Which conditions can cause fat malabsorption and steatorrhea?

• A. Small bowel disease such as celiac or Crohn's
• B. All of the above
• C. Pancreatic insufficiency
• D. Bile acid deficiency

Answer: (B)

Fat absorption relies on bile acids to emulsify fats, pancreatic enzymes to digest triglycerides, and a healthy small-intestinal mucosa to absorb fatty acids and monoglycerides. When any part is impaired, fat malabsorption and steatorrhea can occur. Diseases of the small bowel, such as celiac disease or Crohn's disease, damage the absorptive surface and lead to poor fat absorption. Pancreatic insufficiency reduces lipase delivery, so fats aren’t broken down and absorbed efficiently. Bile acid deficiency prevents proper emulsification and micelle formation, also causing fat malabsorption. Because each of these conditions can cause fat malabsorption and steatorrhea, the all-encompassing choice best fits the scenario.