Hiccups: Difference between revisions

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==Differential Diagnosis==
==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==
==Diagnostic Evaluation==

Revision as of 14:45, 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