Difference between revisions of "Hiccups"

(Differential Diagnosis)
(Definitions)
 
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==Background==
 
==Background==
 
*Usually initiated by gastric distention from food, carbonated beverage, or air
 
*Usually initiated by gastric distention from food, carbonated beverage, or air
*Also known as Singultus  
+
*Also known as Singultus
 +
 
 +
===Definitions===
 +
*Hiccup bout: <48 hours
 +
*Persistent hiccups: 48 hours to 1 month
 +
*Intractable hiccups: >1 month
  
 
==Clinical Features==
 
==Clinical Features==
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*Central nervous system disorders
 
*Central nervous system disorders
 
**Vascular
 
**Vascular
***Ischemic/hemorrhagic stroke, AV malformations, temporal arteritis
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***Ischemic/hemorrhagic [[stroke]]
 +
***AV malformations
 +
***[[Temporal arteritis]]
 
**Infections
 
**Infections
***Encephalitis, meningitis, brain abscess, neurosyphillis, subphrenic abscess
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***[[Encephalitis]]
 +
***[[Meningitis]]
 +
***[[Brain abscess]]
 +
***[[Neurosyphilis]]
 +
***Subphrenic abscess
 
**Structural
 
**Structural
***Head trauma, intracranial neoplasms, brainstem neoplasms, multiple sclerosis, syringomyelia, hydrocephalus
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***[[Head trauma]]
 +
***[[Intracranial neoplasm]]
 +
***Brainstem neoplasms
 +
***[[Multiple sclerosis]]
 +
***[[Syringomyelia]]
 +
***[[Hydrocephalus]]
 
**Vagus and phrenic nerve irritation
 
**Vagus and phrenic nerve irritation
***Goiter, pharyngitis, laryngitis, hair or foreign body irritation of tympanic membrane, neck cyst or other tumor
+
***[[thyroid disease|Goiter]]
 +
***[[Pharyngitis]]
 +
***[[Laryngitis]]
 +
***Hair or foreign body irritation of tympanic membrane
 +
***Neck cyst or other tumor
 
*Gastrointestinal disorders
 
*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
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**Gastric distention
 +
**[[Gastritis]]
 +
**[[Peptic ulcer disease]]
 +
**[[Pancreatitis]]
 +
**Pancreatic cancer
 +
**Gastric carcinoma
 +
**Abdominal abscesses
 +
**[[Gallbladder disease]]
 +
**[[Inflammatory bowel disease]]
 +
**[[Hepatitis]]
 +
**Aerophagia
 +
**Esophageal distention
 +
**[[Esophagitis]]
 +
**[[Bowel obstruction]]
 
*Thoracic disorders
 
*Thoracic disorders
**Enlarged lymph nodes secondary to infection or neoplasm*, pneumonia, empyema, bronchitis, asthma, pleuritis, aortic aneurysm, mediastinitis, mediastinal tumors, chest trauma, pulmonary embolism  
+
**Enlarged lymph nodes secondary to infection or neoplasm
 +
**[[Pneumonia]]
 +
**[[Empyema]]
 +
**[[Bronchitis]]
 +
**[[Asthma]]
 +
**[[Pleuritis]]
 +
**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
 +
**[[Mediastinitis]]
 +
**Mediastinal tumors
 +
**[[Chest trauma]]
 +
**[[Pulmonary embolism ]]
 
*Cardiovascular disorders
 
*Cardiovascular disorders
**Myocardial infarction, pericarditis
+
**[[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
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*Drugs
 
*Drugs
 
**Alpha methyldopa
 
**Alpha methyldopa
**Short-acting barbituates
+
**Short-acting [[barbiturates]]
 
**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
  
==Diagnostic Evaluation==
+
==Evaluation==
 
*Clinical diagnosis
 
*Clinical diagnosis
 
*Consider auditory canal exam (foreign body against TM can trigger hiccups)
 
*Consider auditory canal exam (foreign body against TM can trigger hiccups)
*Consider CXR
+
*Consider [[Hyponatremia]] and [[Hypocalcemia]]
 +
*Consider [[CXR]]
  
 
==Management==
 
==Management==
 
*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
 
*Physical Maneuvers (stimulating pharynx blocks the vagal portion of the reflex arc)
**Remove foreign body from ear
+
**Remove [[ear foreign body|foreign body]] from ear
 
**Swallow teaspoon of sugar
 
**Swallow teaspoon of sugar
 
**Sip ice water
 
**Sip ice water
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[[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