What is the differential diagnosis for a patient presenting with two weeks of persistent hiccups (singultus)?

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Differential Diagnosis for 2 Weeks of Hiccups

Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is often considered the most common cause of persistent hiccups, as stomach acid can irritate the nerves that control breathing, leading to hiccup spasms.

Other Likely Diagnoses

  • Gastritis or esophagitis: Inflammation of the stomach or esophagus can irritate the nerves and cause hiccups.
  • Laryngitis or pharyngitis: Inflammation of the larynx or pharynx can affect the nerves controlling the diaphragm, leading to hiccups.
  • Pneumonia or other respiratory infections: Infections in the lungs can irritate the nerves and cause hiccups.
  • Stress or anxiety: Emotional stress can stimulate the nerves that control breathing, leading to hiccups.

Do Not Miss Diagnoses

  • Pneumothorax: A collapsed lung can put pressure on the nerves and cause hiccups. This is a medical emergency that requires immediate attention.
  • Myocardial infarction: In some cases, hiccups can be a symptom of a heart attack, especially in women.
  • Stroke or brain tumor: Rarely, hiccups can be a symptom of a stroke or brain tumor that affects the brain's breathing centers.
  • Medication side effect: Certain medications, such as anesthetics, steroids, or benzodiazepines, can cause hiccups as a side effect.

Rare Diagnoses

  • Multiple sclerosis: This autoimmune disease can affect the nerves that control breathing, leading to hiccups.
  • Sarcoidosis: This inflammatory disease can affect the nerves and cause hiccups.
  • Hyponatremia: Low sodium levels in the blood can affect the nerves and cause hiccups.
  • Intra-abdominal or intrathoracic malignancies: Rarely, hiccups can be a symptom of a tumor in the abdomen or chest that puts pressure on the nerves.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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