CYANOSIS AND CLUBBING

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CYANOSIS AND CLUBBING

Post by Admin on Tue Mar 16 2010, 14:42

CYANIOSIS:


Bluish discoloration of the skin and the mucous membrane as a result of increase in quantity of reduced hemoglobin or increase in hemoglobin derivatives in the superficial vsls of those arreas.

Degree of cyanosis is modified by colour of skin ,thickness
of skin & state of superficial capillaries.

CUT OFF :
reduced hg value – 4mg/dl (Harrison)

5mg/dl (Macleod)
Meth hb - >1.5 g/dl
Sulf hb - >0.5g/dl
Interms of PaO2 – PaO2 < 85%

DD : cyanosis should be from polycythemia and COHbin Carbon monoxide poison
polycythemia : normal blood hb assay .
COHb – normally produces a cherry red flush unlike cyanosis which produces blue coloR

CYANOSIS – will be seen only when ther is an absolute increase in the REDUCED Hb levels.
ie., in anaemia – blood Hb is low so relatively there wil be an increase in Reduced Hb which will not produce cyanosis.. even in anaemia cyanosi becomes evident when reduced Hb level is adove the cut off value.


TYPES :
Central , peripheral & differential cyanosis.

Central :
Decreased oxygen saturation : altitude , impaired pulmonary ventilation and cyanotic heart disease & Hb with low affinity for O2 (Hb K).

Hemoglobin abnormalities: methhaemoglobulinaemia , sulf ,COHb(also seen in smokers)


Peripheral :
Reduced cardiac output, peripheral vasoconstriction , cold exposure , peripheral vascular disease.

DIFFERENTIAL CYANOSIS:
Cyanosis involving particular parts of the body .
Eg.,
1 cyanosis involving lower half of the body : PDA with PHT & right to left shunts.
2 cyanosis involving upper limbs : PDA with PHT & right to left shunts , TGV.

Intermittent cyanosis is seen in ebstein anamoly.

(c) : CENTRAL : cheeks and tongue
peripheral : hand, tip of nose, ear lobes & lips

CLUBBING :

DEFNITION : The selective bullous enlargement of the distal segment of fingers and toes due to the proliferation of the connective tissue particularly on the dorsal surface with increased sponginess of the tissue at the base of nail of varied etiology is termed clubbing .

Normal angle:160 . lovibond angle. Clubbing first appears in index finger.

Grading :

Grade 1 : fluctuation +
Grade 2 : obliteration of nail bed angle
Grade 3: parrot beak / drumstick appearance .
Grade 4: hypertrophic pulmonary osteoarthropathy.


©️ :
Fluctuation test . stabilize proximal interphalan jt with ur middle fingers and pulp of finger with ur thumbs & test for fluctuation using ur index fingers.


Profile view .. view patients nailbed angle at eye level.
schamroth sign. Approximate the dosum of fingers of both hands and look for the window.
Grade 4 : test tenderness over wrist jt.

OBJECTIVE MEASUREMENT :
VASQUEZ / CLUBBING INDEX:

Measure the diameter of base of nail and the diameter at DISTAL IP jt for all 10 digits. Divide the former value by latter for each digit and calculate the sum for all 10 digits.

CLUBBING – 1 ) if the sum of all ten digits > 10
2) if the single finger value > 1

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Admin
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