History and exam
Key diagnostic factors
common
presence of risk factors
Predisposing factors for the development of benign hiccups include gastric distension from aerophagia, excessive food and alcohol consumption, drinking carbonated beverages, sudden changes in ambient or gastrointestinal temperature (e.g., cold showers, drinking hot or cold beverages), sudden excitement, and emotional stress. Underlying conditions that cause irritation of the diaphragmatic, phrenic, and vagus nerves, central nervous system disease, metabolic disorders and electrolyte disturbances, toxins and drugs, psychogenic disorders, as well as sedation and anaesthesia, may lead to chronic hiccups.
'hic' sound
Hiccups are characterised by a distinctive 'hic' sound resulting from sudden glottic closure interrupting an abrupt inhalation secondary to diaphragmatic spasm.
Other diagnostic factors
common
duration <48 hours (typically benign hiccups)
Benign hiccups are self-limiting with no associated complications.
uncommon
duration >48 hours (chronic hiccups)
Chronic hiccups are not self-limiting and may at times last for several years. They are often associated with an underlying organic cause, which may include a wide range of conditions related to cardiac, respiratory, gastrointestinal, or neurological conditions, and complications may develop.
persistence during sleep
This suggests an organic cause and may lead to insomnia, with subsequent fatigue and exhaustion during the day.[15] This in turn leads to impaired alertness and concentration, with consequences for work and social activities.
associated features of underlying cause
Chronic hiccups may be associated with symptoms and signs of the underlying cause.
weight loss and malnutrition
Severe forms of chronic hiccups can complicate eating and drinking. This may lead to malnutrition and dehydration, with subsequent weight loss.
Weight loss may also be a sign of an underlying aetiology.
Risk factors
weak
aerophagia, temperature changes, and emotional states
Factors known to predispose to benign hiccups are gastric distension from aerophagia, excessive food and alcohol consumption, and drinking carbonated beverages.[5]
Other causes include sudden changes in ambient or gastrointestinal temperature (e.g., cold showers, drinking hot or cold beverages), sudden excitement, and emotional stress.[5]
diaphragmatic and phrenic nerve irritation
Diaphragmatic and phrenic nerve irritation may result from subphrenic abscess, splenomegaly, hepatomegaly, myocardial infarction, pericarditis, a hiatus hernia, oesophageal cancer, or an aberrant cardiac pacemaker electrode.
vagus nerve irritation
Irritation of the vagus nerve may result from a foreign body irritating the tympanic membrane, pharyngitis, laryngitis, a goitre or neck cyst, pneumonia, empyema, bronchitis, asthma, pleuritis, tuberculosis, lung cancer, oesophagitis, aortic aneurysm, cor pulmonale, mediastinitis, gastric atony, gastric cancer, gastritis, duodenal ulcer, pancreatitis, pancreatic cancer, intra-abdominal abscess, bowel obstruction, cholecystitis, cholelithiasis, ulcerative colitis, Crohn's disease, gastrointestinal haemorrhage, appendicitis, hepatitis, or prostatic disease.[6][7][8][9]
central nervous system disorders
Central causes of hiccups include structural lesions (intracranial neoplasm, syringomyelia, multiple sclerosis, ventriculo-peritoneal shunt), vascular lesions (intracranial haemorrhage or infarction, arterio-venous malformation, vascular insufficiency), infection (meningitis, encephalitis, neurosyphilis, malaria, herpes zoster), trauma, and epilepsy.[10][11][12]
metabolic/electrolyte abnormalities
Metabolic causes include uraemia, diabetes mellitus, gout, hyponatraemia, hypocalcaemia, hypokalaemia, and alkalosis. Electrolyte disturbances can decrease the central inhibition of the hiccup reflex arc, leading to chronic hiccups.
toxins/drugs
psychogenic disorders
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