Clubbing

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Clubbing

  1. 1. CLUBBINGFirst described by Hippocrates about 2500yrs ago, hence also called as Hippocratic finger ABHIJIT SAMAL 080201386
  2. 2. DEFINITION• Thickening of the tissues at the base of the finger and toe nails such that the normal angle between the nail & the digit is filled in.
  3. 3. Pathophysiology• VEGF is the key entity, platelet derived growth factor stimulated by hypoxia and produced in diverse malignancies.• VEGF induces vascular hyperplasia, edema, and fibroblast or osteoblast proliferation at peripheral levels in nails
  4. 4. CAUSES• thoracic & non-thoracic• THORACIC causes: bronchitis, empyema, lung abscess, cystic fibrosis, Lung Ca, Esophageal Ca, mesothelioma, Bac. Endocarditis. » Interstitial lung disease: asbestosis, fibrosing alveolitis. » Vascular causes: AV malformations, Cyanotic heart disease. • Non-thoracic causes: Hepatic cirrhosis, Ulcerative colitis, Crohn’s disease.
  5. 5. Criteria• Loss of normal angle between nail and nail bed.• Inc. Nail bed fluctuation• Inc. nail bed curvature in the later stages• Inc. bulk of soft tissue over the terminal phalanges
  6. 6. Grades of clubbing• Grade 1: Nail bed fluctuation• Grade 2: Obliteration of Lovibond angle• Grade 3: Parrot beaking• Grade 4: Hypertrophic osteo- arthropathy(HOA)
  7. 7. Parrot beak app.Drumstick appearance
  8. 8. Hypertrophic Osteo-arthropathy• Earlier known as hypertrophic pulmonary osteo-arthropathy(HPOA)• Syndrome of clubbing of the digits, periostitis of the long bones and arthritis.• Primary: occurs w/o any underlying cause and is familial• Secondary: pulmonary, cardiac, hepatic, intestinal disease.
  9. 9. Hypertrophic Osteo-arthropathy• Earlier known as hypertrophic pulmonary osteo-arthropathy(HPOA)• Syndrome of clubbing of the digits, periostitis of the long bones and arthritis.• Primary: occurs w/o any underlying cause and is familial• Secondary: pulmonary, cardiac, hepatic, intestinal disease.

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