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
Adjective phrase English is that an attributive adjective alone generally precedes the noun, e.g. "a proud man", whereas a head-initial or head-medial adjective phrase follows its noun, e.g. "a man proud of his children". A predicative adjective (phrase), in contrast, appears outside of the noun phrase that it describes, usually after a linking verb, e.g. "The man is proud of his children". There is a tendency to call a phrase an "adjectival phrase" when that phrase is functioning like an adjective phrase, but is not actually headed by an adjective. For example, in "Mr Clinton is a man of wealth", the prepositional