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 phrase An attributive adjective (phrase) precedes the noun of a noun phrase (e.g. "a very happy" man). A predicative adjective (phrase) follows a linking verb and serves to describe the preceding subject, e.g. "The man is very happy". The adjective phrases are underlined in the following example sentences. The head adjective in each of these phrases is in bold, and how the adjective phrase is functioning—attributively or predicatively—is stated to the right of each example: The distinguishing characteristic of an attributive adjective phrase is that it appears inside the noun phrase that it modifies. An interesting trait of these phrases in