103 lines
4.7 KiB
Mathematica
103 lines
4.7 KiB
Mathematica
DVBCWLL2 ;ALB/JEH LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
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;;2.7;AMIE;**74**;July 22, 2004
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;
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;
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TXT ;
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;;
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;;
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;;C. Physical Examination (Objective Findings):
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;;
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;;Address each of the following as appropriate, and fully describe current
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;;findings:
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;;
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;; 1. Abdominal Exam
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;;
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;; a. Describe any areas of tenderness and/or organomegaly, including liver
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;; size and whether it is tender to palpation.
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;; b. Presence or absence of ascites
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;; c. Evidence of Portal Hypertension (e.g. superficial abdominal veins,
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;; splenomegaly, abdominal pain)
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;;
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;; 2. General exam
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;;
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;; a. Describe all other signs of liver disease (e.g. jaundice, palmar
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;; erythema, spider angiomata).
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;; b. Evidence of Malnutrition (e.g. muscle wasting)
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;;
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;;D. Diagnostic and Clinical Tests:
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;;
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;; 1. For esophageal varices, X-ray, endoscopy, etc.
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;;
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;; 2. For gall bladder disease, X-ray or other objective confirmation.
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;;
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;; 3. For liver disease:
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;;
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;; a. serologic tests for hepatitis as appropriate (e.g. HbsAg,
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;; anti-HCV, anti-HBc, ferritin, alpha-fetoprotein); liver imaging
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;; as appropriate, (e.g. ultrasound or abdominal CT scan), biopsy
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;; report (when available).
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;;
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;; b. Viral hepatitis (including Hepatitis C): Name the specific type
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;; (A, B, C, or other). For hepatitis B and / or hepatitis C,
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;; provide an opinion as to which risk factor is the most likely
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;; cause, and whether these risk factors were present during the
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;; veteran's time in the military. Please support your opinion by
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;; discussing all risk factors in the individual and your rationale
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;; for your opinion. If you cannot determine which risk factor is
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;; the likely cause, state that there is no risk factor that is
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;; more likely than another to be the cause, and explain.
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;;
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;; c. Hepatitis C: Please note that Hepatitis C generally does not
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;; produce clinically evident hepatitis at the time of infection.
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;; Please provide results of serologic (anti-HCV antibody) and
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;; viral (HCV RNA) testing for hepatitis C. The anti-HCV assay
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;; confirms exposure to hepatitis C but does not differentiate
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;; between chronic, acute, or resolved infection. False positive
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;; and false negative results occur, but rarely. A positive
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;; qualitative or quantitative HCV RNA assay indicates current
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;; hepatitis C infection. A negative qualitative HCV RNA assay
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;; indicates that the individual does not have active, chronic
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;; hepatitis C. The recombinant immunoblot assay (RIBA) is a
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;; confirmatory serologic test that establishes the diagnosis of
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;; past (resolved) infection if the anti-HCV is positive but the
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;; HCV RNA assay is negative. (Reference: Under Secretary for
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;; Health's Information Letter 10-2002-019 "Diagnostic Testing
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;; for Hepatitis C"
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;; http://vaww.va.gov/publ/direc/health/infolet/10200219.pdf
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;;
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;;The following are established risk factors for acquisition of hepatitis C
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;;infection:
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;;
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;; -Blood transfusion before 1992
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;; -Past or present intravenous drug use
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;; -Blood exposure of skin or mucous membranes including accidental needle
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;; punctures
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;; -Sexual transmission (though most studies have failed to identify sexual
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;; transmission of this agent). Sexual transmission appears to be confined
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;; to such subgroups as persons with multiple sexual partners and sexually
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;; transmitted diseases.
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;; -History of hemodialysis
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;; -Tattoo or repeated body piercing
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;; -History of intranasal cocaine use
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;;
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;;See Harrison's Principles of Internal Medicine, 15th edition, The McGraw Hill
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;;Companies, Inc., page 1709, 1729-1730.
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;;
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;;Please consider the veteran's potential for skin and mucous membrane exposure
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;;to blood, especially where the veteran was a military corpsman, a medical
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;;worker, or a combat veteran.
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;;
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;; (d) Cirrhosis, chronic hepatitis, liver malignancy, or other chronic liver
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;; disease: State the most likely etiology. Address the relationship of
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;; the disease to active service, including any hepatitis that occurred
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;; in service.
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;;
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;; 5.Include results of all diagnostic and clinical tests conducted in the
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;; examination report.
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;;
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;;E. Diagnosis:
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;;
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;;
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;;Signature: Date:
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;;END
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