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Abdominojugular test

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					Abdominojugular test
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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. [1]

Procedure
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 [1] 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. [2]
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 [2] or a fall of 4 cm or
more [1] after the examiner releases pressure. The AJR has a reported sensitivity of 24% [3] to 72% [1] 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.

References
   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,
                                           HEENT
                                                     Rinne)

                                                     Lungs: Respiratory sounds
                                      Respiratory
                                                     Other: Cyanosis · Clubbing

                                                     Heart: Precordium (Heart sounds, Apex beat)
                        PE
                                  Cardiovascular     Other: Jugular venous pressure · Abdominojugular test · Carotid bruit · Peripheral vascular
  Admission           (incl.
                                                     (Ankle brachial pressure index)
                  intimate)
                                                      Digestive    Liver span · Rectal · Murphy's sign · Bowel sounds
                                       Abdominal
                                                        Urinary    Murphy's punch sign

                                            Pelvis   Cervical motion tenderness

                                                     Back (Straight leg raise) · Knee (McMurray test) · Hip · Wrist (Tinel sign, Phalen maneuver) ·
                                Extremities/Joint
                                                     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

                                                               Medical privacy



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posted:9/14/2012
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