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Routine: DVBCWLQ1

DVBCWLQ1.m

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