View source for Abdominojugular test

The '''abdominojugular test''' (AJR), also known as '''hepatojugular reflex''' or '''reflux''', is used as an alternate test for measuring [[jugular venous]] [[pressure]] (JVP) through the distension or swelling of the [[internal jugular vein]].  A positive AJR best correlates with the [[pulmonary capillary wedge pressure]] although it also correlates with the right heart pressure and the left heart ejection fraction <ref name="pmid3415106">{{cite journal |author=Ewy G |title=The abdominojugular test: technique and hemodynamic correlates |journal=Ann Intern Med |volume=109 |issue=6 |pages=456–60 |year=1988 |pmid=3415106}}</ref>.

==Procedure==
The doctor presses firmly over either the [[Right upper quadrant (abdomen)|Right Upper Quadrant]] (over the [[liver]]) or over the center of the abdomen <ref name="pmid3415106"/> for 10-60 seconds with a pressure of 20 to 35 mm Hg while observing the [[internal jugular vein]] in the [[neck]] and also observing to be sure the patient does not [[Valsalva maneuver|Valsalva]] <ref name="pmid8594245">{{cite journal |author=Cook D, Simel D |title=The Rational Clinical Examination. Does this patient have abnormal central venous pressure? |journal=JAMA |volume=275 |issue=8 |pages=630–4 |year=1996 |pmid=8594245 |doi=10.1001/jama.275.8.630}}</ref>.

The [[internal jugular vein]] can be distinguished from the [[carotid artery]] by:
# having a [[Venous waveform#JVP waveform|biphasic waveform]]
# falling pressure during inspiration
# rising with abdominal pressure,
# increasing and decreasing with lowering and elevation of the head of the bed, respectively, and
# being compressible with direct pressure <ref name="pmid8594245"/>.

When the meniscus of the internal jugular vein cannot be determined, one study found the height of the meniscus in the external jugular vein correlated with the right atrial pressure <ref name="pmid4698149">{{cite journal |author=Stoelting R |title=Evaluation of [[External jugular vein|external jugular venous]] pressure as a reflection of right atrial pressure |journal=Anesthesiology |volume=38 |issue=3 |pages=291–4 |year=1973 |pmid=4698149 |doi=10.1097/00000542-197303000-00020}}</ref>. <gallery>Image:Gray558.png</gallery>

* On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a [[Heart rate|heartbeat]] or two, before returning to normal. This ''negative result'' would be indicated by a lack of swelling of the jugular vein. Negative hepatojugular reflux is seen in [[Budd-Chiari syndrome]].
* A ''positive result'' is variously defined as either a sustained rise in the JVP of at least 4cm or more <ref name="pmid8594245"/> or a fall of 4 cm or more <ref name="pmid3415106"/> after the examiner releases pressure. The AJR has a reported [[sensitivity (tests)|sensitivity]] of 24% <ref name="pmid2182296">{{cite journal |author=Marantz P, Kaplan M, Alderman M |title=Clinical diagnosis of congestive heart failure in patients with acute dyspnea |journal=Chest |volume=97 |issue=4 |pages=776–81 |year=1990 |pmid=2182296 |doi=10.1378/chest.97.4.776}}</ref> to 72% <ref name="pmid3415106"/> and a [[specificity (tests)|specificity]] of 96% to 93%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room.

==References==
{{Reflist}}

{{Physical exam}}
[[Category:Medical tests]]
[[Category:Medical signs]]

[[fr:Reflux hépato-jugulaire]]
[[es:Reflujo hepatoyugular]]
[[Category:2Fix]]