A clinician must decide between recommending bile salt replacement therapy or pancreatic enzyme replacement to a patient with combined cholestasis and mild pancreatic insufficiency. Which intervention should the clinician prioritize to improve fat absorption and why? Evaluate clinical priorities.

• A. Prioritize pancreatic enzyme replacement because bile salts are not essential for fat digestion and exogenous lipase will entirely restore fat absorption even if bile is lacking
• B. Prioritize bile salt replacement (or relieving bile obstruction) because bile is required for emulsification and micelle formation enabling pancreatic lipase action and absorption; without bile, enzyme replacement alone is less effective
• C. Advise stopping all dietary fats immediately as the only practical option since neither bile nor pancreatic enzyme therapy will significantly affect fat handling in combined disease
• D. Recommend immediate large-dose vitamin K alone because fat malabsorption primarily causes hemorrhagic complications and treating that vitamin deficiency addresses the main concern

Answer: (B)