Difference between revisions of "Hiccups"

(Diagnostic Evaluation)
(Background)
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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
 +
 
 +
===Deffinitions===
 +
*Hiccup bout: >48 hours
 +
*Persistent hiccups: 48 hours to 1 month
 +
*Intractable hiccups: >1 month
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 14:50, 9 September 2015

Background

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

Deffinitions

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

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

Diagnosis

  • 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