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.

Lymph Node Disorders


Related Terms

  • Adenitis
  • Adenopathy
  • Cervical Adenitis
  • Lymph Follicular Hypertrophy
  • Lymph Gland Infection
  • Lymphadenitis
  • Lymphadenopathy
  • Swollen Lymph Glands

Differential Diagnosis

Specialists

  • Family Physician
  • General Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability depends upon the etiology of symptoms, the disease process diagnosed, and treatment options. The individual’s response to treatment may influence duration.

Medical Codes

ICD-9-CM:
289.1 - Lymphadenitis, Chronic; Adenitis Any Lymph Node, except Mesenteric, Chronic; Lymphadenitis Any Lymph Node, except Mesenteric, Chronic
289.2 - Lymphadenitis, Nonspecific Mesenteric; Mesenteric Lymphadenitis, Acute, Chronic
289.3 - Lymphadenitis, Unspecified, except Mesenteric
683 - Lymphadenitis, Acute; Abscess (Acute) Lymph Gland or Node, except mesenteric; Adenitis (Acute) Lymph Gland or Node, except mesenteric; Lymphadenitis (Acute) Lymph Gland or Node, except Mesenteric
785.6 - Enlargement of Lymph Nodes; Lymphadenopathy, "Swollen Glands"

Overview

A lymph node disorder is a condition in which the lymph nodes, an important part of the immune system, become enlarged in response to an underlying disease process. In addition to producing enlargement of nodes and related organs, disorders of the lymphatic system can reduce the body's ability to fight infection.

The lymph nodes in the human body are small, rounded nodules of tissue that cluster in the neck (cervical nodes), armpits (axillary nodes), chest (supraclavicular and subclavicular nodes, mediastinal nodes), abdomen (mesenteric nodes), and various organs and larger blood vessels, and in and above the groin (popliteal and inguinal nodes). Larger structures of the lymphatic system produce and circulate a type of white blood cell (lymphocyte) to fight infection and disease; these structures include the spleen, thymus, bone marrow, and lymphoid tissue within the digestive system. The spleen is a major cluster of lymph nodes that may become enlarged in lymph node disorders. The lymphatic system also includes the lymphoid tissue through which the nodes and vessels of the lymphatic system circulate a clear fluid (lymph) throughout the body. As highly organized centers of immune cells such as lymphocytes and antigen-presenting cells (APCs), the lymph nodes filter lymph fluid to trap infectious agents and prevent them from entering the bloodstream. Sinuses within the nodes and lymphatic organs use large specialized cells (macrophages) to remove 99% of all foreign antigens associated with infection and disease (Kanwar). Lymph nodes are capable of significant absorption and expansion. Active lymph nodes enlarge as they increase production of immune cells and macrophages and attempt to destroy infective material. Lymph node enlargement occurs most frequently as an immune response to viral, bacterial, or fungal infection. Lymph node disorders include inflammation of the lymph nodes (lymphadenitis); abnormalities of the lymph nodes (lymphadenopathy); infiltration of the lymph nodes by metabolite-laden macrophages (lipid storage disorders such as Gaucher disease or Niemann-Pick disease); infiltration by immune macrophages (histiocytosis); and cancer, which can involve infiltration with malignant cells from a primary cancer or uncontrolled growth of abnormal cells as in lymphoma and lymphoid leukemia.

Lymphadenitis is an inflammation of the lymph nodes that usually occurs as an immune response to a bacterium, virus, fungi, or other organism affecting the body. Common bacterial infections that produce this response include tonsillitis, infected cuts or wounds, and abscesses. Circulating cancer cells or inflammatory autoimmune diseases such as rheumatoid arthritis and lupus erythematosus may also cause lymphadenitis. The location of the affected nodes is usually associated with the site of the underlying infection, tumor, or inflammation; when infection occurs, the lymph node(s) and the area adjacent to the infection may also become swollen and inflamed. The enlarged node(s) tend to be tender to the touch and mobile, meaning that each individual node moves freely when touched.

Lymphadenopathy, which may include lymphadenitis, refers to any condition in which lymph nodes are abnormal either in size, consistency, or number; enlargement may be due to infection, inflammation, infiltration by certain types of cells, or abnormal cell proliferation (malignancies) as in leukemia, lymphoma, and neuroblastoma. The enlarged nodes in malignancies tend to be firm, rubbery, and nontender to the touch. Lymphadenopathy in children can also refer to a condition present since birth (congenital abnormality), such as cytomegalovirus (CMV) infection.

Some of the causes of lymphadenopathy are obvious, as with the individual who presents with a sore throat, tender lymph nodes in the neck area (cervical nodes), and a positive strep test. In other cases, the etiology is less clear, as with the individual who only presents with symptoms of swollen lymph nodes in the groin (inguinal nodes). Such presentation often raises the specter of serious illnesses like cancer of the lymphatic system (lymphoma), acquired immunodeficiency syndrome (AIDS), secondary cancer that has spread from some other primary source (metastatic cancer), lymphomatoid granulomatosis, or Castleman's disease. Swollen cervical nodes can also signal a more serious disease; Kawasaki syndrome, for example, is a childhood disease characterized by cervical lymphadenopathy, fever, and serious complications that can affect heart function. Lymphadenopathy has also been associated with exposure to industrial chemicals or certain antiseizure medications that have been associated with enlarged nodes. Adverse drug reactions can sometimes cause lymphadenopathy, resulting in a syndrome that includes regional or generalized lymph node enlargement, rash, fever, an enlarged spleen and liver, jaundice, and anemia; drugs associated with this reaction include phenytoin, mephenytoin, pyrimethamine, phenylbutazone, allopurinol, and isoniazid (Kanwar). In addition, certain anti-infective drugs, including cephalosporins, penicillins, or sulfonamides, have been associated with enlarged lymph nodes and other symptoms such as fever and rash that may resemble Hodgkin's disease.

Incidence and Prevalence: The exact incidence of lymph node disorders is not known because recorded data usually relate to the associated disease, not to enlargement of nodes or lymphadenopathy. Lymphadenopathy is estimated to occur in 38% to 45% of children, primarily in response to infection (Kanwar).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The most common causes of lymphadenopathy are viral and bacterial infections, especially upper respiratory infections. Age, gender, and race are not significant risk factors, although children are more subject to lymphadenopathy associated with frequent viral infections (Kanwar). The use of certain antibiotics and drug therapies may increase the risk of lymphadenopathy. Exposure to industrial chemicals may also increase the risk in some individuals.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with lymph node disorders may report lymph nodes that are tender, swollen, and hard. If an abscess has formed in the lymph node, it may feel rubbery. The individual may report fever, malaise, sore throat, or cough. There may be a history of recent travel, exposure to industrial chemicals, or contact with individuals with viral or bacterial infections. Because the differential diagnosis of lymphadenopathy is extremely broad, a history of prior illness is important and may include viral infections such as mononucleosis (Epstein-Barr virus), cytomegalovirus, or HIV; autoimmune diseases such as rheumatoid arthritis, lupus erythematosus, or accumulation of macrophages (histiocytoses); or lipid storage diseases in which lipids accumulate in the spleen, liver, lymph nodes, and central nervous system (e.g., Gaucher disease or Niemann-Pick disease). A history of medication use is also important since drug reactions may include lymphadenopathy.

Physical exam: The size, location, and character of lymphadenopathy will be evaluated, as well as other physical findings such as fever, anorexia, aches and pains, weight loss, and night sweats suggestive of more serious lymphadenopathy. On examination, affected lymph nodes and / or vessels are palpable. There may be redness (erythema) or evidence of trauma around the node suggesting lymphadenitis. Acutely infected lymph nodes may be warm, tender, and swollen upon palpation. Nodes that are firm and nontender may suggest malignancy, warranting a complete physical examination. A single node or multiple lymph nodes may be affected. The focus of infection or inflammation may be revealed by examining the area drained by the affected lymph nodes (lymph drainage system).

Tests: A lymph node disorder is a sign of underlying disease. The individual’s history, symptoms, and physical examination are used to determine the source of infection. Diagnostic testing is aimed at confirming the source of infection, inflammation, and lymphadenopathy and will vary based on physical findings. Lymph node aspiration, culture, and biopsy may be needed. Throat or blood culture may be performed to identify causative organisms. Blood tests (complete blood cell count, or CBC) are performed, along with peripheral smear examination to look for the presence of abnormal cells. Blood chemistries and urinalysis may be performed to evaluate liver and kidney function. Serologies may be performed to rule out venereal disease such as syphilis. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be useful in identifying the extent of the inflammation. Tests to identify specific viruses and organisms such as Epstein-Barr virus, cytomegalovirus, HIV, Bartonella henselae, and Toxoplasma species may be needed. Chest x-ray is typically performed to screen for abnormal chest findings and, if positive, is followed by diagnostic ultrasound or CT scans to investigate which disease may be causing lymph node involvement in the lungs, such as tuberculosis, pneumonia, coccidioidomycosis, histiocytoses, Gaucher disease, or non-Hodgkin’s lymphoma or Hodgkin’s disease. Additional laboratory studies such as node biopsy for flow cytometry and chromosome studies may be needed if other tests suggest malignancy. Simple, rapid fine needle aspiration (FNA) biopsy is used extensively in adults to determine the etiology of lymphadenopathy; the sensitivity and specificity of FNA biopsy is 90% effective in identifying the cause of lymph node involvement (Gow). Surgical removal of lymph nodes to confirm the etiology of enlargement is another common practice when infection has been ruled out as a cause.

Source: Medical Disability Advisor



Treatment

Treatment for lymph node disorders depends on the identified cause of lymphadenopathy. When an infection is diagnosed as the underlying cause, specific antibiotics are usually administered for bacterial causes such as strep infection, and antiviral drugs or corticosteroids may be given for viral infections, although in most cases conservative treatment such as bed rest and increased fluid intake is preferred to drug therapies. Anti-inflammatory medications may be used to reduce inflammation and swelling. Aspirin may be recommended as a fever-reducing (antipyretic) medication. When swollen nodes cause tissue degeneration, infection, and the formation of a localized collection of pus buried within the nodes (abscess), surgical drainage of abscesses may be required. Drug-related adenopathy is treated by discontinuing the causative drug therapy. Consultation with a hematologist or oncologist may be needed if malignancy is suspected.

Source: Medical Disability Advisor



Prognosis

In individuals with malignant disease, the prognosis depends on the specific disease. In individuals with bacterial infection, complete recovery may be expected with prompt antibiotic treatment. Recovery time will vary, depending on the underlying cause. It may take a period of time for swelling to completely disappear.

Source: Medical Disability Advisor



Complications

Complications of lymphadenopathy itself include abscess formation, cellulitis, fistula formation, or sepsis. Most complications, however, are related to the underlying disease process. Lymphadenopathy in the chest area (mediastinal adenopathy) can lead to life-threatening complications such as superior vena cava syndrome that obstructs blood flow; bronchial, tracheal, or respiratory tract obstruction; and esophageal compression. Metabolic complications occur in malignant lymphadenopathies, especially kidney problems such as uric acid nephropathy, electrolyte disturbances (i.e., hyperkalemia, hypercalcemia, hypocalcemia, hyperphosphatemia) and renal failure. Abdominal lymphadenopathy can result in back pain or abdominal pain, constipation, and increased urination. The infolding of one intestinal segment into another (intussusception) because of obstruction by abdominal lymph nodes can be life-threatening.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restriction of work activities (usually temporary) may be indicated, depending on the degree of weakness, the general ill health experienced by the individual, and the degree of recovery expected. If the individual is especially fatigued, he or she may need less strenuous or part-time work. If the individual experiences pain, he or she may benefit from avoiding aggravating movements or positions. Accommodations at work may temporarily include an allotment of time and space for quiet rest periods.

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:

  • Has underlying cause of lymphadenopathy been identified and confirmed?
  • Is condition due to infection as a result of bacteria, viruses, fungi, or other organisms?
  • Have the following underlying conditions been investigated or confirmed? Lymphoma, HIV infection, mononucleosis, toxoplasmosis, non-Hodgkin's lymphoma, Epstein-Barr virus, cytomegalovirus, cat-scratch disease, tuberculous lymphadenitis, secondary syphilis, hepatitis B, lymphogranuloma venereum, chancroid, lupus erythematosus, rheumatoid arthritis, leukemia, sarcoidosis, Kawasaki disease, Gaucher disease, Niemann-Pick disease, pelvic malignancies, head-and-neck malignancies, and lung malignancies?

Regarding treatment:

  • If treatment was delayed, what were the criteria for doing so?
  • Did individual undergo a period of observation if clinical signs were reassuring?
  • Is a biopsy now appropriate?
  • Have infection and inflammation been effectively resolved?
  • Has a culture and sensitivity test been done to determine the most effective antibiotic to be used?
  • Was causative agent antibiotic-resistant?
  • If condition has persisted past what is expected for viral resolution, does diagnosis need to be revisited?
  • If infected nodes caused an abscess, was surgical drainage required?
  • Was surgical drainage effective?

Regarding prognosis:

  • Is the underlying illness being effectively resolved or managed?
  • Is delayed recovery due to complication of lymphadenopathy by abscess formation, cellulitis, or sepsis?
  • If treatment of infection has not been as effective as expected, has a culture and sensitivity test been done to determine the most effective antibiotic to be used?
  • Have antibiotic-resistant organisms been ruled out?
  • Is the etiology of generalized lymphadenopathy a malignant or systemic disease, such as lymphoma, AIDS, or leukemia?
  • Has individual experienced any complications related to the underlying illness, such as metabolic complications, electrolyte disturbances, renal failure, constipation, increased urination, or intussusceptions?
  • What is prognosis for the underlying condition?
  • Is underlying cause due to environmental substances, medications, or drugs that can be avoided?
  • Can alternate medications be used instead?
  • Would protective clothing or a change in occupational environment be beneficial?

Source: Medical Disability Advisor



References

Cited

Gow, Kenneth W. "Lymph Node Disorders." eMedicine. Eds. Aviva L. Katz, et al. 14 Jan. 2008. Medscape. 12 Aug. 2009 <http://emedicine.medscape.com/article/937855-overview>.

Kanwar, Vikramjit S., and Richard H. Sills. "Lymphadenopathy." eMedicine. Eds. Gary J. Noel, et al. 12 May. 2009. Medscape. 12 Aug. 2009 <http://emedicine.medscape.com/article/956340-overview>.

Source: Medical Disability Advisor






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