A 49-year-old man comes to the physician for a follow-up appointment. He smokes two packs of cigarettes and drinks a pint of whisky daily. He has intermittent diarrhea. BMI is 20. He has lost 10 pounds during the past 6 months. Fecal Oil Red O staining is positive. Laboratory studies show:
Total bilirubin 1.0 mg/dL (NR <1.3)
ALP 120 IU/L (NR 50-150)
Amylase 70 U/L (NR 40-140)
Lipase 60 U/L (NR 10-140)
Which of the following is the most likely explanation for these findings?
