Difference between revisions of "Hiccups"

(Diagnostic Evaluation)
(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
+
***Ischemic/hemorrhagic [[stroke]]
 
***AV malformations
 
***AV malformations
***Temporal arteritis
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***[[Temporal arteritis]]
 
**Infections
 
**Infections
***Encephalitis
+
***[[Encephalitis]]
***Meningitis
+
***[[Meningitis]]
***Brain abscess
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***[[Brain abscess]]
***Neurosyphillis
+
***[[Neurosyphilis]]
 
***Subphrenic abscess
 
***Subphrenic abscess
 
**Structural
 
**Structural
***Head trauma
+
***[[Head trauma]]
***intracranial neoplasms
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***[[Intracranial neoplasm]]
***brainstem neoplasms
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***Brainstem neoplasms
***multiple sclerosis
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***[[Multiple sclerosis]]
***syringomyelia
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***[[Syringomyelia]]
***hydrocephalus
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***[[Hydrocephalus]]
 
**Vagus and phrenic nerve irritation
 
**Vagus and phrenic nerve irritation
***Goiter
+
***[[thyroid disease|Goiter]]
***pharyngitis
+
***[[Pharyngitis]]
***laryngitis
+
***[[Laryngitis]]
***hair or foreign body irritation of tympanic membrane
+
***Hair or foreign body irritation of tympanic membrane
***neck cyst or other tumor
+
***Neck cyst or other tumor
 
*Gastrointestinal disorders
 
*Gastrointestinal disorders
 
**Gastric distention
 
**Gastric distention
**gastritis
+
**[[Gastritis]]
**peptic ulcer disease
+
**[[Peptic ulcer disease]]
**pancreatitis
+
**[[Pancreatitis]]
**pancreatic cancer
+
**Pancreatic cancer
**gastric carcinoma
+
**Gastric carcinoma
**abdominal abscesses
+
**Abdominal abscesses
**gallbladder disease
+
**[[Gallbladder disease]]
**inflammatory bowel disease
+
**[[Inflammatory bowel disease]]
**hepatitis, aerophagia
+
**[[Hepatitis]]
**esophagael distention
+
**Aerophagia
**esophagitis
+
**Esophageal distention
**bowel obstruction
+
**[[Esophagitis]]
 +
**[[Bowel obstruction]]
 
*Thoracic disorders
 
*Thoracic disorders
 
**Enlarged lymph nodes secondary to infection or neoplasm
 
**Enlarged lymph nodes secondary to infection or neoplasm
**pneumonia
+
**[[Pneumonia]]
**empyema
+
**[[Empyema]]
**bronchitis
+
**[[Bronchitis]]
**asthma
+
**[[Asthma]]
**pleuritis
+
**[[Pleuritis]]
**aortic aneurysm
+
**[[Nontraumatic thoracic aortic dissection|Aortic dissection]]
**mediastinitis
+
**[[Mediastinitis]]
**mediastinal tumors
+
**Mediastinal tumors
**chest trauma
+
**[[Chest trauma]]
**pulmonary embolism  
+
**[[Pulmonary embolism ]]
 
*Cardiovascular disorders
 
*Cardiovascular disorders
**Myocardial infarction
+
**[[Myocardial infarction]]
**pericarditis
+
**[[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
  
==Diagnosis==
+
==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