A 56-year-old man with a history of alcohol abuse presents complaining of diarrhea. He complains of frequent, foul-smelling, oily bowel movements that have gone on for about six months. He notes weight loss of 20 pounds over that period of time. He denies any abdominal pain, nausea, or vomiting. He reports that he used to have frequent episodes abdominal pain that were diagnosed as pancreatitis. He therefore stopped drinking about two years ago. His laboratory values are notable for normal AST, ALT, lipase, and amylase. All of the following statements regarding this man's condition are correct except

Correct Answer: B

Rationale: This man presents with evidence of pancreatic insufficiency due to chronic pancreatitis. Diarrhea and malabsorption (steatorrhea) are the hallmarks of this manifestation of chronic pancreatitis. A 72-hour fecal fat should be elevated in such patients. Low fecal levels of chymotrypsin should also be seen. When pancreatic exocrine function declines due to chronic pancreatitis, the output of lipase from the pancreas is about 10 to $15 \%$ of normal, so serum levels will be low or normal instead of high (as seen in acute pancreatitis). Diarrhea is frequently accompanied by diabetes as a result of destruction of islet cells and impaired insulin production. Treatment of steatorrhea from chronic pancreatitis includes pancreatic enzymes and a low-fat diet. A lactose-free diet is not indicated.

Correct Answer: C

Rationale: Autoimmune hepatitis may present with a fulminant or subfulminant course with new onset of hepatic encephalopathy and transaminases greater than 2000. It tends to relapse without maintenance treatment, and responds well to oral prednisone in a vast majority of cases. However, autoimmune hepatitis does not tend to present with a cholestatic picture as described in C, unless associated with overlap syndromes with PBC or cholangiopathy.

Correct Answer: B

Rationale: Patients with acute infection outside the liver, severe cardiac or pulmonary disease, or metastatic cancer are not eligible for liver transplantation. Patients with HIV, however, are candidates for transplant if they do not have advanced disease (CD4 <200, viral load >400 copies/mL).

Correct Answer: A

Rationale: Antibiotics (e.g., amoxicillin, clarithromycin) are essential to eradicate H. pylori, a primary cause of PUD, as part of combination therapy.

Correct Answer: B

Rationale: Stress can increase gastric acid secretion via the hypothalamic-pituitary-adrenal axis, worsening PUD symptoms, though it's not the primary cause.