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.

Hernia, Umbilical

hernia, umbilical in Português (Brasil)

Related Terms

  • Gastroschisis
  • Omphalocele
  • Paraumbilical Hernia

Differential Diagnosis

Specialists

  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the size of the hernia, whether or not it can be reduced, the surgical procedure used as treatment, the presence and nature of complications, and the individual's job requirements.

Medical Codes

ICD-9-CM:
551.1 - Umbilical Hernia with Gangrene
552.1 - Umbilical Hernia with Obstruction
553.1 - Hernia, Umbilical

Overview

© Reed Group
An umbilical hernia is a protrusion around the navel (umbilicus) that may contain part of the intestine and/or the fatty membrane found inside the abdomen (omentum). Hernias often protrude through areas of muscle weakness such as around the navel. This is the area where blood vessels from the mother supply the developing fetus with nutrients through the umbilical cord. After birth, the umbilical cord is severed, leaving the bellybutton as its lifetime reminder. Umbilical hernias in babies (congenital) usually resolve spontaneously by ages 1 to 2.

An adult umbilical hernia (acquired) occurs when the connective tissue (fascia) of the abdominal wall becomes weak around the area of the navel. The weakening occurs over a period of years until eventually the abdominal contents, encased in a sac, protrude through the abdominal wall, and a bulge forms around the umbilicus. A newly formed umbilical hernia is usually small and contains only the fatty omentum. However, as more of the abdominal contents (transverse colon, small intestine, greater omentum) push into the sac, the umbilical hernia can grow in size.

A reducible hernia can easily be returned to the abdominal cavity. When the hernia can no longer be reduced, it is called “incarcerated”; these hernias have a high risk for losing the blood supply that keeps the tissue alive (strangulation). For that reason, repair of an umbilical hernia is recommended as soon as possible after it is discovered.

Incidence and Prevalence: Of the half million hernia operations performed in the US every year, about 14% are umbilical hernia repairs (Golladay). Congenital umbilical hernias generally close spontaneously by ages 1 or 2 (Nicks).

Slightly more women than men are treated for umbilical hernias, with a ratio of 1.7 to 1 (Golladay). As with all abdominal hernias, the prevalence of umbilical hernia increases with age, and umbilical hernias are more common in individuals of African ancestry (Golladay).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Umbilical hernias are most common in infants. In an adult, any condition that causes buildup of pressure against the abdominal wall may contribute to umbilical hernia formation. This includes extreme obesity, heavy lifting, accumulation of abdominal fluids (ascites), coughing, straining with urination or defecation, chronic obstructive pulmonary disease (COPD), or even multiple pregnancies.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with umbilical hernia report a central mid-abdominal bulge that may expand when the individual coughs or strains the abdomen. Pain in the area of the hernia is not uncommon with coughing or straining. A careful review of symptoms should seek other medical conditions that may be associated with increased intra-abdominal pressure.

Physical exam: The presence of an umbilical hernia is identified by a bulge or a palpable defect at the level of the umbilicus. There may be discoloration of the skin overlying the hernia.

Tests: The diagnosis is made based on the history and physical exam, and tests are usually not needed. However, the physician may use CT imaging, ultrasound, or x-ray aided by contrast material to visualize the herniated contents.

Source: Medical Disability Advisor



Treatment

A small umbilical hernia that is easily pushed back into the abdomen (reduced) in an adult of normal weight may be watched closely, particularly if the individual is a poor surgical risk or elderly. Repair of umbilical hernias is recommended in all other adults. Large umbilical hernias are often treated with the Mayo procedure, which uses an implanted polyurethane mesh to provide support and hold the herniated sac inside the abdomen.

Trusses were sometimes used in the past when surgery was a more dangerous proposition but have fallen out of favor since they can injure delicate skin and bowel and mask signs of strangulation. Corsets and binders are sometimes used on a temporary basis before surgery or for individuals who are not surgical candidates.

Source: Medical Disability Advisor



Prognosis

Surgical repair is recommended in most situations since small umbilical hernias, left untreated, can expand and become problematic. Umbilical hernia repair is often done at outpatient surgery centers, and most healthy individuals who undergo mesh repair can be discharged on the same day as the surgery. Rarely is there recurrence of the condition following surgical treatment (less than 3% of the time) (Jeyarajah). Potential surgical complications include infection, bleeding, and persistent pain (Golladay).

Source: Medical Disability Advisor



Rehabilitation

Following abdominal surgery to repair a hernia, intermittent positive pressure breathing exercises may be necessary to prevent pulmonary complications. Certain exercises such as progressive relaxation and deep-breathing techniques may be performed to reduce postoperative pain and speed recovery. They may be performed several times a day until pain from inhalation/exhalation is less noticeable. Physical therapists instruct individuals to hold a pillow to the abdomen when walking, coughing, or laughing. The pillow acts as a splint in place of the weakened abdominal muscles and decreases the amount of pain perceived during these activities. While lying on his or her back, the individual performs exercises such as pelvic tilts, in which the lower back is flattened against the bed, and neck bends, in which the neck is bent forward. These exercises strengthen the abdominal muscles.

Ankle flexes, knee bends, and crossed-leg muscle contractions (all performed while lying on the back) help increase circulation and make walking easier. These exercises are especially valuable during the first 48 hours after surgery and should be performed 3 to 5 times a day during this time. Individuals may continue these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

Source: Medical Disability Advisor



Complications

Complications of umbilical hernia may include incarceration of the herniated sac and its contents. Consequently, the flow of blood to the tissue within the incarcerated sac may be cut off (strangulation), and the tissue may then start to die (necrosis). Tissue necrosis may be accompanied by bacterial infection, abdominal pain, vomiting, and shock. This condition is a surgical emergency. Other possible complications of umbilical hernia include rupture of the hernial sac, infection, abdominal distention, pneumonia, fluid in the lungs (pulmonary edema), skin discoloration from liver dysfunction (jaundice), intestinal bleeding (hemorrhage), and kidney (renal) problems.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions on lifting, climbing, and strenuous physical activity should be expected for several weeks following surgical repair of umbilical hernia. After recovery, the individual can usually return to work in full capacity with no disability. Rarely, an umbilical hernia will recur after being repaired surgically. If this happens, reassignment to an alternative job requiring less physical strain may be considered. The risk of recurrence can be reduced by addressing risk factors such as obesity, chronic constipation, smoking, and cough.

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 a mid-abdominal protrusion that expands with coughing or straining the abdomen? Does pain occur in the area of the bulge when coughing or straining?
  • Is skin overlying the hernia discolored?
  • Can the mass that protrudes through the incision site be pushed back into the abdominal cavity? That is, is it reducible?
  • Was diagnosis of umbilical hernia confirmed?
  • Were any imaging studies needed to visualize hernia and confirm diagnosis?
  • If diagnosis is uncertain, were other conditions with similar symptoms ruled out?

Regarding treatment:

  • Since even small hernias can expand, has a pre-existing umbilical hernia now become problematic? Is surgical repair now warranted?
  • Was surgical repair successful?
  • Did individual experience any complications associated with the hernia, such as tissue necrosis? Will further procedures be necessary?
  • Were any complications associated with the procedure or anesthesia?
  • If surgical repair is not an option, what are extenuating circumstances?
  • How is the hernia being managed?

Regarding prognosis:

  • Did the hernia recur despite surgical repair?
  • Does individual have a coexisting condition, such as severe obesity, diabetes, or cancer, that may complicate treatment or affect recovery?

Source: Medical Disability Advisor



References

Cited

Golladay, Eustace Stevers, and Kimberly W. McCrudden. "Abdominal Hernias." eMedicine. Eds. Alex Jacocks, et al. 30 Jun. 2008. Medscape. 26 Jan. 2009 <http://emedicine.medscape.com/article/189563-overview>.

Jeyarajah, Rohan, and William V. Harford. "Abdominal Hernias and Gastric Volvulus." Gastrointestinal and Liver Disease. 8th ed. Philadelphia: Saunders Elsevier, 2006.

Nicks, Bret A., and Kim Askew. "Hernias." eMedicine. Eds. Richard Lavely, et al. 4 Nov. 2008. Medscape. 26 Jan. 2009 <http://emedicine.medscape.com/article/775630-overview.>.

General

Weinstein, Phillip R., and Julian T. Hoff. "Hernias and Other Abdominal Lesions of the Abdominal Wall." Current Surgical Diagnosis & Treatment. Eds. L. W. Way and Gerald M. Doherty. 11th ed. New York: McGraw-Hill, 2004. 783-796.

Source: Medical Disability Advisor






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