The operation that precipitates portosystemic encephalopathy is

Portosystemic encephalopathy is a neuropsychiatric syndrome, It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with portosystemic shunting. In portosystemic shunting, absorbed products that would otherwise be detoxified by the liver enter the systemic circulation and reach the brain, causing toxicity, particularly to the cerebral cortex.