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Routine: DVBCWLQ1

DVBCWLQ1.m

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DVBCWLQ1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999

 ;;2.7;AMIE;**36**;Apr 10, 1995

 ;

 ;

TXT ;

 ;;

 ;;A. Review of Medical Records: This may be of particular importance when

 ;;hepatitis C (HCV) or chronic liver disease is claimed as related to service.

 ;;

 ;;

 ;;B. Medical History (Subjective Complaints):

 ;;

 ;;Comment on:

 ;;   1. Vomiting, hematemesis, or melena.

 ;;   2. Current treatment-type (medication, diet, enzymes, etc.), duration,

 ;;      response, side effects.

 ;;   3. Episodes of colic or other abdominal pain, fever, distention, nausea, or

 ;;      vomiting. Describe the duration, frequency, severity, treatment, and 

 ;;      response to treatment.

 ;;   4. Fatigue, weakness, depression, or anxiety, and their severity.

 ;;   5. Past biliary tract surgery.

 ;;   6. When chronic liver disease is claimed:

 ;;      *  Record history of and dates for any risk factors for liver disease, 

 ;;         including transfusion or organ transplant before 1992, hemodialysis,

 ;;         tattoo, body piercing, intravenous (or intranasal cocaine) drug use,

 ;;         occupational blood exposure or other percutaneous blood exposure,

 ;;         high-risk sexual activity, etc. Intramuscular gamma globulin shots

 ;;         may be claimed as a risk factor for hepatitis C, but, to date, no

 ;;         transmission of HCV by this means has been shown.

 ;;      *  Describe current symptoms of liver disease and onset of symptoms.

 ;;      *  Provide history of any hepatitis in service and discuss its

 ;;         relationship to current liver disease.

 ;;      *  Provide history of alcohol use/abuse, both current and past.

 ;;

 ;;

 ;;C. Physical Examination (Objective Findings):

 ;;

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

 ;;current findings:

 ;;   1. Ascites.

 ;;   2. Weight gain or loss, steatorrhea, malabsorption, malnutrition.

 ;;   3. Hematemesis or melena (describe any episodes).

 ;;   4. Pain or tenderness-location, type, precipitating factors.

 ;;   5. Liver size, superficial abdominal veins.

 ;;   6. Muscle strength and wasting.

 ;;   7. Any other signs of liver disease, e.g., palmar erythema,

 ;;      spider angiomata, etc.

 ;;TOF

 ;;D. Diagnostic and Clinical Tests:

 ;;

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

 ;;   2. For adhesions, X-ray to show partial obstruction, delayed motility.

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

 ;;   4. For liver disease:

 ;;      *  Liver function tests (albumin, prothrombin time, bilirubin, AST,

 ;;         ALT, WBC, platelets).

 ;;      *  Serologic tests for hepatitis (HBsAg, anti-HCV (EIA or ELISA) anti-

 ;;         HBc, ferritin, alpha-fetoprotein); and liver imaging (ultrasound or

 ;;         abdominal CT scan), as appropriate.

 ;;      *  If hepatitis C is the suspected diagnosis, a positive EIA (enzyme

 ;;         immunoassay) test for hepatitis C should be confirmed by a RIBA

 ;;         (recombinant immunoblot assay) test OR by an HCV RNA test, 

 ;;         either qualitative or quantitative.  The diagnosis of hepatitis

 ;;         C infection should not be made unless such test results are

 ;;         in the record and support the diagnosis. A positive EIA test alone

 ;;         is not sufficient to establish the diagnosis, nor is a liver biopsy

 ;;         with a report that indicates it is "consistent with"

 ;;         hepatitis C infection.

 ;;      *  With a diagnosis of hepatitis, name the specific type (A, B, C, or

 ;;         other), and for hepatitis B and C, provide an opinion as to which risk

 ;;         factor is the most likely cause.  Support the opinion by discussing all

 ;;         risk factors in the individual and the rationale for your opinion.  If

 ;;         you can not 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.

 ;;      *  With a diagnosis of cirrhosis, chronic hepatitis, liver malignancy, or

 ;;         other chronic liver disease, state the most likely etiology and the

 ;;         basis for your opinion.  Address the relationship of the disease to

 ;;         active service, including any hepatitis or hepatitis risk factor that

 ;;         occurred in service.  If you cannot determine the most likely

 ;;         etiology, cannot determine whether it is more likely than not that one

 ;;         of multiple risk factors is the cause, or cannot determine whether it

 ;;         is at least as likely as not that the liver disease is related

 ;;         to service, so state and explain.

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

 ;;       examination report.

 ;;

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;

 ;;Signature:                                                    Date:

 ;;END