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Exocrine pancreatic insufficiency — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Exocrine pancreatic insufficiencyUSMLE Step 3

A 67-year-old man with chronic pancreatitis from alcohol use has bulky foul-smelling stools, weight loss, and bloating. CT shows pancreatic calcifications. Fecal elastase is low. Hemoglobin A1c is 6.0%. Which of the following is the most appropriate next step in management?

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Correct answer: B — Start pancreatic enzyme replacement with meals

Steatorrhea with low fecal elastase in chronic pancreatitis indicates exocrine pancreatic insufficiency. Pancreatic enzyme replacement with meals is first-line and improves malabsorption.

Reference: American College of Gastroenterology Chronic Pancreatitis Guideline