| Course | PA 526 Comprehensive Clinical Module Gastroenterology |
|---|---|
| Week | 2 |
| Paper type | Abdominal quadrant brief |
| Length | About 730 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 526 Week 2
Abdominal Quadrant Brief: N.R.'s "Squeezing Under the Right Ribs That Goes to My Shoulder Blade" Read Twice, Once as Reported and Once as Anatomy, With the Left Lower Quadrant Ruled Out by Name
Student Name
Chamberlain University
PA 526: Comprehensive Clinical Module Gastroenterology
Instructor Name
Month Day, Year
Abdominal Quadrant Brief: N.R.'s "Squeezing Under the Right Ribs That Goes to My Shoulder Blade" Read Twice, Once as Reported and Once as Anatomy, With the Left Lower Quadrant Ruled Out by Name
The Description as Reported
N.R. said: "It's a squeezing under my right ribs, sometimes in the middle up top, that comes about an hour after a big supper and lasts a couple of hours. It goes through to my right shoulder blade. I can't get comfortable, I walk around. Then it's gone and I'm fine the next day." Three episodes in six weeks, the last one after fried fish. No fever. No vomiting except once. No yellow eyes. Bowel habits unchanged.
The Description Read as Anatomy
"Under my right ribs" places the pain in the right upper quadrant, and "sometimes in the middle up top" adds the epigastrium. "Goes through to my right shoulder blade" is pain referred to the right subscapular area, which fits irritation carried by nerves shared with the gallbladder and the underside of the diaphragm. "Squeezing" that builds and fades over hours, with restlessness rather than lying still, fits pain from a hollow organ working against a blockage, not from an inflamed lining. Its timing, an hour after a large fatty meal, fits the gallbladder contracting against a stone in its outlet.
Sharp Points, Dull Middles
Pain from the organs themselves, such as a stretched gallbladder, is carried by nerves that enter the spinal cord at several levels, so it is felt as dull, deep and poorly localized, often in the midline. Pain from the inflamed lining over an organ, the parietal peritoneum, is carried by the nerves of the abdominal wall and is sharp and precise. N.R.'s pain is a dull middle with a referred point at the shoulder blade, not a sharp point under the ribs, which suggests biliary colic rather than cholecystitis, in which the inflamed gallbladder touches the parietal lining and makes the right upper quadrant tender to the touch.
Why the Midline Is Crowded
The epigastrium holds the stomach, the duodenum, the pancreas, the left lobe of the liver and the lower esophagus, and the heart sits just above it. Each can cause pain in the same few square inches. That is why "sometimes in the middle up top" is not enough on its own: an ulcer, pancreatitis and an inferior heart attack all belong on an epigastric list. N.R.'s timing with meals, the referral to the shoulder blade and the absence of exertional symptoms move the gallbladder to the front, but an ECG was done at the visit and was normal, because the cost of missing the heart is high.
The Region the Example Rules Out
The left lower quadrant, home to the sigmoid colon and in women the left ovary, is ruled out: nothing in the description points there, N.R. has no change in bowel habit, and the examination was not tender there. Saying so plainly prevents a reader from wondering whether diverticulitis was considered.
What Was Found on Examination
Abdomen soft, not distended. Mild tenderness on deep pressure under the right costal margin without guarding. Murphy sign negative between attacks. No mass. Liver edge not palpable. Bowel sounds normal. Temperature 36.8 C. The examination between attacks fits uncomplicated biliary colic, in which the gallbladder is not inflamed once the stone falls back.
What the Brief Leads To
A right upper quadrant ultrasound has been ordered, with liver chemistry and lipase, because ultrasound is the first test for suspected gallstones. N.R. was also asked about heartburn, and described burning behind the breastbone most nights for years, which the ACG reflux guideline treats as typical reflux (Katz et al., 2022). That second complaint is kept apart from the first, since it is a different structure with a different story, and the dyspepsia guideline treats upper abdominal pain and reflux as overlapping but separate problems (Moayyedi et al., 2017).
Length and Format
The section asked for prose with an optional table; this brief uses none, because the reasoning moves from words to anatomy and a table would separate them.
References
Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27-56. https://doi.org/10.14309/ajg.0000000000001538
Moayyedi, P., Lacy, B. E., Andrews, C. N., Enns, R. A., Howden, C. W., & Vakil, N. (2017). ACG and CAG clinical guideline: Management of dyspepsia. American Journal of Gastroenterology, 112(7), 988-1013. https://doi.org/10.1038/ajg.2017.154
Reading the PA 526 Week 2 instructions
Week two asks for a short brief working from a patient's own description of abdominal pain. Quote the description in one paragraph, as reported, with its timing, triggers, radiation and associated symptoms. In the next paragraph, read it again as anatomy: name the regions anatomically, not by pointing, and explain what each phrase suggests about the structure and mechanism involved. Explain the difference between pain from an organ and pain from the lining over it, and apply it to your patient. Address any crowded region where several organs overlap and say how you would avoid missing a dangerous one. Name at least one region your case rules out and why. Report the examination findings and say where the brief leads. Use a table only if your section asks for one.
How the PA 526 Week 2 example is put together
The brief quotes N.R.'s description of squeezing pain under the right ribs and sometimes in the upper middle, an hour after a large supper, lasting hours and going through to the right shoulder blade, with three episodes in six weeks. The anatomical reading maps each phrase to the right upper quadrant, epigastrium and referred subscapular pain, and reads restlessness and timing as a gallbladder working against a stone. A section contrasts dull visceral pain with sharp parietal pain, favoring biliary colic over cholecystitis. Another explains the crowded epigastrium and the normal ECG. The left lower quadrant is ruled out. Examination between attacks is reported. The plan orders ultrasound, liver chemistry and lipase, and separates N.R.'s nightly heartburn, citing the reflux and dyspepsia guidelines.
PA 526 Week 2 rubric: what full points look like
The heaviest weight in this brief goes to separating report from inference. A brief that mixes the patient's words with the writer's conclusions in the same sentences loses the most. Faculty next look for anatomical region names rather than pointing language, and for a mechanism attached to each phrase. Credit goes to applying the visceral and parietal distinction correctly to the patient. For the crowded region, marks depend on naming the dangerous alternatives and what was done to exclude them. Ruling out a region by name earns marks. Examination findings must be reported and must fit the reading. The plan is graded on whether it follows from the analysis, and any guideline cited should support a specific point rather than general background.
PA 526 Week 2 help: mistakes that cost points
Students often lose marks here by turning the patient's description straight into a diagnosis. Share your patient's words and examination findings, and the brief drafted for you would quote the description first, then reread it phrase by phrase as anatomy, naming regions properly and the mechanism behind each feature. The difference between organ pain and lining pain is applied to your case. If your patient's pain sits in a crowded region, the dangerous alternatives are named with how they were addressed. At least one region is ruled out by name. The examination and next steps are tied to the reading. Check every quoted phrase against your own case so the patient's words in your brief are accurate.
Get a PA-526 Week 2 example written to your instructions
Paste the case exactly as your section wrote it, with the rubric rows if you have them, and a custom PA-526 Week 2 brief is written against that description and back inside 24-48h, the first one free. If the assignment supplies a table or a required heading order, include it and the example is built into that shape.
More PA 526 papers and MPAS samples
- PA 526 Week 1: Abdominal Region Discussion Post
- PA 526 Week 3: Alarm Feature Checklist
- PA 526 Week 4: Dysphagia and Reflux Case
- PA 526 Week 5: Liver Panel Interpretation
- PA 526 Week 6: Bleeding Source Triage
- PA 526 Week 7: Endoscopy Indication Write-up
- PA 526 Week 8: Hepatobiliary Case Paper
- PA 524 Week 2: eGFR Estimate Write-Up
- PA 522 Week 2: Feedback Axis Explainer
- PA 520 Week 2: Spirometry Interpretation
- PA 518 Week 2: ECG Interpretation Drill
PA 526 Week 2 questions, answered
My case gives a pain with no clear location at all.
That is usable evidence rather than a gap. A complaint the patient cannot place is telling you which nerve supply is carrying it, and the example builds its opening on exactly that point before moving to the band the description does suggest. Send the wording as given, including any hesitation the case records, since it often carries the argument.
Does the brief need a diagram or an image?
Only where your section asks, and most do not. Where a diagram is wanted the example includes a simple labeled figure with a caption that repeats the region in words, since markers read the caption and not always the figure. If your classroom bars images, the same content is carried in a short list of structures instead.
Can the brief name a condition the course has not covered yet?
It can, and the example does where the anatomy points there, but it is written to be defended from the region rather than dropped in. The safer version names the structure first and the condition second, which keeps the argument intact even if a marker disagrees with the label. Tell the desk which weeks your course has covered.
Where can I find a free PA 526 Week 2 sample paper?
The full PA 526 Week 2 quadrant brief is on this page, reading a patient's description of right upper pain once as reported and once as anatomy.
Why does the PA 526 Week 2 sample favor biliary colic over cholecystitis?
The pain is dull, poorly localized and referred to the shoulder blade, and the abdomen is not tender between attacks, which fits a stretched gallbladder rather than an inflamed lining.