Dysphagia Hematuria General Medicine

Introduction General Medicine

Question. Enumerate The Causes Of Clubbing.
Or
Enumerate The Causes Of Clubbing Of Fingers.
Or
Write Important Cause Of Digital Clubbing

Answer. Clubbing is a bulbous enlargement of the soft part of terminal phalanges with both transverse and longitudinal curving of nails.

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Causes of Clubbing Fingers

Pulmonary Disorders

1. Suppuration of lung
   • Bronchiectasis
   • Lung abscess
   • Suppurative pneumonia
2. Tumors of lung
   • Mesothelioma
   • Primary lung cancer
   • Metastatic lung cancer

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Disorders Cardiac 

1. Cyanotic congenital heart diseases
2. Subacute bacterial endocarditis
3. Atrial myxoma

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Disorders of the Gastrointestinal System And Liver

1. Inflammatory bowel disease
   1. Regional ileitis
   2. Ulcerative colitis
   3. Malabsorption syndrome
2. Cirrhosis of liver
3. Malignancy of liver

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Disorders of Endocrine System

1. Myxedema
2. Thyroid acropachy
3. Acromegaly

Miscellaneous

• Hereditary
• Idiopathic
• Unilateral: Pancoast tumor, subclavian and innominate artery aneurysm
• Unidigital: Traumatic or tophi deposit in gout
• Only in upper limbs in heroin addicts due to chronic obstructive phlebitis.

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Grades of clubbing

• Grade I: Softening of nail bed because of hypertrophy of tissue at that site.
• Grade II: In addition to grade I changes, there is the obliteration of angle between the nail base and the adjacent skin of the finger.
• Grade III: In addition to grade II changes, the nail itself loses its longitudinal ridges, and becomes convex from above downwards and from side to side. The nails assume the shape of a “parrot’s beak” or the terminal segment may become bulbous like a “drumstick”.
• Grade IV: Finger changes are associated with hypertrophic pulmonary osteoarthropathy.