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 Nominalized adjective A nominalized adjective is an adjective that has undergone nominalization, and is thus used as a noun. For example, in "the rich and the poor", the adjectives "rich" and "poor" function as nouns denoting people who are rich and poor respectively. The most common appearance of the nominalized adjective in English is when an adjective is used to indicate a collective group. This happens in the case where a phrase such as "the poor people" becomes "the poor". The adjective "poor" is nominalized, and the noun "people" disappears. Other adjectives commonly used in this way include "rich", "wealthy",