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FINGER CLUBBING -- DIAGNOSIS

SCHAMROTH SIGN 

Absence of a closed triangular space described by the nails of two index 

fingers when their distal phalanges are held in dorsal opposition

PHALANGEAL DEPTH RATIO 

In normal fingers, the distal phalangeal depth should be smaller than the 

interphalangeal depth; this relationship is reversed in the finger with clubbing
.
Since calipers may not be readily available, physicians may estimate the 

phalangeal depth ratio

ANS REVIEW

GALL BLADDER

CELL ADAPTATIONS

 Cell Adaptations

First, in order to preserve the viability of the cell, adaptive changes appear. When the adaptive potential of the cells is exceeded or inexistent, cells and tissues will be damaged, producing cell injury and in the end, cell death.

Examples of nocive agents :

• physiological stresses at higher intensity or longer action, comparing with normal limits
• pathological stimuli : physical (thermal, mechanical, electric, radiations), chemical (chemicals and drugs), microbiological (bacterial, viral, fungi, protozoa), immune, nutritional imbalances, genetic, ischemic, endocrine

Depending on the intensity of the nocive factor and length of it's action, cell injury may be reversible and irreversible.

Acute reversible changes

• Cellular swelling (hydropic change or vacuolar degeneration)

Chronic reversible changes

• Cellular adaptation of growth and differentiation :
  • hypertrophy and hyperplasia
  • atrophy and involution
  • metaplasia
• Intracellular accumulation of lipids :
  • fatty change (steatosis)
  • cholesterolosis
• Pigment accumulation :
  • lipofuscin
  • melanin
  • hemosiderin
  • bilirubin

Extracellular accumulation of proteins

• Hyalinosis
• Amiloidosis

Pathological calcification (metastatic and dystrophic)

Irreversible cell changes (cell death)

• Apoptosis
• Necrosis

YOGA