Hiccups: Difference between revisions
| Line 10: | Line 10: | ||
*Central nervous system disorders | *Central nervous system disorders | ||
**Vascular | **Vascular | ||
***Ischemic/hemorrhagic stroke | ***Ischemic/hemorrhagic stroke | ||
***AV malformations | |||
***Temporal arteritis | |||
**Infections | **Infections | ||
***Encephalitis | ***Encephalitis | ||
***Meningitis | |||
***Brain abscess | |||
***Neurosyphillis | |||
***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 | ||
Revision as of 14:48, 9 September 2015
Background
- Usually initiated by gastric distention from food, carbonated beverage, or air
- Also known as Singultus
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
- Myocardial infarction
- pericarditis
- Toxic-metabolic
- Alcohol
- Diabetes mellitus
- Herpes zoster
- Hypocalcemia
- Hypocapnia
- Hyponatremia
- Influenza
- Malaria
- Tuberculosis
- Uremia
- 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
Diagnostic Evaluation
- 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