Introduction :-
Hiccups or also spelled as hiccoughs are mostly benign and transient (3 to 4 at a time), but sometime it is excessive ( greater than 30 at a time )
Mostly the benign and transient type of hiccups are infrequent and mostly comes in evening time.
But some time they may become continuous and frequent , comes for days or seema, these type of hi chod are mostly seen in females. Female patient complaint of protracted ( again and again ) / intractable ( for long time ) hiccups.
some time patient may complaint sone thee problems along with hiccups.
e need to understand that hiccups may also come due to some psychiatric problem.
In an patient undergone recent surgery , he may complaint of vomiting or hiccups and this is expected.
Causes :-
1) Sometimes involuntary contractions occurs in diaphragm due to which diaphragm moves upwards and air moves out via larynx this causes vibration in vocal cord and thus hiccups are produced.
2) Due to brain / nerve / abdomen disease, autonomic nervous system or phrenic nerve gets irritated and causes the stimulation of centre of phrenic nerve which causes involuntary contractions in diaphragm and so hiccups occurs.
Causes of Transient / Benign Hiccups :–
1) Aerophagia – It means intake of air , like when a person is eating too quickly.
2) Sudden change in temperature – For example a person eating cold food and suddenly started eating hot food.
3) Alcohol – Drinking too much alcohol may induce hiccups in some people
4) Over Excited / Over Laughing – These emotional situations may also induce hiccups
Treatment for Benign Hiccups –
1)Traction of tongue
2)Stimulation of Pharynx – it can be done by touching the spoon to pharynx
3)Valsalva Maneuver
Causes of Protracted-Intractable Hiccups –
1) Brain tumor– Brain Tumor is most common in temporal lobe, patient complaint of headache, vomiting, and hiccups
2) Degenerative Disease of brain – Patient complaint of weak memory with sometime severe hiccups
3) Meningitis / Encephalitis – Patient complaints of headache, fever, vomiting and sometime hiccups
4) Stroke – Suddenly blood clot / hemorrhage in brain’s blood vessel
5) Laryngitis / Pharyngitis
6) Laryngeal TB
7) Pneumonia – Specially when pneumonia is in lower part of lung it irritates diaphragm and causes hiccups.
8) Myocardial infection / Pericarditis – Complaints of restlessness, dyspnea, weakness, hiccups
9) Goitre– Sometime goitre may invade in chest and it is termed as sub sternal goitre.
10) Other causes includes – GERD, Hiatus hernia, Achalasia, Ear wax, Any foreign body in ear.
When patient have wax in his ear, then after taking bath , the water that enters into ear causes ear wax to swell which causes hiccups.
Protracted – Intractable Hiccups broadly occurs due to –
● Psychological Cause- The hiccups that occur only during day time and increases in stress and otherwise patient is normal
● Organic Cause- All other diseases causing factors which are defined above are categorised under organic causes.
Other organic causes –
1)Liver Disease – Amoebic hepatitis, Hydrated Cyst
2)Subphrenic Abcess- Puss collection in between liver and diaphragm
3)Gall bladder diseases
4)Esophageal / Stomach diseases- Gastritis, Peptic ulcer, Cancer
5)Chronic Kidney Disease- Causes uremia
Treatment :-
1)Haloperidol– 1mg , Drug which can stop involuntary activity
2)Nerve Stabilizer- Na-Valproate (250mg), Gabapentin (300mg)
3)Brain Reliver- Chlorpromazine 10mg
4)Lidocaine liquid- Use it for swishing and then spit out from mouth.
Sometime Lidocaine injection 1mg/kg IV may be used
But initially we don’t give it because it have adverse effects on heart. So it is given only when there is a severe need of IV inj.
Happy Learning !