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.

Cholecystectomy


Related Terms

  • Excision of Gallbladder
  • Lap Chole
  • Laparoscopic Cholecystectomy

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

  • Endocrine disorders

Factors Influencing Duration

Factors influencing duration of disability include the type of procedure (i.e., laparoscopic surgery vs. open surgery), underlying conditions (e.g., diabetes), presence of complications, and the individual's general health.

Medical Codes

ICD-9-CM:
51.21 - Partial Cholecystectomy, Other; Revision of Prior Cholecystectomy
51.22 - Cholecystectomy; Excludes Laparoscopic
51.23 - Laparoscopic Cholecystectomy
51.24 - Laparoscopic Partial Cholecystectomy

Overview

Cholecystectomy is the surgical removal of the gallbladder, a pear-shaped organ below the liver in which bile, produced by the liver and used to help digest fats, is stored. When the gallbladder becomes inflamed or blocked with hardened cholesterol and calcium salts (gallstones or biliary calculi), removal may be required to provide pain relief and prevent or treat potentially serious complications such as infection or liver disease.

Either less invasive laparoscopic surgery or open surgery is used to remove the gallbladder. In cases in which the individual's health is extremely fragile, a minimally invasive technique may be considered that involves inserting a flexible tube (catheter) to drain the gallbladder (percutaneous cholecystostomy). However, controversy exists among surgeons about the benefits of percutaneous cholecystostomy, and it is seldom performed. If common bile duct stones are present, they often are removed by endoscopic retrograde cholangiopancreatography (ERCP), a procedure in which the patient swallows a lighted, flexible fiber-optic instrument (endoscope) that allows the surgeon to examine the biliary system and remove the stones. ERCP may also be used for initial drainage in patients who are too ill to undergo acute surgery in acute cholecystitis. In these cases, cholecystectomy is subsequently performed when the patient is more stable to provide definitive treatment.

In other cases when surgery is not feasible and there is no acute infection (acute cholecystitis), drugs made from bile acid may be used to dissolve smaller cholesterol stones (oral dissolution therapy), or similar drugs may be delivered directly into the gallbladder (contact dissolution therapy).

Laparoscopy often is the initial approach, although patients with suspect perforation, cancer, very large stones, end stage liver disease, bleeding disorders, and some with morbid obesity are not candidates for laparoscopic cholecystectomy. With the laparoscopic technique, a thin, flexible fiber-optic instrument (laparoscope) with a tiny camera attached is inserted through a small abdominal incision, allowing the surgeon to view the gallbladder and perform the surgery using tools passed through another small incision.

In an open surgical procedure, the abdomen is cut open to expose the gallbladder. Open surgical removal of the gallbladder is performed most often when complications such as infection or scarring from previous surgery are encountered during a laparoscopic procedure. In both procedures, bile ducts are injected with contrast material (cholangiography) and x-ray studies are done to determine if the common bile duct is obstructed by gallstones that have formed in the bile duct instead of the gallbladder (biliary stones).

Source: Medical Disability Advisor



Reason for Procedure

Cholecystectomy is most often performed for symptomatic gallbladder disease, usually caused by stones in the gallbladder (cholelithiasis) or inflammation of the gallbladder (cholecystitis).

Stones in the gallbladder do not always require surgical removal, particularly in the absence of symptoms such as pain from inflammation or significant blockages. Gallstones may cause intermittent cramping and pain, but their presence does not constitute an emergency. A gallstone may become stuck at the top of the gallbladder when bile is moving, and then relief follows when the stone drops back down to the bottom of the gallbladder. Intermittent discomfort from the movement of gallstones may cause the individual to elect to have them surgically removed, although typically there is no urgency in scheduling a procedure of this type. However, failure to remove the gallbladder when symptoms recur may result in acute inflammation (cholecystitis).

Emergencies may develop when gallstones move and become lodged in the bile duct connecting the gallbladder to the small intestine. This can be extremely painful and result in blockage and inflammation that can affect the pancreas or liver.

Occasionally, an emergency cholecystectomy is required for rupture gall bladder (perforation) or pus formation (empyema) within the gallbladder. Rarely, cholecystectomy may be performed for cancer of the gallbladder, bile ducts, or pancreas.

Source: Medical Disability Advisor



How Procedure is Performed

Cholecystectomy is performed in the operating room under general anesthesia. Laparoscopic cholecystectomy, the most commonly performed method of gallbladder removal, has been modified by more recent surgical innovations that involve the use of voice-controlled, robotic arm-like extensions manipulated by the surgeon (robotic or telerobotic laparoscopy). Single-port access surgery is another laparoscopic procedure that requires only one incision at the naval; it is performed more frequently in recent years. In all laparoscopic cholecystectomies, a small incision is made near the navel (umbilicus) and a thin, flexible laparoscope with a tiny camera attached is inserted, allowing the surgeon to view the gallbladder and surrounding organs. Carbon dioxide is used to inflate the abdominal cavity for better viewing (insufflation), unless the individual is elderly or has an underlying condition that might lead to complications from the gas. Except for single-port access surgery, several smaller laparoscopic incisions are made on the abdomen to allow for insertion of surgical instruments. The artery to the gallbladder and the cystic duct (tubular canal carrying bile from the gallbladder) are tied off and cut. The gallbladder is freed from its surrounding tissue and removed. The incisions are closed with sutures.

Open cholecystectomy is major surgery that is performed in 5% of cases (NDDIC). Most often, open cholecystectomy is performed because of complications such as perforation, infection, or adhesions from previous surgery, and sometimes after such complications are encountered during laparoscopy. Patients with suspect cancer, very large stones, end stage liver disease, or bleeding disorders may also require open cholecystectomy. First, a 5- to 8-inch right or midline incision is made in the abdomen, and the abdominal cavity is opened to expose the gallbladder. The artery to the gallbladder and the cystic duct leading from it are tied off and cut, and the gallbladder is removed. Before the abdomen is closed, drains may be placed under the liver and in the bile duct. The drains, which are kept in place from 4 to 10 days, are removed after x-ray studies show there are no more stones.

In percutaneous cholecystostomy, used in individuals with fragile health, high frequency sound waves and a computer (ultrasound) are used to guide a puncture for access and insertion of a catheter that drains the gallbladder. When the individual's health stabilizes, a laparoscopic or open surgical procedure may later be used to remove the gallbladder.

Recovery from a laparoscopic cholecystectomy typically is rapid. The individual usually leaves the hospital the next day. Soreness is minimal, and return to work is often within 1 to 2 weeks. Open cholecystectomies usually necessitate a longer hospital stay, often up to 7 days. Once the pain has diminished and the individual is tolerating a regular diet, he or she is discharged to home. The individual undergoing percutaneous cholecystostomy likely has other health issues that may delay discharge from the hospital and / or recovery.

Source: Medical Disability Advisor



Prognosis

Cholecystectomy is an effective way to treat recurrent gallstones or gall bladder inflammation (cholecystitis). There are no dietary restrictions after removal of the gallbladder and no long-term consequences, although bile duct stones can form weeks, months, or years after cholecystectomy. Recovery time for laparoscopic cholecystectomy is one night in the hospital and a few days rest at home; open cholecystectomy is major surgery involving a 2- to 7-day hospital stay and several weeks at home (NDDIC). After recovery from surgery, most individuals have no more symptoms related to the original condition. Laparoscopic cholecystectomy is associated with a 0.1% mortality rate, while open surgery is associated with a 0.5% mortality rate; highest mortality is found among older individuals (Naqesh-Bandi). The less invasive laparoscopic procedure is associated with less pain, a shorter hospital stay, and a shorter recovery period than the open procedure. Cholecystectomy for cancer of the gallbladder, bile ducts, or pancreas is usually for comfort only. High mortality rates are associated with these types of cancers.

Source: Medical Disability Advisor



Complications

Bleeding and wound infection are the most common complications of cholecystostomy. In some procedures, the duct that drains bile from the liver (common bile duct) is injured and requires immediate repair with open surgery. Bile duct injury can result in bile leakage into the abdomen, which may require a separate procedure for repair. Gallstones can develop in the bile long after cholecystectomy, requiring ERCP to remove them. Some individuals may develop chronic diarrhea after gallbladder removal.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Heavy lifting and strenuous activity may need to be modified following surgery. In uncomplicated cases, most individuals are able to resume normal activities within 7 to 10 days.

Source: Medical Disability Advisor



References

Cited

Naqesh-Bandi, Hasan, and M. A. Gok. "Cholecystectomy Mortality: a Single Centre Experience." Society for Surgery of the Alimentary Tract. 2007. 27 Feb. 2009 <http://www.ssat.com/cgi-bin/abstracts/07ddw/SSAT-DDW07-Poster-57.cgi>.

General

Hourmont, Katherine. "Robotic Versus Telerobotic Laparoscopic Cholecystectomy." Surgical Clinics of North America 83 6 (2003): 1145-1462.

Rosen, Michael, Fred Brody, and Jeffrey Ponsky. "Predictive Factors for Conversion of Laparoscopic Cholecystectomy." American Journal of Surgery 184 3 (2002): 254-258.

Source: Medical Disability Advisor






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