A 2-year-old boy is brought to the physician because of for poor weight gain. He eats 3 meals and has 3 to 4 bowel movements daily with bulky stools that float. He had recurrent episodes of sinusitis in infancy. Both parents are healthy and have no similar symptoms. He is at the 15th percentile for height and 5th percentile for weight. Examination shows pale conjunctivae. A few scattered expiratory crackles are heard in the thorax. There is abdominal distention. Which of the following is most likely present in this patient?

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Eductional Objective: Pancreatic insufficiency is common in cystic fibrosis because thick, viscous secretions in the pancreas block digestive enzymes, leading to malabsorption (eg, steatorrhea, failure to thrive).  The presence of low fecal elastase is an accurate and noninvasive method for diagnosing pancreatic insufficiency.

A 2-Year-Old Boy Is Brought to the Physician Because of for Poor