A 7 year old girl from Bihar presented with three episodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver and mild ascites. Poal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy revealed esophageal varices. The most likely diagnosis is -

Ans. is 'd' i.e., Poal hypeension due to extrahepatic obstruction Splenomegaly and esophageal varices point to the diagnosis of poal hypeension while absence of jaundice and deranged liver function test indicate an extrahepatic etiology. Differentiation between Extrahepatic and Hepatic / Post hepatic poal hypeension o Post sinusoidal and hepatic causes of poal hypeension will have evidence of Liver parenchymal damage / deranged LFT (jaundice) a dilated poal vein on ultrasonography o Extrahepatic presinusoidal obstruction will not have any effect on the Liver and hence there will be no evidence of hepatocellular damage. No jaundice / No raised deranged LFT Also non visualization of poal vein is a characteristic of poal vein thrombosis, an Extrahepatic cause. o Esophageal varices and splenomegaly are a manifestation of poal hypeension and will be present in all the above sites of obstruction.