Abdominojugular test
Encyclopedia
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 artery pressure
and thus is a marker for right heart dysfunction.
) or over the center of the abdomen 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 perform a Valsalva
maneuver .
On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a 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 4 cm or more or a fall of 4 cm or more after the examiner releases pressure. The AJR has a reported sensitivity of 24% to 72% and a 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.
Pressure
Pressure is the force per unit area applied in a direction perpendicular to the surface of an object. Gauge pressure is the pressure relative to the local atmospheric or ambient pressure.- Definition :...
(JVP) through the distension or swelling of the internal jugular vein
Internal jugular vein
The two internal jugular veins collect the blood from the brain, the superficial parts of the face, and the neck.-Path:On both sides and at the base of the brain, the inferior petrosal sinus and the sigmoid sinus join to form the internal jugular vein...
. A positive AJR best correlates with the pulmonary artery pressure
Pulmonary artery pressure
Pulmonary artery pressure is a measure of the blood pressure found in the pulmonary artery. Mean pulmonary arterial pressure is normally 9 - 18 mmHg.It is usually higher than the pulmonary wedge pressure....
and thus is a marker for right heart dysfunction.
Procedure
The doctor presses firmly over either the right upper quadrant of the abdomen (i.e., over the liverLiver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
) or over the center of the abdomen for 10–60 seconds with a pressure of 20 to 35 mm Hg while observing the internal jugular vein
Internal jugular vein
The two internal jugular veins collect the blood from the brain, the superficial parts of the face, and the neck.-Path:On both sides and at the base of the brain, the inferior petrosal sinus and the sigmoid sinus join to form the internal jugular vein...
in the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
and also observing to be sure the patient does not perform a Valsalva
Valsalva maneuver
The Valsalva maneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut...
maneuver .
On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a heartbeat
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
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
Budd-Chiari syndrome
In medicine , Budd–Chiari syndrome is the clinical picture caused by occlusion of the hepatic veins. It presents with the classical triad of abdominal pain, ascites and hepatomegaly. Examples of occlusion include thrombosis of hepatic veins. The syndrome can be fulminant, acute, chronic, or...
.
A positive result is variously defined as either a sustained rise in the JVP of at least 4 cm or more or a fall of 4 cm or more after the examiner releases pressure. The AJR has a reported sensitivity of 24% to 72% and a 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.