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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.

Appendicitis


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
540.0 - Appendicitis, Acute with Generalized Peritonitis
540.1 - Appendicitis, Acute with Peritoneal Abscess
540.9 - Appendicitis, Acute without Mention of Peritonitis
541 - Appendicitis, Unqualified
542 - Appendicitis, Other

Related Terms

  • Inflammation of the Vermiform Appendix

Overview

Appendicitis refers to infection and inflammation of the appendix (vermiform appendix), a small, narrow, tube-like pouch attached to and branching off from the first part of the large intestine (cecum).

The appendix is located in the lower right side of the abdomen (right iliac region) in an area designated as McBurney's point. It is thought that appendicitis results from the opening of the appendix becoming blocked (obstructed).

Appendicitis commonly develops in three stages: the edematous stage, in which inflammation of the appendix may spontaneously resolve; the purulent stage, in which appendicitis continues to evolve toward rupture (perforation); and the gangrenous stage, in which the appendix ruptures, causing infection of the abdominal cavity (peritonitis) (Santacroce).

Incidence and Prevalence: Among adults, appendicitis occurs at a rate of 10 per 100,000 individuals (Incesu), with a lifetime incidence of 7% of the general population (Craig). Approximately 250,000 cases of appendicitis are treated surgically in the US each year (Ferri). Appendicitis has a lower incidence internationally than in the US; it appears to be more prevalent in affluent countries with low-fiber diets.

Source: Medical Disability Advisor



Causation and Known Risk Factors

There are no known predisposing factors to developing appendicitis, but individuals may be at higher risk if they have other disorders that can lead to obstruction of the appendix. These include inflammation or fluid accumulation (edema) in the lymphoid tissue (50% to 60% of cases); blockage by intestinal feces (30% to 35% of cases); the presence of a foreign body in the intestine such as a stone (calculus), fruit seed, or intestinal parasite (4% of cases); or an intestinal tumor (1% of cases) (Ferri).

Appendicitis is up to 1.7 times more prevalent in men than women (Santacroce), with peak incidence between 10 and 30 years of age (Ferri, Santacroce). There is a familial predisposition for appendicitis (Craig).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of appendicitis typically develop over a period of 4 to 48 hours (Incesu). The classic initial symptoms of appendicitis are cramping or colicky pain around the navel (periumbilical) and loss of appetite (anorexia). As the symptoms from the appendix move into the right lower abdominal area (right lower quadrant), the pain becomes localized above the appendix at McBurney's point, where it becomes more severe. Fever develops within several hours. Other symptoms may include nausea (61% to 92% of cases), vomiting, diarrhea, or constipation (18% of cases), rectal tenderness, chills, and shaking (Incesu). Moving, walking, or coughing may aggravate the pain. Individuals with appendicitis generally report being in good health before the onset of the condition.

Physical exam: The most specific physical findings include rebound tenderness (present in 96% of cases), pain on percussion of the abdomen, rigidity, and guarding (Incesu). The individual is commonly found lying down with the hips and knees bent in an effort to reduce intra-abdominal pressure and movement that might worsen the pain. Manipulation of the abdomen (palpation) reveals extreme tenderness at McBurney's point. The individual frequently tightens (guards) the muscles of the abdomen in response to palpation of this region. When the abdomen is depressed on the left side and held momentarily before being quickly released, the individual may experience a momentary increase in pain (rebound). This suggests inflammation has spread into the membrane lining the abdominopelvic walls (peritoneum). If the individual is pregnant, the enlarging uterus may alter the location of the appendix so the tenderness may be higher in the abdomen.

If the appendix has ruptured, the pain may disappear for a short period during which the individual feels better. Shortly, however, infection of the peritoneum (peritonitis) sets in. The pain then returns as the individual becomes progressively more ill. The entire abdomen becomes extremely tender and tight. A mild fever (<100° F [37.8° C]) may initially be present and increases if the appendix ruptures. In women, a rectal exam or a pelvic exam may help distinguish appendicitis from other conditions that produce abdominal pain.

Tests: Laboratory tests include a complete blood count (CBC) that reveals an increase in the white blood cell (WBC) count (leukocytosis) if an infection is present, a finding that occurs in 80% to 85% of cases (Craig). A test for C-reactive protein may also be performed. A urinalysis helps identify any urological causes for the reported symptoms. Diagnostic tests may include the use of high-frequency sound waves (abdominal ultrasound), which is accurate in 90% of cases (Incesu). Abdominal x-rays are less useful, only identifying appendicitis in 20% of cases (Incesu). CT scan is typically very useful for imaging the appendix, with a diagnostic accuracy of 95% to 98% (Incesu). For a definitive diagnosis, the abdomen may be examined with a fiber-optic microscope (laparoscopy) or visualized during an exploratory laparotomy. A pregnancy test is needed in sexually mature women to check for an abnormal (ectopic) pregnancy.

Source: Medical Disability Advisor



Treatment

The treatment of choice for an uncomplicated appendicitis is surgical removal of the appendix (appendectomy) as soon as possible. Surgery to remove the appendix is always done soon after diagnosis. Once the diagnosis is confirmed, antibiotics are given prior to surgery to reduce complications from wound infection and abdominal abscess formation.

Appendectomy may be done through a surgical opening into the abdomen (laparotomy). Alternatively, a much smaller incision using a fiber-optic microscope (laparoscope) may be the preferred surgical method (laparoscopy). If an abscess is suspected, surgery may be delayed until intravenous fluids and antibiotic medications are administered to reduce the potential for infection. Antibiotics are given during surgery and continued for at least 48 hours postoperatively. The consequences of missing the diagnosis are severe and may include death, generally as a result of untreated or inadequately treated peritonitis.

Source: Medical Disability Advisor



Prognosis

The predicted outcome is good if complications do not develop. Death from appendicitis occurs in 0.2% to 0.8% of cases (Craig), usually in individuals with a perforated appendix (Santacroce). In individuals older than age 70, mortality rises to more than 20% of cases, usually due to delayed diagnosis and surgical intervention (Craig). About 10% of individuals with appendicitis are initially misdiagnosed, and failure to diagnose appendicitis is the leading cause of successful malpractice suits (Craig).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon

Source: Medical Disability Advisor



Rehabilitation

Following abdominal surgery, pulmonary toilet techniques that include chest physical therapy to break up lung secretions, active coughing, and incentive spirometry training, will be useful in preventing postoperative pulmonary complications. Other exercises, including progressive relaxation and deep-breathing techniques, may help reduce postoperative pain and speed recovery. Early ambulation is encouraged.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Possible complications of appendicitis include perforation of the appendix, which occurs in 20% of individuals (Ferri). Other complications include general inflammation of the abdominal cavity (peritonitis), collection of pus (abscess) within the appendix, perforation of the intestines, intestinal tissue death (gangrene), and inflammation of a part of the circulatory system (portal venous system) with pus formation (pylephlebitis). The latter condition is a rare but highly lethal complication of appendicitis, characterized by chills, high fever, liver enlargement (hepatomegaly), and yellow discoloration (jaundice) of the skin.

Although the incidence of appendicitis peaks in the late teens and early twenties, older individuals (50 or older) who develop the condition generally have more complications and longer hospital stays (Craig).

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence disability include the individual's age, the type of surgery performed (laparoscopy, laparotomy), the individual's response to surgical treatment, and any complications associated with the condition, such as perforation of the appendix, general inflammation of the abdominal cavity (peritonitis), collection of pus (abscess) within the appendix, and inflammation of a part of the circulatory system (portal venous system) with pus formation (pylephlebitis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Following appendectomy, the individual must limit physical activity for 2 to 6 weeks, depending on the surgical approach (laparoscopy, laparotomy) (Santacroce). Temporary restrictions on lifting (not greater than 25 pounds for 6 weeks) and heavy physical labor may be necessary until recovery is complete.

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:

  • Did individual complain of cramping or a colicky feeling around the navel?
  • Did pain then move down to McBurney's point?
  • Was there loss of appetite?
  • Was fever present? Chills or shaking?
  • Did individual have nausea and vomiting? Constipation? Rectal pain?
  • Did walking or moving aggravate pain?
  • On exam, was individual exquisitely tender at McBurney's point?
  • Did individual have guarding when the abdomen was examined? Rebound tenderness?
  • Was individual pain-free for a short time? Did pain then worsen?
  • If individual is female, was a pelvic and/or a rectal exam done? Pregnancy test?
  • Was CBC with WBC done? C-reactive protein test?
  • Was abdominal ultrasound done? CT?
  • Was it necessary to do a laparoscopy?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Did individual have an appendectomy?
  • Did individual have peritonitis? Abdominal abscess?
  • Is individual pregnant?

Regarding prognosis:

  • Did individual have a laparoscopic appendectomy? Laparotomy?
  • Does individual have any conditions that may affect ability to recover?
  • Did individual develop any complications such as perforation or peritonitis? Intestinal gangrene? Inflammation of the portal venous system?

Source: Medical Disability Advisor



References

Cited

Craig, Sandy. "Appendicitis, Acute." eMedicine. Eds. William Lober, et al. 1 Jun. 2009. Medscape. 17 Aug. 2009 <http://emedicine.medscape.com/article/773895-overview>.

Ferri, Fred. "Appendicitis, Acute." Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Eds. Mary Beth Murphy, et al. 1st ed. Philadelphia: Mosby Elsevier, 2009.

Incesu, Lutfi, and Caroline R. Taylor. "Appendicitis." eMedicine. Eds. Eugene C. Lin, et al. 12 Mar. 2009. Medscape. 17 Aug. 2009 <http://emedicine.medscape.com/article/363818-overview>.

Santacroce, Luigi, and Juan B. Ochoa. "Appendicitis." eMedicine. Eds. Oscar Joe Hines, et al. 1 May. 2009. Medscape. 17 Aug. 2009 <http://emedicine.medscape.com/article/195778-overview>.

Source: Medical Disability Advisor