Enterohepatic circulation: bacteria release urease to break down urea to produce ammonia

Intestinal bacteria release amino acid oxidase to break down amino acids to produce ammonia

Digestive capacity is reduced and protein is retained in the intestines

Intestinal bacteria are active and the production of amino acid oxidase and urease is increased.

In advanced liver cirrhosis combined with renal dysfunction, urea diffused into the intestine increases

Liver dysfunction combined with alkali respiration or the application of carbonic anhydrase inhibitors will reduce the production of NH4 and increase the diffusion of NH3 into the blood.

Before coma in patients with hepatic encephalopathy, muscle adenylate catabolism is enhanced and ammonia production is increased.