From Wikipedia, the free 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. 
The doctor presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) 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
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 room.
1. ^ a b c d Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Ann Intern Med 109 (6): 456–60.
PMID 3415106 .
2. ^ a b Cook D, Simel D (1996). "The Rational Clinical Examination. Does this patient have abnormal central venous pressure?".
JAMA 275 (8): 630–4. doi:10.1001/jama.1996.03530320054034 . PMID 8594245 .
3. ^ Marantz P, Kaplan M, Alderman M (1990). "Clinical diagnosis of congestive heart failure in patients with acute dyspnea". Chest 97
(4): 776–81. doi:10.1378/chest.97.4.776 . PMID 2182296 .
V · T· E· Medical records and physical exam
History CC · HPI (OPQRST) · ROS · Allergies/Medications · PMH/PSH/FH/SH
(SAMPLE) Psychiatric history
General/IPPA Inspection · Auscultation · Palpation · Percussion
Vital signs T · HR · BP · RR
Oral mucosa · TM · Eyes (Ophthalmoscopy, Swinging-flashlight test) · Hearing (Weber,
Lungs: Respiratory sounds
Other: Cyanosis · Clubbing
Heart: Precordium (Heart sounds, Apex beat)
Cardiovascular Other: Jugular venous pressure · Abdominojugular test · Carotid bruit · Peripheral vascular
(Ankle brachial pressure index)
Digestive Liver span · Rectal · Murphy's sign · Bowel sounds
Urinary Murphy's punch sign
Pelvis Cervical motion tenderness
Back (Straight leg raise) · Knee (McMurray test) · Hip · Wrist (Tinel sign, Phalen maneuver) ·
Shoulder (Adson's sign) · GALS screen
Neuro Mental state (MMSE) · Cranial nerve examination
Neonatal Apgar score · Ballard Maturational Assessment
L/I Labs (Electrolytes, ABG, LFT) · Medical imaging (EKG, CXR, CT, MRI)
A/P Medical diagnosis · Differential diagnosis
Progress SOAP note
via Abdominojugular test