Clubbing agp

Clubbing

1. CLUBBING A k s h a i G e orge Paul

2. NORMAL FINGERS CLUBBED FINGERS

3. Clubbing is the bulbous enlargement of terminal phalanges due to proliferation of connective tissue between the finger nail and the bone

4. Hippocrates fingers Because it was hippocrates who first described this clinical feature

5. Pathology of clubbing Soft tissue swelling is due to interstitial edema and dilation of arteries and capillaries

6. Theories of clubbing 1.Dilation of AV anastomosis In clubbing av anastomosis increases the fingers.this leads to the hypertrophy of tissues in the nail bed. 2.Increased pressure gradient It is between radial arteries and digital arteries which causes edema 3.Cappillary stasis 4.Vitamin deficency and hormonal disorders

7. Criterion for clubbing 1.Lovibond angle >180 degree 2.Schamroth sign positive 3.Phalangeal depth ratio>1

8. Lovibond angle Angle between the nail bed and nail.Normally it is an obtuse angle about 160 degrees. In clubbing lovibond angle > 180 degrees.

9. Schamroth`s sign

10. When two fingers are held togetherwith their nails facing each other,a space is seen at the nail folds called shamroth window.It is lost in clubbing

11. Grades of clubbing Grade I: Softening of the nail beds and fluctuation Grade II: Drumstick type Grade III: Parrot beak Grade IV: Hypertropic osteoarthropathy

12. Checking nail bed fluctuation

13. Parrot beak

14. Causes of clubbing I.Bronchopulmonary diseases. 1.Bronchiectasis 2.Lung abscess 3.Bronchiogenic carcinoma 4.Emphysema 5.mesothelioma II.Cardiac diseases 1.Congenital cyanotic heart disease 2.Subacute bacterial endocarditis 3.Fallot`s tetrology

15. III.GIT diseases 1.Ulcerative colitis 2.Cirrhosis of liver IV.Endocrine disorders 1.Thyrotoxicosis 2.Acromegaly

16. Types of clubbing 1.Unilateral or bilateral 2.Acute or chronic 3.Primary or secondry

17. Acute clubbing Acute clubbing develops within 2-3 weeks. Mostly seen in: Lung abscess Bacterial endocarditis

18. Chronic clubbing Chronic clubbing develops in about 6 months as in cyanotic heart diseases such as Tetralogy of Fallot . In bronchiectasis clubbing may take upto 1year to develop

19. Unilateral clubbing Seen a single limb

20. Unidigital clubbing

21. Bilateral clubbing

22. Primary clubbing Primary form of clubbing is generally idiopathic or hereditary. Pachydermopriostosis contributes to about 85% of primary form of clubbing.

23. Secondry clubbing Secondary form of clubbing is mostly secondary to systemic illness affecting mainly respiratory system, cardiovascular system, hepatobiliary system and gastrointestinal system, and hence is bilateral in general.

24. pseudoclubbing As the name suggests, it refers to appearance of clubbing without actual presence of it, seen in: Hyperparathyroidism: there is excessive resorption of distal phalanges Hansen’s disease Leukemia: bone destruction due to secondary deposits

25. Mnemonics C-Congenital heart disease,cirrhosis LU-Lung abscess B- Bronchiectasis B- Bronchiogenic carcinoma IN-Infective endocarditis G-GIT disorders like ulcerative colitis

26. Thank you