Difference between revisions of "Hiccups"

(Created page with "==Background== Also known as Singultus == == ==Workup== 1) CBC 2) Chem 10 3) CXR (?CT diaphram) 4) LFTs 5) Lipase 5) ?Head-CT 6) ECG ==Treatment == Vagal maneu...")
 
(Definitions)
 
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==Background==
 
==Background==
 +
*Usually initiated by gastric distention from food, carbonated beverage, or air
 +
*Also known as Singultus
  
 +
===Definitions===
 +
*Hiccup bout: <48 hours
 +
*Persistent hiccups: 48 hours to 1 month
 +
*Intractable hiccups: >1 month
  
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]]
 +
***[[Neurosyphilis]]
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***Subphrenic abscess
 +
**Structural
 +
***[[Head trauma]]
 +
***[[Intracranial neoplasm]]
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***Brainstem neoplasms
 +
***[[Multiple sclerosis]]
 +
***[[Syringomyelia]]
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***[[Hydrocephalus]]
 +
**Vagus and phrenic nerve irritation
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***[[thyroid disease|Goiter]]
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***[[Pharyngitis]]
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***[[Laryngitis]]
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***Hair or foreign body irritation of tympanic membrane
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***Neck cyst or other tumor
 +
*Gastrointestinal disorders
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**Gastric distention
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**[[Gastritis]]
 +
**[[Peptic ulcer disease]]
 +
**[[Pancreatitis]]
 +
**Pancreatic cancer
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**Gastric carcinoma
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**Abdominal abscesses
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**[[Gallbladder disease]]
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**[[Inflammatory bowel disease]]
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**[[Hepatitis]]
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**Aerophagia
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**Esophageal distention
 +
**[[Esophagitis]]
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**[[Bowel obstruction]]
 +
*Thoracic disorders
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**Enlarged lymph nodes secondary to infection or neoplasm
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**[[Pneumonia]]
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**[[Empyema]]
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**[[Bronchitis]]
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**[[Asthma]]
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**[[Pleuritis]]
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**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
 +
**[[Mediastinitis]]
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**Mediastinal tumors
 +
**[[Chest trauma]]
 +
**[[Pulmonary embolism ]]
 +
*Cardiovascular disorders
 +
**[[Myocardial infarction]]
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**[[Pericarditis]]
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*Toxic-metabolic
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**[[Alcohol intoxication]]
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**[[Diabetes mellitus]]
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**[[Herpes zoster]]
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**[[Hypocalcemia]]
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**[[Hypocapnia]]
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**[[Hyponatremia]]
 +
**[[Influenza]]
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**[[Malaria]]
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**[[Tuberculosis]]
 +
**[[Uremia]]
 +
*Postoperative
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**General anesthesia
 +
**[[Intubation]] (stimulation of glottis)
 +
**Neck extension (stretching phrenic nerve roots)
 +
**Gastric distention
 +
**Traction on viscera
 +
*Drugs
 +
**Alpha methyldopa
 +
**Short-acting [[barbiturates]]
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**Chemotherapeutic agents (eg, carboplatin)
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**[[Dexamethasone]]
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**[[Diazepam]]
 +
*Psychogenic
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**[[Anorexia nervosa]]
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**[[Conversion reaction]]
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**Excitement
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**Malingering
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**[[Schizophrenia]]
 +
**Stress
  
 +
==Evaluation==
 +
*Clinical diagnosis
 +
*Consider auditory canal exam (foreign body against TM can trigger hiccups)
 +
*Consider [[Hyponatremia]] and [[Hypocalcemia]]
 +
*Consider [[CXR]]
  
==Workup==
+
==Management==
 
+
*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
 
+
**Remove [[ear foreign body|foreign body]] from ear
1) CBC
+
**Swallow teaspoon of sugar
 
+
**Sip ice water
2) Chem 10
+
**Drink water quickly
 
+
*Meds
3) CXR (?CT diaphram)
+
**[[Chlorpromazine]] 25–50mg IV; 25–50mg PO TID
 
+
**[[Metoclopramide]] 10mg IV or IM; 10–20mg PO TID x 10d
4) LFTs
 
 
 
5) Lipase
 
 
 
5) ?Head-CT
 
 
 
6) ECG
 
 
 
 
 
 
==Treatment ==
 
 
 
 
 
Vagal maneuvers
 
 
 
Thorazine
 
 
 
Reglan
 
 
 
Haldol
 
  
 +
==Disposition==
 +
*Discharge for uncomplicated hiccups
  
 +
==See Also==
  
 +
==References==
 +
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]
 +
[[category:Symptoms]]

Latest revision as of 18:00, 23 January 2020

Background

  • Usually initiated by gastric distention from food, carbonated beverage, or air
  • Also known as Singultus

Definitions

  • Hiccup bout: <48 hours
  • Persistent hiccups: 48 hours to 1 month
  • Intractable hiccups: >1 month

Clinical Features

  • Hiccups

Differential Diagnosis

Hiccups

Evaluation

  • Clinical diagnosis
  • Consider auditory canal exam (foreign body against TM can trigger hiccups)
  • Consider Hyponatremia and Hypocalcemia
  • 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

Disposition

  • Discharge for uncomplicated hiccups

See Also

References