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
Scotch (adjective) ma Scotch blue bell." Scotch (adjective) Scotch is an adjective meaning "of Scotland". The modern usage in Scotland is Scottish or Scots, and the word "Scotch" is only applied to specific products, mostly food or drink, such as Scotch whisky, Scotch pie, Scotch broth, and Scotch eggs. "Scotch" applied to people is widely considered pejorative in Scotland, reflecting old Anglo-Scottish antagonisms, but it is still occasionally used in England and Ireland, though the usage is considered old-fashioned. The verb "to scotch" is unrelated to the adjective. It derives from Anglo-French "escocher" meaning "to notch, nick", from "coche", "a notch, groove",