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 where English uses "to be hungry" ("hungry" being an adjective), Dutch, French, and Spanish use "honger hebben", "avoir faim", and "tener hambre" respectively (literally "to have hunger", the words for "hunger" being nouns). Similarly, where Hebrew uses the adjective זקוק "zaqūq" (roughly "in need of"), English uses the verb "to need". In languages which have adjectives as a word class, they are usually an open class; that is, it is relatively common for new adjectives to be formed via such processes as derivation. However, Bantu languages are well known for having only a small closed class of adjectives, and new