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
Nominalized adjective "headwind" is then assumed. The third type is known as the "permanent" adjectival noun and has an adjective that stands alone as a noun. Such adjectives have become nouns over time, and most speakers are aware of their implicit adjectival meaning. Nominalized adjectives occur frequently in both Classical Arabic and Modern Standard Arabic. An example would be "things (that are) Islamic", which is derived from the adjective "Islamic" in the inanimate plural inflection. Another example would be "the big one" (said of a person or thing of masculine gender), from "big" inflected in the masculine singular. Nominalized adjective A nominalized