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.

Dysentery


Related Terms

  • Amoebiasis
  • Diarrhea
  • Gastroenteritis
  • Infectious Colitis
  • Traveler's Diarrhea

Differential Diagnosis

  • Amoebas
  • Bacteria
  • Viruses

Specialists

  • Gastroenterologist
  • Infectious Disease Internist

Comorbid Conditions

  • Antibiotic-resistant bacteria
  • Immune system disorders
  • Infections with other infectious parasites

Factors Influencing Duration

Length of disability may be influenced by the severity of the disease at diagnosis, the degree of dehydration at the initiation of treatment, whether or not causative organisms can be easily identified and symptoms treated, the effectiveness of antibiotic treatment, the presence of complications, immunosuppression, and the age of the individual (disability will last longer in the very young and the very old).

Medical Codes

ICD-9-CM:
004.0 - Shigella Dysenteriae, Infection by Group A Shigella (Schmitz) (Shiga)
006.0 - Amebic Dysentery, Acute, without Mention of Abscess; Acute Amebiasis

Overview

Dysentery is a general term for inflammation of the intestines, particularly the large intestine or colon, which results in bloody diarrhea. The inflammation is usually caused by bacterial infections, bacterial toxins, or protozoa. Dysentery is typically contracted through contaminated food or water but can also be transmitted from one individual to another and via feces from infected individuals.

The two most common types of dysentery are bacillary dysentery and amoebic dysentery. Bacillary dysentery, most often caused from infection by the bacterium Shigella, is also called shigellosis. Other bacterial agents responsible for dysentery include Vibrio parahaemolyticus, enterohemorrhagic or enteroinvasive Escherichia coli (EHEC or EIEC), Clostridium difficile, Salmonella, Campylobacter jejuni, and Yersinia enterocolitica.

Amoebic dysentery is most often caused by infection by the microscopic parasite Entamoeba histolytica, which can exist in two forms, either as free amoebae or as infective cysts. This infection is also more common in tropical, subtropical, and developing countries. Ninety percent of carriers are asymptomatic.

Incidence and Prevalence: Approximately 14,000 cases of Shigella enteritis are reported each year in the US (CDC). The prevalence for amoebiasis in the US approaches 4% (Dhawan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Shigellosis is most common in developing countries, where it is present most of the time (endemic). Severe crowding and poor sanitation contribute to the spread of the disease; however, bacillary dysenteries also occur each year in the US. In developed countries such as the US, amoebic dysentery is most common in immigrants from countries where the disease is widespread; in homosexual men; and in residents of institutions such as prisons, nursing homes, and institutions for the developmentally disabled. With less impact on the workplace, diarrhea imposes the most severe suffering on the very old and the very young.

Source: Medical Disability Advisor



Diagnosis

History: Individuals exposed to disease-causing contaminants may experience mild to severe symptoms, or no symptoms at all. More often, individuals complain of abdominal pain, nausea, frequent (often foul-smelling) diarrhea accompanied by blood and mucus, fever, and rectal pain. Vomiting, generalized muscle aches, and rapid weight loss can also accompany dysentery.

Physical exam: The skin, mouth, and lips may appear dry due to dehydration. Lower abdominal tenderness may be present.

Tests: Stool samples are examined or cultured to identify the organism causing the dysentery. Often several samples must be obtained because the number of amoeba changes from day to day. Blood tests may be used to measure abnormalities in the levels of essential minerals and salts (electrolytes).

Source: Medical Disability Advisor



Treatment

Treatment may not be necessary for mild cases of dysentery. For more severe cases, or cases caused by Shigella, Salmonella, C. difficile, or amoebae, antibiotics are used to kill the responsible microorganisms. Identification of the organism that is causing the dysentery is important to determine the correct antibiotic. Symptoms such as dehydration are treated by fluid replacement, either orally or intravenously.

Antidiarrheal medications such as diphenoxylate (Lomotil) and loperamide (Imodium) are not recommended because they can actually aggravate the diarrhea by prolonging contact of the pathogen with the lining of the intestines.

It is important for individuals with dysentery, as well as those having contact with that individual, to practice careful personal hygiene. Hand washing after defecation and before handling food is especially important.

Source: Medical Disability Advisor



Prognosis

With proper treatment, most cases of bacterial and amoebic dysentery will subside within 10 days, and most individuals will recover fully within 2 to 4 weeks after beginning treatment. The prognosis for untreated disease varies with the immune status of the individual and the severity of disease. Extreme dehydration will prolong recovery and put the individual at greater risk for serious complications.

Source: Medical Disability Advisor



Complications

Dehydration is a common complication of diarrhea. Sepsis, seizures, kidney failure, and hemolytic uremia are rare complications of dysentery. Rarely, the amoebic parasite will invade the body beyond the intestines and spread through the bloodstream, more seriously infecting other organs such as the liver, lungs, and brain.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual may require quarantine for up to 1 week. Food handlers need to be infection-free before they resume working. Accommodations and extended medical restrictions may be required for severe dehydration or untreated cases of severe disease.

Risk: Because risk is a consideration for individuals working in food and beverage services, work restrictions may be necessary for infected individuals until stool samples are negative for bacteria and amoebic parasites. Good personal hygiene including hand washing after toileting and before handling food is important both at work and home to prevent disease transmission.

Capacity: Capacity is influenced by the severity of symptoms (e.g., diarrhea, abdominal and rectal pain, nausea, fever). Apart from food and beverage handlers, most individuals are able to perform work duties during recovery.

Tolerance: Tolerance of symptoms varies according to the individual, although many individuals choose to work despite discomfort. Individuals concerned over frequent diarrhea and fecal urgency may require ready access to bathroom facilities to remain productive during recovery.

Accommodations: Employers willing to accommodate activities as needed can have employees return to work earlier.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

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 complained of abdominal pain, nausea, frequent (often foul-smelling) diarrhea accompanied by blood and mucus, fever, and rectal pain? Were there vomiting, generalized muscle aches, and rapid weight loss?
  • Are skin, mouth, and lips dry? Is the abdomen tender?
  • Were stool samples examined or cultured? Has the causative organism been positively identified? Were blood tests done to measure abnormalities in the levels of essential minerals and salts (electrolytes)?
  • Has diagnosis of dysentery been confirmed?

Regarding treatment:

  • Was culture and sensitivity done to determine the most effective antibiotic to use?
  • Are the organisms causing dysentery resistant to the antimicrobial drugs used? Is a change in antibiotics warranted?
  • Is individual experiencing a reaction to the current medication?
  • Should diagnosis be revisited?
  • If not able to replace fluid loss orally, has individual received intravenous rehydration?
  • Is individual self-treating with over-the-counter antidiarrheal medication?

Regarding prognosis:

  • Did individual delay seeking treatment?
  • How much longer than expected have symptoms persisted?
  • Does individual continue to be exposed to infective organisms or chemicals that may be causing the dysentery?
  • Does individual have an underlying condition that may affect recovery?

Source: Medical Disability Advisor



References

Cited

"Shigellosis." CDC. 14 May. 2013. Centers for Disease Control and Prevention. 15 Aug. 2014 <http://www.cdc.gov/nczved/divisions/dfbmd/diseases/shigellosis/#how_common>.

Dhawan, Vinod K. "Amebiasis." eMedicine. Eds. Michael Stuart Bronze, et al. 12 Aug. 2014. Medscape. 15 Aug. 2014 <http://emedicine.medscape.com/article/212029-overview>.

Source: Medical Disability Advisor






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