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
Proper adjective adjectives. In general, an adjective is capitalized if its meaning is "pertaining to "X"", where "X" is some specific person, place, language, or organized group. Most capitalized adjectives are derived from proper nouns; for example, the proper adjective "American" is derived from the proper noun "America". Sometimes, an adjective is capitalized because it designates an ethnic group with a shared culture, heritage, or ancestry. This usage asserts the existence of a unified group with common goals. For example, in Canadian government documents, "Native" and "Aboriginal" are capitalized. An adjective can lose its capitalization when it takes on new meanings, such