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.

Laparotomy


Medical Codes

ICD-9-CM:
54.11 - Laparotomy, Exploratory
54.12 - Reopening of Recent Laparotomy Site; Reopening of Recent Laparotomy Site for: Control of Hemorrhage, Exploration, Incision of Hematoma
54.19 - Laparotomy, Other; Drainage of Intraperitoneal Abscess or Hematoma
54.21 - Laparoscopy; Peritoneoscopy

Related Terms

  • Celiotomy
  • Exploratory Abdominal Surgery
  • Exploratory Laparotomy

Overview

A laparotomy is an open surgical exploration of the abdomen in order to view its internal organs, including the stomach, small and large intestines, kidneys, liver, pancreas, gallbladder, and organs that make up the female reproductive system. The procedure is used for exploratory purposes, to take samples of abdominal tumors for cancer staging, to make or confirm a diagnosis, and to repair internal organs damaged due to disease or trauma.

Although a laparotomy is a common procedure, its use for exploratory purposes has declined in recent years due to improvements in noninvasive diagnostic procedures such as medical imaging and sonography. Therapeutic laparotomy is performed when a cause has already been identified, such as appendicitis, peptic ulcer, perforated intestine, or colon cancer, and surgical treatment is necessary. However, interest in minimally invasive surgical procedures such as laparoscopy, and improvements in microtechniques and imaging modalities, have also reduced the number of therapeutic laparotomies, for example, for treating endometrial cancer (Zullo).

Source: Medical Disability Advisor



Reason for Procedure

A laparotomy is frequently performed as an exploratory procedure to assist in determining a cause of abdominal pain or to identify a mass or other abnormality palpated during physical examination of the abdomen. Other reasons for laparotomy include making an accurate identification and/or removal of malignant or benign growths (neoplasms), identifying an ectopic pregnancy (a fertilized egg that is trapped in the fallopian tube), correcting twisted intestines (volvulus), taking samples (biopsies) of abdominal tissue or tumors in order to determine the stage of a cancer, draining infection, finding a source of bleeding, and stopping bleeding.

A laparotomy is performed when internal organs such as the appendix, intestines, esophagus, stomach, colon, or gallbladder are ruptured (perforated) in the course of disease or through trauma.

Source: Medical Disability Advisor



How Procedure is Performed

The individual is given a general anesthetic. An incision is most often made in the lower abdominal area. Incisions can be median, made vertically midline between the breastbone (sternum) and lower abdomen (pubis); paramedian, or vertically in another abdominal location; T-shaped or curved, depending on the reason for the surgery; or transverse (horizontal) across the lower part of the abdomen, depending on the suspected condition or area of trauma. However, in the individual with unclear pathology or diffuse symptoms, a median midline incision is used for complete abdominal exploration.

The incision is made with a scalpel through the superficial layers of the skin, subcutaneous fat, deeper muscle layers, and the peritoneum. The incision is then spread open and held in place with a retractor so the abdominal cavity can be directly visualized. Sometimes electrocautery is used to make the incision through the subcutaneous layers because bleeding can be stopped at the same time.

The surgeon will explore the abdominal cavity for abnormalities due to disease or trauma, including infection, inflammation, bleeding, perforation, growths or tumors, obstructions, or other conditions. A biopsy of organ tissue may be taken during the procedure, depending on the suspected source of disease. Pelvic washing may be performed by introducing sterile fluid into the abdominal cavity and withdrawing it to examine it for abnormal cells. After the source of the problem is located or corrected using standard surgical procedures, the incision is closed with surgical thread (suture) or metal staples. The problem may not be able to be corrected during the laparotomy, and a subsequent surgery or other form of treatment may be necessary. If surgery involves the stomach or intestines, the individual may have a rubber or plastic tube inserted through the nose and esophagus into the stomach to drain the contents while the affected area heals; nutrition will be delivered parenterally until the stomach and esophagus can operate normally.

Source: Medical Disability Advisor



Prognosis

The outcome following a laparotomy depends on the underlying reason for surgery, the individual's age and general health, whether the individual is obese, the extent of tissue damage, loss of blood due to trauma, and any disorders such as emphysema or heart disease. Complete recovery typically takes approximately 4 weeks.

Source: Medical Disability Advisor



Specialists

  • General Surgeon

Source: Medical Disability Advisor



Comorbid Conditions

  • Emphysema
  • Heart disease
  • Obesity

Source: Medical Disability Advisor



Complications

Complications include allergy or abnormal responses to anesthesia, unintentional perforation of an organ, excessive bleeding, wound or systemic infection, or internal scarring and chronic pain. If peritonitis is present and not treated rapidly, it can lead to multisystem failure and death. Delayed laparotomy in the instance of trauma can lead to excessive or fatal bleeding.

Source: Medical Disability Advisor



Factors Influencing Duration

Recovery after laparotomy is determined by the reason for the surgery, age and general health status of the individual, findings at the time of the procedure, and final diagnosis. Complications following the procedure can increase duration.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No restrictions or special accommodations are necessary for healthy individuals resuming light to medium work. Resumption of heavy work and lifting should be delayed until healing is complete and medical clearance has been received.

Source: Medical Disability Advisor



References

Cited

Katz, Vern L., et al., eds. "Laparotomy." Comprehensive Gynecology. 5th ed. Mosby, Inc., 2007. 406-407, 860. MD Consult. Elsevier, Inc. 7 Sep. 2009 <http://www.mdconsult.com>.

Zullo, Fulvio, et al. "Laparoscopic Surgery Vs. Laparotomy for Early Stage Endometrial Cancer: Long-Term Data of a Randomized Controlled Trial." American Journal of Obstetrics and Gynecology 200 3 (2009): E1-9.

General

Marx, J. A., et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia: Elsevier, Inc., 2013.

Source: Medical Disability Advisor