GI Flashcards
You are treating a 5 year old boy for constipation. In addition to disimpaction, his mother asks you how long he will need to be treated with PEG for?
a. 3 months
b. 6 months
c. Until he’s toilet trained
d. 3 weeks
6 months
47) 2 ½ year old boy in for routine check-up. Mom mentions he has had 2 episodes of rectal prolapse, reduced in the ER, in the last 6 months. You should:
a. reassure
b. treat for constipation
c. check for CF
—————
Girl with rectal prolapse x 2 reduced easily in the ER. What do you do?
a. reassure mom
b. observe and follow in 3 months
c. sweat chloride
d. barium enema
Check for CF, sweat chloride
- Baby with delayed meconium passage, abdo distension and calcifications on AXR
a. Hirschsprung’s
b. CF
c. Duodenal atresia
CF
Intra-abdo calcification = meconium peritonitis
Meconium ileus
- 10% of CF have MI
- 90% of MI have CF
- Dx with contrast enema
- What is most useful intervention in treating encopresis?
a. pharmacologic
b. behavioural
c. pharmacologic and behavioural
d. biofeedback
Pharmacologic + behavioural
Encopresis = voluntary/involuntary passage of feces into inappropriate places at least 1X/mo for 3 mo once developmental age of 4yo
- What is the most likely cause of childhood functional abdominal pain?
a. Mild inflammation
b. Lack of lactose digestion
c. Slow motility with increased visceral pain response
Slow motility with increased visceral pain response
- A 3 week old baby presents with poor feeding and poor weight gain. He is jaundiced and has hepatosplenomegaly. His bilirubin is 170 with conjugated 115. Which imaging would you do next?
a. Abdominal ultrasound with dopplers
b. HIDA scan
c. CT abdomen
d. MRI abdomen
- —————
8) A neonate has an elevated conjugated bilirubin. What is your next step in management?
a. Liver biopsy
b. Abdominal ultrasound with Doppler
c. HIDA scan
d. Repeat liver enzymes in 2 months
- —————-
83) . 4 week baby presents with poor feeding and poor weight gain. He is jaundiced and has hepatosplenomegaly. His bilirubin is 150 with conjugated 100. Which imaging test would you do next?
a. U/S with dopplers
b. MRI
c. CT abdomen
d. Dis HIDA scan / Nuclear med biliary excretion scan
AUS
Cholestasis (conjugated bili) always pathologic
Intrahepatic (damage to liver cells or structure that secrete bile)
- Infectious: TORCH, UTI, sepsis
- Hepatitis: neonatal idiopathic , viral, bacterial
- Metabolic/genetic: CF, Alagille, alpha-1 antitrypsin deficiency, galactosemia, tyrosinemia, hypothyroidism, PFIC
- TPN-related
- Hemochromatosis
- Idiopathic
- intrahepatic bile duct or pacuity
Extrahepatic (mechanical obstruction of bile flow)
- biliary atresia
- choledochal cyst
- sclerosing cholangitis
- inspissated bile (bile/mucous plug)
AUS can detect biliary tree and other anatomical abnormalities
- triangular cord sign suggests biliary atresia
HIDA is SN but not SP for biliary atresia. Need to wait 5d for this procedure.
- 1 month old with normal physical but total bilirubin 280 and direct 200. Hemoglobin 98 and MCV 95. Most likely cause?
a. breast feeding jaundice
b. haemolytic
c. neonatal hepatitis
d. galactosemia
——————
Baby with bili of 280 and conjugated 200? What is the most likely cause based on incidence?
a. Breastfeeding jaundice
b. Hemolysis ABO
c. Neonatal hepatitis
d. Galactosemia
Neonatal hepatitis
Galactosemia: also conjugated, but less common than neonatal hepatitis and in unwell infants
- 3 week old infant has jaundice. His birth weight was 3250g and he now weighs 3490g. He is breastfeeding well. Hemoglobin is 127 and total bilirubin is 270, conjugated bilirubin is 8. Coombs test is negative. What should be done?
a. Admit for phototherapy
b. Referral to gastroenterology
c. Reassess in 1 week
d. Recommend switching from breastfeeding to formula
Reassess in 1 wk
Unconjugated hyperbilirubinemia
Likely breastmilk jaundice
- Presence of glucuronidase in breast milk
- Presents after first 3-5d, peak within 2wks
- may last for 3-12wks
Feeding + gaining wt well, bili below need for phototherapy, no conjugated bili, negative Coombs, normal Hgb
DDx for unconjugated hyperbili
A. Increased RBC breakdown
1. isoimmunization: ABO, Rh, minor blood group incompatabilities
2. RBC enzyme defects: G6PD, pyruvate kinase deficiency
3. RBC structural abN: hereditary spherocytosis, elliptocytosis
4. Infection: sepsis, UTI
5. Sequestered blood: cephalohematoma, bruising, ICH
6. Polycythemia
7. IDM
B. Decreased hepatic uptake + conjugation of bili
- Immature glucuronyl transferase activity in all newborns
- Breastmilk jaundice (glucoronidase in breastmilk)
- Crigler Najjar Syndrome (low/absent UGT1A1, which catalyzes conjugation of bili with glucuronic acid)
- Gilbert syndrome (mutation in promoter region of UGT1A1 gene)
- Hypothyroidism
- Pyloric stenosis
C. Increased enterohepatic reabsorption
- Breast feeding jaundice (dehydration)
- Bowel obstruction
- NPO
- A 13 year old girl with intermittent cough and early morning throat pain. She also has shortness of breath with exertion. Parents comment that she has had bad breath. What would you do?
a. Upper GI
b. abdominal U/S
c. CXR
d. pH probe
—————
50). A 13 year old girl with intermittent cough and early morning throat pain. Parents comment that she has had bad breath. What would you do?
a. upper GI
b. abdominal U/S
c. CXR
d. pH probe
—————
Bad breath, cobblestoning in pharynx, wheeze. What is the best test?
a. pH probe
b. upper GI series
c. gastroscopy
————- - 7 year old with sore throat in the mornings, bad breath, chronic cough with abdominal pain for 2 weeks. Her cough is worse with activity. What test will give you the diagnosis?
a. Throat swab
b. Pulmonary function tests with methacholine challenge
c. pH probe
d. Upper GI series
pH probe
By NASPHAGN 2018 guidelines for child with suspected GERD (progress down steps if doesn’t improve)
- Assess for alarm signs
- LIfestyle + dietary education
- Acid suppression x4-8wk
- Refer to GI
- Endoscopy
- Ph-MII or pH-metry
UGI
- Can look at anatomical issues
- Can’t differentiate GER + GERD
- Can’t determine severity
Multichannel intraluminal impedance
- Can Dx GERD
- Can assess esophageal fxn
- Can determine non-acid reflux
- a 14 year old boy has epigastric pain, dysphagia with solids and weight loss. He is scoped and diagnosed with eosinophilic esophagitis. What management would you recommend?
a. Referral to Allergy for skin testing to identify potential allergens
b. PPI
c. Oral fluticasone
d. Oral prednisone
What is EoE?
Oral fluticasone
EoE (Consensus 2011)
Dx criteria
1) clinical Sx of esophageal dysfunction: feeding aversion/intolerance, vomiting/regurg, GERD refractory to medical mgmt + surgery, food/FB impaction, epigastric abdo pain, dysphagia, FTT
2) >=15 eosinophils in 1 hpf
3) Exclusion of other possible causes of esophageal eosinophilia (incl’g PPI-responsive esophageal eosinophilia)
IVx
- Dx requires upper endoscopy + Bx
- Furrowed, ring-like, multiple white plaques, strictures, crepe paper mucosa
(None are pathognomonic)
- eosinophilia
- total IgE at Dx + each endoscopic evaluation
- Ingestion of food has been assoc’d with EoE
- food-specific IgE level testing not supported
- consider skin-prick testing for foods + environmental allergens
- atopy patch testing may be promising
Tx
- PPI as therapy (for reflux assoc’d with EoE) + r/o PPI-REE
- short course of PO + topical .l,(swallowed fluticasone or budesonide) C/S (for emergent problems like dysphagia, dehydration, wt loss due to swallowing problems)
- dietary restriction (specific food, 6 food elimination diet, amino acid based formula)
- Esophageal dilatation in symptomatic ps with esophageal narrowing secondary to fixed strictures causing food impaction
- Evaluate for aeroallergen sensitivity
- Note: LTRA + cromolyn sodium not supported b/c no benefit or risk
14) 8 year old boy with gastroesophageal reflux for the last 4 years, now having dysphagia on solids. Which of the following tests would reveal the diagnosis?
a. UGI
b. Upper scope + biopsy
c. Abdominal ultrasound
d. AXR
What are complications of GERD?
Upper scope + biopsy
Look for strictures from GERD and r/o EoE
- Esophageal
- esophagitis
- strictures
- Barrett esophagus
- adenocarcinoma - FTT
- Respiratory Sx
- Apnea + stridor
- Dental erosions
- A 13 month old boy has a diaper rash and diarrhea for the last few months, since his parents have been introducing new foods. Which of the following is correct?
a. do skin testing and RAST
b. Carbohydrate intolerance is common at this age
c. He is now sensitized to cow’s milk protein
Do skin testing and RAST
CMP is leading cause of food allergy in infants + young children <3yo
Lactose intolerance: loss of lactase activity after 3-5yo. Congenital lactase deficiency is extremely rare
19) A 6 year old boy has recurrent vomiting episodes where he need to come to the ER and receive IV fluids. He is completely fine in between these episodes. What is the most likely diagnosis
a. cyclic vomiting
b. malrotation
Cyclic vomiting
ALL
- > =2 periods of intense, unremitting nausea + paroxysmal vomiting within 6mo. Last hours to days
- Stereotypical pattern of episodes in each pt
- Episodes separated by wks to mo with return to baseline health between episodes
- After appropriate medical evaluation, Sx cannot be attributed to another condition
4). 12 year-old teen presents to your office and tells you she would like to begin a vegan diet. What is the best advice you can give her today:
a. Vitamin B12
b. Iron
c. Consult a dietitian or nutritionist
D. calcium supplements
Consult a dietitian or nutritionist
- 2 year old girl, picky eater. (long stem about how she is otherwise healthy but doesn’t like to eat certain foods). Has not gained any weight in the last few months. Has always been trending on the same percentile. What do you advise parents?
a. Offer a variety of accepted foods and allow child to choose what to eat
b. Offer multiple snacks throughout the day
c. Let the child pick whatever they want
Offer a variety of accepted foods + allow child to choose what to eat
Physiologic decrease in appetite between 2-5yo to match slower rate of growth
AT meals, give 1 Tbsp of each food per year fo child’s age.
- What is the recommended vitamin D supplementation for a 6 month old baby living above the 55th latitude during winter months?
a. 200 international units
b. 400 international units
c. 600 international units
d. 800 international units
What are the CPS recommendations for vit D
A) supplementation
B) what is the goal + optimal vit D level
C) what is the mechanism
D) What are the risk of vit D deficiency?
800 units
A. Supplementation
- 400 units daily in breastfed infants until diet has adequate vit D
- 800 units daily if above 55th latitude during winter months
- 1L of formula/dairy milk/fortified rice + soy beverages contain 400units of Vit D3
- 2000 units daily in pregnant + lactating women, esp in winter months
B. Goal + optimal level
- goal is to provide enough Vit D for adequate Ca absorption from gut + minimize PTH secretion but avoid hypercalcemia
- optimal 25(OH)D level is 75-225nmol/L
C. Mechanism
- Vit D3 = skin of animals. Vit D2 = plant origin
- metabolized by 25-hydroxylation in liver to 25(OH)D [inactive, stable, most abundant circulating form]
- then 1-hydroxylation in kidney to 1,25 (OH)2D [active, unstable]
D. Deficiency
- Hypocalcemia + rickets
- osteoporosis
- dental malformations + caries
- SGA
- liked to asthma, autoimmune disease, disturbed muscle function, resistance to TB, pahtogenesis of specific cancer
- 7 wk old baby boy who cries 5h per day and has colic, reflux with feeds; parents try soy milk, baby gets diarrhea; what do you recommend?
a. Try 2 wks of hypoallergenic milk
b. Give PPI
c. Try probiotics
d. Try lactose free something
What is the definition of infant colic?
What can you try?
What are NOT recommended?
Try 2 wks of hypoallergenic milk
CPS statement
Infant colic
In infants birth to 4mo, ALL of:
1. Paroxysms of irritability, fussing or crying that starts or stops without cause
2. Episodes lasting >=3h/d + occur >=3d/wk for at least 1wk
3. No FTT
Consider trying hypoallergic diet in BF mother
OR hydrolyzed formulas if formula fed (Alimentum, Nutramigen)
If suspect CMPA
- eliminate cow’s milk in BF mother
OR extensively hydrolyzed formula if formula fed (Nutramigen, Alimentum)
Note: completely hydrolyzed formula = amino acid based = Puramino + Neocate
NOT RECOMMENDED
- partially hydrolyzed (Gentlease) b/c not hypoallergenic
- soy formula (only use in galactosemia or religious reasons)
- lactose-free formula
- lactase
- probiotic
6) Baby with G-tube that looks like this: (This was the exact photo on the exam)
a. Reassure
b. Silver nitrate cautery
c. Topic ABx
d. Fungal abx cream
Err on side of silver nitrate cautery
Granulation usually occurs in first 2-3mo after G-tube insertion
- Mild cases: do nothing (ensure Gtube secured, area is dry, observe)
- NS or hypertonic saline dressings 3-4X/d until improved
- Topical 1% HC cream x3-4d
- Silver nitrate cautery if large granulation tissue. Put Vaseline to surrounding healthy skin to prevent injury.
8. A 7 month old baby is switched from breastmilk to formula and solids. He develops diarrhea, eczema and an erythematous rash around his orifices (mouth and anus). What is the most likely nutrient he’s deficient in? A. Calcium B. Zinc C. Protein D. Vitamin ----------------- 9) A 7 month old boy presents with failure to thrive, diarrhea, and a severe eczematous rash around his mouth and perineum. He was previously breastfed, but was switched to an appropriate combination of formula and pureed solids. Which laboratory investigation would be most important in order to make the diagnosis? 1) Immunoglobulins 2) Zinc level 3) Vitamin A level 4) Electrolytes
Zinc Deficiency
- decreased growth
- dermatitis of extremities + around orifices
- poor wound healing
- diarrhea
- hypogonadism, infertility
- impaired immunity
Causes
- TPN, chronic malabsorption, burns, CF, chronic renal disease, liver disease, Crohn’s disease
Acrodermatitis enteropathica
- rare AR disorder
- inability to absrob sufficient zinc from diet
- Initial SSx in first few mo of life, often after weaning from breast milk to cow’s milk
- Vesciulobullous, eczematous, dry, scaly. Symmetrically distributed. perioral, acral, perineal areas. Cheeks, knees, elbows.
- Reddish tint hair, alopecia.
Low plasma zinc Low ALP (zinc dependent)
Tx:
PO elemental zinc 3mg/kg/d. Monitor Q3-6mo
10. 8yo male. Duodenal ulcer. What is treatment? (Note: none of them listed a PPI) A. amox + clarithro B. clinda + clarithro C. metronidazole + clinda D. bismuth subsalicylate + metronidazole ------------ 38. Kid with peptic ulcer. His treatment would likely include a. amoxil +clarithro b. clinda and clarithro c. flagyl and ????
Amox + clarithro + PPI!
H pylori is a PACman making ulcers. P = PPI, A = amox, C = clarithro
H pylori prefers triple therapy
Amox + clarithro + PPI
OR amox + flagyl + PPI
OR clarithro + flagyl + PPI
PUD can be managed with PPI or H2RA
- 15 year old with h. pylori. You should treat with:
a. h2 blocker
b. amox, clarithro and proton pump inhibitor
c. clarithro and h2 blocker
d. amox and proton pump inhibitor
————
Treatment of H. pylori is likely to consist of which combination:
a. amoxicillin + clarithromycin
b. bismuth salts + Abx
c. clarithryomycin + Abx
Amox + clarithro + PPI
H pylori is a PACman making ulcers. P = PPI, A = amox, C = clarithro
H pylori prefers triple therapy
Amox + clarithro + PPI
OR amox + flagyl + PPI
OR clarithro + flagyl + PPI
PUD can be managed with PPI or H2RA
- 15 year old with h. pylori. You should treat with:
a. h2 blocker
b. amox, clarithro and proton pump inhibitor
c. clarithro and h2 blocker
d. amox and proton pump inhibitor
————
Treatment of H. pylori is likely to consist of which combination:
a. amoxicillin + clarithromycin
b. bismuth salts + Abx
c. clarithryomycin + Abx
Amox + clarithro + PPI
H pylori is a PACman making ulcers. P = PPI, A = amox, C = clarithro
H pylori prefers triple therapy
Amox + clarithro + PPI
OR amox + flagyl + PPI
OR clarithro + flagyl + PPI
PUD can be managed with PPI or H2RA
- GI. 3 week old blood mixed with stool, has been having since 2 weeks old,
normal exam, growing/thriving, formula fed
A. Anal fissure
B. Cow’s milk allergy
C. Meckel’s
CMPA
- presents at 2-8wk
- resolves by 6-18mo
- loose BM with occult or gross blood mixed
Anal fissure
- idiopathic in <1yo or passing hard BM w constipation
Meckel's - intermittent painless rectal bleeding - brick or currant jelly coloured - Rule of 2s: 2% of population <2yo 2:1 M (Meckel's):F 2 ft proximal to ileocecal valve 2 inch long 2 types of tissue (gastric + pancreatic) Dx: Meckel scan with Tc99
- 1 mo old baby with blood in his stool. Cause?
a. Anal fissure
b. Cows milk allergy
c. Colitis
d. Mat blood
————–
2 week old baby, well, with stool and blood mixed within. Cause?
a. cow milk protein allergy
b. anal fissure -
c. gastroenteritis
Cow’s milk allergy
Likely FPIAP b/c no FTT
- 3 week old with loose stools and red blood intermixed with the stools, no FTT. What is it?
a) Anal Fissure
b) CMPA
CMPA
Likely FRIAP b/c no FTT
- A 2 yo is in the ER with bright red rectal bleeding. He is pale-looking but otherwise well. He does not appear to be in any discomfort. On rectal exam, you find blood mixed with stool on your glove. Hemoglobin is normal. What is the most likely diagnosis?
a. ulcerative colitis
b. Meckel’s diverticulum
c. Anal fissures
Meckel’s diverticulum
Rule of 2s
- 2% of population
- <2yo
- 2:1 (M = Meckel’s: F)
- 2 ft proximal to ileocecal
- 2 in length
- 2 types of tissues (pancreatic or gastric)
Most common congenital anomaly of GI tract
Incomplete obliteration of omphalomesenteric duct
Lined with ectopic mucosa
Painless rectal bleeding
Brick coloured or red-currant jelly stools
Dx: Meckel’s scan with 99Tc (taken up by ectopic mucosa)
Tx: surgical diverticulectomy
- 15yo boy presents with severe epigastric pain that worsens after eating. He has had a few episodes of non-bilious emesis. On exam he is tachycardic and has epigastric tenderness, but is otherwise stable. Blood work reveals a lipase of 1650, wbc 12.5, and normal plt, hb, lytes, renal function and ALT. What is the next best step in management?
a. NPO and IV fluids
b. Surgical consult
c. Ceftriaxone
d. IV pantoprazole
NPO + IV fluids
As per NASPHAGN
A. Fluid resuscitation
- NS/RL bolus if needed + 1.5-2X maintenance
- monitor Cr, BUN, u/o for adequate fluid resusc + AKI
B. Pain mgmt
- NSAIDs + tylenol
- IV morphine/opioids
C. Nutrition
- consider early (within 48-72H of presentation) PO/enteral feeds to decrease LOS + risk of GI dysfunction
- If contraindication to gut use for >5-7d (ileus, abdo compartment syndrome), then parenteral nutrition
D. ABx
- Not recommended empirically
- only if documented infected necrosis
E. ERCP
- indicated for choledocholithiasis causing biliary pancreatitis + pancreatic duct issues (stones, leaks)
F. Surgery
- cholecystectomy before D/C if mild uncomplicated acute biliary pancreatitis
- if acute necrotic collections (even if infected), delay or avoid surgery >4wks (better outcomes)
- if drainage or necrosectomy is necessary, use endoscopic (EUS , ERCP-assisted) or percutaneous over open surgical methods
G. F/U
- close F/U to monitor for complications + recurrence
Not recommended
- antiproteases
- antioxidants
- probiotics
- EGD (endoscopy)
- EUS
- What is the most specific test for pancreatitis:
a. Amylase
b. Lipase
c. Abdo U/S
d. Abdo CT scan
e. AXR
Lipase
Dx of acute pancreatitis requires at least 2 of
- abdo pain consistent with acute pancreatitis
- Lipase or amylase 3X ULN
- imaging findings consistent with acute pancreatitis
- 1st line AUS
- CT/MRI if more complicated
1) Mother uses marijuana for chronic pain. Breastfeeding. What do you tell her about the risks to the baby:
a) continue breastfeeding. Benefits of breastfeeding outweigh risk of marijuana
b) marijuana is contraindicated due to risks on the developing brain
c) recent studies on the legal use of marijuana found no risk
d) Counsel to stop using marijuana. Risks to baby unknown.
e) Call CAS
Counsel to stop using marijuana. Risks to baby unknown
THC absorbed in GI tract + lungs.
Highly lipophilic. Rapidly distributed to brain + fat tissue.
Metabolized by liver
Excreted in urine + feces.
Can be detected for up to 1mo after last use.
Theoretically can affect brain development.
- A mother who just gave birth to a newborn was taking propanolol and fluoxetine during her pregnancy. She now wishes to breastfeed the child. What would be your recommendation?
a. This is compatible with breastfeeding
b. Change the propanolol to another drug
c. Stop taking fluoxetine
What are the CPS recommendations for SSRI in pregnancy + breastfeeding?
Compatible with BF
SSRI (CPS statement)
- adequate Tx of depression in pregnancy is v important
- typically minimal SE in exposed infants
- unlikely congenital malformations in utero
- SSRI neonatal behavioural syndrome (CNS, resp, GI) in 10-30% exposed in late gestation. Present in first few hrs, resolve within 2wks
- observe babies with late TM SSRI exposure for min 48H
- other possible neonatal effects: early GA, low BW, resp distress, PPHN
- compatible with BF
BB
- excreted in small quanitities, so compatible with BF
2) 12 year-old teen presents to your office and tells you she would like to begin a vegan diet. What is the best advice you can give her today:
a. Vitamin B12
b. Iron
c. Consult a dietitician or nutritionist
d. Calcium supplements
Consult a dietician or nutritionist
- Vegan infant, about 1 year old. Diet included two eggs per week, green leafy vegetables, soy milk. What are they deficient in?
a. Vitamin B12
b. Nothing
Vit B12
Not getting 3 servings/d
Need at least 3 servings of food rich in vit B12 in daily diet or supplement of 5-10 mcg/d
Sources of vit B12: fortified soy formula, soy/nut beverages, cereals, yeasts
- A 13-month-old child on a vegetarian diet is at risk for which deficiency:
a. vitamin C
b. calcium
c. folate
d. zinc
e. iron
Iron
- ## Vegan mother breastfeeding 1 mo old, what would you supplement baby
- A vegan mother (on no supplements) is breastfeeding her baby, and wants to know what kind of supplements should be recommended:
a. Vitamin D
b. Vitamin B12
c. Iron
d. Vit C
—————
A mother who maintains a strictly vegan diet presents with her one month old baby who is exclusively breastfed. What supplementation do you recommend?
a. vitamin D
b. vitamin B12
————————————– - Breastfed 7 month old babe of a vegan mom. Thriving. What do you supplement baby with? (no vitamin D option)
a. Vitamin B12
b. Folic acid
c. calcium
d. iron
————–
Breastfeeding vegan mother. Nutritional deficiency:
a. folate
b. iron
c. B12
——————————- - Vegan mother with infant. Mother is not on any supplements. What should be recommended for the baby? (The question does NOT tell you if she is breastfeeding!)
a. Vit D
b. Iron
c. Vit B12
d. Vit C
Vit B12
Though Vit D also important
- A 6-month-old child of a vegan mother is at risk for which deficiency:
a. vitamin A
b. vitamin B12
c. vitamin C
d. vitamin K
e. folate
Vit B12
- What is the best test to look for vitamin D deficiency?
a. Serum calcium
b. Serum 25-OH-Vitamin D
c. Serum 1-25-OH Vitamin D
d. PTH
Serum 25 OH Vit D
25 D is an abnormal bra size, must measure this!
Vit D3 = animal skin, Vit D2 = plant form
- metabolized by 25-hydroxylation in liver to 25(OH)D [inactive, stable, most abundant circulating form]
- then by 1-hydroxylation in kidney to 1, 25 (OH)2D [active, unstable]
5) Who should not receive soy formula due to its phytoestrogen content?
a. Baby with galactosemia
b. Baby whose family is vegan
c. Baby with congenital hypothyroidism
What are the CPS recommendations for
A) NO soy (3)
B) Consider soy (2)
Baby with congenital hypothyroidism
CPS statement
A. Do not use soy formulas for
1. congenital hypothyroidism (b/c can inhibit thyroid peroxidase, lowering free T4)
2. premature infants (may not promote adequate growth)
3. Non-IgE mediated CMPA (high risk of coincident soy allergy, which is lower in true IgE mediated CMPA)
B. Save soy formula for
- infants with galactosemia or
- who cannot consume dairy for cultural/religious reasons
- Phytoestrogens have theoretical risk of mimicking estradiol (animal studies showing infertility, sex organ dvlpt, brain maturation, immune system, cancer dvlpt issues)
- no proven risk
11 What indications is it appropriate to offer Soy milk?
a) Vegan family
b) Fructose deficiency
c) CMPA
Vegan family
Soy milk may have high levels of fructose
- Phytoestrogens in soy contraindicated for:
a. all males
b. immune deficiency
c. galactosemia
d. congenital hypothyroidism
————–
In which of the following is soy formula not suggested secondary to increased phytoestrogen?
a. congenital hypothyroidism
b. galactosemia
c. males
Congenital hypothyroidism
