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an abnormal backward flow of body fluids

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/04/08 16:57:44」(JST)

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The abdominojugular test (AJR), also known as hepatojugular 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 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

^ ^a ^b ^c ^d Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Ann Intern Med 109 (6): 456–60. PMID 3415106.
^ ^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.

UpToDate Contents

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1. 頚静脈波の検討 examination of the jugular venous pulse
2. うっ血肝 congestive hepatopathy
3. 石綿肺症 asbestosis
4. 心不全が疑われる患者の評価 evaluation of the patient with suspected heart failure
5. 救急外来における胸痛を有する成人の評価 evaluation of the adult with chest pain in the emergency department

English Journal

Assessing for hepatojugular reflux.

Pullen RL Jr.SourceAmarillo College, Amarillo, TX, USA.
Nursing.Nursing.2006 Feb;36(2):28.
PMID 16462243

Emergency diagnosis of congestive heart failure: impact of signs and symptoms.

Mueller C, Frana B, Rodriguez D, Laule-Kilian K, Perruchoud AP.SourceUniversity of Basel, University Hospital, Department of Internal Medicine, Basel, Switzerland. chmueller@uhbs.ch
The Canadian journal of cardiology.Can J Cardiol.2005 Sep;21(11):921-4.
BACKGROUND: The most useful features in the diagnosis of congestive heart failure (CHF) have been poorly investigated.OBJECTIVE: To determine the utility of signs and symptoms in the diagnosis of CHF in the emergency department.METHODS: Detailed clinical data were collected prospectively from 452 co
PMID 16239975