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1DVBCWLQ1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
2 ;;2.7;AMIE;**36**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;
7 ;;A. Review of Medical Records: This may be of particular importance when
8 ;;hepatitis C (HCV) or chronic liver disease is claimed as related to service.
9 ;;
10 ;;
11 ;;B. Medical History (Subjective Complaints):
12 ;;
13 ;;Comment on:
14 ;; 1. Vomiting, hematemesis, or melena.
15 ;; 2. Current treatment-type (medication, diet, enzymes, etc.), duration,
16 ;; response, side effects.
17 ;; 3. Episodes of colic or other abdominal pain, fever, distention, nausea, or
18 ;; vomiting. Describe the duration, frequency, severity, treatment, and
19 ;; response to treatment.
20 ;; 4. Fatigue, weakness, depression, or anxiety, and their severity.
21 ;; 5. Past biliary tract surgery.
22 ;; 6. When chronic liver disease is claimed:
23 ;; * Record history of and dates for any risk factors for liver disease,
24 ;; including transfusion or organ transplant before 1992, hemodialysis,
25 ;; tattoo, body piercing, intravenous (or intranasal cocaine) drug use,
26 ;; occupational blood exposure or other percutaneous blood exposure,
27 ;; high-risk sexual activity, etc. Intramuscular gamma globulin shots
28 ;; may be claimed as a risk factor for hepatitis C, but, to date, no
29 ;; transmission of HCV by this means has been shown.
30 ;; * Describe current symptoms of liver disease and onset of symptoms.
31 ;; * Provide history of any hepatitis in service and discuss its
32 ;; relationship to current liver disease.
33 ;; * Provide history of alcohol use/abuse, both current and past.
34 ;;
35 ;;
36 ;;C. Physical Examination (Objective Findings):
37 ;;
38 ;;Address each of the following as appropriate, and fully describe
39 ;;current findings:
40 ;; 1. Ascites.
41 ;; 2. Weight gain or loss, steatorrhea, malabsorption, malnutrition.
42 ;; 3. Hematemesis or melena (describe any episodes).
43 ;; 4. Pain or tenderness-location, type, precipitating factors.
44 ;; 5. Liver size, superficial abdominal veins.
45 ;; 6. Muscle strength and wasting.
46 ;; 7. Any other signs of liver disease, e.g., palmar erythema,
47 ;; spider angiomata, etc.
48 ;;TOF
49 ;;D. Diagnostic and Clinical Tests:
50 ;;
51 ;; 1. For esophageal varices, X-ray, endoscopy, etc.
52 ;; 2. For adhesions, X-ray to show partial obstruction, delayed motility.
53 ;; 3. For gall bladder disease, X-ray or other objective confirmation.
54 ;; 4. For liver disease:
55 ;; * Liver function tests (albumin, prothrombin time, bilirubin, AST,
56 ;; ALT, WBC, platelets).
57 ;; * Serologic tests for hepatitis (HBsAg, anti-HCV (EIA or ELISA) anti-
58 ;; HBc, ferritin, alpha-fetoprotein); and liver imaging (ultrasound or
59 ;; abdominal CT scan), as appropriate.
60 ;; * If hepatitis C is the suspected diagnosis, a positive EIA (enzyme
61 ;; immunoassay) test for hepatitis C should be confirmed by a RIBA
62 ;; (recombinant immunoblot assay) test OR by an HCV RNA test,
63 ;; either qualitative or quantitative. The diagnosis of hepatitis
64 ;; C infection should not be made unless such test results are
65 ;; in the record and support the diagnosis. A positive EIA test alone
66 ;; is not sufficient to establish the diagnosis, nor is a liver biopsy
67 ;; with a report that indicates it is "consistent with"
68 ;; hepatitis C infection.
69 ;; * With a diagnosis of hepatitis, name the specific type (A, B, C, or
70 ;; other), and for hepatitis B and C, provide an opinion as to which risk
71 ;; factor is the most likely cause. Support the opinion by discussing all
72 ;; risk factors in the individual and the rationale for your opinion. If
73 ;; you can not determine which risk factor is the likely cause, state that
74 ;; there is no risk factor that is more likely than another
75 ;; to be the cause, and explain.
76 ;; * With a diagnosis of cirrhosis, chronic hepatitis, liver malignancy, or
77 ;; other chronic liver disease, state the most likely etiology and the
78 ;; basis for your opinion. Address the relationship of the disease to
79 ;; active service, including any hepatitis or hepatitis risk factor that
80 ;; occurred in service. If you cannot determine the most likely
81 ;; etiology, cannot determine whether it is more likely than not that one
82 ;; of multiple risk factors is the cause, or cannot determine whether it
83 ;; is at least as likely as not that the liver disease is related
84 ;; to service, so state and explain.
85 ;; 5. Include results of all diagnostic and clinical tests conducted in the
86 ;; examination report.
87 ;;
88 ;;
89 ;;E. Diagnosis:
90 ;;
91 ;;
92 ;;Signature: Date:
93 ;;END
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