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.

Abscess


Related Terms

  • Abscesses
  • Bartholin Abscess
  • Boils
  • Carbuncles
  • Furuncles
  • Pilonidal Abscess
  • Pustules

Differential Diagnosis

Specialists

  • Dermatologist
  • General Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Oral/Maxillofacial Surgeon

Comorbid Conditions

  • Alcoholism
  • Cancer
  • Compromised immune system
  • Diabetes
  • Impaired circulation
  • Kidney disease

Factors Influencing Duration

Length of disability may be influenced by the type and location of the abscess, the individual's age and health status, timeliness of intervention, whether surgical or percutaneous drainage was performed, and response to treatment.

Medical Codes

ICD-9-CM:
006.4 - Amebic Lung Abscess; Amebic Abscess of Lung, Liver
254.1 - Abscess of Thymus
289.59 - Diseases of Spleen, Other; Lien Migrans; Perisplenitis; Splenic Abscess, Atrophy, Cyst, Fibrosis, Infarction, Rupture, Nontraumatic; Splenitis; Wandering Spleen
324.0 - Intracranial Abscess; Abscess (Embolic): Cerebellar, Cerebral; Abscess (Embolic) of Brain [Any Part]: Epidural, Extradural, Otogenic, Subdural
324.1 - Intraspinal Abscess; Abscess (Embolic) of Spinal Cord [Any Part]: Epidural; Extradural; Subdural
326 - Late Effects of Intracranial Abscess or Pyogenic Infection
360.04 - Vitreous Abscess
370.55 - Interstitial and Deep Keratitis; Corneal Abscess
376.01 - Orbital Cellulitis; Abscess of Orbit
379.09 - Scleritis and Episcleritis, Other; Scleral Abscess
383.01 - Subperiosteal Abscess of Mastoid
475 - Peritonsillar Abscess
478.24 - Retropharyngeal Abscess
478.29 - Diseases of Pharynx, Other, Not Elsewhere Classified, Other; Abscess of Pharynx or Nasopharynx
478.79 - Abscess, Larynx
513.0 - Abscess of Lung
513.1 - Abscess of Mediastinum
522.5 - Periapical Abscess without Sinus
522.7 - Periapical Abscess with Sinus
527.3 - Diseases of the Salivary Glands; Abscess
528.5 - Diseases of Lips; Abscess of Lip(s); Cellulitis of Lip(s); Fistula of Lip(s); Hypertrophy of Lip(s), Angular; Cheilodynia; Cheilosis
529.0 - Glossitis; Abscess of Tongue; Ulceration (Traumatic) of Tongue
540.1 - Appendicitis, Acute with Peritoneal Abscess
566 - Abscess of Anal and Rectal Regions
569.5 - Abscess of Intestine
572.0 - Liver Abscess and Sequelae of Chronic Liver Disease, Liver Abscess
590.2 - Renal and Perinephric Abscess; Abscess: Kidney, Nephritic, Perirenal; Carbuncle of Kidney
611.0 - Disorders of Breast, Inflammatory Disease of Breast; Abscess (acute) (chronic) (nonpuerperal) of Breast, Areola; Mammillary Fistula; Mastitis (acute) (subacute) (nonpuerperal) NOS, Infective, Retromammary, Submammary
681.00 - Finger, Cellulitis and Abscess, Unspecified
681.01 - Finger, Felon; Pulp abscess; Whitlow
681.10 - Toe, Cellulitis and Abscess, Unspecified
681.9 - Cellulitis and Abscess of Unspecified Digit; Infection of Nail NOS
682.0 - Cellulitis and Abscess of Face; Cheek, External; Chin; Forehead; Nose, External; Submandibular; Temple (Region)
682.1 - Cellulitis or Abscess of Neck
682.2 - Cellulitis and Abscess of Trunk; Abdominal Wall; Back [Any Part, except Buttocks]; Breasts; Chest Wall; Flank; Groin; Pectoral Region; Perineum; Umbilicus
682.3 - Cellulitis and Abscess of Upper Arm and Forearm [Any Part, except hand], including Shoulder and Axilla
682.4 - Cellulitis and Abscess of Hand, except Fingers and Thumb; Wrist
682.5 - Cellulitis and Abscess of Buttock; Gluteal Region
682.6 - Cellulitis and Abscess of Leg, Except Foot; Ankle; Hip; Knee; Thigh
682.7 - Cellulitis and Abscess of Foot, Except Toes; Heel
682.8 - Cellulitis and Abscess, Other Specified Sites; Head [except Face]; Scalp
682.9 - Cellulitis and Abscess, Other Unspecified Sites
685.0 - Pilonidal Cyst; Fistula, Coccygeal or Pilonidal; Sinus, Coccygeal or Pilonidal, with Abscess

Overview

An abscess is a localized infection, usually caused by a bacterium, that has been walled off by a protective lining called a pyogenic membrane. Abscess formation is a defense mechanism designed to prevent the spread of the infective organism to other parts of the body. The abscess contains pus made up of destroyed tissue cells, microorganisms (dead and alive), and white blood cells (leukocytes) that have been carried to the area to fight the infection. Whether the abscess enlarges or subsides depends on whether the microorganisms or the leukocytes gain the upper hand. Fungi or single-celled parasites called amoeba also can cause abscesses. Abscesses may form in reaction to a puncture wound, a foreign body (e.g., a splinter), or an obstructed gland or follicle.

Superficial abscesses usually are painful, swollen, and warm to touch (palpation); the skin overlying the abscess may appear reddened. Although an abscess may occur in any organ or tissue, common sites include the breast (mammary abscess), gums (dental abscess), armpit, groin, and perineal area (e.g., Bartholin abscess, pilonidal abscess). Less common sites include the liver, lung, gastrointestinal tract, kidney, spleen, pancreas, brain, and spinal cord; in these cases, the infective organism usually is transported through the bloodstream (hematogenous spread) to the affected organ. Abscesses are classified according to location, as follows: in the abdominal cavity (intraperitoneal abscess), near the kidney or spine (retroperitoneal abscess), or within abdominal organs (visceral abscess).

Incidence and Prevalence: Breast abscesses occur in up to 10% of women with postpartum mastitis (Miller). Incidence of liver abscess is 8 to 16 cases per 100,000 hospitalized individuals (Peralta). Incidence of spinal epidural abscesses after injection of drugs or spinal surgery is 25 to 30 cases per 100,000 individuals (Wallace).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Superficial abscesses in the breast, mouth, and skin are common. Women of childbearing age are at increased risk for breast abscesses, which typically occur following childbirth and are more common in women who smoke (Miller). Dental infections leading to jaw and throat abscesses are most common in individuals of lower socioeconomic status (Peng). Men develop brain abscesses twice as often as women (Thomas). Epidural abscesses and lung abscesses are more common in men than in women (Wallace, Kamangar). Individuals at risk for spinal epidural abscess include those who have had a spinal injection or spinal tap (lumbar puncture), spinal anesthesia, or spinal surgery. Brain abscesses may originate from an ear or sinus infection.

Intra-abdominal abscesses may form when gastrointestinal contents (including bacteria) are released into the abdominal cavity. Conditions such as appendicitis, diverticulitis, perforated peptic ulcers, and abdominal surgery increase the risk of intra-abdominal abscesses.

In general, individuals with weakened immune systems, cancer, diabetes, dialysis-dependent renal disease, alcoholism, and those who regularly use corticosteroids or who have had surgery, major trauma, or burns are at increased risk of abscesses. Injection drug users are also at increased risk of developing abscesses.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with an abscess close to the skin (cutaneous or subcutaneous) may complain of heat, swelling (edema), tenderness, and redness over the affected site, and possibly fever. Internal abscesses produce local pain and tenderness, fever, chills, weight loss, fatigue, and loss of appetite. Individuals with a dental abscess will report local pain, swelling of the face and cheek, sensitivity to air and temperature, and occasionally, difficulty in swallowing and/or breathing. Intra-abdominal abscesses can cause vomiting, diarrhea, or constipation. Symptoms of a lung abscess include a cough, foul-smelling material coughed up from the lungs, fever, chills, chest pain, weakness, fatigue, and a vague feeling of discomfort or illness (malaise). A spinal epidural abscess causes back pain, fever, and weakness. Brain abscess may cause headache, fever, speech disorder, muscle weakness, impaired vision, seizures, nausea, and vomiting. In some individuals, the presenting symptom is abnormal functioning of the organ in which the abscess has formed.

Physical exam: Physical findings will depend on the location of the abscess. A breast abscess typically is noted near the areola and is frequently associated with nipple inversion; discharge from the nipple may be present (Miller). An intra-abdominal abscess may cause tenderness localized to a particular abdominal quadrant, and a mass may be detected by touch (palpation). Lung abscess may cause abnormal breath sounds, crackling (rales), wheezing, and dullness to percussion.

Tests: Because most abscesses are caused by bacterial infection, material removed from the abscess and blood samples are cultured in the laboratory to identify the causative organism(s). Mucous material coughed up from the lungs (sputum) of individuals with a suspected lung abscess can be cultured. Cerebrospinal fluid may be cultured in individuals with suspected spinal epidural abscess. Antibiotic susceptibility tests also may be performed. A complete blood count (CBC), erythrocyte sedimentation rate (ESR), liver enzymes, and amoebic serology tests may be performed. If amoebic abscess is suspected, stool samples can be analyzed for the presence of amoeba. A tuberculin test (PPD test) may be performed on individuals with lung abscess.

The diagnosis may be confirmed by plain x-rays, computed tomography (CT) scanning, or magnetic resonance imaging (MRI) techniques. Ultrasound testing (ultrasonography) is useful in differentiating between superficial abscesses and cellulitis. Radionuclide scanning, in which radioactively labeled white blood cells or the element gallium concentrate in the region where pus has recently formed, also may be used.

Source: Medical Disability Advisor



Treatment

A minor abscess can sometimes heal without intervention; however, abscesses that do not spontaneously open and drain may require surgical incision and drainage. Drugs frequently are necessary to combat infection. Antibiotics are used for bacterial infections, antifungal drugs for fungal infections, and anti-amoebic drugs for amoebic infections. Drainage is performed either through an open surgical procedure or directly through the skin (percutaneous). Following drainage of a superficial or subcutaneous skin abscess, the wound is packed with gauze and left open to drain. Aftercare may include warm soaks or wound irrigation 3 to 4 times daily for 7 to 10 days, or until the wound heals (Doerr).

Breast abscesses smaller than 3 cm are treated with needle aspiration and drainage, followed by antibiotic therapy; larger abscesses may require surgical excision (Miller). Repair of a gastrointestinal defect may involve closure of a perforation, or removal of the appendix. Most spinal abscesses are treated with antibiotic therapy before neurological complications occur, making surgical drainage and removal of the lamina (laminectomy) unnecessary.

Source: Medical Disability Advisor



Prognosis

Early intervention and appropriate treatment of minor abscesses result in an effective cure. Most superficial and subcutaneous abscesses will heal within 10 to 14 days after incision and drainage (Doerr). The outcome of a deep-seated abscess depends on the location of the abscess, the age and health status of the individual, and the timing and effectiveness of treatment. Following incision and drainage, breast abscesses have a recurrence rate of 39% to 50% (Miller). An abscess within a vital organ (e.g., liver, brain) may occasionally cause enough pressure or damage to the surrounding tissue that some permanent loss of function results.

A ruptured intra-abdominal abscess has a high mortality rate. Although brain abscess has only a 10% mortality rate, up to 50% of the survivors experience nervous system complications (Thomas). In spinal abscess, laminectomy and drainage can prevent, reverse, or improve developing paralysis; however, these procedures probably will not improve established nervous system deficits. With spinal epidural abscess, the prognosis improves if the condition is rapidly diagnosed; overall, the mortality rate is 2% to 20% (Wallace). The mortality rate from intracranial epidural abscesses treated with antibiotics is 6% to 20% (Ramachandran). Untreated liver abscesses may progress to sepsis, liver failure, and multiple organ failure with a 5% to 30% mortality rate (Peralta). Individuals with a lung abscess treated with antibiotics have a mortality rate of 5% to 10%; however, the mortality rate is 75% in those who are immunocompromised (Kamangar).

Source: Medical Disability Advisor



Complications

Without timely treatment, bacterial infection of the blood (bacteremia) may spread infection to other sites (sepsis). Individuals who attempt to self-treat a superficial abscess by pressing on the lump may push the infected material deeper into the body, causing the infection to spread (Doerr). Other complications include rupture into adjacent tissue, bleeding from vessels eroded by inflammation, and impaired function of a vital organ. A dental abscess may restrict the airway, requiring a tracheostomy (Peng). A spinal abscess can cause paralysis. A brain abscess can cause nervous system deficits.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations require individual consideration. An abscess in an internal organ (e.g., liver, lung, gastrointestinal tract, kidney, spleen, pancreas, brain, or spinal cord) may require temporary restriction on heavy lifting or activities that involve physical exertion. Temporary reassignment to sedentary duties may be necessary.

An armpit or groin abscess may temporarily limit the use of the affected limb or the ability to sit. An individual with a complicated brain or spinal epidural abscess may require more extensive accommodations or restrictions depending on the severity of any nervous system deficits. An individual with a complicated spinal epidural abscess, for example, may be confined to a wheelchair and thus requires a wheelchair-accessible workplace. An individual with speech impairment caused by a complicated brain abscess may need reasonable accommodations or reassignment to more appropriate duties.

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:

  • Where was the abscess located? How large was abscess? Was a vital organ involved?
  • Was a foreign body present? Puncture wound?
  • Did physical findings confirm individual's report?
  • Were there nonspecific symptoms such as fever, weight loss, fatigue, or loss of appetite?
  • Did a blood test confirm an abnormally high number of white blood cells indicative of infection?
  • Were x-rays, ultrasound scanning, CT, or MRI used to determine size and position of abscess?
  • Was laboratory culture done to identify causative organism?
  • Do culture results confirm diagnosis?

Regarding treatment:

  • Was surgical drainage necessary? Needle aspiration?
  • Was laboratory analysis of pus or sputum used to select the most effective antibiotic, antifungal, or antiamoebic drug?
  • Is there evidence of response to treatment?
  • Is there a possibility the causative organism is drug resistant?
  • Is a change of antibiotic warranted?
  • If abscess is superficial, is individual compliant with follow-up care for warm soaks or wound irrigation?
  • Has individual recently used any alternative medicine or health practices?
  • Was treatment delayed?

Regarding prognosis:

  • What is the health status of individual?
  • Does individual have comorbidities that may affect outcome?
  • Is any permanent loss of function expected?
  • Can employer make reasonable accommodations?

Source: Medical Disability Advisor



References

Cited

Doerr, Steven. "Abscess." eMedicine Health. Ed. Melissa Conrad Stoppler. 17 Dec. 2008. WebMD, LLC. 12 Oct. 2009 <http://www.emedicinehealth.com/abscess/article_em.htm#overview>.

Kamangar, Nader, Curtis C. Sather, and Sat Sharma. "Lung Abscess." eMedicine. Eds. Stephen P. Peters, et al. 19 Aug. 2009. Medscape. 10 Oct. 2009 <http://emedicine.medscape.com/article/299425-overview>.

Miller, Andrew, Tajinderpal S. Saraon, and Mark Silverberg. "Breast Abscess and Masses." eMedicine. Eds. David F. M. Brown, et al. 30 Apr. 2009. Medscape. 12 Oct. 2009 <http://emedicine.medscape.com/article/781116-overview>.

Peng, Lynnus F., et al. "Dental Infections." eMedicine. Eds. Michael Glick, et al. 11 Aug. 2009. Medscape. 12 Oct. 2009 <http://emedicine.medscape.com/article/763538-overview>.

Peralta, Ruben, et al. "Liver Abscess." eMedicine. Eds. Marco G. Patti, et al. 15 Sep. 2009. Medscape. 10 Oct. 2009 <http://emedicine.medscape.com/article/188802-overview>.

Ramachandran, Tarakad S., and Arun Ramachandran. "Intracranial Epidural Abscess." eMedicine. Eds. Ramon Diaz-Arrastia, et al. 9 Sep. 2009. Medscape. 10 Oct. 2009 <http://emedicine.medscape.com/article/1165292-overview>.

Thomas, Lisa Elizabeth, and Joshua N. Goldstein. "Brain Abscess." eMedicine. Eds. Edward Bessman, et al. 25 Sep. 2008. Medscape. 10 Oct. 2009 <http://emedicine.medscape.com/article/781021-overview>.

Wallace, Mark Raymond, Aadia Rana, and Gopala K. Yadavalli. "Epidural Abscess." eMedicine. Eds. Fred A. Lopez, et al. 20 Apr. 2009. Medscape. 2 Nov. 2009 <http://emedicine.medscape.com/article/232570-overview>.

Source: Medical Disability Advisor






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