رجل صائم في رمضان، يأخذ مسكنات للظهر بدون وصفة على السحور. بعد أسبوعين صار يتعب بسرعة، ولاحظ براز أسود لزج. الضغط ١١٠/٧٠، النبض ٩٨، الهيموغلوبين ٩٫٨ (كان ١٤ قبل شهر). ما التفسير الأرجح؟

A man fasting in Ramadan takes over-the-counter painkillers for back pain at suhoor. After two weeks he tires easily and notices black, tarry stools. BP 110/70, HR 98, Hb 9.8 g/dL (14 a month ago). What is the most likely explanation?

1. Stool colour change from eating many dates
2. Bleeding from an NSAID-induced ulcer on an empty stomach
3. Colitis from changed meal and sleep times
4. Mild anaemia from eating less during fasting only

Answer: B) Bleeding from an NSAID-induced ulcer on an empty stomach. Tarry stools with a falling Hb indicate upper GI bleeding. NSAIDs raise ulcer and bleeding risk, especially without gastroprotection; urgent assessment and endoscopy are needed.