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
Postpositive adjective Postpositive adjective A postpositive or postnominal adjective is an attributive adjective that is placed after the noun or pronoun that it modifies. This contrasts with prepositive adjectives, which come before the noun or pronoun. In some languages the postpositive placement of adjectives is the normal syntax, but in English it is less usual, largely confined to archaic and poetic uses (as in "They heard wights unseen), phrases loaned from Romance languages or Latin (such as "heir apparent, "aqua regia"), and certain particular grammatical constructions (as in "those anxious to leave"). Recognizing postpositive adjectives in English is important for determining the