A 48-year-old male complains of abdominal pain that began about 6 months previously which is constant in nature, especially after meals and is located in the upper mid abdomen superior to the umbilicus. He also repos some heaburn that occurred during the previous year. He has been under significant stress and has been self-medicating himself with over-the-counter antacids, with some relief. He states that his stools have changed in colour over the previous 2 months and now are intermittently dark and tarry in consistency. The physician tests the patient's stool and finds following result. What organs are likely to be affected?

A- Stomach B- Gallbladder C- Distal Ileum and caecum This patient has a history typical for peptic ulcer disease, that is, constant mid epigastric pain after meals. The patient also has symptoms consistent with gastro-esophageal reflux disease. The dark and tarry stools reflect blood in the stools; that is, hemoglobin has been conveed to melena. This is suggestive of an upper gastrointestinal bleeding disorder. The next step would be an upper endoscopy to visualize the suspected ulcer. If the stomach is the site, a biopsy is usually performed to assess concurrent malignancy. Treatment includes a histamine-blocking agent, proton pump inhibitor, and antibiotic therapy. The bacterium Helicobacter pylori has been implicated in most cases of peptic ulcer disease. If an ulcer occurs in the duodenum, the posterior wall of the ampulla of the duodenum (duodenal cap) is the usual site. The gastro-duodenal aery lies posterior to the duodenum at this point and is at risk in the event of ulcer perforation.