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.

Splenomegaly

splenomegaly in العربية (مصر)

Related Terms

  • Enlarged Spleen
  • Hypersplenism
  • Spleen Enlargement

Differential Diagnosis

  • Alpha thalassemia
  • Angioimmunoblastic lymphadenopathy
  • Bacterial sepsis
  • Banti disease
  • Berylliosis
  • Beta thalassemia
  • Budd-Chiari syndrome
  • Cirrhosis
  • Congestive heart failure (CHF)
  • Drug reaction with serum sickness
  • Gaucher's disease
  • Hereditary spherocytosis
  • Histiocytosis X
  • Histoplasmosis
  • Hodgkin disease
  • Hyperlipidemia
  • Idiopathic splenomegaly
  • Immune hemolytic anemia
  • Immune thrombocytopenic purpura
  • Infectious mononucleosis
  • Infective endocarditis
  • Iron deficiency anemia
  • Leishmaniasis
  • Leukocyte disorders
  • Lupus
  • Lymphomas
  • Malaria
  • Mucopolysaccharidosis
  • Myeloproliferative disease
  • Niemann-Pick disease
  • Ovalocytosis
  • Portal vein obstruction
  • Primary thrombocytosis
  • Sickle cell anemia
  • Splenic abscess
  • Splenic vein obstruction
  • Symptomatic HIV infection
  • Trypanosomiasis
  • Tuberculosis
  • Viral hepatitis

Specialists

  • General Surgeon
  • Hematologist
  • Internal Medicine Physician

Comorbid Conditions

  • Anemia
  • Bleeding disorders
  • Immune system disorders
  • Leukemia
  • Lymphoma

Factors Influencing Duration

The individual's age, the underlying condition, the type of treatment required, and the response to the treatment will influence the length of disability.

Medical Codes

ICD-9-CM:
789.2 - Splenomegaly; Enlargement of Spleen

Overview

The term "splenomegaly" refers to abnormal enlargement of the spleen, an abdominal organ that is part of the lymph system and has many immune system and circulatory functions. The spleen plays a key role in manufacturing antibodies to fight inflammation and infection, cleansing the blood of foreign material, and producing red and white blood cells. Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system; bacterial, viral and parasitic infections; malignancies; and liver disease.

The enlargement may be due to one or more of the following conditions: cirrhosis of the liver; infectious inflammatory diseases such as mononucleosis and hepatitis; chronic infections such as syphilis, tuberculosis, and malaria; diseases of the bone marrow; hemolytic anemias; cancers such as leukemia, lymphoma and Hodgkin's disease; diseases of the metabolic system; cystic fibrosis; biliary atresia; sclerosing cholangitis; Wilson's Disease; Banti's syndrome; liver disease; primary thrombocytosis; or trauma. However, in nearly 5% of individuals with enlarged spleens, no underlying cause can be determined.

Incidence and Prevalence: Recent studies revealed that 2% to 5.6% of individuals have a large spleen on physical exam; in Africa, tropical splenomegaly is very common (Kaplan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women are twice as likely as men to get tropical splenomegaly, and enlarged spleens occur more often in older people (Kaplan).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report a history of chronic or acute infectious disease, inflammatory and connective tissue disorders, or liver conditions. They may complain of left upper quadrant abdominal pain; early appetite satisfaction (feeling full immediately upon eating); and recent, unintentional weight loss.

Physical exam: Physical exam may reveal signs and symptoms of an infectious or inflammatory process, such as fever, rapid heart rate, fatigue, tender and/or swollen lymph nodes, and abdominal distention. The edge of the spleen may be felt (palpated) when examining the left upper abdomen. Abnormal swooshing sounds (bruits) may be heard when using a stethoscope to listen (auscultate) over the region of the spleen.

Tests: Laboratory tests include blood chemistries, bone marrow examination, and complete blood and platelet count. Imaging studies include ultrasound, CT scan, abdominal x-ray, splenic scan with technetium, and splenic uptake studies. A biopsy of the spleen may be done if cancer is suspected; because the spleen tends to bleed profusely, the biopsy is usually done in association with an open surgical exploration of the abdomen (exploratory laparotomy) and partial or total removal of the spleen (splenectomy). A reliable biopsy cannot be obtained via laparoscopic splenectomy because the tissue is damaged when removed through the laparoscope.

Source: Medical Disability Advisor



Treatment

Most individuals with splenomegaly require treatment for the underlying disease. Medical interventions such as administration of medications for underlying infections and possible radiation therapy (to shrink the enlarged organ) are used as appropriate. The spleen is surgically removed (splenectomy) only via open abdominal surgery (laparotomy) when medically necessary, when it is markedly enlarged, and when other treatments are not effective. A splenectomy may also be done to assess the rate of disease progress (staging) if it is cancerous.

Source: Medical Disability Advisor



Prognosis

Outcome can be good for splenomegaly associated with acute infections that have been adequately treated or poor, depending upon the underlying disease process and treatment required. Those whose splenomegaly is associated with chronic conditions such as immune system depression or cancer tend to have a poorer outcome. However, due to the wide range of conditions associated with splenomegaly, it is impossible to determine the exact outcome for those with splenomegaly. Surgical outcomes following splenectomy are usually good. Those who have underlying bleeding disorders may have more bleeding complications; they usually resolve quickly once the spleen is removed. Individuals who have a complete splenectomy will be susceptible to sudden death from infectious causes, and should receive proper immunization for pneumococcus, influenza, hepatitis, and meningococcemia.

Source: Medical Disability Advisor



Complications

Complications relate to the underlying condition responsible for the splenomegaly. Spontaneous rupture of an enlarged spleen is rare; however, such ruptures can result in massive bleeding and shock. Enlarged spleens may easily rupture and bleed during laparoscopy. In general, spleens that rupture during laparoscopy are promptly removed (splenectomy), which eliminates the source of the bleeding and minimizes the risk for shock. Postsplenectomy infection has a very high death rate of 50% to 70%; it falls to 10% if the individual receives antibiotic treatment quickly (Kaplan). Death from bacterial sepsis may occur years after a splenectomy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are made based on the underlying condition, the type of treatment required, and the individual's physical response to treatment. Anyone with an enlarged spleen is at risk for its accidental rupture and possible hemorrhage. Consequently, strenuous activity, contact sports, and heavy lifting should be avoided until the spleen returns to a normal size or is removed.

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 splenomegaly been confirmed?
  • Have other conditions (tumors in the left upper abdomen or fluid in the abdomen (ascites) been ruled out?
  • Has the cause of spleen enlargement been identified?
  • Is underlying condition being appropriately addressed?

Regarding treatment:

  • Have medical interventions, such as rest, good nutrition, administration of medications for underlying infections, and possible radiation therapy, been successful?
  • If surgical intervention was necessary, for what purpose was the splenectomy performed? Were any complications associated with the procedure?

Regarding prognosis:

  • Have underlying conditions responded favorably to treatment?
  • If symptoms persist despite treatment, does diagnosis need to be revisited?
  • Has condition for which splenectomy was performed improved or resolved with removal of spleen?
  • What additional therapy may be required?
  • Is individual compliant with vaccinations for pneumococcus, influenza, hepatitis, and meningococcemia?

Source: Medical Disability Advisor



References

Cited

Kaplan, Lewis J., and David Coffman. "Splenomegaly." eMedicine. Eds. Wadie F. Bahou, et al. 5 Oct. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/med/topic2156.htm>.

Source: Medical Disability Advisor






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