Why look for JVP in an abdominal exam?

Looking for a raised jugular venous pressure is normally reserved for cardiac and respiratory examinations. A raised JVP is a sign of venous hypertension and most commonly manifests in the context of heart failure when the right side of the heart is unable to cope with venous return from the systemic circulation. The subsequent back-up manifests in a visible internal jugular vein.

However, it is also worth looking for an elevated JVP in an abdominal exam for both common and rare causes:

  1. Portopulmonary hypertension. This is the simultaneous co-existance of high blood pressure in both the portal circulation and the pulmonary circulation. It is a complication of liver cirrhosis and occurs in up to 4% of cirrhotic patients.
  2. Carcinoid of the gastrointestinal tract. This is caused by neuroendocrine tumours arising from enterochromaffin cells of luminal epithelia throughout the gut
  3. Congestive hepatopathy. Also called cardiac cirrhosis, this is deranged liver function in the setting of right heart failure. Increased pressure in the hepatic veins (secondary to right heart failure) causes necrosis of the liver lobules. This post’s image demonstrates the congested and fibrotic change that occurs histologically in congestive hepatopathy.