Difference between revisions of "Hiccups"

(Background)
(Differential Diagnosis)
Line 15: Line 15:
 
*Central nervous system disorders
 
*Central nervous system disorders
 
**Vascular
 
**Vascular
***Ischemic/hemorrhagic stroke
+
***Ischemic/hemorrhagic [[stroke]]
 
***AV malformations
 
***AV malformations
***Temporal arteritis
+
***[[Temporal arteritis]]
 
**Infections
 
**Infections
***Encephalitis
+
***[[Encephalitis]]
***Meningitis
+
***[[Meningitis]]
***Brain abscess
+
***[[Brain abscess]]
***Neurosyphillis
+
***[[Neurosyphillis]]
 
***Subphrenic abscess
 
***Subphrenic abscess
 
**Structural
 
**Structural
***Head trauma
+
***[[Head trauma]]
***intracranial neoplasms
+
***Intracranial neoplasms
***brainstem neoplasms
+
***Brainstem neoplasms
***multiple sclerosis
+
***[[Multiple sclerosis]]
***syringomyelia
+
***Syringomyelia
***hydrocephalus
+
***Hydrocephalus
 
**Vagus and phrenic nerve irritation
 
**Vagus and phrenic nerve irritation
 
***Goiter
 
***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
+
**Esophagael 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
+
**[[Aortic aneurysm]]
**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
Line 85: Line 86:
 
*Drugs
 
*Drugs
 
**Alpha methyldopa
 
**Alpha methyldopa
**Short-acting barbituates
+
**Short-acting [[barbituates]]
 
**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
  

Revision as of 14:53, 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

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