20yrs female c/o intractable hiccups since 1month CBC uric acid .BL urea Srcret tsh normal what other investigations needed to diagnosis
Causes of persistent and intractable 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
If no cause can be identified, empiric therapy with physical maneuvers is first-line treatment. These maneuvers are easy to perform and have a low risk of complications. Pharmacologic therapy should be reserved for treatment of hiccups when physical maneuvers have failed. In the absence of data comparing pharmacologic treatments, we suggest initiating pharmacologic treatment with chlorpromazine, which has good efficacy and is generally well-tolerated at low doses. Physical maneuvers — Physical maneuvers include (table 2): ●Interrupt normal respiratory function (eg, breath holding, Valsalva maneuver) ●Stimulate nasopharynx or uvula (eg, sipping cold water, gargling with water, swallowing a teaspoon of dry sugar) ●Increase vagal stimulation (eg, pressing on the eyeballs) [35] ●Counteract irritation of the diaphragm (eg, pulling knees to chest, leaning forward to compress the chest) The efficacy of these maneuvers has only been suggested by case reports and is not confirmed.
The persistence of hiccups during sleep suggests an organic rather than psychogenic etiology. In the physical examination, the external auditory canals should be examined to rule out potential irritants of tympanic membranes such as an infection or a foreign body. A detailed head and neck examination is important to exclude an enlarged thyroid and lymphadenopathy. Additional components of the physical examination that are important include a thorough neurologic examination (including cranial nerve assessment), auscultation of the chest, and an abdominal examination to palpate for any mass lesions. Laboratory tests to obtain in patients with persistent or intractable hiccups include: a complete blood count, electrolytes, blood urea nitrogen (BUN), creatinine, calcium, liver function tests, and amylase/lipase.
I have seen these kind of cases It might be pan erosive gastritis or fundus gastritis most of the cases present w/ hiatus hernia better do endoscopy to rule out this. Currently u can advise them to take sompraz d in the morning and Pansec L in the night before 45 mins of food, adv them to take jeera boiled water atleast once after food. Diet adv to restrict green chilli, junk food and yogurt. Plenty of water intake shouldn't leave stomach empty. Let me know for further help @Dr. Gopal B Patil
Hiccup bouts are usually caused by gastric distention from overeating, carbonated beverages, aerophagia (eg, swallowing with chewing gum or smoking), and gastric insufflation during endoscopy
Much of the approach to hiccup therapy is based upon observational studies, case reports and small series that do not directly compare treatment options
Get serum electrolytes.done...if normal get gastroscopy done to rule out severe gastritis and gastric ulcer
20 year old female Intractable hiccup ,one month No other symptoms attributable to any other systems. If organic causes are ruled out, Conversion Reaction is a plausible diagnosis. Psychiatric councelling can be suggested.
Do gastroscopy serum bilirrubin ECG sy sucrafil10 ml bd rabe dsr bd ondem8 mg bd blant diet ice cream cold milk if doesn't stop largectil tab best milk drip
no need of more investigations plz go 4 barium meal study &ask 4 few mental symptoms &if ask 4 food habits &see 4 liver profile
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