The GI System

Haematological abnormalities such as a raised WBC may result from compromised bowel due to DIOS or intussusception, as well as from appendicitis or C diff colitis. Haemoglobin levels may reflect anaemia of chronic disease, nutritional iron deficiency, and chronic upper GI loss or can indicate acute severe blood loss in haematemesis.

Biochemical assays such as liver function tests can be useful in determining whether symptoms are attributable to cholelithiasis, although alkaline phosphatase and GGT are often elevated in patients with CF because of intrinsic liver disease. Amylase or lipase may also be elevated in pancreatitis. Hypokalaemia and hypomagnesaemia are commonly found due to chronic aminoglycoside use. Serum glucose may be elevated as diabetes can present with progressive infections.

Abdominal x-rays can show loaded bowel consistent with constipation. A colon distended with granular or bubbly/foamy contents in the right iliac fossa is seen in DIOS.  Dilatation of the ileum with air fluid levels and an empty distal colon is sometimes seen.

Ultrasound scans of the abdomen are useful in investigating upper abdominal pain in CF patients due to the high incidence of biliary tract disease. Ultrasound can also demonstrate an obstructing mass in DIOS, and identify intussusception.

CT scan of the abdomen can be useful when there is diagnostic uncertainty.

Learning Bite

CF is one of a few conditions where plain abdominal x-rays are recommended for evaluation of abdominal pain.