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
Collateral adjective Collateral adjective A collateral adjective is an adjective that is identified with a particular noun in meaning, but that is not derived from that noun. For example, the word "bovine" is considered the adjectival equivalent of the noun "cow", but it is derived from a different word, which happens to be the Latin word for "cow". Similarly, "lunar" serves as an adjective to describe attributes of the Moon; "moon" comes from Old English "mōna" "moon" and "lunar" from Latin "luna" "moon". The adjective "thermal" and the noun "heat" have a similar semantic relationship. As in these examples, the collateral adjective