List 2 causes of clubbing (apart from cardiovascular and respiratory causes)

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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

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

References

References

Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.

Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where. Get your own.

Rutherford, John D. "Digital Clubbing." Circulation 127.19 (2013): 1997-1999.

Velur, Prasuna, and Giridhar P. Kalamangalam. "Teaching NeuroImages: Unilateral clubbing in hemiplegia." Neurology 78.19 (2012): e122-e122.

Stoller, James K., et al. "Reduction of intrapulmonary shunt and resolution of digital clubbing associated with primary biliary cirrhosis after liver transplantation." Hepatology 11.1 (1990): 54-58.

Dickinson, C. J., and J. F. Martin. "Megakaryocytes and platelet clumps as the cause of finger clubbing." The Lancet 330.8573 (1987): 1434-1435.