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.

Jaundice


Related Terms

  • Cholestatic Jaundice
  • Hemolytic Jaundice
  • Icterus
  • Infectious Jaundice
  • Malignant Jaundice
  • Obstructive Jaundice

Differential Diagnosis

  • Carotenemia
  • Lycopenemia

Specialists

  • Gastroenterologist
  • General Surgeon
  • Hematologist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Factors that might influence length of disability include age, mental illness, cause of the jaundice, severity and extent of underlying disease at presentation, complications, type of treatment, and response to treatment.

Medical Codes

ICD-9-CM:
782.4 - Symptoms Involving Skin and Other Integumentary Tissue; Jaundice, Unspecified, Not of Newborn; Cholemia NOS; Icterus NOS

Overview

Jaundice is a physical sign often characterized by yellowish color of the skin, tissues, eyes, and certain body fluids. It may result when excess amounts of a pigmented substance from old, discarded red blood cells (bilirubin) dissolve in the layer of fat just beneath the skin (subcutaneous fat).

Bilirubin is formed when a certain pigment (hemoglobin) in red blood cells breaks down as part of the body's continuing process of replacing old red blood cells with new ones. In normal circumstances, this form of bilirubin (unconjugated bilirubin) is converted by the liver into conjugated bilirubin. Conjugated bilirubin becomes a component of digestive fluid (bile), and ultimately is eliminated from the body primarily in the feces. Jaundice occurs with elevated levels of either unconjugated bilirubin or conjugated bilirubin.

Except for the newborn form of jaundice (caused by accumulation of discarded red blood cells), the condition is a symptom of overload or damage to the liver, or inability to move bilirubin from the liver through structures transporting bile (biliary tract) to the intestines. For example, overproduction of bilirubin from the breakdown of red blood cells (after internal bleeding or in bleeding disorders) may overburden the liver with more bilirubin than it can process or conjugate. Because unconjugated bilirubin dissolves in fats but not liquid, this form causes yellowing of the skin (hemolytic jaundice). Jaundice may occur in liver cancer (malignant jaundice) or infectious diseases (infectious jaundice) such as hepatitis or cirrhosis where the damaged or inflamed liver cells are unable to convert bilirubin to the conjugated form. Obstructive or cholestatic jaundice occurs with blockage of the flow of bilirubin from the liver to the intestines.

Infectious jaundice due to hepatitis can result from varied causes such as bacterial or viral infections, infestation with parasites, chemicals (alcohol or drugs), toxins, or immune diseases. Some forms of infectious hepatitis are transmitted through blood products, eating contaminated food, sexual contact, and other unknown means. Over-consumption of foods containing an orange colored anti-oxidant pigment (beta-carotene) such as carrots and melons can create a yellowish skin condition called pseudojaundice, which generally does not produce other symptoms.

Incidence and Prevalence: Jaundice typically presents as a symptom of other diseases. About 5% of the US population is thought to have a hereditary disorder called Gilbert syndrome (benign unconjugated hyperbilirubinemia), which can produce jaundice during periods of unusual stress or illness. This type of jaundice usually is considered clinically insignificant. About 10% of the American population has cholelithiasis (gallstones), which can cause jaundice (Jensen).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with gallstones (cholelithiasis) are at risk of developing jaundice. Other conditions associated with jaundice include pancreatitis, hepatitis, autoimmune disorders, viruses, cancer, Gilbert syndrome, cirrhosis, and certain rare hereditary diseases (Dubin-Johnson syndrome, Rotor's syndrome).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report yellowing of the whites of the eyes (sclerae) and skin. Depending on the underlying cause of the jaundice, symptoms may also include abdominal pain, loss of appetite, nausea and vomiting, fever, chills, and itching. Because bilirubin is excreted through the kidneys, the urine may be dark.

Individuals should be questioned about family history, use of drugs or alcohol, unprotected sexual activity, pre-existing metabolic disorders, recent receipt of blood or blood components, hepatitis, and prior surgery.

Physical exam: The exam may reveal yellow skin or eyes, elevated temperature, abdominal tenderness, abdominal mass, enlarged liver or spleen, fluid accumulation in the abdomen (ascites), enlarged breast in men (gynecomastia), decreased testicle size (testicular atrophy), dilated and irregular blood vessels (spider angioma), and surgical scar. The inside of the mouth may appear yellowish.

Tests: Diagnostic tests depend on the underlying cause and may include several of the following: serum bilirubin, serum chemistries especially liver enzymes, measurements of blood clotting ability (prothrombin time), imaging studies (CT, MRI, ultrasound), x-rays of gallbladder and bile ducts (percutaneous cholangiography, endoscopic retrograde cholangiopancreatography [ERCP]), liver scan, and examination of liver tissue (liver biopsy).

Source: Medical Disability Advisor



Treatment

Treatment varies based on the underlying cause of the jaundice. Treatment may include rest for recovery from an infection or dietary modifications (moderate protein, low fat, and high caloric intake) to promote liver health. If cholestatic liver disease is present, treatment may include cessation of alcohol, discontinuance of a drug, use of certain drugs (e.g., interferon), blood drawing (phlebotomy) for iron metabolism disorder (hemochromatosis), and copper chelation. If primary biliary cirrhosis is present, treatment may include skin softeners and drug therapy.

If obstruction of the bile ducts (cholestatic jaundice) is the underlying cause of the jaundice, mechanical intervention may be required. In many cases, diagnosis and treatment can be performed at the same time by placing a lighted tube (endoscope) through the mouth and the upper intestinal tract into the pancreatic or bile ducts (ERCP). A similar procedure called percutaneous transhepatic cholangiography (PTC) may be performed by passing the endoscope through a puncture in the skin. If indicated, special instruments can be placed through the endoscope and into the ducts in order to open the entry of the ducts into the bowel or stretch out narrow segments (papillotomy), remove or crush stones (stone extraction), take tissue samples (biopsy), or drain obstructed areas.

Treatments vary for release of hemoglobin into fluids (hemolytic conditions) that produce jaundice. Corticosteroids, folic acid, and sometimes iron supplements may be given. Blood transfusions may occasionally be required.

Jaundice occurring secondary to cancers is typically treated with surgery to remove the cancer tumor (tumor resection) then followed by anticancer drugs (chemotherapy) and/or the use of radiation to arrest cancer growth (radiation therapy).

Source: Medical Disability Advisor



Prognosis

Outcome depends on the cause. As the underlying condition improves, the jaundice will usually disappear. Individuals with jaundice secondary to cirrhosis may develop kidney (chronic renal) or liver failure. Individuals with jaundice secondary to acute viral hepatitis may develop chronic active hepatitis.

ERCP is usually successful in removing stones that are often the source of obstructive jaundice. Therefore, once the obstruction is relieved, the jaundice clears. Complications that may arise from ERCP, however, include pancreatitis and, less commonly, inflammation of the bile duct (cholangitis) and bleeding or duodenal perforation.

Outcomes for jaundice secondary to cancers are less favorable. Cancers of the liver have a fair prognosis if discovered in time to be treated with surgery, with a 5-year survival rate of 30% to 40% ("How is Liver Cancer...").

Source: Medical Disability Advisor



Complications

Jaundice is a physical sign of an underlying disease. Consequently, no complication results from jaundice itself. Many varied complications can result from underlying conditions.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individual may temporarily need job assignments that limit physical exertion and allow frequent rest periods.

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 have yellowing of the whites of the eyes (sclerae) and skin?
  • Does individual have other symptoms such as abdominal pain, loss of appetite, nausea and vomiting, fever, chills, and itching?
  • Is urine dark?
  • Does individual have history of drug or alcohol use, unprotected sexual activity, pre-existing metabolic disorders, recent receipt of blood or blood components, hepatitis, and prior surgery?
  • Is liver or spleen enlarged?
  • Does physical exam reveal fluid accumulation in the abdomen (ascites), enlarged breast in men (gynecomastia), decreased testicle size (testicular atrophy), dilated and irregular blood vessels (spider angioma), and surgical scar?
  • Does individual take any medications that are cleared by the liver and may contribute to liver toxicity (e.g., erythromycin, sulfa drugs, antidepressants, anticancer drugs, methyldopa, rifampin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosterone, or propylthiouracil)?
  • Were diagnostic tests that may include, if indicated, serum bilirubin, serum chemistries, prothrombin time, CT, abdominal ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous cholangiography, MRI, liver scan, and liver biopsy done to confirm diagnosis?

Regarding treatment:

  • To promote liver health, did individual rest from an infection and modify diet (moderate protein, low fat, and high caloric intake)?
  • If cholestatic liver is present, did individual stop alcohol consumption and discontinue any drug use? Was phlebotomy performed for hemochromatosis? Was copper chelation needed?
  • Were skin softeners and drug therapy used if individual has primary biliary cirrhosis?
  • Was mechanical intervention required if cholestatic jaundice is the underlying cause?
  • Was endoscopy, ERCP or PTC performed? Were stones removed?
  • For hemolytic conditions producing jaundice, were corticosteroids, folic acid, or iron supplements given? Was a blood transfusion required?

Regarding prognosis:

  • Has the underlying condition improved? Did jaundice disappear?
  • Did individual develop chronic renal or liver failure or chronic active hepatitis?
  • Have any complications developed from ERCP such as pancreatitis, inflammation of the bile duct (cholangitis), or bleeding or duodenal perforation?
  • Does individual have any comorbid conditions such as congestive heart failure, liver failure, kidney failure, cancer, or autoimmune diseases that could impair the response to treatment?

Source: Medical Disability Advisor



References

Cited

"How is Liver Cancer Treated?" American Cancer Society. 9 Dec. 2003. 22 Dec. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_2_4X_How_Is_Liver_Cancer_Treated_25.asp?sitearea=.>.

Jensen, Jonathan, et al. "Gallstones." Colorado Center for Digestive Disorders. 22 Dec. 2004 <http://www.gastromd.com/education/gallstones.html>.

Source: Medical Disability Advisor






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