TTP is a blood disorder and can lead to microangipathic hemolytic anemia (MAHA), neurologic abnormalities, fever, and renal disease. Pharmacology
Gemcitabine is hydrophilic and must be transported into cells via molecular transporters for nucleosides (the most common transporters for gemcitabine are SLC29A1 SLC28A1, and SLC28A3). After entering the cell, gemcitabine is first modified by attaching a phosphate to it, and so it becomes gemcitabine monophosphate (dFdCMP). This is the rate-determining step that is catalyzed by the enzyme deoxycytidine kinase (DCK). Two more phosphates are added by other enzymes. After the attachment of the three phosphates gemcitabine is finally pharmacologically active as gemcitabine triphosphate (dFdCTP). After being thrice phosphorylated, gemcitabine can masquerade as deoxycytidine triphosphate and is incorporated into new DNA strands being synthesized as the cell replicates.When gemcitabine is incorporated into DNA it allows a native, or normal, nucleoside base to be added next to it. This leads to "masked chain termination" because gemcitabine is a "faulty" base, but due to its neighboring native nucleoside it eludes the cells normal repair system (base-excision repair). Thus, incorporation of gemcitabine into the cells DNA creates an irreparable error that leads to inhibition of further DNA synthesis, and thereby leading to cell death.The form of gemcitabine with two phosphates attached (dFdCDP) also has activity; it inhibits the enzyme ribonucleotide reductase (RNR), which is needed to create new DNA nucleotides. The lack of nucleotides drives the cell to uptake more of the components it needs to make nucleotides from outside the cell, which also increases uptake of gemcitabine.
A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to haematogenous spread through the portal vein. It can also develop as a complication of a liver injury. Causes
Risk factors for developing liver abscess can be due to infection, post-procedural infection and metastasis such as primary liver tumours, liver metastasis, biliary procedures, biliary injuries, biliary tract disease, appendicitis, and diverticulitis.Major bacterial causes of liver abscess include the following:
Streptococcus species (including Enterococcus)
Escherichia species
Staphylococcus species
Klebsiella species (Higher rates in the Far East)
Anaerobes (including Bacteroides species)
Pseudomonas species
Proteus species
Entamoeba HistolyticaHowever, as noted above, many cases are polymicrobial. Diagnosis
Types
There are several major forms of liver abscess, classified by cause:
Pyogenic liver abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States. Amoebic liver abscess due to Entamoeba histolytica accounts for 10% of cases. The incidence is much higher in developing countries. Fungal abscess, most often due to Candida species, accounts for less than 10% of cases. Iatrogenic abscess, caused by medical interventions

Management
Antibiotics: IV metronidazole and third generation cephalosporin/quinolones, β-lactam antibiotics, and aminoglycosides are effective. Prognosis
The prognosis has improved for liver abscesses. The mortality rate in-hospital is about 2.5-19%. The elderly, ICU admissions, shock, cancer, fungal infections, cirrhosis, chronic kidney disease, acute respiratory failure, severe disease, or disease of biliary origin have a worse prognosis. References
External links

Liver Abscess CT Images CTCases Liver Abscess CT Scan.