(Hiccup; Singultus)

Under hiccups is understood involuntary spasms of the diaphragm with the following closure of the epiglottis, which controls the influx of air and produces a characteristic sound. Temporary bouts of hiccups are very common. Persistent (> 2 days) and nichtbehandelbarer (> 1 month) hiccup is rare but excruciating. Etiology hiccup occurs with irritation of afferent or efferent phrenic nerves or of medullary centers that control the respiratory muscles, particularly the diaphragm here. Hiccups usually occurs in men. The cause is usually unknown, but temporary hiccups often caused by the following factors: expansion of the stomach drinking swallowing hot or irritating substances Persistent and intractable hiccups has numerous causes (see Table: Some causes of intractable hiccups). Some causes of intractable hiccups category Examples Esophageal Reflux Disease Gastroesophageal other oesophageal diseases Abdominal Abdominal bowel disease gallbladder disease liver metastases hepatitis pancreatitis pregnancy Thoracic Diaphragmatic pleurisy pneumonia pericarditis Thoracic Surgery Other alcoholism tumors or infarcts in the posterior cranial fossa uremia clarification History A history of existing Ekrankung should record the duration of the hiccup and applied remedy as well as query the relationship between the beginning and a recent illness or surgery. The examination of the body systems trying accompanying gastrointestinal symptoms such as reflux, difficulty swallowing, uncover thoracic symptoms such as cough, fever or chest pain and neurological symptoms. The history should clarify known gastrointestinal and neurological disorders. A drug history should include details regarding the consumption of alcohol erfassen.Körperliche investigation: The investigation is not effective in general, but should for signs of chronic diseases (such as cachexia.) Search. A complete neurological examination is wichtig.Warnhinweise following are of particular importance: neurological symptoms or signs interpretation of the findings Few findings are specific. A hiccup after drinking alcohol or surgery can very well stand with these events in context. Other possible causes (see Table: Some causes of intractable hiccups) are both numerous and rarely a cause of Schluckauf.Testverfahren A specific evaluation is not necessary in acute hiccups when the routine medical history and physical examination are unremarkable; pathological findings be ascertained with the appropriate test methods. In patients with a hiccup of longer duration or for no apparent reason, further investigations are required, incl. Serum electrolytes, urea and creatinine, chest x-ray and ECG. An endoscopic examination of the upper GIT and possibly also monitoring the pH in the esophagus must be considered. If these are normal, an MRI of the brain and a CT of the chest can be made. Therapy Identified Problems to be treated (for. Example, proton pump inhibitors in gastroesophageal reflux disease, stricture dilatation in the esophagus). Symptomatic relief many simple measures can be tried, although each is only moderately effective: the PaCO2 can be increased and the diaphragmatic activity is inhibited by frequently holding the breath or through deep single or exhaling (in a paper bag Cave: Plastic bags can hang in the nostrils remain and are not recommended.) a vagal stimulation (by a Pharynxirritation z. B. swallowing of dry bread, granulated sugar or pieces of ice, train on the tongue or engagement of a knob) may be effective. In addition, a variety of home remedies exist. Persistent hiccups is often resistant to therapy. Many drugs have been used anecdotally. Baclofen, a gamma-aminobutyric acid agonist (5 mg p.o. every 6 h, increased to 20 mg), may be effective. Other drugs are chlorpromazine, 10-50 mg po 3 times a day, metoclopramide, 10 mg p.o. 2 to 4 times daily, and various anticonvulsants (z. B. gabapentin). In addition, a test with proton pump inhibitors can be taken. For severe symptoms chlorpromazine may 25-50 mg i.m. or i.v., are given. In intractable cases can be the phrenic nerve block by small amounts of 0.5% procaine; Here a prudent approach is appropriate in order to avoid respiratory depression and pneumothorax. Even the bilateral Phrenikotomie is not beneficial in all cases. Key points The cause is usually unknown. Rarely is a serious condition. Clarification is usually not purposeful, but should be done for a hiccup last long. There are numerous remedies, but none with a clear superiority (or even effectiveness).

Health Life Media Team

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