skip to main content

Hiccups from Gastric Distension in MBO — SCE Palliative Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGI SymptomsHiccups from Gastric Distension in MBOSCE Palliative Medicine

A 68‑year‑old woman with advanced ovarian cancer and malignant bowel obstruction (MBO) has been managed conservatively with symptom control via a CSCI. She develops severe new‑onset hiccups. What is the most likely mechanism in this context?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Gastric distension causing diaphragmatic irritation (via vagal and phrenic pathways); management should include gastric decompression plus a hiccup‑specific agent such as chlorpromazine

In palliative care guidelines (GMMMG), gastric stasis and distension is identified as the most common cause of hiccups in advanced disease. In the setting of MBO, retained gastric content can distend the stomach, irritating the diaphragm via vagal and phrenic nerve pathways. This pathophysiology supports mechanical decompression (e.g., NG tube or venting gastrostomy) combined with pharmacotherapy. NICE‑aligned UK resources (NHS) support chlorpromazine as a licensed agent for persistent hiccups when no clear cause is identified. Distractors A and B ignore the direct link between MBO and hiccups; D misattributes cause to morphine rather than mechanical irritation; E incorrectly states hiccups are always self‑limiting — contrary to guidelines that recommend active treatment when they are distressing.

Reference: Palliative Care Pain & Symptom Control Guidelines for Adults (GMMMG), 2020; NHS hiccups information, 2023