DVBCWLL3 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
 ;;2.7;AMIE;**86**;July 22, 2004
 ;
 ;
TXT ;
 ;;
 ;;A. Review of Medical Records: This may be of particular importance when
 ;;   hepatitis C or chronic liver disease is claimed as related to service.
 ;;
 ;;B. Medical History (Subjective Complaints): 
 ;;
 ;;   1. For Gall Bladder Disease (Including Gall bladder removal): Episodes of
 ;;      colic or other abdominal pain, distention, nausea, and / or vomiting.
 ;;      Include a statement on frequency of attacks (number within past year).
 ;;      Provide statement as to what x-ray (or other) evidence supports diagnosis 
 ;;      of chronic cholycystitis. Include current treatment - type (medication,
 ;;      diet, etc.), duration, response, side effects. For Gall Bladder injury,
 ;;      refer to Stomach, Duodenum and Peritoneal Adhesions worksheet. 
 ;;
 ;;   2. For Pancreatic conditions: Does veteran have steatorrhea, malabsorption,
 ;;      or malnutrition? Comment on whether veteran has attacks of abdominal
 ;;      pain. Include frequency of attacks (per year). Comment on whether veteran
 ;;      has diarrhea, weight loss. Is there evidence of continuing pancreatic
 ;;      insufficiency between acute attacks? Provide evidence (lab or other
 ;;      clinical studies) that abdominal pain is a consequence of pancreatic
 ;;      disease. Has veteran had pancreatic surgery? If so, describe. Include
 ;;      current treatment - type (medication, diet, enzymes, etc.), duration,
 ;;      response, side effects. 
 ;;
 ;;   3. For Chronic Liver disease (including hepatitis B, chronic active
 ;;      hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,
 ;;      etc., but excluding bile duct disorders and Hepatitis C): (a) Does
 ;;      veteran have "incapacitating episodes" (defined as periods of acute signs
 ;;      and symptoms with symptoms such as fatigue, malaise, nausea, vomiting,
 ;;      anorexia, arthralgia, and right upper quadrant pain with symptoms severe 
 ;;      enough to require bed rest and treatment by a physician)? If so, provide
 ;;      frequency of episodes and total duration of episodes over the past
 ;;      12-month period. Please include comment on whether this is veteran
 ;;      reported, and / or documented in the available records. (b) Include
 ;;      current treatment - type (medication, diet, enzymes, etc.), duration,
 ;;      response, side effects. (c) Comment on presence and severity (e.g.
 ;;      near-constant, debilitating, daily or intermittent), as appropriate, of
 ;;      fatigue, malaise, anorexia and weight loss, right upper quadrant pain and
 ;;      hepatomegaly. (d) Include a history of risk factors for the liver
 ;;      condition which the veteran is claiming service connection. For instance
 ;;      (as appropriate) is there a history of occupational blood exposure? IV
 ;;      drug use? Taking medications that are associated with liver disease?
 ;;      Include a history of alcohol use / abuse, past and present.  Note presence
 ;;      or absence of extrahepatic manifestations of veteran's liver disease (e.g.
 ;;      vasculitis, kidney disease, arthritis.)  Refer to additional worksheets
 ;;      as necessary.   See and address 4. Cirrhosis of the liver when cirrhosis
 ;;      is a sequelae. See and address 7 (below) where veteran is status post
 ;;      liver transplant.
 ;;
 ;;   4. For Cirrhosis of the Liver, primary biliary cirrhosis, cirrhotic phase of
 ;;      sclerosing cholangitis, or as a sequelae of hepatitis from any cause:
 ;;      (a)Fully describe the following, indicating, as appropriate, the number
 ;;      of episodes, periods of remission, or whether the condition is refractory
 ;;      to treatment: (i) ascites, (ii) hepatic encephalopathy, (iii) hemorrhage
 ;;      from varicies (include comment on episodes of hemetemesis and/or melana,
 ;;      (iv) portal gastropathy (v) portal hypertension, (vi) jaundice. (b)
 ;;      comment on: (i) current treatment (s) (medications, diet, response, side
 ;;      effects, duration) (ii) Discuss presence, frequency (e.g., daily,
 ;;      intermittent, etc.) and severity of each of the following: weakness,
 ;;      anorexia, malaise, abdominal pain, weight loss (include amount and time 
 ;;      frame), weight gain, and weakness. Note presence or absence of
 ;;      extrahepatic manifestations of veteran's liver disease (e.g.
 ;;      vasculitis, kidney disease, arthritis.)  Refer to additional worksheets
 ;;      as necessary.  See and address 3 (above) where cirrhosis is a sequaele
 ;;      of Chronic Liver disease (including hepatitis B, chronic active
 ;;      hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
 ;;      hepatitis, etc., but excluding bile duct disorders and Hepatitis C).
 ;;      See and address 7 (below) where veteran is status post liver transplant. 
 ;;
 ;;   5. For Hepatitis C: (a) Does veteran have "incapacitating episodes" (defined
 ;;      as periods of acute signs and symptoms with symptoms such as fatigue,
 ;;      malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant
 ;;      pain with symptoms severe enough to require bed rest and treatment by a
 ;;      physician)? If so, provide frequency of episodes and total duration of
 ;;      episodes over the past 12-month period. Please include comment on whether
 ;;      this is veteran reported, and/ or documented in the available records.
 ;;      (b) comment on: (i) current treatment (s) (medications, diet, response,
 ;;      side effects, duration) (ii) Discuss presence, frequency (e.g., daily,
 ;;      intermittent, etc.) and severity of each of the following: weakness,
 ;;      anorexia, malaise, abdominal pain, weight loss (include amount and time
 ;;      frame), weight gain, and weakness. (c) Include a history of risk factors
 ;;      for the liver condition for which the veteran is claiming service
 ;;      connection. For instance (as appropriate) is there a history of
 ;;      occupational blood exposure? IV drug use? See established risk factors
 ;;      for Hepatitis C, below. Note presence or absence of extrahepatic
 ;;      manifestations of veteran's liver disease (e.g. vasculitis, kidney
 ;;      disease, arthritis.)  Refer to additional worksheets as necessary.
 ;;      See and address 7 (below) where veteran is status post liver transplant. 
 ;;
 ;;   6. For Liver Malignancy: Address presence or absence of symptomatolgy, etc.,
 ;;      as outlined in both: 3. (For Chronic Liver disease (including hepatitis B,
 ;;      chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
 ;;      drug-induced hepatitis, etc., but excluding bile duct disorders and
 ;;      Hepatitis C) and 4. (For Cirrhosis of the Liver, primary biliary
 ;;      cirrhosis, cirrhotic phase of sclerosing cholangitis, or as a sequelae
 ;;      of hepatitis from any cause) above. 
 ;;
 ;;   7. For Liver Transplant: Provide date of transplant. Describe current
 ;;      treatment(s) (medications, diet, response, side effects, duration).
 ;;      Please refer to additional AMIE worksheets to address conditions veteran
 ;;      has as a consequence of the transplant, treatment for the transplant, and
 ;;      as a consequence of any underlying disease that prompted the transplant
 ;;      in the first place (e.g. extrahepatic complications / manifestations of
 ;;      hepatitis C). 
 ;;