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Routine: DVBCWLL4

DVBCWLL4.m

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  1. DVBCWLL4 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
  1.  ;;2.7;AMIE;**86**;July 22, 2004
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;
  1.  ;;
  1.  ;;C. Physical Examination (Objective Findings): 
  1.  ;;
  1.  ;;Address each of the following as appropriate, and fully describe current
  1.  ;;findings: 
  1.  ;;
  1.  ;;   1. Abdominal Exam
  1.  ;;
  1.  ;;      a. Describe any areas of tenderness and/or organomegaly, including liver
  1.  ;;         size and whether it is tender to palpation. 
  1.  ;;      b. Presence or absence of ascites 
  1.  ;;      c. Evidence of Portal Hypertension (e.g. superficial abdominal veins,
  1.  ;;         splenomegaly, abdominal pain) 
  1.  ;;
  1.  ;;   2. General exam
  1.  ;;
  1.  ;;      a. Describe all other signs of liver disease (e.g. jaundice, palmar
  1.  ;;         erythema, spider angiomata). 
  1.  ;;      b. Evidence of Malnutrition (e.g. muscle wasting)
  1.  ;; 
  1.  ;;D. Diagnostic and Clinical Tests: 
  1.  ;;
  1.  ;;        1. For esophageal varices, X-ray, endoscopy, etc.
  1.  ;;
  1.  ;;        2. For gall bladder disease, X-ray or other objective confirmation.
  1.  ;;
  1.  ;;        3. For liver disease: 
  1.  ;;
  1.  ;;             a. serologic tests for hepatitis as appropriate (e.g. HbsAg,
  1.  ;;                anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); liver imaging
  1.  ;;                as appropriate, (e.g. ultrasound or abdominal CT scan), biopsy
  1.  ;;                report (when available). 
  1.  ;;
  1.  ;;             b. Viral hepatitis (including Hepatitis C): Name the specific type
  1.  ;;                (A, B, C, or other). For hepatitis B and / or hepatitis C,
  1.  ;;                provide an opinion as to which risk factor is the most likely
  1.  ;;                cause, and whether these risk factors were present during the
  1.  ;;                veteran's time in the military. Please support your opinion by
  1.  ;;                discussing all risk factors in the individual and your rationale
  1.  ;;                for your opinion. If you cannot determine which risk factor is
  1.  ;;                the likely cause, state that there is no risk factor that is
  1.  ;;                more likely than another to be the cause, and explain.
  1.  ;;
  1.  ;;             c. Hepatitis C: Please note that Hepatitis C generally does not
  1.  ;;                produce clinically evident hepatitis at the time of infection.
  1.  ;;                Please provide results of serologic (anti-HCV antibody) and
  1.  ;;                viral (HCV RNA) testing for hepatitis C. The anti-HCV assay
  1.  ;;                confirms exposure to hepatitis C but does not differentiate
  1.  ;;                between chronic, acute, or resolved infection. False positive
  1.  ;;                and false negative results occur, but rarely. A positive
  1.  ;;                qualitative or quantitative HCV RNA assay indicates current
  1.  ;;                hepatitis C infection. A negative qualitative HCV RNA assay
  1.  ;;                indicates that the individual does not have active, chronic
  1.  ;;                hepatitis C. The recombinant immunoblot assay (RIBA) is a
  1.  ;;                confirmatory serologic test that establishes the diagnosis of
  1.  ;;                past (resolved) infection if the anti-HCV is positive but the
  1.  ;;                HCV RNA assay is negative. (Reference: Under Secretary for
  1.  ;;                Health's Information Letter 10-2002-019 "Diagnostic Testing
  1.  ;;                for Hepatitis C"
  1.  ;;                http://vaww.domain.ext/publ/direc/health/infolet/10200219.pdf
  1.  ;; 
  1.  ;;The following are established risk factors for acquisition of hepatitis C
  1.  ;;infection:
  1.  ;;
  1.  ;;  -Blood transfusion before 1992 
  1.  ;;  -Past or present intravenous drug use 
  1.  ;;  -Blood exposure of skin or mucous membranes including accidental needle
  1.  ;;   punctures 
  1.  ;;  -Sexual transmission (though most studies have failed to identify sexual
  1.  ;;   transmission of this agent). Sexual transmission appears to be confined
  1.  ;;   to such subgroups as persons with multiple sexual partners and sexually
  1.  ;;   transmitted diseases. 
  1.  ;;  -History of hemodialysis 
  1.  ;;  -Tattoo or repeated body piercing 
  1.  ;;  -History of intranasal cocaine use
  1.  ;; 
  1.  ;;See Harrison's Principles of Internal Medicine, 15th edition, The McGraw Hill
  1.  ;;Companies, Inc., page 1709, 1729-1730.
  1.  ;;
  1.  ;;Please consider the veteran's potential for skin and mucous membrane exposure
  1.  ;;to blood, especially where the veteran was a military corpsman, a medical
  1.  ;;worker, or a combat veteran.
  1.  ;;
  1.  ;;     (d) Cirrhosis, chronic hepatitis, liver malignancy, or other chronic liver
  1.  ;;         disease: State the most likely etiology. Address the relationship of
  1.  ;;         the disease to active service, including any hepatitis that occurred
  1.  ;;         in service.
  1.  ;; 
  1.  ;;  5.Include results of all diagnostic and clinical tests conducted in the
  1.  ;;    examination report.
  1.  ;; 
  1.  ;;E. Diagnosis: 
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                                    Date:
  1.  ;;END