CLUBBING

Dr.S.K.K.Malik
Assistant Professor
Dept. of Medicine
Cyanosis
 Introducti
on
Bluish discoloration of the tissues and
mucous membrane that results -
• when the absolute level of reduced
hemoglobin (Deoxyhemoglobin) in the
capillary bed exceeds 5g/DL.
or
• increased concentration of abnormal
Hemoglobine derivatives (eg.
Methemoglobinemia, sulphaemoglobinemia)
in the superficial blood vessels.
 Mechanism of
cyanosis
• Alveolar hypoventilation
• Diffusion impairment
• Ventilation-perfusion mismatch
• Right-to-left shunting at the
intracardiac, great vessel, or
intrapulmonary level
• Hemoglobinopathy (including
methemoglobinemia, sulphaemoglobinemia)
that limits oxygen transport
 central Perpheral
cyanosis cyanosis
Area generalize localize
Tongue involve Not involve
Hand Feel warm Feel cold
shake Usually Not
clubbing present present
On O2 Pulmonary Not
Application
application cause improved improve
improved
of warming Not d
Mechanism improved of
Diminution Diminution
oxygen of blood
Capillary refill saturation flow
time <2 sec >2 sec
 Central
cyanosis
• Pathologic condition caused by
reduced arterial oxygen saturation
(SO2).
• Involves highly vascularized tissues, such
as the lips, tongue and mucous
membranes, through which blood flow is
brisk and the arteriovenous difference is
minimal.
• Cardiac output typically is normal,
and patients have warm extremities.
 Central
cyanosis
 Peripheral
cyanosis
• Normal systemic arterial oxygen saturation and
increased oxygen extraction from peripheral blood,
resulting in a wide systemic arteriovenous oxygen
difference
• The increased extraction of oxygen results from
sluggish movement of blood through the capillary
circulation.
• Affects the distal extremities, and circumoral or
periorbital areas .
Peripheral
cyanosis
 Differential
cyanosis
• When cyanosis is present only in the toes but not
in the fingers, it is called Differential cyanosis. It is
seen in PDA.
ETIOLOG
Y
 Pulmonary causes
1. Alveolar hypoventilation
A. Central nervous system depression: asphyxia,
maternal sedation, intraventricular
hemorrhage, seizure, meningitis, encephalitis
B. Neuromuscular disease:
myasthenia gravis, phrenic nerve
injury
C. Airway obstruction: choanal atresia,
laryngotracheomalacia,
macroglossia,
2. Ventilation/perfusion mismatch
A. Airway disease: pneumonia, aspiration,
cystic adenomatoid malformation,
diaphragmatic hernia, pulmonary
hypoplasia, lobar emphysema, atelectasis,
pulmonary hemorrhage, hyaline membrane
disease, transient tachypnea of the
newborn
B. Extrinsic compression of lungs:
pneumothorax, pleural effusion, chylothorax,
hemothorax, thoracic dystrophy
 3. Diffusion
impairment
A.Pulmonary edema: left-sided obstructive cardiac
disease, cardiomyopathy
B. Pulmonary fibrosis
C. Congenital lymphangiectasia
 Cardiac causes
1. Decreased pulmonary blood flow-
A. Tetralogy of Fallot
B. Tricuspid valve anomaly
C. Pulmonary valve atresia
D. Critical valvular pulmonary steanosis
2. Increased pulmonary blood flow-
A. Transposition of great arteries
B. Truncus arteriosus
C. Total anomalous pulmonary venous connection
 3. Severe heart
failure-
A. Hypoplastic left heart
syndrome
B. Coarctation of the aorta
C. Interrupted aortic arch
D. Critical valvular aortic steanosis
Hemoglobinopathy :
. Methemoglobinemia: congenital or
secondary to toxic exposure >1.5gm/dl

.sulphaemoglobinemia: secondary to
toxic exposure >0.5gm/dl
.
 Treatment of
•
cyanosis
It is a symptom of an underlying condition
rather than being a disease in itself.
• Treatment of cyanosis thus focus on the
Treatment of underlying disease rather than the
symptom alone.
• Symptomatic treatment of cyanosis -
1. Warming of the affected areas- Peripheral
cyanosis brought about by exposure to cold or
Raynaud’s phenomenon and acrocyanosis may be
treated symptomatically using gentle warming of
the fingers and toes.
2.Oxygenation as a treatment for cyanosis-
Initial stabilization requires oxygenation. Sometimes
a breathing machine or ventilator might be
required.

3.Intravenous fluids- Children who have difficulty in

feeding due to cyanosis and heart failure due to an
underlying cyanotic heart disease need to be
administered intravenous fluids.
THANK YOU