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.

Peritonitis


Related Terms

  • Dialysis-associated Peritonitis
  • Inflammation of the Peritoneum
  • Secondary Peritonitis
  • Spontaneous Peritonitis

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Gastroenterologist
  • General Surgeon
  • Gynecologist
  • Infectious Disease Internist
  • Nephrologist
  • Pulmonologist

Comorbid Conditions

  • Alcoholism
  • Cirrhosis
  • Hepatitis
  • Leukocytosis
  • Malnutrition

Factors Influencing Duration

Factors that might influence the length of disability include the underlying condition causing peritonitis, the individual's age, duration of disease prior to treatment, type of treatment and response to it, job requirements, and any complications.

Medical Codes

ICD-9-CM:
567 - Peritonitis and Retroperitoneal Infections
567.0 - Peritonitis in Infectious Diseases Classified Elsewhere
567.1 - Peritonitis, Pneumococcal
567.8 - Peritonitis, Other Specified
567.81 - Peritonitis, Other Specified, Choleperitonitis; Peritonitis Due to Bile
567.82 - Peritonitis, Other Specified; Sclerosing Mesenteritis; Fat Necrosis of Peritoneum; (Idiopathic) Sclerosing Mesenteric Fibrosis; Mesenteric Lipodystrophy; Mesenteric Panniculitis; Retractile Mesenteritis
567.89 - Peritonitis, Other Specified; Chronic Proliferative Peritonitis; Mesenteric Saponification; Peritonitis Due to Urine
567.9 - Peritonitis, Unspecified

Overview

Peritonitis is an acute or chronic inflammation of the membrane (peritoneum) that lines the wall of the abdomen and covers the abdominal organs.

Peritonitis is caused by an invasion of bacteria or foreign matter following rupture of an internal organ, an infection in the bloodstream, an infection originating elsewhere in the body, a penetrating injury to the abdominal wall, or an accidental contamination during surgery.

There are three types of peritonitis: spontaneous peritonitis, secondary peritonitis, and dialysis-associated peritonitis. Risk factors for spontaneous peritonitis include liver disease (cirrhosis) caused by alcoholism or other liver conditions, a group of kidney diseases (nephrotic syndrome), ulcer disease, appendicitis, and diverticulitis. Risk factors for secondary peritonitis include a perforation in the gastrointestinal tract (e.g., perforated bowel or ruptured appendix), and severe chemical reactions from bile or pancreatic enzymes as a result of injury to, or perforation of, the intestine or biliary tract. Dialysis-associated peritonitis occurs when bacteria (most commonly pneumococci and staphylococci) are introduced into the peritoneum by the dialysis procedure.

Source: Medical Disability Advisor



Diagnosis

History: The individual will present with complaints of abdominal pain, abdominal distension, fever, and excessive thirst. The individual may also complain of low urine output and an inability to pass gas or feces. Many individuals will complain of a specific area of tenderness that they are able to touch or point out (point tenderness). Additional symptoms include nausea and vomiting, joint pain, and chills.

Physical exam: Physical examination will reveal abdominal pain to the touch (upon palpation), rebound tenderness, abdominal rigidity, increased heart rate (tachycardia), low blood pressure (hypotension), fever, decreased bowel sounds, an accumulation of fluid in the abdomen (ascites), and decreased respirations. Those with dialysis-associated peritonitis will have cloudy dialysis fluid.

Tests: Laboratory tests will include complete blood count (CBC) with differential; blood culture; peritoneal fluid culture, chemical analysis, and cell studies (cytology); urinalysis; and urine culture. Other diagnostic procedures may include chest and abdominal x-rays, and an ultrasound or CT scan of the abdomen and pelvis. Sometimes a surgical procedure called an exploratory laparotomy may be performed.

Source: Medical Disability Advisor



Treatment

The individual is usually hospitalized for treatment. Treatment depends on the underlying cause of the peritonitis. Surgery is sometimes necessary to remove an infected bowel, abscess, inflamed appendix, or other source of infection; or to repair sources of infection, such as a perforated ulcer. Either intravenous or intraperitoneal antibiotics will be given to control infection. Intravenous fluids will be given to control dehydration. A nasogastric (NG) tube will be placed to decompress the stomach, and narcotics and sedatives will be given to keep the individual comfortable and calm.

Source: Medical Disability Advisor



Prognosis

For dialysis-associated peritonitis, most individuals recover uneventfully with either intraperitoneal or intravenous antibiotics.

For spontaneous and secondary peritonitis, regardless of treatment modality, the outcome depends on the underlying cause of the disease and the duration of symptoms before treatment was begun. Complete recovery can occur, but in some cases the disease can be lethal. Individuals with spontaneous peritonitis due to cirrhosis have a 3-year mortality rate of 50% (Shah). Severe sepsis occurs in 11% of all individuals with peritonitis, and of these cases, 63% are fatal (Anaya).

Source: Medical Disability Advisor



Complications

Possible complications that may arise include development of abdominal abscesses, intestinal obstruction from scar tissue, secondary organ failure, septic shock, intraperitoneal adhesions, recurrent peritonitis, catheter tract infection (in those individuals with dialysis-associated peritonitis), and hepatic encephalopathy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If the individual underwent surgery, heavy lifting should be avoided for a minimum of 6 weeks.

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 complain of abdominal pain, abdominal distension, or excessive thirst?
  • Does individual have a medical history (i.e., peptic ulcer disease, recent gastrointestinal surgery, cirrhosis, or peritoneal dialysis, etc.) that may place him/her at increased risk for developing peritonitis?
  • Was abdomen rigid? Was there abdominal guarding?
  • Was a peritoneal tap done? Was a peritoneal culture positive?
  • Did an ultrasound or CT of the abdomen demonstrate findings consistent with the diagnosis of peritonitis? Were blood cultures positive?
  • If culture of dialysis fluid was appropriate, were results positive?
  • If the diagnosis was uncertain, were other possible conditions ruled out (e.g., constipation/fecal impaction, appendicitis, perforated ulcer)?

Regarding treatment:

  • Was individual given intravenous or intraperitoneal antibiotics?
  • Did individual require surgery? If so, what did the surgical exploration reveal?

Regarding prognosis:

  • What was the expected outcome?
  • Did individual have any complications, such as abscess formation, adhesions, sepsis, or multisystem organ failure that would impact recovery?
  • Does individual have any underlying conditions that could impact ability to recover (e.g., cirrhosis, malnutrition, or immune suppression)?

Source: Medical Disability Advisor



References

Cited

Anaya, D. A., and A. B. Nathens. "Risk Factors for Severe Sepsis in Secondary Peritonitis." Surgical Infections 4 4 (2003): 355-362.

Shah, Rahil, and Janice M. Spears. "Ascites." eMedicine. Eds. Robert J. Fingerote, et al. 22 Nov. 2004. Medscape. 19 Dec. 2004 <http//emedicine.com/med/topic173.htm>.

Source: Medical Disability Advisor






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