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.

Lithotomy


Related Terms

  • Open Lithotomy
  • Ureterolithotomy

Specialists

  • Nephrologist
  • Urologist

Comorbid Conditions

  • History of kidney transplant
  • Miscellaneous chronic illnesses
  • Obesity

Factors Influencing Duration

Surgical complications, such as antibiotic-resistant infections, may affect length of recovery, but usually do not lead to permanent disability.

Medical Codes

ICD-9-CM:
55.01 - Nephrotomy; Evacuation of Renal Cyst; Exploration of Kidney, Nephrolithotomy
56.2 - Ureterotomy; Incision of Ureter for: Drainage, Exploration, Removal of Calculus
57.19 - Other Cystotomy; Cystolithotomy

Overview

Lithotomy is a surgical procedure in which a kidney stone (renal calculus, nephrolithiasis) is removed from the urinary tract. Extraction of the stone can take place from the kidney, the bladder, or the tube connecting the kidney and bladder (ureter).

Kidney stones are rock-like masses created when crystalline substances, such as calcium, build up along the wall of the kidney rather than being excreted in the urine. Tiny stones can be washed out of the urinary tract without symptoms, but larger stones cause pain or inflammation as they pass through the kidneys, ureters, bladder, and urethra. Rarely, stones may be caused by infection (struvite stones), uric acid, or the amino acid, cystine.

Open lithotomy is required in about 2% of those treated for kidney stones. Newer, noninvasive or less invasive procedures such as transurethral removal of the stone, shock wave lithotripsy, or percutaneous lithotomy are more commonly used. An advantage of an open lithotomy is the ability of the surgeon to remove the stone fragments directly from the urinary tract rather than relying on their natural passage from the kidney.

Source: Medical Disability Advisor



Reason for Procedure

The open lithotomy procedure is an option in cases of kidney stones where (a) other approaches have failed or are contraindicated, (b) the individual is very obese, (c) the stone does not pass after a reasonable period of time and causes constant pain, (d) the stone is too large to pass on its own or is caught in a difficult anatomic location, (e) the stone has remained in the ureter for more than 4 weeks, (f) the stone blocks the flow of urine, (g) the stone causes ongoing urinary tract infection, (h) the stone damages kidney tissue or causes constant bleeding, or (i) the stone has grown larger (as seen on follow-up x-ray studies). The criteria remain the same, whether the stone is located in the kidney or the ureter.

Lithotomy is the preferred approach for renal transplant patients when there are structural abnormalities in the kidney or surrounding area, for drug-resistant cystine stones, which are usually resistant to shock wave therapy, or for complicated conditions involving stones that branch out within the body of the kidney (staghorn calculi).

Source: Medical Disability Advisor



How Procedure is Performed

During an open lithotomy, an incision is made through the skin in the area between the back and side, or flank, and under the lowest rib. A small incision is then made in the kidney, ureter, or bladder, and an instrument called a nephroscope is used to locate and remove the stone. For large stones, an energy probe such as an ultrasonic device, a pneumatic drill-like device, or a holmium laser lithotriptor may be needed to break the stone into small pieces before removal. After removal, a small plastic or latex tube is inserted into the kidney (nephrostomy) or ureter (ureteral stent) to allow drainage of urine while the operation site heals. The tissues under the skin are closed with large absorbable sutures, and the skin is closed with sutures or metal clips (staples) that are removed about 1 week after surgery.

Source: Medical Disability Advisor



Prognosis

Success rates for lithotomy have been reported to be about 98% for kidney stones and 88% for ureteral stones. The recurrence rate of new stone formation, even after successful stone removal or natural passing of a stone, is approximately 50%.

Source: Medical Disability Advisor



Complications

Complications, which occur in approximately 3% of cases, include an abnormal response to anesthetics; scarring, which usually does not impair kidney function; excessive bleeding after surgery; surgical site infection; imbalances in the fluid used to irrigate the area between the skin and kidney or ureter; collapsed lung; and injuries to areas outside the kidney but within the operative area, such as the abdomen or chest. A recent study reports that the holmium laser produces cyanide as a by-product of uric acid stone fragmentation, although poisoning has not been reported in any individual following this procedure.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

There are no specific accommodations required for individuals with a normal recovery.

Source: Medical Disability Advisor



References

General

Miller, Ronald D. Miller's Anesthesia. 6th ed. Philadelphia: Elsevier, Inc., 2005.

Source: Medical Disability Advisor






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