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Hiccups

Hiccups

Definition

Hiccups are the result of an involuntary, spasmodic contraction of the diaphragm followed by the closing of the throat.

Description

Virtually everyone experiences hiccups, but they rarely last long or require a doctor's care. Occasionally, a bout of hiccups will last longer than two days, earning it the name "persistent hiccups." Very few people will experience intractable hiccups, in which hiccups last longer than one month.

A hiccup involves the coordinated action of the diaphragm and the muscles that close off the windpipe (trachea). The diaphragm is a dome-shaped muscle separating the chest and abdomen. It is normally responsible for expanding the chest cavity for inhalation. Sensation from the diaphragm travels to the spinal cord through the phrenic nerve and the vagus nerve, which pass through the chest cavity and the neck. Within the spinal cord, nerve fibers from the brain monitor sensory information and adjust the outgoing messages that control contraction. These messages travel along the phrenic nerve.

Irritation of any of the nerves involved in this loop can cause the diaphragm to undergo an involuntary contraction, or spasm, pulling air into the lungs. When this spasm occurs, it triggers a reflex in the throat muscles. Less than a tenth of a second afterward, the trachea is closed off, making the characteristic "hic" sound.

Causes & symptoms

Hiccups can be caused by disorders of the central nervous system, by injury or irritation to the phrenic and vagus nerves, and by toxic or metabolic disorders affecting the central or peripheral nervous systems. They may be of unknown cause or may be a symptom of psychological stress . Hiccups often occur after drinking carbonated beverages or alcohol. They may also follow overeating or rapid temperature changes. Persistent or intractable hiccups may be caused by any condition that irritates or damages the relevant nerves, including:

  • overstretching of the neck
  • laryngitis
  • heartburn (gastroesophageal reflux)
  • irritation of the eardrum (which is innervated by the vagus nerve)
  • general anesthesia
  • surgery
  • bloating
  • tumor
  • infection
  • diabetes

Diagnosis

Hiccups are diagnosed by observation and by hearing the characteristic sound. Diagnosing the cause of intractable hiccups may require imaging studies, blood tests, pH monitoring in the esophagus, and other tests.

Treatment

Most cases of hiccups will disappear on their own. Home remedies, which interrupt or override the spasmodic nerve circuitry, are often effective. Such remedies include:

  • Holding one's breath for as long as possible.
  • Breathing into a paper bag.
  • Swallowing a spoonful of sugar or peanut butter.
  • Bending forward from the waist and drinking water from the wrong side of a glass.

Acupressure techniques can also be helpful in eliminating hiccups. Acupressure is a Chinese medicine treatment that involves placing pressure on different points of the body, called acupoints. It is based on the premise that good health is based on a harmony of energy flow, or qi, throughout the body. By placing pressure on acupoints, qi is balanced and harmonyand healthis restored to the patient.

To treat hiccups through acupressure, rest the heels of the palms on both cheekbones while placing hands over the eyes. Massage the temples by pulling the thumbs in towards the palm. After massaging, remove the hands from the eyes and lightly press the tip of the nose with a fingertip.

Allopathic treatment

Treating any underlying disorder will usually cure the associated hiccups. Chlorpromazine (Thorazine) relieves intractable hiccups in 80% of cases. Metoclopramide (Reglan), carbamazepam, valproic acid (Depakene), and phenobarbital are also used. As a last resort, surgery to block the phrenic nerve may be performed, although it may lead to significant impairment of respiration.

Expected results

Most cases of hiccups last no longer than several hours, with or without treatment.

Prevention

Some cases of hiccups can be avoided by drinking in moderation, avoiding very hot or very cold food, and avoiding cold showers. When carbonated beverages are drunk through a straw, more gas is delivered to the stomach than when they are sipped from a container; therefore, avoid using straws.

Resources

BOOK

Hurst, J. Willis, ed. Medicine for the Practicing Physician. 4th ed. Stamford, Conn.: Appleton & Lange, 1996.

Paula Ford-Martin

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hiccough

hiccough or hiccup We are all familiar with the common occurrence of hiccup or hiccough. It consists of a series of forceful but abruptly blocked intakes of breath. Each abrupt blocking of inspiration gives rise to a characteristic sound. The condition is often triggered by gastric distension or alcohol intake, normally lasts for no longer than a few hours, and is either self-terminating or responds to simple folk remedies. However, on rare occasions hiccups can be present continuously for more than 24 hours or prolonged bouts may recur daily. Such cases of chronic hiccups may reflect a great variety of underlying disease processes. Chronic hiccups have been reported in association with disorders and lesions of systems as diverse as the gastrointestinal, hepatic, renal/urinary, and both the central and peripheral nervous systems. In addition, chronic hiccups can occur following the administration of certain drugs and as an accompaniment to psychiatric illness. The direct danger of severe hiccups, continuously present over a long period of time, is simply one of physical exhaustion, quite apart from any hazards relating to underlying disease or drugs.

A hiccup is produced by a sudden, forceful contraction of the diaphragm. This causes a rapid inspiration but the inflow of air through the larynx into the lungs is blocked by an almost immediate closure of the glottis, meaning that the vocal cords come together. This process has no known physiological function; in fact there is remarkably little information on the biology of hiccups. They can occur in a wide variety of circumstances, from those associated in the fetus with normal activity to those accompanying terminal disease. Some workers have suggested that there is a hiccup centre in the brain and experimental work in anaesthetized animals has located a region in the medulla which, when stimulated electrically, produces a powerful inspiration with sudden glottic closure. This can also be produced by mechanical stimulation of the back wall of the upper pharynx.

The general assumption is consequently that hiccups are due to activation of a reflex because of an adequate but abnormal or pathological sensory input, or because the threshold for the reflex is substantially lowered by excitation within the brain, or because an existing inhibition of the reflex is removed. It is difficult to envisage the circumstances in which such a reflex would have any utility. An alternative suggestion is that the condition is not a reflex but a myoclonus, which is defined in this context as a sudden, brief, involuntary movement, arising from abnormal spontaneous activity within the central nervous system, comparable to that occurring in epilepsy. Chronic hiccups have been associated with brain lesions in diverse areas including the temporal lobe, the thalamus, and understandably, the medulla.

Simple hiccups may respond to a variety of folk remedies, e.g. a sudden fright, breath-holding, or drinking a large glass of water without taking a breath. Most of such remedies have the common feature in that they interrupt breathing and so could increase the level of carbon dioxide circulating in the blood. An increased arterial carbon dioxide level in turn increases the drive to the respiratory system and the assumption is that this enables the medullary respiratory centre to suppress interruptions (hiccups) to its ongoing rhythmic activity. However, in the rare cases of chronic hiccups, attention has to be directed to diagnosis and treatment of the underlying disease state, to remove the triggering factors. If no underlying disease can be found, or if a drug is inducing the hiccups but that drug is essential to some other treatment, the condition may have to be treated symptomatically using an agent that will simply suppress it.

Despite many well-conducted investigations, the current state of knowledge of hiccups is still unsatisfactory.

Allan Thexton

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Hiccups

Hiccups

Definition

Hiccups are the result of an involuntary, spasmodic contraction of the diaphragm followed by the closing of the throat.

Description

Hiccups are one of the most common, but thankfully mildest, disorders to which humans are prey. Virtually everyone experiences them at some point, but they rarely last long or require a doctor's care. Occasionally, a bout of hiccups will last longer than two days, earning it the name "persistent hiccups." Very few people will experience intractable hiccups, in which hiccups last longer than one month.

A hiccup involves the coordinated action of the diaphragm and the muscles that close off the windpipe (trachea). The diaphragm is a dome-shaped muscle separating the chest and abdomen, normally responsible for expanding the chest cavity for inhalation. Sensation from the diaphragm travels to the spinal cord through the phrenic nerve and the vagus nerve, which pass through the chest cavity and the neck. Within the spinal cord, nerve fibers from the brain monitor sensory information and adjust the outgoing messages that control contraction. These messages travel along the phrenic nerve.

Irritation of any of the nerves involved in this loop can cause the diaphragm to undergo involuntary contraction, or spasm, pulling air into the lungs. When this occurs, it triggers a reflex in the throat muscles. Less than a tenth of a second afterward, the trachea is closed off, making the characteristic "hic" sound.

Causes and symptoms

Hiccups can be caused by central nervous system disorders, injury or irritation to the phrenic and vagus nerves, and toxic or metabolic disorders affecting the central or peripheral nervous systems. They may be of unknown cause or may be a symptom of psychological stress. Hiccups often occur after drinking carbonated beverages or alcohol. They may also follow overeating or rapid temperature changes. Persistent or intractable hiccups may be caused by any condition which irritates or damages the relevant nerves, including:

  • overstretching of the neck
  • laryngitis
  • heartburn (gastroesophageal reflux)
  • irritation of the eardrum (which is innervated by the vagus nerve)
  • general anesthesia
  • surgery
  • bloating
  • tumor
  • infection
  • diabetes

Diagnosis

Hiccups are diagnosed by observation, and by hearing the characteristic sound. Diagnosing the cause of intractable hiccups may require imaging studies, blood tests, pH monitoring in the esophagus, and other tests.

Treatment

Most cases of hiccups will disappear on their own. Home remedies which interrupt or override the spasmodic nerve circuitry are often effective. Such remedies include:

  • holding one's breath for as long as possible
  • breathing into a paper bag
  • swallowing a spoonful of sugar
  • bending forward from the waist and drinking water from the wrong side of a glass

Treating any underlying disorder will usually cure the associated hiccups. Chlorpromazine (Thorazine) relieves intractable hiccups in 80% of cases. Metoclopramide (Reglan), carbamazepam, valproic acid (Depakene), and phenobarbital are also used. As a last resort, surgery to block the phrenic nerve may be performed, although it may lead to significant impairment of respiration.

Prognosis

Most cases of hiccups last no longer than several hours, with or without treatment.

Prevention

Some cases of hiccups can be avoided by drinking in moderation, avoiding very hot or very cold food, and avoiding cold showers. Carbonated beverages when drunk through a straw deliver more gas to the stomach than when sipped from a container; therefore, avoid using straws.

Resources

BOOKS

Hurst, J. Willis. Medicine for the PracticingPhysician. Stamford: Appleton & Lange, 1988.

KEY TERMS

Nerve Fibers that carry sensory information, movement stimuli, or both from the brain and spinal cord to other parts of the body and back again. Some nerves, including the vagus nerve, innervate distantly separated parts of the body.

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hiccup

hiccup or hiccough, involuntary spasmodic contraction of the diaphragm followed by a sharp intake of air, which is abruptly stopped by a sudden, involuntary closing of the glottis (opening between the vocal cords); the consequent blocking of air produces a repeated characteristic sharp sound, or hic. It is believed that hiccup is caused by stimulation of the nerve pathways or centers that control the muscles of respiration, particularly the diaphragm. In most instances hiccups are transient, although their course may sometimes be shortened by such measures as holding the breath, deep regular breathing, or rebreathing into a paper bag to increase the carbon dioxide content of the body. However, persistent hiccups may last for weeks, months, or even years. When hiccups are prolonged, therapy may include the administering of certain drugs, inhalation of carbon dioxide, and even interruption of the phrenic nerve either by injection of an anesthetic or by surgery.

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hiccup

hic·cup / ˈhikəp/ (also hic·cough) • n. an involuntary spasm of the diaphragm and respiratory organs, with a sudden closure of the glottis and a characteristic sound like that of a cough. ∎  (hiccups) an attack of such spasms occurring repeatedly for some time: he got the hiccups. ∎  a temporary or minor difficulty or setback: just a little hiccup in our usual wonderful service. • v. (-cuped, -cup·ing) [intr.] suffer from or make the sound of a hiccup or series of hiccups. DERIVATIVES: hic·cup·y adj.

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"hiccup." The Oxford Pocket Dictionary of Current English. . Encyclopedia.com. 22 Oct. 2017 <http://www.encyclopedia.com>.

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"hiccup." The Oxford Pocket Dictionary of Current English. . Retrieved October 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/hiccup-0

Hiccups

Hiccups

Are Hiccups Dangerous?

What Are the Different Types of Hiccups?

What Is the Treatment for Hiccups?

Hiccups occur when the diaphragm* suddenly contracts during breathing. The vocal cords quickly close, and an odd sound comes from the throat. Hiccups are involuntary. Their cause is not known, and hiccups do not seem to serve any useful purpose.

* diaphragm
(DY-a-fram) is the muscle that separates the chest and abdominal cavities. It is the chief muscle used in breathing.

KEYWORDS

for searching the Internet and other reference sources

Pulmonary system

Respiratory system

Singultus

Are Hiccups Dangerous?

Most hiccups are not harmful. The frequency of most hiccups is usually from 4 to 60 hiccups a minute. Hiccups usually occur in people (even

babies and fetuses) for a minute or two and then pass. There are, however, cases of prolonged hiccuping that can be dangerous, especially for people who are ill from other causes and who may become exhausted if they do not seek medical treatment.

What Is Your Home Cure for Hiccups?

Everyone seems to have a special way to stop hiccups even though none of these remedies has been proved to work consistently. Here are some of the most common home cures:

Holding ones breath and then exhaling very slowly

  • Holding the nose
  • Breathing into a paper bag
  • Sucking on ice cubes
  • Sucking on hard candy
  • Drinking water from the far side of a glass
  • Gargling
  • Pulling on the tongue
  • Biting on a lemon
  • Swallowing granulated sugar
  • Swallowing hard crusts of bread
  • Sneezing
  • Peeling onions
  • Bending over so that the head is lower than the chest
  • Surprising or frightening the person with hiccups
  • Slapping the person with hiccups on the back

What Are the Different Types of Hiccups?

Hiccups are classified into several categories. A hiccup bout can last from several seconds to several days. A persistent hiccup is one that lasts for several days or weeks. Hiccups lasting more than a month are called intractable. In rare cases, intractable hiccups may continue for years.

What Is the Treatment for Hiccups?

Everyone seems to have a favorite cure for hiccups, but usually they just go away by themselves. In severe cases of hiccups, doctors may try to block the hiccup process (also called the hiccup arc or pathway) by stimulating parts of the respiratory (breathing) system or by prescribing medications to relax the muscles involved. When all else fails, surgery is done to block the nerve signals from the phrenic (FREN-ik) nerve to the diaphragm. The purpose of this procedure is to paralyze part of the diaphragm.

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hiccup

hiccup (hik-up) n. abrupt involuntary lowering of the diaphragm and closure of the sound-producing folds at the upper end of the trachea, producing a characteristic sound as the breath is drawn in. Hiccups, which usually occur repeatedly, may be caused by indigestion or more serious disorders, such as alcoholism. Medical name: singultus.

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hiccough

hiccough sb. and vb. XVI. imit.; early forms hickop, hi(c)kup, which superseded earlier †hicket, †hickock. The form hiccough (XVII) is due to assim. to cough, but the pronunc. has not been affected.

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hiccup

hiccupcup, grown-up, pup, scup, straight-up, stuck-up, summing-up, sup, totting-up, tup, two-up, up, washing-up •pick-me-up • fry-up • wind-up •round-up • hold-up • backup • markup •check-up •break-up, make-up, shake-up, take-up •teacup •hiccup, pickup, stick-up •link-up •cock-up, lock-up •walk-up •hook-up, lookup •buttercup • snarl-up • pile-up •pull-up • warm-up • clean-up • pin-up •line-up • grown-up •run-up, sun-up, ton-up •turn-up • hang-up • slap-up • zip-up •top-up • chirrup • press-up • piss-up •toss-up •nosh-up, wash-up •punch-up • start-up •let-up, set-up •sit-up • cut-up • rave-up

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