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Abe M, Soga T, Obana N, Seiji K, Tabata M, Saito N, Arita R, Numata T, Tanaka J, Kuroda H, Takayama S, Kagaya Y, Ishii T. Recommendation of Repeated Ammonia Tests for Intrahepatic Portal-Systemic Shunt Without Cirrhosis in Elderly Patients With Psychiatric Symptoms. JAPANESE CLINICAL MEDICINE 2017; 8:1179066017693597. [PMID: 28469525 PMCID: PMC5398300 DOI: 10.1177/1179066017693597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/20/2017] [Indexed: 12/02/2022]
Abstract
We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. The contrast computed tomography of the abdomen revealed a congenital type of IPSSwoC. As blood ammonia levels are inconstant, repeated blood tests are recommended when this disease is suspected in elderly patients with psychiatric symptoms.
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Affiliation(s)
- Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Temma Soga
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.,Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan
| | - Nobuya Obana
- Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
| | - Kazumasa Seiji
- Department of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masao Tabata
- Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan
| | - Natsumi Saito
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Ryutaro Arita
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Takehiro Numata
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Junichi Tanaka
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Hitoshi Kuroda
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin Takayama
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yutaka Kagaya
- Office of Medical Education, Tohoku University School of Medicine, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
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