Changes

*the catabolic metabolism of glutamine as an energy source by small intestinal enterocytes.

*the catabolic metabolism of glutamine as an energy source by small intestinal enterocytes.

*endogenous hepatic protein metabolism by excess dietary protein intake, breakdown of lean body mass and gastrointestinal bleeding.

*endogenous hepatic protein metabolism by excess dietary protein intake, breakdown of lean body mass and gastrointestinal bleeding.

==Diagnosis==

==Diagnosis==

Confirmation of a [[Portosystemic Shunt]] requires visualisation of the shunting blood vessel.  This may be done with either ultrasonography or contrast portography or at surgery.

Confirmation of a [[Portosystemic Shunt]] requires visualisation of the shunting blood vessel.  This may be done with either ultrasonography or contrast portography or at surgery.

==Treatment==

==Treatment==

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.

**The aim is to provide adequate nutrients and energy to support hepatic tissue [[Liver General Pathology - Pathology#Fibrosis - Repair|repair]], reduce the metabolic load on the liver and minimise the development of hepatic encephalopathy

**The aim is to provide adequate nutrients and energy to support hepatic tissue [[Liver General Pathology - Pathology#Fibrosis - Repair|repair]], reduce the metabolic load on the liver and minimise the development of hepatic encephalopathy

==Prognosis==

==Prognosis==