Hepatic encephalopathy An imbalance between aromatic amino acids (phenylalanine, tryptophan and tyrosine) and branched-chain amino acids (leucine, isoleucine and valine) has been described; this would lead to the generation of false neurotransmitters (such octopamine and 2-hydroxyphenethylamine). Dysregulation of the serotonin system, too, has been reported. Depletion of zinc and accumulation of manganese may play a role. Inflammation elsewhere in the body may precipitate encephalopathy through the action of cytokines and bacterial lipopolysaccharide on astrocytes. The diagnosis of hepatic encephalopathy can only be made in the presence of confirmed liver disease (types A and C) or a portosystemic shunt (type B), as its
Adjective in context. Determiners generally do this by indicating definiteness (as in "a" vs. "the"), quantity (as in "one" vs. "some" vs. "many"), or another such property. An adjective acts as the head of an "adjective phrase" or "adjectival phrase" (AP). In the simplest case, an adjective phrase consists solely of the adjective; more complex adjective phrases may contain one or more adverbs modifying the adjective (""very" strong"), or one or more complements (such as "worth "several dollars"", "full "of toys"", or "eager "to please""). In English, attributive adjective phrases that include complements typically follow the noun that they qualify ("an