Question
A 55-year-old man with a history of recurrent episodes of heartburn, epigastric pain and intractable gastric and duodenal ulcers was found to have a gastrin-secreting tumor in the pancreas. His BAO was determined to be 20 mmol/hour (normally 2-3 mmol/hour). He also had a history of steatorrhea (fatty, bulky, malodorous stool). Stool fat excretion was 10 g on a 24 hour stool collection on a diet consisting of 50 g fat per day. What is the most likely reason for the excretion of large amount of fat in stool in this patient?
Answers
Because of the gastrinoma-induced hyperchlorhydria, duodenal pH remains lower than normal despite secretion of a large volume of alkaline secretions from the liver and pancreas. Unless the pH in the duodenal lumen is increased to about 6, pancreatic lipase is known to be inactive. Also, the fact that steatorrhea occurs in individuals with a gastrinoma suggests that pancreatic lipase is quantitatively more important than lingual lipase and gastric lipase for normal digestion and absorption of ingested fat.   Your Comment




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