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.

Hypersplenism

hypersplenism in português (Portugal)

Related Terms

  • Big Spleen Syndrome
  • Dyssplenism
  • Hypersplenia
  • Splenic Anemia

Differential Diagnosis

Specialists

  • Family Physician
  • Gastroenterologist
  • General Surgeon
  • Hematologist
  • Internal Medicine Physician

Comorbid Conditions

  • Cirrhosis
  • Hemolytic disorder
  • Infectious disease
  • Malignancy

Factors Influencing Duration

Length of disability and intensity and complications of the disorder are affected by the cause of hypersplenism, any complications, and the individual's response to treatment. If treatment includes surgical removal of the spleen (splenectomy), length of disability will be increased.

Medical Codes

ICD-9-CM:
289.4 - Hypersplenism; "Big Spleen" Syndrome; Dyssplenism; Hypersplenia

Overview

Hypersplenism is a disorder in which the spleen becomes increasingly active and then rapidly and prematurely destroys blood cells. One of the major functions of the normal spleen (which is located in the upper left abdomen) is to remove those blood cells from the body's bloodstream that are abnormal, aging, or covered with antibodies. In hypersplenism, the spleen's normal function accelerates such that the spleen begins to automatically destroy and remove blood cells that may still be normal in function.

Hypersplenism is thought to be caused by a variety of other disorders. Primary (idiopathic) hypersplenism is brought on by a disorder within the spleen itself. When brought on by another disease, such as chronic malaria, rheumatoid arthritis, tuberculosis, or tumor, the disorder is referred to as secondary hypersplenism. Research has shown that, in general, spleen disorders are almost always secondary in nature.

Incidence and Prevalence: According to reports issued by the Centers for Disease Control and Prevention (CDC) in 1998, the number of diagnoses listed for hypersplenism in the US was small (about 10,000 total) for both males and females. A recent study revealed that 2% to 5.6% of individuals have an enlarged spleen (splenomegaly) on physical exam, which is often associated with hypersplenism (Kaplan).

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis of hypersplenism requires that the individual experience such symptoms as easy bruising; susceptibility to bacterial diseases; fever; weakness; heart palpitations; and ulcerations of the mouth, legs, and feet. Many individuals will develop an enlarged spleen (splenomegaly) which may encroach on the stomach, causing stomach pain on the left side as well as a premature feeling of fullness when beginning to eat (early satiety). Other symptoms may stem from the underlying disease (such as malaria and tuberculosis) that has caused the disorder.

Because there is such a wide range of possible symptoms for this disorder, a thorough patient history should be obtained. Hypersplenism is rarely diagnosed on the basis of symptoms alone, but is usually discovered when an underlying medical condition is identified and the physician finds an enlarged spleen during the course of a physical examination. The most commonly associated symptoms are abdominal fullness or lack of appetite (inappetence).

Physical exam: The physician's manipulation of and pressing on the abdominal area (palpation) may reveal an abnormally enlarged spleen (splenomegaly) or a shrunken, hard liver (cirrhosis). Examination with a stethoscope may reveal abnormal vascular sounds (bruits). Fever, bruising, and ulceration may also be confirmed during this exam.

Tests: Blood tests, including a complete blood count (CBC), are taken to check counts of the various types of blood cells. These tests usually reveal a decrease in white blood cells (leukopenia), red blood cells (anemia), and platelets (thrombocytopenia). Other diagnostic tests (such as liver function tests, CT scans, MRI, and ultrasound) are used to confirm an enlarged spleen (splenomegaly). Bone marrow aspiration can help to identify many of the causes of hypersplenism, such as leukemia, lymphoma, and metastatic cancer.

Source: Medical Disability Advisor



Treatment

Most individuals with secondary hypersplenism require therapy for the underlying disease (e.g., chronic malaria or tuberculosis), which must be treated to prevent further destruction of blood cells and possible spleen enlargement. In general, treatments for possible underlying diseases should be attempted prior to consideration of removal of the spleen (splenectomy).

Surgical removal of the spleen (splenectomy) is often used to treat primary hypersplenism. Indications for splenectomy also include severe reduction of platelets or immune cells, direct involvement of the spleen by disorders such as leukemia and lymphoma, and the spread of cancer from other organs to the spleen. Following splenectomy, individuals will need to immunized to help combat encapsulated organisms such as Streptococcus pneumoniae.

Source: Medical Disability Advisor



Prognosis

The prognosis depends on the underlying cause and the type of treatment required. For those individuals who receive therapy for the underlying condition causing hypersplenism, the outcome is usually favorable. However, if massively enlarged spleens (splenomegaly) are not treated promptly, they can destroy blood components, causing low red blood cell count (anemia), low white blood cell count (leukopenia), and low platelet count (thrombocytopenia). Low platelet counts can lead to complications including mucosal bleeding and bleeding from abnormally dilated or swollen veins in the esophagus (esophageal varices). Following splenectomy, individuals have an increased risk for recurrent infections.

When treatment for hypersplenism includes removal of the spleen (splenectomy), the outcome is often unfavorable because the individual becomes more vulnerable to severe bacterial infections, such as Streptococcus pneumoniae. This occurs because individuals without spleens become less effective in filtering bacterial pathogens from the bloodstream, predisposing the individual to a severe blood infection (septicemia). Individuals without spleens are also more susceptible to attacks of malaria.

Source: Medical Disability Advisor



Complications

A number of complications may occur when the spleen enlarges or when hypersplenism is left untreated. In addition to the individual experiencing problems with bleeding and infection, the spleen may become uncomfortably large (splenomegaly) and susceptible to rupture, which occurs with increased frequency in individuals with underlying infectious mononucleosis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work activities may need to be restricted to reduce potential trauma that may cause the spleen to rupture.

Individuals with hypersplenism may need frequent sick leave for treatment of the disorder and its complications. If surgery is required, an extended leave of absence may be necessary for rest and recuperation.

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 primary or secondary hypersplenism?
  • Has individual noticed increased bruising or frequent illness?
  • Has individual had weakness, heart palpitations, or ulcerations of the mouth, legs, and feet?
  • Have they had unexpected bleeding from the nose?
  • GI tract?
  • Urinary tract?
  • Do they have left-sided abdominal pain?
  • Do they feel full after eating a small amount?
  • On physical exam, did palpation reveal splenomegaly or cirrhosis?
  • Were any bruits heard?
  • Was fever, bruising, or ulcerations noted?
  • Has individual had a CBC and liver function tests?
  • CT scan?
  • MRI?
  • Was a bone marrow aspiration done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual received treatment for the underlying disease and hypersplenism?
  • Did individual have a splenectomy?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Has individual had any complications such as bleeding or recurrent infections?
  • Has the spleen become uncomfortably large?

Source: Medical Disability Advisor



References

Cited

Kaplan, Lewis J., and David Coffman. "Splenomegaly." eMedicine. Eds. Wadie F. Bahou, et al. 5 Oct. 2004. Medscape. 15 Feb. 2005 <http://emedicine.com/med/topic2156.htm>.

Source: Medical Disability Advisor






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