The abdominojugular test, also known as abdominojugular reflux (AJR), is a physical examination test useful in diagnosing right ventricle dysfunction, particularly right ventricular failure.[1]
| Abdominojugular test | |
|---|---|
| Synonyms | Abdominojugular reflux, hepatojugular reflux |
| Purpose | Diagnosis of right ventricle dysfunction |
AJR is a test for measuring jugular venous pressure (JVP) through the distention of the internal jugular vein. A positive AJR test correlates with the pulmonary artery pressure and thus is a marker for right heart dysfunction,[2] specifically right ventricular failure.[1]
Reflux in this context means backup of the circulatory system and is not to be confused with reflex.[3]
Procedure
editThe clinician presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen [2] for 10 seconds with a pressure of 20 to 35 mm Hg while observing the swelling of the internal jugular vein in the neck and also observing to be sure the patient does not perform a Valsalva maneuver.[4]
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 [4] or a fall of 4 cm or more [2] after the examiner releases pressure. The AJR has a reported sensitivity of 24% [5] to 72% [2] 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
edit- ^ a b Wiese, J. (July 2000). "The abdominojugular reflux sign". American Journal of Medicine. 109 (1): 59–61. doi:10.1016/s0002-9343(00)00443-5. PMID 10936479.
- ^ a b c d Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Annals of Internal Medicine. 109 (6): 456–60. doi:10.7326/0003-4819-109-6-456. PMID 3415106.
- ^ Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
- ^ 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.
- ^ 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.