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 phrase: The following trees illustrate the structure of head-medial adjective phrases: Adjective phrase An adjective phrase (or adjectival phrase) is a phrase the head word of which is an adjective, e.g. "fond of steak", "very happy", "quite upset about it", etc. The adjective can initiate the phrase (e.g. "fond of steak"), conclude the phrase (e.g. "very happy"), or appear in a medial position (e.g. "quite upset about it"). The dependents of the head adjective—i.e. the other words and phrases inside the adjective phrase—are typically adverb or prepositional phrases, but they can also be clauses (e.g. "louder than you are"). Adjectives