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.

Cirrhosis of the Liver


Related Terms

  • Cryptogenic Cirrhosis of Liver
  • Macronodular Cirrhosis
  • Portal Cirrhosis
  • Post-hepatic Cirrhosis
  • Postnecrotic Cirrhosis

Differential Diagnosis

  • Congenital hepatic fibrosis
  • Portal hypertension
  • Schistosomiasis

Specialists

  • Gastroenterologist
  • General Surgeon
  • Internal Medicine Physician

Comorbid Conditions

  • Cardiac disease
  • Debilitation
  • Poor nutrition
  • Renal disease

Factors Influencing Duration

Factors include the severity and extent of disease at the time of diagnosis, the type of cirrhosis and underlying cause, the age and general health of the individual upon initial diagnosis, and the development of complications, such as bleeding, blood flow impairment through the portal vein, which serves the liver (portal hypertension), ascites, and inflammation of the pancreas (pancreatitis). Many of these individuals will be unable to work.

Medical Codes

ICD-9-CM:
571.2 - Cirrhosis of the Liver, Alcoholic
571.5 - Cirrhosis of the Liver without Mention of Alcohol; Healed Yellow Atrophy (liver); Portal Cirrhosis
571.6 - Cirrhosis, Biliary; Chronic Nonsuppurative Destructive Cholangitis
571.8 - Liver Disease, Chronic, Nonalcoholic
571.9 - Liver Disease without Mention of Alcohol, Chronic, Unspecified

Overview

Cirrhosis is a chronic liver disease characterized by the progressive and irreversible destruction of liver tissue.

When exposed to an infectious agent, alcohol, or other toxic substances, liver cells (hepatocytes) may be killed faster than they can be replaced. Scar tissue replaces the liver cells that are lost causing the liver to initially increase in size to compensate for the loss of function. As the scar tissue formation continues, the liver is unable to compensate adequately and will then shrink in size.

There are numerous forms of cirrhosis that are distinguished by known or suspected cause, the tissue changes noted in liver biopsies, and the symptoms that an individual exhibits. Cirrhosis occurs as a result of viral infection; chronic exposure to alcohol, drugs, toxic substance; or in association with another disease. Alcoholic cirrhosis is the most common type of cirrhosis in the US, occurring in nearly 15% of alcoholics. Hepatitis C is the second most common cause of cirrhosis. Although hepatitis B virus is probably the most common cause of cirrhosis in the world, it is a less common cause of cirrhosis in the US ("Cirrhosis of the Liver").

The cause of primary biliary cirrhosis, which involves the inflammation of tiny ducts that carry bile within the liver, is unknown. It tends to affect women between the ages of 35 and 60. Cirrhosis may also result from the accumulation of excessive amounts of either iron (hemochromatosis) or copper (Wilson's disease) within the liver, or as a result of a congenital error of metabolism, such as in alpha-1 antitrypsin enzyme deficiency.

Incidence and Prevalence: The overall incidence of cirrhosis in the US is approximately 360 per 100,000 population, or approximately 900,000 total individuals ("Cirrhosis of the Liver"). At least 26,000 deaths per year in the US can be attributed to cirrhosis of the liver. Additionally, the liver cancer associated with some types of cirrhosis accounts for another 10,000 deaths annually.

Source: Medical Disability Advisor



Diagnosis

History: The different forms of cirrhosis share many clinical signs and symptoms. Individuals may report loss of appetite, abdominal pain, weight loss, yellowing of the skin (jaundice), water retention (edema, ascites), and spider angiomata (distinctive blood vessels visible in the skin). Other signs and symptoms are unique to the type of cirrhosis.

Males with alcoholic cirrhosis may report an increase in breast size (gynecomastia) and a decrease in testicular size (testicular atrophy). Females may report menstrual irregularities or the complete cessation of menstruation (amenorrhea).

Physical exam: In primary biliary cirrhosis, the physical examination may be completely normal early on in the course of the disease. However, as the disease progresses, physical examination may reveal findings common to cirrhosis of all causes. These include yellow skin pigmentation, intense itching (pruritus), dark urine, soft yellow spots of fat accumulation on the eyelids (xanthelasmas and xanthomas), an enlarged liver and spleen, or a scarred shrunken (small) liver, and increased tissue at the end of the fingers (clubbing). Up to 40% of individuals with cirrhosis have no symptoms (asymptomatic), and the cirrhosis is discovered only on routine examination or autopsy.

Tests: In all cases, definitive diagnosis requires a liver biopsy in which a small piece of liver tissue is removed and examined microscopically for signs of inflammation, scarring, or infection. Other tests that may be performed include complete blood count (CBC), key liver enzymes, folate and vitamin B12 levels, serum chemistries, viral antibodies, serum immunoglobulin levels, and antibodies to DNA, smooth muscle, and mitochondria. Serum albumin and prothrombin time measure proteins produced by the liver. Cholangiography (a procedure used to view the gallbladder duct and determine whether an obstruction is present) may be recommended for those individuals suspected of having primary biliary cirrhosis.

Source: Medical Disability Advisor



Treatment

Treatment is largely dependent upon the cause of the cirrhosis. Some methods of treating cirrhosis, regardless of the underlying cause, include dietary restrictions, such as placing an individual on a low-protein diet: supplementation with vitamins A, K, and D: salt restrictions to reduce problems associated with fluid retention (ascites, edema): and diuretics. Individuals with alcoholic cirrhosis will be instructed to stop drinking alcohol immediately. Individuals with primary biliary cirrhosis may be treated with antihistamines to relieve symptoms of itching, medications that bind bile salts, and anti-inflammatory drugs, such as corticosteroids. In addition, a liver transplant may be recommended for individuals with end-stage liver disease and ascites.

Source: Medical Disability Advisor



Prognosis

Although cirrhotic liver damage is permanent and irreversible, treatment is usually successful in prolonging life, decreasing morbidity, and preventing complications. Survival is a function of the severity of liver disease. Most individuals with cirrhosis will develop increasing jaundice, weakness, ascites, and portal hypertension within 5 years of diagnosis. Individuals with alcoholic cirrhosis who stop drinking have a 5-year survival rate of 60%, while those who continue to drink have a 5-year survival rate of only 40%. Individuals with advanced alcoholic cirrhosis typically die sooner.

The 5-year mortality rate in individuals with primary biliary cirrhosis is approximately 33%. Asymptomatic patients generally survive longer.

Source: Medical Disability Advisor



Complications

Almost all forms of cirrhosis are associated with portal hypertension, esophageal bleeding, enlarged spleen, fluid retention (ascites and edema), and coma. Other complications may include portal vein thrombosis (blood clot formation), the development of liver tumors, altered drug metabolism, spontaneous bacterial peritonitis, and hepatic encephalopathy, in which the brain is poisoned by high blood levels of ammonia and other toxins the liver fails to remove from the body.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A leave of absence, transfer to sedentary work, and increased rest periods may be needed. Since the condition is progressive, these individuals may need increasingly longer periods of time off of work and may have frequent hospitalizations. Eventually, most individuals will need to be on permanent disability status and will be unable to work at all.

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:

  • Does individual report loss of appetite, abdominal pain, weight loss, yellowing of the skin (jaundice), and water retention (edema, ascites)?
  • Does individual have yellow skin pigmentation, intense itching (pruritus), dark urine, soft yellow spots of fat accumulation on the eyelids (xanthelasmas and xanthomas), an enlarged liver and spleen, or a scarred shrunken (small) liver, and increased tissue at the end of the fingers (clubbing)?
  • Is individual asymptomatic?
  • Was liver biopsy performed to confirm the diagnosis and determine the type of cirrhosis? Were other tests done such as a complete blood count (CBC), measuring key liver enzymes, folate and vitamin B12 levels, serum chemistries, viral antibodies, serum immunoglobulin levels, and antibodies to DNA, smooth muscle, and mitochondria? Cholangiography?
  • If diagnosis is uncertain, were other conditions with similar symptoms ruled out?

Regarding treatment:

  • Was treatment appropriate for the underlying cause of the cirrhosis? Was it effective?
  • Was individual instructed in dietary restrictions including low-protein and salt?
  • Did individual receive supplementation with vitamins A, K, and D?
  • Were symptoms of biliary cirrhosis effectively relieved through drug therapy?
  • Does individual with alcoholic cirrhosis understand the importance of not drinking alcoholic beverages, and has he/she stopped drinking?
  • Can individual stop drinking? Was individual referred to a community support group such as Alcoholics Anonymous (AA)?
  • Is individual a candidate for a liver transplant? On a national transplant list?

Regarding prognosis:

  • At what stage of the disease was cirrhosis diagnosed?
  • What is the expected outcome for this type and severity of cirrhosis?
  • Does individual have a coexisting condition such as advanced age, debilitation, poor nutritional status, cardiac or renal disease that may complicate treatment or impact recovery?
  • Have any complications developed?
  • If symptoms do not respond to treatment, does diagnosis need to be revisited?

Source: Medical Disability Advisor



References

Cited

"Cirrhosis of the Liver (NIH Publication No. 06-5166)." National Digestive Diseases Information Clearinghouse. Oct. 2005. National Institute of Diabetes and Digestive and Kidney Diseases. 14 Oct. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis_ez/>.

Mukherjee, Sandeep, Hermant K. Roy, and Rowen K. Zetternan. "Hepatorenal Syndrome." eMedicine. Eds. Ann Ouyang, et al. 15 May. 2008. Medscape. 14 Oct. 2009 <http://emedicine.medscape.com/article/178208-overview>.

Pyrsopoulos, Nikolaos T., and K. Rajender Reddy. "Primary Biliary Cirrhosis." eMedicine. Eds. George Y. Wu, et al. 22 Sep. 2008. Medscape. 14 Oct. 2009 <http://emedicine.medscape.com/article/171117-overview>.

Wolf, David C. "Cirrhosis." eMedicine. Eds. Ann Ouyang, et al. 11 Aug. 2008. Medscape. 14 Oct. 2009 <http://emedicine.medscape.com/article/185856-overview>.

General

Mohan, Venkat. "Cirrhosis of the Liver." WebMD.com. 13 Sep. 2008. WebMD, LLC. 14 Oct. 2009 <http://www.webmd.com/digestive-disorders/cirrhosis-liver>.

Shaffer, Eldon A. "Cirrhosis." The Merck Manuals Online Medical Library, Home Edition. Sep. 2007. Merck & Co., Inc. 14 Oct. 2009 <http://www.merck.com/mmhe/sec10/ch136/ch136c.html>.

Source: Medical Disability Advisor






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