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.

Pyloric Stenosis, Acquired (Adult) Hypertrophic


Related Terms

  • Acquired Hypertrophic
  • Acquired Hypertrophic Pyloric Stenosis
  • Adult Hypertrophic Pyloric Stenosis
  • AHPS
  • Pyloric Constriction
  • Pyloric Obstruction
  • Pyloric Stenosis

Differential Diagnosis

  • Pyloric tumor
  • Scarring from ingestion of caustic agents

Specialists

  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by underlying conditions, individual's response to treatment, extent of treatment, and presence of complications.

Medical Codes

ICD-9-CM:
537.0 - Acquired Hypertrophic Pyloric Stenosis

Overview

Adult or acquired hypertrophic pyloric stenosis (AHPS) is a disorder that occurs when the opening (pylorus) between the stomach and the first part of the small intestine (duodenum) becomes partially or completely blocked. This occurs when the pyloric muscle (muscularis propria) has increased in size (hypertrophy) and its cells have abnormally multiplied (hyperplasia). This results in inflammation, swelling (edema), and mononuclear cell infiltration. Primary AHPS can occur without any apparent cause (idiopathic). Secondary AHPS results from other problems in the gastrointestinal tract. Conditions that may put an individual at risk for secondary AHPS include prolonged pylorospasm, pyloric ulcer, hiatal hernia, inflammation of the stomach (gastritis), gallbladder disease, and stomach cancer (gastric carcinoma).

The terms "acquired" and "adult" are used when describing this disorder to differentiate it from the more common congenital or infantile hypertrophic pyloric stenosis (IHPS). Some researchers suggest that having the infantile condition may predispose an individual to primary AHPS later in life. AHPS is uncommon and was not recognized as a distinct disorder until 1930.

Incidence and Prevalence: The infant form of the disease (IHPS) occurs in between 1.5 and 5 per 1,000 live births. In the US, it is most common in whites, and less prevalent in blacks and Asian Americans (Beals). AHPS occurs far less frequently than IHPS.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The reasons why either infants or adults develop hypertrophic pyloric stenosis are unclear. Having the similar condition as an infant (IHPS) may increase chances of developing the disorder as an adult. Male infants are 4 times more likely than female infants to have this condition (Feldman 685), with firstborn white males at highest risk (Beals). Twin studies also suggest that there appears to be a genetic component to HPS (Irish).

Source: Medical Disability Advisor



Diagnosis

History: Individuals often do not report any symptoms. But when symptoms do occur, they may be episodic or persistent. The individual often reports weight loss, a feeling of fullness after just beginning to eat (early satiety), loss of appetite (anorexia), gradual increase of upper abdominal pain that occurs over weeks to months, nausea, and frequent vomiting. Many individuals with obstruction have a long history of peptic ulcers, pylorospasms, or other stomach (gastric) problems.

Physical exam: The upper abdomen may be tender and the individual may be dehydrated. There is generally no mass in AHPS that can be felt from outside the abdomen.

Tests: Blood and urine analyses are important, establishing the individual's electrolyte balance and extent of dehydration. X-rays taken after barium has been swallowed (barium swallow) may reveal an elongated and thickened pylorus and a markedly increased stomach emptying time. An internal examination of the stomach and upper area of the small intestine using a flexible fiber optic instrument (endoscopy) is generally performed.

Source: Medical Disability Advisor



Treatment

Treatment for AHPS is surgical. The condition is structural and medications are not effective except as needed for underlying gastrointestinal conditions such as an ulcer. If the individual experiences swelling and spasms, initial treatment usually involves passing a tube through the nose into the stomach (NG, or nasogastric tube) to remove its contents (nasogastric suctioning). This may be done for several days until symptoms subside. Once improvement is noted, surgery is performed to remove the pylorus (partial gastrectomy). Endoscopic balloon dilations are also sometimes used to stretch and open the pylorus. However, recurrence rate is high.

Source: Medical Disability Advisor



Prognosis

Symptoms of AHPS generally resolve after partial gastrectomy. The long-term outcome, however, depends on the treatment of any underlying gastrointestinal disorder. Increased size (hypertrophy) as a result of ulcer scarring or other conditions may recur unless these problems are corrected.

Source: Medical Disability Advisor



Complications

Surgical infection can complicate recovery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals requiring surgery may need to be temporarily assigned lighter duties on return to work.

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 diagnosis of acquired hypertrophic pyloric stenosis been confirmed?
  • Have other conditions with similar symptoms been ruled out?
  • Is AHPS secondary to another gastrointestinal disorder?

Regarding treatment:

  • Was partial gastrectomy, the treatment of choice for AHPS, done? If not, what are the extenuating circumstances?
  • Did surgery effectively relieve symptoms?
  • Did individual experience any surgical complications such as infection?
  • Are complications responding to treatment?
  • Is individual following doctors' orders for postsurgical recovery?
  • Does individual have coexisting conditions, such as ulcer, hiatal hernia, gallbladder disease, or cancer of the stomach, duodenum, or pancreas, that may complicate treatment or impact recovery? Are these conditions being adequately addressed in the overall treatment plan?

Regarding prognosis:

  • Do symptoms persist despite treatment?
  • Has hypertrophy recurred as a result of uncorrected ulcer scarring or other condition?

Source: Medical Disability Advisor



References

Cited

Beals, Daniel A. "Pyloric Stenosis, Hypertrophic." eMedicine. Eds. Jeffery J. DuBois, et al. 11 Dec. 2002. Medscape. 1 Feb. 2005 <http://emedicine.com/ped/topic1103.htm>.

Feldman, M., L. S. Friedman, and M. H. Sleisenger, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 7th ed. Philadelphia: W.B. Saunders, 2002.

Irish, Michael. "Hypertrophic Pyloric Stenosis: Surgical Perspective." eMedicine. Eds. A. Katz, et al. 30 May. 2003. Medscape. 1 Feb. 2005 <http://emedicine.com/ped/topic/2965.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.