ampicillin, gent, vanco) 4. yeast 5. lactobacillus abdominal fluid (ruq, jp#1) 1. klebsiella pna 2. enterococcus faecalis 3. lactobacillus 4. yeast abdominal fluid (ruq, jp#2) 1. klebsiella pneumonia 2. enterococcus faecalis 3. coag negative staph aureus (r=cefazolin, erythromycin, oxacillin, pcn, bactrim; s=rifampin, tetracycline, vanco) abdominal fluid (luq jp) 1. klebsiella pneumonia 2. enterococcus faecalis 3. lactobacillus species 4. yeast abdominal fluid (luq jp) 1. staphylococcus specias coagulase negative (s=rifampin, tetracylcine, vancomycin) sputum cx - respiratory flora only cath tip culture (a line) - no growth blood culture - coag negative staphylococcus (s=clinda, rifampin, tetracycline, vancomycin) abdominal fluid (luq jp) 1. coag neg staph (s=clinda, rifampin, tetracycline, vanco) 2. coag neg staph (s=clinda, tetracycline, vanco) deep wound culture 1. coag neg staph (s=clinda, rifampin, tetracycline, vanco) 2. coag neg staph (s=clinda, rifampin, tetracycline, vanco) urine culture - no growth bile fluid cx 1. coag neg staph (s=clinda, rifampin, tetracycline, vanco) blood cx - no growth abdominal fluid (ruq jp) 1. coag neg staph (s=clinda, rifampin, tetracycline, vanco) 2. coag neg staph (s=clinda, rifampin, tetracycline, bactrim, vanco) abdominal fluid (ruq jp #2) 1. coag neg staph (s=clinda, rifampin, tetracycline, vanco) abscess smear -- no afb : jp #3 no growth hcv undetectable viral load (< 43) blood cx -- e. coli (r=amp/unasyn, ciprofloxacin) . images: reports from osh: . cxr: low lung volumes, crowding of lung markings, linear atelectasis in right mid-lung. . ct guided abdominal wall collection drainage: 300 cc bloody fluid aspirated . ct ab/pelvis with oral/iv contrast: post-op changes in upper abdomen. areas of decreased attenuation in l lob of liver (4.2x6.3cm, 3x2.7cm) which are nonspecific but may represent areas of hepatic injury or ischemia have mildly improved from prior study of . a 22.6x4.1 cm fluid collection which contains a small drain in the subcutaneous tissues of the lower abdomen has moderately increased in size since . no contrast progressed distally beyond stomach. no dilated loops to suggest obstruction. . upper venous doppler, bilateral: normal study showing no evidence of thrombus involving the major veins of the ues. . cholangiogram (intraop): biliary tree is opacified, some contrast extravasation; see detailed surgical report for evaluation of findings. . upper gi series with gastrografin: some reflux of gastrografin up into the distal esophagus; no significant movement of gastrografin out of the stomach for greater than 15 minutes. repeat kub 30 minutes after study showed no contrast passage into small bowel loops and no evidence for contrast leak. repeat report 2 hours later also shows no progression of contrast into small bowel. . ct ab/pelvis w/o iv contrast: hypodensity within the liver with adjacent subhepatic fluid, may represent liver laceration or abscess or collection extending from the subhepatic area affecting the liver parenchyma. hypodense round structure around the third portion of the duodenum measuring 2.9x4 cm for which hematoma or abscess cannot be excluded. non-inflamm/post-surgical changes in gallbladder fossa with biliary stent. ascites. small bilateral effusions. anterior pelvic subcutaneous fluid collection with drain within it measuring 9x2.8cm. . femoral/popliteal dopplers: no dvt. hypoechoic area within the soft tissues near the l common femoral , represent edema or fluid structure. . trans-catheter embolization: procedure: celiac arteriogram, sma arteriogram, cannulation of 2 third-order sma branches with arteriogram of both; cannulation of gastroduodenal artery and arteriogram; successful embolization of the gastroepiploic and portions of the gastroduodenal artery; post-embolization arteriogram. findings/impression: pseudoaneurysm identified region of the base of the gastroduodenal/gastroepiploic artery which flows in the reverse direction. it was difficult to cannulate the abnormality, although this was cannulated and multiple coils placed across the area of abnormality. there are dilated pancreaticoduodenal arcades and reversed flow in the gda. . ruq us: cholelithiasis and gallbladder sludge; no gb wall thickening or pericholecystic fluid. cbd measures 9 mm, mildly dilated. past medical history: recent surgical history from osh: : ercp with sphincterotomy c/b gastric artery laceration celiac arteriogram, sma arteriogram, cannulation of 2 third order sma branches, embolization of the gastroepiploic and portions of gastroduodenal artery : emergenct ex-lap with partial gastrectomy, ccy,suture of periampullary artery, tube gastrostomy, divertizulization of duodenal stump and hunt- : ex-lap with evacuation of clot, repair of mesenteric defect and repair of hunt- : ex-lap with abdominal wall closure using modified technique (stratus absorbable pigskin mesh unerlay and overlay of 12 x 14 inches marlex mesh) : development of sbo requiring ex-lap with loa, tracheostomy/t-tube cholangiogram : ct guided abscess drainage of 300ml bloody fluid . past medical history: - hypertension - hyperlipidemia - coronary artery disease s/p 2 stents to lcx in - aortic regurgitation - hepatitis c (from blood transfusion), ? hbv - remote h/o testicular cancer (stage i seminoma testicular cancer, s/p left orchiectomy with radiation therapy in ) - osteoarthritis s/p left hip replacement x 2 c/b osteomyelitis social history: widowed. he lives independently downstairs from his daughter, who is a middle school teacher. he is a semi-retired produce seller. - tobacco: smoked as an adolescent but quit 60 years ago. - alcohol: rare. - illicits: denies. family history: non-contributory physical exam: vitals: t: bp: p: r: 18 o2: general: ill-appearing man, unresponsive with eyes open and head bobbing heent: sclera anicteric, mmm, ngt in place neck: supple, jvp not elevated, no lad, trach collar in place lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, multiple drains in place including: colostomy, biliary drain, 3 jp drains, gj tube gu: foley in place ext: l foot heel ulcer, wrapped pertinent results: tte: la, ra normal in size. mild symmetric lvh, lvef>55%. rv normal. av mildly thickened, no as. mild ar. mv normal. : head ct w/o contrast ct head: no acute intracranial process, including no hemorrhage. hypodensity within the right frontal lobe is unchanged from , and may represent sequelae of prior small vessel infarct. : ct torso: 1. contrast is tracking from bowel loops to the anterior abdominal wall in the lower right lower quadrant area. the findings are concerning for enterocutaneous fistula. 2. status post multiple upper gi surgeries including roux-en-y gastrojejunostomy . no obstruction or leak is noted. 3. the previously noted fluid collection within the anterior abdominal wall has significantly improved. 4. 4.5 cm focus of hyperdense fluid collection adjacent to the acetabulum on the left side which may be related to the left total hip replacement and protrusio acetabulum. : ruq ultrasound with doppler: 1. patent hepatic vasculature. 2. 2.5 x 2.3 x 3.0 cm heterogeneous lesion within the left lobe of the liver, incompletely characterized, recommend contrast-enhanced multiphasic ct or mri for further delineation. 3. known midline collection with drainage tube, partially imaged, as more fully characterized on concurrent ct examination. 4. coarsened echotexture of the liver, compatible with known cirrhosis. : portable abdomen. the bowel gas pattern is nonspecific. there is an air-filled loop of bowel within the left upper abdomen of unclear etiology due to the lack of significant features. there is some stool seen within the right and left colon. no definite dilated small bowel loops are appreciated. : eeg spike detection programs: these contained muscle and electrode artifact but no evidence of epileptiform discharges. seizure detection programs: there was no evidence of electrographic seizures contained in these files. pushbutton activations: there were no entries in these files. automated time samples: this showed more sustained 8 hz posterior dominant rhythm in the waking state which attenuated with eye opening. no areas of focal slowing, epileptiform discharges, or electrographic seizures were seen in these files. sleep: the patient progressed from wakefulness to sleep without additional findings. cardiac monitor: showed a generally regular rhythm with an average rate of 84 bpm. impression: this is a normal video eeg study in the sleeping and waking states. no focal, lateralized, or epileptiform features were seen in this study. this telemetry captured no pushbutton activations and contained no electrographic seizures. : eeg impression: this is an abnormal video eeg study due to slowing and disorganization of the background rhythm consistent with a moderate encephalopathy. note is made of several instances of rhythmic theta activity located in the posterior quadrant without obvious clinical correlate and in the context of a severely limited technical study associated with electrode artifact. these findings do suggest possible seizure activity in the right posterior quadrant; however, repeat eeg, if clinically indicated, would help clarify the above findings due to the limited technical nature of this study. : abdominal fluoro impression: 1. percutaneous duodenostomy tube with small leakage seen around the catheter entrance into the duodenum, with tracking along the catheter and liver. no definite biliary leak of contrast that refluxed into the biliary system, though a small contained leak at the t tube entrance site to the cbd can not be excluded. 2. gastrojejunostomy was filled retrograde but unable to distend completely, a followup radiograph in 45- 60 minutes is recommended. : gtube study: distention of the stomach without filling of the gastrojejunostomy. reflux into the esophagus is noted. no leak by the gastric tube injection. : r forearm: mild swelling at the level of the wrist. extensive vascular calcifications. no safe evidence of cortical disruptions indicative of fracture. moderate degenerative changes at the level of the wrist in the proximal hand. : 1. no evidence of acute aortic dissection. no definite main pulmonary artery embolism is identified, within limits of the examination. 2. no new intra-abdominal collection is noted. there is no evidence of bowel obstruction. 3. extensive fat stranding in the cholecystectomy bed and in the region surrounding the pancreatic head, likely relates to the recent surgery. 4. aneurysmal dilation of the abdominal aorta just above the iliac bifurcation measuring up to 3.4 cm. 5. bilateral atelectasis of the dependent lungs, associated with small pleural effusions, are new since the prior study. 6. extensive retained barium within the colon. : t-tube study: focal area of opacification near the area of the anastomosis, consistent with a contained leak. : ct torso: 1. increased consolidative component within the left lower lobe lung is concerning for pneumonia. 2. unchanged positioning of three surgical drains, g- and j-tubes, and internal biliary catheter. 3. stable small focal fluid collection at the surgical bed. 4. no new focal fluid collections detected. 5. no change in fluid collection adjacent to the left acetabular component of the hip athroplasty. : cxr: no appreciable interval change. culture results: pt. never had positive blood cultures at : bile cx: klebsiella pneumoniae, e.coli, c albicans : peritoneal fluid from jp: e.coli, klebsiella, prob enterococcus : hcv viral load: undetectable and : cdiff positive : cmv viral load 5620 copies : wound culture: c. albicans : uculture: pseudomonas aeruginosa : uculture: negative : sputum cx: oral flora : bal: 2+pmns, no microorganisms brief hospital course: 74 yo male s/p multiple surgical interventions at an osh now being transferred to with concern for infected mesh, infected hematoma, enterocutaneous fistula and respiratory failure. mr. had a very complicated hospital course marked by slow and steady improvement of every organ system and from an infectious disease perspective. salient aspects of his hospital course will be summarized by problem below. in brief, he came to us critically ill and was for a time admitted to the medical icu. care was eventually transferred to the sicu under dr. . he later made it to the floor, off ventilator assistance. on admission, he was continued on tpn, required ventilator assistance and was kept on broad spectrum antibiotics. as he improved clinically, he was started on tube feeds through his duodenostomy tube, which he was ultimately able to tolerate well and is now up to goal. his jp drains have remained in place and continue to drain various amounts of turbid fluid. as his liver function tests improved, his t-tube was able to be capped and his jaundice resolved. he initially required ventilator support but was able to be weaned from the vent over many days. he is now on trach collar with a passy-muir valve and is able to speak. on admission, his mental status was in question and eegs were done to rule out seizure activity. no seizures were noted. as sedation was removed, the patient's mental status got progressively better. at discharge, he is lucid, alert, and interactive. his tube feeds have been advanced to goal and his tpn was stopped. for a time, due to excessive losses from his gtube and from his biliary drain, he had difficulty with electrolyte imbalance which was treated prn. hypernatremia was a problem and he was treated with and later with h2o flushes through his duodenostomy tube with good result. his d-tube flushes were recently reduced to 100 cc q4h to reduce the amount of free water given in order to avoid fluid overload. furthermore, his stomach and the duodenostomy were both studied and it appears that the stomach is currently not emptying well into the distal gi tract. for this reason, he has been primarily provided for nutritionally by tube feeds. his gtube is treated with the following regimen: 3 hrs to gravity and one hour to low intermitted wall suction for 1 hour, which is then repeated. at the time of discharge, the patient was afebrile, tolerating tube feeds, alert and oriented and able to handle his own secretions. by problem: # fever/id: from an id perspective, the patient was treated for a number of infections. here are his culture results below. of note, he never had a positive blood culture at . : bile cx: klebsiella pneumoniae, e.coli, c albicans : peritoneal fluid from jp: e.coli, klebsiella, prob enterococcus : hcv viral load: undetectable and : cdiff positive : cmv viral load 5620 copies : wound culture: c. albicans : uculture: pseudomonas aeruginosa : uculture: negative : sputum cx: oral flora : bal: 2+pmns, no microorganisms lines were removed as pertinent. he now only has peripheral iv access. he was treated with various different antibiotic regimens for his various infections and infectious disease was consulted to help in antibiotic management. he was treated for the uti, the infected bile and peritoneal fluid as well as for c. difficile. at discharge, the patient was afebrile, not having diarrhea and had completed a full course of cdiff treatment. shortly after the patient's admission, his surgical staples were removed. soon thereafter, the superior portion of his abdominal incision began to breakdown with small amounts of bilious and purulent drainage. he was started on wet to dry dressing changes twice daily. this was changed to an ostomy bag. it continues to drain turbid fluid. the underlying mesh is almost certainly infected, however, the wound is adequately drained. the patient is now stable from this perspective. he was on the following antibiotics: : vanc/zosyn/micafungin : zosyn changed to meropenem : flagy added : vancomycin dc'd : dc'd : flagyl dc'd (off antibiotics, only on micafungin) : micafungin dc'd, started po vanc and ceftazidime : ceftazidime dc'd : po vanc dc'd . # c. difficile infection the patient was noted to have a large increase in stool production and a c. diff antigen test was sent. this returned c. difficile positive and the patient was started on metronidazole iv. he was transitioned to po vancomycin and completed a course through . . # nutrition: the patient had been maintained on tpn at the outside hospital, and enteral feeding had not been attempted. after his tube studies there was concern over extravasation of fluid from the duodenostomy tube. we wanted to place -intestinal tube distal to this duodenostomy tube for enteral feedings, but unfortunatey neither angio nor ir thought that a feeding tube could be passed through his duodenum. . the patient was started on tube feeds via existing duodenostomy tube with tube feeds based on nutrition recs of vivonex ten full strength. he was finally transitioned to his current tube feeds, impact with fiber 3/4 strength at 105 cc/hr with free water flushes 100 cc q4h. he did well with this. he was transitioned off of tpn and had his last tpn on . of note, his duodenostomy tube had to be changed out twice as it was leaking and then clogged. the current tube is working well. . # respiratory failure: the patient had undergone a tracheostomy at the outside hospital and was transferred to us on assist control. the patient was transitioned to psv and then to trach collar. ip was able to place a smaller tracheostomy tube, and he subsequently had a pmv placed and is now talking in full sentences. . # incision drainage ?????? he now has an ostomy bag over the superior aspect of his incision, still draining purulent fluid, but controlled. # hypernatremia: the patient had intermittent hypernatremia into the high 140s that responded well to d5w. no further hypernatremia with free h2o flushes in duodenostomy tube. he will need to be monitored for volume overload in the future and these free h2o flushes can be tapered off as tolerated. . #melena: patient with episodes of melena early during this hospitalization, ultimately, he received 3 units of red cells. his hct stabilized and he required no further transfusions. . #liver mass: during the patient's ruq ultrasound, a 2.5 x 2.3 x 3.0 cm heterogeneous lesion within the left lobe of the liver was noted. this lesion will require more definitive imaging on an outpatient basis when the patient is more stable. afp was sent and was normal. . # cmv +: the patient had cmv viral load sent that returned elevated. this was likely due to the large volume of blood products that he received while in the osh. no intervention was thought necessary. . # neurology: on the day of admission, the patient's daughter noticed head bobbing activity that was concerning for seizure activity. no history of seizures in the past, though decreased rhythmic activity overnight on hd 1. the patient had no further head bobbing or seizure like activity during his hospitalization. . he underwent multiple video eegs that did not demonstrate evidence of seizure. . # elevated lfts: possibly due to hypoperfusion vs. hepatitis c infection vs tpn cholestasis. lfts have trended down and are now back in normal range and his t-tube has been capped without elevation of his bilirubin. . # acute renal failure: the patient had acute renal failure and his creatinine reached a peak of 1.9 from baseline of 1.0. this was thought to be due to volume depletion based upon exam and elevated sodium. the patient was initially given ns fluid boluses and d5w for hypernatremia with improvement of his creatinine to 0.8. . the patient's creatinine was monitored throughout the hospitalization and remained at or below his baseline level. . # cad: on b-blocker, statin, aspirin at home, not continued at osh # r arm pain: patient has osteoarthritis and complained intermittently of r arm pain. this was imaged and showed no fracture. the pain seems to be tolerable at this point. consider gouty arthritis as the source? # prior to discharge, the patient underwent a ct of the torso to make sure there was no major infection hiding. a left lower lobe consolidation was noted and so the patient underwent bronchoscopy on with ip with findings of thick mucous plugging but no obvious infection. a bal gram stain only showed pmns, no microorganisms. this will be followed to ensure a negative culture. the patient remained stable from a respiratory perspective and is fit for discharge to rehab. medications on admission: medications at home: - aspirin 325 mg daily - atorvastatin 10 mg daily - lisinopril 5 mg daily - metoprolol succinate sr 25 mg daily - ranitidine hcl 150 mg - nitroglycerin sl 0.4 mg prn . medications on transfer to 1. vancomycin 900mg iv q 12 2. lovenox 40mg sc daily 3. reglan 10mg iv q 6 hours 4. erythromycin 500mg iv q 6hours 5. zosyn 3.375gm iv q 6 hours 6. tygacil 50mg iv q 12 hours 7. tpn 8. fentanyl boluses for pain 9. protonix 40mg iv q 12 hours 10. caspofungin 50mg iv daily 11. atrovent 2.5ml neb q 4 hours 12. albuterol neb q 4 hours 13. acetic acid 1000ml discharge medications: 1. acetaminophen 500 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for fever. 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation. 4. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 5. acetylcysteine 20 % (200 mg/ml) solution : 1-10 mls miscellaneous q8h (every 8 hours) as needed for thick secretions. 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : three (3) ml inhalation q6h (every 6 hours) as needed for wheezing. 8. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 9. erythromycin 250 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q6h (every 6 hours): for gi motility. 10. metoclopramide 5 mg/ml solution : ten (10) mg injection q6h (every 6 hours) as needed for motility. 11. ondansetron hcl (pf) 4 mg/2 ml solution : four (4) mg injection q8h (every 8 hours) as needed for nausea. 12. nitroglycerin 0.4 mg tablet, sublingual : one (1) tab sublingual prn as needed for chest pain. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: acute cholecystitis s/p ercp complicated by pancreaticoduodenal injury with gastroduodenal artery injury requiring emergent ex-lap, partial gastrectomy, cholecystectomy, suture of periampullary artery, tube gastrostomy, divertizulization of duodenal stump and hunt- . followed by ex-lap on following day with evacuation of clot, repair of mesenteric defect and repair of hunt- . e. coli sepsis s/p abdominal wall closure using modified technique (stratus absorbable pigskin mesh unerlay and overlay of 12 x 14 inches marlex mesh) small bowel obstruction s/p ex-lap with loa, difficult weaning from ventilator s/p tracheostomy t-tube placement intraabdominal abscess hepatitis c with cirrhosis malnutrition requiring tpn and tube feeds hypernatremia hyperbilirubinemia acute renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to after being transferred from an icu in , fl. at you were given supportive care and started on tube feeds through your duodenostomy tube. please call your doctor or return to the emergency department for the following: - fever, chills, nausea, vomiting - increasing abdominal pain, hypotension - chest pain, shortness of breath followup instructions: please call dr. office at ( in order to schedule a follow up appointment in approximately 2 weeks. please follow up with your primary care provider as needed. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus replacement of tracheostomy tube replacement of tube or enterostomy device of large intestine diagnoses: coronary atherosclerosis of native coronary artery other postoperative infection urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute respiratory failure blood in stool intestinal infection due to clostridium difficile pressure ulcer, lower back personal history of malignant neoplasm of testis other constipation pressure ulcer, heel hyperosmolality and/or hypernatremia cholangitis peritoneal abscess tracheostomy status unspecified disorder of liver hip joint replacement long-term (current) use of aspirin pressure ulcer, stage ii jaundice, unspecified, not of newborn osteoarthrosis, unspecified whether generalized or localized, other specified sites nonspecific abnormal results of function study of liver attention to other artificial opening of digestive tract osteoarthrosis, unspecified whether generalized or localized, upper arm 

Answer: The patient is high likely exposed to