Pt. has Familial dyslipidemias. Type I—Hyperchylomicronemia.

Very large increase in TGs causes pancreatitis.
Deficiencies in:

Apo B-100: Type II familial hypercholesterolemia, increases mostly LDL which increases cholesterol

Apo E: Decreased remnant uptake, which increases mostly chylomicrons and VLDL, but it's milder so no pancreatitis.

HSL: deficiency would decrease TGs, not increase

LDL receptor: Type II hypercholesterolemia also

So lipoprotein lipase deficiency is the anser, which causes large increase in chylomicrons and TGs, leading to pancreatitis and has a creamy layer in supernatant.

Side note for those of you who hate familial dyslipidemias: don't usually watch dirty USMLE videos but I couldn't keep the familial dyslipidemias straight in my head and someone on reddit recommended his video on this. Personally found it really helped.