[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) › Hepatojugular (abdominojugular) reflux [Clinical exam](https://durgical.com/en/clinical-exam/) · [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) # Hepatojugular (abdominojugular) reflux - Maneuver Pressing the abdomen gently and steadily and watching whether the neck vein rises and stays up shows whether the right heart can take more blood. Updated 2026-11-01 **See it in 3D:** [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) · [Liver](https://durgical.com/en/anatomy/liver/) · [Inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) · [Right atrium](https://durgical.com/en/anatomy/right-atrium/) · [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) ## Key points - Sustained abdominal pressure for about 10–15 seconds with the patient breathing normally. - Positive = sustained jugular rise of about 3 cm or more. - Means the right heart cannot accommodate the volume: heart failure, constriction. - Straining gives false positives. ## What it is It is a volume challenge for the right heart. Abdominal pressure pushes blood toward the right atrium; a healthy heart handles it within a few beats, a failing one does not. It helps confirm heart failure when the resting jugular pressure is equivocal. ## The anatomy it tests - Abdominal compression shifts blood from the splanchnic bed and the liver through the inferior vena cava into the right atrium and ventricle. - A well-functioning right ventricle raises its output and the jugular returns to baseline within a few beats. - If the right ventricle cannot take the load, or left-sided filling pressures are high, the jugular column rises and stays up. ## How to do it - Patient lying with the head of the bed at 30–45 degrees, as for jugular pressure, and the top of the pulsation identified. - Explain the maneuver and ask the patient to breathe normally, without straining or holding the breath. - Place the palm on the middle of the abdomen (periumbilical or right upper quadrant) and press firmly and steadily for about 10 to 15 seconds. - Watch the jugular throughout the compression and on release. - Record how many centimeters it rises and whether the rise is sustained while pressure is held. ## What a positive result means - Positive: a sustained rise in jugular pressure of about 3 cm or more during compression, falling abruptly on release. - Suggests heart failure (right-sided or with high left filling pressures), constrictive pericarditis, restrictive cardiomyopathy or tricuspid regurgitation. - A brief rise that returns to baseline within a few beats is normal. - A negative test does not exclude compensated or treated heart failure. ## Usefulness and limits - False positive if the patient strains (Valsalva) or the pressure is painful. - Avoid in a tender abdomen or suspected abdominal aortic aneurysm. - Interpret with the resting jugular pressure, edema, crackles and natriuretic peptides. ## Test yourself Think of the answer, then tap the question to see it. ## When is hepatojugular reflux considered positive? When jugular pressure rises about 3 cm or more and stays up for as long as abdominal compression lasts, then falls on release. ## Why is the patient asked not to strain during the maneuver? Valsalva raises intrathoracic and jugular pressure regardless of ventricular function and gives a false positive. ## Which vein carries abdominal blood to the right atrium during the maneuver? The inferior vena cava, which receives blood from the liver and the splanchnic bed. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/hepatojugular-reflux/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Internal jugular vein](https://durgical.com/en/anatomy/internal-jugular-vein/) - [Liver](https://durgical.com/en/anatomy/liver/) - [Inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) - [Right atrium](https://durgical.com/en/anatomy/right-atrium/) - [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) ## Related - [Jugular venous pressure and the venous pulse](https://durgical.com/en/clinical-exam/jugular-venous-pressure-and-the-venous-pulse/) - [Heart failure syndrome: left- and right-sided signs](https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) - [Edema: pitting, grading and distribution](https://durgical.com/en/clinical-exam/edema-pitting-grading-and-distribution/) ## Related conditions - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Constrictive pericarditis](https://durgical.com/en/conditions/constrictive-pericarditis/) - [Restrictive cardiomyopathy (amyloid, sarcoid, haemochromatosis)](https://durgical.com/en/conditions/restrictive-cardiomyopathy/) - [Pulmonary hypertension and cor pulmonale](https://durgical.com/en/conditions/pulmonary-hypertension-and-cor-pulmonale/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Heart failure: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000158.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax](https://openstax.org/books/clinical-nursing-skills/pages/24-3-nursing-assessment) (OpenStax (Rice University), 2024); [Mitral valve regurgitation: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000176.htm) (MedlinePlus, U.S. National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/hepatojugular-reflux/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/hepatojugular-reflux/