Hiccups (hiccups, hiccups) is a reflex disturbance of external respiration, manifested by convulsive contractions of the diaphragm and intercostal muscles with a characteristic stifled sound and a short-term sensation of holding the breath. Usually has a physiological origin. It can occur in diseases of the digestive organs, central and peripheral nervous system, diaphragm, thoracic inflammation and volumetric processes, intoxication. To determine the causes of hiccups, ultrasound, radiography, tomography of various organs, and EFI techniques are used. Often, hiccups stop on their own. At the prehospital stage, reflex methods, sedatives, tranquilizers and antipsychotics are used.
A sudden attack of hiccups may be preceded by overeating, fast food with poor chewing of hard and dry foods, swallowing air, drinking highly carbonated and alcoholic beverages. In young children and sometimes in adults, hiccups are provoked by hypothermia. Some patients begin to hiccup after taking muscle relaxants, barbiturates, benzodiazepines and other drugs. Often the symptom appears for no reason and goes away on its own within a few minutes.
At the time of an attack, a person experiences jerky muscle contractions in the epigastric region, accompanied by a protrusion of the anterior abdominal wall and a squeezed sound. Due to the overlap of the glottis for a short period of time, there is a delay in breathing. A feature of hiccups is the impossibility of its conscious control. With intense hiccups, moderate pain behind the sternum, in the lower parts of the chest, is sometimes noted. Hiccups are characterized by rhythmic muscle contractions at approximately regular intervals.
Prolonged, especially pathological hiccups often have a debilitating effect, may be accompanied by irritability, emotional instability, increasing asthenia, vegetative manifestations - sweating of the palms, blanching or redness of the skin, and a decrease in the temperature of the skin of the distal extremities. For episodes that recur several times a day or several days a week, lasting more than an hour and combined with other disorders (heartburn, pain, shortness of breath, etc.), you should seek medical help.
The main criteria used in the systematization of hiccup variants are its relationship with pathological conditions, development mechanisms, and duration. In most cases, hiccups are physiological in nature and are not associated with any disease. Pathological are called diaphragmatic myoclonus that occurs against the background of various diseases and is represented by such forms as:
Physiological hiccups are usually short-lived. With pathological contractions of the diaphragm, episodes of transient hiccups (from several minutes to several hours), persistent hiccups lasting more than 2 days, and long-term (from a month or more) are distinguished. Although usually prolonged hiccups indicate the presence of pathological conditions, in rare cases it can be observed in a healthy person.
Most often, hiccups are associated with improper eating habits: fast food, insufficient chewing of food, dry eating, smoking on an empty stomach. Hiccups are also provoked by overeating and drinking highly carbonated drinks, which leads to distension of the stomach, irritation of the vagal receptors. With a forced position of the body, fear, the passage of large pieces of solid food in the esophageal opening of the diaphragm, the vagus nerve can be infringed. In such cases, hiccups are protective in nature and are aimed at restoring normal innervation.
In childhood, less often in adulthood, hiccups become the result of autonomic dysfunction caused by general hypothermia. During pregnancy, the increase in episodes of hiccups is potentiated by a complex of changes occurring in a woman's body. The leading cause is an increase in the uterus, which is accompanied by an increase in intra-abdominal pressure and a displacement of the internal organs towards the diaphragm. An additional factor is the increased emotionality of the pregnant woman.
The causes of hiccups in patients with brain pathology are usually irritation of structures that directly or indirectly stimulate diaphragmatic contractions. Most often, hiccups are observed in pathological formations and processes in the posterior cranial fossa. However, the occurrence of a symptom is possible with other localization of damage. Identification of often recurrent and persistent hiccups may indicate the development of diseases such as:
Since the reflex arc that causes myoclonic contractions of the diaphragm closes in the cervical segments of the spinal cord, hiccups are associated with damage to the spinal tissue. Inflammation, trauma and volumetric processes are sometimes accompanied by increased activity of motor neurons, from the processes of which the phrenic nerve is formed. In the presence of persistent hiccups, the following are excluded:
Reflex development of pathological hiccups is noted with lesions of the roots of the spinal nerves, nerve plexuses and nerves connecting the diaphragm with the upper segments of the cervical brain. As an independent symptom, hiccups are rarely observed in patients. Often this manifestation is combined with other focal neurological symptoms within the framework of such pathological conditions as:
The immediate cause of hiccups is the contraction of diaphragmatic fibers, respectively, this symptom can be detected in inflammatory, traumatic and other injuries of the muscular septum separating the chest and abdominal cavities. The prerequisites for triggering an attack of reflex hiccups depend on the characteristics of the pathological process:
A symptom of frequent or prolonged hiccups is observed in esophageal pathology, in which the vagus nerve is compressed. The direct cause of hiccups is pathological afferentation aimed at implementing a protective reflex and restoring normal nerve conduction. Hiccups in combination with pathognomonic symptoms may manifest:
In some patients, hiccuping is one of the manifestations of the pathology of the digestive tract, which is associated with the peculiarities of the passage of the phrenic-abdominal branches of the phrenic nerves and their anastomosis with the sympathetic plexus of the diaphragm. An additional role is played by the possible irritation of the vagus during abdominal pathological processes. An attack of hiccups can be complicated by both chronic diseases of the gastrointestinal tract (atrophic gastritis, pancreatitis) and acute pathology (intestinal obstruction due to infringement of inguinal, umbilical and femoral hernias).
Episodes of hiccups are possible with pathological processes in the right hypochondrium: subdiaphragmatic abscesses, attacks of cholecystitis, biliary colic. A feature of such conditions, in addition to signs of organ damage, is the identification of a phrenicus symptom, indicating irritation (irritation) of the phrenic nerve. Sometimes hiccups occur with abdominal trauma and during abdominal operations, which is associated mainly with vagal effects. For enteritis, colitis, giardiasis and helminthiases, the so-called reflected hiccup is characteristic.
The cause of the symptom in people suffering from cardiological, bronchopulmonary and mediastinal diseases is usually irritation of the vagus nerve, which passes in the mediastinum near the esophagus. With the localization of the pathological focus in the region of the diaphragm, stimulation of diaphragmatic receptors that trigger hiccups is possible. The combination of hiccups with pain radiating to the shoulder girdle and neck is characteristic of mediastinal teratomas that compress the vagus.
Hiccups that occur with dry diaphragmatic pleurisy often make diagnostic search difficult. Its combination with flatulence, abdominal tension, pain in the hypochondrium and abdominal cavity is often mistakenly interpreted as an additional sign of an acute abdomen. A similar situation is noted in the leading abdominal syndrome in patients with pulmonary embolism and severe dyspeptic symptoms in pulmonary infarction. In sporadic cases, hiccups against the background of dull pain in the chest and signs of heart failure are manifested in postcardiotomy syndrome.
Reflected hiccups are sometimes observed in the pathology of the uterus and appendages (endometritis, adnexitis, benign and malignant tumors). The mechanism of its occurrence is still unclear, although the role of complex regulatory interactions involving sympathetic and parasympathetic fibers of the visceral nervous system is not excluded. In addition, autonomic dysfunction causes the development of hiccups in algomenorrhea. Patients also experience functional disorders of many systems: dyspepsia, fainting, palpitations, etc.
The appearance of agonal hiccups is a formidable sign of an unfavorable course of serious illnesses and terminal conditions. Usually, the development of a symptom indicates gross metabolic disorders in the brain tissue, dysfunction of the nuclei of the medulla oblongata and subcortical structures. Hiccups of central origin are observed in severe metabolic disorders caused by functional insufficiency of various organs and systems - hepatic, uremic and diabetic coma. Intoxication hiccups are possible with burn disease, cancer cachexia.
The most common causes of exogenous intoxications that occur with hiccups are poisoning with various substances: alcohol, muscle relaxant, sedative and anesthetic drugs, and some hormonal agents. The probable cause of the symptom is considered to be brain dysfunction with an imbalance of excitatory and inhibitory influences, a change in the metabolism of neurons, and the formation of foci of pathological activity.
A diagnostic search aimed at clarifying the causes of hiccups is carried out when it is combined with other symptoms, frequent occurrence, and the duration of attacks is more than 6 minutes. The examination plan is drawn up taking into account the anamnesis and concomitant symptoms. Most often, the primary diagnosis is carried out by a gastroenterologist, who, according to indications, involves other specialists in examining the patient. Depending on the alleged cause of the symptom, for the purpose of express diagnostics, the following are used:
Upon receipt of preliminary information about a possible disease that provoked hiccups, further examination is performed according to the appropriate protocol and may include a wide range of laboratory and instrumental methods. Differential diagnosis is carried out between various pathological processes in which the development of hiccups is possible.
When hiccups, it is recommended to drink water in small sips.
Episodes of physiological hiccups pass on their own in 2-1 minutes. Sometimes, for their faster relief, it is enough to be distracted, take a deep breath 2-3 times, hold your breath for a while or drink a couple of sips of water. If the attack continues, despite the distraction and reflex methods being taken, taking into account the patient's condition, it is recommended to contact the local or family doctor, who will prescribe a further examination, or call an ambulance if the patient's condition quickly worsens.
Before hospitalization and examination to stop hiccups, a medical worker can stimulate some reflexogenic zones in the face and exit points of the phrenic nerve, install a catheter intranasally to a depth of 12 cm. Sometimes an intravenous infusion of calcium preparations has a stopping effect. With a probable central and especially psychogenic genesis of hiccups, sedative herbal preparations, tranquilizers and neuroleptics are used.
Intractable hiccups lasting more than an hour may be a sign of intoxication or severe brain pathology. In such cases, delay in hospitalization significantly worsens the prognosis of the underlying disease, leads to the need to prescribe more complex drug regimens and conduct emergency invasive interventions. An urgent call to an ambulance is necessary for hiccups, combined with vomiting, impaired sensitivity, motor activity and consciousness. Repeated bouts of hiccups are also a reason for a thorough examination.