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.

Pancreatitis


Related Terms

  • Acute Pancreatitis
  • Chronic Pancreatitis
  • Pancreatic Inflammation

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

  • Alcoholism
  • Diabetes mellitus
  • Hypertriglyceridemia

Factors Influencing Duration

Degree of severity (extent of resection), type of treatment, the individual's age and health status, presence of complications, and the ability of the individual to abstain from alcohol and from tobacco smoking affect the length of disability.

Medical Codes

ICD-9-CM:
577.0 - Pancreatitis, Acute; Abscess of Pancreas; Necrosis of Pancreas
577.1 - Pancreatitis, Chronic
577.2 - Pancreatic Cyst and Pseudocyst

Overview

Pancreatitis is an inflammation of the pancreas, an organ located in the abdominal cavity behind the stomach. The pancreas normally secretes enzymes that aid in digestion and the hormones insulin and glucagon, which help regulate blood sugar (glucose) levels. With pancreatitis, the digestive enzymes become overactive, damaging pancreatic tissue.

There are two types of pancreatitis, acute and chronic. Acute pancreatitis is a sudden, usually painful, inflammation of the pancreas that often resolves without permanent damage to the organ. Nevertheless, recurrent attacks of acute pancreatitis can lead to progressive deterioration of pancreatic structure and function. Chronic pancreatitis occurs when the pancreas is continually inflamed, resulting in irreversible damage from scar tissue formation (fibrosis) and calcification of the organ.

Incidence and Prevalence: The incidence of acute pancreatitis is 40 cases per 100,000 population (Khoury), resulting in 210,000 hospital admissions annually ("Pancreatitis").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Acute pancreatitis is caused by alcohol consumption in approximately 60% to 70% of cases (Obideen). Individuals who abuse alcohol, smoke tobacco, and those with gallbladder disease (cholelithiasis) are at the highest risk for pancreatitis (Khoury, Obideen). Pancreatitis also may be caused by prescription drugs, peptic ulcer disease, surgical complications, viral or bacterial infections, intestinal parasites, autoimmune disease (e.g., Sjögren's syndrome), direct trauma to the abdomen or back, and obstruction of the pancreatic duct due to pancreatic cancer, gallstone formation, structural abnormalities, or excessive calcium or fats in the blood (Khoury).

The risk of developing pancreatitis varies among ethnic groups in the US, occurring in 4 per 100,000 Native Americans, 5.7 per 100,000 whites, and 20.7 per 100,000 African-Americans each year (Khoury). African-Americans between the ages of 35 and 64 have a risk of developing pancreatitis that is 10 times higher than any other group (Khoury). Males are slightly more than twice as likely to develop pancreatitis as females (Obideen).

Source: Medical Disability Advisor



Diagnosis

History: Pain is the most common symptom reported in acute pancreatitis. Pain can be severe and usually involves the epigastric region on the right or left upper quadrant of the abdomen, depending on which portion of the pancreas is affected (Gardner). The pain can radiate through the abdomen to the back. Frequently, individuals with acute pancreatitis report nausea and vomiting, fever and diarrhea. Individuals may describe a transient reduction in symptoms when lying face-up (supine) (Gardner). Individual may report a history of previous episodes of gastritis, gallstones, or binge alcohol consumption.

The abdominal pain of chronic pancreatitis is less severe and is usually more a dull ache. It typically is sporadic in nature. Individuals with chronic pancreatitis may report diarrhea and weight loss despite adequate nutrition. They may also report a reduction in symptoms when lying on the left side in a fetal position (Obideen).

Physical exam: Individuals with acute pancreatitis often have low-grade fevers (76% of cases), rapid heart rate (tachycardia) (65% of cases), rapid respiration (tachypnea), and low blood pressure (hypotension). Abdominal tenderness with muscular guarding and distension occurs in 65% to 68% of cases, and a yellowish skin tone (jaundice) is present in 28% of cases (Gardner). Many individuals have decreased or absent bowel sounds. In severe cases, leaking of blood (hemorrhage) from the pancreas will cause bluish discoloration of the flanks (Grey Turner sign) or of the periumbilical area (Cullen sign). The physical exam is less useful in diagnosing chronic pancreatitis because the intensity of the symptoms varies widely, and often the individual sees the doctor between episodes.

Tests: Blood tests for infection and pancreatic function include complete blood count (CBC), blood glucose, blood urea nitrogen (BUN), creatinine, electrolytes, serum amylase and lipase, and serum bilirubin. A serum trypsin test and urine test for para-aminobenzoic acid (Chymex test) can reveal residual pancreatic function in chronic cases. Computed tomography (CT) and magnetic resonance imaging (magnetic resonance cholangiopancreatography) help in the visualization of the pancreas. X-rays and ultrasound also may be useful; in some cases, ultrasound may be performed internally through a flexible tube inserted into the small intestine (endoscopic ultrasound) to visualize the pancreas, gallbladder, and bile duct.

Source: Medical Disability Advisor



Treatment

Treatment for acute and mild pancreatitis is aimed only at nutritional support and maintaining normal blood chemistry using intravenous (IV) fluids with careful monitoring until the inflammation subsides. No food is taken by mouth during the episode; nutrition is provided through a tube inserted into the stomach (nasogastric tube, NG tube) or proximal intestine (nasojejunal tube, NJ tube). An NG suction tube also may be used to remove fluids and air from the stomach and to counteract vomiting. Oxygen ventilation may be performed. After the inflammation subsides, the IV and NG or NJ tube are discontinued, and the individual resumes regular eating. If acute pancreatitis is severe, treatment takes place in an intensive care unit (ICU) of a hospital. In some cases, antibiotics may be given.

Treatment of chronic pancreatitis is directed at the control of pain and replacement of pancreatic enzymes that aid in the absorption of nutrients. Control of pain begins with avoidance of alcohol and tobacco smoking. Analgesics, enzyme therapy, and, sometimes, endoscopic therapy are then used to relieve obstructions.

Surgical treatment is indicated in individuals who fail to improve with medical treatment, in those with excessive bleeding from the pancreas (hemorrhagic pancreatitis), and in those with infection of the pancreas. Individuals with painful, persistent fluid (pancreatic pseudocyst) may need to have the fluid drained (percutaneous aspiration). In cases of infection of the pancreas, abscesses are drained and necrotic tissue removed. In hemorrhagic pancreatitis, surgical procedures to cauterize or tie off (ligate) blood vessels are performed. A blood transfusion may be necessary. Procedures that remove (resect) part of the pancreas and adjacent ducts often are performed. If pancreatic disease is localized to the head of the pancreas, a pancreaticoduodenectomy (Whipple procedure) can selectively remove the diseased portion. In very severe cases, total removal of the pancreas (total pancreatectomy) with islet autotransplantation may be performed. Individuals with pancreatitis caused by gallstones may need surgery to remove the stones (cholecystectomy). A less invasive procedure called therapeutic endoscopic retrograde cholangiopancreatography (ERCP) can be used in acute or chronic pancreatitis to endoscopically remove some gallstones, open narrowed pancreatic or bile ducts, and remove pancreatic pseudocysts.

Source: Medical Disability Advisor



Prognosis

Eighty percent of pancreatitis cases treated conservatively will resolve without surgical intervention (Khoury). In mild pancreatitis where inflammation is confined to the organ itself, the condition usually results in no permanent damage and prognosis is excellent, with a mortality rate of less than 1% (Khoury). Severe acute pancreatitis resulting in hemorrhage or damage to other organs occurs in 20% of cases, in which mortality can reach 30% (Khoury). With acute pancreatitis, the overall mortality rate is 10% to 15% (Gardener).

Acute pancreatitis is graded according to a system called the Ranson score. This is based on the individual's age, disease progression, and results of a variety of lab tests. A Ranson score of 0 to 2 has a minimal mortality rate; a Ranson score of 3 to 5 has a 10% to 20% mortality rate; a Ranson score of 5 or higher has a 50% mortality rate (Khoury).

In chronic pancreatitis, recurrent attacks tend to become progressively more severe, especially if the individual is not compliant with recommendations to avoid alcohol, tobacco smoking, and to modify diet. One-third of individuals with chronic pancreatitis will develop diabetes mellitus (Obideen). The mortality rate with chronic pancreatitis is 30% at 10 years and 55% at 20 years after diagnosis (Obideen). By 20 years, the risk of pancreatic cancer is 4% (Obideen).

Surgical intervention usually is successful, with low mortality rates; pain reduction occurs in 82% of individuals (Obideen). However, as a result of surgery, individuals will require life-long pancreatic enzyme supplementation and many develop insulin-dependent diabetes.

Source: Medical Disability Advisor



Complications

Acute pancreatitis may be complicated by infections from pancreatic fluid collections in the abdominal cavity (ascites), accumulation of fluid in the chest (pleural effusion), formation of a pseudocyst (80% of cases), abscesses, death of pancreatic tissue (necrosis), and cysts forming channels (fistulas) to other body organs (Obideen). Other possible complications are bleeding into the gastrointestinal tract, intestinal obstruction, bile duct obstruction, splenic vein blood clots (thrombosis), and excessive loss of fats in the feces (steatorrhea). Other complications may include weight loss, abdominal pain, fatigue, and diabetes. In intractable cases, circulating toxins may cause systemic failure due to septic shock.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may need temporary reassignment to modified duty or to switch to part-time work. Heavy lifting restrictions may be necessary for a minimum of 6 weeks. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

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 have severe abdominal pain and tenderness? Low-grade fever, elevated pulse rate, low blood pressure, jaundice, or rapid respiration?
  • Did individual report nausea, vomiting, diarrhea, and weight loss?
  • Did individual have bluish discoloration of the flanks (Grey Turner sign)? Of the periumbilical area (Cullen sign)?
  • Was the abdominal pain dull rather than sharp?
  • Did individual report history of alcohol abuse or binge drinking? Tobacco smoking? Gallbladder disease?
  • Did individual receive adequate blood testing to establish the diagnosis? Was endoscopic ultrasound performed?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • If treated for acute and mild pancreatitis, is individual following treatment plan until inflammation subsides?
  • If acute pancreatitis was severe, was hospitalization required? Were NG suction tube and oxygen ventilation used? Intravenous fluids? NG or NJ tube feeding?
  • Did individual receive antibiotics?
  • If treated for chronic pancreatitis, is individual avoiding alcohol? Tobacco smoking? Was endoscopy needed? Analgesics or enzyme therapy?
  • Was surgery necessary? What procedure(s) was performed? Duct drainage? Percutaneous aspiration of pseudocyst? Pancreatic head resection (Whipple procedure)? Therapeutic endoscopic retrograde cholangiopancreatography (ERCP)? Total pancreatectomy?

Regarding prognosis:

  • What was individual's Ranson score?
  • Has individual become an insulin-dependent diabetic? Is diabetes being controlled?
  • Does individual need pancreatic enzyme supplementation?
  • Does individual have any comorbid conditions that may affect recovery?
  • Have complications occurred that could slow recovery and lengthen disability?
  • Would individual benefit from smoking cessation program?
  • Would individual benefit from treatment for alcohol abuse?

Source: Medical Disability Advisor



References

Cited

"Pancreatitis." National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). Jul. 2008. National Institutes of Health (NIH). 7 Oct. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis>.

Gardner, Timothy B., Brian S. Berk, and Paul Yakshe. "Pancreatitis, Acute." eMedicine. Eds. Tushar Patel, et al. 10 Jun. 2008. Medscape. 7 Oct. 2009 <http://emedicine.medscape.com/article/181364-overview>.

Khoury, Gattas, and Samer Deeba. "Pancreatitis." eMedicine. Ed. Jerome F.X. Naradzay. 26 Jan. 2009. Medscape. 7 Oct. 2009 <http://emedicine.medscape.com/article/775867-overview >.

Obideen, Kamil, Paul Yakshe, and Mohammad Wehbi. "Pancreatitis, Chronic." eMedicine. Eds. Tushar Patel, et al. 16 Jun. 2008. Medscape. 7 Oct. 2009 <http://emedicine.medscape.com/article/181554-overview>.

Source: Medical Disability Advisor






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