Hiccups: Difference between revisions
| Line 15: | Line 15: | ||
*Central nervous system disorders | *Central nervous system disorders | ||
**Vascular | **Vascular | ||
***Ischemic/hemorrhagic stroke | ***Ischemic/hemorrhagic [[stroke]] | ||
***AV malformations | ***AV malformations | ||
***Temporal arteritis | ***[[Temporal arteritis]] | ||
**Infections | **Infections | ||
***Encephalitis | ***[[Encephalitis]] | ||
***Meningitis | ***[[Meningitis]] | ||
***Brain abscess | ***[[Brain abscess]] | ||
***Neurosyphillis | ***[[Neurosyphillis]] | ||
***Subphrenic abscess | ***Subphrenic abscess | ||
**Structural | **Structural | ||
***Head trauma | ***[[Head trauma]] | ||
*** | ***Intracranial neoplasms | ||
*** | ***Brainstem neoplasms | ||
*** | ***[[Multiple sclerosis]] | ||
*** | ***Syringomyelia | ||
*** | ***Hydrocephalus | ||
**Vagus and phrenic nerve irritation | **Vagus and phrenic nerve irritation | ||
***Goiter | ***Goiter | ||
*** | ***[[Pharyngitis]] | ||
*** | ***[[Laryngitis]] | ||
*** | ***Hair or foreign body irritation of tympanic membrane | ||
*** | ***Neck cyst or other tumor | ||
*Gastrointestinal disorders | *Gastrointestinal disorders | ||
**Gastric distention | **Gastric distention | ||
** | **[[Gastritis]] | ||
** | **[[Peptic ulcer disease]] | ||
** | **[[Pancreatitis]] | ||
** | **Pancreatic cancer | ||
** | **Gastric carcinoma | ||
** | **Abdominal abscesses | ||
** | **[[Gallbladder disease]] | ||
** | **[[Inflammatory bowel disease]] | ||
** | **[[Hepatitis]] | ||
** | **Aerophagia | ||
** | **Esophagael distention | ||
** | **[[Esophagitis]] | ||
**[[Bowel obstruction]] | |||
*Thoracic disorders | *Thoracic disorders | ||
**Enlarged lymph nodes secondary to infection or neoplasm | **Enlarged lymph nodes secondary to infection or neoplasm | ||
** | **[[Pneumonia]] | ||
** | **[[Empyema]] | ||
** | **[[Bronchitis]] | ||
** | **[[Asthma]] | ||
** | **[[Pleuritis]] | ||
** | **[[Aortic aneurysm]] | ||
** | **[[Mediastinitis]] | ||
** | **Mediastinal tumors | ||
** | **[[Chest trauma]] | ||
** | **[[Pulmonary embolism ]] | ||
*Cardiovascular disorders | *Cardiovascular disorders | ||
**Myocardial infarction | **[[Myocardial infarction]] | ||
** | **[[Pericarditis]] | ||
*Toxic-metabolic | *Toxic-metabolic | ||
**Alcohol | **[[Alcohol intoxication]] | ||
**Diabetes mellitus | **[[Diabetes mellitus]] | ||
**Herpes zoster | **[[Herpes zoster]] | ||
**Hypocalcemia | **[[Hypocalcemia]] | ||
**Hypocapnia | **[[Hypocapnia]] | ||
**Hyponatremia | **[[Hyponatremia]] | ||
**Influenza | **[[Influenza]] | ||
**Malaria | **[[Malaria]] | ||
**Tuberculosis | **[[Tuberculosis]] | ||
**Uremia | **[[Uremia]] | ||
*Postoperative | *Postoperative | ||
**General anesthesia | **General anesthesia | ||
**Intubation (stimulation of glottis) | **[[Intubation]] (stimulation of glottis) | ||
**Neck extension (stretching phrenic nerve roots) | **Neck extension (stretching phrenic nerve roots) | ||
**Gastric distention | **Gastric distention | ||
| Line 85: | Line 86: | ||
*Drugs | *Drugs | ||
**Alpha methyldopa | **Alpha methyldopa | ||
**Short-acting barbituates | **Short-acting [[barbituates]] | ||
**Chemotherapeutic agents (eg, carboplatin) | **Chemotherapeutic agents (eg, carboplatin) | ||
**Dexamethasone | **[[Dexamethasone]] | ||
**Diazepam | **[[Diazepam]] | ||
*Psychogenic | *Psychogenic | ||
**Anorexia nervosa | **[[Anorexia nervosa]] | ||
**Conversion reaction | **[[Conversion reaction]] | ||
**Excitement | **Excitement | ||
**Malingering | **[[Malingering]] | ||
**Schizophrenia | **[[Schizophrenia]] | ||
**Stress | **Stress | ||
Revision as of 14:53, 9 September 2015
Background
- Usually initiated by gastric distention from food, carbonated beverage, or air
- Also known as Singultus
Deffinitions
- Hiccup bout: >48 hours
- Persistent hiccups: 48 hours to 1 month
- Intractable hiccups: >1 month
Clinical Features
- Hiccups
Differential Diagnosis
Hiccups
- Central nervous system disorders
- Vascular
- Ischemic/hemorrhagic stroke
- AV malformations
- Temporal arteritis
- Infections
- Encephalitis
- Meningitis
- Brain abscess
- Neurosyphillis
- Subphrenic abscess
- Structural
- Head trauma
- Intracranial neoplasms
- Brainstem neoplasms
- Multiple sclerosis
- Syringomyelia
- Hydrocephalus
- Vagus and phrenic nerve irritation
- Goiter
- Pharyngitis
- Laryngitis
- Hair or foreign body irritation of tympanic membrane
- Neck cyst or other tumor
- Vascular
- Gastrointestinal disorders
- Gastric distention
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Pancreatic cancer
- Gastric carcinoma
- Abdominal abscesses
- Gallbladder disease
- Inflammatory bowel disease
- Hepatitis
- Aerophagia
- Esophagael distention
- Esophagitis
- Bowel obstruction
- Thoracic disorders
- Enlarged lymph nodes secondary to infection or neoplasm
- Pneumonia
- Empyema
- Bronchitis
- Asthma
- Pleuritis
- Aortic aneurysm
- Mediastinitis
- Mediastinal tumors
- Chest trauma
- Pulmonary embolism
- Cardiovascular disorders
- Toxic-metabolic
- Postoperative
- General anesthesia
- Intubation (stimulation of glottis)
- Neck extension (stretching phrenic nerve roots)
- Gastric distention
- Traction on viscera
- Drugs
- Alpha methyldopa
- Short-acting barbituates
- Chemotherapeutic agents (eg, carboplatin)
- Dexamethasone
- Diazepam
- Psychogenic
- Anorexia nervosa
- Conversion reaction
- Excitement
- Malingering
- Schizophrenia
- Stress
Diagnosis
- Clinical diagnosis
- Consider auditory canal exam (foreign body against TM can trigger hiccups)
- Consider CXR
Management
- Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
- Remove foreign body from ear
- Swallow teaspoon of sugar
- Sip ice water
- Drink water quickly
- Meds
- Chlorpromazine 25–50mg IV; 25–50mg PO TID
- Metoclopramide 10mg IV or IM; 10–20mg PO TID x 10d
Disposition
- Discharge for uncomplicated hiccups