Differential Diagnosis for Intractable Hiccups
Intractable hiccups are hiccups that last for more than 48 hours and can be caused by a variety of factors. Here are some differentials for intractable hiccups, categorized for clarity:
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This is often considered the most likely diagnosis because GERD is a common condition that can irritate the nerves that control breathing, leading to hiccups. The stomach acid can flow up into the esophagus and stimulate the nerves, causing hiccups.
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 also irritate the nerves and cause hiccups.
- Pneumonia or other lung infections: Infections in the lungs can cause irritation of the nerves that control breathing, leading to hiccups.
- Stroke or other central nervous system disorders: Certain conditions that affect the brain or nervous system can cause abnormal breathing patterns, including hiccups.
Do Not Miss Diagnoses
- Myocardial infarction (heart attack): Although less common, hiccups can be a symptom of a heart attack, especially in women. It's essential to consider this diagnosis to avoid missing a life-threatening condition.
- Pancreatitis: Inflammation of the pancreas can cause abdominal pain and hiccups, and it requires prompt medical attention.
- Pneumothorax: A collapsed lung can cause hiccups, among other symptoms, and requires immediate medical attention.
Rare Diagnoses
- Neurosyphilis: A rare condition caused by syphilis infection of the nervous system, which can cause hiccups among other symptoms.
- Multiple sclerosis: A chronic condition that affects the central nervous system and can cause a range of symptoms, including hiccups.
- Medullary thyroid cancer: A rare type of thyroid cancer that can cause hiccups due to compression of the nerves in the neck.
- Intrapulmonary shunt: A rare condition where there is an abnormal connection between the pulmonary arteries and veins, which can cause hiccups among other symptoms.