Abdominojugular test
{{short description|Physical examination test useful in diagnosing right ventricle dysfunction}}
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| name = Abdominojugular test
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| synonyms = Abdominojugular reflux, hepatojugular reflux
| purpose = Diagnosis of right ventricle dysfunction
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The abdominojugular test, also known as abdominojugular reflux (AJR), is a physical examination test useful in diagnosing right ventricle dysfunction, particularly right ventricular failure.{{cite journal|pmid=10936479 |title=The abdominojugular reflux sign.|last=Wiese |first=J. |journal=American Journal of Medicine |date=July 2000 |volume=109 |issue=1|pages=59–61|doi=10.1016/s0002-9343(00)00443-5}}
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,{{cite journal |author =Ewy G |title=The abdominojugular test: technique and hemodynamic correlates |journal=Annals of Internal Medicine |volume=109 |issue=6 |pages=456–60 |year=1988 |pmid=3415106 |doi=10.7326/0003-4819-109-6-456}} specifically right ventricular failure.
Reflux in this context means backup of the circulatory system and is not to be confused with reflex.{{Citation |author=Elsevier |authorlink=Elsevier |title=Dorland's Illustrated Medical Dictionary |publisher=Elsevier |url=http://dorlands.com/ |postscript=.}}
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Procedure
The clinician 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 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.{{cite journal |vauthors =Cook D, Simel D |title=The Rational Clinical Examination. Does this patient have abnormal central venous pressure? |journal=JAMA |volume=275 |issue=8 |pages=630–4 |year=1996 |pmid=8594245 |doi=10.1001/jama.1996.03530320054034 }}
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% {{cite journal |vauthors =Marantz P, Kaplan M, Alderman M |title=Clinical diagnosis of congestive heart failure in patients with acute dyspnea |journal=Chest |volume=97 |issue=4 |pages=776–81 |year=1990 |pmid=2182296 |doi=10.1378/chest.97.4.776}} 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
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