ITEM 38. Abdomen and Viscera

• I. Code of Federal Regulations
• All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

II. Examination Techniques (updated 09/30/2026)

Colostomy following surgery for cancer may be allowed by the FAA with special follow-up reports.

III. Aerospace Medical Disposition

The following tables list the most common conditions of aeromedical significance and the course of action that should be taken by the AME as defined by the protocol and disposition in the table.

Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

Conditions:

(Updated 09/30/2026)

The following list of hyperlinks will take the user to the Web version of the AME Guide where the conditions are grouped together with any applicable, related documents. All the Gastrointestinal (GI) dispositions are on the following pages of this document.

Diaphragmatic Hernia)

• BARRETT'S ESOPHAGUS
• All Classes
• (Updated 4/27/2022)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Endoscopy (EGD) biopsy finding	If the AME can determine the medications are acceptable, the pilot has no symptoms that would interfere with flight duties, and there is no evidence of a GI bleed, esophageal cancer, or other pathology:The AME should comment on the approximate date of the procedure and any complications or additional findings (see corresponding section).	ISSUE Summarize this information including approximate date of procedure in Block 60
B. Abnormal findings or complications(High-grade dysplasia, progression)	Submit the following to the FAA for review: 1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days prior to the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and followup.2. It must specifically include if there is any history of GI bleed, GI cancer, or complications. If history of GI cancer - see that section	DEFER Submit the information to the FAA for a possible Special IssuanceFollow up Issuance will be per the airman’s authorization letter

• CHOLELITHIASIS
• All Classes
• (Updated 05/29/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.AsymptomaticORPost-surgery with NO complications.	If the AME can determine the condition is under control and the individual has no symptoms that would interfere with flight duties.Note: The AME should comment on the date of surgery, any complications, and if the individual has been released to full activity by the treating physician.If AME comments are absent, the individual may be asked to provide a current, detailed Clinical Progress Note from their physician.	ISSUEAnnotate this information in Block 60 including approximate date of surgery
B. All others:Symptomatic or history of symptoms (e.g., biliary colic)ORSurgical complications (unresolved)If surgical complications such as DVT, see that page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or surgeon no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) inBlock 60
	• Prognosis; and Follow-up.2. Hospital records (if applicable):• Admission History and Physical;• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) printed from electronic medical records are NOT sufficient for medical certification purposes.); and• Operative/procedure report(s).

• CIRRHOSIS
• All Classes
• (Updated 02/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI)	The AME should review the following:• Most recent detailed clinical progress note from the treating physicianIf this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease:NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C.If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page.	ISSUEAnnotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
B.Non-alcoholic cirrhosis	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating hepatologist (liver specialist) or gastroenterologist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.2. It must specifically include: o How the condition was diagnosed, etiology, hospitalizations, o If there is ANY history of hepatic encephalopathy, ascites or varices. o Calculation of Child-Pugh score 3. Lab: Performed within 90 days of exam to include: o CBC; o Comprehensive metabolic panel; o GGT; o Alpha-fetoprotein; and o PT/PTT/INR	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.
	4. Most recent imaging studies (e.g., ultrasound, MRI, etc.)5. Most recent upper endoscopy report and any associated pathology reports6. Biopsy results (if performed)7. Neuropsychological Evaluation with interpretation of CogScreen-Aeromedical Edition.*8. Results of any other testing deemed appropriate by the treating physician.*Note: If CogScreen-AE is interpreted as abnormal, completion of neurocognitive testing per specs for Potential Neurocognitive Impairment is indicated.
C. Alcoholic Cirrhosis	Submit the following for FAA review:1. All items in Row B2. Once stable, all items for Substance Abuse/Dependence	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

• ABDOMEN AND VISCERA AND ANUS CONDITIONS
• All Classes
• (Updated 02/25/2026)

CACI - Colitis Worksheet

(Updated 04/29/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified colitis. (Documents do not need to be submitted to the FAA.) [ ] Has current OR previous SI/AASI but now CACI qualified colitis. [ ] NOT CACI qualified. I have deferred. (Submit supporting documents.)

• COLON CANCER/ COLORECTAL CANCER
• All Classes
• (Updated 02/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Non metastatic - treatment completed 5 or more years ago	If no recurrence or ongoing treatment:	ISSUE Summarize this history in Block 60.
B. Pedunculated cancerous polyp (Adenocarcinoma) removed by colonoscopy Less than 5 years ago	Review current, detailed Clinical Progress Note. If it shows:• Local lesion only (TNM stage 0 or I);• Complete resection with no additional treatment needed;• Follow up is annual or less frequent colonoscopy;• No clinical concerns.	ISSUE Summarize this history in Block 60.
C. Non metastatic and no High-Risk features*Treatment completed Less than 5 years ago	Follow CACI worksheet.	Follow the CACI-Colon Cancer/ Colorectal Cancer WorksheetNote in Block 60
D. HIGH RISK features*OrMetastatic disease (Refers to distant metastatic disease such as: lung, liver, lymph nodes, peritoneum, brain.)	Submit the following to the FAA for review: ☐ Status report or treatment records from treating oncologist that provide the following information: o Initial staging; o Disease course including recurrence(s); o Location(s) of metastatic disease (if any); o Treatments used; o How long the condition has been stable; and o If any upcoming treatment change is planned or expected and prognosis. ☐ Medication list. Dates started and stopped. Description of side effects. ☐ Treatment records including clinic notes. ☐ Operative notes and discharge summary, if applicable. ☐ Colonoscopy reports. ☐ Pathology reports.	DEFERSubmit the information to the FAA for a possible Special IssuanceFollow-up Special Issuance – Will be per the airman’s authorization letter
	☐ Results of MRI/CT or PET scan reports that have already been performed (In some cases, the actual CDs will be required in DICOM format for FAA review.) ☐ Lab reports. o CBC and CEA performed within the last 90 days; o Previous tumor marker lab results (such as CEA).

*Notes: High-Risk features for FAA purposes include the following. These DO NOT CACI qualify:

An applicant with an ileostomy or colostomy may also receive FAA consideration. A report is necessary to confirm that the applicant has fully recovered from the surgery and is completely asymptomatic.

In the case of a history of bowel obstruction, a report on the cause and present status of the condition must be obtained from the treating physician.

CACI - Colon Cancer/ Colorectal Cancer Worksheet

(Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days before the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified colon cancer/colorectal cancer.

[ ] Has current OR previous SI/AASI but now CACI qualified colon cancer/colorectal cancer.

[ ] NOT CACI qualified colon cancer/colorectal cancer. I have deferred. (Submit supporting documents.)

Congenital Sucrase-Isomaltase Deficiency (CSID)

All Classes

(Updated 08/26/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Well-controlledANDNo medication side effects	If the AME can determine the condition is under control, current medications are acceptable, and no symptoms that would interfere with flight or safety related dutiesANDVerifies a 7-day waiting period has elapsed since starting medication sacrosidase (Sucraid):	ISSUESummarize findings in Item 60.
B. With severe complications	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Results of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.

Eosinophilic Esophagitis

All Classes

(Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. In clinical AND histologic remissionANDTreated with medication	See the CACI – Eosinophilic EsophagitisThis will require a detailed Clinical Progress Note	ISSUEIf the pilot meets all CACI worksheet criteria and is otherwise qualified, with no time limitation.Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
B. All others• History of food impaction within the past year;• Symptomatic;• Not adequately treated;• Fibrostenotic disease	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the Gastroenterologist (GI) no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and Plan;• Prognosis and Follow-up.2. It must specifically include if any history of:• complications such as food impaction,• need for endoscopic dilation3. Copies of most recent endoscopy and pathology reports.4. Labs or imaging already performed or determined necessary by the treating provider.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize elements or findings in Item 60.

CACI – Eosinophilic Esophagitis

(Updated 04/29/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Eosinophilic Esophagitis.

[ ] Has current OR previous SI/AASI but now CACI qualified Eosinophilic Esophagitis.

[ ] NOT CACI qualified Eosinophilic Esophagitis. I have deferred. (Submit supporting documents.)

• ESOPHAGEAL VARICES
• All Classes
• (Updated 02/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Small varices (grade 1 or F1)without red signsIf the underlying cause is identified (e.g., cirrhosis), see that page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified Gastroenterologist, no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis; assessment and plan;• Prognosis; and follow-up.2. The Clinical Progress Note must specifically include:• Underlying cause of the varices;• Dates of any bleeding events, treatment, and outcome;• If no history of bleeding events, that should be stated;• Size, grade, and location of varices;• ANY red signs (e.g., red wale markings, erythematous raised spots, also referred to as cherry red spots); and• Prognosis for risk of bleeding.3. Report from the most recent upper endoscopy study/EGD (esophagogastroduodenoscopy)4. Labs:• Complete Blood Count (CBC) performed within the past 90 days; and• Copies of other labs already performed or clinically indicated.5. Results of any other testing already performed or clinically indicated.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) inItem 60.
B.Any history of bleeding esophageal varies,after adequate treatmentSee corresponding page if underlying cause is identified (e.g., cirrhosis)	After a 6-month recovery period, submit the following for FAA review:• All items in row AIf less than 6 months recovery period, go to row C.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
C.Enlarged or large varices (Grade 2-3 or F2-3)ORVaries of ANY size WITH red signsORHistory of bleeding esophageal varices, within the past 6 monthsORDisease process inadequately controlled	Submit the following for FAA review:1. The most recent detailed Clinical Progress Note generated from a clinic visit with a board-certified Gastroenterologist.It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis; assessment and plan;• Prognosis; and follow-up.2. The Clinical Progress Note must specifically include:• Underlying cause of the varices;• Dates of any bleeding events, treatment, and outcome;• If no history of bleeding events that should be stated;• Size, grade, and location of varices• ANY red signs (e.g., red wale markings, erythematous raised spots, also referred to as cherry red spots); and• Prognosis for risk of bleeding.3. Report from the most recent upper endoscopy study/EGD (esophagogastroduodenoscopy).	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

• GI Procedures (EGD or Esophagogastroduodenoscopy; Colonoscopy)
• All Classes
• Updated 09/30/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Uncomplicated, with or without biopsyEGD esophagogastroduodenoscopy, endoscopy, upper endoscopy, upper GIorColonoscopy (c-scope)	For a routine procedure with no complications, the recovery period is based on anesthesia.In most cases, 48 hours applies after a routine procedure and recovery.If the AME can determine the condition has fully resolved without sequelae with no symptoms or current problems that would interfere with flight duties:	ISSUESummarize findings in Item 60.If any underlying condition is found, see that section.
B. All others (unresolved complications)(e.g., complications such as infection, or reaction to anesthesia have not resolved.)If bleeding or tearing of the GI tract, see corresponding page.The individual should not return to flight or SRD until the complication(s) are resolved and they have been released by their treating physician/surgeon to full duty.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or surgeon no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Current CBC (lab).3. Results of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.If any underlying condition is found, see that section.

• GERD (gastroesophageal reflux disease or reflux)
• All Classes
• (Updated 03/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treated with lifestyle/diet changes or acceptable medication	If the AME can determine the condition is under control, medications are acceptable, and the individual has no symptoms that would interfere with flight or safety related duties:	ISSUE Summarize in Item 60 including if meds are needed or any complications.
B.Requiring a surgical procedure2 or more months ago	If the AME can determine through history and exam, the surgery was 2 or more months ago with no complications, no evidence of GI bleed or cancer, and the condition has resolved:	ISSUE Summarize findings in Item 60.AME must specifically mention if any complications.
C. SevereorRequiring surgical procedure less than 2 months agoorRecurrent procedure(s)NOTE: most require a six (6) week recovery period after a surgical procedure such as Nissen fundoplication.	Submit the following to the FAA:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating gastroenterologist or surgeon no more than 90 days before the AME exam. It must include a detailed summary and discussion of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up. 2. It must specifically include etiology, surgical outcomes, and any complications. 3. Other testing performed or deemed clinically necessary by the treating physician.	DEFER Submit the information to the FAA for a possible Special IssuanceSummarize findings in Item 60.

HERNIA (Abdominal; Incisional; Inguinal; Femoral; Perineal; Ventral; Congenital

• Diaphragmatic Hernia)
• All Classes
• Updated 09/30/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Incisional, Inguinal, Femoral or Ventral Hernia, surgically repairedORInguinal hernia in a male applicant that is asymptomatic or associated with mild symptoms only, reducible, and uncomplicatedORSmall (less than 1-2 cm), ventral or incisional hernia that is asymptomatic or associated with mild symptoms only, reducible, and uncomplicatedANDTreated with watchful waiting	AME should list the specific type of hernia in Item 60.If asymptomatic, or repaired, with no evidence of complications, incarceration or strangulation and this surgery/procedure was not due to cancer, and released for full duty:	ISSUESummarize findings in Item 60.
B. All others	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or surgeon no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Results of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.

• HIATAL HERNIA (Sliding or Paraesophageal)
• All Classes
• Updated 09/30/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Asymptomatic simple hiatal hernia with typical reflux symptomsadequately controlled with or without medicationORtreated surgically, with full recoveryANDNo alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting)	If the AME can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable:Note: Medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.	ISSUESummarize findings in Item 60.
B. Paraesophageal hernia, surgically repaired 2 or more years ago	The AME should review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or surgeon no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Current CBC (lab).3. Results of any other testing already performed by the treating physician.If the AME can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed:	ISSUESummarize findings in Item 60 and submit the evaluation to the FAA for retention in the file.
C. All others (Complicated)Unrepaired paraesophageal herniaORSurgically repaired less than 2 years ago.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or surgeon no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Current CBC (lab).3. Results of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.

• ABDOMEN AND VISCERA AND ANUS CONDITIONS
• All Classes

CACI - Hepatitis C - Chronic Worksheet

(Updated 04/13/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Hepatitis C - Chronic. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Hepatitis C - Chronic.

[ ] NOT CACI qualified Hepatitis C - Chronic. I have deferred. (Submit supporting documents.)

• LIVER FUNCTION TEST ELEVATION
• (abnormal LFTs, elevated liver enzymes)
• All Classes
• Updated 09/30/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Persistently elevated LFTs diagnosed as:- Statin-induced OR- Gilbert syndromeANDAsymptomaticANDAST and ALT are less than 5X ULN (upper limit of normal) on lab or mentioned on clinic/hospital records	If the AME can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed:NOTE: If due to an identified underlying cause, see that page.	ISSUESummarize findings in Item 60.
B. Persistently elevated LFTs due to• Any other cause (including unknown)OR• Symptomatic,• Require treatment,• AST/ALT 5X ULN or higher on lab reports or mentioned on clinic/hospital records, or• AST/ALT ratio is > 2 (consider personal statement addressing history of alcohol use)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their Hepatologist (preferred) or Gastroenterologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Results of any other testing (such as labs or imaging) deemed necessary by the treating physician.NOTE: If due to an identified underlying cause, see that page.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
C. Related to alcohol and/or drug use.	See Drug and Alcohol section.

• LIVER TRANSPLANT
• All Classes
• (Updated 02/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Donor	Surgery One year ago or longer If the AME can determine the condition has fully resolved with no issues affecting flight duties:Surgery Within the Last Year AME must review a detailed clinical progress note from the transplant team physician. If no complications or issues affecting flight duties:	ISSUEAnnotate this information in Block 60.If any complications or concerns, DEFER.
B. Recipient	After a six (6) month post-transplant recovery period with documented stability for the last three (3) months: Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the transplant surgeon or transplant team physician no more than 90 days before the AME exam from transplant surgeon or transplant team physician. It should include a detailed summary of the history of the condition or diagnosis; treatments and outcomes; current medications, dosages, and side effects (if any); physical exam findings; all pertinent test results obtained; assessment; plan (prognosis); and follow-up.2. It must specifically include: Indication for transplant, any sequelae prior to transplant, if alcohol was a contributing factor (abuse or dependence), status of the transplant, functional capacity, modifiable risk factors, and prognosis for incapacitation.3. Any recent or expected change in treatment plan.4. Complication history such as: o Rejection or graft versus host disease/GVHD; o Infection Hepatitis C (HCV) or CMV; and/or	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.
	o Malignancy due to hepatocellular carcinoma (HCC) or following transplant and initiation of immune-suppressants.5. Lab: Complete blood count (CBC), CMP with LFTs performed within the past 90 days.6. Imaging: Copies of the initial and most recent MRI, CT, or PET scan with clinical interpretation.7. Specific testing: Results of liver biopsy (already performed).8. Hospital records: History and Physical (H&P), operative notes, and discharge summary.9. Pre-transplant treatment notes that identify the diagnosis/underlying condition which required transplant.
C. Combined TransplantsLiver + kidneyLiver + heartLiver + other	Submit the required items for each individual organ transplanted.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

Metabolic dysfunction-Associated Liver Disease (MASLD)/Non-Alcoholic Fatty Liver Disease (NAFLD), and Metabolic dysfunction-Associated Steatohepatitis (MASH)/Non-Alcoholic Steatohepatitis (NASH)

All Classes

(Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Metabolic dysfunctionassociated steatotic liver disease (MASLD)ORNon-alcoholic fatty liver disease (NAFLD)NOT due to diabetes and/or substance use disorder	If the AME can determine the condition is under control, and no symptoms that would interfere with flight or safety related duties:	ISSUEAnnotate this information in Block 60.If any underlying cause is found, see that section.
B.Metabolic dysfunctionassociated steatohepatitis (MASH)ORNon-alcoholic steatohepatitis (NASH)If diabetes present, see that section.	See the CACI MASH/NASH Worksheet.This requires a current, detailed Clinical Progress Note from the Hepatologist (Liver Specialist) and fibrosis score.If the pilot meets all CACI worksheet criteria and is otherwise qualified:	If the pilot meets all CACI worksheet criteria and is otherwise qualified,ISSUEwith no time limitationAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.If no AME explanation, the individual may be asked to provide documentation.
C. All others• Symptomatic• Fibrosis score F2 or greater• FIB-4 index 2.68 or greater• Liver biopsy showed cirrhosisCirrhosis - See that section	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating Hepatologist or treating physician no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;• Prognosis; and Follow-up.2. Lab. Current liver function testing, CBC, and any other testing clinically indicated.3. Results of any imaging studies performed or clinically indicated. Fibrosis score such as FIB-4 or VCTE or Magnetic resonance elastography should be included.4. Liver biopsy results (if performed).	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

CACI – MASH/NASH (Liver) Worksheet

(Updated 04/29/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE one of the following in Block 60:

[ ] CACI qualified MASH/NASH. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified MASH/NASH.

[ ] NOT CACI qualified MASH/NASH. I have deferred. (Submit supporting documents.)

• PANCREATITIS
• All Classes
• (Updated 06/24/2020)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Gallstone pancreatitisSingle episode resolved	1 month recovery period after release from treating physician.Must have specific documentation from General Surgery (GS) or Gastroenterology (GI) verifying definitive treatment: Alcohol must be ruled out as a contributing factor (via hospital records or treating physician determination. If not available, AME should screen). Common Bile Duct (CBD) was cleared of stones/debris; Cholecystectomy; and Off all pain medications.	ISSUE Summarize this history in Block 60.
B. Any others such as:• Alcohol induced or contributing factor• CBD• Stricture/stenosis• Chronic pancreatitis• Recurrent pancreatitis• Retained stones• Secondary to elevate Triglycerides• Etiology unknown• Other causes	3-month recovery period then:Submit the following for FAA review: 1. Current, detailed Clinical Progress Note from the treating Gastroenterologist (GI) describing:• Cause of the condition, how long the condition has been stable, and prognosis;• If CBD stricture/stenosis or obstruction verify it has resolved;• If there is any evidence of alcohol involvement; and• Verify off all pain medication 2. Current Medication list, dosages, and side effects, If any; 3. Lab (minimum amylase and lipase, from hospital admission, discharge, and current evaluation; 4. Operative notes, admission H&P and discharge summary, if applicable; and 5. Results of MRI/CT or other imaging, if performed.	DEFERSubmit the information to the FAA for reviewFollow up Issuance Will be per the airman’s authorization letter

Notes:

• SPLENOMEGALY
• All Classes
• Updated 09/30/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Splenomegaly noted on progress notes/problem list or imaging (CT/ultrasound)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include: Etiology and date diagnosed.3. Imaging reports: Copies of the initial and most recent MRI, CT, PET scan or ultrasound(s) already performed. In some cases, actual images may be required after review.4. Lab: Complete blood count (CBC), performed within the past 90 days:5. Results of any other testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60.
If due to an underlying condition, see that page.