The abdominojugular test, also known as abdominojugular reflux (AJR), is a physical examination test useful in diagnosing

right ventricle A ventricle is one of two large chambers toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium, an adjacent chamber in the uppe ...

dysfunction, particularly

right ventricular failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, an ...

. AJR is a test for measuring

jugular venous pressure The jugular venous pressure (JVP, sometimes referred to as ''jugular venous pulse'') is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different for ...

(JVP) through the distention of the internal jugular vein. A positive AJR test correlates with the

pulmonary artery pressure A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and t ...

and thus is a marker for right heart dysfunction, specifically

. ''Reflux'' in this context means backup of the circulatory system and is not to be confused with

reflex In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous response to a stimulus. Reflexes are found with varying levels of complexity in organisms with a nervous system. A reflex occurs ...

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Procedure

The patient is asked to lie down at 30 degrees with his/her head tilted 45 degrees to the left. Then an oblique light is used to illuminate the jugular region of the neck to help in identifying the internal jugular vein. Care must be taken not to confuse it with the external jugular, whose beating is more easily seen under the skin due to it being more superficial. In patients with severe right heart congestion, observation of the internal jugular might not be feasible due to its distention all the way into the upper neck and skull. The clinician presses firmly over either the

right upper quadrant The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other ...

of the abdomen (i.e., over the liver) or over the center of the abdomen for 10 seconds with a pressure of 20 to 35 mm Hg while observing the swelling of the internal jugular vein in the

neck The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...

and also observing to be sure the patient does not perform a

Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air out as if blowing up a balloon. Variations of the maneuver can ...

. 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 abdominojugular reflux is seen in Budd-Chiari syndrome. A ''positive result'' is variously defined as either a sustained rise in the JVP of at least 3 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 93% to 96%. 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 department.

References

{{DEFAULTSORT:Abdominojugular Test Physical examination Medical signs Cardiology