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 Pain


Related Terms

  • Acute Abdomen

Differential Diagnosis

  • Endocrine and metabolic disorders
  • Exposure to toxins or ingestions of drugs
  • Gynecological disorders
  • Hematologic disorders (leukemia)
  • Infections and inflammatory disorders
  • Narcotic withdrawal
  • Referred pain from thoracic region, hip, or back

Specialists

  • Emergency Medicine Physician
  • Gastroenterologist
  • General Surgeon
  • Gynecologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Cardiovascular diseases
  • Diabetes
  • Hepatic disease
  • Immunodeficiency
  • Obesity
  • Pulmonary disease

Factors Influencing Duration

Length of disability may be influenced by the severity of the symptoms, underlying cause or specific diagnosis, type of treatment, response to treatment, and the development of complications.

Medical Codes

ICD-9-CM:
789.00 - Abdominal Pain, Unspecified Site
789.01 - Abdominal Pain, Right Upper Quadrant
789.02 - Abdominal Pain, Left Upper Quadrant
789.03 - Abdominal Pain, Right Lower Quadrant
789.04 - Abdominal Pain, Left Lower Quadrant
789.05 - Abdominal Pain, Periumbilic
789.06 - Abdominal Pain, Epigastric
789.07 - Abdominal Pain, Generalized
789.09 - Abdominal Pain, Other Specified Site; Multiple Sites

Overview

Abdominal pain is a symptom that occurs during the course of many acute and chronic illnesses.

Abdominal pain may vary in severity and duration. It may resolve before a diagnosis can be made or may be indicative of a severe, life-threatening condition. Sudden onset of severe abdominal pain may require hospitalization for control of symptoms and diagnosis of the underlying condition. Chronic abdominal pain does not usually require hospitalization for treatment or diagnosis.

Pain may be diffused over the entire abdomen or may be localized to the right or left side and/or the upper or lower quadrants. The source of abdominal pain is often difficult to pinpoint and may, in fact, not involve abdominal organs (liver, gall bladder, intestines or spleen). Abdominal pain can originate in another part of the body such as the lungs (pleurisy, pneumonia), heart (myocardial infarction, endocarditis, pericarditis), pelvic region or spine (osteomyelitis, nerve root pain). Several causes of abdominal pain (e.g., ascending cholangitis, acute pancreatitis, acute mesenteric ischemia, ruptured aortic aneurysm) are associated with high morbidity and mortality and require immediate evaluation and treatment.

The term "acute abdomen" refers to an episode of severe abdominal pain that lasts for several hours or longer, may be accompanied by other signs and symptoms, and requires immediate medical attention. Examples of conditions causing an acute abdomen include gastrointestinal tract disorders (perforated gastric or duodenal ulcer, appendicitis, bowel obstruction, pseudo-obstruction, bowel perforation, incarcerated hernia); liver, spleen, and biliary tract disorders (acute cholecystitis, acute cholangitis, biliary colic, hepatic abscess, splenic infarct or rupture); pancreatic disorders (acute pancreatitis); urinary tract disorders (renal colic, acute pyelonephritis, perinephric abscess); vascular disorders (ruptured aortic aneurysm, mesenteric ischemia/thrombosis); and peritoneal disorders (peritonitis and intra-abdominal abscess). Additional causes of acute abdominal symptoms in women include gynecological disorders, such as ruptured ectopic pregnancy, torsion (twisting) of a normal ovary, torsion of an ovarian cyst, acute salpingitis, endometriosis, spontaneous abortion, and degeneration of a fibroid especially during pregnancy. An acute abdomen may also occur with the worsening of chronic abdominal conditions.

Recurrent milder abdominal pain may suggest chronic illness such as chronic gastritis, pancreatitis, cholecystitis, hepatitis, peptic and duodenal ulcers, abdominal tumors, diverticulosis, Crohn's disease, ulcerative colitis, irritable bowel syndrome, gynecologic problems, or psychosomatic pain.

Risk for acute abdominal pain is related to the underlying cause, including disorders of major abdominal organ systems, vascular disorders, gynecologic disorders and presence of tumors. For chronic abdominal pain, risk is increased in individuals with chronic gastrointestinal disorders such as gastritis, cholecystitis, peptic and duodenal ulcers, diverticulosis, ulcerative colitis or irritable bowel syndrome.

Incidence and Prevalence: Males and females are affected equally and incidence varies with the underlying cause or diagnosis. All age groups are affected although incidence increases with advancing age (King). Annually, more than 13.5 million individuals are seen in primary care settings for abdominal pain (Flasar). Abdominal pain accounts for 10% of all emergency room visits (King).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Use of aspirin and other nonsteroidal anti-inflammatory drugs, alcohol, or tobacco can lead to abdominal pain, but because the pain is a symptom of a variety of underlying causes, risks related to demographics and lifestyle are difficult to anticipate.

Source: Medical Disability Advisor



Diagnosis

History: The timing mode of onset and initial characteristics of pain are all key elements of the history. Abdominal pain can vary in location, mode of onset, progression, and character. The individual may complain of slow onset; dull poorly localized abdominal pain; or acute, sharp, and highly localized pain. Abdominal pain can spread or shift over time. Onset may be rapid (within seconds), rapidly progressive (within 1 to 2 hours), or gradual (over several hours or days). Pain can be constant, intermittent, vague, or crampy. The individual may describe it as "stabbing" or capable of "taking my breath away." The pain may radiate or be referred to the shoulder, the back or, in men, the testicles. The relationship of pain to food intake can offer valuable clues about causation. Individuals may also complain of fever, loss of appetite, nausea, vomiting, constipation, or diarrhea. In many cases, other symptoms are helpful in identifying the cause of abdominal pain. Besides the present condition, the history must include a detailed account of all existing medical conditions, medications, family history and occupational history.

Physical exam: Physical findings vary depending on the cause of the abdominal pain. The abdomen can be tense, rigid, generally or locally tender, and/or distended. Contractions may be visible, and bowel sounds may be diminished. Abdominal masses may be detected by deep touch (palpation). Pain with gentle pressure on the abdomen may intensify when the pressure is released (rebound tenderness). Other pertinent findings may include pale complexion (pallor), low blood pressure (hypotension), fever, rapid heartbeat, shallow breathing, sweating. A yellow tinge to the skin and whites of the eyes (jaundice) suggests liver involvement. Blood in the vomitus, stool, or urine (hematuria) suggests other diagnoses. Rectal and pelvic examinations may help identify the location and source of the pain. Vital signs (i.e., blood pressure, or heart rate) should be monitored; abnormalities in vital signs may indicate a more serious life-threatening condition.

Tests: Commonly ordered laboratory tests include blood studies such as a complete blood count, liver function panel, kidney function panel, pregnancy test, amylase, and lipase. Urinalysis may be done to look for infection, kidney dysfunction, or urinary tract disorders. The stool may be tested for occult blood, parasites, or other abnormalities. Diagnostic imaging studies may include plain chest and abdominal x-rays, contrast x-rays (upper and lower GI series), intravenous pyelogram (to look for kidney/urinary tract abnormalities), angiography, ultrasound, CT, and radionuclide scan. Endoscopy (colonoscopy, gastroduodenoscopy, proctosigmoidoscopy) may be indicated, as well as paracentesis (removal of excess abdominal fluid) and laparoscopy. In women, diagnostic laparoscopy may be done for suspected gynecologic causes because the technique allows both rapid diagnosis and immediate surgical intervention. In some cases, cardiovascular tests such as ECG or echocardiography may be done to help determine the cause of pain. Such tests are especially important if there is a history of atherosclerotic disease, or arrhythmias, as well as when the individual has certain risk factors.

Source: Medical Disability Advisor



Treatment

Treatment depends on the symptoms, their severity, and the specific underlying diagnosis. Hospitalization is often necessary for individuals experiencing acute abdominal pain, but is less common for chronic abdominal pain. Treatment of abdominal pain related to chronic conditions (such as chronic gastritis, pancreatitis, cholecystitis, peptic and duodenal ulcers, diverticulosis, Crohn's disease, ulcerative colitis, or irritable bowel syndrome) usually involves drug therapy to manage pain, inflammation, excess stomach secretions, and other symptoms.

Food, drink or medication by mouth is usually withheld from individuals with an acute abdomen. Intravenous fluids are given to maintain hydration. Antibiotics may be given intravenously to treat infectious causes of abdominal pain such as peritonitis or pelvic inflammatory disease. Immediate surgery may be required to correct certain life-threatening conditions such as a ruptured appendix, ruptured aortic aneurysm, intestinal obstruction, perforated bowel, mesenteric ischemia, or a ruptured fallopian tube in ectopic pregnancy.

Source: Medical Disability Advisor



Prognosis

Outcome depends on diagnosis, severity of symptoms, and prompt, effective treatment. Surgical outcome depends on the underlying condition that requires surgical repair. Prognosis for the majority of surgeries is good (i.e., appendicitis or cholecystectomy). The prognosis is more variable when an aneurysm or malignancy is the underlying cause. In women, a ruptured fallopian tube from an ectopic pregnancy can be life threatening, especially when hemorrhage occurs. Outcome may also be guarded if severe or widespread infection (e.g., peritonitis or sepsis) is present, especially in older individuals or individuals with increased risk of comorbidities (e.g., obesity, diabetes, immunodeficiency, or other chronic conditions).

Source: Medical Disability Advisor



Complications

Complications of underlying conditions causing abdominal pain include rupture of an inflamed organ (e.g., ruptured appendix, ruptured fallopian tube in ectopic pregnancy, or ruptured aneurysm), hemorrhage, bowel obstruction, perforation of the intestines (a hole in the intestinal wall that allows feces to spill into the abdominal cavity), or systemic infection (sepsis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations depend on cause and type of abdominal pain (acute or chronic), severity of symptoms, specific diagnosis, and type of treatment (i.e., medication or surgery).

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 was the time course, mode of onset, and initial characteristics of pain? Did pain spread or shift? What was the character of the pain? Constant or recurrent? Vague, crampy, stabbing, or breathtaking?
  • Did individual have fever, loss of appetite, nausea, vomiting, constipation, or diarrhea?
  • Was abdomen tense, rigid, generally or locally tender, distended, or diminished bowel sounds?
  • Did individual have pale complexion (pallor), low blood pressure (hypotension), fever, rapid heartbeat, shallow breathing, sweating, or shock? Was there a yellow tinge to the skin and whites of eyes (jaundice)? Was there blood in the urine, stool, or vomit?
  • Were diagnostic tests performed to help identify cause of abdominal pain?
  • Was underlying cause of abdominal pain identified?
  • Was specific diagnosis confirmed?

Regarding treatment:

  • Has underlying cause of pain been identified and resolved? Infection eliminated? Condition surgically repaired?
  • If caused by a malignancy, is malignancy operable? If not, what other modes of treatment are available?
  • Did individual respond as expected to treatment? If not, what further or alternative treatment options are planned?

Regarding prognosis:

  • What is the expected outcome for this diagnosis?
  • Why or in what ways does individual's course differ?
  • What is expected prognosis for this diagnosis?
  • What accommodations can be made to assist individual?
  • Would individual benefit from referral to a pain clinic?
  • Has individual experienced any complications?
  • Were underlying conditions identified that may impact course of illness or recovery?
  • Was a pre-existing chronic condition or illness aggravated by the present diagnosis?

Source: Medical Disability Advisor



References

Cited

Flasar, M. H., et al. "Acute Abdominal Pain." Primary Care: Clinics in Office Practice 33 3 (2006): 659-684.

King, K. E., and J. M. Wightman. "Abdominal Pain." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 6th ed. Philadelphia: Mosby Elsevier, 2006.

General

Hart, Jacqueline A., ed. "Abdominal Pain." MedlinePlus. Ed. Jacqueline A. Hart. 4 Sep. 2003. National Library of Medicine. 19 May 2005 <http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm>.

Silen, W. Cope's Early Diagnosis of the Acute Abdomen. 21st ed. New York: Oxford University Press, 2005.

Source: Medical Disability Advisor






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