Fat malabsorption in liver disease is caused by what?

• A. Decreased lipase production
• B. Increased bile flow
• C. Decreased pancreatic enzyme activity
• D. Altered bile acid circulation

Answer: (D)

Fat digestion and absorption depend on bile acids to emulsify fats and form micelles that carry lipids to the intestinal lining. In liver disease, cholestasis and impaired bile production reduce the amount of bile acids reaching the gut and disrupt the enterohepatic circulation, shrinking the bile acid pool available in the intestine. Without enough bile acids, fats aren’t emulsified properly and micelles aren’t formed efficiently, leading to fat malabsorption. The other factors—decreased lipase production or pancreatic enzyme deficiency—are not the primary drivers in liver disease, and increased bile flow would actually improve fat absorption.