Hepatic encephalopathy treatment may benefit people with hepatic encephalopathy. LOLA lowers ammonia levels by increasing the generation of urea through the urea cycle, a metabolic pathway that removes ammonia by turning it into the neutral substance urea. LOLA may be combined with lactulose and/or rifaximin if these alone are ineffective at controlling symptoms. In those with cirrhosis, the risk of developing hepatic encephalopathy is 20% per year, and at any time about 30–45% of people with cirrhosis exhibit evidence of overt encephalopathy. The prevalence of minimal hepatic encephalopathy detectable on formal neuropsychological testing is 60–80%; this increases the likelihood of developing overt
Proper adjective Proper adjective In English orthography, the term proper adjective is sometimes applied to adjectives that take initial capital letters, and the term common adjective to those that do not. For example, a person from Boston is Bostonian. "Bostonian" is a proper adjective. These terms are used informally only; they are not used by grammarians or linguists. The term "proper noun" denotes a noun that, grammatically speaking, identifies a specific unique entity; for example, "England" is a proper noun, because it is a name for a specific country, whereas "dog" is not a proper noun; it is, rather, a "common noun"