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1DVBCWLL4 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
2 ;;2.7;AMIE;**86**;July 22, 2004
3 ;
4 ;
5TXT ;
6 ;;
7 ;;
8 ;;C. Physical Examination (Objective Findings):
9 ;;
10 ;;Address each of the following as appropriate, and fully describe current
11 ;;findings:
12 ;;
13 ;; 1. Abdominal Exam
14 ;;
15 ;; a. Describe any areas of tenderness and/or organomegaly, including liver
16 ;; size and whether it is tender to palpation.
17 ;; b. Presence or absence of ascites
18 ;; c. Evidence of Portal Hypertension (e.g. superficial abdominal veins,
19 ;; splenomegaly, abdominal pain)
20 ;;
21 ;; 2. General exam
22 ;;
23 ;; a. Describe all other signs of liver disease (e.g. jaundice, palmar
24 ;; erythema, spider angiomata).
25 ;; b. Evidence of Malnutrition (e.g. muscle wasting)
26 ;;
27 ;;D. Diagnostic and Clinical Tests:
28 ;;
29 ;; 1. For esophageal varices, X-ray, endoscopy, etc.
30 ;;
31 ;; 2. For gall bladder disease, X-ray or other objective confirmation.
32 ;;
33 ;; 3. For liver disease:
34 ;;
35 ;; a. serologic tests for hepatitis as appropriate (e.g. HbsAg,
36 ;; anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); liver imaging
37 ;; as appropriate, (e.g. ultrasound or abdominal CT scan), biopsy
38 ;; report (when available).
39 ;;
40 ;; b. Viral hepatitis (including Hepatitis C): Name the specific type
41 ;; (A, B, C, or other). For hepatitis B and / or hepatitis C,
42 ;; provide an opinion as to which risk factor is the most likely
43 ;; cause, and whether these risk factors were present during the
44 ;; veteran's time in the military. Please support your opinion by
45 ;; discussing all risk factors in the individual and your rationale
46 ;; for your opinion. If you cannot determine which risk factor is
47 ;; the likely cause, state that there is no risk factor that is
48 ;; more likely than another to be the cause, and explain.
49 ;;
50 ;; c. Hepatitis C: Please note that Hepatitis C generally does not
51 ;; produce clinically evident hepatitis at the time of infection.
52 ;; Please provide results of serologic (anti-HCV antibody) and
53 ;; viral (HCV RNA) testing for hepatitis C. The anti-HCV assay
54 ;; confirms exposure to hepatitis C but does not differentiate
55 ;; between chronic, acute, or resolved infection. False positive
56 ;; and false negative results occur, but rarely. A positive
57 ;; qualitative or quantitative HCV RNA assay indicates current
58 ;; hepatitis C infection. A negative qualitative HCV RNA assay
59 ;; indicates that the individual does not have active, chronic
60 ;; hepatitis C. The recombinant immunoblot assay (RIBA) is a
61 ;; confirmatory serologic test that establishes the diagnosis of
62 ;; past (resolved) infection if the anti-HCV is positive but the
63 ;; HCV RNA assay is negative. (Reference: Under Secretary for
64 ;; Health's Information Letter 10-2002-019 "Diagnostic Testing
65 ;; for Hepatitis C"
66 ;; http://vaww.va.gov/publ/direc/health/infolet/10200219.pdf
67 ;;
68 ;;The following are established risk factors for acquisition of hepatitis C
69 ;;infection:
70 ;;
71 ;; -Blood transfusion before 1992
72 ;; -Past or present intravenous drug use
73 ;; -Blood exposure of skin or mucous membranes including accidental needle
74 ;; punctures
75 ;; -Sexual transmission (though most studies have failed to identify sexual
76 ;; transmission of this agent). Sexual transmission appears to be confined
77 ;; to such subgroups as persons with multiple sexual partners and sexually
78 ;; transmitted diseases.
79 ;; -History of hemodialysis
80 ;; -Tattoo or repeated body piercing
81 ;; -History of intranasal cocaine use
82 ;;
83 ;;See Harrison's Principles of Internal Medicine, 15th edition, The McGraw Hill
84 ;;Companies, Inc., page 1709, 1729-1730.
85 ;;
86 ;;Please consider the veteran's potential for skin and mucous membrane exposure
87 ;;to blood, especially where the veteran was a military corpsman, a medical
88 ;;worker, or a combat veteran.
89 ;;
90 ;; (d) Cirrhosis, chronic hepatitis, liver malignancy, or other chronic liver
91 ;; disease: State the most likely etiology. Address the relationship of
92 ;; the disease to active service, including any hepatitis that occurred
93 ;; in service.
94 ;;
95 ;; 5.Include results of all diagnostic and clinical tests conducted in the
96 ;; examination report.
97 ;;
98 ;;E. Diagnosis:
99 ;;
100 ;;
101 ;;Signature: Date:
102 ;;END
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