Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abdominal Adhesions


Related Terms

  • Adhesions Related Disorder
  • Asherman’s Syndrome
  • Diaphragm Adhesions
  • Mesenteric Adhesions
  • Omentum Adhesions
  • Pelvic Adhesions
  • Peritoneal Adhesions
  • Stomach Adhesions
  • Surgical Adhesions

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • Gastroenterologist
  • General Surgeon
  • Gynecologist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Complications from surgery lengthen the time of disability, as does recurrence of adhesions.

Medical Codes

ICD-9-CM:
560.81 - Intestinal Obstruction; Intestinal or Peritoneal Adhesions with Obstruction
568.0 - Abdominal Adhesions

Overview

Abdominal adhesions are bands of scar tissue that have formed inside the abdomen. They can form between the inside lining of the abdominal wall (called the peritoneum or omentum) and abdominal organs, between loops of intestine, or between any of the abdominal organs.

Abdominal adhesions may form in response to surgery, bleeding or an inflammatory disease in the abdomen, as part of the body's normal attempt to repair itself. After surgery, adhesions begin to form within the first few days and may progressively enlarge, eventually producing symptoms after months or years (Parker). Adhesions are the most common cause of bowel obstruction, particularly in the small bowel, because the adhesion wraps around the intestine, progressively blocking a portion of the bowel. Adhesions can also result in blockage of blood flow to parts of the bowel, called strangulation, which requires immediate surgical treatment. In women, adhesions may form on or adhere to the ovaries, uterus, and fallopian tubes (pelvic adhesions), resulting in obstruction of the reproductive tract and often leading to infertility.

Incidence and Prevalence: Abdominal adhesions occur after approximately 95% of all abdominal surgeries, with up to 6% of cases requiring follow-up care (Menzies). Adhesions are also present in 10.4% of individuals who have never had abdominal surgery (Menzies). In the US in 2005, over 350,000 individuals required surgical correction of abdominal adhesions (a procedure called lysis of adhesions, or adhesiolysis) (Sikirica).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Although abdominal adhesions most commonly occur following abdominal or pelvic surgery, they can also occur in those who have never had surgery. Adhesions can result from endometriosis, perforated ulcers, appendicitis, or infections in the fallopian tubes. Other causes of adhesions include radiation treatment of the abdomen, or a foreign substance or object left in the abdomen after surgery. Any trauma to the abdomen may result in adhesions. Adhesion formation remains a major complication after lower abdominal and gynecologic operations. Although more of these procedures are now being done through use of small incisions and a scope (laparoscopy), the rate of adhesion formation has not significantly decreased.

Source: Medical Disability Advisor



Diagnosis

History: Individuals usually report prior abdominal surgery, particularly if a postoperative infection developed. The majority of abdominal adhesions are asymptomatic. Cramping, bloating, and intense abdominal pain are the primary symptoms of adhesions that are causing partial intestinal obstruction. Nausea followed by vomiting that may occur in waves is also reported if the adhesion causes complete intestinal obstruction. With symptomatic pelvic adhesions, females may report experiencing painful intercourse or being infertile.

Physical exam: The exam may reveal a surgical scar. Abdominal distention may be seen if complete intestinal obstruction has occurred. Listening to the abdomen with a stethoscope (auscultation) may reveal abnormal bowel sounds such as high-pitched rushes. Tenderness to palpation will be found in more advanced cases.

Tests: Plain abdominal x-rays or contrast films (upper GI or barium enema) may reveal small bowel obstruction. If pain is the only symptom and there is no evidence of intestinal obstruction, many other tests may be done to confirm the diagnosis. Visually examining the various areas and levels of the gastrointestinal tract with various scopes (endoscope, colonoscope, sigmoidoscope, proctoscope, capsule studies) can identify strictures probably due to adhesions. MRI evaluation may be useful in some cases. In cases in which the diagnosis is questionable, surgical exploration and visualization, either by laparoscopy or laparotomy, may be the definitive diagnostic test.

Source: Medical Disability Advisor



Treatment

Surgical release of adhesions is the only effective treatment, but it may be problematic since surgery may have been the original cause of adhesions. Adhesiolysis of both abdominal and pelvic adhesions can often be performed through a scope inserted through a small skin incision (laparoscopy). Through the laparoscope or via open surgical procedure, the adhesions will be cut (sharp dissection), electrically coagulated, or treated with laser (ablation).

If an area of bowel has had its blood supply cut off, it may be necessary to remove (resect) that portion of intestine. This may necessitate connecting the bowel to the abdominal wall (ostomy); it may be possible to reconnect the bowel at a later time.

Newer surgical techniques have been developed in which absorbable barrier agents, made of cellulose, chemically modified sugars, fibrin, or Gore-Tex, are inserted between organs during surgery to release adhesions; these barriers reduce the tendency for adhesions to re-develop (Ahmad). Spray-on adhesion barriers are also being developed to use during surgery to protect underlying tissues during the first few postoperative days, before the barriers are safely absorbed (Ferland).

Source: Medical Disability Advisor



Prognosis

Surgical removal of adhesions produces a good outcome, with full recovery in the majority of individuals. However, recurrence is seen in 11% to 17% of patients.

Source: Medical Disability Advisor



Complications

Abdominal adhesions are permanent unless a surgical procedure to remove symptomatic adhesions is performed. More adhesions may develop following the surgery to remove the original adhesions. Bleeding, infection, and mechanical injury may occur as complications after surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If the individual has had surgical treatment, time off from work to recover from surgery is needed. If sedentary duties are available, the individual may return to work during the latter weeks of recovery, but lifting, pushing, pulling, and climbing activities may not be permitted until postoperative recovery is complete. Use of prescribed medications for management of postoperative pain may require review of drug policies. Safety issues may need to be evaluated.

Risk: Adhesion risk is greatest with colonic and rectal surgery with nearly 50% of these patients readmitted for abdominal adhesions (Parker). However, a high percentage of abdominal surgeries result in adhesions ranging from 50% for rectal surgery, 49% for colonic, 21% for appendix, and 36% for both abdominal wall and small intestinal surgery. Thus recurrence of adhesions would be expected in approximately 25% to 30% or more of all abdominal surgeries (Parker; Ellis). Once the individual is treated surgically, there is no job that would increase the risk of adhesion re-formation. The restrictions for return to work have to do with the surgical considerations and entry through the abdominal wall.

Capacity: Once healed, there would not be an impact on capacity expected.

Tolerance: Tolerance of return to work would be altered if there is a colostomy. Worker re-assurance and bathroom proximity may be needed to ensure return to work.

Source: Medical Disability Advisor



Maximum Medical Improvement

6 weeks

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What is the suspected cause of the adhesions? Previous surgery? Bleeding? Inflammatory disease?
  • Was radiation treatment to the abdomen performed?
  • Does individual have a history of a perforated ulcer, appendicitis, endometriosis, or infections in the fallopian tubes?
  • On exam, were there abnormal bowel sounds? Was abdominal distention evident?
  • Were plain abdominal x-rays, upper GI, or barium enema done to rule out a bowel obstruction?
  • Was endoscopic examination of the GI tract done?
  • Was MRI done?
  • Was it necessary to do surgical exploration (exploratory laparoscopy)?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Were the adhesions released through the laparoscope or open procedure?
  • Were the adhesions cut, electrically coagulated, or laser treated?
  • What kind of absorbable barrier was used during the current surgery?

Regarding prognosis:

  • Does individual have any comorbid conditions that could affect recovery?
  • Did adhesions reform?

Source: Medical Disability Advisor



References

Cited

Ahmad, G., et al. "Barrier Agents for Adhesion Prevention after Gynecological Surgery." Cochrane Database of Systematic Reviews 16 2 (2008): CD000475. PubMed. 12 Sep. 2013 <PMID: 18425865>.

Ellis, H. , et al. "Adhesion-Related Hospital Readmissions after Abdominal and Pelvic Surgery: A Retrospective Cohort Study." Lancet 353 (1999): 1476-1480.

Ferland, R., and P. K. Campbell. "Pre-clinical Evaluation of a Next-Generation Spray Adhesion Barrier for Multiple Site Adhesion Protection (Abstract)." Surgical Technology International 18 (2009): 137-143. PubMed. <PMID: 19579201>.

Menzies, D. , and H. Ellis. "Intestinal Obstruction from Adhesions--How Big Is the Problem?" Annals of the Royal College of Surgeons of England 72 (1990): 60-63.

Parker, M. C. , et al. "Postoperative Adhesions: Ten-Year Follow-up of 12,584 Patients Undergoing Lower Abdominal Surgery." Diseases of the Colon and Rectum 44 (2001): 829-830.

Sikirica, V. "The Inpatient Burden of Abdominal and Gynecological Adhesiolysis in the Us." BMC Surgery 11 (2011): 13.

Source: Medical Disability Advisor






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