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.

Dyspepsia


Related Terms

  • Indigestion
  • Nervous Indigestion

Differential Diagnosis

  • Biliary tract disease
  • Cancer (malignancy)
  • Diabetes mellitus
  • Excessive alcohol consumption
  • Gastrointestinal tract dysfunction
  • Hypercalcemia
  • Ischemic heart disease
  • Ovarian disease
  • Pancreatic disease
  • Peptic ulcer
  • Pregnancy
  • Side effects of certain drugs
  • Thyroid disease

Specialists

  • Family Physician
  • Gastroenterologist

Comorbid Conditions

Factors Influencing Duration

The length of disability resulting from dyspepsia may be influenced by the severity of the symptoms, the underlying disease state that is causing the dyspeptic symptoms, and the response of the underlying disease to treatment.

Medical Codes

ICD-9-CM:
536.8 - Dyspepsia and Other Specified Disorders of Function of Stomach

Overview

Dyspepsia is the medical term for indigestion. It is a symptom of an underlying disease or disorder rather than a disease in itself.

Abdominal pain, discomfort or fullness, intestinal gas (flatulence), heartburn, and/or nausea are associated with dyspepsia. Eating too much, eating too quickly, or eating foods that are very spicy, rich, or fatty may produce these symptoms. Symptoms are often increased during times of stress, and dyspepsia is sometimes still referred to as "nervous indigestion." Other causes of dyspepsia include excessive intake of alcohol or caffeine, excess stomach acidity, reflux of stomach acid into the esophagus (gastroesophageal reflux), dysfunction of the stomach or intestines, abnormal quantity or quality of bile secretion, liver disease, parasitic infections, milk sugar (lactose) intolerance, pregnancy, pancreatic disease, cancer (malignancy) in the abdominal cavity, thyroid disease, and low blood flow to the heart (coronary ischemia). Dyspepsia may also occur with the use of certain drugs or dietary supplements, including iron, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, diuretics, and cardiotonic glycosides. Persistent or recurrent dyspepsia may be the result of a lesion in the stomach or small intestine (peptic ulcer), gallstones, or inflammation of the esophagus (esophagitis). However, in up to half of the individuals who seek treatment for dyspepsia, no underlying disease disorder is found for the reported symptoms.

Incidence and Prevalence: Dyspepsia is diagnosed in 10% of the US population each year, and the disease is severe enough in 15% of the people affected that they seek medical attention within 3 months of their first symptoms. In general medical practices, dyspepsia accounts for 7% of office visits and 40% to 70% of visits with gastrointestinal complaints (McQuaid 102). However, only 25% of those affected seek medical care for their condition (Talley 691). Dyspepsia is common, affecting more than 25% of the population of developed countries (McQuaid 102).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Dyspepsia is most common in women ages16 to 60 ("Dyspepsia"). Dyspepsia that is caused by another organic disease is usually found in men 40 years of age or older, and smokers tend to have a higher incidence of underlying organic disease associated with dyspepsia.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report vague abdominal discomfort, a sense of fullness after eating, excessive belching, heartburn, bloating, gas (flatulence), nausea, vomiting, or loss of appetite. These symptoms can occur irregularly, but they are usually increased during times of stress.

Physical exam: Abdominal distention and increased bowel sounds due to excessive gas in the stomach or intestine may be observed during physical examination. The site of the pain and pattern of symptoms can help to identify the underlying causes of dyspepsia. Weight loss, enlarged abdominal organs, abdominal mass, or blood in the stool are indicators of an underlying organic disease and point to the need for further investigation.

Tests: A chemical test done on a stool sample (fecal occult blood test, or FOBT) should always be done; this can identify blood that may be hidden within the fecal material (occult blood). A complete blood count (CBC) and a test for liver function (liver chemistry panel) may also be done. An upper GI series (barium swallow) is a test that may be used to determine the cause of symptoms. For this test the individual drinks a preparation of barium sulfate and x-rays track its path to view abnormalities in the esophagus and stomach. A flexible fiber-optic tube can be used to examine the inside of the stomach (diagnostic gastroscopy) to identify stomach lesions (peptic ulcer disease), reflux of acid into the esophagus from the stomach (gastroesophageal reflux disease or GERD), and stomach cancer (gastric malignancy). Ultrasound (abdominal sonography) may be used to identify biliary or pancreatic disease.

Source: Medical Disability Advisor



Treatment

Treatment is directed at the underlying cause and alleviation of symptoms. Alcohol and caffeine intake should be curtailed, and medications that exacerbate the problem (such as nonsteroidal anti-inflammatory drugs, or NSAIDs) should be eliminated. Self-medication with over-the-counter antacids may be helpful. Prescription medications that may be useful include histamine receptor antagonists, antispasmodics, anti-nausea drugs, antidepressants, drugs that stimulate stomach emptying and decrease acid reflux into the esophagus (prokinetic agents), and drugs that prevent stomach acid secretion (proton pump inhibitors). In some cases, the individual may need to keep a record of food intake, symptoms, and daily events that may cause stress in order to reveal dietary or social factors that trigger the dyspepsia episodes.

Source: Medical Disability Advisor



Prognosis

Dyspepsia is not a disease, but rather a symptom of other diseases or disorders. Consequently, the predicted outcome ultimately depends on the underlying cause of the dyspeptic symptoms. For acute treatment of dyspepsia, there is no evidence to suggest that antacid medications work better than an inert compound (placebo) in alleviating symptoms. Nevertheless, the effect of antacids to reduce dyspeptic symptoms may decrease the number of extensive and costly procedures, such as endoscopy. Histamine receptor antagonists lead to a 50% reduction in acid output by the stomach, and this has been found to produce significant improvement in individuals who are experiencing pain and nausea. Prokinetic agents are found to be the most effective treatment for disorders of gastrointestinal motility. Drugs that inhibit acid secretion by the stomach (proton pump inhibitors) are usually the best treatment for acid reflux from the stomach into the esophagus (gastroesophageal reflux).

Source: Medical Disability Advisor



Rehabilitation

Regular physical activity on a daily basis is recommended to relieve stress, which may exacerbate dyspepsia. Aerobic exercise, such as walking, jogging, or swimming (30 to 45 minutes per session), is usually beneficial.

Source: Medical Disability Advisor



Complications

Dyspepsia may be complicated by an underlying condition. Taking antacids or other prescription medications can mask a serious, underlying disease or disorder, and this may cause delay in diagnosis and treatment. Certain underlying diseases—including ulcer, cancer of the stomach or duodenum, and low blood flow to the heart (coronary ischemia)—may develop into life-threatening situations.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually associated with dyspepsia. However, each case must be considered on an individual basis depending on the underlying cause for the condition. If stress is aggravating the dyspepsia, transfer to a less stressful position may be necessary.

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 any underlying cause of the dyspepsia, such as gastrointestinal tract dysfunction, pancreatic disease, biliary tract disease, thyroid disease, coronary ischemia, pregnancy, side effects of certain drugs, and excessive alcohol consumption been identified?
  • Is individual receiving appropriate treatment for condition?
  • Have other underlying conditions (gastrointestinal ulcers, cancer, coronary ischemia) been ruled out?
  • Does individual have coexisting condition that may impact recovery, such as diabetes mellitus, hyperparathyroidism, or thyrotoxicosis?

Regarding treatment:

  • Is underlying condition serious enough to require more extensive treatment? Has individual been evaluated by appropriate specialist (gastroenterologist, endocrinologist)?
  • Has individual been compliant in eliminating substances that are known gastric irritants (alcohol, caffeine, NSAIDs)?
  • Have symptoms been relieved with over-the-counter antacids? If not, have prescription medications been tried?
  • Has individual kept a record of daily food intake and events that may be stressful?
  • Has individual been instructed in stress-reduction techniques?

Regarding prognosis:

  • Have any underlying conditions responded to treatment?
  • Have symptoms persisted despite apparently successful treatment of underlying condition?
  • Does diagnosis need to be revisited?
  • Would individual benefit from stress-reduction therapy? Dietary changes or counseling? Occupational change? Support group?

Source: Medical Disability Advisor



References

Cited

"Dyspepsia." HealthScout. 2 Jan. 2005 <http://www.healthscout.com/ency/416/294/main.html#CausesandRiskFactorsofDyspepsia>.

McQuaid, Kenneth. "Dyspepsia." Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Eds. M. Feldman, L. S. Friedman, and M. H. Sleisenger. 7th ed. Philadelphia: W.B. Saunders, 2002. 102-103.

Talley, Nicholas J. "Functional Gastrointestinal Disorders: Irritable Bowel Syndrome, Non-ulcer Dyspepsia, and Non-cardiac Chest Pain." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 687-693.

Source: Medical Disability Advisor






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