Hippocratic fingers - hipocratism

Hippocratic fingers - hipocratismHippocrates first described the glass plate fingers in patients with empyema. Since then Hippocratic fingers have been associated with many pulmonary diseases, cardiovascular, neoplastic, infectious, hepatobiliary, mediastinal, endocrine and gastrointestinal. Hippocratic fingers can occur without an underlying condition as a form of idiopathic or dominant Mendelian model. Fingers in the glass plate or clubbing are clinically descriptive terms referring to the bulbous shape of the last phalanx pulp with secondary loss of the angle between the normal nail and nail bed.
Hipocratismul is classified into primary (idiopathic, hereditary) and secondary. Can be symmetric bilaterally or unilaterally affect a single finger. Anatomical considerations such as measurement or later Lovibond angle curve index fingernail, can be identified through a simple physical examination and help supervise hipocratismului.Pahidermoperiostozei Hipocratismul is a characteristic of a rare genodermatoza characterized by pahidermie, hipocratism, periostoza, affecting mainly men.
There is no specific treatment for hipocratism. Treating the disease can reduce hipocratismul background. Once you have installed the chronic tissue changes, including increased collagen deposited reversal is unlikely. Treatment is symptomatic for pain.
Pathogenesis
Hipocratismului specific pathogenic mechanism remains unknown. Alteration in size and configuration of the finger nail bed resulting in changes, beginning with increased interstitial edema early in the process. As the volume progresses hipocratismul terminal portion of the finger may increase because of excess connective tissue and vascular changes in quality.Numerous studies have shown increased blood flow in the deformed portion of the finger. Cause increased vasodilation is unknown. The evidence favoring the presence of a circulating vasodilator derived from hipocratismului association with cyanotic heart disease. After shunt surgery diminishes hipocratismul improve.
He proposed a neural mechanism, in particular the vagal system. Hipocratismului An increased incidence of disease pathology was associated with vagal innervated organs. Hipocratismului regression has been reported after vagotomy was performed. Neural theory has declined in popularity due to lack of evidence in neurological disease and the presence hipocratismului in vagal innervated organs are not.
Hypoxia has been proposed as an alternative to explain hipocratismul in cyanotic heart disease and those pumonare. Hypoxia may increase local vasodilatatorii active with secondary increase of blood flow in the distal portion of the fingers.Inheritance and genetic predisposition may also play a role in hipocratism. Digital Hipocratismul is observed in two hereditary forms associated with hereditary and idiopathic pahidermoperiostoza. The two forms are considered different entities. Both show an autosomal dominant pattern with incomplete penetrance.
Causes and Risk Factors
Hipocratismul may be idiopathic or secondary school background of many diseases. Causes of idiopathic or primary hipocratism include pahidermoperiostoza, hipocratismul osteoartropatia family and hypertrophic.
Causes of secondary hipocratism include:-Pulmonary disease: pulmonary cancer, cystic fibrosis, interstitial lung disease-Idiopathic pulmonary fibrosis, sarcoidosis, lipoid pneumonia, empyema, pleural mesotheliomaPulmonary-artery sarcoma, cryptogenic fibrosis alveolitis, lung metastasesHeart-disease: cyanotic congenital heart disease, bacterial endocarditis, right-left shunts-Gastrointestinal diseases: ulcerative colitis, Crohn's disease, primary biliary cirrhosis, liver cirrhosisLeiomyoma, esophageal achalasia, esophageal peptic ulcer-Skin disease: pahidermoperiostoza syndrome Bureau-Barriere-Thomas, Fischer syndromePalmar-plantar-keratodermia syndrome Volavsek-Neoplasms: thyroid cancer, thymus cancer, Hodgkin's disease, disseminated chronic myeloid leukemia-Acromegaly, thyroid acropatia task.
Signs and symptoms
Hipocratismul clinical signs and fingers is not an independent cause of mortality, though mortality associated with the pathologies of these patients varies from general fund. Development hipocratismului is invisible for many patients, some reports distal swelling of the fingers, bilaterally or unilaterally, or may involve a single finger. Although hipocratismul specialties is a painless, rarely can this pain in the fingers. On palpation there feeling the spongy tissue of the nail bed. When you are looking at the profile angle of the fingers and nail fold periunghial is between 160-180 degrees.
Diagnosis
Studies:Observed radiological changes include dissolution-bone, bone formation, connective tissue hypertrophy-Thermography shows vasodilation increasing blood flow secondary to distal portion of the fingersPositron-emission tomography showed increased glucose metabolism in Hippocratic fingers.Histological examination. Microscopic collagen fibers are separated by an abnormally large distance, forcing the nail bed matrix less dense. Primitive fibroblasts are observed with large nuclei, cytoplasmic basophilia. Nail bed is thickened periosteum with high vascular penetration. Collagen fibers are thick and dense.The differential diagnosis is made with the following conditions: Dermatological manifestations of heart disease, gastrointestinal, hematological, pulmonary, pahidermoperiostoza, osteoartropatia hypertrophic.Medical therapy is dictated by the background condition. There are no direct complications hipocratismului except for cosmetic appearance.