Hiccups
Hiccups (hiccoughs) are the characteristic sounds produced by the involuntary contractions of the diaphragm terminated by sudden closure of the glottis. In the majority, it is a self-limiting condition. The most common cause of hiccups is thought to be gastric distension after rapid ingestion of food, fluid or air. The causes of intractable hiccups are listed below.
History
The causes of hiccups predominantly originate in the respiratory, abdominal and nervous systems, therefore the history is structured similarly.
Respiratory history
The presence of cough with purulent sputum production implies respiratory tract infection. However, patients with pneumonia tend to be more unwell and may complain of rigors with high temperatures. Following pneumonia or thoracic surgery, chronic pyrexia and pleuritic chest pains with failure of resolution of symptoms of the original infection may herald the onset of an empyema. Hiccups may (rarely) complicate routine thoracic surgery. When a chronic cough is associated with haemoptysis and weight loss in a smoker, bronchial tumour is the most likely diagnosis.
