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*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.
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==Diagnosis==
 
==Diagnosis==
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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.
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==Treatment==
 
==Treatment==
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*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
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==Prognosis==
 
==Prognosis==
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