DVBCWLV1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
;;2.7;AMIE;**26**;Apr 10, 1995
;
;
TXT ;
;;
;;A. Review of Medical Records: This may be of particular importance when
;; hepatitis C 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, distention, nausea,
;; vomiting, duration, frequency, severity, treatment, and
;; response to treatment.
;;
;;
;; 4. Fatigue, weakness, depression, or anxiety.
;;
;;
;; 5. When chronic liver disease is claimed, record history of any risk
;; factors for liver disease, including transfusions, hepatitis (and
;; what type), intravenous drug use, occupational blood exposure,
;; high-risk sexual activity, etc. When did they take place?
;; Describe current symptoms of liver disease and onset of symptoms.
;;
;;
;; 6. 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.
;;
;;TOF
;;C. Physical Examination Cont'd (Objective Findings):
;;
;; 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.
;;
;;
;;
;;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, anti-HBc, ferritin, alpha-fetoprotein); and liver
;; imaging (ultrasound or abdominal CT scan), as appropriate. If
;; hepatitis C is the diagnosis, a positive EIA (enzyme immunoassay)
;; test for hepatitis C should be confirmed by a RIBA (recombinant
;; immunoblot assay) test.
;;
;; a. 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 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.
;;
;;TOF
;;
;; b. With a diagnosis of 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. 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
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWLV1 4284 printed Apr 09, 2024@20:57:08 Page 2
DVBCWLV1 ;ALB/JAM LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
+1 ;;2.7;AMIE;**26**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;
+2 ;;A. Review of Medical Records: This may be of particular importance when
+3 ;; hepatitis C or chronic liver disease is claimed as related to service.
+4 ;;
+5 ;;
+6 ;;
+7 ;;B. Medical History (Subjective Complaints):
+8 ;;
+9 ;; Comment on:
+10 ;; 1. Vomiting, hematemesis, or melena.
+11 ;;
+12 ;;
+13 ;; 2. Current treatment - type (medication, diet, enzymes, etc.),
+14 ;; duration, response, side effects.
+15 ;;
+16 ;;
+17 ;; 3. Episodes of colic or other abdominal pain, distention, nausea,
+18 ;; vomiting, duration, frequency, severity, treatment, and
+19 ;; response to treatment.
+20 ;;
+21 ;;
+22 ;; 4. Fatigue, weakness, depression, or anxiety.
+23 ;;
+24 ;;
+25 ;; 5. When chronic liver disease is claimed, record history of any risk
+26 ;; factors for liver disease, including transfusions, hepatitis (and
+27 ;; what type), intravenous drug use, occupational blood exposure,
+28 ;; high-risk sexual activity, etc. When did they take place?
+29 ;; Describe current symptoms of liver disease and onset of symptoms.
+30 ;;
+31 ;;
+32 ;; 6. Provide history of alcohol use/abuse, both current and past.
+33 ;;
+34 ;;
+35 ;;
+36 ;;C. Physical Examination (Objective Findings):
+37 ;;
+38 ;; Address each of the following as appropriate, and fully describe
+39 ;; current findings:
+40 ;; 1. Ascites.
+41 ;;
+42 ;;
+43 ;; 2. Weight gain or loss, steatorrhea, malabsorption, malnutrition.
+44 ;;
+45 ;;TOF
+46 ;;C. Physical Examination Cont'd (Objective Findings):
+47 ;;
+48 ;; 3. Hematemesis or melena (describe any episodes).
+49 ;;
+50 ;;
+51 ;; 4. Pain or tenderness - location, type, precipitating factors.
+52 ;;
+53 ;;
+54 ;; 5. Liver size, superficial abdominal veins.
+55 ;;
+56 ;;
+57 ;; 6. Muscle strength and wasting.
+58 ;;
+59 ;;
+60 ;; 7. Any other signs of liver disease, e.g., palmar erythema, spider
+61 ;; angiomata, etc.
+62 ;;
+63 ;;
+64 ;;
+65 ;;D. Diagnostic and Clinical Tests:
+66 ;;
+67 ;; 1. For esophageal varices, X-ray, endoscopy, etc.
+68 ;;
+69 ;;
+70 ;; 2. For adhesions, X-ray to show partial obstruction, delayed motility.
+71 ;;
+72 ;;
+73 ;; 3. For gall bladder disease, X-ray or other objective confirmation.
+74 ;;
+75 ;;
+76 ;; 4. For liver disease: liver function tests (albumin, prothrombin time,
+77 ;; bilirubin, AST, ALT, WBC, platelets); serologic tests for hepatitis
+78 ;; (HBsAg, anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); and liver
+79 ;; imaging (ultrasound or abdominal CT scan), as appropriate. If
+80 ;; hepatitis C is the diagnosis, a positive EIA (enzyme immunoassay)
+81 ;; test for hepatitis C should be confirmed by a RIBA (recombinant
+82 ;; immunoblot assay) test.
+83 ;;
+84 ;; a. With a diagnosis of hepatitis, name the specific type (A,B,C,
+85 ;; or other), and for hepatitis B and C, provide an opinion as
+86 ;; to which risk factor is the most likely cause. Support the
+87 ;; opinion by discussing all risk factors in the individual and
+88 ;; the rationale for your opinion. If you cannot determine
+89 ;; which risk factor is the likely cause, state that there is
+90 ;; no risk factor that is more likely than another to be the
+91 ;; cause, and explain.
+92 ;;
+93 ;;TOF
+94 ;;
+95 ;; b. With a diagnosis of cirrhosis, chronic hepatitis, liver
+96 ;; malignancy, or other chronic liver disease, state the most
+97 ;; likely etiology. Address the relationship of the disease
+98 ;; to active service, including any hepatitis that occurred in
+99 ;; service. If you cannot determine the most likely etiology,
+100 ;; cannot determine whether it is more likely than not that one
+101 ;; of multiple risk factors is the cause, or cannot determine
+102 ;; whether it is at least as likely as not that the liver
+103 ;; disease is related to service, so state and explain.
+104 ;;
+105 ;;
+106 ;; 5. Include results of all diagnostic and clinical tests conducted
+107 ;; in the examination report.
+108 ;;
+109 ;;
+110 ;;
+111 ;;E. Diagnosis:
+112 ;;
+113 ;;
+114 ;;
+115 ;;Signature: Date:
+116 ;;END
