Digestive System

• Author: David A. Morton III
• Pages: 573-660

5-1

CHAPTER 5

Digestive System

Contents

Part I – Adults

§5.00 Digestive System

§5.01 Category of Impairments, Digestive System

§5.02 Gastrointestinal Hemorrhaging From Any Cause

§5.03 (Reserved)

§5.04 (Reserved)

§5.05 Chronic Liver Disease

 

 

§5.08 Weight Loss

§5.09 Liver Transplantation

Part II – Children

§105.00 Digestive System

§105.01 Category of Impairments, Digestive System

§105.02 Gastrointestinal Hemorrhaging From Any Cause

§105.03 (Reserved)

§105.04 (Reserved)

§105.05 Chronic Liver Disease

 

 

 

§105.09 Liver Transplantation

§105.10 Need for Supplemental Daily Enteral Feeding Via a Gastrostomy

Part III – Forms

§5.02 Gastrointestinal Hemorrhaging From Any Cause

§5.05 Chronic Liver Disease

 

 

§5.08 Weight Loss

§5.09 Liver Transplantation

Note: Form 5.03 (2006 version, Appendix 27) for esophageal obstruction and Form 5.04 (2006 version, Appendix 28) for peptic ulcer disease may



DIGESTIVE SYSTEM

§5.00  5-2

Part I – Adults

§5.00 Digestive System

[The applicable Listing of Impairments introduces

  

subsection.]

SSA Listing of Impairments

A. What kinds of disorders do we consider in the diges-

tive system?

Disorders of the digestive system include gastro-

intestinal hemorrhage, hepatic (liver) dysfunction,



malnutrition. They may also lead to complications, such

as obstruction, or be accompanied by manifestations in

other body systems.

What documentation do we need?

We need a record of your medical evidence, including

  

should include appropriate medically acceptable imag-

ing studies and reports of endoscopy, operations, and

pathology, as appropriate to each listing, to document the

severity and duration of your digestive disorder. Medi-

cally acceptable imaging includes, but is not limited to,

X-ray imaging, sonography, computerized axial tomog-

raphy (CAT scan), magnetic resonance imaging (MRI),

and radionuclide scans. Appropriate means that the tech-

nique used is the proper one to support the evaluation and





 -



C. 

1. Digestive disorders frequently respond to medical or





of prescribed treatment.

 -

cation, therapy, surgery, or any other form of treatment

you receive, by determining if there are improvements





treatment that may further limit your functioning.



information about:

a. The treatment you have been prescribed (for exam-

ple, the type of medication or therapy, or your use

of parenteral (intravenous) nutrition or supplemental

enteral nutrition via a gastrostomy);

b. The dosage, method, and frequency of administration;

c. Your response to the treatment;



e. The expected duration of the treatment.





impact of your treatment, including its expected duration

 





consider the duration or expected duration of the treat-



5. If you need parenteral (intravenous) nutrition or sup-

plemental enteral nutrition via a gastrostomy to avoid

debilitating complications of a digestive disorder, this





syndrome (see 5.00F).

6. If you have not received ongoing treatment or have not

 -

 

 

impairment on the basis of the current medical and other

evidence in your case record. If you have not received



meets the criteria of one of the digestive system listings,

but your digestive impairment may medically equal a list-

ing or be disabling based on consideration of your residual



D. How do we evaluate chronic liver disease?

1. General. Chronic liver disease is characterized by



cirrhosis), due to any cause, that persists for more than

6 months. Chronic liver disease may result in portal

  

extrahepatic manifestations, or liver cancer. (We eval-

 

function may be manifested by hemorrhage from varices

or portal hypertensive gastropathy, ascites (accumulation



in the chest cavity), or encephalopathy. There can also be

DIGESTIVE SYSTEM

5-3 DIGESTIVE SYSTEM §5.00

 

indicative of liver dysfunction. Liver transplantation is the



2. Examples of chronic liver disease include, but are not

limited to, chronic hepatitis, alcoholic liver disease, non-al-

coholic steatohepatitis (NASH), primary biliary cirrhosis



hepatitis, hemochromatosis, drug-induced liver disease,



Acute hepatic injury is frequently reversible, as in viral,

drug-induced, toxin-induced, alcoholic, and ischemic hep-

atitis. In the absence of evidence of a chronic impairment,

episodes of acute liver disease do not meet 5.05.

3. Manifestations of chronic liver disease.

a. Symptoms may include, but are not limited to, pruri-

tis (itching), fatigue, nausea, loss of appetite, or sleep

disturbances. Symptoms of chronic liver disease may

-

ease and functional ability.

b. Signs may include, but are not limited to, jaundice,

enlargement of the liver and spleen, ascites, peripheral

edema, and altered mental status.

c.  may include, but are not lim-

ited to, increased liver enzymes, increased serum

total bilirubin, increased ammonia levels, decreased

serum albumin, and abnormal coagulation studies,

such as increased International Normalized Ratio

 

serum albumin or elevated INR levels indicate loss



 

other abnormal lab tests, such as liver enzymes, serum

total bilirubin, or ammonia levels, may have a poor

-

tional ability. A liver biopsy may demonstrate the

 



 





size and consistency (fatty liver, scarring) of the liver

and document ascites (see 5.00D6).

4. Chronic viral hepatitis infections.

a. General.

(i) Chronic viral hepatitis infections are commonly

caused by hepatitis C virus (HCV), and to a lesser

  

 





 

 

(liver enzymes, imaging studies, liver biopsy

pathology) and complications are generally similar









liver tests; extrahepatic manifestations; cirrhosis,



the need for liver transplantation; and liver cancer.

Treatment for chronic viral hepatitis infections

varies considerably based on medication tolerance,

 

and duration of the treatment. Comorbid disorders,

such as HIV infection, may accelerate the clinical

course of viral hepatitis infection(s) or may result

in a poorer response to medical treatment.

(ii) We evaluate all types of chronic viral hepatitis



body system(s). If your impairment(s) does not



 

residual functional capacity.

b. Chronic hepatitis B virus (HBV) infection.

(i) Chronic HBV infection can be diagnosed by the



the blood for at least 6 months. In addition, detec-











(ii) The therapeutic goal of treatment is to suppress



cirrhosis and ESLD, and hepatocelluar carcinoma.

Treatment usually includes interferon injections,

oral antiviral agents, or a combination of both.



as noted in 5.00D4c(ii) for HCV, and generally end



c. Chronic hepatitis C virus (HCV) infection.

(i) Chronic HCV infection is diagnosed by the

detection of hepatitis C viral RNA in the blood for

DIGESTIVE SYSTEM