| ID | 21 |
|---|---|
| Name | HICCOUGH |
| Cause | Causes: Causes of benign, self-limited hiccough: 1. Gastric distention due to over eating, carbonated beverages & air swallowing. 2. Sudden temperature changes. 3. Alcohol ingestion. 4. States of emotion (excitement, stress, laughing). Causes of recurrent or persistent hiccough: 1. CNS causes- Neoplasms, infections, cerebrovascular disease, trauma. 2. Metabolic causes- Renal failure (uremia), hypocapnia (hyperventilation). 3. Irritation of the vagus or phrenic nerve: Causes in the head & neck- Foreign body in the ears, goiter, neoplasms. Causes in the thorax- Pneumonia, pneumothorax, empyema, neoplasms, myocardial infarction, pericarditis, aneurysm, oesophageal obstruction, reflux oesophagitis. Causes in the abdomen- Subphrenic abscess, hepatomegaly, hepatitis, cholecystitis, gastric distention, gastric neoplasm, pancreatitis, or pancreatic malignancy. 4. Surgical causes- General anesthesia, post operative complications. 5. Psychogenic (hysteria). 6. Idiopathic disorders. |
| Signs Symptoms | Uncontrolled spasms in your diaphragm and a "hic" sound. Sometimes patient may feel a slight tightening sensation in your chest, stomach area or throat |
| Diagnosis | Listen to the 'hic' sound |
| Investigations | Balance and coordination. Muscle strength and tone. Reflexes. Sight and sense of touch. Lab tests Samples of blood may be checked for signs of diabetes, infection or kidney disease. Imaging tests Imaging tests may be able to detect issues inside the body that may be affecting diaphragm or the nerve that controls your diaphragm, called the phrenic nerve. Or these tests may show issues with a main nerve in your nervous system, called the vagus nerve. Imaging tests may include a chest X-ray, a CT or an MRI. Endoscopic tests The purpose is to check for issues in your esophagus or your windpipe. |
| Management | Management: 1. Home remedies: 1. Taking of deep breath. 2. Valsalva’s maneuver, sneezing, gasping. 3. Holding breath for sometimes, 4. Divertion of patients attention by conversations, fright, unplesant or painful stimuli. 5. Pulling the tongue forward. 6. Relief of gastric distention by NG tube. 7. Rebreathing into a paper bag (not plastic) 2. Medical measures: 1. Stimulation of nasopharynx and pharynx by- - introduction of a soft nasal catheter through the nose to a distance of 3-4 inch. - ingestion of 1 tsp of dry granulated sugar. 2. Sedation- diazepam 5mg 3 times daily or phenobarbitone 50mg or, chlorpromazine 25-50mg orally or i.m, may be repeated 8 hourly if needed (caution hepatic diseases). 3. Antispasmodics- atropine sulphate 3-6mg subcutaneously. 4. Metoclopramide 10mg i.m may be useful. 5. CO2 inhalation. 6. Antacids. 7. Anticonvalsant- phenytoin, carbamazepine or gabapentin may be used. 3. Surgical measures indicated when above measures fail, such as: 1. General anesthesia. 2. When above measures fail then bilateral phrenicotomy. |
| Introduction | Involuntary spasmodic contraction and lowering of the diaphragm, followed by sudden closure of the glottis which checks the inflow of the air and produce a short, sharp, inspiratory cough with a characteristic sound is known as hiccough. It may be benign and self-limited, but occasionally it is recurrent or persistent and a sign of serious underlying illness. |
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| Clinical Features | |
| Preventions | Reduce the likelihood of hiccups occurring by avoiding the following: eating or drinking too quickly. drinking alcohol or carbonated beverages. eating spicy foods. smoking. suddenly changing the temperature in the stomach by eating or drinking something very cold after something very hot, or vice versa. |
| Treatment | Most cases of hiccups go away on their own without medical treatment. If an underlying medical condition is causing hiccups, treating that condition may stop the hiccups. If your hiccups last longer than two days, medicines or certain procedures may be needed. Medicines Drugs used to treat long-term hiccups include baclofen, chlorpromazine and metoclopramide. Procedures If less invasive treatments aren't effective, recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups. |
| Complications | Discomfort, difficulty in feeding, gastro-oesophageal reflux, respiratory alkalosis (in tracheostomised patients), wound dehiscence, sleep deprivation, and psychiatric disorders |
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