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.

Hepatitis B


Related Terms

  • HBV
  • Hepatitis, Yellow Jaundice
  • Viral Hepatitis Type B

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist
  • Preventive Medicine Specialist

Comorbid Conditions

Factors Influencing Duration

The illness usually lasts 1 to 2 months, and it may take as long as 6 months for the liver to regain proper function. If recovery does not take place within that period, the individual may have a chronic and possibly incurable form of hepatitis B. Liver damage and accompanying complications may cause the individual's condition to gradually worsen. The severity of symptoms and response to treatment determine if individuals can manage tasks demanding physical strength.

Medical Codes

ICD-9-CM:
070.20 - Hepatitis, Viral Type B with Hepatic Coma, Acute or Unspecified, without Mention of Hepatitis delta
070.21 - Hepatitis, Viral Type B with Hepatic Coma, Acute or Unspecified, with Hepatitis delta
070.22 - Hepatitis, Viral Type B with Hepatic Coma, Chronic, without Mention of Hepatitis delta
070.23 - Hepatitis, Viral Type B with Hepatic Coma, Chronic, with Hepatitis delta
070.30 - Hepatitis, Viral Type B without Mention of Hepatic Coma, Acute or Unspecified, without Mention of Hepatitis Delta
070.32 - Hepatitis, Viral Type B without Mention of Hepatic Coma, Chronic, without Mention of Hepatitis Delta
070.33 - Hepatitis, Viral Type B without Mention of Hepatic Coma, Chronic, with Hepatitis Delta

Overview

Sometimes described as a "silent killer," because individuals can be chronic carriers without any symptoms of the disease, hepatitis type B (hepatitis B) is an inflammation of the liver caused by the hepatitis B virus (HBV). The virus is transmitted by contact with blood or other body fluids (semen or vaginal secretions) of an infected individual. Possible transmission modes are perinatal (from the mother to the newborn during childbirth); early childhood infections (infection that goes unrecognized through close contact with infected individuals at home); unsafe injection practices; transfusions of contaminated blood; and unprotected sexual intercourse. The disease is characterized by hepatocellular necrosis and inflammation. The acute and most common form of the disease typically clears up within several months. If the disease persists beyond 6 months, the individual is said to have chronic hepatitis B. The rate at which individuals develop chronic hepatitis B depends in part on when they acquire the virus. About 90% of newborns who acquire the infection from their mothers develop chronic hepatitis B, but the rate drops to about 5% for infections acquired as an adult ("Viral Hepatitis B"). Often undetected in its early stages, the disease slowly destroys the liver or leads to liver cancer over a period that sometimes lasts decades. It is estimated that 53% of all liver cancer is attributable to HBV (Perz).

Regarding the transmission period, HBV can be found in blood and other body fluids several weeks before the onset of symptoms and generally persists several months afterwards. About 10% of infected adults may become chronic (permanent) carriers.

Incidence and Prevalence: As many as 1.4 million individuals are thought to be living with HBV in the US ("Viral Hepatitis B"). In 2010, there were an estimated 35,000 cases of HBV infection in the US. The number of acute cases of HBV declined by 29% between 2006 and 2010, from 4,713 to 3,350 cases. In China and other parts of Asia, 8% to 10% of the adult population is chronically infected with HBV. The Amazon and the southern parts of eastern and central Europe also experience high rates of chronic HBV infections. In the Middle East and Indian subcontinent, approximately 2% to 5% of the general population is chronically infected. Less than 1% of the population in western Europe and North America is chronically infected. Two billion people worldwide have been infected with the virus and about 600,000 people die every year due to the consequences of hepatitis B ("Hepatitis B").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Most hepatitis B virus infections occur in young adults. HBV spreads when people share body fluids, primarily by using shared needles during drug abuse and through sexual activity. The three groups at highest risk of contracting hepatitis B are sexually active heterosexuals, homosexual men, and injection drug users. Healthcare workers are also at risk of accidental infection through punctures from needles contaminated with the blood of an infected individual.

Individuals with compromised immune systems have a higher risk of getting hepatitis B. Blacks have a greater chance of contracting the disease than white or Hispanic Americans. In the past, the virus was spread by transfusions of contaminated blood and blood products. This form was called serum hepatitis and has virtually been eliminated in the US because of screening for the virus by blood banks.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period ranges from 30 to 180 (mean 60 to 90) days; the onset of symptoms may be insidious or acute. Many individuals who are infected with HBV show no symptoms. Those who do may report early symptoms of muscle and joint aches, headache, and weakness. They may also complain of bad breath and a bitter taste in the mouth. Loss of appetite and nausea are common and accompanied by weight loss. A low-grade fever, diarrhea, and constipation may variably occur. The urine may be dark (choluria) and the stools light-colored (acholia). Yellow skin and eyes (jaundice or icterus) develop soon thereafter. At this point in the illness, the fever and aches may subside. Individuals with a chronic form of the disease may also report chest pain or itchy skin eruptions.

Physical exam: The exam commonly reveals tenderness over the liver when pressure is applied just below the ribs on the right side of the body. Enlargement of the liver (hepatomegaly) and occasionally the spleen (splenomegaly) may be detected. Jaundice may occur but is variable.

Tests: Blood tests (serology) will show general signs of impaired liver function (high alanine aminotransferase [ALT], aspartate aminotransferase [AST], and bilirubin). To specifically diagnose hepatitis B, other blood tests are needed for detection of hepatitis B surface antigen (HBsAg) and IgM antibodies to HBV core antigen (anti-HBc). CT and MRI scans may be done to rule out other disorders. A liver biopsy may also be done to assess the stage of liver damage.

Source: Medical Disability Advisor



Treatment

The goal of treatment is to improve symptoms and prevent complications. Antiviral therapy is not required in previously healthy individuals with mild–moderate acute hepatitis B (recovery in about 99%). Severe acute hepatitis B is treated with a injectable drug called interferon alpha (IFN-a) that weakens viral activity. Oral drugs used in treatment since 2008 include lamivudine, a drug that helps block virus replication, and adefovir dipivoxil, another drug that blocks the virus from reproducing, entecavir, telbivudine or tenofovir. Liver transplant may be indicated for individuals with an advanced form of the disease that does not respond to treatment, but availability of organs is limited. Rest, a healthy diet, and abstinence from alcohol also help slow the progress of the disease. Since hepatitis B is a serious worldwide health problem, many clinical trials are investigating new treatments.

Hepatitis B can be prevented by vaccination, and in the US a vaccination program was begun in 1992. Complete vaccination provides immunity in 90% of individuals (Eng-Kiong).

Source: Medical Disability Advisor



Prognosis

The duration of acute hepatitis B illness is variable. Most healthy adults who acquire hepatitis B recover completely within 6 months, but about 1% of individuals in the US develop a chronic form of the disease. Among those who were infected as infants and are chronically infected, up to 40% experience complications, mainly liver cancer or cirrhosis (scarring and destruction) of the liver (Dienstag).

Source: Medical Disability Advisor



Rehabilitation

Individuals with hepatitis B require no specific rehabilitation. They may wish to consult with a physical therapist and develop an exercise program to maintain endurance and strength. Psychological counseling may help individuals deal with fears of dying and depression that accompany the illness. Because distress and depression lower the immune system, counseling has a beneficial effect on an individual's physical health. For individuals infected through sexual contact, counseling may help them deal with issues of trust and betrayal. Psychologists and psychiatrists also develop behavior modification programs for individuals infected through intravenous drug use. These programs can help individuals recover from drug addiction.

Source: Medical Disability Advisor



Complications

Progressive liver disease (cirrhosis) and liver cancer (hepatocellular carcinoma) are the most serious complications that may develop. Other possible complications include arthritis, inflammation of the arteries (polyarteritis nodosa), inflammation of small structures in the kidney (membranous glomerulonephritis), pancreatitis, and reversible nerve damage causing paralysis of the extremities, breathing muscles, and face (Guillain-Barré syndrome). Inflammation may also affect the heart muscle or tissue (myocarditis). Individuals over 40 and those with drug addictions are more likely to develop a worsening of the disease (subacute hepatic necrosis). Older individuals may also develop muscle pain similar to rheumatism (polymyalgia rheumatica).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals usually do not work during the jaundice phase of hepatitis B, but this recommendation varies according to the type of job. Absence of jaundice is not required before a return to work, but employees with significant social interaction may need to limit their contact with the public. Customers at a restaurant or other places of business may fear contact with a contagious disease when it is obvious that an employee is jaundiced. Employees required to perform strenuous tasks may need to limit their job-related activities in the first few days after returning to work. Individuals who develop complications from hepatitis B, such as paralysis or joint pain, may need easy accessibility to work stations and accommodation such as appropriate seating and support.

For information on risk, capacity, and tolerance as they relate to chronic liver disease, a possible comorbidity, refer to "Work Ability and Return to Work," pages 363-364.

Risk: If a coagulopathy is present, then there would need to be restrictions from use of machinery where the risk of accidental lacerations is high, from working at unprotected heights, and from the use of firearms.

Tolerance: Some treatment protocols last for a year and can be associated with significant fatigue.

Source: Medical Disability Advisor



Maximum Medical Improvement

84 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 diagnosis of viral hepatitis type B been confirmed?
  • Has individual had appropriate blood tests to confirm impaired liver function and the specific presence of the hepatitis B virus?
  • Were other conditions ruled out, such as hepatitis A, C, and E, infectious mononucleosis, cytomegalovirus, or jaundice resulting from prescription drugs, poisons, alcohol, or gallstones?
  • Has individual developed complications such as cirrhosis, arthritis, polyarteritis nodosa, membranous glomerulonephritis, Guillain-Barré syndrome, myocarditis, subacute hepatic necrosis, or polymyalgia rheumatica?
  • Does individual have an underlying condition such as alcoholism, blood clotting disorder, chronic liver disease, or liver transplant that may affect recovery?
  • Has co-infection with hepatitis D (delta antigen) been identified?

Regarding treatment:

  • Is individual considered a candidate for newer therapies such as interferon injections?
  • Has individual received adequate rest, nutritional, and fluid intake?
  • Is individual registered in an organ transplant program?

Regarding prognosis:

  • Since the virus must run its course, has individual had an appropriate length of time to recover?
  • Does disease appear to be progressing? Is there evidence of liver tissue death?
  • Is a more aggressive treatment now indicated?
  • Is individual a carrier?
  • What precautions must individual now take for self and for others with whom he or she comes in contact?
  • Is there evidence of liver cancer?
  • Is individual a candidate for interferon drug therapy? If not, why not?
  • Have all associated individuals received appropriate vaccination for hepatitis B, or treatment with immune globulin injection?

Source: Medical Disability Advisor



References

Cited

"Hepatitis B." WHO. Jul. 2013. World Health Organization. 3 Oct. 2013 <http://www.who.int/mediacentre/factsheets/fs204/en/>.

"Viral Hepatitis B." Centers for Disease Control and Prevention. 16 May. 2012. U.S. Department of Health and Human Services. 3 Oct. 2013 <http://www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm>.

Dienstag, J. L. "Hepatitis B Virus Infection." New England Journal of Medicine 359 (2008): 1486-1500.

Eng-Kiong, Teo, and Anna SF Lok. "Hepatitis B virus vaccination." Up to Date. Eds. Rafael Esteban, et al. 14 May. 2013. Wolters Kluwer Health. 3 Oct. 2013 <http://www.uptodate.com/contents/hepatitis-b-virus-vaccination>.

Perz, J. F. , et al. "The Contributions of Hepatitis B Virus and Hepatitis C Virus Infections to Cirrhosis and Primary Liver Cancer Worldwide." Hepatology 45 (2006): 529-538.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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