Examination of hepatic jugular venous reflux sign. The patient is asked to take a flat position with the head elevated and the provider presses the patient’s liver with his hand to observe if the patient has filling of the jugular veins on both sides. This test is usually done to see if the patient has right heart failure, and if the patient then has right heart failure the liver should be enlarged. When the enlarged liver is pressed, the filling of the jugular vein will be more obvious and this condition is called the reflux sign of the hepatic jugular vein. This is called the hepatic jugular reflux sign. It is usually positive in cases of right heart failure and right heart insufficiency. If the patient does not have right heart failure and the liver is not enlarged, the test will be negative for hepatic jugular reflux.