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.

Diverticulosis and Diverticulitis of Colon


Related Terms

  • Diverticular Disease
  • Diverticular Inflammation

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that can influence disability include severity of the symptoms and whether the individual receives surgical treatment. Age and health status also may be factors because older individuals usually require a longer period of recovery following surgery.

Medical Codes

ICD-9-CM:
562.10 - Diverticulosis of Colon (without Mention of Hemorrhage); Diverticulosis without Mention of Diverticulitis; Diverticular Disease (Colon) without Mention of Diverticulitis
562.11 - Diverticulitis of Colon (without Mention of Hemorrhage) with Diverticulosis

Overview

© Reed Group
Diverticulosis describes a ballooning out of a section of the large intestine (colon). It occurs when the inner lining (mucosa) of the colon weakens and forms one or more sac-like projections (diverticula) that push through the muscular layer of the colon. When those pouches become inflamed or infected, or if they rupture, the condition is called diverticulitis.

The number of diverticula in an individual can range from one to hundreds and may vary in size from a few millimeters to several centimeters. Generally, diverticulosis produces no symptoms and only is discovered incidentally by barium enema (x-ray), CT scan, or colonoscopy. However, when food backs up into the diverticula and bacteria begin to thrive there, the blood supply becomes compromised, and the result may be abscesses, local adhesions, and possible perforation. In diverticulitis, complaints range from mild abdominal discomfort to life-threatening infection that has spread to the peritoneal lining of the abdomen (peritonitis). In 95% of the patients, diverticulosis or diverticulitis affects the narrowest section of colon that lies immediately before the rectum (sigmoid colon) (Joffe).

The definitive cause of diverticulosis is not known, but low-fiber diets that are high in fat and refined carbohydrates are suspect; treatment is directed to correct this (Cunha). The theory is that low-volume stools create more work for the muscles lining the colon. These muscles become hypertrophied (enlarged) and thickened and eventually elevated pressure in the colon causes small herniations of colon mucosa (diverticuli). Individuals on low-fiber diets also are more prone to constipation, which can cause increased colon pressure during a bowel movement and may lead to weakening of the colon wall (NDDIC).

Incidence and Prevalence: It is estimated that diverticular disease is present in 30% to 55% of individuals living in developed countries (Murray).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for diverticulosis and diverticulitis include a low-fiber diet, high in fat and refined carbohydrates; advancing age; sedentary lifestyle; obesity; and postponement of defecation. Individuals in the US, Australia, and the United Kingdom have high incidence rates of diverticulosis and/or diverticulitis (Cunha). Diverticulosis affects 5% of individuals by the time they reach their forties, 33% to 50% of those age 50 and older, and more than 50% of those over age 80 (Joffe). Diverticulitis occurs in up to 20% of individuals with diverticulosis (Joffe).

The disease is uncommon in Africa and Asia, although congenital right-sided diverticular disease is 5 times more common than left-sided disease in Japanese individuals (Joffe). Both sexes are equally affected.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with diverticulosis often are asymptomatic, but some may complain of colicky pain in the lower left side of the abdomen that is relieved by a bowel movement. Other symptoms may include constipation, gas pains, bloating, and upset stomach; less frequently, diarrhea may occur (Cunha). Painless rectal bleeding (hemorrhage) occurs in up to 25% of individuals (Joffe). Individuals with diverticulitis may complain of persistent fever and acute pain (mild or severe) localized to the lower left side of the abdomen. They also may report changes in bowel habits, abdominal tenderness, extended periods of constipation or increased frequency of defecation. Other symptoms of diverticulitis include nausea, vomiting, painful urination, and/or increased urinary frequency.

Physical exam: Exploration of the abdomen with hands and fingers (palpation) may reveal a firm, tender section of colon that lies immediately before the rectum (sigmoid colon). Examination also may reveal a distended abdomen that is resonant or drum-like in tone (tympanic) to percussion. With diverticulitis, palpation over the left lower quadrant of the abdomen produces pain and sometimes may reveal a tender mass in the abdomen. The individual also may respond to abdominal palpation by contracting (guarding) the abdominal muscles. Decreased bowel sounds may be noted in individuals with diverticulitis. The individual may report tenderness when the examiner inserts a gloved finger into the rectum (digital rectal examination) to assess possible causes of bleeding and pain (Cunha).

Tests: Tests for diverticulosis or diverticulitis include a complete blood count (CBC) with differential, urinalysis and urine culture, and occult blood testing of the stool. Barium enema x-rays may be done after recovery from an episode of presumed acute diverticulitis to verify that colon cancer was not the actual cause of the illness. Barium enema x-rays are not generally done during an episode of presumed diverticulitis. Abdominal x-rays may reveal diverticulum perforation (free air in the abdomen). Computed tomography (CT) of the abdomen and pelvis may be useful in diagnosis. A flexible, fiberoptic viewing scope (endoscope) can be inserted through the anus and into the colon (sigmoidoscopy or colonoscopy) to assess for bleeding or strictures. X-rays may be taken following injection of a radiopaque dye into a vein (intravenous pyelogram) to rule out other conditions that produce symptoms similar to diverticulosis and/or diverticulitis (e.g., left ureter stone or colovesical fistula).

Source: Medical Disability Advisor



Treatment

Dietary modification is central to the management of either diverticulosis or diverticulitis, and a high-residue diet with 20 to 35 grams of daily fiber is recommended (NDDIC). Individuals with mild symptoms are treated on an outpatient basis, advised to drink plenty of fluids, ingest a fiber product containing methylcellulose or psyllium, and given oral antibiotics (NDDIC). Individuals are advised to respond to bowel urges in a timely manner to reduce colon pressure and to increase exercise to at least 30 minutes on most days (Mayo Clinic). Those with acute severe symptoms of diverticulitis may be hospitalized and given intravenous fluids and antibiotics. If the individual has nausea and vomiting and bowel rest is prescribed, feeding may be done intravenously (total parenteral nutrition). Oral feeding may then be resumed gradually with clear liquids and gradual advancement to a soft, low-roughage diet. Stool-softeners and antispasmodic drugs also may be recommended.

Approximately 20% of individuals with diverticulitis require surgical intervention because of failure to respond to medical treatment; development of abscess, fistula, perforation, or bowel obstruction; or hemorrhage that cannot be controlled (Joffe). The affected bowel segment is removed (bowel resection), and the cut ends of the bowel are then joined (anastomosis). In some cases, a 2-stage procedure is used (Hartmann procedure), in which a temporary opening is created for emptying the bowel (colostomy) with anastomosis delayed until a later time. A second surgery is then performed 2 to 3 months later to create the anastomosis and close the temporary colostomy. In some individuals, surgical drainage of a large intra-abdominal abscess may be necessary. This is performed by inserting a catheter into the abscess while viewing the area under ultrasound or CT guidance; the catheter is left in place temporarily to allow the abscess to drain (Mayo Clinic).

Source: Medical Disability Advisor



Prognosis

Most of individuals can expect relief from the diverticulitis and/or diverticulosis symptoms within 7 to 10 days following implementation of dietary modifications and medical therapy. However, approximately 50% of individuals will develop recurrent symptoms within 7 years following medical treatment (Cunha).

Twenty percent of individuals with diverticulitis eventually will need surgical intervention (Joffe). The outcome for individuals treated surgically for diverticulitis using a single-step bowel resection and anastomosis or the Hartmann procedure usually is very good. The mortality rate following either type of surgery is low, although the mortality rate for individuals who develop peritonitis or pelvic abscesses is 7.7% (Joffe).

Source: Medical Disability Advisor



Rehabilitation

Following abdominal surgery, pulmonary toilet techniques may be useful in preventing postoperative pulmonary complications. Early ambulation is encouraged. Also, certain exercises may be performed to reduce postoperative pain and speed recovery, including progressive relaxation and deep-breathing techniques. These exercises are especially valuable during the first 48 hours after surgery and may be performed several times per day until pain from inhalation/exhalation is less noticeable. Individuals may continue with these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

Source: Medical Disability Advisor



Complications

Complications of diverticulosis or diverticulitis include intra-abdominal abscess, colonic stricture, bowel obstruction, peritonitis, and rectal bleeding. Abnormal channels (fistulae) arising from diverticulitis may involve surrounding structures such as the bladder, vagina, uterus, or abdominal wall.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Diverticulosis as an incidental finding on imaging studies or at colonoscopy should not require time away from work. Individuals with mild episodes of acute diverticulitis treated as an outpatient should typically return to work in 7-10 days; those with severe cases that require surgical treatment may require the Maximum disability duration in the table above.
For individuals treated with surgery restrictions on lifting heavy objects or performing hard manual labor usually extend for 10-12 weeks following return to work. Reassignment to light or sedentary duties will be required during this time. Individuals with a temporary colostomy may need increased access to bathroom facilities. If pain medication is needed after return to work, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

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:

  • Is individual asymptomatic?
  • Does individual report colicky pain in the left side of the abdomen that is relieved by a bowel movement?
  • Does individual have constipation, gas pains, upset stomach, or painless rectal hemorrhage?
  • Has fever or acute pain (mild or severe) localized to the left side of the abdomen occurred?
  • Does individual defecate frequently?
  • Does exploration (palpation) of the abdomen reveal a firm, tender section of sigmoid colon?
  • Is abdomen distended with a resonant or drum-like tone to percussion?
  • Is individual tender upon digital rectal examination?
  • Has individual received adequate diagnostic testing to establish the diagnosis, such as a CBC with differential, urinalysis and urine culture, occult blood testing of the stool, and barium enema followed by x-rays?
  • Were CT or ultrasound done?
  • Does individual have diverticulosis or diverticulitis?
  • Has the patient had recurrent attacks?

Regarding treatment:

  • Has individual complied with recommended diet?
  • Did condition respond favorably to a high-fiber diet?
  • Has individual increased fluid intake?
  • Is individual increasing exercise to 30 minutes on most days?
  • If symptoms were severe, was hospitalization and treatment with intravenous fluids and antibiotics required?
  • Following discharge, did individual follow instructions regarding diet?
  • Were stool-softeners and antispasmodic drugs effective?
  • Was surgery performed as a result of failure to respond to medical treatment or from hemorrhage that could not be controlled?
  • Was surgical drainage of intra-abdominal abscess necessary?
  • If colostomy was necessary, is it temporary? Was date set for second procedure to create the anastomosis and close the temporary colostomy?

Regarding prognosis:

  • Have symptoms persisted despite dietary modifications and medical therapy?
  • Is this a recurrence of the condition?
  • Does individual have a coexisting condition that may complicate treatment or affect recovery?
  • Has individual experienced any complications related to the condition?

Source: Medical Disability Advisor



References

Cited

Cunha, John P. "Diverticulosis and Diverticulitis." eMedicine Health. Ed. William C. Shiel. 21 Aug. 2009. WebMD, LLC. 1 Oct. 2009 <http://www.emedicinehealth.com/diverticulosis_and_diverticulitis/article_em.htm>.

Joffe, Sandor, and Apasia Kachulis. "Colon, Diverticulitis." eMedicine. Eds. John L. Haddad, et al. 14 Aug. 2009. Medscape. 1 Oct. 2009 <http://emedicine.medscape.com/article/367320-overview>.

Mayo Clinic Staff. "Diverticulitis." MayoClinic.com. 21 May. 2009. Mayo Foundation for Medical Education and Research. 10 Jan. 2009 <http://www.mayoclinic.com/print/diverticulitis/DS00070>.

Murray, C. D., and A. V. Emmanuel. "Medical Management of Diverticular Disease (Abstract)." Best Practices & Research in Clinical Gasteroenterology 16 4 (2002): 611-620. PubMed. 1 Oct. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/12406454>.

NDDIC. "Diverticulosis and Diverticulitis ." National Digestive Diseases Clearinghouse. Jul. 2009. 1 Oct. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.