In cystic fibrosis, pancreatic ducts are blocked; which enzymes are deficient and need supplementation?

• A. Pancreatic enzymes (amylase, protease, lipase)
• B. Salivary amylase
• C. Bile acids
• D. Gastric enzymes

Answer: (A)

In cystic fibrosis, thick secretions clog the pancreatic ducts, leading to pancreatic exocrine insufficiency. That means the digestive enzymes the pancreas normally releases into the small intestine—amylase, protease, and lipase—aren’t reaching the gut. Without these enzymes, digestion and absorption of fats, proteins, and carbohydrates falter, with fat malabsorption causing steatorrhea and poor weight gain. Replacing these pancreatic enzymes through pancreatic enzyme replacement therapy is necessary to restore digestion with meals and snacks, and lipase is especially crucial for fat digestion.

The other options don’t fit because salivary amylase comes from the mouth and doesn’t compensate for pancreatic enzyme loss; bile acids are not enzymes and aren’t deficient in CF; gastric enzymes are not the primary issue in CF-related malabsorption.