Related Subjects:
|Lung Cancer
About
- Clubbing is an increased amount of soft tissue in the terminal phalanx of the fingers and toes, concentrated around the nail base.
- It is best seen by inspecting the nails
(fingers and toes) from the side and palpating the sponginess of the nail bed.
- Gross clubbing has an almost drumstick appearance of fingers but Mild clubbing just shows loss of the angle at the base of the nail and sponginess of the nail bed
- In some cases it can be simply benign and a familial trait
Examination - Look at the hands
- General Preparation
- Wash hands
- Ensure that the patient is comfortable
- Introduction and consent
- Check hands are not tender or sore
- Take time to look at the hands palm and dorsum
- Look for clues to cause for extra marks
- Cachexia and Nicotine staining, lung cancer
- On oxygen - Fibrosing alveolitis, Bronchiectasis
- Central cyanosis: Congenital Cyanotic heart disease
- Splinter haemorrhages - Endocarditis
- Pt under 40 - could it be cystic fibrosis or congenital heart disease
- Look at the fingers and look for the bulbous swelling
- Look laterally and see for a loss of the normal angle
- Ask for a CXR - Tumour, Fibrosis, Bronchiectasis, Empyema, Congenital Heart disease
Causes
- Respiratory (NOT ASTHMA OR COPD)
- Lung Cancer
- Idiopathic pulmonary fibrosis
- Empyema, Lung abscess
- Bronchiectasis
- Cystic fibrosis
- Cardiac NOT Ischaemic heart disease
- Congenital cyanotic heart disease
- Infective endocarditis
- Atrial myxoma
- Gastrointestinal
- Cirrhosis
- Primary biliary cirrhosis
- Ulcerative colitis
- Crohn's disease
- Coeliac disease
- Leiomyoma of the oesophagus or Achalasia
- Inherited
- Local Vascular causes
- Bronchial arteriovenous aneurysm
- Axillary artery aneurysm
Clubbing
Clubbing and cyanosed