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.

Colon Resection


Medical Codes

ICD-9-CM:
45.71 - Open and Other Multiple Segmental Resection of Large Intestine; Segmental Resection for Multiple Traumatic Lesions of Large Intestine
45.72 - Open and Other Cecectomy; Resection of Cecum of Terminal Ileum
45.73 - Open and Other Right Hemicolectomy; Ileocolectomy; Right Radical Colectomy
45.74 - Open and Other Resection of Transverse Colon
45.75 - Open and Other Left Hemicolectomy
45.76 - Open and Other Sigmoidectomy
45.79 - Other and Unspecified Partial Excision of Large Intestine; Enterocolectomy NEC

Related Terms

  • Anterior Resection of the Sigmoid Colon
  • Colectomy
  • Hemicolectomy
  • Left Hemicolectomy
  • Partial Resection of the Large Intestine
  • Right Hemicolectomy
  • Segmental Resection of the Colon
  • Transverse Colectomy

Overview

A colon resection, also known as a colectomy, is the surgical removal (resection) of a part or all of the large intestine (colon). The large intestine consists of five main sections: the ascending colon, transverse colon, descending colon, and the sigmoid colon, ending with the rectum. The colon normally receives partially digested food from the small intestine and extracts water and nutrients before storing the rest as waste (stool, feces); the waste is then moved by wave-like motions of the muscular intestinal wall (peristalsis) from the colon into the rectum, and passed out of the body through the anus. Individuals at risk for requiring a colectomy have been diagnosed with some type of gastrointestinal disorder such as diverticulitis, cancer, inflammatory bowel disease (i.e., Crohn's disease or ulcerative colitis), an intestinal condition in which the intestine twists and causes an obstruction (volvulus), volvulus complicated by gangrene, or bowel obstruction. The amount of the colon that is to be removed depends on the diagnosis, the sections affected, and the extent of the disease. Adjacent sections are sometimes removed if the diagnosis is colon cancer and the surgeon determines that spread (metastasis) of the cancer may be avoided by removing nearby tissue.

Source: Medical Disability Advisor



Reason for Procedure

Colon resection is used to treat a variety of gastrointestinal disorders. This procedure may be performed to treat small sacs or pouches on the walls of the colon that become inflamed (diverticulitis), to remove malignant colon polyps or tumors, to treat inflammatory conditions of the bowel (e.g., Crohn's disease, ulcerative colitis), or to remove an intestinal obstruction. Colon resection also is performed for volvulus or when the intestinal tract is damaged due to trauma.

Source: Medical Disability Advisor



How Procedure is Performed

A colon resection or colectomy is performed in the hospital as an inpatient procedure using general anesthesia. Preoperative examination includes assessing the cardiovascular, pulmonary, and renal function of the patient as well as routine laboratory studies. A colonoscopy is performed preoperatively to confirm the presence and location of polyps and malignant lesions. Computed tomography (CT) of the abdomen and pelvis usually is done. Colon lesions that are found on colonoscopy are biopsied either pre-operatively or during colectomy to stage possible malignancy.

Colectomies are classified according to the portion of the colon to be removed as well as the type of procedure used. If the right side of the colon is to be removed, the procedure is called a right hemicolectomy. If the part of the colon on the individual's left side is to be removed, it is known as a left hemicolectomy. A transverse colectomy is performed when the part of the colon that crosses from the right to the left side (transverse colon) is removed. In an anterior resection of the sigmoid colon, the part of the colon next to the rectum (sigmoid colon) is removed.

Two types of colon resection procedures are performed regularly, open and laparoscopic. The patient is placed lying face upward (supine), and a tube is inserted through the nose into the stomach (nasogastric tube) to remove gastric secretions. A Foley catheter is inserted into the bladder to divert urine during the surgery. In either procedure, the abdomen is cleansed with an antibacterial surgical scrub solution. In open procedures, an incision is made in the middle of the abdomen (midline). The small bowel is moved to the side of the abdomen and held in place with retractors. The colectomy needed is then performed through the midline incision. After removal of the diseased portion of the colon, the intestine is reconnected (anastomosed). The anastomosis may be either hand-sewn or stapled.

In laparoscopic colon resections, surgeons create four or five small openings, each about 0.5inch (1.5 cm) long in the abdomen. The laparoscope and ancillary equipment (camera, dissection tools) are inserted through the wounds, and the procedure is performed with visual guidance on a television monitor. In some cases, one of the small openings may be lengthened to 2 to 3 inches (5 to 7.5 cm) in order to complete the procedure.

With either procedure, the surgeon works down through abdominal tissues to the segment of the colon to be removed. It is loosened from surrounding tissues (dissected and mobilized), and the blood vessels that supply that part of the colon are identified and sealed off with electrocautery. Vessels that supply the remaining segments of the colon are closed off to prevent bleeding during the surgery. The diseased portion of the colon is removed. The healthy ends of the colon that remain usually are reconnected. (anastomosed). Sometimes the colon cannot be reconnected, and an artificial opening (colostomy) is required to divert the passage of waste outside the body. The colostomy can be temporary or permanent depending on the extent of the colon resection. Drain tubes may be placed to allow drainage of any secretions that accumulate. The incision is sutured closed, and dressings are placed over the incision.

Source: Medical Disability Advisor



Prognosis

Colon resection reduces the risk of recurrence of diverticular disease. Colectomy is potentially curative for ulcerative colitis, and generally curative for obstructions due to volvulus; however, with ulcerative colitis about half the individuals require a second surgery within 10 years of the initial surgery.
The outcome of colon resection performed to treatment of cancer varies depending on the stage and extent of metastasis of the cancer at the time of diagnosis and the individual's response to treatment. The outcome of individuals with colon cancer diagnosed in the early stages (stages I and II without metastasis) is good.

The outcome of laparoscopic colon resection includes better lung and immune system functioning post-operatively because of reduced use of anesthesia, and there is greater patient satisfaction with body image because of the small incisions vs. the large midline incision of standard colectomy. Earlier resumption of bowel function is another advantage of the laparoscopic procedure, which involves less handling of the bowel.

Source: Medical Disability Advisor



Specialists

  • Colon and Rectal Surgeon
  • Gastroenterologist
  • General Surgeon

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications from colon resection may include wound infection, pelvic abscess, leakage at the anastomosis site, development of an abnormal tube-like passage (fistula) in surrounding tissue, narrowing of the intestine where the ends of the intestine were sutured together (stricture), and a recurrence of disease.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that influence the length of disability include number and severity of postoperative complications, amount of blood loss during surgery and postoperatively, success in treating the underlying condition necessitating the surgery, individual's nutritional status and mental and emotional stability, and strength of the individual's support system. The type of colectomy (open or laparoscopic) performed also influences the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Several weeks off from work are needed for wound healing and recovery before light work may be resumed. Heavy lifting should be avoided until approved by the surgeon. If additional treatment such as chemotherapy or radiation is necessary for cancer treatment, time off from work may be necessary for treatment and recovery.

Source: Medical Disability Advisor



References

General

Becker, J. M. "Chronic Ulcerative Colitis." The Practice of General Surgery. Ed. K. I. Bland. Philadelphia: W.B. Saunders, 2002. 478-486.

Belin, B. M., and S. D. Wexner. "Crohn's Disease of the Colon." The Practice of General Surgery. Ed. K. I. Bland. Philadelphia: W.B. Saunders, 2002. 492-498.

Kaufman, H. S., and C. J. Sunnenday. "Diverticulitis." The Practice of General Surgery. Ed. K. I. Bland. Philadelphia: W.B. Saunders, 2002. 503-508.

Khatri, Vijay, et al. "Colon Resection." Operative Surgery Manual. 1st ed. Saunders Elsevier, 2003. MD Consult. Elsevier, Inc. 12 Sep. 2009 <http://mdconsult.com>.

Townsend, Courtney M., et al., eds. "Laparascopic Colon Resection." Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia: Saunders Elsevier, 2007. MD Consult. Elsevier, Inc. 12 Sep. 2009 <http://mdconsult.com>.

Source: Medical Disability Advisor