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.

Gastroenteritis


Related Terms

  • Diarrhea
  • Dysentery
  • Food Poisoning
  • Infectious Colitis
  • Intestinal Flu
  • Norovirus
  • Stomach Flu
  • Traveler's Diarrhea

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

The source of the illness, the severity of symptoms, the individual's response or adverse reaction to medication, or the development of complications, especially dehydration, may influence the length of disability. For some parasitic infections, treatment with antiparasitic drugs can cause side effects that extend the required period of disability.

Medical Codes

ICD-9-CM:
003.0 - Salmonella Gastroenteritis, Salmonellosis
009.0 - Ill-defined Intestinal Infections; Infectious Colitis, Enteritis, and Gastroenteritis; Colitis, Septic; Dysentery, NOS, Catarrhal, Hemorrhagic; Enteritis, Septic; Gastroenteritis, Septic
558.1 - Gastroenteritis and Colitis Due to Radiation
558.2 - Gastroenteritis and Colitis, Toxic
558.3 - Gastroenteritis and Colitis, Allergic

Overview

Gastroenteritis is a general, nonspecific term given to a variety of conditions causing inflammation of the stomach and intestinal tract. Its most notable sign is the sudden onset of frequent bowel movements with loose or liquid feces (diarrhea), associated with nausea and vomiting, as well as abdominal cramping, abdominal pain, weakness, and sometimes either chills or fever.

Infectious gastroenteritis may be caused by viruses (50% to 70%), bacteria (15% to 20%), or parasites (10% to 15%) (Diskin). It occurs when microorganisms such as viruses, bacteria, or protozoa infect the stomach or intestines. Two of the most common viruses that cause infectious gastroenteritis are the rotavirus, which often affects travelers, babies, and young children, and is responsible for 12% of cases; and the norovirus (formerly known as the Norwalk virus), which affects older children and adults and is the most common cause of gastroenteritis in the US (Diskin). Bacteria that can cause gastroenteritis include staphylococci, clostridia, Bacillus cereus, Salmonella, Escherichia coli, Shigella, and vibrios (V. cholerae causes a severe type of gastroenteritis called cholera). Protozoa that can cause gastroenteritis include Entamoeba histolytica and Giardia. Infectious gastroenteritis is more common in individuals with compromised immune system or HIV infection/AIDS; they may develop gastrointestinal infections from the herpes simplex virus or cytomegalovirus, a virus that often causes no symptoms in a healthy person.

Noninfectious gastroenteritis is usually due to food or shellfish intoxication (caused by bacterial toxins); medication, chemotherapy, or radiation therapy side effects; or underlying conditions such as ulcerative colitis, Crohn's disease, certain cancers, or AIDS. Its severity may vary from mild and inconvenient to severe and life-threatening.

Incidence and Prevalence: An estimated 90 million cases of gastroenteritis occur annually (Diskin). Ninety percent of individuals do not go to the doctor; 1% to 2% require hospitalization (Diskin).

An estimated 20% to 50% of individuals traveling to developing countries are affected by infectious gastroenteritis (Bonheur), of which an estimated 3% to 13% of cases are caused by the protozoa Giardia (Chacon-Cruz). The rate of hospital admissions for gastroenteritis caused by Giardia is 2 per 100,000 individuals; Shigella is responsible for 2.4 per 100,000 (Chacon-Cruz).

Gastroenteritis occurs all over the world, although specific microorganisms may be more prevalent in one part of the world than another. It is estimated that each year, 3 billion to 5 billion cases of gastroenteritis occur around the world (Diskin). Gastroenteritis caused by rotavirus is most common in Asia, Africa, and South America. Vibrio bacteria cause gastroenteritis (cholera) in Asia. Shigella causes epidemics of gastroenteritis in Central and South America, South Asia, and sub-Saharan Africa. Gastroenteritis is caused by the protozoa E. histolytica in 10% of the world's population (Chacon-Cruz). In some developing countries, diarrhea is a leading cause of death and can reach epidemic proportions.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The majority of viruses and bacteria that cause infectious gastroenteritis are transmitted via the fecal-oral route; therefore, improper hand washing prior to food preparation, especially following a bowel movement, increases the risk. Other risk factors for infectious gastroenteritis include traveling to countries where ingesting contaminated food and/or water is likely. Eating inadequately cooked food can also cause infectious gastroenteritis. The disease is prevalent in places where groups of people congregate, such as nursing homes, cruise ships, dormitories, or schools. Day care centers are especially common places for outbreaks because the disease can be spread through diaper changing. Infectious parasitic gastroenteritis may be transmitted through drinking or swimming in water from an infected mountain lake, river, or swimming pool.

Each type of gastrointestinal virus has a particular active season. In the Northern Hemisphere, an individual is more likely to contract rotavirus and the norovirus, for example, between the months of October and April. Other viruses are more prevalent during summer months due to higher rates of travel.

Risk factors for noninfectious gastroenteritis may include overeating, extreme emotional stress, or adverse reactions to a food or food ingredient (e.g., lactose intolerance, food allergies, food poisoning) or to very spicy foods. Excessive alcohol intake, exposure to toxic substances (chemical toxins, heavy metals), or ingestion of certain drugs (antibiotics, steroids, antacids) may also upset the balance of natural intestinal bacteria (gut flora), causing symptoms of gastroenteritis.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of gastroenteritis vary, depending on the cause of the disease. In general, the onset is sudden; gastroenteritis from food poisoning will manifest within 2 to 72 hours (Wedro). Individuals often report watery, nonbloody, or bloody diarrhea; loss of appetite; nausea and/or vomiting; and abdominal pain or cramping. Aching muscles and exhaustion may also be present. Fever is present in 50% of cases (Diskin). Individuals may or may not report ingestion of suspect food or water or contact with an infected individual; in approximately 50% of cases, no specific cause is identified (Wedro).

When isolation of the particular agent is not feasible or cost-effective, diagnosis may rest on the individual's recent history, ruling out other causes, and on symptoms of infectious disease that appear in many individuals at the same time in the same geographic area (the epidemiologic setting). In addition, recent medical history is pertinent because certain medications and underlying illnesses may make an individual more susceptible to noninfectious gastroenteritis.

Physical exam: Bowel sounds may be hyperactive, and individuals may have abdominal tenderness, low-grade fever, or paleness of the skin. The intestine may be swollen or inflated (distended). Irritation of the perianal area or throat may be present due to repeated bouts of diarrhea and vomiting. There may also be signs of dehydration such as dry mucous membranes, a whitish or "coated" tongue, sunken eyes, decreased skin tension (turgor), lethargy, increased heart rate, or changes in blood pressure when the individual changes position (orthostatic hypotension).

Tests: In mild cases, the symptoms alone are usually sufficient to diagnose gastroenteritis. In more serious cases, diagnostic tests may be needed to determine the cause, including a complete blood count (CBC) and electrolyte panel. Other tests, such as stool tests for erythrocytes and leukocytes, as well as tests and cultures for infectious organisms (pathogenic bacteria and parasites), may be done, especially if the individual's history includes foreign travel or drinking mountain water.

In infectious diarrhea, visual (gross) examination of the stool is the single most important test. If it contains blood or mucus, microscopic examination should be done to look for bacteria, ova (eggs), and parasites. Since a single stool sample may not reveal parasites even when present, three fresh, separate stool samples should be tested if blood or mucus is found in the first sample. In individuals with persistence of symptoms beyond 3 to 4 days, fever or bloody diarrhea, or deficient immune systems (immunocompromised), a culture should be done on the stool to isolate the infective organism.

Urinalysis may be performed to rule out urinary tract infection or kidney stones. Liver profile and amylase may be used to rule out disease of the gallbladder or pancreas. X-rays of the abdomen may be taken to rule out bowel obstruction.

Source: Medical Disability Advisor



Treatment

Treatment for gastroenteritis depends on the cause of the illness. Most cases resolve in 3 to 5 days (Diskin). Lost fluids, sugars, and electrolytes should be replaced by drinking an oral rehydration solution (ORS), sports drink, water, diluted tea, or juices. After 24 hours, as individuals improve, the BRAT diet (bananas, rice, applesauce, and toast) may be given until symptoms resolve (Bonheur, Wedro).

When symptoms are severe, if they persist for longer than 72 hours, or if bloody diarrhea occurs, medical assistance is required. Intravenous fluid therapy is indicated if the individual is unable to keep fluids down and remain hydrated. Infectious viral gastroenteritis is usually self-limited within 24 to 48 hours. Treatment involves resting the stomach and intestines and allowing the diarrhea to run its course. Fluid intake should be enough to prevent dehydration, but solid food should not be eaten until symptoms subside.

In cases of infectious bacterial gastroenteritis, a specific diagnosis must be made so that appropriate antibiotics can be started. Dehydration may need to be treated by administration of intravenous fluids.

Parasitic infections are more difficult to treat, although a number of effective antiparasitic drugs are available once the organism has been correctly identified. Rarely, surgery to remove part of the colon (partial colectomy) or needle aspiration of abscesses in the liver or abdominal cavity may be necessary with extensive protozoal infection (Chacon-Cruz).

Although drugs that decrease the movement of the intestines (antimotility or antidiarrheal drugs) may be used safely for mild to moderate traveler’s or chronic diarrhea, they should not be used when there is blood in the stool, high fever, or systemic infection in individuals with acute diarrhea, for fear of worsening the condition. They should also be discontinued when diarrhea worsens despite treatment.

In rare cases, preventive medication, including antibiotics and drugs that coat the stomach (bismuth subsalicylates), can prevent gastroenteritis in individuals traveling to areas where diarrheal illnesses are endemic. When traveling, individuals are encouraged to eat acidic foods; drink carbonated or steaming hot beverages; avoid shellfish and undercooked meat and eggs; and avoid water, ice, raw fruits and vegetables, and foods sold by street vendors (Diskin).

Individuals with noninfectious gastroenteritis should avoid spicy foods or those to which they have intolerance. Alcohol and caffeine intake may need to be decreased or stopped. Treatment of gastroenteritis caused by stress or excess stomach acid may include medications that neutralize the acid (antacids) or block acid secretion; conversely, antacids or routinely used medications may also need to be stopped, as gastroenteritis can be provoked by alteration of protective levels of stomach acid.

Noninfectious gastroenteritis caused by adverse drug effects can sometimes be relieved by taking the drug with food or antacids. In some cases, however, the dosage may need to be altered, the medication changed, or the drug discontinued.

Source: Medical Disability Advisor



Prognosis

In most cases, gastroenteritis is a self-limited condition with an excellent prognosis. Symptoms of gastroenteritis usually subside within 3 to 5 days (Diskin). Failure to improve within 2 weeks should bring the diagnosis into question. The duration of traveler’s diarrhea caused by E. coli or Shigella infection can be significantly shortened with antibiotic therapy (Diskin).

Although infectious gastroenteritis is usually acute (rapid onset with a short duration), certain parasites such as Giardia can cause chronic diarrhea. For more severe or prolonged cases, the prognosis depends on the organism causing the gastroenteritis and the effectiveness of treatment. Recovery can be delayed by an extensive infection, unusual reactions to medicines, or infection from bacteria that produce a more powerful toxin. Without replacement, extreme loss of body fluid and electrolytes can lead to shock, coma, or death.

The prognosis for prolonged (more than 2 weeks) noninfectious gastroenteritis depends upon accurate identification and treatment of the underlying cause and ranges from good (food intolerances or allergies, medication side effects) to fair or poor (heavy metal toxicity, cytomegalovirus infection in HIV-compromised individuals).

The international mortality rate for gastroenteritis is estimated to be 3 to 10 million individuals each year, primarily from dehydration secondary to diarrhea (Diskin, Wedro).

Source: Medical Disability Advisor



Complications

Severe or prolonged diarrhea and vomiting may result in the loss of essential body fluids and nutrients, causing dehydration, shock, and collapse. Frequent vomiting may lead to irritation of the esophagus and unrelenting burning in the chest (esophagitis) because of stomach acid reflux. Accidental inhalation (aspiration) of vomit can cause severe pneumonia.

Irritation of the stomach (gastritis) or ulceration of the stomach can also be associated with prolonged or severe vomiting. Frequent bowel movements with loose stools may irritate the anus or result in the development of hemorrhoids or anal tears that can cause rectal bleeding. The inability to take routine medications due to nausea may worsen other ongoing medical conditions.

Certain types of microorganisms, such as E. coli 0157:H7, can cause more serious conditions such as hemorrhagic colitis. When bacterial or parasitic infections are inadequately treated, the infection may spread to other areas of the body, especially the liver.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Part-time work or less rigorous physical demands may be required for a few days until complete recovery is ensured. Adequate access to toilet facilities should be available.

Because infectious gastroenteritis may inadvertently be spread through poor hygiene practices, workers should not be allowed to handle food or beverages until symptoms resolve. In cases of severe fluid loss, restrictions on heavy lifting or operation of machinery may be considered until the individual recovers his or her strength. Individuals who work in the health care profession or as food handlers must exhibit a negative stool culture before being allowed to return to work (Wedro).

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 live or work in a place where many people are congregated, such as a nursing home, day care facility, or school?
  • Has individual traveled to any countries where contaminated food or water is prevalent?
  • Has individual had any recent infectious exposure or immune suppressive condition?
  • Has diagnosis of infectious gastroenteritis been confirmed or just assumed due to symptoms?
  • If gastroenteritis was noninfectious, was the cause identified? (It may include overeating, extreme emotional stress, adverse reactions to a food or food ingredient, very spicy foods, toxic substances, or excessive intake of alcohol.)
  • Does exam reveal an elevated heart rate, fever, paleness of the skin, and a soft but distended abdomen? Are the mucous membranes of the mouth pink? Dry? Is the tongue whitish or coated?
  • Although in mild cases the symptoms alone are usually sufficient to diagnose gastroenteritis, if this was a more serious case, were diagnostic tests (including CBC and electrolyte panel) done?
  • Did stool samples reveal the presence of bacterial infection or intestinal parasites?
  • If diagnosis was uncertain, were other conditions with similar symptoms (i.e., inflammatory bowel disease, biliary infection, pancreatitis) ruled out?

Regarding treatment:

  • Is individual able to remain hydrated? Is intravenous fluid therapy needed?
  • Has the organism causing infectious gastroenteritis been identified so that appropriate antimicrobial therapy can be used?
  • If individual does not respond to current treatment, would a change in antibiotic be warranted? Should diagnosis be revisited?
  • If noninfectious gastroenteritis is associated with the taking of prescribed antibiotics, was the full course of antibiotics completed yet? Are there alternative medications that individual could be taking instead?
  • Was food intolerance identified?
  • Was excessive stomach acid successfully resolved?
  • Is stress aggravating the condition? Has individual participated in a stress management program?
  • Has individual received appropriate supportive care and interventions to help relieve symptoms (i.e., antipyretics, fluids)?
  • Is individual experiencing a reaction to the current medication?

Regarding prognosis:

  • Based on the underlying cause, severity of symptoms and general health of individual, what was the expected outcome? Has adequate time elapsed for complete recovery?
  • If the symptoms have persisted despite treatment, has individual been reevaluated to rule out the possibility of bacterial resistance or secondary infection?
  • Has individual adhered to dietary modifications such as avoidance of spicy foods? Has individual reduced alcohol intake?
  • Does individual have a comorbid condition, such as cancer, ulcers, inflammatory bowel disease, food intolerance, diabetes, HIV infection/AIDS, heart disease, liver disease, or kidney disease, which may worsen the effects of noninfectious gastroenteritis or affect recovery?
  • Did individual suffer any associated complications, such as severe dehydration, shock, or systemic infection that could affect recovery and prognosis?

Source: Medical Disability Advisor



References

Cited

Bonheur, Jennifer Lynn, et al. "Gastroenteritis, Bacterial." eMedicine. Eds. John Gunn Lee, et al. 19 Feb. 2009. Medscape. 5 Oct. 2009 <http://emedicine.medscape.com/article/176400-overview>.

Chacon-Cruz, Enrique, and Douglas K. Mitchell. "Intestinal Protozoal Diseases." eMedicine. Eds. Ashir Kumar, et al. 7 Nov. 2007. Medscape. 5 Oct. 2009 <http://emedicine.medscape.com/article/999282-overview>.

Diskin, Arthur. "Gastroenteritis." eMedicine. Eds. Michelle Ervin, et al. 18 Sep. 2009. Medscape. 5 Oct. 2009 <http://emedicine.medscape.com/article/775277-overview>.

Wedro, Benjamin C. "Gastroenteritis." eMedicine Health. Ed. Melissa Conrad Stoppler. 6 Jun. 2008. WebMD, LLC. 5 Oct. 2009 <http://www.emedicinehealth.com/gastroenteritis/article_em.htm>.

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.