A 60 year old male had a sudden fall in toilet. His BP was 90/50 mm Hg and pulse was 100/mm. His relatives repoed that his stool was black/dark in colour. Fuher careful history revealed that he is a known case of hypeension and coronary aery disease and was regularly taking aspirin, atenolol and sorbitrate. The most likely diagnosis is:

Ans. a. Gastric ulcer with bleeding In the given question, the 60-year old patient is presenting with black stool (melena) due to G.I. blood loss, history o aspirin use. So the diagnosis is most probably NSAID induced peptic ulcer disease. "GI bleeding is the most common complication observed in PUD. It occurs in -15% of patients and more often in individuals >60 years of age. The moality rate is as high as 5-10%. The higher incidence in the elderly is likely due to the increased use of NSAIDs in this group. Up to 20% of patients with ulcer-related hemorrhage bleed without any preceding warning signs or symptoms."- Harrison 18/e p2444