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.

Colorectal Polyps

colorectal polyps in français (France)

Related Terms

  • Adenomatous Polyps
  • Hamartoma Polyps
  • Hyperplastic Polyps
  • Polypoid Disease

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

  • Compromised immune system
  • Morbid obesity

Factors Influencing Duration

Factors that might influence the length of disability include the size and number of polyps that are removed, whether sedation or general anesthesia was required during polyp removal, whether surgery to remove part of the rectum was part of the treatment, whether the individual was fitted with a colostomy during the surgical procedure, the physical demands of the workplace and the individual's psychological adjustment if a colostomy was performed.

Medical Codes

ICD-9-CM:
569.0 - Anal and Rectal Polyps

Overview

© Reed Group
Rectal polyps are well-defined projections that grow from the mucous membrane that lines the wall of the lower colon (rectum).

Polyps may grow singly or in groups, and they may grow on stalks (pedunculated) or they can have a broad, flat base (sessile). They range in size from 1 to 2 millimeters to greater than 10 centimeters.

Rectal polyps are classified according to their tissue-type (histology). There are three major groups: adenomas (67%), hyperplastic polyps (11%), and a miscellaneous group (22%) that includes mucosal polyps (made of normal mucosa), inflammatory polyps, juvenile polyps, hamartomas, and a variety of nonmucosal lesions. Adenomas are unique among polyps in that only they are known to be direct precursors of cancer (carcinoma).

Lifestyle choices, including a high fat and calorie, low-fiber diet; obesity; cigarette smoking; and alcohol consumption, increase the risk of developing rectal polyps. Those with cirrhosis of the liver, or chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) also are at increased risk.

Rectal polyps are also associated with two inherited conditions, familial adenomatous polyposis and Gardner's syndrome. In both these conditions, hundreds of small adenomas begin to develop during the teen years, and colon cancer usually develops before age 40.

Incidence and Prevalence: Adenomas occur in up to 30% to 40% of individuals over age 60 in the US (Russell 742). In 2000, there were 36,400 new cases of reported rectal cancer in the US (Hassan). Incidence of rectal polyps worldwide follows the incidence of colon cancer, being higher in North America and northern Europe, Australia, and New Zealand; lower in Japan, and southern Europe; and almost non-existent in most parts of Africa and Asia (Goldman 742; Hassan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Chance of developing rectal polyps increases with age. They are uncommon before age 40 (Beers). White males are at greater risk than black males for developing rectal cancer (and thus adenomatous polyps), but the risk for women of both races is the same, and slightly lower than for men.

Source: Medical Disability Advisor



Diagnosis

History: Individuals will occasionally complain of abdominal pain, diarrhea, or rectal bleeding. More commonly, there are no signs or symptoms, and rectal polyps are detected during routine screening for rectal cancer.

Physical exam: The exam is usually normal. A gloved finger inserted into the rectum (digital rectal examination) may reveal rectal polyps, but cannot confirm the diagnosis.

Tests: Tests include examination of the inside of the rectum using a flexible, fiberoptic viewing instrument (colonoscopy). Also, small samples of polyp tissue (biopsy) may be taken during colonoscopy for microscopic examination. If necessary, the rectum may be evaluated further with proctosigmoidoscopy or anoscopy. X-rays of the colon can be taken following instillation of a contrast medium into the bowel (barium enema) in order to further visualize the polyps. Blood in the stool can be identified using a fecal occult blood test (FOBT), which may be used as a screening test for rectal polyps or cancer.

Source: Medical Disability Advisor



Treatment

The preferred treatment for rectal polyps is to remove them during colonoscopy (colonoscopic polypectomy) or sigmoidoscopy. The specific technique for polyp removal during colonoscopy (hot biopsy technique, snare excision with electrocautery, piecemeal snare excision) depends upon polyp size and configuration, experience and expertise of the physician, and the equipment that is available for the procedure. Surgical removal (excision) of polyps by cutting out a section (resection) of the rectum is recommended for individuals with polyps that cannot be removed completely during colonoscopy. Depending upon the extent of the surgical resection, the individual may require an artificial opening (stoma) through the abdominal wall for the purpose of fecal elimination (colostomy).

Source: Medical Disability Advisor



Prognosis

Most rectal polyps are removed without incident and serious complications occur in less than 0.2% of sigmoidoscopy procedures. Following removal, rectal polyps will recur 40% of the time. Individuals with adenomas have a 1% to 15% chance of developing rectal cancer within 15 years of diagnosis. Approximately one-third of polyps that are removed from the rectum will be cancerous, although less than 5% of small polyps (1 cm tubular adenomas) will be cancerous (Townsend 1448-1449). Surgical cure is possible in 70% of individuals with adenomas (Beers).

Source: Medical Disability Advisor



Rehabilitation

Adequate fluid intake, a high fiber diet, and a regular exercise routine may be useful in reducing the risk of recurrence of rectal polyps. Aerobic exercise such as walking, jogging, or swimming (30 to 45 minutes per session) is usually beneficial.

Source: Medical Disability Advisor



Complications

If not removed, rectal polyps may develop into cancer and/or grow to block the colon.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No workplace restrictions should be necessary for individuals who are treated using colonoscopy for rectal polyps. If surgery was used as a treatment, heavy physical labor may have to be restricted until recovery is complete. Workplace accommodations should include easy access to restroom facilities if the individual has a colostomy.

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 diagnosis of rectal polyps been confirmed?
  • If diagnosis was uncertain, was a colonoscopy exam used to confirm the diagnosis and rule out other conditions with similar symptoms?
  • Were x-rays of the colon taken to further visualize the polyps?
  • Was biopsy of polyp tissue used to determine the type of polyp?
  • Did a fecal occult blood test (FOBT) reveal unseen blood in the stool?

Regarding treatment:

  • Were polyps removed during colonoscopy?
  • If not, will the individual need to undergo a resection in order to remove them?
  • Did the individual require a colostomy during the surgery?
  • What is the anticipated recovery time after surgery?
  • Because psychological issues can be associated with a colostomy, would individual benefit from counseling?

Regarding prognosis:

  • Were the polyps removed successfully?
  • Was the polyp cancerous?
  • Did postsurgical complications occur, such as severe bleeding or infection?
  • Were complications effectively treated? What is the expected outcome after treatment?
  • If colostomy was necessary, have psychological issues been resolved through counseling?
  • Because polyps recur about 40% of the time, has individual been instructed in lifestyle modifications which may reduce the risk of polyps?
  • Has individual complied with recommendations to lower fat and calories and increase fiber in the diet? Would individual benefit from consultation with a nutritionist?
  • If individual has not been able to reduce weight, would he or she benefit from enrollment in a community weight loss program?
  • Has individual been able to abstain from alcohol and tobacco use? Would individual benefit from enrollment in community programs or support group?

Source: Medical Disability Advisor



References

Cited

Goldman, Lee, and J. Claude Bennett, eds. Cecil Textbook of Medicine. 21st ed. Philadelphia: W.B. Saunders, 2000.

Hassan, Isaac. "Rectal Carcinoma." eMedicine. Eds. Ludwig G. Strauss, et al. 18 Jun. 2004. Medscape. 19 Dec. 2004 <http//emedicine.com/radio/topic595.htm>.

Russell, Paul S. "Large-Bowel Tumors: Polyps of the Colon and Rectum." The Merck Manual of Diagnosis and Therapy. Eds. Mark H. Beers and Robert Berkow. 17th ed. Whitehouse Station, NJ: Merck and Company, Inc., 1999. Merck. Merck & Co., Inc. 19 Dec. 2004 <http://www.merck.com/mrkshared/mmanual/home.jsp>.

Townsend, C. M., and D. C. Sabiston, eds. Sabiston Textbook of Surgery. 16th ed. Philadelphia: W.B. Saunders, 2001.

Source: Medical Disability Advisor






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