Topic: Medical Guideline Books-5
SIngultus (HICCUP)
Synonims :
LATIN - Singult
Singultus, Hiccup, Hiccough
Synchronous Diaphragmatic Flutter (SDF)
Definition :
An Involuntary Action Involving A Reflex Arc, Which Manifest As A Myoclonus Of The Diaphragm That Repeats Several Times Per Minute.
Singult - The Act Of Catching One's Breath While Sobbing.
The Abrupt Rush Of Air Into The Lungs Causes The Vocal Cords To Close, Creating A "HIC" Sound
Frequency : Between 4 - 60 Hiccups / Minute
Increase Frequency Is Noted With Falls In PaCO2
Transient Hiccups Tend To Occur At Night,
Intractable Hiccups Tend To Predominate In Men
Majority Of Hiccups Are Benign, However Chronic Hiccups May Portend More Ominous Pathology
Incidence :
Spare No Population And Have Been Observed In Human Beings From PRETERM INFANTS To ADULTS
Also Occur In Other Mammals
Hiccups Appear To Serve No Particular Function And May Be Remnants Of A Primitive Reflex
Classification :
Acute Episodes - TERMINATE WITHIN 48 HOURS
Persistent Hiccups - LASTING > 48 HOURS, But < 1 MONTH
Intractable Hiccups - AFFLICTED FOR > 1 MONTH
Pathophysiology :
Due To Stimulation Of A HICCUP REFLEX ARC That Involves Both Central And Peripheral Components
Afferent Limb :
Phrenic Nerve, Vagus Nerve, And Sympathetic Chain From T6 To T12
Efferent Limb :
Multiple Brainstem And Midbrain Areas Interacting With The Motor Fibers Of The Phrenic Nerve
Connection Between Afferent And Efferent Limbs Exists Within Cervical Spinous Processes C3-C5
Irritation In Any Component Of This Reflex Arc May Result In Hiccups
Repetitive, Involuntary Contractions Of Intercostal And Diaphragmatic Muscles With Glottic Closure Resulting In The Familiar HICCUP
More Commonly Involve Unilateral Diaphragmatic Contraction
Etiology :
Structural Disturbances
Inflammatory Disturbances
Infectious Disturbances, Or
Metabolic Disturbances
Diagnosis :
History :
Onset, Severity, And Duration Of Hiccups
Example :
Hiccups Occuring During Sleep : Organic Causes
Chronic Persistent Hiccups : Associated With Malnutrition, Fatigue, Dehydration, Cardiac Arrhythmias, And Insomnia
Etiology : Excessive Alcohol And Tobacco, Medications
Physical Examination :
Head And Neck Exam - Search For Masses, Foreign Bodies, Or Evidence Of Infection
Lympn Nodes : Lymphadenopathy - Compression Of Neural Structures
Chest : Pneumonia Or Asthma
Abdomen : Gastric Distention, Peptic Ulcers, Pancreatic / Biliary Disease
Neurologic Assessment : Strokes, Multiple Sclerosis
Latin - SINGULT
Singultus, Hiccup, Hiccough
Synchronous Diaphragmatic Flutter (SDF)
Laboratory Examination :
No One Laboratory Study Can Diagnose HICCUPS
Specific Laboratory Study :
Serum Alcohol, Or Serum Electrolyte Levels - Exclude Metabolic And Toxic Causes Of Persistent Hiccups
Chest X-Ray - Exclude Cardiac, Pulmonary, And Mediastinal Sources Of Peripheral Nerve Irritation
Others : Electroencephalogram (EEG), MRI, And Endoscopy
Therapy :
Indication :
When Persistent Hiccups Adversely Affect A Patient's Quality Of Life
Non Pharmacologic :
Aimed At Manipulating Phrenic And Vagal Nerve Activity
Such As (ANEDOCTAL METHODS) :
Respiratory Manuevers, Nasopharyngeal Stimulation, And Methods To Decrease Gastric Distension
Sneezing, Inducing Unexpected Fright, Swallowing Granulated Sugar, Carotid Massage, Valsalva Manuevers, Supraorbital Pressure, Holding One's Breath, Or Other Various Maneuvers To Manipulate PaCO2
Drinking Water While Upside Down, Sticking A Finger In The Mouth, Massaging The Back Of The Throat, A Teaspoon Of Vinegar, A Teaspoon Of Honey, Drinking Water From The Far Side Of A Glass, Drinking A Full Glass Through A Paper Towel, Breathing Deeply Followed By Swallowing Quickly, Altering One's Breathing Patterns, Eating A Spoonful Of Peanut Butter, Drinking Hot Coffee, Or Drinking Water (Large Amounts)
Pharmacologic :
Aimed At Inhibition Of Stimulated Points In The Hiccup Reflex Arc - Largely Effecting Blockade Through Inhibitory Neurotransmitters
Such As :
GABA And DOPAMINE ANTAGONISTS - Baclofen, Chlorpromazine, Haloperidol, Metoclopramide
ANTI-CONVULSANTS - Valproic Acid, Carbamazepine, Phenytoin
Miscellaneous Agents - Nifedipine, Sertraline, Anesthetics, Gastric Acid Suppresors
ANEDOCTAL :
CARBONATED Beverage - For Hiccups Due To Electrolyte Imbalance (Hypokalemia, Hyponatremia) - Contain Salt To Normalize The Potassium-Sodium Balance In The Nervous System
Promotes Quicker Absorption
However, Carbonated Beverages May Also Provoke Hiccups In Some People.
Instill Xylocaine Liniment 3% Or Gel 2% In The External Ear - Somehow This Seems To Be Able To Break A Vagus Nerve Triggering Reflex Through Its Extensions To The External Ear And Tympanus (Ear Drum).
Effect Can Be Immediate, And Also Have Lasting Effect After The Xylocain Effect Expires After About Two Hours
Surgical Manipulation :
Implantation Of Vagus Nerve Stimulator In The Upper Chest - Introduced By Dr. Bryan R. Payne
It Sends Rhythmic Bursts Of Electricity To The Brain By Way Of The Vagus Nerve, Which Passes Through The Neck
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