DVBCWLQ1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
 ;;2.7;AMIE;**36**;Apr 10, 1995
 ;
 ;
TXT ;
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 ;;A. Review of Medical Records: This may be of particular importance when
 ;;hepatitis C (HCV) or chronic liver disease is claimed as related to service.
 ;;
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;
 ;;Comment on:
 ;;   1. Vomiting, hematemesis, or melena.
 ;;   2. Current treatment-type (medication, diet, enzymes, etc.), duration,
 ;;      response, side effects.
 ;;   3. Episodes of colic or other abdominal pain, fever, distention, nausea, or
 ;;      vomiting. Describe the duration, frequency, severity, treatment, and 
 ;;      response to treatment.
 ;;   4. Fatigue, weakness, depression, or anxiety, and their severity.
 ;;   5. Past biliary tract surgery.
 ;;   6. When chronic liver disease is claimed:
 ;;      *  Record history of and dates for any risk factors for liver disease, 
 ;;         including transfusion or organ transplant before 1992, hemodialysis,
 ;;         tattoo, body piercing, intravenous (or intranasal cocaine) drug use,
 ;;         occupational blood exposure or other percutaneous blood exposure,
 ;;         high-risk sexual activity, etc. Intramuscular gamma globulin shots
 ;;         may be claimed as a risk factor for hepatitis C, but, to date, no
 ;;         transmission of HCV by this means has been shown.
 ;;      *  Describe current symptoms of liver disease and onset of symptoms.
 ;;      *  Provide history of any hepatitis in service and discuss its
 ;;         relationship to current liver disease.
 ;;      *  Provide history of alcohol use/abuse, both current and past.
 ;;
 ;;
 ;;C. Physical Examination (Objective Findings):
 ;;
 ;;Address each of the following as appropriate, and fully describe
 ;;current findings:
 ;;   1. Ascites.
 ;;   2. Weight gain or loss, steatorrhea, malabsorption, malnutrition.
 ;;   3. Hematemesis or melena (describe any episodes).
 ;;   4. Pain or tenderness-location, type, precipitating factors.
 ;;   5. Liver size, superficial abdominal veins.
 ;;   6. Muscle strength and wasting.
 ;;   7. Any other signs of liver disease, e.g., palmar erythema,
 ;;      spider angiomata, etc.
 ;;TOF
 ;;D. Diagnostic and Clinical Tests:
 ;;
 ;;   1. For esophageal varices, X-ray, endoscopy, etc.
 ;;   2. For adhesions, X-ray to show partial obstruction, delayed motility.
 ;;   3. For gall bladder disease, X-ray or other objective confirmation.
 ;;   4. For liver disease:
 ;;      *  Liver function tests (albumin, prothrombin time, bilirubin, AST,
 ;;         ALT, WBC, platelets).
 ;;      *  Serologic tests for hepatitis (HBsAg, anti-HCV (EIA or ELISA) anti-
 ;;         HBc, ferritin, alpha-fetoprotein); and liver imaging (ultrasound or
 ;;         abdominal CT scan), as appropriate.
 ;;      *  If hepatitis C is the suspected diagnosis, a positive EIA (enzyme
 ;;         immunoassay) test for hepatitis C should be confirmed by a RIBA
 ;;         (recombinant immunoblot assay) test OR by an HCV RNA test, 
 ;;         either qualitative or quantitative.  The diagnosis of hepatitis
 ;;         C infection should not be made unless such test results are
 ;;         in the record and support the diagnosis. A positive EIA test alone
 ;;         is not sufficient to establish the diagnosis, nor is a liver biopsy
 ;;         with a report that indicates it is "consistent with"
 ;;         hepatitis C infection.
 ;;      *  With a diagnosis of hepatitis, name the specific type (A, B, C, or
 ;;         other), and for hepatitis B and C, provide an opinion as to which risk
 ;;         factor is the most likely cause.  Support the opinion by discussing all
 ;;         risk factors in the individual and the rationale for your opinion.  If
 ;;         you can not determine which risk factor is the likely cause, state that
 ;;         there is no risk factor that is more likely than another
 ;;         to be the cause, and explain.
 ;;      *  With a diagnosis of cirrhosis, chronic hepatitis, liver malignancy, or
 ;;         other chronic liver disease, state the most likely etiology and the
 ;;         basis for your opinion.  Address the relationship of the disease to
 ;;         active service, including any hepatitis or hepatitis risk factor that
 ;;         occurred in service.  If you cannot determine the most likely
 ;;         etiology, cannot determine whether it is more likely than not that one
 ;;         of multiple risk factors is the cause, or cannot determine whether it
 ;;         is at least as likely as not that the liver disease is related
 ;;         to service, so state and explain.
 ;;    5. Include results of all diagnostic and clinical tests conducted in the
 ;;       examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                                                    Date:
 ;;END