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
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
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.
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.
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
yes it's a case of acid peptic disease with GERD. Scopy will diagnose oesophagitis . Oesophageal pH monitoring also advised .
Agree with dr mahajan,it is GERD,do esophageal pH monitoring.
Much of the approach to hiccup therapy is based upon observational studies, case reports and small series that do not directly compare treatment options
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
Cases that would interest you
- Login to View the image
Patient complains of sudden onset pain in epigastrium region, retrosternal discomfort. ECG done. What is the diagnosis?
Dr. Kanika Kalra1 Like36 Answers - Login to View the image
A male aged 45 years came to Emergency with complaints of pain Chest and Dyspnea...his Xray showed like this...what are the possible causes
Dr. Hardik Ahuja1 Like25 Answers - Login to View the image
A 16yrs female admit in casualty due to c/o chest pain. on examination PR100bpm,no other positive finding.on investigation ECG normal, CBC normal, thyroid profile report T3 T4 FT4 TSH report attached.what is further management plz help me
Dr. Mahaveer Jakhar1 Like7 Answers - Login to View the image
Today my topic is on #Haemoptysis #Coughing of blood.Most of the peoples are worrying about this I will try to give solutions. Hlaemoptysis is the coughing of blood originating from the respiratory tract below the level of the larynx. Haemoptysis should be differentiated from: • Haematemesis - vomiting of blood from the gastrointestinal (GI) tract. • Pseudohaemoptysis - where a cough reflex is stimulated by blood not derived from the lungs or bronchial tubes. This may be from the oral cavity or nasopharynx (eg, following an epistaxis) or following aspiration of haematemesis into the lungs. Classifications of severity vary. Although volumes of 100 to 1000 mL of blood have been described as indicative of massive haemoptysis, no specific volume has been universally accepted. However, a large volume of expectorated blood alone should not define massive haemoptysis, but rather an amount of blood sufficient to cause a condition that threatens the patient's life is usually a more correct and functional definition of severe haemoptysis[1. Trachea or bronchus • Malignancy: • Bronchogenic carcinoma. • Endobronchial metastatic tumour. • Kaposi's sarcoma. • Carcinoid tumour. • Bronchitis. • Bronchiectasis. • Airway trauma. • Foreign body. Lung parenchyma • Lung abscess. • Pneumonia - bacterial (eg, Staphylococcus aureus, Pseudomonas aeruginosa) or viral (eg, influenza). • Tuberculosis (TB). • Fungal infection and mycetoma. • Hydatid cysts. • Goodpasture's syndrome. • Pulmonary haemosiderosis. • Granulomatosis with polyangiitis (GPA). • Behçet's disease. • Lupus pneumonitis. • Lung contusion. • 'Crack' lung. Vascular • Arteriovenous malformation. • Aortic aneurysm. • Pulmonary embolism (PE). • Mitral stenosis. • Other cause of pulmonary venous hypertension - eg, left ventricular failure (LVF). • Trauma. • Iatrogenic (eg, chest drain malposition, secondary to pulmonary artery catheter manipulation). Other • Pulmonary endometriosis. • Congenital or acquired systemic coagulopathy - eg, leukaemia. • Anticoagulant or thrombolytic agents. • Factitious haemoptysis. • There is a large list of therapeutics for the treatment of cough. Among them, the top-ranked include – Drosera Rotundifolia, Antimonium Tart, and Conium Maculatum • . Bryonia. This remedy relieves dry and painful cough, with dry throat and intense thirst. ... • Phosphorus. ... • Pulsatilla. ... • Rumex crispus. ... • Aconitum napellus. ... • Antimonium tartaricum. ... • Belladonna. ... • Chamomilla.
Dr. Rajesh Gupta1 Like3 Answers - Login to View the image
A 37-year-old male presented to the ED with two days of chest pain . constant, rated at a level of 3 (on a scale of 0 to 10), and slightly worsening on deep inspiration. He described increased shortness of breath with exertion and a cough productive of clear sputum but denied fevers, chills, nausea, lightheadedness or sweating. The patient was a pale, obese male who appeared in no acute discomfort .temp - 97.5◦F ,1 Rr18 beats/minute BP 102/72 mmHg RR 18 Spo2 -96% CVS s1s2+ Rs : Rales at the lung bases bilaterally P/a Soft, nontender, nondistended. CNS Nonfocal. TLC 18 K/μL with 90% neutrophils, hematocrit - 31% creatinine - 1.5 mg/dL positive D-dimer. troponin I - normal
Dr. Mahesh Mareddy10 Likes19 Answers
1 Like