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NAIL CLUBBING

Nail clubbing (also known as drumstick fingers and watch-glass nails)[1]

is a deformity of

thefingers andfingernails associated with a number of diseases, mostly of

theheart andlungs.[2]:656

Hippocrates was probably the first to document clubbing as a sign of

disease, and the phenomenon is therefore occasionally called Hippocratic fingers.Idiopathic clubbing can also occur, as 60% of cases have no associated underlying disease

Clubbing develops in five steps:[4]

1. Fluctuation and softening of the nail bed (increased ballotability)2. Loss of the normal

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Mesothelioma of the pleura Arteriovenous fistula or malformation Cystic fibrosis

Heart disease: Any disease featuring chronichypoxia Congenitalcyanotic heart disease (most common cardiac cause) Subacute bacterial endocarditis Atrial myxoma (benign tumor)

Gastrointestinal and hepatobiliary: Malabsorption Crohn's disease andulcerative colitis Cirrhosis,especially inprimary biliary cirrhosis[7] Hepatopulmonary syndrome,a complication of cirrhosis[8]

Others: Graves' disease (autoimmune hyperthyroidism) - in this case it is known

as thyroidacropachy[9]

Familial and racial clubbing and "pseudoclubbing" (people of African descent often havewhat appears to be clubbing)

Vascular anomalies of the affected arm such as anaxillary artery aneurysm (in unilateralclubbing)

Nail clubbing is notassociated withchronic obstructive pulmonary disease (COPD). Therefore,in patients with COPD with significant degrees of clubbing, a search for signs of bronchogenic

carcinoma (or other causes of clubbing) might be indicated

The exact cause for sporadic clubbing is unknown, with numerous theories as to its

cause.Vasodilation (distended blood vessels), secretion ofgrowth factors (such asplatelet-

derived growth factor andhepatocyte growth factor)from the lungs, and other mechanisms have

been proposed. The discovery of disorders in theprostaglandin metabolism in primary

osteoarthropathy has led to suggestions that overproduction of PGE2 by other tissues may be the

causative factor for clubbing

The exact frequency of clubbing in the population is not known. A 2008 study found clubbing in

1% of all patients admitted to a department ofinternal medicine.Of these, 40% turned out to

have significant underlying disease of various causes, while 60% had no medical problems on

further investigations and remained well over the subsequent year

http://en.wikipedia.org/wiki/Mesotheliomahttp://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Cyanotic_heart_diseasehttp://en.wikipedia.org/wiki/Endocarditishttp://en.wikipedia.org/wiki/Atrial_myxomahttp://en.wikipedia.org/wiki/Malabsorptionhttp://en.wikipedia.org/wiki/Crohn%27s_diseasehttp://en.wikipedia.org/wiki/Ulcerative_colitishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Primary_biliary_cirrhosishttp://en.wikipedia.org/wiki/Primary_biliary_cirrhosishttp://en.wikipedia.org/wiki/Primary_biliary_cirrhosishttp://en.wikipedia.org/wiki/Hepatopulmonary_syndromehttp://en.wikipedia.org/wiki/Nail_clubbing#cite_note-8http://en.wikipedia.org/wiki/Nail_clubbing#cite_note-8http://en.wikipedia.org/wiki/Nail_clubbing#cite_note-8http://en.wikipedia.org/wiki/Graves%27_diseasehttp://en.wikipedia.org/wiki/Acropachyhttp://en.wikipedia.org/wiki/Acropachyhttp://en.wikipedia.org/wiki/Acropachyhttp://en.wikipedia.org/w/index.php?title=Axillary_artery_aneurysm&action=edit&redlink=1http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Growth_factorhttp://en.wikipedia.org/wiki/Platelet-derived_growth_factorhttp://en.wikipedia.org/wiki/Platelet-derived_growth_factorhttp://en.wikipedia.org/wiki/Hepatocyte_growth_factorhttp://en.wikipedia.org/wiki/Prostaglandinhttp://en.wikipedia.org/wiki/Internal_medicinehttp://en.wikipedia.org/wiki/Internal_medicinehttp://en.wikipedia.org/wiki/Prostaglandinhttp://en.wikipedia.org/wiki/Hepatocyte_growth_factorhttp://en.wikipedia.org/wiki/Platelet-derived_growth_factorhttp://en.wikipedia.org/wiki/Platelet-derived_growth_factorhttp://en.wikipedia.org/wiki/Growth_factorhttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttp://en.wikipedia.org/w/index.php?title=Axillary_artery_aneurysm&action=edit&redlink=1http://en.wikipedia.org/wiki/Acropachyhttp://en.wikipedia.org/wiki/Acropachyhttp://en.wikipedia.org/wiki/Graves%27_diseasehttp://en.wikipedia.org/wiki/Nail_clubbing#cite_note-8http://en.wikipedia.org/wiki/Hepatopulmonary_syndromehttp://en.wikipedia.org/wiki/Primary_biliary_cirrhosishttp://en.wikipedia.org/wiki/Primary_biliary_cirrhosishttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Ulcerative_colitishttp://en.wikipedia.org/wiki/Crohn%27s_diseasehttp://en.wikipedia.org/wiki/Malabsorptionhttp://en.wikipedia.org/wiki/Atrial_myxomahttp://en.wikipedia.org/wiki/Endocarditishttp://en.wikipedia.org/wiki/Cyanotic_heart_diseasehttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Cystic_fibrosishttp://en.wikipedia.org/wiki/Mesothelioma