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Routine: DVBCWLL2

DVBCWLL2.m

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DVBCWLL2 ;ALB/JEH LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999

 ;;2.7;AMIE;**74**;July 22, 2004

 ;

 ;

TXT ;

 ;;

 ;;

 ;;C. Physical Examination (Objective Findings): 

 ;;

 ;;Address each of the following as appropriate, and fully describe current

 ;;findings: 

 ;;

 ;;   1. Abdominal Exam

 ;;

 ;;      a. Describe any areas of tenderness and/or organomegaly, including liver

 ;;         size and whether it is tender to palpation. 

 ;;      b. Presence or absence of ascites 

 ;;      c. Evidence of Portal Hypertension (e.g. superficial abdominal veins,

 ;;         splenomegaly, abdominal pain) 

 ;;

 ;;   2. General exam

 ;;

 ;;      a. Describe all other signs of liver disease (e.g. jaundice, palmar

 ;;         erythema, spider angiomata). 

 ;;      b. Evidence of Malnutrition (e.g. muscle wasting)

 ;; 

 ;;D. Diagnostic and Clinical Tests: 

 ;;

 ;;        1. For esophageal varices, X-ray, endoscopy, etc.

 ;;

 ;;        2. For gall bladder disease, X-ray or other objective confirmation.

 ;;

 ;;        3. For liver disease: 

 ;;

 ;;             a. serologic tests for hepatitis as appropriate (e.g. HbsAg,

 ;;                anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); liver imaging

 ;;                as appropriate, (e.g. ultrasound or abdominal CT scan), biopsy

 ;;                report (when available). 

 ;;

 ;;             b. Viral hepatitis (including Hepatitis C): Name the specific type

 ;;                (A, B, C, or other). For hepatitis B and / or hepatitis C,

 ;;                provide an opinion as to which risk factor is the most likely

 ;;                cause, and whether these risk factors were present during the

 ;;                veteran's time in the military. Please support your opinion by

 ;;                discussing all risk factors in the individual and your 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.

 ;;

 ;;             c. Hepatitis C: Please note that Hepatitis C generally does not

 ;;                produce clinically evident hepatitis at the time of infection.

 ;;                Please provide results of serologic (anti-HCV antibody) and

 ;;                viral (HCV RNA) testing for hepatitis C. The anti-HCV assay

 ;;                confirms exposure to hepatitis C but does not differentiate

 ;;                between chronic, acute, or resolved infection. False positive

 ;;                and false negative results occur, but rarely. A positive

 ;;                qualitative or quantitative HCV RNA assay indicates current

 ;;                hepatitis C infection. A negative qualitative HCV RNA assay

 ;;                indicates that the individual does not have active, chronic

 ;;                hepatitis C. The recombinant immunoblot assay (RIBA) is a

 ;;                confirmatory serologic test that establishes the diagnosis of

 ;;                past (resolved) infection if the anti-HCV is positive but the

 ;;                HCV RNA assay is negative. (Reference: Under Secretary for

 ;;                Health's Information Letter 10-2002-019 "Diagnostic Testing

 ;;                for Hepatitis C"

 ;;                http://vaww.domain.ext/publ/direc/health/infolet/10200219.pdf

 ;; 

 ;;The following are established risk factors for acquisition of hepatitis C

 ;;infection:

 ;;

 ;;  -Blood transfusion before 1992 

 ;;  -Past or present intravenous drug use 

 ;;  -Blood exposure of skin or mucous membranes including accidental needle

 ;;   punctures 

 ;;  -Sexual transmission (though most studies have failed to identify sexual

 ;;   transmission of this agent). Sexual transmission appears to be confined

 ;;   to such subgroups as persons with multiple sexual partners and sexually

 ;;   transmitted diseases. 

 ;;  -History of hemodialysis 

 ;;  -Tattoo or repeated body piercing 

 ;;  -History of intranasal cocaine use

 ;; 

 ;;See Harrison's Principles of Internal Medicine, 15th edition, The McGraw Hill

 ;;Companies, Inc., page 1709, 1729-1730.

 ;;

 ;;Please consider the veteran's potential for skin and mucous membrane exposure

 ;;to blood, especially where the veteran was a military corpsman, a medical

 ;;worker, or a combat veteran.

 ;;

 ;;     (d) 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.

 ;; 

 ;;  5.Include results of all diagnostic and clinical tests conducted in the

 ;;    examination report.

 ;; 

 ;;E. Diagnosis: 

 ;;

 ;;

 ;;Signature:                                                    Date:

 ;;END