College Answer

°     Inflammatory bowel disease

°     Thyrotoxicosis

°     Idiopathic

°     Familial

°     Cirrhosis

°     Celiac

°     Pregnancy

Discussion

There are numerous causes of clubbing.

Here is an unreasonably long list:

Causes of bilateral clubbing in both hands and feet

Cardiac

• Congenital heart disease, particularly cyanotic defects
• Congestive cardiac failure
• Aortic aneurysm
• Subacute bacterial endocarditis
• Arteriovenous fistula (and it would have to be a major one)

Respiratory

• Chronic lung disease of any sort, really;
  • Bronchiectasis, which makes you think of cystic fibrosis
  • COPD, asbestosis
  • Pulmonary fibrosis of any aetiology
  • Empyema which has been going on for a while
• Lung carcinoma (according T and O’C, usually not the small-cell variety)

Gastrointestinal

• Cirrhosis; for some reason, particularly primary biliary cirrhosis
• Coeliac disease
• Inflammatory bowel disease
• Malignancy of the colon

Uncommon causes of clubbing

• Thyrotoxicosis
• Pregnancy
• Syringomyelia
• Hyperparathyroidism
• Pregnancy
• Inherited familial (some people are just born that lucky – it’s a Mendelian dominant trait)

Causes of clubbing in feet only

• Coarctation of aorta
• Abdominal aortic aneurysm

Causes of unilateral clubbing 

• Any sort of arterial aneurysm leading into the clubbed limb
• Apical lung tumour
• Hemiplegia