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.

Esophageal Diverticula


Related Terms

  • Acquired Diverticulum
  • Epiphrenic Diverticula
  • Epiphrenic Diverticulum
  • Hypopharyngeal Diverticula
  • Intramural Pseudodiverticulosis
  • Midesophageal Diverticula
  • Pharyngoesophageal Diverticula
  • Pulsion Diverticulum
  • Zenker's Diverticula
  • Zenker's Diverticulum

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by the location and size of the diverticulum and the method of treatment. Disability is longer for individuals who are treated using surgical techniques. Individuals who undergo laparoscopic surgery require a shorter recovery period than those who undergo open surgery.

Medical Codes

ICD-9-CM:
530.6 - Diverticulum of Esophagus, Acquired

Overview

© Reed Group
Esophageal diverticula refer to sacs that protrude from the wall of the tube (esophagus) that leads from the throat to the stomach.

Esophageal diverticula can be classified in a number of different ways, but commonly they are placed into one of four different categories based on their location in the esophagus. These locations are between the throat (pharynx) and the upper end of the esophagus (Zenker's or pharyngoesophageal diverticula); in the upper end or middle portion of the esophagus (hypopharyngeal or midesophageal diverticula); in the lower part of the esophagus near the diaphragm (epiphrenic diverticula); and all along the wall of the esophagus, appearing as minute, flask-like outpouchings (intramural pseudodiverticulosis).

Pharyngoesophageal diverticula often occur when the circular muscle (upper esophageal sphincter, or UES) at the entrance to the esophagus fails to relax during the act of swallowing. Instead, the sphincter resists the passage of food, and as the powerful throat muscles used for swallowing push against this resistance, part of the lining of the esophagus is forced back through the esophageal wall. The lining then bulges through the wall, forming the diverticulum pouch. The diverticulum gradually enlarges, and food can become trapped in it, causing irritation and swallowing difficulties.

Midesophageal diverticula are the most common type of esophageal diverticula, and they may develop as a result of either a pull on the esophagus by connective tissue in the chest cavity (traction diverticulum) or by a force on the inside of the esophagus that pushes out to form a pouch (pulsion diverticulum). Food accumulation in midesophageal diverticula is rare.

Some experts suggest that risk factors for pharyngoesophageal diverticulum may include reflux of acid from the stomach into the esophagus (gastroesophageal reflux) or bulging of the stomach past the diaphragm into the chest cavity (hiatal hernia). However, no studies to date prove an association between these conditions and pharyngoesophageal diverticula.

Risk factors for midesophageal diverticula may include gastroesophageal reflux, although this has not been proved.

In contrast, the major risk factor for epiphrenic diverticula is well-defined. It occurs when the muscles of the contractile ring that is located at the point in which the esophagus empties into the stomach (lower esophageal sphincter, or LES) fail to relax normally during swallowing. In other words, the muscles of the esophagus do not relax or contract as they should, which is often referred to as a movement, or motility, disorder.

Major risk factors for intramural pseudodiverticulosis include chronic inflammation of the esophagus (esophagitis) and, possibly, esophageal motility disorders.

Incidence and Prevalence: Esophageal diverticulitis is a relatively rare condition. It is found during fewer than 1% of all barium swallows performed to evaluate swallowing difficulties (Wachtel 934).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Although esophageal diverticula may happen at any age, it occurs most often in individuals over age 50 and are increasingly common with advanced age (Perez).

Source: Medical Disability Advisor



Diagnosis

History: Often, individuals with esophageal diverticula are asymptomatic. Others may complain of a sensation of food sticking in the throat or vague throat irritation, chest pain, intermittent cough, excessive salivation, vomiting after eating, difficulty swallowing (dysphagia), gurgling after swallowing, a sour metallic taste in the mouth, or bad breath (halitosis).

Physical exam: The exam may reveal no remarkable symptoms. In rare cases of pharyngoesophageal diverticula, the esophageal pouch may become so large that it produces a bulge on the side of the neck.

Tests: Diverticula may be visualized with x-rays after swallowing a contrast medium, such as barium (esophagram). Other tests to visualize diverticula may include insertion of a flexible fiber-optic tube into the esophagus (endoscopy), use of high-frequency sound waves (ultrasound), or computer-aided x-ray analysis (computed tomography, or CT).

Source: Medical Disability Advisor



Treatment

Treatment depends on the type of diverticulum. Small pharyngoesophageal diverticula are usually not treated, but large diverticula of this type may require surgery (diverticulopexy, diverticulectomy, or cricopharyngeal myotomy). During the surgical procedures, the sphincter muscle at the entrance of the esophagus may be partially cut to weaken it to help prevent recurrence of the condition. Recently, these surgeries have been performed using a flexible tube that is inserted into the esophagus (endoscopy) or through tiny cuts in the abdomen (laparoscopy) rather than as open surgery.

Treatment for midesophageal or epiphrenic diverticula is rarely needed. However, if treatment is necessary, it usually involves surgical removal of the diverticulum (diverticulectomy) and, occasionally, separation of the esophageal muscle (myotomy). Intramural pseudodiverticulosis may be treated using a balloon to expand the esophagus (esophageal dilatation).

Individuals are advised to avoid consumption of alcohol or irritating foods for a short period following surgical treatment for esophageal diverticula. Also, it is advisable that foods be liquid or softened until recovery is complete.

Source: Medical Disability Advisor



Prognosis

Surgical treatment (diverticulopexy, diverticulectomy, or cricopharyngeal myotomy) of large pharyngoesophageal diverticula usually produce excellent results the vast majority of the time. Mortality from surgery is 1.5%, and the rate of recurrence of the condition is 4% (Wachtel 934). If recurrence of the diverticulum requires that the surgery be repeated, complications can be expected, and the prognosis dims somewhat. Individuals with midesophageal or epiphrenic diverticula who are treated surgically (diverticulectomy and/or myotomy) usually have good long-term results, but leakage from the esophagus or death during the procedure may occur. Intramural pseudodiverticulosis treated using esophageal dilatation usually responds with relief of symptoms for a few years. Some individuals may require periodic dilatations.

Source: Medical Disability Advisor



Complications

Complications of esophageal diverticula are rare, but they may include formation of a lesion (ulceration) on the esophagus, uncontrolled coughing at night, and aspiration of stomach contents, which can result in lung infection (aspiration pneumonia). Formation of a hole (perforation), bleeding (hemorrhage), or compression of the esophagus may occur in pharyngoesophageal diverticulum.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually required for asymptomatic individuals. Individuals who are treated using surgery may require a period of recovery at work in which physical labor (heavy lifting, climbing) is less demanding.

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 problem with esophageal sphincter relaxing?
  • Does lower esophageal sphincter or LES fail to relax normally during swallowing?
  • Does individual have esophagitis or esophageal motility disorders?
  • Does individual have risk factors?
  • Does individual have sensation of food sticking in throat or vague throat irritation?
  • Does individual have chest pain or intermittent cough?
  • Does individual have excessive salivation, vomiting after eating, dysphagia, or gurgling after swallowing?
  • Does individual have sour metallic taste in mouth and halitosis?
  • Is there a bulge on one side of neck?
  • Has individual had esophagram, endoscopy, ultrasound, or CT?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual had surgery?
  • Has he or she had esophageal dilatation done?
  • Was he or she advised to avoid consumption of alcohol and irritating foods for a short time after surgery?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have conditions that could affect recovery?
  • Does individual have complications, such as ulceration on the esophagus or uncontrolled coughing at night?
  • Has individual aspirated stomach contents, causing pneumonia?
  • Has he or she had perforation, hemorrhage, or compression of the esophagus?

Source: Medical Disability Advisor



References

Cited

Perez, Rodney A., and John B. Marshall. "Esophageal Diverticula." eMedicine. Eds. Maurice A. Cerulli, et al. 14 Jun. 2004. Medscape. 2 Jan. 2005 <http://emedicine.com/med/topic736.htm>.

Wachtel, P. L. "Zenker’s (Pharyngoesophageal) Diverticulum." Ferri's Clinical Advisor. Ed. Fred Ferri. St. Louis: Mosby-Year Book, Inc., 2000. 934-935.

Source: Medical Disability Advisor






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