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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.

Colitis


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:
009.0 - Ill-defined Intestinal Infections; Infectious Colitis, Enteritis, and Gastroenteritis; Colitis, Septic; Dysentery, NOS, Catarrhal, Hemorrhagic; Enteritis, Septic; Gastroenteritis, Septic
557.0 - Acute Vascular Insufficiency of Intestine; Acute Hemorrhagic Enterocolitis, Ischemic Colitis, Enteritis, Enterocolitis, Massive Necrosis of Intestine; Bowel Infraction; Embolism of Mesenteric Artery, Intestinal Gangrene, Thrombosis of Mesenteric Artery
558.1 - Gastroenteritis and Colitis Due to Radiation
558.2 - Gastroenteritis and Colitis, Toxic
558.3 - Gastroenteritis and Colitis, Allergic

Related Terms

  • Crohn's Disease
  • Enteritis
  • Gastroenteritis
  • IBD
  • Ileitis
  • Inflammatory Bowel Disease
  • Ischemic Colitis
  • Jejunitis
  • Pseudomembranous Colitis
  • Ulcerative Colitis

Overview

Colitis is an inflammation of the lining of the large intestine (colon). The disease has many causes and variants. Colitis may be due to infection caused by bacteria (e.g., Escherichia coli, Salmonella, Shigella), certain virus (e.g., norovirus, rotavirus), or some protozoa (e.g., Entamoeba histolytica). Bacteria may cause colitis by directly infecting the inner lining of the colon or by producing toxins that irritate the lining of the intestine (e.g., Campylobacter).

Antibiotics can cause colitis secondary to an overgrowth of a specific type of bacterium (Clostridium difficile), which may then proliferate and produce a toxin that irritates the colon (pseudomembranous colitis). The antibiotic itself also may have an irritating effect that can cause colonic inflammation. Colitis also can result from a restriction in blood flow to the bowel (ischemia), drug side effects, and allergic hypersensitivities (Singh).

Two variants of unknown etiology (idiopathic), ulcerative colitis and Crohn's disease, are generally described by the term inflammatory bowel disease (IBD). Ulcerative colitis is a serious intestinal disorder that usually begins in young adulthood. This condition is characterized by inflammation and ulceration that is limited to the colon and rectum. Ulcerative colitis contrasts with Crohn's disease, the other major type of IBD, in that colitis affects only the colon and involves only the inner lining, whereas Crohn's disease may also involve the lower small intestine and can affect all layers of the intestinal wall. See entries for Crohn's Disease and Ulcerative Colitis for additional details.

Incidence and Prevalence: The incidence of ulcerative colitis is 15 cases per 100,000 population, and the incidence of Crohn's disease is 3 to 4 cases per 100,000 population (Singh).

Colitis from bacterial infection with C. difficile occurs in 84 cases per 100,000 hospitalizations each year (Aberra).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who take antibiotics are at risk of developing colitis secondary to overgrowth of nonsusceptible bacteria. Individuals who are hospitalized are at increased risk for colitis caused by bacterial infection with C. difficile (Aberra). Individuals with a history of recent travel, ingestion of an unusual diet, or contaminated food or water have a higher risk for colitis from bacterial infection with Campylobacter, Shigella, or Yersinia (Wedro).

Other risk factors for colitis include older age, cancer, abdominal surgery or cesarean delivery, and burns. In individuals over age 60, ischemic colitis may occur when narrowing of the blood vessels (atherosclerosis) impairs the blood supply to the intestinal wall (Khan). Ischemic colitis also occurs in up to 10% of individuals recovering from abdominal aortic reconstruction and is more common in women taking oral contraceptives (Khan).

Colitis can occur at any age, but IBD has a higher incidence among young adults and individuals of Jewish descent (Singh). Both sexes are affected equally. Family members of an individual with IBD have a 7% to 22% greater risk of getting the disease; a child will be 35% more likely to be affected when both parents have IBD (Singh).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report watery diarrhea containing mucus, pus, or blood; abdominal pain, tenderness, or spasm (colic); intermittent or irregular fever; and feeling a constant urge to produce stools (tenesmus). There may be a history of recent travel, abdominal surgery, hospitalization, or antibiotic therapy; an acute onset of colitis may occur within 1 day to 6 weeks (on average 3 to 9 days) after beginning antibiotic treatment (Yassin).

Physical exam: The abdomen may be tender to gentle probing (palpation) on exam. A digital exam of the rectum with a gloved finger may be performed to detect abnormalities. A stethoscope is used to listen (auscultate) to bowel sounds. Blood pressure may be low (hypotension) and the heart rate fast (tachycardia) if the individual is dehydrated or in shock (Wedro).

Tests: A sample of feces is examined for parasites, (coproparasitoscopic examination), and a stool stained smear or culture is microscopically analyzed to identify bacteria. Complete blood count (CBC) and blood tests to determine electrolyte levels and assess kidney function are done. A flexible viewing scope (colonoscope or sigmoidoscope) may be used to examine the inside of the rectum and colon for inflammation or ulceration of the lining (sigmoidoscopy, colonoscopy). Small samples (biopsies) of inflamed areas may be taken for examination with a microscope. A radiographic procedure to visualize the colon (barium enema) may help identify bowel problems such as areas of narrowing (stricture) or severe inflammation. Abdominal x-rays can be used to rule out alternate diagnoses.

Source: Medical Disability Advisor



Treatment

Most infections that cause acute colitis resolve without treatment. However, infections caused by Campylobacter or Clostridium may need to be treated with antibiotics specific for those organisms. Protozoal infections are treated with antiprotozoal drugs; for example, amoebic infections are treated with amebicides. Initiating a clear liquid diet can allow the bowel to rest while maintaining hydration (Wedro). Individuals unable to maintain adequate hydration may need intravenous fluid therapy.

When colitis is caused by low blood flow (ischemia), it may be treated by surgical removal of the diseased section of the colon (partial or total colectomy). Ulcerative colitis may be treated with combinations of systemic or locally acting corticosteroid anti-inflammatory drugs, nonabsorbable sulfa-based antibiotics, locally acting nonsteroidal anti-inflammatory drugs (NSAIDs), antidiarrheal agents, a special diet, and vitamin supplements. Newer agents modify the inflammatory cascade responsible for the tissue destruction. If surgical intervention is necessary for ulcerative colitis, the entire colon and rectum commonly are removed (total proctocolectomy).

Following surgery, the individual may require an artificial opening (stoma) of the colon through the abdominal wall to enable bowel emptying (colostomy). A colostomy may be temporary or permanent depending on the portion of bowel surgically removed. If the entire colon and rectum are removed, the individual will require a permanent stoma of the lower small intestine (ileum) through the abdominal wall (ileostomy).

Source: Medical Disability Advisor



Prognosis

Colitis caused by infection often resolves without treatment, with 75% of symptomatic individuals recovering within 10 days (Yassin). If treatment is necessary, however, the infection usually responds well to drug therapy. Antibiotic-associated colitis normally resolves once the offending antibiotic therapy is discontinued and antibiotic therapy that targets the causative bacteria is initiated. Colitis caused by the bacteria C. difficile has a recurrence rate of 20% to 27% (Aberra). Elderly individuals with colitis from bacterial with C. difficile have a mortality rate of 25% (Aberra); the overall mortality rate is 2% (Yassin).

Ulcerative colitis and Crohn’s disease are chronic conditions requiring long-term management. The predicted outcome for ischemic colitis depends on the extent of damaged colon removed. With ischemic colitis, the disease is reversible in 44% of cases, persistent in 18.7%, and proceeds to tissue death (gangrene) or perforation in nearly 19% (Khan).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

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

Source: Medical Disability Advisor



Rehabilitation

Because ischemic colitis may be in part caused by atherosclerosis or blood clot (thrombus) formation, a regular exercise routine to control blood pressure and improve circulation may be useful in reducing the risk (Mayo Clinic). Aerobic exercise (e.g., walking, jogging, swimming) usually is beneficial. For individuals who do not engage in regular exercise, a consultation with a physical therapist may be useful: individuals learn how to properly warm up all muscle groups, stretch to prevent injury, and gradually increase the amount of exercise performed.

If surgery was necessary for ischemic colitis, ulcerative colitis, or Crohn’s disease, learning progressive relaxation and deep breathing techniques may help to reduce postoperative pain and speed recovery. Early ambulation is recommended to decrease the risk of postoperative thrombus formation.

Source: Medical Disability Advisor



Comorbid Conditions

  • Circulatory disorders

Source: Medical Disability Advisor



Complications

Prolonged diarrhea may result in dehydration and electrolyte imbalance. In severe cases of colitis, intestinal bleeding (hemorrhage), hypovolemic shock, toxic megacolon, overwhelming infection (sepsis), and perforation of the colon can occur. Colitis can cause chronic abdominal pain. It is important to treat abdominal pain in these patients. Lack of appropriate pain management can lead to poor treatment outcomes.

Source: Medical Disability Advisor



Factors Influencing Duration

In general, colitis does not disable individuals unless there are complications that make surgical intervention necessary. The severity of the symptoms, health status of the individual, type of treatment, response to treatment, and the presence of complications may influence length of disability. A mild episode of colitis can be treated in 1 to 2 days with rest and medication. If the individual has moderate to severe ischemic colitis, hospitalization usually is required, and a longer recovery period (1 week or more) will be needed. If abdominal surgery is required, 4 to 6 weeks may be needed before an individual can return to work.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations usually are not associated with this condition, although more frequent breaks and ready access to bathroom facilities may be necessary. Following a prolonged episode of colitis, the individual may need to limit strenuous activities until physical stamina returns. If treatment involves surgery, return to work will be delayed for several weeks and may then be limited to modified duty 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:

  • Has individual recently been on antibiotic therapy?
  • Has the individual recently traveled out of the country? Has individual ingested an unusual diet or contaminated food or water?
  • Does individual have atherosclerosis?
  • What type of colitis does individual have? Infectious colitis, including pseudomembranous colitis? Ulcerative colitis? Crohn’s disease? Ischemic colitis?
  • Did individual report watery diarrhea containing mucus, pus, or blood; abdominal pain, tenderness, or spasm (colic); and intermittent or irregular fever?
  • Did individual report feeling a constant urge to produce stools (tenesmus)?
  • Did individual have a digital examination of the rectum?
  • Was auscultation of the abdomen done?
  • Has individual had comprehensive stool testing done? Blood tests?
  • Has individual had a sigmoidoscopy or colonoscopy? Biopsies?
  • Has individual had a barium enema?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual on clear liquid diet?
  • Is individual being treated with broad-spectrum antibiotics or antiprotozoal drugs? Antidiarrheal agents?
  • Is individual being treated with corticosteroids, special diet, and vitamin supplements as needed?
  • Was it necessary for the individual to have a partial or total colectomy, or total proctocolectomy?
  • Does the individual have a colostomy or ileostomy? If colostomy, is it temporary or permanent?

Regarding prognosis:

  • Does individual exercise regularly?
  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Has individual experienced any complications that could delay recovery?

Source: Medical Disability Advisor



References

Cited

Aberra, Faten N., and Craig A. Gronczewski. "Clostridum Difficile Colitis." eMedicine. Eds. Waqar A. Qureshi, et al. 4 Aug. 2009. Medscape. 30 Sep. 2009 <http://emedicine.medscape.com/article/186458-overview>.

Khan, Ali Nawaz, et al. "Colitis, Ischemic." eMedicine. Eds. Claire Barker, et al. 1 Sep. 2009. Medscape. 30 Sep. 2009 <http://emedicine.medscape.com/article/366808-overview>.

Mayo Clinic Staff. "Ischemic Colitis." MayoClinic.com. 2009. Mayo Foundation for Medical Education and Research. 30 Sep. 2009 <http://www.mayoclinic.com/health/ischemic>.

Singh, J. "Colitis." eMedicine. Eds. Robert Baldassano, et al. 17 Jun. 2009. Medscape. 20 Sep. 2009 <http://emedicine.medscape.com/article/927845-overview>.

Wedro, Benjamin C. "Colitis." eMedicine Health. Ed. Melissa C. Stoppler. 2009. WebMD, LLC. 30 Sep. 2009 <http://www.emedicinehealth.com/colitis/article_em.htm>.

Yassin, Said Fadi. "Pseudomembranous Colitis, Surgical Treatment." eMedicine. Eds. Scott H. Bjerke, et al. 7 Apr. 2009. Medscape. 30 Sep. 2009 <http://emedicine.medscape.com/article/193031-overview>.

Source: Medical Disability Advisor