| Course | PA 526 Comprehensive Clinical Module Gastroenterology |
|---|---|
| Week | 6 |
| Paper type | Bleeding source triage |
| Length | About 690 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 6
Bleeding Source Triage: Two Black, Tarry Stools and a Urea to Creatinine Ratio of 32 Placed Above the Ligament of Treitz in N.R., With the Rate Question and What Stays Unsettled Before Endoscopy
Student Name
Chamberlain University
PA 526: Comprehensive Clinical Module Gastroenterology
Instructor Name
Month Day, Year
Bleeding Source Triage: Two Black, Tarry Stools and a Urea to Creatinine Ratio of 32 Placed Above the Ligament of Treitz in N.R., With the Rate Question and What Stays Unsettled Before Endoscopy
The Presentation
Three weeks before the planned endoscopy, N.R. called the clinic after two black, sticky, foul-smelling stools in one morning and a lightheaded spell on standing. N.R. had been taking naproxen 500 mg twice daily for ten days for a back strain, on top of omeprazole. In the emergency department: blood pressure 112/70 lying and 96/62 standing, pulse 104, hemoglobin 10.9 g/dL against 14.2 three months earlier, urea nitrogen 38 mg/dL, creatinine 1.2.
What Transit Does to Blood
Blood that enters the gut high up is exposed to stomach acid and digestive enzymes and spends hours in transit. Acid turns hemoglobin into a dark pigment, and bacteria in the colon act on it further, so it arrives as black, tarry, sticky stool with a typical smell. Blood that enters low, near the rectum, comes out red because it has had no time to change. The appearance of the stool is therefore evidence of how far the blood traveled, which is the move this triage rests on.
One Divider, Two Answers
The ligament of Treitz, where the duodenum meets the jejunum, divides upper from lower gastrointestinal bleeding. Above it sit the esophagus, stomach and duodenum, which an upper endoscopy can reach; below it lie the small intestine and colon. Melena points above the divider in most patients. The urea nitrogen supports it: digested blood protein is absorbed and turned into urea, so a urea to creatinine ratio above about 30 is more common with upper bleeding. N.R.'s ratio is about 32. The naproxen, a recognized cause of ulcers in the stomach and duodenum, adds weight.
When Rate Disguises Position
Position and rate can be confused. A very fast upper bleed can rush through the gut and come out red or maroon, mimicking a lower source; a slow bleed in the right colon can sometimes darken enough to look like melena. N.R.'s stools are fully black and the blood pressure has fallen only modestly, so the rate seems moderate. If N.R. began passing red blood with a falling pressure, the triage would have to be reopened, because brisk upper bleeding would then be the leading concern.
Risk, Not Just Location
The upper gastrointestinal bleeding guideline recommends using a risk score to identify patients at very low risk who can be managed as outpatients, and supports the Glasgow-Blatchford score for this purpose (Laine et al., 2021). N.R.'s score is well above the very low risk cutoff because of the hemoglobin, urea nitrogen, pulse and melena, so admission and endoscopy within 24 hours are appropriate. The guideline also recommends a restrictive transfusion threshold of 7 g/dL for most patients, and N.R.'s hemoglobin is above it.
Saying What Remains Unsettled
The triage places the source above the ligament of Treitz, but it does not say which structure. A duodenal or gastric ulcer from naproxen is most likely. A bleeding cancer at the lower esophagus, related to the dysphagia already being investigated, must also be considered. A tear at the junction of the esophagus and stomach is unlikely without retching. The endoscopy that was planned for the swallowing complaint now has a second, more urgent purpose.
Immediate Actions Recorded
Naproxen stopped, and the daily omeprazole N.R. had started for reflux (Katz et al., 2022) was replaced by an intravenous proton pump inhibitor, as the guideline supports before endoscopy in patients with significant bleeding (Laine et al., 2021). Two large-bore cannulas, crossmatch two units, hemoglobin every six hours. Endoscopy requested for the next morning.
Table or Prose
The section allowed either. Prose was used because the argument moves from appearance to transit to position, and a table would break that chain.
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
Laine, L., Barkun, A. N., Saltzman, J. R., Martel, M., & Leontiadis, G. I. (2021). ACG clinical guideline: Upper gastrointestinal and ulcer bleeding. American Journal of Gastroenterology, 116(5), 899-917. https://doi.org/10.14309/ajg.0000000000001245
The Chamberlain PA 526 Week 6 instructions
The sixth week asks you to sort the likely source of gastrointestinal bleeding before naming a cause. Describe the appearance of the blood in your own words and then read it as evidence of how far it traveled and how long it took. Name the ligament of Treitz as the divider between upper and lower sources and explain which side your evidence favors, using supporting findings such as the urea to creatinine ratio and medicines. Explain how the rate of bleeding can disguise its position and say what would make you reopen the triage. Apply a recognized risk score to decide where care should happen. State what the triage leaves unsettled. Record the immediate actions taken. Use a table only where your template supplies one, and cite the bleeding guideline you rely on.
How this PA 526 Week 6 example is built
The paper presents N.R.'s two black, sticky stools, a lightheaded spell, ten days of naproxen with omeprazole, orthostatic changes, a hemoglobin fall from 14.2 to 10.9 and a urea nitrogen of 38. A section explains how acid, enzymes and colonic bacteria turn blood black during transit. The ligament of Treitz section places the source above it, supported by a ratio near 32 and the naproxen. A rate section explains how a brisk upper bleed can look red and names the change that would reopen the triage. The Glasgow-Blatchford score and restrictive transfusion threshold are applied, citing Laine and colleagues. An unsettled section names ulcer, a bleeding esophageal cancer and a junctional tear. Immediate actions include stopping naproxen, an intravenous proton pump inhibitor and next-morning endoscopy.
Where the points sit in the PA 526 Week 6 rubric
Points for this triage go first to reasoning from the blood's appearance. A paper that names a cause without explaining what transit did to the blood loses the most. Faculty next check that the ligament of Treitz is named as the divider and that supporting evidence is used. Credit goes to the section on how rate can disguise position, which shows awareness of the method's main weakness. A recognized risk score applied correctly earns a solid share. The unsettled section is graded on honesty about what the triage cannot decide. Immediate actions must match the guideline, including transfusion thresholds. Naming a definite diagnosis before endoscopy is a deduction, since the week asks for sorting. The bleeding guideline should be cited.
Common PA 526 Week 6 mistakes, and how to avoid them
The usual trap in this triage is jumping to a diagnosis, such as an ulcer, without showing how the evidence places the bleeding. Send your case details, including the stool description, vital signs and laboratory values, and the triage written for you would read the blood's appearance as evidence of transit, place it against the ligament of Treitz and support the call with your other findings. The rate question is addressed, along with what would reopen the triage. A risk score your course uses is applied. What stays unsettled is listed, along with immediate actions that fit current guidance. If your patient has red blood rather than melena, the reasoning is reversed accordingly. Check every value against your own case before using the triage.
Get a PA-526 Week 6 example written to your instructions
Send the case and the rubric rows your section grades against and a custom PA-526 Week 6 triage document is written to that presentation, back inside 24-48h with the first one free. If your classroom wants it as a table, include the headers, since the argument has to be compressed differently to survive inside fixed cells.
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PA 526 Week 6 questions, answered
My case gives a color and nothing else.
That is enough to build the argument on, and the example shows how. A single descriptive term about appearance supports a statement about transit, which supports a position, which supports a short candidate list, with the confidence falling at each step and the paper saying so. What it does not do is invent history the case never supplied.
Is the ligament of Treitz expected by name?
Sections differ, but naming it costs nothing and shows the anatomy behind the sorting, so the example uses it and explains it in one clause. Where your classroom uses a different convention for the same division, send that wording and the sample adopts it. The reasoning underneath does not change with the vocabulary.
The assignment asks for a triage table rather than a paper.
Then the example is built as a table and the argument is carried in whichever column is meant for rationale. Compressed cells are harder than prose, because a fragment cannot show reasoning and a full sentence may not fit. The desk writes those cells as short complete claims, which is what markers can actually award points against.
Where can I find a free PA 526 Week 6 sample paper?
The full PA 526 Week 6 bleeding triage is on this page, placing black, tarry stools above the ligament of Treitz with a urea to creatinine ratio of 32.
When would the PA 526 Week 6 triage be reopened?
If the patient began passing red blood with a falling blood pressure, because a brisk upper bleed can rush through and look like a lower source.