hiccup
Introduction
Hiccup introduction Hiccup refers to the involuntary intermittent contraction of the diaphragm (transverse), causing air to be suddenly inhaled into the respiratory tract and digestive tract. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: indigestion
Cause
Hiccup cause
Central nervous system lesions (15%):
Such as encephalitis, meningitis, brain tumors, hydrocephalus, cerebrovascular disease, etc., when the lesion spreads to the medulla, it is more likely to hiccup. Myelitis, cervical spinal cord disease or spinal cord paralysis is associated with a crisis.
Peripheral neuropathy (10%):
Hiccup is mainly caused by stimulation of the vagus nerve and phrenic nerve. Multiple diseases of the digestive system, chest and mediastinal diseases are common causes of hiccups.
Intra-abdominal lesions (12%):
Gastric dilatation or bloating, which is common to various causes. Stomach, intestinal paralysis. Pyloric obstruction. Intestinal obstruction or flatulence. Hepatic or spleen syndrome, that is, colonic hepatic or spleen is highly flatulence. High abdominal distension after surgery, after the operation of gallbladder, postoperative gastrointestinal surgery, prostate or bladder surgery is more common. Liver abscess, underarm abscess or liver cancer. Cholecystitis or cholelithiasis. Diffuse peritonitis. A large amount of ascites caused by the elevation of the sputum.
Cross-thoracic lesions (10%):
More common in lung, bronchial and pleural diseases, such as leaf pneumonia, exudative pleurisy, bronchiectasis and so on. Mediastinal tumor. Esophagus, tumor of the cardia. Acute myocardial infarction, pericarditis. Acute pulmonary embolism. Lower aortic aneurysm, etc. After major surgery in the thoracic cavity.
Diaphragm itself (8%):
More common in sputum pleurisy, congenital diaphragmatic or esophageal hiatus hernia.
Systemic or toxic disease (5%):
Hiccups can be seen in systemic infectious diseases such as sepsis, acute severe pancreatitis, typhoid fever, toxic dysentery, etc.; in acute alcoholism, strong acid, strong alkalosis or uremia can also cause hiccups; a small number of diabetes complicated by gastroparesis Can cause hiccups.
Hysteria or neurological hiccup (5%):
More common in people with gastroenteritis (neurotropia), often because of continuous swallowing of air, can be expressed as a hiccup.
Pathogenesis
The mechanism of hiccup is complicated, and the generation of hiccup is undoubtedly a kind of nerve reflex activity. Its low-level reflex center is generally located in the third and fourth cervical vertebrae (but still controlled by the medullary respiratory center), and the stimulation or impulsive afferent From the sensory fibers of the phrenic nerve or the vagus nerve, in addition to the nerve reflex, the occurrence of hiccup must be completed by the participation of the respiratory muscles. The paroxysmal spasm of the diaphragm, intercostal muscles and other respiratory muscles, contraction is an important factor in synergy.
Prevention
Hiccup prevention
1. Abandon carbonated drinks. The carbon compounds in soda water contain air, and when this air enters the stomach, it produces a lot of gas, which causes snoring.
2. Eat slowly. The slower you eat, the harder it is for the gas to enter the stomach. Eating the opposite is the opposite.
3. Try to chew thoroughly when swallowing food. Chewing 20 times per mouth can effectively reduce the entry of gas into the stomach.
4. Avoid chewing gum. Swallowing causes the gas to enter the stomach. If you have to chew your chewing gum, make sure your mouth is closed when you chew.
5. Avoid eating foods that produce gas. Such as onions, milk, ice cream, alcoholic beverages, mint and chocolate.
Complication
Hiccup complications Complications, indigestion
If there is too much air entering the stomach and overflowing from the mouth, mental and neurological factors (such as vagus nerve excitement, pyloric palsy), poor eating habits (such as eating, drinking too fast), excessive swallowing action (such as excessive or too little mouth) ), leading to gastrointestinal neurosis, chronic diseases of the gastrointestinal tract, causing weakening of gastric motility, indigestion, insufficient gastric motility, bloating and other complications.
Symptom
Hiccup symptoms common symptoms dyspnea intestinal paralysis nausea headache
Because the vocal cords are closed when the hiccups are reversed, a special kind of sound is often produced. When this sound is heard, it can be judged to be caused by hiccups.
Because of the many causes of hiccups, the diagnosis of the cause should be based on medical history, clinical manifestations, physical examination, and combined with necessary laboratory tests and other auxiliary examinations.
Inquire about the history of the disease, understand the cause, frequency, duration of the hiccup, whether it affects eating or sleeping, and the previous hiccup episodes. It is very important for patients to have a hiccup episode for many years, without treatment or hiccup after general symptomatic treatment. Stop, more suggestion of hiccups improper diet, gastrointestinal flatulence or neurological factors; if hiccups are in the chest, after abdominal surgery, more suggestion that hiccups are caused by gastrointestinal palsy, flatulence or diaphragmatic muscles; Frequent episodes of rebellion are accompanied by other symptoms, and nighttime does not affect sleep (the hiccup can stop the episode during sleep), which is mostly caused by neurological factors; if the patient is rebellious, accompanied by severe headache, nausea, vomiting, etc. Pathological nerve reflex, it is suggested that hiccup is caused by central nervous system disease; such as hiccup with cough, cough, dyspnea or chest pain, should consider lung, bronchial or mediastinal lesions; hiccup accompanied by acid reflux , burning sensation after the sternum, upper abdominal pain, nausea, vomiting, eating sensation, etc., should consider the hiccup Lymphatic ulcer, gastric cancer, reflux esophagitis, cardia cancer, esophageal cancer, esophageal hiatal hernia or liver, caused by biliary tract disease. Therefore, after detailed medical history and serious physical examination, most patients' hiccups can roughly define their causes. .
Examine
Hiccup check
If the hiccup is caused by systemic infection, poisoning or uremia, the corresponding laboratory examination should be performed. For example, blood analysis, blood culture or bone marrow culture should be performed when suspected sepsis, and renal function should be performed in uremia. Check and so on.
1. Upper gastrointestinal barium meal examination: can observe the esophagus, cardia, stomach and duodenum with or without inflammation, dilatation, stenosis, ulcer or tumor lesions, with or without esophageal hiatal hernia or cardia, and the cause of hiccup diagnosis Often important help.
2. Chest, abdominal plain film: X-ray chest X-ray can observe the presence or absence of bronchi, lung and mediastinal lesions; abdominal plain film can be observed whether there is high intestinal flatulence (including colonic hepatic flexion and spleen), with or without intestinal obstruction, There are no abnormalities in the horizontal and vertical sides.
3. Gastroscopy: The cause of hiccup is unclear, and gastroscopy is indispensable. Compared with barium meal examination, endoscopy has a higher diagnostic value for disease.
4. Abdominal B-ultrasound examination: suspected hiccup is cholelithiasis, cholecystitis or liver abscess, liver cancer and other hepatobiliary lesions, should be preferred B-ultrasound, B-ultrasound can provide important information or diagnostic basis for the diagnosis of these lesions.
5. CT or MRI examination: If the hiccup is caused by central nervous system lesions, intracranial CT or MRI should be performed in time to determine the location or nature of the lesion, such as chest or abdominal lesions can not be clearly diagnosed in other examinations. CT, or MRI examinations are also available to further assist in the diagnosis.
Diagnosis
Hiccup diagnosis
According to long-term clinical observation, the most common causes of hiccup are gastrointestinal dilatation caused by various causes, flatulence, peristalsis or paralysis, intra-abdominal gallbladder, bile duct, postoperative liver or gastrointestinal surgery, postoperative prostate, In addition, neurological hiccups are not uncommon, and intrathoracic diseases, diaphragmatic diseases, central nervous system diseases and systemic or toxic diseases are less common, so the following diseases should be paid attention to in differential diagnosis. .
1. Esophagus, stomach, duodenal diseases
Reflux esophagitis, esophageal hiatal hernia, esophageal cancer, cardiac cancer, gastric retention caused by various causes, gastric dilatation or gastric stenosis (including pyloric obstruction, leather stomach, gastric antrum cancer, etc.) can cause hiccups. According to the clinical manifestations of these lesions, combined with upper gastrointestinal barium meal or gastroscopy can confirm the diagnosis.
2. Intestinal diseases
Such as intestinal obstruction, intestinal paralysis can occur hiccups, according to the characteristics of abdominal pain and accompanying nausea, vomiting, no bowel movements, no venting, bowel sounds, sputum, etc., combined with X-ray film examination, intestinal obstruction, intestinal paralysis, intestines The diagnosis of high flatulence is often difficult.
3. Biliary and liver diseases
Such as cholelithiasis, cholecystitis, cholangitis, acute severe pancreatitis, pancreatic cancer, liver abscess or liver cancer, according to the pain characteristics of these diseases, pain areas, and nausea, vomiting, chills and fever, jaundice and other symptoms, signs, Combined with B-ultrasound or CT, MRI and other tests can establish a diagnosis.
4. Abdominal cavity, pelvic internal organs after surgery
Including biliary tract, liver and gastrointestinal surgery, prostate or bladder surgery, female pelvic surgery, etc., hiccups occur after surgery in these diseases, suggesting that surgery may lead to intestinal paralysis, flatulence, or inflammation, the surgery itself stimulates Caused by nerves, diagnosis is often easy to establish.
5. Neurological hiccups
Is a common digestive tract functional disease, more common in women, the incidence is often related to mental stress, emotional instability or anxiety and other factors, most patients are introverted, not cheerful, easy to sulking, its main clinical manifestations are frequent Hiccups (helium), this kind of disobedience is often controlled by subjective consciousness. In the case of medical personnel or people, the rebellion can occur frequently, and when distracting or alone, hiccups can be alleviated or terminated. There is hiccup but does not affect sleep (that is, no hiccups during sleep). As a result of frequent hiccups, the result is that a large amount of air is swallowed into the stomach, so patients often feel aggravated bloating, and a large number of patients swallow a large amount of gas with the stomach Peristaltic and enter the intestine, because the colonic hepatic or spleen is located in the highest position of the colon, so the gas can accumulate in the liver or the spleen, and the severe can cause the pain in the left and right upper abdomen and the sense of swelling, called the liver complex Zheng or Spleen Syndrome, when the diaphragm is affected, it can aggravate hiccups. There is no specific diagnostic method for neurological hiccups. If the upper digestive tract is barium meal, gastroscope and B-ultrasound, CT and other tests are not available. Qualitative lesions exist, and symptomatic treatments such as psychotherapy, sedation, and anti-depression can alleviate hiccups and help to diagnose neurological hiccups.
6. Intrathoracic lesions
Such as a variety of lung and bronchial lesions, mediastinal lesions, etc. have their characteristic symptoms and signs, such as cough, cough, hemoptysis, chest pain, dyspnea, etc., combined with X-ray or chest CT, MRI and other tests are often clear diagnosis.
7. Intracranial lesions
Encephalitis caused by various causes, meningitis, cerebrovascular disease and brain tumors, etc., generally have characteristic clinical manifestations, such as headache, nausea, vomiting, meningeal irritation, etc., combined with brain CT, etc. Inspection, diagnosis is often no difficulty.
