In a child with cystic fibrosis, which finding on stool analysis most likely indicates malabsorption due to pancreatic enzyme deficiency?

• A. Not compliant with taking vitamins.
• B. Not compliant with taking her enzymes.
• C. Eating too many foods high in fat.
• D. Eating too many foods high in fiber.

Answer: (B)

In cystic fibrosis, pancreatic exocrine insufficiency means lipase and other digestive enzymes aren’t delivered to the intestine in adequate amounts, so fats aren’t digested and absorbed. When fat digestion is impaired, fat stays in the stool, producing steatorrhea—bulky, pale, greasy, and foul-smelling stools. If the child is not taking pancreatic enzymes with meals, this fat malabsorption becomes obvious on stool analysis.

So, not being compliant with taking pancreatic enzymes would most directly lead to steatorrhea, reflecting fat malabsorption due to the enzyme deficiency. Not taking vitamins can cause deficiencies but doesn’t specifically indicate pancreatic lipase failure; consuming a high-fat diet can worsen stool fat if malabsorption exists but doesn’t by itself prove pancreatic deficiency; a high-fiber diet doesn’t point to fat malabsorption.