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.

Intestinal Obstruction


Related Terms

  • Acute Colonic Pseudo-Obstruction
  • Bowel Obstruction
  • Colonic Ileus
  • Intestinal Volvulus
  • Ogilvie Syndrome
  • Paralytic Ileus

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon
  • Hematologist
  • Oncologist
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The severity of symptoms, location and cause of the obstruction, and method of treatment influence the length of disability. Age and health status will influence the individual's ability to undergo treatment and recovery time. The individual's diet may contribute to either a smooth recovery or to a potential resumption of intestinal symptoms and conditions.

Medical Codes

ICD-9-CM:
560.0 - Intestinal Obstruction (No Hernia), Intussusception
560.1 - Intestinal Obstruction (No Hernia), Paralytic Ileus
560.2 - Intestinal Obstruction, Volvulus; Knotting, Strangulation, Torsion or Twist of Intestine, Bowel or Colon
560.30 - Intestinal Obstruction, Intestinal Impaction, Unspecified Impaction of Colon
560.31 - Intestinal Obstruction; Intestinal Impaction, Gallstone Obstruction of Intestine
560.39 - Intestinal Obstruction, Other; Intestinal Impaction, Concretion of Intestine, Enterolith
560.81 - Intestinal Obstruction; Intestinal or Peritoneal Adhesions with Obstruction
560.89 - Intestinal Obstruction, Other Specified, Other; Acute Pseudo-obstruction of Intestine; Mural Thickening Causing Obstruction
560.9 - Intestinal Obstruction, Unspecified; Enterostenosis, Obstruction, Occlusion, Stenosis or Stricture of Intestine or Colon

Overview

An intestinal obstruction is a partial or complete blockage of the small or large intestine that results in failure of intestinal contents to pass normally through the bowel. Obstruction can occur anywhere in the intestinal tract and can be mechanical or nonmechanical. A mechanical cause physically blocks the movement of material through the intestines. Mechanical blockage may be caused by scar tissue from prior surgery (adhesions), benign or malign tumors (e.g., lipomas, large polyps, colorectal cancer), weakness in the abdominal wall that may trap a portion of small intestine (abdominal hernia), a swallowed foreign body, a gallstone (that migrated into the intestine), a bolus of undigested food, telescoping of the intestines (intussusception), twisting of the intestines (volvulus), narrowing of a portion of the intestines (stricture), or small, balloon-shaped pouches on the intestinal wall (diverticula). Nonmechanical causes stem from certain intestinal conditions, such as a disruption of the normal propelling motion (peristalsis) of muscles of the intestinal wall (dysmotility syndrome or pseudo-obstruction) or paralysis of the bowel wall (paralytic ileus). Paralytic ileus may result from infection within the abdominal cavity, decreased blood supply to support structures in the abdomen, disorders of the upper gastrointestinal (GI) tract, or metabolic disturbances (e.g., decreased potassium levels).

In older individuals or in the bedridden, feces can become hardened into a solid mass and obstruct the bowel (fecal impaction). In the elderly, the large intestine may appear to be obstructed but is actually massively dilated (acute colonic pseudo-obstruction, Ogilvie syndrome). When not treated rapidly, this condition can result in inadequate blood flow to the bowel (bowel ischemia) and bowel perforation. In individuals who have experienced rapid, significant weight loss, an abdominal artery (superior mesenteric artery) can compress part of the intestines causing a rare type of obstruction called superior mesenteric artery (SMA) syndrome.

Incidence and Prevalence: Intestinal obstruction is found in 20% of individuals admitted to hospital with acute abdominal pain; of this number, 80% of the obstructions involve the small intestine (Khan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Abdominal surgery, appendectomy, gynecological surgery, hernia, bowel tumors, diverticular disease, and digestive disturbances put individuals at higher risk for intestinal obstruction. Adhesions that formed after these surgeries account for 50% to 70% of all small-bowel obstructions admitted to US hospitals, and hernias account for 25% of small bowel obstruction cases in the US ("Bowel Obstruction").

Approximately 50% to 60% of all cases of large bowel obstruction in the US are caused by cancer of the colon or rectum, 20% are caused by diverticular disease, and up to 5% result from twisting of an intestinal segment (volvulus) (McCowan). Individuals over age 60 are at increased risk for acute colonic pseudo-obstruction of the large intestine, especially following surgery or severe medical illness (Remy).

Source: Medical Disability Advisor



Diagnosis

History: With a complete intestinal obstruction, the individual will report an inability to produce a bowel movement or pass gas; those experiencing partial obstruction may be able to produce bowel movements and gas in reduced quantities. Symptoms of obstruction in the small intestine include episodic cramping abdominal pain, nausea, and vomiting. With obstruction in the large intestine, vomiting is less likely, but abdominal pain is still present. Abdominal bloating also may be present.

Physical exam: In a complete obstruction, the exam will show abdominal distention and tenderness. Listening to the abdomen may reveal characteristic bowel sounds of obstruction such as high pitched “tinkling” or loud rushes of sound. Temperature is normal or slightly elevated, and heart and respiratory rates may be elevated. Digital rectal examination may reveal an absence of stool in the rectum and/or rectal bleeding.

Tests: Blood tests include a complete blood count (CBC), electrolytes, and prothrombin time (PT). Serum chemistries, blood urea nitrogen (BUN), creatinine, lactate, urinalysis, and arterial blood gases (ABGs) also may be done. Fecal occult blood testing is performed. Abdominal x-rays may reveal an obstruction, but can appear normal in early obstruction. X-rays can be enhanced by contrast material (opaque media) when given either by mouth or as an enema (barium enema) to help confirm the obstruction. Sometimes computed tomography (CT) scanning or magnetic resonance imaging (MRI) are used, especially if a tumor is suspected. A sigmoidoscopy may be done in conjunction with a barium enema to visualize the lower bowel (sigmoid colon) with a lighted, flexible fiberoptic instrument (sigmoidoscope) that is inserted rectally.

Source: Medical Disability Advisor



Treatment

Complete obstruction typically is treated with immediate surgery, while partial obstruction seldom requires surgery. A partial obstruction is treated in the hospital by stopping oral intake of liquids and food; giving intravenous fluids; using a tube inserted through the nose and into the stomach (nasogastric tube) to aspirate stomach contents and keep the stomach empty of gas and fluids (nasogastric suction); or decompressing the bowel with a long intestinal tube. These methods are employed before possible surgery and may resolve a partial intestinal obstruction within a few days (“Bowel Obstruction”). If intestinal obstruction is thought to be caused by ischemia, intravenous antibiotics may be given (Ansari).

A complete small-bowel obstruction may be treated by open surgical exploration of the abdomen (laparotomy). The obstruction is relieved, any diseased or nonfunctioning intestine is removed, and the healthy ends of the intestine are re-attached (anastomosed). Laparotomy also may be used to remove gallstones that have entered the small intestine. Insertion of a fiber-optic instrument (laparoscope) through a “keyhole” abdominal incision sometimes is an alternative to open surgery; this minimizes risk and complications. Laparoscopic-assisted lysis of adhesions (laparoscopic adhesiolysis) reduces complications, has a shorter recovery time, and produces fewer new adhesions.

Large-bowel obstruction usually requires surgery to remove the diseased or nonfunctioning segment of intestine. If the obstruction is caused by intestinal volvulus, an experienced surgeon may carefully reduce the intestinal torsion using an endoscope. In some cases, the lower colon and anus may be bypassed with placement of a shunt through the skin for the removal of feces (colostomy). Fecal impactions sometimes can be removed manually by digital rectal exam.

Source: Medical Disability Advisor



Prognosis

With proper diagnosis and early treatment of the obstruction, the outcome generally is good. Only 15% of partial small bowel obstructions will need surgery, whereas 85% of complete small bowel obstructions require surgery (Ansari). Laparoscopic lysis of adhesions has shown lower morbidity and a faster return to normal diet and bowel function. If the obstruction is secondary to cancer, the outcome is dependent on the cancer prognosis. The mortality rate for small-bowel obstruction is approximately 8%, increasing to 25% if part of the intestine has become necrotic, and surgery was delayed for more than 36 hours (Nobie). Overall mortality for large-bowel obstruction is 18.8% (Biondo). The mortality rate of acute colonic pseudo-obstruction is 15% to 50% (Remy).

Individuals who have a colostomy are able to return to normal activities, although colostomy bags will need to be emptied and changed routinely by the individual. Those with a temporary colostomy usually have a second surgery a few months later to reattach the bowel and remove the colostomy. In these cases, bowel function often returns to normal.

Source: Medical Disability Advisor



Complications

If treatment is delayed, dehydration and resulting electrolyte imbalance can complicate treatment, or dehydration may progress to hypovolemic shock, which is often fatal. Delayed treatment can significantly increase morbidity and mortality. The intestine can become perforated, sometimes through a pre-existing weak spot (diverticulum), which may result in peritonitis. Abdominal abscesses, wound rupturing (dehiscence), sepsis, and post-operative infection can occur. In 5% to 42% of cases, the small intestine can become strangulated and its blood supply seriously reduced (Khan). This may cause gangrene and subsequent necrosis of bowel tissue, a very serious complication with a high fatality rate.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If abdominal surgery is required to relieve the obstruction, heavy lifting may be restricted. When major surgery has been performed to remove segments of the intestinal tract or a colostomy performed, reassignment to other work may be needed. Dietary restrictions may occur, and arrangements for these may need to be made in the work place.

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:

  • Did individual complain of abdominal pain, nausea, and vomiting?
  • Were bowel movements and passing gas infrequent or absent?
  • Were a CBC, blood chemistries, PT, and ABGs done?
  • Was digital rectal examination performed? Was rectal bleeding present?
  • Were x-rays of the abdomen done? Did they reveal an obstruction? If not, may they have been taken before the obstruction could be seen?
  • Was CT scan or MRI done, especially if a tumor was suspected?
  • How was the diagnosis of intestinal obstruction been confirmed?
  • Has the cause of the obstruction been determined?
  • Was the obstruction partial or complete?
  • Did large intestine appear to be obstructed but was actually massively dilated? Was pseudo-obstruction present? Paralytic ileus?
  • Did individual have fecal impaction?

Regarding treatment:

  • For partial obstruction, was individual hospitalized to stop oral intake of liquids and food, to give intravenous fluids, to keep the stomach empty through a stomach tube, or to decompress the bowel with an intestinal tube? Was this treatment successful, or was surgery required?
  • For complete obstruction, was surgical exploration of the abdomen done and the obstruction relieved? Was any diseased intestine removed?
  • If intestinal ischemia was present, were intravenous antibiotics given?
  • If part of the large intestine twisted (volvulus), was surgeon able to carefully untwist the intestine using an endoscope, or was a bowel resection required?
  • For fecal impaction, was surgeon able to manually remove the impaction?
  • Was colostomy performed? If so, is the colostomy expected to be temporary or permanent?
  • If obstruction is related to an underlying condition (e.g., cancer, metabolic disease), is that condition being treated?

Regarding prognosis:

  • Is this the first intestinal obstruction individual has had, or is this a recurrence?
  • If the obstruction is secondary to cancer, was it possible to relieve obstruction? Has the cancer spread (metastasized) to other parts of the body?
  • Did any surgical complications occur?
  • Did individual experience dehydration or electrolyte imbalance complications? Hypovolemic shock?
  • Did the intestine become perforated? Did peritonitis result?
  • Did individual experience abdominal abscesses, dehiscence, sepsis, or post-operative infection?
  • Did the intestine become strangulated causing decreased blood flow and development of gangrene? If so, is individual expected to live?
  • If individual has a colostomy, would psychological counseling be of benefit to cope with the impact of the changes in body image?

Source: Medical Disability Advisor



References

Cited

"Bowel Obstruction." InteliHealth. 4 Mar. 2007. 3 Oct. 2009 <http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/25862.html>.

Ansari, Parswa. "Intestinal Obstruction." The Merck Manual of Diagnosis and Therapy. Eds. Robert S. Porter, et al. 18th ed. Whitehouse Station, NJ: Merck and Company, Inc., 2008. Merck Manuals Online. Sep. 2007. Merck & Co., Inc. 3 Oct. 2009 <http://www.merck.com/mmpe/sec02/ch011/ch011h.html>.

Biondo, S., et al. "Large Bowel Obstruction: Predictive Factors for Postoperative Mortality." Diseases of the Colon and Rectum 47 11 (2004): 1889-1897. PubMed. 3 Oct. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/15622582>.

Khan, Ali Nawaz, Sumaira Macdonald, and John Howat. "Small-Bowel Obstruction." eMedicine. Eds. Eric P. Weinberg, et al. 11 Sep. 2009. Medscape. 3 Oct. 2009 <http://emedicine.medscape.com/article/374962-overview>.

McCowan, Christy. "Obstruction, Large Bowel." eMedicine. Eds. Joseph J. Sachter, et al. 16 Jul. 2009. Medscape. 3 Oct. 2009 <http://emedicine.medscape.com/article/774045-overview>.

Nobie, Brian A. "Obstruction, Small Bowel." eMedicine. Eds. Joseph J. Sachter, et al. 17 Aug. 2009. Medscape. 3 Oct. 2009 <http://emedicine.medscape.com/article/774140-overview>.

Remy, Prospere, et al. "Ogilvie Syndrome." eMedicine. Eds. Julian Kat, et al. 30 Jul. 2008. Medscape. 3 Oct. 2009 <http://emedicine.medscape.com/article/184579-overview>.

Source: Medical Disability Advisor






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