- The hiccup (or hiccough) is an onomatopoeic name stemming from the sound made by the abrupt glottic closure following involuntary contraction of the diaphragm and intercostal muscles.
- The medical term for hiccup is singultus, which stems from the Latin singult, originally used to describe the sharp intake of breath associated with prolonged sobbing.
- Usually a benign, yet recurrent nuisance
- Prolonged bouts of hiccups can be indicative of an underlying or serious condition.
- Fetal hiccups are common in pregnancy, and are frequently felt in the third trimester.
- Hiccups are a physiologic movement in newborns, who may spend as much as 2.5% of their time hiccupping, which decreases in infancy.
- There is no seasonal, geographic, racial, or socioeconomic predilection.
- Persistent (>48 hours) and intractable (>1 month) hiccups more commonly occur in men and adults.
Avoid precipitating factors (e.g., eating rapidly, carbonated beverages, alcohol, tobacco).
- A hiccup reflex arc has been elucidated through the study of pathologic hiccups.
- Afferent limb: receptors in the distal esophagus, stomach, and abdominal side of the diaphragm; signals travel through the phrenic nerve, vagus, and sympathetic (T6–T12) chain branches.
- Central component: the middle and dorsolateral medulla; independent from the respiratory center, the hypothalamus, and the phrenic nerve nuclei
- Efferent limb: phrenic nerve to the diaphragm; accessory nerves to the intercostal and scalene muscles, glottis structures, and the esophagus
- Hiccups are often unilateral, involving the left hemidiaphragm.
- Associated with a change in the ambient or internal temperature
- Examples: cold showers, hot/cold beverages
- Central nervous system
- Examples: neuromyelitis optica, migraine aura, brainstem lesion, hydrocephalus, VP shunt, meningitis, brain abscess
- Peripheral nervous system
- Due to irritation or stimulation of phrenic or vagal nerves
- GI: aerophagia, gastric insufflation, Gastroesophageal reflux disease (GERD), GI malignancies
- Thoracic: asthma, goiter, pneumonia
- CV: pericarditis, pericardial effusion, central catheter migration
- Examples: alcohol, tobacco, uremia, electrolyte imbalance, thrush
- Examples: excitement, stress, conversion disorder, anorexia nervosa, secondary gain
- Examples: opioid, benzodiazepines, chemotherapy, anesthetic agents
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