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In an elderly male patient with alcohol-related liver disease,who developed episodic confusion and tremor,we found a large extrahepatic portacaval shunt.He had no clinical or laboratory evidence of liver dysfunction except for an elevated serum ammonia level that increased further in response to an ammonium chloride challenge test.Extrahepatic portacaval shunting causing episodic confusion and tremor may occur with alcohol liver disease without overt liver failure and may require abdominal angiography or a transhepatic portogram to demonstrate the shunt. |
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