Difference between revisions of "Hiccups"

(Differential Diagnosis)
(Hiccups)
Line 10: Line 10:
 
*Central nervous system disorders
 
*Central nervous system disorders
 
**Vascular
 
**Vascular
***Ischemic/hemorrhagic stroke, AV malformations, temporal arteritis
+
***Ischemic/hemorrhagic stroke
 +
***AV malformations
 +
***Temporal arteritis
 
**Infections
 
**Infections
***Encephalitis, meningitis, brain abscess, neurosyphillis, subphrenic abscess
+
***Encephalitis
 +
***Meningitis
 +
***Brain abscess
 +
***Neurosyphillis
 +
***Subphrenic abscess
 
**Structural
 
**Structural
***Head trauma, intracranial neoplasms, brainstem neoplasms, multiple sclerosis, syringomyelia, hydrocephalus
+
***Head trauma
 +
***intracranial neoplasms
 +
***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
+
***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
+
**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*, 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
 +
**aortic aneurysm
 +
**mediastinitis
 +
**mediastinal tumors
 +
**chest trauma
 +
**pulmonary embolism  
 
*Cardiovascular disorders
 
*Cardiovascular disorders
**Myocardial infarction, pericarditis
+
**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
  • 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

Disposition

  • Discharge for uncomplicated hiccups

See Also

References