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 number and nominative case. "Den Alten" is a similar inflection but in the accusative case. The nominalized adjective is derived from the adjective "alt" and surfaces as it does by taking the appropriate inflection. Like in English, adjectival nouns are used as a plural definite ("the unemployed") and with nationality words ("the Swedish"). However, Swedish does not require "one or ones" with count nouns ("The old cat is slower than the new (one)"). The use of inflection, which incorporates the number and the gender of the noun, allows Swedish to avoid the need for a visible noun to describe a