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1DVBCWLL7 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 12 FEB 2007
2 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
3 ;
4 ;
5TXT ;
6 ;;C. Physical Examination (Objective Findings):
7 ;;
8 ;;Address each of the following as appropriate, and fully describe current
9 ;;findings:
10 ;;
11 ;; 1. Abdominal Exam
12 ;;
13 ;; a. Describe any areas of tenderness and/or organomegaly, including liver
14 ;; size and whether it is tender to palpation.
15 ;; b. Presence or absence of ascites
16 ;; c. Evidence of Portal Hypertension (e.g. superficial abdominal veins,
17 ;; splenomegaly, abdominal pain)
18 ;;
19 ;; 2. General exam
20 ;;
21 ;; a. Describe all other signs of liver disease (e.g. jaundice, palmar
22 ;; erythema, spider angiomata).
23 ;; b. Evidence of Malnutrition (e.g. muscle wasting)
24 ;;
25 ;;D. Diagnostic and Clinical Tests:
26 ;;
27 ;; 1. For esophageal varices, X-ray, endoscopy, etc.
28 ;;
29 ;; 2. For gall bladder disease, X-ray or other objective confirmation.
30 ;;
31 ;; 3. For liver disease:
32 ;;
33 ;; a. serologic tests for hepatitis as appropriate (e.g. HbsAg,
34 ;; anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); liver imaging
35 ;; as appropriate, (e.g. ultrasound or abdominal CT scan), biopsy
36 ;; report (when available).
37 ;;
38 ;; b. Viral hepatitis (including Hepatitis C): Name the specific type
39 ;; (A, B, C, or other). For hepatitis B and / or hepatitis C,
40 ;; provide an opinion as to which risk factor is the most likely
41 ;; cause, and whether these risk factors were present during the
42 ;; veteran's time in the military. Please support your opinion by
43 ;; discussing all risk factors in the individual and your rationale
44 ;; for your opinion. If you cannot determine which risk factor is
45 ;; the likely cause, state that there is no risk factor that is
46 ;; more likely than another to be the cause, and explain.
47 ;;
48 ;; c. Hepatitis C: Please note that Hepatitis C generally does not
49 ;; produce clinically evident hepatitis at the time of infection.
50 ;; Please provide results of serologic (anti-HCV antibody) and
51 ;; viral (HCV RNA) testing for hepatitis C. The anti-HCV assay
52 ;; confirms exposure to hepatitis C but does not differentiate
53 ;; between chronic, acute, or resolved infection. False positive
54 ;; and false negative results occur, but rarely. A positive
55 ;; qualitative or quantitative HCV RNA assay indicates current
56 ;; hepatitis C infection. A negative qualitative HCV RNA assay
57 ;; indicates that the individual does not have active, chronic
58 ;; hepatitis C. The recombinant immunoblot assay (RIBA) is a
59 ;; confirmatory serologic test that establishes the diagnosis of
60 ;; past (resolved) infection if the anti-HCV is positive but the
61 ;; HCV RNA assay is negative.
62 ;;
63 ;;The following are established risk factors for acquisition of hepatitis C
64 ;;infection:
65 ;;
66 ;; -Blood transfusion before 1992
67 ;; -Past or present intravenous drug use
68 ;; -Blood exposure of skin or mucous membranes including accidental needle
69 ;; punctures
70 ;; -Sexual transmission (though most studies have failed to identify sexual
71 ;; transmission of this agent). Sexual transmission appears to be confined
72 ;; to such subgroups as persons with multiple sexual partners and sexually
73 ;; transmitted diseases.
74 ;; -History of hemodialysis
75 ;; -Tattoo or repeated body piercing
76 ;; -History of intranasal cocaine use
77 ;;
78 ;;See Harrison's Principles of Internal Medicine, 15th edition, The McGraw Hill
79 ;;Companies, Inc., page 1709, 1729-1730.
80 ;;
81 ;;Please consider the veteran's potential for skin and mucous membrane exposure
82 ;;to blood, especially where the veteran was a military corpsman, a medical
83 ;;worker, or a combat veteran.
84 ;;
85 ;; d. Cirrhosis, chronic hepatitis, liver malignancy, or other chronic
86 ;; liver disease: State the most likely etiology. Address the
87 ;; relationship of the disease to active service, including any
88 ;; hepatitis that occurred in service.
89 ;;
90 ;; 4. Include results of all diagnostic and clinical tests conducted in the
91 ;; examination report.
92 ;;
93 ;;E. Diagnosis:
94 ;;
95 ;;
96 ;;
97 ;;Signature: Date:
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