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 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"