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: penicillins / vancomycin / cephalosporins attending: chief complaint: abdominal pain major surgical or invasive procedure: none history of present illness: 70 year old female who was admitted to dr on for gastroenteritis. reports from the outside hospital included a diagnosis of possible internal hernia and sbo. repeat abdominal ct at , however, demonstrated only wall thickening and fat stranding of a 23cm segment of the mid small bowel. there was no sign of sbo, and the patient had no peritoneal signs and she was discharged with a running diagnosis of gastroenteritis on . she is on coumadin for a mechanical valve and while in the hospital she was on a heparin drip. she was discharged from the hospital on 5 mg of coumadin daily and taking lovenox. she was told by her clinic that her last dose of lovenox was to be taken yesterday. she denies any trauma. she comes in because she was having similar abdominal pain. she was having lower abdominal which was similar to her previous symptoms. she denies nausea or vomiting. last bowel movement was two days ago. she is passing flatus. denies melena or bright red blood per rectum. past medical history: pmhx: 1st degree av block and episodes of 2nd degree av block (wenckiebach); htn; hemolytic anemia; question of tia when she had endocarditis 18 yrs ago; hypothyroidism; hyperlipidemia, htn, oa, hashimoto thyroiditis. . pshx: cabg, mechanical mvr , reoperative mvr st. , open tubal ligation. social history: married. has 4 daughters, has grandchildren. family involved. lives with husband in . retired. like to go down to a nearby beach with her husband. denies smoking, alcohol, drugs. safe at home. family history: non-contributory physical exam: on admission: vitals: 97.0, 128/88, 78, 18, 95% ra. general: alert, oriented, no acute distress, conversational. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, click heard with s1 at llsb, harsh systolic murmur iv/vi heard throughout precordium abdomen: soft throughout other than firmness at the midline and slightly to the left of midling in the infraumbilical region, +bs in surrounding regions but not auscultated over that firm region, non-distended, ttp+ at midline/infraumbilical region but not ttp elsewhere, no rebound or guarding. no organomegaly. no bruises. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: significant purple/blue bruising ranging from 2cm x 2cm to 6cm x 6cm lesions (not ttp) over the arms bilaterally. neuro: grossly intact. pertinent results: admission cbc, chemistry panel, coags: wbc-9.2# rbc-3.79* hgb-10.6* hct-33.2* mcv-88 mch-27.9 mchc-31.9 rdw-15.1 plt ct-322 pt-41.3* ptt-34.9 inr(pt)-4.4* glucose-114* urean-17 creat-0.8 na-139 k-3.7 cl-104 hco3-25 angap-14 . cardiac enzymes: 11:45pm ctropnt-0.06* 09:10am ctropnt-0.03* . 2:02am ct abdomen and pelvis with contrast: 1. interval development of new bilateral rectus abdominis hematomas. superinfection of these fluid collections cannot be excluded. linear hyperdensity in between fluid-fluid level of one of the hematomas is identified and may represent active extravasation. if clinical concern for active extravasation exists, repeat delayed imaging or angiography should be performed. 2. small amount of high-density fluid in the right paracolic gutter, similar in appearance. 3. mild biliary prominence, unchanged. 4. renal and splenic hypodensities, incompletely characterized. dedicated renal/spleen ultrasound is recommended on nonurgent basis. 5. interval improvement in small bowel wall thickening as compared to prior exam. . 1:39pm abd/pelvic ct w/contrast: 1. there is increase in size of the left rectus sheath hematoma in both transverse, ap and craniocaudal dimension with an increase of the extraperitoneal pelvic pre- and perivesical component of the hematoma. 2. unchanged small amount of fluid in the paracolic gutters bilaterally. 3. no additional foci of bleeds including no retroperitoneal bleeding. . abd/pelvic ct w/contrast: 1. active extravasation idicating arterial bleeding into left rectus hematoma from a branch of the left epigastric artery. multiple rectus sheath abdominal wall hematomas, in a different configuration although not significantly changed in size. hematoma in the extraperitoneal pelvic pre- and perivesical space, unchanged. 2. hemoperitoneum adjacent to the liver and in paracolic gutters, slightly increased when compared to prior exam. 3. right basilar atelectasis. . microbiology: mrsa screen: negative. mrsa screen: negative. brief hospital course: 70 year old female with h/o mvr on coumadin, with recent admission from to for gastroenteritis treated with cipro and flagyl, now with recurrent abdominal pain and found to have a new large rectus hematoma, which likely formed spontaneously in the setting of a supratherapeutic inr (likely secondary to coumadin plus antibiotic use). also, the abdominal pain could include a component of the patient's resolving colitis. . the patient presented with decreased blood pressure and increased tense abdomen on with a repeat ct scan showing an enlarging restus hematoma. anticoagulation was held. the patient was transfused a unit of blood, and the hct did not bump significantly. a subsequent repeat ct scan showed active bleeding, for which the patient given a unit of ffp and planned for interventional radiology to embolize the bleed. cardiology was consulted. based on risk/benefits of embolizing a patient with an elevated inr (3.3 at that time), the embolization was not performed. the patient remained hemodynamically stable, but with more tense/painful abdomen. as such, patient was then admitted to the sicu and transferred to the surgical service for further management. . in the sicu, the patient was given vitamin k 2mg iv, 5units of ffps, and 2units prbc. a (r)ij cvl was placed. on , she went to interventional radiology, where attempts to perform selective catheterization were unsuccessful, as the left inferior epigastric artery was found to be tortuous, thus no prophylatic embolization was performed. of note, no active extravasation was seen on arteriogram. on , she received another unit of prbc for a hct of 22.6. lasix was given to prevent fluid overload. serial hcts remained stable. on , cardiology was consulted regarding anticoagulation recommendations, and a heparin drip was started. coagulation studies were closely monitored. tha patient was transferred to the inpatient floor on , at which time coumadin was restarted at 4mg in the evening. . the patient was continued on a heparin drip, which was adjusted regularly according to routine ptt, until the inr became therapeutic again on coumadin prophylaxis. once the inr became therapeutic, the heparin was discontinued. inr goal 2.5-3.5. during this hospitalization, the patient ambulated early and frequently, was adherent with respiratory toilet and incentive spirrometry, and actively participated in the plan of care. labwork was routinely followed; electrolytes were repleted when indicated. . at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. she will follow-up with her pcp to further manage her coumadin prophylaxis. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: lipitor 80mg qday lovenox 120mg qday hctz 12.5mg qday levothyroxine 125mcg qday lisinopril 20mg qday metoprolol tartrate 50mg cipro 250mg until metronidazole 500mg until coumadin 5mg alternating with 7.5mg daily asa 81mg daily discharge medications: 1. levothyroxine 125 mcg tablet sig: one (1) tablet po qmon, tues, thurs, fri, sat and 2 tab po qwed. and sun. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: over-the-counter. 3. 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* 4. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain: do not exceed 4gm (4000mg) acetaminophen daily. 5. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 6. lipitor 80 mg tablet sig: one (1) tablet po once a day. 7. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 9. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: 1. spontaneous rectus sheath hematomas. 2. left epigastric artery bleed. 3. history of mechanical mitral valve replacement on coumadin prophylaxis. 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.** please follow-up with your primary care provider (pcp) and the clinic as advised. if you experience any of the following, please call your doctor or come to the emergency department: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. coumadin information: coumadin (warfarin): what is this medicine used for? this medicine is used to thin the blood so that clots will not form. how does it work? warfarin changes the body's clotting system. it thins the blood to prevent clots from forming. what you should contact your healthcare provider : signs of a life-threatening reaction. these include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat, severe dizziness or passing out, falls or accidents, especially if you hit your head. talk with healthcare provider even if you feel fine, significant change in thinking clearly and logically, severe headache, severe back pain, severe belly pain, black, tarry, or bloody stools, blood in the urine, nosebleeds, coughing up blood, vomiting blood, unusual bruising or bleeding, severe menstrual bleedin, or rash. call your doctor if you are unable to eat for several days, for whatever reason. also call if you have stomach problems, vomiting, or diarrhea that lasts more than 1 day. these problems could affect your coumadin??????/warfarin dosage. coumadin (warfarin) and diet: certain foods and beverages can impair the effect of warfarin. for this reason, it's important to pay attention to what you eat while taking this medication. until recently, doctors advised taking warfarin to avoid foods high in vitamin k. this is because large amounts of vitamin k can counteract the benefits of warfarin. however, recent research shows that rather than eliminating vitamin k from your diet, it is more important to be consistent in your dietary vitamin k intake. these foods contain vitamin k: fruits and vegetables, such as: kiwi, blueberries, broccoli, cabbage, sprouts, green onions, asparagus, cauliflower, peas, lettuce, spinach, turnip, collard, and mustard greens, parsley, kale, endive. meats, such as: beef liver, pork liver. other: mayonnaise, margarine, canola oil, soybean oil, vitamins, soybeans and cashews. limit alcohol. alcohol can affect your coumadin??????/warfarin dosage but it does not mean you must avoid all alcohol. serious problems can occur with alcohol and coumadin??????/warfarin when you drink more than 2 drinks a day or when you change your usual pattern. binge drinking is not good for you. be careful on special occasions or holidays, and drink only what you usually would on any regular day of the week. monitoring: the doctor decides how much coumadin??????/warfarin you need by testing your blood. the test measures how fast your blood is clotting and lets the doctor know if your dosage should change. if your blood test is too high, you might be at risk for bleeding problems. if it is too low, you might be at risk for forming clots. your doctor has decided on a range on the blood test that is right for you. the blood test used for monitoring is called an inr. use of other medications: when coumadin??????/warfarin is taken with other medicines it can change the way other medicines work. other medicines can also change the way coumadin??????/warfarin works. it is very important to talk with your doctor about all of the other medicines that you are taking, including over-the-counter medicines, antibiotics, vitamins, or herbal products. followup instructions: provider: , md (pcp). phone: . location: , ste gb, ,. . provider: , md phone: date/time: 10:00. location: 3, , . procedure: arteriography of other intra-abdominal arteries diagnoses: other and unspecified noninfectious gastroenteritis and colitis abnormal coagulation profile unspecified essential hypertension acute posthemorrhagic anemia unspecified acquired hypothyroidism aortocoronary bypass status other and unspecified hyperlipidemia heart valve replaced by other means hypotension, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use hemorrhage, unspecified unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to