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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.

Volvulus


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
560.2 - Intestinal Obstruction, Volvulus; Knotting, Strangulation, Torsion or Twist of Intestine, Bowel or Colon

Related Terms

  • Cecal Volvulus
  • Cecum Volvulus
  • Colonic Volvulus
  • Gastric Volvulus
  • Ileum Volvulus
  • Sigmoid Volvulus
  • Splenic Flexure Volvulus
  • Torsion
  • Transverse Volvulus

Overview

Image Description:
Volvulus - A profile of the torso reveals the large and small intestines filling the abdominal cavity. A twisted segment (volvulus) of the lower large intestine (sigmoid colon) is depicted as swollen and inflamed.
Click to see Image

Volvulus is an abnormal twisting of a segment or loop of bowel back on itself along its longitudinal axis. The twisting causes intestinal obstruction.

The condition is frequently the result of a prolapsed segment of the membrane that anchors organs to the abdominal wall (mesentery). Volvulus occurs most often in the lower portion of the small intestine (ileum), the first portion of the large intestine (cecum), or the lower portion of the large intestine (sigmoid colon). Volvulus of the middle portion of the large intestine (transverse colon) occurs rarely. In other rare cases, volvulus involves the stomach (gastric volvulus or torsion).

Sigmoid volvulus is the most common form of volvulus and usually occurs when the sigmoid colon is excessively long, resulting in a redundant loop. A narrowed base where the sigmoid colon is anchored to the abdominal wall can cause it to stretch and become volvulus. Also, a torque force to the sigmoid colon can initiate the torsion process. When volvulus occurs, the far end of the sigmoid colon enlarges (hypertrophy) with dilation that extends into the rectum.

Certain drugs, including psychotropics or sedatives that interfere with colonic motility, are risk factors. Other risk factors may include long-standing constipation, pregnancy, Parkinson's disease, multiple sclerosis, and spinal cord injuries. Volvulus of the ileum may be present at birth as a result of an abnormal rotation that permitted twisting, an internal hernia into which the small bowel may intrude, or a pre-existing intestinal obstruction, such as bands of scar tissue (adhesions) that somehow predisposes to secondary volvulus. Volvulus of the cecum is uncommon but is associated with an abnormally moveable area between the distal end of the ileum and the ascending colon. This is generally due to congenitally incomplete retroperitoneal fixation of the cecum or ascending colon. Transverse colon volvulus is caused by distal colon obstruction, elongation, and resulting expansion of the transverse colon, causing the potential for volvulus. Splenic flexure volvulus is common after abdominal surgery or distal colon obstruction, and it can be due to an abnormally enlarged colon (megacolon). Gastric volvulus is associated with a hernia in the diaphragm or esophageal area.

Incidence and Prevalence: In the US and Western Europe, volvulus causes 1% to 4% of obstructions of the intestine and 10% to 15% of obstructions of the colon (Feldman 2122). In the US, incidence is estimated at about 3 per 100,000 (Marx 1333). In Eastern Europe and parts of Asia and Africa, volvulus causes 20% to 50% of intestinal obstructions (Feldman 2122).

Source: Medical Disability Advisor



Causation and Known Risk Factors

A vegetarian or high fiber diet with large amounts of coarse vegetables that result in the production of significant intestinal gas or an overload of the sigmoid colon appears to be a risk factor in beginning the twisting process.

Individuals with volvulus are usually middle-aged or elderly.

Source: Medical Disability Advisor



Diagnosis

History: Individuals complain of severe abdominal pain, nausea, and vomiting. Superimposed over the severe pain may be waves of severe spasms (colicky pain) as progressive involuntary movements in the intestine (peristaltic activity) attempt to move the obstruction along. Some individuals may recall previous subacute episodes of abdominal pain preceding the final acute attack. Depending on the location of the obstruction, the individual may report either diarrhea or the inability to pass flatus.

Physical exam: On physical exam, the abdomen is extremely distended, moderately tender, and rigid. Bowel sounds are usually absent. In some cases, high pitched bowel sounds may be heard.

Tests: X-ray studies (plain or with barium as a contrast medium) and computer aided x-ray analysis (computed tomography, or CT) can confirm the diagnosis. Examination of the inside of the colon with a flexible, fiberoptic viewing instrument (colonoscopy or sigmoidoscopy) may help to diagnose cecal, transverse, or sigmoid volvulus. A test for serum electrolytes and a complete blood count (CBC) may also be done.

Source: Medical Disability Advisor



Treatment

Vomiting resulting in severe fluid loss into the sigmoid colon can cause shock, which must be corrected with fluid replacement before any attempts are made to reduce the volvulus. Antibiotics should be given prophylactically in case bowel perforation occurs. Treatment of a sigmoid volvulus may then be approached with conservative corrective treatment, which may include inserting a rectal tube (colonoscope, sigmoidoscope) to untwist the loop or deflate (or at least reduce) the bowel before surgery. The timing and type of surgery for sigmoid volvulus are determined by suspected lack of blood flow (ischemic) to the bowel or dead (necrotic) bowel tissue and the success or failure of sigmoidoscopic reduction. Laparotomy or open abdominal surgery is also indicated if the colon does not untwist (detorsion) or if there is any indication of blood or dark blue/black mucosa on colonoscopy. Surgical removal (resection) of part of a floppy sigmoid colon (colonopexy, sigmoidopexy) with fixation of the base is advisable so that volvulus does not recur.

Correction of an ileum volvulus requires surgery (surgical detorsion). The management of cecal volvulus is more controversial. Reduction of cecal volvulus by barium enema and colonoscopy is possible but runs the risk that a portion of bowel that is dead and decaying (gangrenous) will be left untwisted. The alternative is surgical detorsion with fixation of the cecum to the wall of the pelvic cavity (peritoneum).

Source: Medical Disability Advisor



Prognosis

Conservative treatment using flexible scoping (colonoscopy, sigmoidoscopy) can successfully reduce sigmoid volvulus in 40% to 50% of cases (Feldman 2125). However, the volvulus recurs in more than half of these successful cases. Surgical detorsion, bowel resection, and fixation of the bowel corrects volvulus in most individuals with no further recurrence. Surgery without fixation for cecal volvulus may result in recurrence. About 8% of individuals with colonic volvulus die as a result of the obstruction (Feldman 2125).

Source: Medical Disability Advisor



Differential Diagnosis

  • Foreign objects in the bowel
  • Impaction of feces in the intestine
  • Intussusception
  • Postoperative adhesions or scar tissue

Source: Medical Disability Advisor



Specialists

  • Gastroenterologist
  • General Surgeon

Source: Medical Disability Advisor



Comorbid Conditions

  • Abnormal tissue growth (granulomatous process)
  • Chronic constipation
  • Intussusception

Source: Medical Disability Advisor



Complications

Death and decay (gangrene) of the affected portion of bowel is the most common complication if surgery is not performed. Other complications may include puncture (perforation) of the bowel, extreme electrolyte disturbances, and dehydration. Death is a possibility in cases that are left untreated.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the location of the volvulus, the method of treatment, type of surgery, or complications of surgery. In addition, the presence of tissue death and decay (gangrene) requires surgery to remove (resect) part of the intestine; this increases the risk of complications. Conservative treatments may allow for the condition to recur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or special accommodations are required after conservative treatments or after simple surgery for those with light work duties. Individuals may require less demanding physical labor upon their return to work until recovery is complete; heavy lifting or climbing may need to be restricted for up to 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 have clinical history (high-fiber diet, constipation, Parkinson's disease, multiple sclerosis, spinal cord injury, or previous bowel surgery) consistent with diagnosis of volvulus?
  • Did individual present with severe abdominal pain, nausea, vomiting, and inability to pass flatus?
  • Was diagnosis confirmed with abdominal x-rays or CT?
  • If diagnosis was uncertain, were conditions with similar symptoms ruled out (postoperative adhesions or scar tissue, impaction of feces, foreign objects in bowel, or intussusception)?

Regarding treatment:

  • Was conservative treatment with insertion of intestinal tube effective at correcting condition?
  • If not, was surgical correction considered?
  • Were other associated conditions or symptoms, such as dehydration or infection, addressed in treatment plan?

Regarding prognosis:

  • Was individual treated promptly?
  • Did volvulus recur?
  • Was surgery required?
  • What was expected outcome?
  • Does individual have existing conditions (intussusception, chronic constipation, granulomatous processes) or complications (bowel infarct, gangrene, bowel perforation, or fluid and electrolyte disturbances) that may influence length of disability or recovery?

Source: Medical Disability Advisor



References

Cited

Feldman, Mark, Lawrence S. Friedman, and Marvin H. Sleisenger, eds. Gastrointestinal and Liver Disease. 7th ed. 2 vols. Philadelphia: W.B. Saunders, 2002.

Marx, J. A., et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis: Mosby, Inc., 2002.

Source: Medical Disability Advisor