Finger Clubbing Revealed!!

Finger clubbing is always an essential sign in clinical skills that sometimes, we medical students tend to forget the very reason of why we do it. There are of course, many causes of finger clubbing, ranging from lungs, heart, liver, hyperthyroidism to gastrointestinal diseases, although there may be few idiopathic cases as well. The range was too wide that sometimes, the sign had became of not a sign. What on earth could so many conditions have in common? However, what concerns the medical world is the sign of finger clubbing may indicates the presence of lung cancer. What now some researchers in Leeds had found out, at least could explain for the presence of finger clubbing in lung and heart diseases.
The 101 causes

The researchers found clues in the medical literature, detailing past cases and previous research. "We knew that in cystic fibrosis patients who have undergone a lung transplant, their finger clubbing goes away. The same goes for empyema patients who have had their lungs drained. It suggested that impaired lung function was somehow crucial to finger clubbing - but we didn't understand how.

Their findings implicated a fatty compound called PGE2, which is produced naturally by the body to mediate the effects of internal inflammation. Crucially, once it has done its work, PGE2 is broken down by an enzyme 15-HPGD, produced in the lungs. The patients followed by the Leeds study were found to have a genetic mutation which prevented the production of 15-HPGD, reulting in up to ten times as much of the PGE2 in their systems.

"If you don't have this enzyme the PGE2 isn't broken down normally and simply builds up," said Bonthron, whose findings are published online this week in Nature Genetics.

In lung cancer patients, it is most likely overproduction of PGE2 by the tumour that causes the clubbing. In congenital heart disease, blood bypasses the lungs, where PGE2 is normally broken down by 15-HPGD.

The researchers have suggested that a straightforward urine test for levels of PGE2 may be a useful first step in the diagnosis of individuals with unexplained clubbing, and to understanding whether it is the symptom of something far more serious.

The results also suggest that existing drugs such as aspirin, which are already used to prevent PGE2 production, may be effective in reducing the painful symptoms of finger clubbing.

Now, at least we get to impress our friends with that eh? Make good use of that piece of information. It might came in handy just to impress your lecturers as well. :P

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