Sign-in
(your email):
(case sensitive):



 
 

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.

Diarrhea


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Specialists | 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:
009.2 - Ill-defined Intestinal Infections; Infectious Diarrhea, Dysenteric, Epidemic; Infectious Diarrheal Disease NOS
009.3 - Ill-defined Intestinal Infections; Diarrhea of Presumed Infectious Origin
564.5 - Functional Digestive Disorders Not Elsewhere Classified, Functional Diarrhea

Related Terms

  • Acute Diarrheal Illness
  • Acute Enteritis
  • Dysentery
  • Gastroenteritis
  • the Runs

Overview

Diarrhea is an increase in the fluidity, frequency, and/or volume of bowel movements as compared to the usual pattern for a particular individual. In normal bowel activity, the large intestine (colon) absorbs much of the water from the liquid food residues that pass through it, resulting in semisolid feces. Diarrhea results when the intestinal contents pass through the colon too quickly or when an inflamed small intestine secretes fluid back into the fecal material.

Diarrhea is a symptom of an underlying condition and may be acute or chronic. A more advanced form of diarrhea is called dysentery and contains blood, pus, and mucus.

Incidence and Prevalence: Diarrhea is one of the most common illnesses in all age groups and is second only to the common cold as a cause of lost days of work. It is estimated that almost 100 million cases of acute diarrhea occur per year in adults in the US. Adults have about one bout with diarrhea a year. Less than 10% of cases of diarrhea are brought to the attention of a doctor because most individuals use home care effectively. Diarrhea and dysentery (diarrhea that contains blood, pus, or mucus) are common disorders in third-world countries. In industrialized nations, the occurrence of diarrhea mirrors the US experience.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of diarrhea in most cases is unknown. Many individuals contract diarrhea through infections (bacterial, parasitic, viral) that usually occur after the ingestion of contaminated food or water. Infections may also be transmitted individual-to-individual through contaminated hands or objects or in some cases through viral droplet infection. Diarrhea may also be caused by anxiety, failure to absorb certain foods, and drugs (including some antibiotics) that interfere with the harmless bacteria normally found in the intestines. Ingestion of magnesium laxatives or antacids, immune disorders such as Crohn's disease and ulcerative colitis, hormone abnormalities, and cancer of the large intestine may result in diarrhea. Diarrhea may accompany disease of small areas of the colon (diverticula), irritable bowel syndrome, fecal impaction, lack of blood and oxygen to portions of the intestines following radiation therapy, and with certain surgical procedures (stomach, small intestine segment). Diarrhea may also be associated with infectious processes outside the gastrointestinal tract, such as pneumonia, urinary tract infection, and pelvic inflammatory disease.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may include bowel movements that are increased in fluidity, frequency, or volume compared to the individual's usual pattern. Blood, secretions (mucus), or pus may be present in the stool when damage has occurred to the mucous lining of the intestinal tract. Other symptoms often associated with diarrhea include nausea, vomiting, and fever. Individuals may report family or friends with diarrhea or a history of recent travel.

Physical exam: The exam is usually normal, although abdominal tenderness may be present. If diarrhea has occurred for a while, dehydration may be evident with signs of dry mouth, decreased blood pressure, weakness, lethargy, or confusion. Individual may have increased skin pigmentation or inflammation of the tongue (glossitis).

Tests: In most cases of acute diarrhea, laboratory investigation is unnecessary, unrevealing, and does not affect treatment or outcome. Microscopic examination of the stool for white blood cells (leukocytes) distinguishes noninflammatory from inflammatory diarrhea. If leukocytes are present, a stool culture is done to identify the infectious agent. If diarrhea persists for more than 10 days, examinations are done on three consecutive stools to look for eggs (ova) or parasites.

In cases of chronic diarrhea, additional tests may include 24-hour stool collection for weight and quantitative fecal fat to identify a malabsorption process; a stool laxative screen to rule out laxative abuse; and a stool osmolality to rule out lactase deficiency, laxative abuse, or malabsorption syndromes. Routine laboratory tests to rule out malabsorption, anemia, and inflammatory diseases include complete blood count (CBC), serum electrolytes, liver function tests, calcium, phosphorus, albumin, thyroid-stimulating hormone (TSH), total thyroxine (T4), beta-carotene, and prothrombin. In individuals with severe inflammation of the rectum or anus, direct visualization of the sigmoid colon and the entire colon via an instrument inserted into the rectum (sigmoidoscopy and colonoscopy) may be needed. Removal of a small sample of mucous membrane for microscopic analysis (biopsy) is warranted to distinguish infectious diarrhea from ulcerative colitis or ischemic colitis. X-ray studies of the digestive tract using barium to visualize the intestines are useful in detecting abnormal narrowing (strictures) or other anatomic abnormalities beyond the reach of the sigmoidoscope.

Source: Medical Disability Advisor



Treatment

Treatment is directed at the underlying cause of the diarrhea. Most cases of acute diarrhea do not require any treatment other than oral fluids (containing carbohydrates and electrolytes such as sports drinks) and temporary diet modification to exclude gluten or dairy products. Solid food should be avoided until diarrhea subsides. Antibiotic or antimicrobial therapy may be necessary when severe diarrhea is due to an infectious agent and to treat bacterial overgrowth. Antidiarrheal drugs may be used as a comfort measure. However, they should not be used in cases where diarrhea is caused by infection, as they may prolong the illness. In chronic diarrhea, hospitalization with intravenous fluid and electrolyte replacement may be required if dehydration is severe. Offending drugs should be discontinued, if possible.

Tumors are treated with surgery or chemotherapy. Pancreatic enzymes are used to treat pancreatic insufficiency. Bulk-forming agents are used in treating irritable bowel syndrome and disorders involving the anus or rectum. Fecal impaction may be resolved with the manual removal of the impaction.

Source: Medical Disability Advisor



Prognosis

In over 90% of cases, acute diarrhea is mild, self-limited, and responds within 5 days to rehydration therapy or antidiarrheal agents. Individuals with diarrhea caused by infectious agents recover with appropriate antibiotic therapy. Diarrhea resulting from other causes improves with treatment of the underlying condition. Individuals with diarrhea of probable immune cause may have chronic inflammation with bouts of diarrhea for years.

Most deaths from diarrhea occur in the elderly whose health may be put at risk from a moderate amount of dehydration.

Source: Medical Disability Advisor



Specialists

  • Gastroenterologist
  • Internal Medicine Physician
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

The most common complications of diarrhea are dehydration and electrolyte imbalance.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the individual's age, severity of symptoms, and response to treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended leave of absence during the acute phase of the disease may be required. After the individual returns to work easy and immediate access to restrooms may be required during the latter stages of this disease.

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 complain of bowel movements that are increased in fluidity, frequency, or volume compared to usual pattern?
  • Does blood, mucus, or pus occur in the stool? Does individual complain of nausea, vomiting, or fever?
  • Do family or friends have diarrhea? Does individual have history of recent travel?
  • Is individual anxious? Does individual fail to absorb certain foods? Taking drugs (including some antibiotics) that interfere with bacteria normally found in the intestines?
  • Does individual use magnesium laxatives or antacids?
  • Does individual have Crohn's disease, ulcerative colitis, hormone abnormalities, or cancer of the large intestine? Diverticula, irritable bowel syndrome, fecal impaction, lack of blood and oxygen to portions of the intestines following radiation therapy, or surgical procedures of the stomach or small intestine?
  • Are infectious processes outside the gastrointestinal tract present such as pneumonia, urinary tract infection, or pelvic inflammatory disease?
  • On exam, is the abdomen tender to palpation?
  • Does individual have a dry mouth, decreased blood pressure, weakness, lethargy, or confusion, evidence of increased skin pigmentation, or glossitis?
  • Was comprehensive stool testing done? CBC, serum electrolytes, liver function tests, calcium, phosphorus, albumin, TSH, T4, beta-carotene, and prothrombin testing?
  • Was a sigmoidoscopy and/or colonoscopy performed? Biopsy? Barium enema?

Regarding treatment:

  • What is the underlying condition? Is it being treated?
  • Does individual use sports drinks to maintain hydration? Has individual modified diet?
  • Are antidiarrheal drugs used?
  • Was individual treated with antimicrobial therapy?
  • Was hospitalization necessary?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed such as dehydration or electrolyte imbalance that may impact recovery?

Source: Medical Disability Advisor



References

General

"Diarrhea." National Digestive Diseases Information Clearinghouse. Oct. 2003. National Institute of Diabetes and Digestive and Kidney Diseases. 20 May 2005 <http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/>.

Source: Medical Disability Advisor