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.

Liver Disease


Related Terms

  • Cancer of Liver
  • Cirrhosis of Liver
  • Fatty Liver
  • Hepatitis A,B,C,D

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Factors that influence the length of disability include continued alcohol consumption, the development of associated complications, compliance with treatment, the age and general health of the individual, and the severity of the disease or condition upon initial diagnosis.

Medical Codes

ICD-9-CM:
573.0 - Liver Congestion, Passive, Chronic
573.2 - Hepatitis in Other Infectious Diseases Classified Elsewhere
573.3 - Hepatitis, Unspecified; Toxic (Noninfectious) Hepatitis
573.4 - Hepatic Infarction

Overview

Liver disease refers to many conditions that affect the ability of the liver to function properly.

The principal diseases of the liver are scarring of the liver tissue (cirrhosis) and inflammatory damage to liver cells (hepatitis). Cirrhosis is a chronic liver disease characterized by the progressive and irreversible destruction of liver tissue as a result of viral infection; as a result of chronic exposure to alcohol, drugs, or toxic substances; or in association with other diseases. As liver cells die, they are replaced with scar tissue.

Hepatitis refers to an inflammatory disease of liver cells resulting from exposure to certain chemicals or from exposure to viral infections (hepatitis strains A, B, C, D, and E). Hepatitis A is an acute inflammation occurring soon after exposure, whereas hepatitis B, C, D, and E are more likely to be chronic, lasting longer than 6 months. Hepatitis A is foodborne or waterborne; the others are spread through exchange of body fluids (blood, semen).

Many infections of the liver itself can also occur, including those from viruses, fungi, bacteria, amoebae, protozoa, and worms (helminths). Numerous types of tumors can begin in the liver (primary tumors), including many cancerous tumors (malignant tumors). Cancer from other parts of the body (metastatic cancer) may spread to the liver. Rare, hereditary diseases of the biochemical functions of the liver (metabolic diseases) can occur, especially Wilson's disease (a disorder of copper metabolism) and alpha-1 antitrypsin deficiency (a disorder of protein metabolism). Other metabolic disorders of the whole body can affect the liver. They include sarcoidosis, hemochromatosis, cystic fibrosis, and amyloidosis. Two notable liver (hepatic) complications of pregnancy are acute fatty liver of pregnancy and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).

Incidence and Prevalence: The overall incidence of cirrhosis in the US is 360 per 100,000 population, or approximately 900,000 total individuals. At least 30,000 people die from cirrhosis annually in the US; cirrhosis is the ninth leading cause of death in the US (Wolf).

With regard to hepatitis, the Centers for Disease Control and Prevention (CDC) reports an estimated 500,000 to 750,000 new cases in the US annually (Buggs). Worldwide, there are approximately 350 million hepatitis B carriers (or 5% of the population), and approximately 170 million people are infected with hepatitis C ("Hepatitis").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for developing liver disease include poor sanitation, intravenous drug use, blood transfusions, food poisoning, hemophilia, promiscuous sexual behavior, a family history of liver disease, alcoholism, Group B Streptococcal infections, hepatitis, and cirrhosis.

Source: Medical Disability Advisor



Diagnosis

History: A family history of hepatitis, occupational and environmental exposures, contact with jaundiced individuals, recent vaccinations, drugs, medical treatment, episodes of jaundice, recent illness, drug use, transfusions, and tattooing may be reported. It is important to keep in mind that many people with liver disease have no symptoms. The most common nonspecific symptoms include fatigue, weakness, fever and chills, weight loss, and occasional itching. More specific symptoms of liver disease include yellowing of the skin (jaundice), bleeding from the GI tract, dark urine, mental confusion, and retention of fluids in the abdomen.

Physical exam: The exam may reveal pale skin; muscle loss; yellowing of the skin or whites of the eye (scleral icterus); enlargement of the liver, spleen, and/or salivary gland behind the ear (parotid gland); decreased testicular size; bruising; redness of the palms (palmar erythema); clubbing of the fingers; and darkening of the skin (increase in pigmentation). Tenderness may be noted when touching (palpating) the edge of the liver (liver tip) through the abdominal skin, and fluid in the abdominal cavity (ascites) may be evident.

Tests: Blood tests may include measurement of key liver enzymes (alkaline phosphatase, AST, ALT, GGT, LDH), liver protein (bilirubin, albumin, fibrinogen), ammonia, clotting factors, blood lipids, total blood count, and hematocrit. In order to determine if a form of viral hepatitis is responsible, serologic tests, such as IgM anti-HAV, HBSAG, IgM anti-HBC, and anti-HCV are obtained. In addition, MRI, diagnostic ultrasound, CT scan, or other similar methods of visualization may be performed. A liver biopsy, in which a small piece of liver tissue is removed and analyzed microscopically for evidence of inflammation, cirrhosis, and infection, may also be performed.

Source: Medical Disability Advisor



Treatment

The specific course of treatment recommended depends on the type and underlying cause of the liver disease. In other words, a more specific diagnosis must be made. General treatment strategies for liver conditions may include dietary and vitamin supplementation and rest. Avoidance of alcohol and chemicals that are toxic to the liver or that are metabolized by the liver is important. Family members and other contacts at risk for contracting viral hepatitis should be identified and counseled regarding the method of hepatitis spread and availability of vaccinations.

Antibiotic therapy is necessary for abscesses and infection, and anticancer chemotherapy may be useful for some tumors. Surgical resection of tumors is sometimes necessary.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the specific condition, the underlying cause and severity of the disease, and the presence or absence of complications. Outcomes may range from complete recovery to cirrhosis, cancer, liver and renal failure, and death.

Source: Medical Disability Advisor



Complications

Complications of liver disease vary with the specific condition, underlying cause, and severity of the disease. Complications may include infection, fluid retention in the abdomen (ascites), blood flow impairment through the vein that serves the liver (portal hypertension), liver failure, bleeding, inflammation of the pancreas (pancreatitis), and neurologic damage (hepatic encephalopathy).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A leave of absence, frequent rest periods, or transfer to sedentary duties may be needed and will require consideration on a case-by-case basis. Additionally, individuals with a pre-existing underlying liver condition who work near or with inhaled toxins (leaning solvents, aerosoled paints, or thinners) may need to be reassigned; these substances can be toxic to the liver. Individuals with hepatitis B should avoid jobs involving the possibility of blood contact, as this disease is contagious by way of blood exposure.

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 history of chronic exposure to alcohol and/or drugs? Occupational or environmental contact with toxic substances?
  • Has individual received a recent blood transfusion?
  • Has individual had a recent tattoo applied?
  • Is there a history of viral infection, particularly of hepatitis A, B, C, D, or E? Does individual have a history of infections, metabolic disorders, or cancer that can affect the liver directly?
  • Does individual report abdominal pain, yellowing of the skin (jaundice), fatigue, weakness, and/or fever and chills?
  • Is there weight loss, dark urine, itching, or loss of appetite?
  • Were blood tests done to measure liver enzymes (alkaline phosphatase, AST, ALT, GGT, LDH) and proteins (bilirubin, albumin, fibrinogen)?
  • Were tests for viral hepatitis performed?
  • Were immunoglobulin levels, ammonia, clotting factors, and blood lipids measured? Was MRI, ultrasound, or CT required? Was a tissue sample (biopsy) of the liver taken to identify inflammation, cirrhosis, and infection?
  • Was a diagnosis of liver disease confirmed?

Regarding treatment:

  • What type of liver disease does individual have, and what is the underlying cause? How is the underlying cause being treated?
  • Did general treatment include dietary and vitamin supplementation and the administration of anti-inflammatory drugs?
  • Does individual understand the importance of avoidance of alcohol and chemicals that are toxic to the liver?
  • Would individual benefit from chemical dependency counseling?
  • If abscesses and infection were present, were organism-specific antibiotics given?
  • Was individual compliant with the medication regimen?
  • Was surgical removal (resection) of a tumor required? If so, was the tumor removed completely?

Regarding prognosis:

  • What type of liver disease does individual have?
  • How severely was the liver damaged?
  • Is the underlying cause under control? If not, what other treatment options are available?
  • Has individual developed complications of liver disease such as infection, fluid retention in the abdomen (ascites), blood flow impairment through the portal vein that serves the liver (portal hypertension), liver failure, bleeding, inflammation of the pancreas (pancreatitis), or neurological damage (hepatic encephalopathy)?
  • How will the complications be treated, and what is the expected outcome with treatment?

Source: Medical Disability Advisor



References

Cited

"Hepatitis C Information Center." Hepatitis Central. 22 Dec. 2004 <http://hepatitis-central.com/>.

Buggs, Adrienne M. "Hepatitis." eMedicine. Eds. Robert M. McNamara, et al. 24 Aug. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/emerg/topic244.htm>.

Wolf, David C. "Cirrhosis." eMedicine. Ed. Ann Ouyang. 17 Jun. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/med/topic3183.htm>.

Source: Medical Disability Advisor






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