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1DVBCWLV1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
2 ;;2.7;AMIE;**26**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;
7 ;;A. Review of Medical Records: This may be of particular importance when
8 ;; hepatitis C or chronic liver disease is claimed as related to service.
9 ;;
10 ;;
11 ;;
12 ;;B. Medical History (Subjective Complaints):
13 ;;
14 ;; Comment on:
15 ;; 1. Vomiting, hematemesis, or melena.
16 ;;
17 ;;
18 ;; 2. Current treatment - type (medication, diet, enzymes, etc.),
19 ;; duration, response, side effects.
20 ;;
21 ;;
22 ;; 3. Episodes of colic or other abdominal pain, distention, nausea,
23 ;; vomiting, duration, frequency, severity, treatment, and
24 ;; response to treatment.
25 ;;
26 ;;
27 ;; 4. Fatigue, weakness, depression, or anxiety.
28 ;;
29 ;;
30 ;; 5. When chronic liver disease is claimed, record history of any risk
31 ;; factors for liver disease, including transfusions, hepatitis (and
32 ;; what type), intravenous drug use, occupational blood exposure,
33 ;; high-risk sexual activity, etc. When did they take place?
34 ;; Describe current symptoms of liver disease and onset of symptoms.
35 ;;
36 ;;
37 ;; 6. Provide history of alcohol use/abuse, both current and past.
38 ;;
39 ;;
40 ;;
41 ;;C. Physical Examination (Objective Findings):
42 ;;
43 ;; Address each of the following as appropriate, and fully describe
44 ;; current findings:
45 ;; 1. Ascites.
46 ;;
47 ;;
48 ;; 2. Weight gain or loss, steatorrhea, malabsorption, malnutrition.
49 ;;
50 ;;TOF
51 ;;C. Physical Examination Cont'd (Objective Findings):
52 ;;
53 ;; 3. Hematemesis or melena (describe any episodes).
54 ;;
55 ;;
56 ;; 4. Pain or tenderness - location, type, precipitating factors.
57 ;;
58 ;;
59 ;; 5. Liver size, superficial abdominal veins.
60 ;;
61 ;;
62 ;; 6. Muscle strength and wasting.
63 ;;
64 ;;
65 ;; 7. Any other signs of liver disease, e.g., palmar erythema, spider
66 ;; angiomata, etc.
67 ;;
68 ;;
69 ;;
70 ;;D. Diagnostic and Clinical Tests:
71 ;;
72 ;; 1. For esophageal varices, X-ray, endoscopy, etc.
73 ;;
74 ;;
75 ;; 2. For adhesions, X-ray to show partial obstruction, delayed motility.
76 ;;
77 ;;
78 ;; 3. For gall bladder disease, X-ray or other objective confirmation.
79 ;;
80 ;;
81 ;; 4. For liver disease: liver function tests (albumin, prothrombin time,
82 ;; bilirubin, AST, ALT, WBC, platelets); serologic tests for hepatitis
83 ;; (HBsAg, anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); and liver
84 ;; imaging (ultrasound or abdominal CT scan), as appropriate. If
85 ;; hepatitis C is the diagnosis, a positive EIA (enzyme immunoassay)
86 ;; test for hepatitis C should be confirmed by a RIBA (recombinant
87 ;; immunoblot assay) test.
88 ;;
89 ;; a. With a diagnosis of hepatitis, name the specific type (A,B,C,
90 ;; or other), and for hepatitis B and C, provide an opinion as
91 ;; to which risk factor is the most likely cause. Support the
92 ;; opinion by discussing all risk factors in the individual and
93 ;; the rationale for your opinion. If you cannot determine
94 ;; which risk factor is the likely cause, state that there is
95 ;; no risk factor that is more likely than another to be the
96 ;; cause, and explain.
97 ;;
98 ;;TOF
99 ;;
100 ;; b. With a diagnosis of cirrhosis, chronic hepatitis, liver
101 ;; malignancy, or other chronic liver disease, state the most
102 ;; likely etiology. Address the relationship of the disease
103 ;; to active service, including any hepatitis that occurred in
104 ;; service. If you cannot determine the most likely etiology,
105 ;; cannot determine whether it is more likely than not that one
106 ;; of multiple risk factors is the cause, or cannot determine
107 ;; whether it is at least as likely as not that the liver
108 ;; disease is related to service, so state and explain.
109 ;;
110 ;;
111 ;; 5. Include results of all diagnostic and clinical tests conducted
112 ;; in the examination report.
113 ;;
114 ;;
115 ;;
116 ;;E. Diagnosis:
117 ;;
118 ;;
119 ;;
120 ;;Signature: Date:
121 ;;END
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