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.

Ulcerative Colitis


Related Terms

  • Idiopathic Proctitis
  • Inflammatory Bowel Disease
  • Rectosigmoiditis
  • Toxic Megacolon
  • Ulcerative Enterocolitis
  • Ulcerative Ileocolitis
  • Ulcerative Proctitis

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Disability is influenced by the severity of symptoms (frequency of diarrhea, enlarged colon, colon cancer) and whether hospitalization is needed to treat dehydration, infection, or other complications.

Medical Codes

ICD-9-CM:
556.0 - Ulcerative (Chronic) Enterocolitis
556.1 - Ulcerative (Chronic) Ileocolitis
556.2 - Ulcerative (Chronic) Proctitis
556.5 - Left-sided Ulcerative (Chronic) Colitis
556.6 - Universal Ulcerative (Chronic) Colitis; Pancolitis
556.8 - Other Ulcerative Colitis
556.9 - Ulcerative Colitis, Unspecified

Overview

© Reed Group
Ulcerative colitis is a serious, chronic inflammatory bowel disease (IBD) involving the large intestine (colon) and characterized by ulceration and episodes of bloody diarrhea.

Theories about what causes ulcerative colitis abound, but none has been proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestinal wall. Individuals with ulcerative colitis have abnormalities of the immune system, but physicians have not ascertained whether these abnormalities are a cause or a result of the disease. Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods (e.g., milk), but these factors have been shown to trigger or aggravate symptoms in some individuals.

Inflammation usually begins in the rectum, spreading upward into the lower intestine (sigmoid colon) and then on to the entire colon. Ulcerative colitis rarely affects the small intestine, except rarely, the lower section of the small intestine (ileum). Inflammation involves the mucosal and, to a lesser extent, the submucosal layers of the large intestine, causing the bowel to empty frequently (diarrhea). Tiny open sores (ulcers) form in places where inflammation has killed the cells lining the colon. The ulcers bleed and produce mucus and pus.

Ulcerative colitis varies widely in severity from mild (4 or fewer bowel movements per day, rectal bleeding, no fever, and normal blood counts) to severe (6 or more bowel movements per day, rectal bleeding, frequent blood in the stool, fever, and anemia).

Incidence and Prevalence: Annual incidence is 10.4 to 12 cases per 100,000 populations (Le). Prevalence of ulcerative colitis is 3 to 10 cases per 100,000 population (Khan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Ulcerative colitis may appear at any age, although it develops most often in young adults between the ages of 15 and 25 (Le). Individuals over age 55 also are slightly more likely to contract this disorder. Women are 30% more likely to develop ulcerative colitis than men (Le). The incidence of ulcerative colitis is highest in white individuals (Le).

The incidence of ulcerative colitis varies with geographic location, with a higher incidence of ulcerative colitis in zones with colder climates (Rowe). There appears to be a genetic component to the disease, with a positive family history increasing the risk; first-degree relatives are at 5 to 20 times greater risk for developing inflammatory bowel diseases such as ulcerative colitis and Crohn's disease (Rowe). People who smoke and those who have had an appendectomy have a lower rate of ulcerative colitis (Le).

Source: Medical Disability Advisor



Diagnosis

History: The most common symptoms of ulcerative colitis are abdominal cramps and bloody diarrhea. Affected individuals may report having to strain to produce stools (tenesmus), repeated bouts of bloody diarrhea alternating with constipation or symptom-free intervals, rectal urgency, rectal bleeding, fever, bloating, nausea and vomiting, an overall feeling of body discomfort (malaise), joint pain (arthralgias), night sweats, weight loss, and dehydration from loss of body fluids.

About half of individuals with ulcerative colitis experience severe symptoms such as frequent fever (as high as 104° F [40° C]), bloody diarrhea (from 10 to 20 bowel movements per day), nausea, and severe abdominal cramps. Other individuals experience less severe problems such as arthritis, inflammation of the eye, liver disease (e.g., fatty liver, hepatitis, cirrhosis, and primary sclerosing cholangitis), osteoporosis, skin rashes, anemia, and kidney stones.

Physical exam: The exam may reveal fever, dehydration, increased heart rate (tachycardia), extreme or unnatural paleness of the skin (pallor), joint tenderness, abdominal tenderness in the left lower quadrant upon exam, and anal tenderness and bleeding upon exam.

Tests: Tests to ascertain the presence of ulcerative colitis include a complete blood count (CBC) with differential, blood iron, and ferritin level; C-reactive protein; erythrocyte sedimentation rate (ESR); a blood test for liver, kidney, and electrolyte levels (Chem. 20); a liver enzyme test (gamma-glutamyl transpeptidase [GGTP]); a white-blood-cells-in-the-stool test (fecal leukocytes); a flat plate x-ray of the abdomen; a radiographic x-ray of the colon (barium enema); and an invasive procedure in which a scope is placed through the rectal opening and passed up into the colon (endoscopy). There are two kinds of colon endoscopies: the sigmoidoscopy and the colonoscopy. A sigmoidoscopy is a procedure in which a scope is used to view the sigmoid flexure, a part of the colon that is shaped like the letter S. In a colonoscopy, the entire colon is viewed. A colonoscopy with biopsy can confirm the diagnosis of ulcerative colitis. Computed tomography (CT) technology has improved to the point at which a CT scan of the abdomen may be performed.

Source: Medical Disability Advisor



Treatment

Treatment for ulcerative colitis depends on the seriousness of the symptoms. Most individuals are treated with aspirin-like anti-inflammatory drugs (e.g., aminosalicylates such as sulfasalazine [a sulfa drug], mesalamine, balsalazide, olsalazine) rectally or orally. Mild symptoms are managed with antidiarrheal drugs. Moderate symptoms may be treated with one of the aforementioned anti-inflammatory drugs. For severe symptoms, corticosteroids may be given orally or rectally along with immunosuppressant drugs (e.g., azathioprine, mercaptopurine, cyclosporine) for long-term therapy. Tumor necrosis factor inhibitors (e.g., infliximab) also may be necessary. When severe symptoms cannot be controlled through medication, the individual may need surgery to remove the diseased colon.

Surgery is the only cure for ulcerative colitis. One of several surgeries may be performed. The most common surgery is a proctocolectomy with ileostomy, which is done in two stages. In the proctocolectomy, the surgeon removes the colon and the rectum. In the ileostomy, the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine (ileum) to it. This type of ileostomy is called a Brooke ileostomy. Waste travels through the small intestine and exits the body through the stoma. A pouch worn over the stoma to collect the waste is emptied by the individual as needed. For younger individuals, an ileal pouch/anal anastomosis (IPAA) also may be performed, in which an ileostomy is connected to the anus after the rectal mucosa has been removed.

Some individuals whose symptoms are triggered by certain foods are able to control the symptoms by avoiding foods that upset their intestines, such as highly seasoned foods or milk sugar (lactose). Vitamin and mineral supplements and iron replacement may be given to compensate for decreased uptake in the intestines. For individuals with persistent abdominal cramping, eating cooked and skinned fruits and vegetables and eliminating raw fruits and vegetables are recommended. If diarrhea is present, the individual should avoid roughage in the diet. Stress reduction techniques also may help prevent flare-ups. Each individual may experience ulcerative colitis differently, so treatment is geared to addressing the individual's specific symptoms. In addition to medical care, emotional and psychological support is important.

Source: Medical Disability Advisor



Prognosis

Individuals who are treated with medication for minimal and moderate symptoms may have long periods of remission when symptoms disappear or are under control if they adhere to their medication regimen, watch their diet, and keep stress to a minimum. However, most often symptoms eventually return. On average, individuals with ulcerative colitis have a 50% chance of having their next flare within 2 years (Rowe).

Noncompliance with medical regimens can lead to progression of the disease, dehydration, infection, and overwhelming systemic infection (sepsis) that has a high mortality. If left to progress untreated over an undetermined period, ulcerative colitis may eventually lead to an enlarged colon (toxic megacolon) or colon cancer. Individuals with ulcerative colitis have an increased risk of developing colorectal cancer at a rate of 0.5% to 1% per year (Le); overall, cancer occurs in 3% to 5% of individuals (Khan).

The majority of individuals who advance to more extensive disease will do so within the first 5 years after diagnosis (Rowe). If ulcerative colitis is initially limited to the rectum at the time of diagnosis, fewer than 30% of individuals will go on to develop more extensive disease (Rowe). If ulcerative colitis involves the rectum and sigmoid colon, there is a 50% chance of more extensive disease progression; for these individuals, the rate of complete or partial surgical removal of the colon (colectomy) is 12% over 25 years (Rowe). If the entire colon is involved at the time of diagnosis, 60% will need to have the colon removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer (Rowe). Most individuals who are treated with surgery can expect a cure and a fairly normal life, provided they learn to live with caring for their ileostomy pouch.

Source: Medical Disability Advisor



Complications

Individuals can develop many complications, including rectal bleeding, life-threatening blood loss, ulceration through the intestinal wall, cancer of the colon or rectum, inflammation of various parts of the eye (e.g., conjunctivitis, iritis, uveitis, episcleritis), bone loss (osteoporosis), and arthritis of the knees, ankles, elbows, and wrists. Toxic megacolon occurs in up to 2% of individuals and may be caused by performing a barium enema in the presence of severe disease (Le). Stress may aggravate the disease. After 8 to 10 years of active disease, cancer of the colon may be found (Rowe).

Some individuals have periods of remission when the symptoms disappear. These may last for months or even years, but symptoms generally return. This changing pattern of the disease means one cannot always tell when a treatment has been effective.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If surgery is not performed, individuals may need time off from work for doctor's visits and short hospital stays when symptoms flare up. Individuals in whom stress causes increased symptoms may need to be transferred to a lower-stress job. Accommodations for immediate access to a nearby toilet will need to be made for individuals with recurrent diarrhea.

If surgery is performed, individuals will need a transfer to sedentary work for several weeks before returning to their usual work responsibilities. A leave of absence may be required for the surgery and for the postoperative therapy and rehabilitation that follow.

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:

  • What symptoms did individual report?
  • Was individual able to identify factors that trigger or aggravate the symptoms?
  • What is individual's age?
  • Was individual able to maintain hydration and electrolyte balance?
  • On exam, was there fever or evidence of dehydration? Was abdominal or anal tenderness present?
  • Were a complete blood workup and stool tests preformed?
  • Were x-rays done, both flat plate of the abdomen and barium enema?
  • Was endoscopy done? Biopsy? What were the results?
  • Were similar intestinal diagnoses considered and ruled out?

Regarding treatment:

  • Has individual had adequate trials of the various medications?
  • Did individual have surgery?
  • Is individual able to care for the stoma, or does individual need assistance?
  • Is individual compliant with the treatment program?
  • Is individual involved in a support group?
  • If needed, has individual obtained psychological counseling?
  • Has the disease progressed?
  • Has individual had periods of remission?

Regarding prognosis:

  • Is individual's employer able to make necessary accommodations as individual progresses back to normal work?
  • Does individual have any conditions that may affect recovery?
  • Has individual had any complications?
  • Would individual benefit from psychological counseling?

Source: Medical Disability Advisor



References

Cited

Khan, Ali Nawaz, et al. "Ulcerative Colitis." eMedicine. Eds. Jocelyn D. Chertoff, et al. 30 Jan. 2009. Medscape. 29 Sep. 2009 <http://emedicine.medscape.com/article/375166-overview>.

Le, Tri H. "Ulcerative Colitis." eMedicine. Eds. Anil Minocha, et al. 7 Aug. 2008. Medscape. 29 Sep. 2009 <http://emedicine.medscape.com/article/183084-overview>.

Rowe, William A. "Inflammatory Bowel Disease." eMedicine. Eds. Rajeev Vasudeva, et al. 28 Apr. 2008. Medscape. 29 Sep. 2009 <http://emedicine.medscape.com/article/179037-overview>.

General

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

Source: Medical Disability Advisor






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