DVBCWLV1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
 ;;2.7;AMIE;**26**;Apr 10, 1995
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TXT ;
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 ;;A.  Review of Medical Records: This may be of particular importance when
 ;;    hepatitis C or chronic liver disease is claimed as related to service.
 ;;
 ;;
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 ;;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, distention, nausea,
 ;;        vomiting, duration, frequency, severity, treatment, and 
 ;;        response to treatment.
 ;;
 ;;
 ;;    4.  Fatigue, weakness, depression, or anxiety.
 ;;
 ;;
 ;;    5.  When chronic liver disease is claimed, record history of any risk
 ;;        factors for liver disease, including transfusions, hepatitis (and
 ;;        what type), intravenous drug use, occupational blood exposure,
 ;;        high-risk sexual activity, etc.  When did they take place?
 ;;        Describe current symptoms of liver disease and onset of symptoms.
 ;;
 ;;
 ;;    6.  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.
 ;;
 ;;TOF
 ;;C.  Physical Examination Cont'd (Objective Findings):
 ;;
 ;;    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.
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 ;;
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 ;;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, anti-HBc, ferritin, alpha-fetoprotein); and liver
 ;;        imaging (ultrasound or abdominal CT scan), as appropriate.  If
 ;;        hepatitis C is the diagnosis, a positive EIA (enzyme immunoassay)
 ;;        test for hepatitis C should be confirmed by a RIBA (recombinant
 ;;        immunoblot assay) test.
 ;;
 ;;        a. 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 cannot 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.
 ;;
 ;;TOF
 ;;
 ;;        b. With a diagnosis of cirrhosis, chronic hepatitis, liver
 ;;           malignancy, or other chronic liver disease, state the most
 ;;           likely etiology.  Address the relationship of the disease 
 ;;           to active service, including any hepatitis 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:
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 ;;
 ;;
 ;;Signature:                             Date:
 ;;END