You are treating a 43-year-old woman who complains that her stools have recently acquired a foul smell and have an oily consistency. Ultrasonic examination reveals no apparent abnormalities in the gallbladder or pancreas. Biopsy of the main pancreatic duct also shows no overt pathology. Analysis of pancreatic juice isolated during the biopsy would most likely show a reduction or loss in the presence of which of the following enzymes, accounting for the change in stool in this patient?

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Quizplus · Accepted Answer

The oily and foul-smelling stools suggest steatorrhea, which is often due to fat malabsorption. Lipase is the enzyme responsible for breaking down fats, and a deficiency or reduction in lipase would lead to the symptoms described.  Pancreatic lipase is the primary lipase that hydrolyzes dietary triglycerides in the small intestines. The action of alkaline pancreatic juice results in inhibition of the activity of the acid lipases (lingual and gastric) that begin the process of triglyceride hydrolysis in the stomach. Loss of pancreatic lipase secretion would, therefore, result in incomplete digestion of dietary fats preventing their absorption and leading to increased fat content of the stools.

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