HICCUPS

From Big Medical Encyclopedia

HICCUPS (Latin. singultus) — the involuntary, usually in the same way repeating short and intensive breath at the closed or sharply narrowed glottis caused by sudden clonic reduction of a diaphragm (at simultaneous reduction of muscles of a throat), most often the central genesis or in connection with irritation of a phrenic nerve. Each act And. is followed by tolchkoobrazny protrusion of a stomach and a characteristic inspiratory sound (if the glottis is not completely closed).

And. can be a symptom of very various diseases and occasionally as manifestation of passing functional frustration is observed at healthy faces during the use dry and firm beggars, during the overcooling, after alcohol intake, and sometimes and for no apparent reason.

The pathogeny

the Pathogeny at different diseases is not completely identical, but is always connected with carrying out patol. impulses in motive fibers of a phrenic nerve. The last are a part of an efferent link of a difficult reflex arc with «center» And. in cervical department of a spinal cord (at the level of III — the IV segments) and the afferent part presented by the sensitive terminations and fibers of the phrenic and wandering nerves and also partially chest part of a sympathetic trunk between VII and XII segments. V. V. Mikheyev (1969) considers lawful idea of vertical creation of «center» And., the structure to-rogo, except neurons of front horns of the IV cervical segment of a spinal cord, joins lateral departments of a myelencephalon with the reticular formation located here, deep subcrustal formations and some sites of a cerebral cortex.

Depending on the level of defeat of the described reflex arc allocate the main pathogenetic options I.: the central, peripheral and so-called reflected I.

Tsentralnaya I. arises at damages of a head or spinal cord, at their tumors, at encephalitis, meningitis, hematencephalons, injuries of a skull. The option epid, encephalitis is known, at Krom And. is the leading symptom. Treats central also psychogenic And. at asthenic and hysterical neurosises.

And. a peripheral origin it is most often connected with involvement in patol, process of a phrenic nerve and its branchings. It is observed at a mediastinitis, tumors of a mediastinum and lungs, neuritis of a phrenic nerve, its prelum by an aortic aneurysm, hems, at phrenic pleurisy, at defeats of a diaphragm, defeats and irritations (at surgeries) the peritoneum covering bodies, close to a diaphragm. At diseases of a stomach and gall bladder without involvement in patol, process of a peritoneum And. it can be caused by irritation of branches of a vagus nerve.

Call reflected And., edges it is observed at pathology of the bodies located far from zones of an innervation of a phrenic nerve. Such And. happens sometimes at helminthoses, a lambliasis, at patol, processes in a uterus, appendages and at other diseases.

In a separate form allocate toxic And., in an origin a cut both the central, and peripheral disturbances connected with intoxication, e.g. can play a role. And. at diabetes, uraemia, heavy infectious intoxication, and also agonal by I. Intoksikation it is caused as well., connected using an anesthesia at surgeries.

Diagnostic value I. it is small since it is not a symptom, pathognomonic for any disease. At the same time registration of this symptom in special epid, a situation or in specific a wedge, situations (e.g., during anesthesia ) can define timely recognition of a serious illness or complications. Diagnostic value I. increases in the analysis of reasons for its emergence (food, emotions, cooling and so forth), its durations, and also communication with other possible symptoms of a disease.

And., observed at almost healthy faces, usually short, has incidental character and very seldom is the cause for the address to the doctor. Patol. And. differs in a frequent recurrence, duration (from several hours to many months, even years), quite often exhausting action on the patient changing his mental status. The last circumstance demands careful nevrol. and somatic inspection of patients with persistent And. even when changes of mentality allow to assume hysteria («hysterical behavior», low development of the personality, the increased suggestibility, superstitiousness and so forth).

Treatment

Incidental And. does not demand treatment; it passes independently, is often stopped by two-three drinks of water or several deep breaths.

At long And., if the diagnosis of a disease is not established yet or causal treatment in general is impossible, symptomatic therapy is applied. For the purpose of stopping And. make irritation of some reflexogenic zones; manual pressing on eyeballs or between legs of a grudinoklyuchichno-mastoidal muscle on both sides, intranasal introduction of a catheter on depth of 10 — 12 cm. In some cases effectively intravenous administration of 10 ml of 10% of solution of calcium chloride. Expressed though sometimes bilateral cervical vagosympathetic novocainic blockade according to Vishnevsky gives temporary effect.

At central and especially psychogenic And. sedatives (bromides, a valerian), tranquilizers (diazepam), neuroleptics are shown (aminazine in or on 1 — 2 ml of 2,5% of solution intramusculary, etaperazin but 0,002 — 0,008 g 3 — 4 times a day). There can be reasonable also hypnotherapy.

At especially persistent And. appoint enemas from Chlorali hydras, carry sometimes out a roentgenotherapy on a neck and an anticardium.

And., arising during surgery, it is stopped in some cases by transfer of the patient in the provision of Trendelenburga and removal from under a back of the raising roller. If these measures are insufficient, to the patient enter additional doses of muscle relaxants or block novocaine an abdominal brain.


Bibliography: Acupuncture, under the editorship of V. G. Vogralik, page 104, Gorky, 1974; P l and in and N with to and y A. A. O reflex reductions of a diaphragm during an anesthesia, Klin, hir., No. 12, page 72, 1964; Pomosov D. V. Cervical vagosympathetic blockade at an unrestrained hiccups, Klin, medical, t. 37, No. 2, page 97, 1959.

A. L. Grebenev.

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