The level of deoxygenated hemoglobin in the blood is more important in determining the change in mucosa color. Artificial light may alter patient color. Peripheral tissue compensate by forming more capillaries to improve oxygenation, this results in swelling of the peripheries of digits. Clubbing is also seen in other diseases associated with tissue hypoxia such as lung diseases and hepatic and intestinal diseases such as Crohn's disease and ulcerative colitis due to anemia. Familial clubbing is also known to occur.
Pulses are the result of difference between systolic and diastolic status of the vasculature.
Increase in the difference between systole and diastole results in a more pronounced pulse. Narrow pulse pressure Pulses should be easily palpable and equal in their intensity throughout the body. Generalized week pulses is suggestive of poor cardiac output either due to severe heart failure or severe aortic stenosis. Better pulses in the upper upper extremities than the lower extremities is suggestive of coarctation of the aorta. The precordium should be normally quiet.